Supervised PH Exercise Training Significantly Improves Exercise Capacity, QoL

No association was found between exercise training in patients with pulmonary hypertension and increased risk for serious adverse events.

Supervised exercise training for those with pulmonary hypertension (PH) significantly increases exercise capacity and improves patients’ health-related quality of life (HRQoL) and functional class, according to study findings presented at the American Thoracic Society (ATS) 2023 International Conference, held in Washington, DC, May 19 to 24.

Pulmonary hypertension leads to reduced HRQoL and exercise capacity. Investigators aimed to evaluate the efficacy and safety of exercise-based rehabilitation for people with PH and to update a previous Cochrane review that had published on this subject.

Primary outcomes of interest were exercise capacity, as measured via 6-minute walk distance (6MWD) and peak exercise capacity; HRQoL; and serious adverse events.

The investigators searched the Cochrane Airways Specialized Register of Trials for randomized controlled trials (RCTs) focused on PH exercise programs/supervised rehabilitation programs through May 2022. The reviewers selected 8 new studies to add to their previous review, including a total of 14 RCTs with 462 participants in their meta-analyses.

In people with PH, supervised exercise training may result in a large increase in exercise capacity.

The meta-analyses found exercise training vs usual care was associated with increases in (1) peak exercise capacity(mean difference [MD], 2.1 mL/kg/min; 95% CI, 1.2-2.9; 7 RCTs; I2=67%, low-quality evidence), (2) 6MWD (MD, 48.5m; 95% CI, 33.4-63.6; 11 RCTs; I2=72%, low-quality evidence), and (3) HRQoL (Short-Form 36 physical component score MD, 4.20 points higher; 95% CI, 1.43-6.98; 5 RCTs; I2=0.0%, medium quality evidence).

Exercise-based rehabilitation was somewhat associated with functional class improvement (MD, -0.60; 95% CI, -0.85 to 0.35; P <.00001; 2 RCTs, n=40; I2=57%, moderate quality evidence). Additionally, there was a mean reduction in mean pulmonary artery pressure following exercise-based rehabilitation in 2 studies (mean reduction, 9.29 mmHg; 95% CI, -12.96 to -5.61; n=133; I2=0.0%, low-quality evidence).

Notably, the researchers found no association between exercise training and increased risk for serious adverse events (risk difference, 0.00; 95% CI, -0.03 to 0.03; 11 RCTs, n=415; I2=0.0%, medium quality evidence).

“In people with PH, supervised exercise training may result in a large increase in exercise capacity,” investigators concluded. “It is likely that exercise training increases both HRQoL and functional class and is probably not associated with an increased risk of a serious adverse event,” they added.


Morris N, Kermeen F, Jones AW, Lee JYT, Holland A. Updated Cochrane Review: exercise-based rehabilitation programs for pulmonary hypertension. AJCCRM. 2023;207:A1026. doi:10.1164/ajrccm-conference.2023.207.1_MeetingAbstracts.A1026