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(Circulation. 2006;114:1482-1489.)
© 2006 American Heart Association, Inc.

Exercise Physiology

Exercise and Respiratory Training Improve Exercise Capacity and Quality of Life in Patients With Severe Chronic Pulmonary Hypertension

Derliz Mereles, MD^*; Nicola Ehlken^*; Sandra Kreuscher^*; Stefanie Ghofrani, MD; Marius M. Hoeper, MD; Michael Halank, MD; F. Joachim Meyer, MD; Gabriele Karger, MD; Jan Buss, MD; Jana Juenger, MD; Nicole Holzapfel, MA; Christian Opitz, MD; Jörg Winkler, MD; Felix F.J. Herth, MD; Heinrike Wilkens, MD; Hugo A. Katus, MD; Horst Olschewski, MD; Ekkehard Grünig, MD

From the Departments of Cardiology and Pneumology (D.M., N.E., S.K., F.J.M., H.A.K., E.G.), Psychosomatic Medicine (J.J., N.H.), and Internal Medicine, Pneumology, and Critical Care Medicine Thoraxklinik (F.F.J.H.), University of Heidelberg, Heidelberg, Germany; Clinic of Rehabilitation (G.K., J.B.), Heidelberg, Germany; Internal Medicine of University Hospital I (M.H.), Dresden, Germany; Department of Pneumology, University of Giessen (S.G.), Giessen, Germany; Department of Pneumology, University of Hannover (M.M.H.), Hannover, Germany; Department of Pneumology, University of Leipzig (J.W.), Leipzig, Germany; Department of Pneumology, University of Homburg (H.W.), Homburg, Germany; Department of Cardiology, DRK Hospital-Westend (C.O.), Berlin, Germany; and Division of Pulmonology, Medical University Graz (H.O.), Graz, Austria.

Correspondence to Ekkehard Grünig, MD, Department of Cardiology and Pneumology, University Hospital Heidelberg, INF 410, D-69120 Heidelberg. E-mail ekkehard_gruenig{at}med.uni-heidelberg.de

Received February 16, 2006; revision received June 21, 2006; accepted June 23, 2006.

Background— Pulmonary hypertension (PH) is associated with restricted physical capacity, limited quality of life, and a poor prognosis because of right heart failure. The present study is the first prospective randomized study to evaluate the effects of exercise and respiratory training in patients with severe symptomatic PH.

Methods and Results— Thirty patients with PH (21 women; mean age, 50±13 years; mean pulmonary artery pressure, 50±15 mm Hg; mean World Health Organization [WHO] class, 2.9±0.5; pulmonary arterial hypertension, n=23; chronic thromboembolic PH, n=7) on stable disease-targeted medication were randomly assigned to a control (n=15) and a primary training (n=15) group. Medication remained unchanged during the study period. Primary end points were the changes from baseline to week 15 in the distance walked in 6 minutes and in scores of the Short Form Health Survey quality-of-life questionnaire. Changes in WHO functional class, Borg scale, and parameters of echocardiography and gas exchange also were assessed. At week 15, patients in the primary and secondary training groups had an improved 6-minute walking distance; the mean difference between the control and the primary training group was 111 m (95% confidence interval, 65 to 139 m; P<0.001). Exercise training was well tolerated and improved scores of quality of life, WHO functional class, peak oxygen consumption, oxygen consumption at the anaerobic threshold, and achieved workload. Systolic pulmonary artery pressure values at rest did not change significantly after 15 weeks of exercise and respiratory training (from 61±18 to 54±18 mm Hg) within the training group.

Conclusions— This study indicates that respiratory and physical training could be a promising adjunct to medical treatment in severe PH. The effects add to the beneficial results of modern medical treatment.

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