Exercise Training as a Non-Pharmacological Therapy for Patients with Pulmonary Arterial Hypertension: Home-Based Rehabilitation Program and Training Recommendations
Abstract
:1. Introduction
2. Qualification for Rehabilitation
3. Main Components of the Exercise Training
3.1. Aerobic Training
3.2. Resistance Training
3.3. Breathing Training
3.4. Education and Psychological Support
4. Setting of Rehabilitation Programs
4.1. Inpatient Rehabilitation
4.2. Outpatient Rehabilitation
4.3. Home-Based Rehabilitation
5. Notes on Implementing the Home-Based Rehabilitation Program
6. Conclusions
Supplementary Materials
Author Contributions
Funding
Conflicts of Interest
References
- El-Korashy, R.I. Exercise desaturation as a marker of disease severity in pulmonary arterial hypertension. Egypt. J. Chest Dis. Tuberc. 2019, 68, 412–415. [Google Scholar] [CrossRef]
- Morris, Z.V.; Chin, L.M.K.; Chan, L.; Guccione, A.A.; Ahmad, A.; Keyser, R.E. Cardiopulmonary exercise test indices of respiratory buffering before and after aerobic exercise training in women with pulmonary hypertension: Differentiation by magnitudes of change in six-minute walk test performance. Respir. Med. 2020, 164, 105900. [Google Scholar] [CrossRef] [PubMed]
- Dong, C.; Li, Y. Exercise Rehabilitation Training in Patients with Pulmonary Hypertension: A Review. Heart Lung Circ. 2022, 31, 1341–1348. [Google Scholar] [CrossRef] [PubMed]
- Riou, M.; Pizzimenti, M.; Enache, I.; Charloux, A.; Canuet, M.; Andres, E.; Talha, S.; Meyer, A.; Geny, B. Skeletal and Respiratory Muscle Dysfunctions in Pulmonary Arterial Hypertension. J. Clin. Med. 2020, 9, 410. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Sabbahi, A.; Severin, R.; Ozemek, C.; Phillips, S.A.; Arena, R. The role of cardiopulmonary exercise testing and training in patients with pulmonary hypertension: Making the case for this assessment and intervention to be considered a standard of care. Expert Rev. Respir. Med. 2020, 14, 317–327. [Google Scholar] [CrossRef]
- Dean, B.B.; Saundankar, V.; Stafkey-Mailey, D.; Anguiano, R.H.; Nelsen, A.C.; Gordon, K.; Classi, P. Medication Adherence and Healthcare Costs Among Patients with Pulmonary Arterial Hypertension Treated with Oral Prostacyclins: A Retrospective Cohort Study. Drugs Real World Outcomes 2020, 7, 229–239. [Google Scholar] [CrossRef] [Green Version]
- Benza, R.L.; Gomberg-Maitland, M.; Elliott, C.G.; Farber, H.W.; Foreman, A.J.; Frost, A.E.; McGoon, M.D.; Pasta, D.J.; Selej, M.; Burger, C.D.; et al. Predicting Survival in Patients with Pulmonary Arterial Hypertension: The REVEAL Risk Score Calculator 2.0 and Comparison With ESC/ERS-Based Risk Assessment Strategies. Chest. 2019, 156, 323–337. [Google Scholar] [CrossRef] [Green Version]
- Kylhammar, D.; Kjellström, B.; Hjalmarsson, C.; Jansson, K.; Nisell, M.; Söderberg, S.; Wikström, G.; Rådegran, G. A comprehensive risk stratification at early follow-up determines prognosis in pulmonary arterial hypertension. Eur. Heart J. 2018, 39, 4175–4181. [Google Scholar] [CrossRef]
- Sisniega, C.; Zayas, N.; Pulido, T. Advances in medical therapy for pulmonary arterial hypertension. Curr. Opin. Cardiol. 2019, 34, 98–103. [Google Scholar] [CrossRef]
- Rafikova, O.; Al Ghouleh, I.; Rafikov, R. Focus on Early Events: Pathogenesis of Pulmonary Arterial Hypertension Development. Antioxid. Redox. Signal. 2019, 31, 933–953. [Google Scholar] [CrossRef] [Green Version]
- Vinke, P.; Jansen, S.M.; Witkamp, R.F.; van Norren, K. Increasing quality of life in pulmonary arterial hypertension: Is there a role for nutrition? Heart Fail. Rev. 2018, 23, 711–722. [Google Scholar] [CrossRef] [Green Version]
- Okumus, G.; Aslan, G.K.; Arseven, O.; Ongen, G.; Issever, H.; Kiyan, E. The role of an activity monitor in the objective evaluation of patients with pulmonary hypertension. Clin. Respir. J. 2018, 12, 119–125. [Google Scholar] [CrossRef]
- Cascino, T.M.; McLaughlin, V.V.; Richardson, C.R.; Behbahani-Nejad, N.; Moles, V.M.; Visovatti, S.H.; Jackson, E.A. Barriers to physical activity in patients with pulmonary hypertension. Pulm. Circ. 2019, 9, 1–8. [Google Scholar] [CrossRef] [Green Version]
- Humbert, M.; Guignabert, C.; Bonnet, S.; Dorfmüller, P.; Klinger, J.R.; Nicolls, M.R.; Olschewski, A.J.; Pullamsetti, S.S.; Schermuly, R.T.; Stenmark, K.R.; et al. Pathology and pathobiology of pulmonary hypertension: State of the art and research perspectives. Eur. Respir. J. 2019, 53, 1801887. [Google Scholar] [CrossRef] [Green Version]
- Eichstaedt, C.A.; Benjamin, N.; Xanthouli, P.; Marra, A.M.; Grünig, E. The role of rehabilitation in patients with pulmonary arterial hypertension. Curr. Opin. Pulm. Med. 2019, 25, 398–404. [Google Scholar] [CrossRef]
- Babu, A.S.; Arena, R.; Myers, J.; Padmakumar, R.; Maiya, A.G.; Cahalin, L.P.; Waxman, A.B.; Lavie, C.J. Exercise intolerance in pulmonary hypertension: Mechanism, evaluation and clinical implications. Expert Rev. Respir. Med. 2016, 10, 979–990. [Google Scholar] [CrossRef]
- Babu, A.S.; Padmakumar, R.; Nayak, K.; Shetty, R.; Mohapatra, A.K.; Maiya, A.G. Effects of home-based exercise training on functional outcomes and quality of life in patients with pulmonary hypertension: A randomized clinical trial. Indian Heart J. 2019, 71, 161–165. [Google Scholar] [CrossRef]
- Johnson, M.K.; Peacock, A.J. Treating pulmonary arterial hypertension with exercise: The role of rehabilitative medicine. Adv. Pulm. Hyperten. 2019, 18, 56–62. [Google Scholar] [CrossRef] [Green Version]
- Grünig, E.; Eichstaedt, C.; Barberà, J.A.; Benjamin, N.; Blanco, I.; Bossone, E.; Cittadini, A.; Coghlan, G.; Corris, P.; D’Alto, M.; et al. ERS statement on exercise training and rehabilitation in patients with severe chronic pulmonary hypertension. Eur. Respir. J. 2019, 53, 1800332. [Google Scholar] [CrossRef] [Green Version]
- McGoon, M.D.; Ferrari, P.; Armstrong, I.; Denis, M.; Howard, L.S.; Lowe, G.; Mehta, S.; Murakami, N.; Wong, B.A. The importance of patient perspectives in pulmonary hypertension. Eur. Respir. J. 2019, 53, 1801919. [Google Scholar] [CrossRef]
- Leggio, M.; Fusco, A.; Armeni, M.; D’Emidio, S.; Severi, P.; Calvaruso, S.; Limongelli, G.; Sgorbini, L.; Bendini, M.G.; Mazza, A. Pulmonary hypertension and exercise training: A synopsis on the more recent evidences. Ann. Med. 2018, 50, 226–233. [Google Scholar] [CrossRef] [PubMed]
- Nogueira-Ferreira, R.; Moreira-Gonçalves, D.; Santos, M.; Trindade, F.; Ferreira, R.; Henriques-Coelho, T. Mechanisms underlying the impact of exercise training in pulmonary arterial hypertension. Respir. Med. 2018, 134, 70–78. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Soares, L.L.; Drummond, F.R.; Lavorato, V.N.; Carneiro-Junior, M.A.; Natali, A.J. Exercise training and pulmonary arterial hypertension: A review of the cardiac benefits. Sci. Sport. 2018, 33, 197–206. [Google Scholar] [CrossRef]
- Glöckl, R.; Schneeberger, T.; Boeselt, T.; Kenn, K.; Koczulla, A.R.; Held, M.; Oberhoffer, R.; Halle, M. Körperliches Training bei pulmonaler—Ein systematisches Review mit Metaanalyse [Exercise Training in Patients with Pulmonary Hypertension: A Systematic Review and Meta-analysis]. Pneumologie 2019, 73, 677–685. (In German) [Google Scholar] [CrossRef] [PubMed]
- Dalla Vecchia, L.A.; Bussotti, M. Exercise training in pulmonary arterial hypertension. J. Thorac. Dis. 2018, 10, 508–521. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Waller, L.; Krüger, K.; Conrad, K.; Weiss, A.; Alack, K. Effects of Different Types of Exercise Training on Pulmonary Arterial Hypertension: A Systematic Review. J. Clin. Med. 2020, 9, 1689. [Google Scholar] [CrossRef]
- Benjamin, N.; Marra, A.M.; Eichstaedt, C.; Grünig, E. Exercise Training and Rehabilitation in Pulmonary Hypertension. Heart Fail. Clin. 2018, 14, 425–430. [Google Scholar] [CrossRef]
- Von Oetinger, A.; Trujillo, L.M.; Villanueva, S.; Zagolin, M. Hipertensión arterial pulmonar: El entrenamiento físico como complemento de la terapia farmacológica [Cardiopulmonary rehabilitation in pulmonary arterial hypertension]. Rev. Med. Chil. 2018, 146, 627–635. [Google Scholar] [CrossRef] [Green Version]
- Vallerand, J.R.; Weatherald, J.; Laveneziana, P. Pulmonary Hypertension and Exercise. Clin. Chest Med. 2019, 40, 459–469. [Google Scholar] [CrossRef]
- Ozemek, C.; Berry, M.J.; Arena, R. A Review of Exercise Interventions in Pulmonary Arterial Hypertension and Recommendations for Rehabilitation Programing. J. Cardiopulm. Rehabil. Prev. 2019, 39, 138–145. [Google Scholar] [CrossRef]
- Chia, K.S.; Wong, P.K.; Faux, S.G.; McLachlan, C.S.; Kotlyar, E. The benefit of exercise training in pulmonary hypertension: A clinical review. Intern. Med. J. 2017, 47, 361–369. [Google Scholar] [CrossRef]
- Marra, A.M.; Egenlauf, B.; Bossone, E.; Eichstaedt, C.; Grünig, E.; Ehlken, N. Principles of rehabilitation and reactivation: Pulmonary hypertension. Respiration 2015, 89, 265–273. [Google Scholar] [CrossRef]
- González-Saiz, L.; Fiuza-Luces, C.; Sanchis-Gomar, F.; Santos-Lozano, A.; Quezada-Loaiza, C.A.; Flox-Camacho, A.; Munguía-Izquierdo, D.; Ara, I.; Santalla, A.; Morán, M.; et al. Benefits of skeletal-muscle exercise training in pulmonary arterial hypertension: The WHOLEi + 12 trial. Int. J. Cardiol. 2017, 231, 277–283. [Google Scholar] [CrossRef]
- Ehlken, N.; Lichtblau, M.; Klose, H.; Weidenhammer, J.; Fischer, C.; Nechwatal, R.; Uiker, S.; Halank, M.; Olsson, K.; Seeger, W.; et al. Exercise training improves peak oxygen consumption and haemodynamics in patients with severe pulmonary arterial hypertension and inoperable chronic thrombo-embolic pulmonary hypertension: A prospective, randomized, controlled trial. Eur. Heart J. 2016, 37, 35–44. [Google Scholar] [CrossRef] [Green Version]
- Kabitz, H.J.; Bremer, H.C.; Schwoerer, A.; Sonntag, F.; Walterspacher, S.; Walker, D.J.; Ehlken, N.; Staehler, G.; Windisch, W.; Grünig, E. The combination of exercise and respiratory training improves respiratory muscle function in pulmonary hypertension. Lung 2014, 192, 321–328. [Google Scholar] [CrossRef]
- Tran, D.; Munoz, P.; Lau, E.M.T.; Alison, J.A.; Brown, M.; Zheng, Y.; Corkery, P.; Wong, K.; Lindstrom, S.; Celermajer, D.S.; et al. Inspiratory Muscle Training Improves Inspiratory Muscle Strength and Functional Exercise Capacity in Pulmonary Arterial Hypertension and Chronic Thromboembolic Pulmonary Hypertension: A Pilot Randomised Controlled Study. Heart Lung Circ. 2021, 30, 388–395. [Google Scholar] [CrossRef]
- Saglam, M.; Arikan, H.; Vardar-Yagli, N.; Calik-Kutukcu, E.; Inal-Ince, D.; Savci, S.; Akdogan, A.; Yokusoglu, M.; Kaya, E.B.; Tokgozoglu, L. Inspiratory muscle training in pulmonary arterial hypertension. J. Cardiopulm. Rehabil. Prev. 2015, 35, 198–206. [Google Scholar] [CrossRef]
- Madden, B.P.; Shaw, E.J. Skeletal muscle exercise training in pulmonary arterial hypertension. Int. J. Cardiol. 2017, 246, 59–60. [Google Scholar] [CrossRef]
- Keen, C.; Hashmi-Greenwood, M.; York, J.; Armstrong, I.J.; Sage, K.; Kiely, D. Exploring a physiotherapy well-being review to deliver community-based rehabilitation in patients with pulmonary hypertension. Pulm. Circ. 2019, 9, 1–9. [Google Scholar] [CrossRef] [Green Version]
- Richter, M.J.; Grimminger, J.; Krüger, B.; Ghofrani, H.A.; Mooren, F.C.; Gall, H.; Pilat, C.; Krüger, K. Effects of exercise training on pulmonary hemodynamics, functional capacity and inflammation in pulmonary hypertension. Pulm. Circ. 2017, 7, 20–37. [Google Scholar] [CrossRef]
- Chia, K.S.W.; Shiner, C.T.; Brown, K.; Holloway, C.J.; Moreyra, C.; Bart, N.; Wong, P.K.K.; Faux, S.G.; Kotlyar, E. The exercise in pulmonary arterial hypertension (ExPAH) study: A randomized controlled pilot of exercise training and multidisciplinary rehabilitation in pulmonary arterial hypertension. Pulm. Circ. 2022, 12, e12069. [Google Scholar] [CrossRef] [PubMed]
- Chia, K.S.; Faux, S.G.; Wong, P.K.; Holloway, C.; Assareh, H.; McLachlan, C.S.; Kotlyar, E. Randomised controlled trial examining the effect of an outpatient exercise training programme on haemodynamics and cardiac MR parameters of right ventricular function in patients with pulmonary arterial hypertension: The ExPAH study protocol. BMJ Open 2017, 7, e014037. [Google Scholar] [CrossRef] [PubMed]
- Koudstaal, T.; Wapenaar, M.; van Ranst, D.; Beesems, R.; van den Toorn, L.; van den Bosch, A.; Chandoesing, P.; Boomars, K. The Effects of a 10-wk Outpatient Pulmonary Rehabilitation Program on Exercise Performance, Muscle Strength, Soluble Biomarkers, and Quality of Life in Patients with Pulmonary Hypertension. J. Cardiopulm. Rehabil. Prev. 2019, 39, 397–402. [Google Scholar] [CrossRef] [PubMed]
- Brown, M.B.; Kempf, A.; Collins, C.M.; Long, G.M.; Owens, M.; Gupta, S.; Hellman, Y.; Wong, V.; Farber, M.; Lahm, T. A prescribed walking regimen plus arginine supplementation improves function and quality of life for patients with pulmonary arterial hypertension: A pilot study. Pulm. Circ. 2018, 8, 2045893217743966. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Butāne, L.; Šmite, D.; Šablinskis, M.; Skride, A. Individualized home-based exercise program for idiopathic pulmonary arterial hypertension patients: A preliminary study. Cor Vasa 2019, 61, e403–e410. [Google Scholar] [CrossRef] [Green Version]
- Morris, N.R.; Kermeen, F.D.; Holland, A.E. Exercise-based rehabilitation programmes for pulmonary hypertension. Cochrane Database Syst. Rev. 2017, 1, CD011285. [Google Scholar] [CrossRef] [Green Version]
- Buckingham, S.A.; Taylor, R.S.; Jolly, K.; Zawada, A.; Dean, S.G.; Cowie, A.; Norton, R.J.; Dalal, H.M. Home-based versus centre-based cardiac rehabilitation: Abridged Cochrane systematic review and meta-analysis. Open Heart 2016, 3, e000463. [Google Scholar] [CrossRef] [Green Version]
- Wojciuk, M.; Ciolkiewicz, M.; Kuryliszyn-Moskal, A.; Chwiesko-Minarowska, S.; Sawicka, E.; Ptaszynska-Kopczynska, K.; Kaminski, K. Effectiveness and safety of a simple home-based rehabilitation program in pulmonary arterial hypertension: An interventional pilot study. BMC Sports Sci. Med. Rehabil. 2021, 13, 79. [Google Scholar] [CrossRef]
- Butāne, L.; Spilva-Ekerte, L.; Skride, A.; Šmite, D. Individually Tailored Remote Physiotherapy Program Improves Participation and Autonomy in Activities of Everyday Life along with Exercise Capacity, Self-Efficacy, and Low-Moderate Physical Activity in Patients with Pulmonary Arterial Hypertension: A Randomized Controlled Study. Medicina 2022, 58, 662. [Google Scholar] [CrossRef]
- Kagioglou, O.; Mouratoglou, S.A.; Giannakoulas, G.; Kapoukranidou, D.; Anifanti, M.; Deligiannis, A.; Skarbaliene, A.; Razbadauskas, A.; Kouidi, E. Long-Term Effect of an Exercise Training Program on Physical Functioning and Quality of Life in Pulmonary Hypertension: A Randomized Controlled Trial. Biomed. Res. Int. 2021, 2021, 8870615. [Google Scholar] [CrossRef]
Study | Training Program | ||
---|---|---|---|
1. | Brown [44] (2018) PAH (n = 11) USA (Indianapolis) | 12 weeks 6 days per week |
|
2. | Babu [17] (2019) all PH (n = 34) India (Manipal) | 12 weeks 3–5 days per week | Warm-up (5 min):
|
3. | Wojciuk [48] (2021) PAH (n = 16) Poland (Bialystok) | 24 weeks 5–7 days per week | Warm-up (5–10 min):
|
4. | Butāne [49] (2022) PAH (n = 11) Latvia (Riga) | 12 weeks 5 days per week | Monday: aerobic training, breathing exercises, neuromuscular relaxation. Tuesday: upper body resistance exercises, breathing exercises, neuromuscular relaxation. Wednesday: rest. Thursday: aerobic training, breathing exercises, neuromuscular relaxation. Friday: lower body resistance exercises, breathing exercises, neuromuscular relaxation. Saturday: aerobic training, breathing exercises, neuromuscular relaxation. Sunday: rest.
|
Day of the Week | Components of the Exercise Training |
---|---|
Monday | Interval aerobic training Breathing training and relaxation |
Tuesday | Resistance training Interval aerobic training Breathing training and relaxation |
Wednesday | REST |
Thursday | Interval aerobic training Breathing training and relaxation |
Friday | Resistance training Interval aerobic training Breathing training and relaxation |
Saturday | Interval aerobic training Breathing training and relaxation |
Sunday | REST |
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Wojciuk, M.; Dzięcioł-Anikiej, Z.; Kaniewska, K.; Ciołkiewicz, M.; Moskal-Jasińska, D.; Kuryliszyn-Moskal, A. Exercise Training as a Non-Pharmacological Therapy for Patients with Pulmonary Arterial Hypertension: Home-Based Rehabilitation Program and Training Recommendations. J. Clin. Med. 2022, 11, 6932. https://doi.org/10.3390/jcm11236932
Wojciuk M, Dzięcioł-Anikiej Z, Kaniewska K, Ciołkiewicz M, Moskal-Jasińska D, Kuryliszyn-Moskal A. Exercise Training as a Non-Pharmacological Therapy for Patients with Pulmonary Arterial Hypertension: Home-Based Rehabilitation Program and Training Recommendations. Journal of Clinical Medicine. 2022; 11(23):6932. https://doi.org/10.3390/jcm11236932
Chicago/Turabian StyleWojciuk, Mariusz, Zofia Dzięcioł-Anikiej, Katarzyna Kaniewska, Mariusz Ciołkiewicz, Diana Moskal-Jasińska, and Anna Kuryliszyn-Moskal. 2022. "Exercise Training as a Non-Pharmacological Therapy for Patients with Pulmonary Arterial Hypertension: Home-Based Rehabilitation Program and Training Recommendations" Journal of Clinical Medicine 11, no. 23: 6932. https://doi.org/10.3390/jcm11236932