Exercise and Pulmonary Hypertension

The role of exercise in the diagnosis and treatment of pulmonary arterial hypertension (PAH) has evolved. Years ago, patients were encouraged to minimize their activity to avoid overwhelming the stressed right ventricle. With the advent of agents to treat PAH, this approach has changed.

The benefits of pulmonary rehabilitation are well established for left ventricular systolic dysfunction. Recent studies suggest similar findings for right ventricular dysfunction. For example, Mereles et al (Circulation. 2006;114[14]:1482) demonstrated that patients with PAH benefited from guided exercise training as measured by the 6-min walk test, Vo2 max, workload at anaerobic threshold, and quality of life. This program utilized stationary cycling, walking, and low impact weight training and was closely supervised.

Pulmonary hemodynamic response to exercise may identify patients with PAH who have normal or modest elevation of pulmonary artery pressure (PAP) at rest.

Tolle and colleagues (Circulation. 2008;118[21]:2183) identified a subset of patients with heightened pulmonary artery response to exercise. Some 406 patients referred for evaluation of dyspnea had pulmonary artery catheterization and cardiopulmonary exercise testing. They found a subset of patients with normal resting PAP who developed increased PAP and pulmonary vascular resistance with exercise.

Saggar and colleagues (Arthritis Rheum. 2010;62[12]:3741) examined patients with scleroderma and normal resting pulmonary hemodynamics. They found distinctive patterns that included normal response, pulmonary venous hypertension, and exercise-associated PAH.

These findings suggest that exercise may be beneficial to patients with known PAH and may help to diagnose PAH earlier in a patient’s course.

Dr. Victor Test, FCCP
NetWork Steering Committee Member