Exercise Training in Patients with Pulmonary Arterial Hypertension: A Case Report Shoemaker MJ, Wilt JL, Dasgupta R, Oudiz RJ. Exercise training in patients with pulmonary arterial hypertension: A case report. Cardiopulm Phys Ther J. 2009; 20(4): 12-18. Abstract and Purpose.
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Exercise Training in Patients with Pulmonary Arterial Hypertension: A Case Report
Shoemaker MJ, Wilt JL, Dasgupta R, Oudiz RJ. Exercise training in patients with pulmonary arterial hypertension: A case report. Cardiopulm Phys Ther J. 2009; 20(4): 12-18.
Abstract and Purpose
Methods and Materials
“Aerobic exercise training in individuals with PAH is directed at improving aerobic capacity of skeletal muscle, thus compensating for reduced diffusing capacity and cardiac output.” Exercise Training can help to reduce effects of PAH and slow the disease process. Medical management has made improvements in the QOL of these patients. Exercise can help to increase QOL and can also slow or reverse damage to cardiovascular systems.
Purpose: To describe the benefits of a feasible, outpatient exercise training program on exercise tolerance and health-related quality of life in individuals with (PAH).
Methods: Case report on two that underwent exercise training 3 times per week for 6 weeks using a cycle ergometer.
Results: Both subjects made substantial improvements in oxygen consumption and workload at anaerobic threshold HRQL and 6MWT distance. Only Subject 1 made substantial improvements in peak oxygen and peak work rate.
CONCLUSIONS: A short and practical exercise training program can improve measures of workload, aerobic capacity, and HRQL in individuals with PAH with no adverse effects shown in these two case studies.
Effects of Exercise Training in Patients with iPAH
Cardiopulmonary Exercise Testing in Patients with PAH
Table 3 Cardiopulmonary Exercise Test Changes
SUBJECT 1 BaselinePost-Training (% Change)
Peak VO2, (mL·kg−1·min−1) 16 18.3 (+14%)
Peak Work (W) 117 134 (+14.5%)VO2at AT (mL·kg−1·min−1) 10 13.8 (+38%)
Work at AT (W) 56 82 (+46%)
Peak RER 1.28 1.27
Maximum Heart Rate 145 145
VEmax(L/min) 61.0 70.1
VE/VCO2 at AT 35.2 34.9
Peak Oxygen Pulse 8.0 9.0
SUBJECT 2 Baseline Post- Training (% Change)
Peak VO2(mL·kg−1·min−1) 15.0 15.6 (+4%)Peak Work (W) 66 69 (+4.5%)
VO2at AT (mL·kg−1·min−1) 9.2 13.4 (+46%)Work at AT (W) 34 52 (+53%)
Peak RER 1.401.39 Maximum Heart Rate 120145
VE/VCO2 at AT 33.539.1
Peak Oxygen Pulse 7.0 6.0
VO2=oxygen consumption, AT = anaerobic threshold, RER = respiratory exchange ratio, VE = minute ventilation, VE/VCO2 = ventilatory equivalent for carbon dioxide
Table 2 Screening Prior to Each Session
Vital Signs: Resting vital signs as follows:
Heart Rate: 60-110 beats per minute
Blood Pressure: >90/50 mmHg
Respiratory Rate: <24 breaths per minute
No weight gain >2 lbs over the past 2 days
No change in baseline LE edema
Has there been a change in or development of orthopnea or paroxysmal nocturnal dyspnea?
Is there any dyspnea, chest pain, or lightheadedness at rest?
Has there been a change in or development of new musculoskeletal pain?
In a person with stable PAH, exercise can help improve QOL and improve some areas compromised, such as VO2. In the case report, exercise training led to improvements in function and to improved QOL. When the effect of exercise on idiopathic PAH was studied, exercise improved endurance and muscle function. The evidence-based review found that functional capacity can be improved and exercise testing can be used as diagnostic criteria that can tell degree of severity of the disease process.
Both subjectsshowed increasesin function, exercise tolerance, and HRQOL. The findings were similar to previous studies investigating the effect of exercise in PAH. Further studiesare needed to demonstrate safety and efficacy of exercise in patients with PAH.
Mercedes Nelson, Bellarmine University Physical Therapy Student