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Lavender M, Chia KS, Dwyer N, Corte TJ, Spencer L, Thakkar V, McWilliams T, Kotlyar E, Whitford H. Safe and effective exercise training for patients with pulmonary arterial hypertension: putting current evidence into clinical practice. Expert Rev Respir Med 2018; 12:965-977. [PMID: 30251562 DOI: 10.1080/17476348.2018.1527687] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
INTRODUCTION While there have been significant advances in the medical treatment of pulmonary arterial hypertension (PAH), life expectancy, and quality of life remain reduced in this disease. Strenuous exercise may be hazardous for PAH patients; however, several relatively small trials have confirmed that exercise training programs can be used safely and effectively as adjunctive treatment for selected patients. The use of exercise training is now recommended in consensus international PAH treatment algorithms; however, there is no published guideline detailing how this intervention should be carried out. Areas covered: This review describes the evidence available and evaluates its applicability to 'real life' clinical practice. The limitations of current evidence are acknowledged, and we discuss how the existing data can be applied to management of PAH patients in Australia, New Zealand, and countries with similar healthcare systems. Recommendations for PAH exercise training are proposed including patient selection, program structure and duration, training modalities, training intensity, supervision, monitoring, safety precautions, and outcome assessments. Expert commentary: It is recognized that knowledge gaps remain and further research is required into physiological mechanisms associated with improved exercise capacity, optimal outpatient exercise regimen, durability of benefit, and whether there is any disease-modifying effect or impact on long-term prognosis.
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Affiliation(s)
- Melanie Lavender
- a Department of Respiratory Medicine , Fiona Stanley Hospital , Clayton , Australia.,b University of New South Wales Rural Clinical School , Clayton , Australia
| | - Karen Sw Chia
- b University of New South Wales Rural Clinical School , Clayton , Australia.,c Coffs Harbour Health Campus , Coffs Harbour , Australia.,d Department of Medicine , University of New South Wales Rural Clinical School , Coffs Harbour , New South Wales , Australia
| | - Nathan Dwyer
- e Cardiology Department, Royal Hobart Hospital , Hobart , Australia.,f School of Medicine, University of Tasmania , Hobart , Australia
| | - Tamera J Corte
- g Department of Respiratory Medicine , Royal Prince Alfred Hospital and University of Sydney , Camperdown , Australia
| | - Lissa Spencer
- h Physiotherapy Department , Royal Prince Alfred Hospital , Camperdown , Australia
| | - Vivek Thakkar
- i Department of Rheumatology , Liverpool Hospital , Liverpool BC , Australia.,j Faculty of Medicine and Health Sciences , Macquarie University , Campbelltown , Australia.,k School of Medicine , Western Sydney University , Campbelltown , Australia
| | | | - Eugene Kotlyar
- m Heart and Lung Transplant unit and Cardiology department , St Vincent's Hospital , Darlinghurst , Australia
| | - Helen Whitford
- n Department of Respiratory Medicine , The Alfred Hospital , Melbourne , Australia
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Exercise intolerance in pulmonary arterial hypertension. Pulm Med 2012; 2012:359204. [PMID: 22737582 PMCID: PMC3377355 DOI: 10.1155/2012/359204] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2012] [Revised: 04/13/2012] [Accepted: 04/16/2012] [Indexed: 01/12/2023] Open
Abstract
Pulmonary arterial hypertension (PAH) is associated with symptoms of dyspnea and fatigue, which contribute to exercise limitation. The origins and significance of dyspnea and fatigue in PAH are not completely understood. This has created uncertainly among healthcare professionals regarding acceptable levels of these symptoms, on exertion, for patients with PAH. Dysfunction of the right ventricle (RV) contributes to functional limitation and mortality in PAH; however, the role of the RV in eliciting dyspnea and fatigue has not been thoroughly examined. This paper explores the contribution of the RV and systemic and peripheral abnormalities to exercise limitation and symptoms in PAH. Further, it explores the relationship between exercise abnormalities and symptoms, the utility of the cardiopulmonary exercise test in identifying RV dysfunction, and offers suggestions for further research.
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