Exercise training improves peak oxygen consumption and hemodynamics in patients with pulmonary hypertension – A prospective, randomized, controlled trial

Aims: This prospective randomized controlled study investigates the effects of exercise training on peak VO₂/kg, hemodynamics and further clinically relevant parameters in pulmonary hypertension (PH) patients. Methods: Eighty-seven patients with pulmonary arterial hypertension and inoperable chronic thromboembolic PH (54% female, 56±15years, 84% WHO functional class III/IV, 53% combination therapy) on stable disease-targeted medication were randomly assigned to a control and training group. Medication remained unchanged during the study period. Non-invasive assessments and right heart catheterization at rest and during exercise were performed at baseline and after 15 weeks. Primary endpoint was the change in peak VO₂/kg. Secondary endpoints included changes in hemodynamics. For missing data, multiple imputation and responder analyses were performed. Results: Study results showed a significant improvement of peak VO₂/kg in the training group (difference baseline to 15 weeks: training +3.1±2.7 equals +24.3% vs. control -0.2±2.3mL/min/kg equals +0.9%, p<0.001). Cardiac index (CI) at rest and during exercise, mean pulmonary arterial pressure, pulmonary vascular resistance, 6-minute walking distance, quality of life significantly improved by exercise training. Conclusions: Low-dose exercise training at 4-7days/week significantly improved peak VO₂/kg, hemodynamics and further clinically relevant parameters. The improvements of CI at rest and during exercise indicate that exercise training may improve the right ventricular function. Further, large multicenter trials are necessary to confirm these results.