Long-Term Effect of an Exercise Training Program on Physical Functioning and Quality of Life in Pulmonary Hypertension: A Randomized Controlled Trial

Abstract

The aim of this study was to evaluate the effects of a 6-month combined aerobic and strength exercise training program on functional and psychological aspects and health-related quality of life in patients with PH and to evaluate its longer-term impact. In total, 22 stable patients (mean age $53.9\pm 13.8$ , 13 female) with pulmonary hypertension of World Health Organization (WHO) class I-III participated in a nine-month study. They were randomly assigned into two groups: Group A participated in a 6-month combined aerobic and strength exercise training program, whereas Group B remained untrained. All patients underwent physical and psychological assessment at baseline and at month 6 (after completing the exercise program) and physical assessment after 9 months (3 months posttraining). After the 6-month exercise training program, patients of Group A significantly improved their physical (6MWD, STS 10 rep, STS 20 rep, TUG, lower limb strength, cardiopulmonary exercise time, METs, peak VO2, VCO2, and VE/VCO2 slope) and psychological aspects (SF-36, STAI, and BDI). Between the two groups, differences were observed at the 6MWD (95% CI: 36.2-64.6, ${\eta }^2=0.72$ ), STS 10 rep (95% CI: 6.6-2.2, ${\eta }^2=0.4$ ), STS 20 rep (95% CI: 10.8-2.4, ${\eta }^2=0.34$ ), lower limb strength (95% CI: 7.2-3.6, ${\eta }^2=0.38$ ), cardiopulmonary exercise time (95% CI: 0.1-3.3, ${\eta }^2=0$ . $2$ ), and VCO2 (95% CI: 0.1-0.5, ${\eta }^2=0$ . $2$ ). Additionally, psychological changes were noted at SF-36, PCS (95% CI: 3.6-14.8, ${\eta }^2=0.35$ ), MCS (95% CI: 1.3-16.1, ${\eta }^2=0.22$ ), TCS (95% CI: 1.3-16.1, ${\eta }^2=0.22$ ), and STAI (95% CI: 1.8-28.2, ${\eta }^2=0.18$ ). The favorable results of exercise were maintained at the 3-month posttraining follow-up assessment. No exercise-induced complications were observed throughout the study. In conclusion, a long-term exercise training program is a safe and effective intervention to improve functional status, psychological aspects, and health-related quality of life in patients with PH.