Effect of supervised exercise training in severe PAH and inoperable or persistent CTEPH on pulmonary arterial compliance and stroke volume; a post hoc analysis

Introduction: This post hoc analysis aimed to evaluate the effect of training therapy on pulmonary arterial compliance (PAC) and stroke volume (SV) at baseline and after 15 weeks on patients with severe pulmonary arterial hypertension (PAH) and inoperable or recurrent chronic thromboembolic pulmonary hypertension (CTEPH).

Methods: Forty-three patients with severe PAH and inoperable or persistent CTEPH (53% female, 47% male, 79% World Health Organization functional class III/IV, 58% combination therapy, 42% on supplemental oxygen therapy) on stable disease and stable targeted medication who were randomly assigned to a control and training group and who had a complete haemodynamic evaluation at baseline and after 15 weeks were analyzed. Medication remained unchanged for all patients. Non-invasive assessments and right heart catheterization at rest and during exercise were performed at baseline and after 15 weeks.

Results: Low-dose exercise training at 4 – 7 days/week significantly improved pulmonary arterial compliance (p = 0.004) and stroke volume (p < 0.001). mPAP at rest changed in the training group after 15 weeks by − 4 ± 11 mmHg vs. 4 ± 7 mmHg in the control group (mean difference training vs. control − 8.9 mmHg; lower 95% confidence limit of the mean (LCI) − 14.3; upper 95% confidence limit of the mean (UCI) − 3.6). CO at rest changed in the training group by 0.6 ± 0.9 L/min. vs. − 0.2 ± 0.8 L/min. in the control group (mean difference training vs. control 0.77 L/min.; LCI 0.26; UCI 1.3). PVR at rest changed in the training group after 15 weeks by − 94 ± 170 dynes·s · cm⁻⁵ vs. 66 ± 90 dynes·s · cm⁻⁵ in the control group (mean difference training vs. control − 160 dynes·s · cm⁻⁵; LCI − 244; UCI − 77). Peak VO₂ in the training group increased by 216 ± 123 ml/min. vs. 13.5 ± 157.2 ml/min. in the control group (mean difference training vs. control 203 ml/min.; LCI 112; UCI 293).

Conclusion: These findings suggest that supervised exercise training may improve right ventricular function and pulmonary arterial stiffness at the same time in patients with severe PAH and inoperable or recurrent CTEPH.