The Combination of Exercise and Respiratory Training Improves Respiratory Muscle Function in Pulmonary Hypertension
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Increased dyspnea and reduced exercise capacity in pulmonary arterial hypertension (PAH) can be partly attributed to impaired respiratory muscle function. This prospective study was designed to assess the impact of exercise and respiratory training on respiratory muscle strength and 6-min walking distance (6MWD) in PAH patients.
Patients with invasively confirmed PAH underwent 3 weeks of in-hospital exercise and respiratory training, which was continued at home for another 12 weeks. Medication remained constant during the study period. Blinded observers assessed efficacy parameters at baseline (I) and after 3 (II) and 15 weeks (III). Respiratory muscle function was assessed by twitch mouth pressure (TwPmo) during nonvolitional supramaximal magnetic phrenic nerve stimulation.
Seven PAH patients (4 women; mean pulmonary artery pressure 45 ± 11 mmHg, median WHO functional class 3.1 ± 0.4, idiopathic/associated PAH n = 5/2) were included. The training program was feasible and well tolerated by all patients with excellent compliance. TwPmo was I: 0.86 ± 0.37 kPa, II: 1.04 ± 0.29 kPa, and III: 1.27 ± 0.44 kPa, respectively. 6MWD was I: 417 ± 51 m, II: 509 ± 39 m, and III: 498 ± 39 m, respectively. Both TwPmo (+0.41 ± 0.34 kPa, +56 ± 39 %) and 6MWD (+81 ± 30 m, +20 ± 9 %) increased significantly in the period between baseline and the final assessment (pairwise comparison: p = 0.012/<0.001; RM-ANOVA considering I, II, III: p = 0.037/<0.001).
Exercise and respiratory training as an adjunct to medical therapy may be effective in patients with PAH to improve respiratory muscle strength and exercise capacity. Future, randomized, controlled trials should be carried out to further investigate these findings.
KeywordsBreathing exercises Diaphragm Respiratory muscle weakness Twitch pressure Inspiratory muscle training
The authors thank all patients who participated in this demanding study. We are grateful to nSpire Health GmbH (Oberthulba, Germany) for technical support, Dr. Claudia Schmoor (Biometry and Data Management, Center of Clinical Trials, University Medical Center Freiburg, Germany) for biometric consulting, and Dr. Sandra Dieni for writing assistance. This work was supported by a research grant from the German Research Society DFG (Deutsche Forschungsgemeinschaft), Bonn, Germany [KA 2992/2-1]. Further support was provided by the German Pulmonary Hypertension self-help group (Pulmonale Hypertonie e.v.), Rheinstetten, Germany. The study was registered at the WHO Primary Register of Germany (German Clinical Trials Register DRKS00003567).
Conflict of interest
The authors declare that they have no conflict of interest.
The Institutional Review Board for human studies at the Universities of Freiburg and Heidelberg, Germany approved the study protocol. All experiments comply with the current laws of Germany and the study was performed in agreement with the ethical standards laid down in the current version of the Declaration of Helsinki (59th World Medical Association General Assembly, Seoul, Korea, October 2008). Written informed consent was obtained from all patients.
- 8.Galie N, Hoeper MM, Humbert M, Torbicki A, Vachiery J, Barbera JA, Beghetti M, Corris P, Gaine S, Gibbs JS, Gomez-Sanchez MA, Jondeau G, Klepetko W, Opitz C, Peacock A, Rubin L, Zellweger M, Simonneau G (2009) Guidelines for the diagnosis and treatment of pulmonary hypertension. Eur Respir J 34:1219–1263CrossRefPubMedGoogle Scholar
- 9.Grunig E, Ehlken N, Ghofrani A, Staehler G, Meyer FJ, Juenger J, Opitz CF, Klose H, Wilkens H, Rosenkranz S, Olschewski H, Halank M (2011) Effect of exercise and respiratory training on clinical progression and survival in patients with severe chronic pulmonary hypertension. Respiration 81:394–401CrossRefPubMedGoogle Scholar
- 10.Grunig E, Lichtblau M, Ehlken N, Ghofrani HA, Reichenberger F, Staehler G, Halank M, Fischer C, Seyfarth HJ, Klose H, Meyer A, Sorichter S, Wilkens H, Rosenkranz S, Opitz C, Leuchte H, Karger G, Speich R, Nagel C (2012) Safety and efficacy of exercise training in various forms of pulmonary hypertension. Eur Respir J 40:84–92CrossRefPubMedGoogle Scholar
- 14.Jaenisch RB, Hentschke VS, Quagliotto E, Cavinato PR, Schmeing LA, Xavier LL, Dal Lago P (2011) Respiratory muscle training improves hemodynamics, autonomic function, baroreceptor sensitivity, and respiratory mechanics in rats with heart failure. J Appl Physiol 111:1664–1670CrossRefPubMedGoogle Scholar
- 21.Mereles D, Ehlken N, Kreuscher S, Ghofrani S, Hoeper MM, Halank M, Meyer FJ, Karger G, Buss J, Juenger J, Holzapfel N, Opitz C, Winkler J, Herth FFJ, Wilkens H (2006) Exercise and respiratory training improve exercise capacity and quality of life in patients with severe chronic pulmonary hypertension. Circulation 114:1482–1489CrossRefPubMedGoogle Scholar
- 23.Miller MR, Crapo R, Hankinson J, Brusasco V, Burgos F, Casaburi R, Coates A, Enright P, van der Grinten CPM, Gustafsson P, Jensen R, Johnson DC, MacIntyre N, McKay R, Navajas D, Pedersen OF, Pellegrino R (2005) General considerations for lung function testing. Eur Respir J 26:153–161CrossRefPubMedGoogle Scholar
- 26.Miyamoto S, Nagaya N, Satoh T, Kyotani S, Sakamaki F, Fujita M, Nakanishi N, Miyatake K (2000) Clinical correlates and prognostic significance of six-min walk test in patients with primary pulmonary hypertension. Comparison with cardiopulmonary exercise testing. Am J Respir Crit Care Med 161:487–492CrossRefPubMedGoogle Scholar