Evolution of patients with Pulmonary Arterial Hypertension (PAH) six months after an exercise training program

Introduction: In stable patients with Pulmonary Arterial Hypertension (PAH), exercise training (ET) in addition to appropriate pharmacological treatment is effective, safe and cost-effective. However, the long-term impact of this intervention remains unclear. For this, we evaluated exercise capacity, right ventricular response during exercise and daily physical activity (DPA) 6 months after the end of an ET program in these patients. Methods: A prospective analysis of 10 consecutive patients with PAH (idiopathic=3; VIH=3, connective tissue disease=3 and atrial septal defect=1) that successfully finished an ET program (8 weeks) was evaluated after 6 months. Incremental cardiopulmonary exercise testing (ICPET) with synchronic echocardiography and accelerometer validated for the assessment of daily DPA were used to evaluate the outcomes. Results: All patients showed training-induced increase on endurance time (mean change 287 seconds). Compared to values immediately after the completion of ET, 6 monthspeak VO2 and peak watts did not change significantly (51% vs 50% predicted, and 75% vs 67% predicted; respectively). In addition, pulmonary tricuspid valve regurgitation (TVR) and tricuspid annular plane systolic excursion (TAPSE) did not show significant differences during the follow-up at rest (4.16 vs 4.13 m/sec and 22.4 vs 22.7 cm;respectively) and at the end of exercise (3.9 vs 4.0 m/sec and 24 vs 22 cm). DPA was similar in two time points (after ET=6889 steps per day and 6 months=6753 steps per/day). Conclusions: In patients with PAH, exercise training maintains exercise capacity, right ventricular function and daily physical activity up to 6 months after the end of the program.