View Abstract

A2183 - European Respiratory Society Task Force: Exercise Training and Rehabilitation in Patients with Severe Chronic Pulmonary Hypertension
Author Block: E. Grünig1, J. A. Barbera2, N. Benjamin1, I. Blanco2, E. Bossone3, A. Cittadini3, G. Coghlan4, P. Corris5, M. D'Alto6, A. D'Andrea6, M. Delcroix7, F. De Man8, C. A. Eichstaedt1, S. P. Gaine9, S. Ghio10, S. Gibbs11, L. Gumbiene12, L. S. Howard13, M. Johnson14, E. Jurevičienė12, D. Kiely15, G. Kovacs16, A. MacKenzie14, A. Marra1, N. McCaffrey9, P. N. McCaughey14, R. Naeije17, H. Olschewski16, J. Pepke-Zaba18, A. Reis19, M. Santos19, S. Saxer20, R. Tulloh21, S. Ulrich20, A. Vonk Noordegraaf8, A. J. Peacock14; 1Center for pulmonary hypertension, Thoraxclinic at the University Hospital Heidelberg, Heidelberg, Germany, 2Hospital Clinic at the University of Barcelona, Barcelona, Spain, 3Department of Cardiac Surgery, University Hospital Salerno, Salerno, Italy, 4Pulmonary Hypertension Unit, Royal Free Hospital, University College London, London, United Kingdom, 5Department of Respiratory Medicine, Freeman Hospital, University of Newcastle, Newcastle, United Kingdom, 6Department of Cardiology, Second University of Naples - Monaldi Hospital, Naples, Italy, 7Department of Pneumology, University Hospitals Leuven, Leuven, Belgium, 8Department of Pulmonology, VU University Medical Center Amsterdam, Amsterdam, Netherlands, 9Department of Pulmonology, Mater Misericordiae University Hospital, Dublin, Ireland, 10Division of Cardiology, Università degli studi di Pavia, Pavia, Italy, 11Faculty of Medicine, Imperial College London, National Heart and Lung Institute, London, United Kingdom, 12Competence Centre of Pulmonary Hypertension, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania, 13Hammersmith Hospital, Imperial College London, National Pulmonary Hypertension Service, London, United Kingdom, 14Scottish Pulmonary Vascular Unit, Golden Jubilee National Hospital, Glasgow, United Kingdom, 15Department of Respiratory Medicine, Royal Hallamshire Hospital, Sheffield, United Kingdom, 16Department Internal Medicine, Medical University of Graz, Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria, 17Department of Cardiology, University Clinic Brussels - Erasme Hospital, Brussels, Belgium, 18Pulmonary Vascular Disease Unit, Papworth Hospital, Cambridge, United Kingdom, 19Department of Internal Medicine, Hospital Geral de Santo António, Porto, Portugal, 20Center for pulmonary hypertension, University Hospital Zurich, Zurich, Switzerland, 21Department of Congenital Heart Disease, Bristol Royal Hospital for Children, Bristol, United Kingdom.
Rationale: Specialised rehabilitation programmes for patients with pulmonary hypertension (PH) as add-on to medical treatment are offered only in few countries and are not yet standardised. This task force aimed to increase the number of centers who offer a specialised rehabilitation programmes for PH in Europe, enhance knowledge and awareness among patients, healthcare providers and payers and to coordinate research activities investigating the effects of exercise training.
Methods: A thorough literature review covering different aspects of exercise training in PH was performed. The main chapters of the statement included clinical effects of exercise training, training modalities and setting, implementation and pathophysiologic mechanisms. Practical experiences in the implementation of exercise training in PH were also gathered by the Task Force centers throughout Europe.
Results: Exercise training has shown to improve exercise capacity, muscle strength, quality of life, and probably hemodynamics in patients with different types of PH. Due to the prognostic relevance of these parameters exercise training might also have an impact on disease progression and prognosis. Most of the data are available for a closely supervised training initiated as in-hospital with carefully selected patients and is monitored by PH and rehabilitation specialists. To implement a specific training programme in further countries, both the needs of the different healthcare systems and the patients have to be met.
Conclusions: Exercise training has shown to be a very efficient treatment to improve prognostically important parameters in patients with PH. The task force statement summarized the current knowledge about pathophysiology, training mechanisms and clinical effects of exercise training. It shows that an international cooperation is necessary to address further research questions and to create the infrastructure in different European health care systems to allow access for PH patients to this specialized add-on therapy.