Pulmonary Hypertension and Exercise - 09/05/19

Doi : 10.1016/j.ccm.2019.02.003

James R. Vallerand, PhD ^a, Jason Weatherald, MD ^b,^c,^d,^{^{1
J. Weatherald and P. Laveneziana contributed equally.}}, Pierantonio Laveneziana, MD, PhD ^e,^f,^⁎,^{^{1
J. Weatherald and P. Laveneziana contributed equally.}}
^a Undergraduate Medical Education, Cumming School of Medicine, University of Calgary, 3330 Hospital Drive Northwest G702, Calgary, Alberta T2N 4N1, Canada
^b Division of Respiratory Medicine, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
^c Libin Cardiovascular Institute of Alberta, Calgary, Alberta, Canada
^d Peter Lougheed Centre, 3500 26 Avenue Northeast, Calgary, Alberta T1Y 6J4, Canada
^e Sorbonne Universités, Université Pierre et Marie Curie Université Paris 06, Institut National de la Santé et de la Recherche Médicale, Unité Mixte de Recherche S_1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France
^f Service des Explorations Fonctionnelles de la Respiration, de l’Exercice et de la Dyspnée Hôpital Universitaire Pitié-Salpêtrière (AP-HP), Département Respiration, Réanimation, Réhabilitation, Sommeil, Pôle PRAGUES, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Assistance Publique-Höpitaux de Paris, Paris, France

^∗Corresponding author. Service d’Explorations Fonctionnelles de la Respiration, de l’Exercice et de la Dyspnée Hôpital Universitaire Pitié-Salpêtrière (AP-HP), 47-83 Boulevard de l’Hôpital, Paris 75013, France.Service d’Explorations Fonctionnelles de la Respirationde l’Exercice et de la Dyspnée Hôpital Universitaire Pitié-Salpêtrière (AP-HP)47-83 Boulevard de l’HôpitalParis75013France

Résumé

Cardiopulmonary exercise testing can be a useful tool for clinicians working with pulmonary hypertension (PH) patients. Exercise magnifies numerous cardiopulmonary decompensations, which can help inform diagnoses, assess degrees of physical impairment, evaluate exertional dyspnea, and estimate prognoses for PH patients. Supervised exercise training also holds promise in PH, because it is safe for patients and feasible and may improve key prognostic outcomes that relate to improvements in quality of life and survival. Still, few clinical trials have evaluated the potential therapeutic effects of exercise training, and future trials may benefit from integrating programming that focuses on light-intensity endurance, strength, and respiratory training.

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Keywords : Pulmonary vascular disease, Pulmonary arterial hypertension, Chronic thromboembolic pulmonary hypertension, Cardiopulmonary exercise testing, Dyspnea

Plan

Key points

Introduction

Exercise pathophysiology in pulmonary hypertension

General Hallmarks

Cardiovascular Anomalies

Ventilatory Anomalies

Diagnostic utility of cardiopulmonary exercise testing

Cardiopulmonary exercise testing for prognostic evaluation

Exercise variables as clinical trial efficacy endpoints

Exercise training in pulmonary hypertension

Safety Considerations for Programming

Preliminary Efficacy of Exercise Trials

Exercise Programming Recommendations

Summary

Disclosure Statement: The authors have no disclosures.

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Vol 40 - N° 2

P. 459-469 - juin 2019 Retour au numéro

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Pulmonary Hypertension and Exercise - 09/05/19

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