Pulmonary arterial hypertension (PAH) is a life-threatening condition. Current ESC guidelines recommend exercise training and rehabilitation in clinically stable PAH patients.

To assess the beneficial effect of exercise training on exercise capacity, quality of life and cardiac function as assessed by echocardiography and cardio-pulmonary exercise test.

We prospectively included 11clinically stable PAH patients over a 6-months period. Exercise echocardiography (EE), cardio-pulmonary exercise test (CPET), SF-12quality of life questionnaire, 6-minute walking test (6MWT), BNP and clinical assessment were performed before and after cardio-pulmonary rehabilitation. Patients underwent 8-weeks of exercise training (3times a week of aerobic training and at home daily prescribed exercises).

All patients underwent EE and CPET without any complication. Five patients experienced a reduction in WHO functional class whereas 5 remained stable. Patients significantly improved their physical quality of life (P=0.006). They also improved their exercise capacity according to the maximum workload during CPET (P=0.008) and CPET duration (P=0.001) whereas a trend toward an improved 6MWT was observed (+58m, P=0.10). Anaerobic threshold and peak VO2 (+1.7±2.7mL/kg/min) improved significantly (P=0.01 and 0.03). Regarding imaging data, at rest, peak strain improved after rehabilitation (P=0.05) whereas the RV became more dilated. RV contractile reserve, defined by the change in peak systolic longitudinal RV strain between rest and maximum exercise, significantly improved (−3.9±4.7%, P=0.03).

In this preliminary study, cardio-pulmonary rehabilitation led to improved quality of life and exercise capacity in PAH. The increased RV contractile reserve post-rehabilitation might explain, in association with the peripheral muscular effects of exercise training, the clinical benefits of rehabilitation in PAH.