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Left Ventricular Function Before and After Aerobic Exercise Training in Women With Pulmonary Arterial Hypertension

Woolstenhulme, Joshua G., PhD, DPT; Guccione, Andrew A., PhD, DPT; Herrick, Jeffrey E., PhD; Collins, John P., PhD; Nathan, Steven D., MD; Chan, Leighton, MD, MPH; Keyser, Randall E., PhD

Journal of Cardiopulmonary Rehabilitation and Prevention: March 2019 - Volume 39 - Issue 2 - p 118–126
doi: 10.1097/HCR.0000000000000397
Exercise Physiology

Background: Pulmonary arterial hypertension (PAH) is a chronic debilitating illness. The effects of vigorous aerobic exercise training (AET) on heart function in PAH are poorly understood.

Methods: Eighteen women with PAH (aged 56.2 ± 8.8 yr, body mass index: 28.8 ± 7.3 kg/m2) underwent 10 wk of vigorous AET. Cardiac function was observed at rest and peak exercise using bioelectrical impedance cardiography before and after the AET. Cardiac function was observed in a small PAH subset (n = 7) for 10 wk before beginning the AET. A cohort of sedentary women (n = 19) served as healthy controls.

Results: Left ventricular ejection fraction (48 ± 9.2 vs 61.5 ± 13.3%, P = .034) and the systemic vascular resistance index (2258 ± 419.1 vs 2939 ± 962.4 dyn·sec/cm5·m2, P = .008) were lower at supine rest in the baseline PAH group versus the healthy group, as were peak exercise heart rate (140 ± 13.3 vs 170 ± 13.8 beats/min, P < .001) and systemic vascular resistance index (828 ± 141.1 vs 824 ± 300.9 dyn·sec/cm5·m2, P = .050) after controlling for age and heart rate. Systemic vascular resistance index measured at peak exercise decreased in the PAH group after AET (828 ± 141.1 vs 766 ± 139.6 dyn·sec/cm5·m2, P = .020). Left ventricular early diastolic filling ratio worsened in the PAH subset prior to AET (95.9 ± 19.4 vs 76.2 ± 18.9%, P = .043) and remained unchanged after AET.

Conclusion: Vigorous AET was not associated with significant declines in left ventricular systolic or diastolic function in women with PAH. Aerobic exercise training may be beneficial for reducing afterload and may preserve left ventricular diastolic function.

Left ventricular filling dynamics (LVFD) were measured in patients with pulmonary hypertension during cardiopulmonary exercise testing before and after a cardiopulmonary rehabilitation program. Noninferiority analysis revealed that LVED were unaltered after the program, implying that vigorous exercise did not adversely influence right ventricular or pulmonary vascular function.

Department of Rehabilitation Science, George Mason University, Fairfax, Virginia (Drs Woolstenhulme, Guccione, Herrick, Collins, and Keyser); Rehabilitation Medicine Department, Clinical Research Center, National Institutes of Health, Bethesda, Maryland (Drs Woolstenhulme, Collins, Chan, and Keyser); The Department of Physical Therapy and Health Care Sciences, The George Washington University, Washington, District of Columbia (Dr Woolstenhulme); and Advanced Lung Disease and Transplant Program, Inova Fairfax Hospital, Falls Church, Virginia (Dr Nathan).

Correspondence: Randall E. Keyser, PhD, Department of Rehabilitation Science, George Mason University, 4400 University Dr, Fairfax, VA 22030 (

The authors declare no conflicts of interest.

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