Effects of physical rehabilitation interventions on pulmonary hypertension: an overview of systematic reviews of randomized controlled trials.

Abstract

Introduction: Pulmonary hypertension (PH) is characterized by exertional dyspnea and reduced exercise capacity. This study aims to synthesize current evidence to guide more effective exercise-based interventions.

Methods: This overview included systematic reviews (SRs) of randomized controlled trials in adults with PH that performed an exercise intervention as exercise training (ET), inspiratory muscle training (IMT) or combined training (CT). The main outcome was exercise capacity measured (e.g. six-minute walk test (6MWT) or cardiopulmonary exercise test (CPET). The searches were conducted in seven databases. Two independent reviewers conducted the analysis, with a third resolving disagreements. Methodological quality and certainty of evidence were assessed using AMSTAR-2 and GRADE, along with overlap analysis.

Results: A total of 14 SRs were included, categorized into ET, IMT, and CT. All three interventions demonstrated improvements in functional capacity, with increases in 6MWT distance of >48.5 m (ET), 39.1 m (IMT), and 49.5 m (CT). VO₂peak improved in ET and CT groups by >2.07 and >3.0 mL/kg/min, respectively. Only one study performed IMT, with gains. Overall, methodological quality was rated as critically low, with significant overlap across studies.

Conclusion: These findings suggest a clinically significant benefit of exercise-based interventions, with a slight superiority of CT.Protocol registration: http://www.crd.york.ac.uk/prospero identifier is CRD42025643615.