Effects of an Outpatient Service Rehabilitation Programme in Patients Affected by Pulmonary Arterial Hypertension: An Observational Study.

M. Bussotti, P. Gremigni, R. Pedretti, Patrycja Kransinska, S. Di Marco, Paola Corbo, G. Marchese, P. Totaro, M. Sommaruga
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引用次数: 24

Abstract

BACKGROUND Pulmonary arterial hypertension (PAH) is a rare disease characterised by a severe impairment of functional status and quality of life (QoL). Use of rehabilitative programmes may help to improve outcomes. The aim of this pre/post test case series was to evaluate the impact of a training program, including sessions of aerobic and resistance exercise, inspiratory muscle reinforcement, slow breathing, relaxation, and psychological support, on functional outcomes. METHODS Fifteen patients affected by PAH, in World Health Organization (WHO) Functional Class (FC) II or III and in stable clinical condition, were included in a 4-week cardiorespiratory training programme conducted in outpatient service. Patients were tested during a routine control visit (T0), one month later at the beginning of the training programme (T1), and at study end (T2). Between T0 and T1, patients continued their normal activities and therapies. At each step, patients underwent respiratory and functional evaluation by spirometry, 6-minute walk test (6-MWT), maximal cardiopulmonary exercise testing (CPET), echocardiography, and levels of brain natriuretic peptide (BNP). QoL was also assessed at T1 and T2 using the Hospital Anxiety and Depression Scale and the EuroQoL-5D questionnaire. The primary endpoint was the effect of training on peak oxygen consumption (peak V̇O2). RESULTS There were no significant differences in BNP levels, or in any of the respiratory or echocardiographic parameters measured, between T0 and T1. Between T1 and T2, significant improvements were recorded in QoL (HADS-Anxiety mean change 3.5 ± 3.3 and HADS-Depression mean change 1.6 ± 2.0, all p < 0.01). Significant improvements were also observed in functional capacity with distance walked at 6-MWT increasing from 455 ± 115 to 487 ± 120 (+8%, p < 0.01), workload (WR) of CPET increased of 22% (from 73 ± 22 to 87 ± 21 watt, p < 0.001), peak V̇O2 increasing from 17.3 ± 4.2 to 19.9 ± 4.5 mL/kg/min (p < 0.001) and pulse O2 increasing from 7.8 ± 1.8 to 8.8 ± 2.4 mL/beat (p < 0.01). No adverse events or deterioration in clinical status were observed during the training sessions. CONCLUSION Cardiorespiratory training in a outpatient service is a suitable option for patients with PAH in WHO FC II/III thanks to improved exercise capacity and QoL, which may allow them to achieve better outcomes.
门诊康复方案对肺动脉高压患者的影响:一项观察性研究。
背景肺动脉高压(PAH)是一种罕见的疾病,其特征是严重损害功能状态和生活质量(QoL)。使用康复方案可能有助于改善结果。这个前后测试案例系列的目的是评估训练计划的影响,包括有氧和阻力运动、吸气肌强化、慢呼吸、放松和心理支持,对功能结果的影响。方法选取世界卫生组织(WHO)功能分类(FC) II或III级的15例临床情况稳定的PAH患者,在门诊进行为期4周的心肺训练。患者分别在常规对照访视(T0)、一个月后训练计划开始时(T1)和研究结束时(T2)进行测试。在T0至T1期间,患者继续正常活动和治疗。在每一步中,患者通过肺活量测定法、6分钟步行试验(6-MWT)、最大心肺运动试验(CPET)、超声心动图和脑钠肽(BNP)水平进行呼吸和功能评估。在T1和T2使用医院焦虑和抑郁量表和EuroQoL-5D问卷评估生活质量。主要终点是训练对峰值耗氧量(峰值V O2)的影响。结果在T0和T1之间,BNP水平或任何呼吸或超声心动图参数均无显著差异。在T1和T2之间,生活质量有显著改善(hads -焦虑平均变化3.5±3.3,hads -抑郁平均变化1.6±2.0,均p < 0.01)。6 mwt步行距离从455±115增加到487±120 (+8%,p < 0.01), CPET负荷(WR)增加22%(从73±22增加到87±21瓦,p < 0.001),峰值V (O2)从17.3±4.2增加到19.9±4.5 mL/kg/min (p < 0.001),脉搏O2从7.8±1.8增加到8.8±2.4 mL/次(p < 0.01)。在培训期间没有观察到不良事件或临床状况恶化。结论门诊心肺训练是WHO FC II/III级PAH患者的合适选择,可提高患者的运动能力和生活质量,可使患者获得更好的预后。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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