Exercise prescription for patients with pulmonary artery hypertension (PAH) must be individualised based on current medical management, status of PAH-specific medications and other co-morbidities that would impact on the individual's ability to undertake exercise. Current evidence supports exercise in NYHA functional class II, III, and IV.
Exercise in patients with PAH:
- Improves cardiovascular fitness
- Improves right and left ventricular function
- Reduces pro-inflammatory cytokines
- Improves peripheral muscle function
Evidence currently supports aerobic exercise including walking, exercise bike and treadmill; and low resistance training.
A rating of perceived exertion of 11-13 on the Borg scale, or 3-4 on the modified Borg scale, is recommended to monitor exercise intensity. Interval training regimens are recommended to avoid marked increases in pulmonary pressures with exercise. High-intensity exercise, isometrics and Valsalva manoeuvres are to be avoided.
The exercise clinician should monitor:
- Oxygen saturation during exercise – aiming to maintain SpO2 above 85%
- HR response – if bradycardia is observed during exercise, the patient should cease exercising and should be monitored. Recommencement of exercise should be carried out with caution and medical advice should be sought if necessary
- Evidence of right HF