This Cochrane systematic review aimed to estimate the effects of supervised exercise-based rehabilitation compared with usual care or no exercise-based rehabilitation on the primary outcomes; exercise capacity, serious adverse events and health-related quality of life in people with pulmonary hypertension.
This review included randomised controlled trials that assessed supervised exercise-based rehabilitation for people with pulmonary hypertension. Eligible trials were identified from five electronic databases. Trials were included if they compared supervised exercise-based rehabilitation of any duration, frequency or setting to a control group of education or usual care with no specific exercise component. Primary outcomes were; exercise capacity, which included measures such as the six-minute walk test and peak exercise capacity; serious adverse events during the intervention period, defined as mortality, disease progression, symptoms precluding training, and discontinuation of the study; and health-related quality of life, which was measured with any validated generic or disease specific quality of life measure.
Two reviewers independently identified and selected studies, extracted data, and assessed risk of bias using the Cochrane Risk of Bias 1.0 tool. Certainty of the evidence was evaluated using the GRADE framework.
The review included 14 trials (574 participants), of which 11 trials (462 participants) contributed to the meta-analyses. The mean age of participants ranged from 35 to 68 years and all trials included participants who were classified as being stable on medical therapy. Exercise-based programmes included both inpatient- and outpatient-based rehabilitation that incorporated both upper and lower limb exercise.
For the outcome exercise capacity, there is low certainty that supervised exercise-based rehabilitation compared with control may increase mean six-minute walk distance (MD 48.52 metres, 95% CI 33.42 to 63.62; 11 studies, 418 participants), may increase mean peak oxygen uptake (MD 2.07 mL/kg/min, 95% CI 1.57 to 2.57; 7 studies, 314 participants) and may increase mean peak power (MD 9.69 W, 95% CI 5.52 to 13.85; 5 studies, 226 participants).
For the outcome serious adverse events, there was moderate certainty that supervised exercise-based rehabilitation compared with control was probably not associated with an increased risk of serious adverse events (RD 0, 95% CI −0.03 to 0.03; 11 studies, 439 participants).
For the outcome health-related quality of life, there was moderate certainty that supervised exercise-based rehabilitation compared with control probably increases the 36-item Short Form Physical Component Score (MD 3.98 points, 95% CI 1.89 to 6.07; 5 studies, 187 participants) and the 36-item Short Form Mental Component Score (MD 3.60 points, 95% CI 1.21 to 5.98 points; 5 RCTs, 186 participants).
In people with pulmonary hypertension who are medically stable, supervised exercise-based rehabilitation may result in a large increase in exercise capacity, it is probably safe and probably improves quality of life.
Morris NR, Kermeen FD, Jones AW, Lee JYT, Holland AE. Exercise-based rehabilitation programmes for pulmonary hypertension. Cochrane Database of Systematic Reviews 2023, Issue 3. Art. No.: CD011285. DOI: 10.1002/14651858.CD011285.pub3.
