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      Functional exercise capacity, physical activity, and respiratory and peripheral muscle strength in pulmonary hypertension according to disease severity

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          Abstract

          [Purpose] This study investigated functional capacity, physical activity, and respiratory and peripheral muscle strength in different functional classes of pulmonary arterial hypertension (PAH) compared with healthy subjects. [Subjects and Methods] This study included 31 patients with class II (n = 16) or class III (n = 15) PAH, classified according to the World Health Organization. Fifteen healthy subjects served as controls. Functional capacity was assessed using the 6-minute walk test (6MWT). Physical activity was determined using the International Physical Activity Questionnaire Short Form (IPAQ-SF). Respiratory muscle strength was measured using a mouth pressure device. Peripheral muscle strength was evaluated using a dynamometer. [Results] The 3 groups had similar demographic variables (p > 0.05). There were significant differences in 6MWT distance, maximal inspiratory pressure, and IPAQ categorical classification between the 3 groups (p < 0.05). Maximal expiratory pressure; total IPAQ score; and knee extensor, shoulder abductor, and hand grip strength were significantly lower in PAH patients (classes II and III) than in healthy subjects (p < 0.05). [Conclusion] As PAH progresses, respiratory muscle strength, functional exercise capacity, and physical activity decrease. Functional class should be taken into consideration when planning rehabilitation programs for this patient group.

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          Guidelines for the diagnosis and treatment of pulmonary hypertension.

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            Diagnosis and assessment of pulmonary arterial hypertension.

            The diagnosis and assessment of pulmonary arterial hypertension is a rapidly evolving area, with changes occurring in the definition of the disease, screening and diagnostic techniques, and staging and follow-up assessment. The definition of pulmonary hypertension has been simplified, and is now based on currently available evidence. There has been substantial progress in advancing the imaging techniques and biomarkers used to screen patients for the disease and to follow up their response to therapy. The importance of accurate assessment of right ventricular function in following up the clinical course and response to therapy is more fully appreciated. As new therapies are developed for pulmonary arterial hypertension, screening, prompt diagnosis, and accurate assessment of disease severity become increasingly important. A clear definition of pulmonary hypertension and the development of a rational approach to diagnostic assessment and follow-up using both conventional and new tools will be essential to deriving maximal benefit from our expanding therapeutic armamentarium.
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              Clinical correlates and prognostic significance of six-minute walk test in patients with primary pulmonary hypertension. Comparison with cardiopulmonary exercise testing.

              The six-minute walk test is a submaximal exercise test that can be performed even by a patient with heart failure not tolerating maximal exercise testing. To elucidate the clinical significance and prognostic value of the six-minute walk test in patients with primary pulmonary hypertension (PPH), we sought (1) to assess the relation between distance walked during the six-minute walk test and exercise capacity determined by maximal cardiopulmonary exercise testing, and (2) to investigate the prognostic value of the six-minute walk test in comparison with other noninvasive parameters. The six-minute walk test was performed in 43 patients with PPH, together with echocardiography, right heart catheterization, and measurement of plasma epinephrine and norepinephrine. Symptom-limited cardiopulmonary exercise testing was performed in a subsample of patients (n = 27). Distance walked in 6 min was significantly shorter in patients with PPH than in age- and sex-matched healthy subjects (297 +/- 188 versus 655 +/- 91 m, p < 0. 001). The distance significantly decreased in proportion to the severity of New York Heart Association functional class. The distance walked correlated modestly with baseline cardiac output (r = 0.48, p < 0.05) and total pulmonary resistance (r = -0.49, p < 0. 05), but not significantly with mean pulmonary arterial pressure. In contrast, the distance walked correlated strongly with peak V O(2) (r = 0.70, p < 0.001), oxygen pulse (r = 0.57, p < 0.01), and V E-VCO(2) slope (r = -0.66, p < 0.001) determined by cardiopulmonary exercise testing. During a mean follow-up period of 21 +/- 16 mo, 12 patients died of cardiopulmonary causes. Among noninvasive parameters including clinical, echocardiographic, and neurohumoral parameters, only the distance walked in 6 min was independently related to mortality in PPH by multivariate analysis. Patients walking < 332 m had a significantly lower survival rate than those walking farther, assessed by Kaplan-Meier survival curves (log-rank test, p < 0.01). These results suggest that the six-minute walk test, a submaximal exercise test, reflects exercise capacity determined by maximal cardiopulmonary exercise testing in patients with PPH, and it is the distance walked in 6 min that has a strong, independent association with mortality.
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                Author and article information

                Journal
                J Phys Ther Sci
                J Phys Ther Sci
                JPTS
                Journal of Physical Therapy Science
                The Society of Physical Therapy Science
                0915-5287
                2187-5626
                26 May 2015
                May 2015
                : 27
                : 5
                : 1309-1312
                Affiliations
                [1) ] Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Hacettepe University, Turkey
                [2) ] School of Physiotherapy and Rehabilitation, Dokuz Eylul University, Turkey
                [3) ] Department of Internal Medicine, Faculty of Medicine, Hacettepe University, Turkey
                [4) ] Department of Cardiology, Faculty of Medicine, Hacettepe University, Turkey
                Author notes
                [* ]Corresponding author. Melda Saglam, Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Hacettepe University: 06100 Samanpazari, Ankara, Turkey. (E-mail:  msaglam@ 123456hacettepe.edu.tr )
                Article
                jpts-2014-742
                10.1589/jpts.27.1309
                4483385
                26157207
                e1bf815f-d699-4dd5-8389-9a52f2b47c2e
                2015©by the Society of Physical Therapy Science. Published by IPEC Inc.

                This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial No Derivatives (by-nc-nd) License.

                History
                : 11 November 2014
                : 11 January 2015
                Categories
                Original Article

                pulmonary hypertension,functional capacity,physical activity

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