Open Questions about Pulmonary Hypertension and Exercise Training: A Critical Review

Background: Pulmonary hypertension (PH) is a potentially life-threatening condition with an increased global awareness. Although PH can be long-time asymptomatic in the early stages, it may participate in cardiac remodelling, leading to heart failure and death. Generally, physical exercise is not recommended for safety concerns, but nowadays, evidences in scientific literature are proving its efficacy as complementary treatment in PH. Methods: An increasing number of studies are focusing on how exercise can improve the cardiopulmonary function and the quality of life overall. We briefly examined and summarized the benefit of exercise training in patients with PH, analyzing the evidence-based recommendations about exercise training in these patients. Results: Throughout the analysis of the physiological mechanisms that may be the basis for the amelioration of the symptoms and provided evidence-based recommendations about frequency, type, intensity and setting of exercise training, we consistently verified that increasing physical activity could help to better manage the pulmonary hypertension. Conclusion: An exponential number of studies show the potential role of exercise as additional treatment in PH, with significant effects in several clinical and haemodynamic parameters as endurance, peak oxygen consumption, cardiovascular, respiratory and musculo-skeletal function. In terms of activity of daily living, the improvement in 6-minute walking distance is similar to that achieved with optimal use of medication. Longer and larger studies are needed to determine whether exercise training benefits on exercise capacity, cardiorespiratory fitness and quality of life are maintained in the long-term and also include an improvement in clinical outcomes.