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Benefits of skeletal-muscle exercise training in pulmonary arterial hypertension: the WHOLEi+12 trial
Gonzalez-Saiz L, Fiuza-Luces C, Sanchis-Gomar F, Santos-Lozano A, Quezada-Loaiza CA, Flox-Camacho A, Munguia-Izquierdo D, Ara I, Santalla A, Moran M, Sanz-Ayan P, Escribano-Subias P, Lucia A
International Journal of Cardiology 2017 Mar 15;231:277-283
clinical trial
7/10 [Eligibility criteria: Yes; Random allocation: Yes; Concealed allocation: No; Baseline comparability: Yes; Blind subjects: No; Blind therapists: No; Blind assessors: Yes; Adequate follow-up: Yes; Intention-to-treat analysis: Yes; Between-group comparisons: Yes; Point estimates and variability: Yes. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed*

BACKGROUND: Pulmonary arterial hypertension is often associated with skeletal-muscle weakness. The purpose of this randomized controlled trial was to determine the effects of an 8-week intervention combining muscle resistance, aerobic and inspiratory pressure-load exercises on upper/lower-body muscle power and other functional variables in patients with this disease. METHODS: Participants were allocated to a control (standard care) or intervention (exercise) group (n = 20 each, 45 +/- 12 and 46 +/- 11years, 60% women and 10% patients with chronic thromboembolic pulmonary hypertension per group). The intervention included five, three and six supervised (inhospital) sessions/week of aerobic, resistance and inspiratory muscle training, respectively. The primary endpoint was peak muscle power during bench/leg press; secondary outcomes included N-terminal pro-brain natriuretic peptide levels, 6-min walking distance, five-repetition sit-to-stand test, maximal inspiratory pressure, cardiopulmonary exercise testing variables (eg, peak oxygen uptake), health-related quality of life, physical activity levels, and safety. RESULTS: Adherence to training sessions averaged 94 +/- 0.5% (aerobic), 98 +/- 0.3% (resistance) and 91 +/- 1% (inspiratory training). Analysis of variance showed a significant interaction (group x time) effect for leg/bench press (p < 0.001/p = 0.002), with both tests showing an improvement in the exercise group (p < 0.001) but not in controls (p > 0.1). We found a significant interaction effect (p < 0.001) for five-repetition sit-to-stand test, maximal inspiratory pressure and peak oxygen uptake (p < 0.001), indicating a training-induced improvement. No major adverse event was noted due to exercise. CONCLUSIONS: An 8-week exercise intervention including aerobic, resistance and specific inspiratory muscle training is safe for patients with pulmonary arterial hypertension and yields significant improvements in muscle power and other functional variables.

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