Effect of Ground-Based Walk Training in Pulmonary Hypertension

This study aimed to determine the effect of ground-based walking training on exercise capacity, physical activity, quadriceps muscle strength, and quality of life (QoL) in patients with pulmonary hypertension. A total of 24 patients were included in the study. Patients were randomly assigned to 2 groups as the walking group or the control group. The walking group participated in 30-minute supervised ground-based walking training 2 days/week for 8 weeks. Also, they walked unsupervised at least 1 day/week. The control group received no intervention. The number of weekly steps taken in both groups was recorded using a pedometer. In addition to the sociodemographic and clinic characteristics of the patients, the endurance shuttle walk test, incremental shuttle walk test, and 6-minute walk test were used for the evaluation of exercise capacity, and an activity monitor and pedometer for physical activity, a dynamometer for quadriceps muscle strength, and emPHasis-10 for QoL. After 8 weeks, endurance capacity, maximal exercise capacity, and the number of steps significantly improved in the walking group (p <0.05). The 6-minute walk distance, physical activity, quadriceps muscle strength, and QoL were similar in both groups (p >0.05). The results of the study showed that ground-based walking could improve endurance capacity, maximal exercise capacity, and the number of steps. Quadriceps muscle strength also improved in the walking group. No adverse effects were reported during the training period. Ground-based walking training can be performed safely in patients with pulmonary hypertension.

Introduction

Pulmonary hypertension (PH) is a condition defined by a mean pulmonary artery pressure measured at rest >20 mm Hg at a right-sided cardiac catheterization.¹ Exercise intolerance is common in PH, caused by incompatible responses of the right and partially the left ventricle, changes in dead space ventilation and ventilation/perfusion mismatch, and decreased peripheral and respiratory muscle strength.² Recent guidelines suggested that patients with PH should be physically active at the symptom limit and could participate in supervised exercise training while they were stable with medical treatment.³ Supervised exercise training improves skeletal muscle endurance and strength, exercise capacity, and quality of life (QoL) in patients with PH.⁴ Ground-based walking training (GBWT) was applied safely and an easy-to-apply exercise type when special exercise equipment was not available.^5,6 To best of our knowledge, no study has investigated the effect of GBWT in patients with PH. The primary aim of this study was to determine the effect of GBWT on exercise endurance capacity, and the secondary aim was to determine the effect of GBWT on maximal and submaximal exercise capacity, the level of physical activity (PA), quadriceps muscle strength, and QoL in patients with PH.