Throughout most of human history, people did not relate exercise with health to the same degree that we see today. This was probably because people were already getting ample amounts of physical activity without the need for additional prompts. It was not more exercise that people needed; it was less of it. 

Fast forward to today, we now live in an extraordinary time in which a large proportion of tasks can be carried out from a sedentary position (ie, working on a laptop). We also live in a time in which unhealthy foods are generally cheaper than healthier options—the opposite of what has historically been the case. 

The draw of a sedentary lifestyle, the abundance of unhealthy foods, and a blasé attitude toward optimal health: these ingredients form the perfect storm for many of the diseases we see today. It is indeed unfortunate that in a time in which we have more healthcare facilities than ever before and hunger is barely an issue in the developed world, more and more people are falling ill due to lifestyle choices. 


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On the bright side, there is a growing awareness of the indispensable value of physical exercise. In some countries, physicians are able to “prescribe” physical exercise to patients, just like they would prescribe a drug. Healthcare authorities around the world are coming up with initiatives to get people moving, literally. Just a little bit more of physical activity every day can make all the difference. 

Proven Clinical Benefits in PAH 

Aside from general fitness, clinical researchers are also emphasizing the value of exercise in alleviating the symptoms of some diseases. This includes pulmonary arterial hypertension (PAH), a condition in which the resting mean pulmonary arterial pressure is pathologically elevated. 

Because patients with PAH often suffer from right heart insufficiency, physical activity can take a greater toll on them than the general population. Exercise insufficiency may also be indicative of the severity of the disease. In Clinics in Chest Medicine, Vallerand and colleagues wrote, “Exercise magnifies numerous cardiopulmonary decompensations, which can help inform diagnoses, assess degrees of physical impairment, evaluate exertional dyspnea, and estimate prognoses for PH patients.” 

Read more about PAH etiology 

So if physical movement is generally more difficult for PAH patients, why are some scientists encouraging more physical activity for them? This is because while intense exercise may result in overexertion, light-to-moderate exercise has proven clinical benefits.

“Applying different exercise intensities is associated with different levels of effectiveness in endothelium-dependent vasodilation, depending on the interaction between the intensities of both exercises,” Seo and colleagues wrote in the Journal of Thoracic Disease.

Tailoring Routines by PAH Type

In determining the type of exercise suitable for patients with PAH, it may be wise to group them into 5 different categories, as proposed by Vallerand et al: 

  • Group 1: PAH only
  • Group 2: PAH due to left-sided heart disease
  • Group 3: PAH due to lung disease and/or chronic hypoxia
  • Group 4: Chronic thromboembolic pulmonary hypertension (CTEPH) and other pulmonary artery obstructions
  • Group 5: PAH with unclear and/or multifactorial mechanisms. 

These categories were created in consideration of the physiological processes driving the disease. Depending on the underlying cause of their disease, PAH patients may experience limitations that impede their ability to live normal lives.

“The pairing of physiological limitations and behavioral limitations produces a debilitating spiral of deconditioning that ultimately leads to even greater levels of fatigue and much poorer quality of life,” Vallerand et al wrote.

Functional and Quality of Life Improvements

In Heart Failure Clinics, Benjamin and colleagues wrote about the specific ways in which exercise training can improve PAH clinical outcomes. For example, studies in which a 12-week cycling and quadriceps training program was implemented for patients with PAH demonstrated an increase in quadriceps strength and endurance at the end of the study.

Studies examining the effect of exercise training on respiratory muscle strength demonstrated significantly improved nonvolitional respiratory muscle strength after 3 weeks, compared to baseline parameters. Research has also indicated that patients with PAH who commit to an exercise routine perform better on the 6-minute walking test. 

Read more about PAH treatment

Another important benefit of exercise training is that it improves the quality of life of patients with PAH. Studies demonstrate they experience improvements in both physical and mental health after committing to an exercise program. In a study conducted on patients with chronic thromboembolic PAH, participants reported significant improvements in physical functioning and vitality after exercise. In addition, exercise training also makes them feel less fatigued, as assessed by the Fatigue Severity Scale. 

Seo and colleagues wrote that patients with PAH who undergo exercise training showed that “domains including physical function, general health, vitality, social function, and mental health demonstrated significant improvements.” 

Given the clear benefits of physical exercise, physicians should persuade their patients to undergo light-to-moderate exercise according to their physical capacity a few times a week. Patients should be made to understand the possible clinical benefits that a commitment to an exercise routine can confer. Physicians should also help patients in determining the type of exercise that can be done, and encourage them to keep an exercise journal to chronicle their progress. 

References

Seo YG, Oh S, Park WH, et al. Optimal aerobic exercise intensity and its influence on the effectiveness of exercise therapy in patients with pulmonary arterial hypertension: a systematic reviewJ Thorac Dis. 2021;13(7):4530-4540. doi:10.21037/jtd-20-3296

Vallerand JR, Weatherald J, Laveneziana P. Pulmonary hypertension and exerciseClin Chest Med. 2019;40(2):459-469. doi:10.1016/j.ccm.2019.02.003

Benjamin N, Marra AM, Eichstaedt C, Grünig E. Exercise training and rehabilitation in pulmonary hypertensionHeart Fail Clin. 2018;14(3):425-430. doi:10.1016/j.hfc.2018.03.008