Moderate to high-intensity aerobic exercise is necessary to improve exercise tolerance and quality of life in patients with pulmonary arterial hypertension (PAH), according to the results of a systematic literature review published in the Journal of Thoracic Disease

However, the researchers warned that data obtained from the reviewed articles were not sufficient to suggest any exercise intensity recommendations and added that more randomized controlled trials are necessary to compare the effects of different exercise intensities.

It is unclear whether differently applied exercise intensities are effective when used in exercise-based cardiac rehabilitation programs for patients with PAH.

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In order to clarify this, a group of researchers led by Jidong Sung, MD, MPH, PhD, from Sungkyunkwan University School of Medicine in Seoul, Republic of Korea conducted a literature review of comparative studies of exercise interventions for patients with PAH. They reviewed 1452 studies and analyzed 8, 3 of which were randomized controlled trials, 3 that were prospective studies, and 2 that were case series.

They found that exercise capacity and quality of life improved in patients who did above moderate-intensity exercise. However, no improvements were seen in those who did low-intensity exercise.

“The findings in this study suggest that at least moderate aerobic exercise intensity is needed to significantly improve 6-minute walk distance and [quality of life] in individuals diagnosed with World Health Organization Group 1 of pulmonary arterial hypertension,” the researchers wrote. They added that strict termination criteria are warranted in this group of patients. 

PAH is a rare disease with progressive development of dyspnea and fatigue and increasing deterioration of exercise tolerance. Exercise therapy has been suggested as a treatment for the disease since 2000. However, it is important to determine the optimal exercise intensity to prevent adverse events such as arrhythmias, syncope, and respiratory disease and to increase the effectiveness of the therapy.


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 review. J Thorac Dis. 2021;13(7):4530-4540. doi:10.21037/jtd-20-3296