Departments of Pulmonary Medicine (Drs Koudstaal, van den Toorn, Chandoesing, and Boomars and Ms Wapenaar) and Cardiology (Dr van den Bosch), Erasmus MC, University Medical Center Rotterdam, the Netherlands; and Pulmonary Rehabilitation Centre, Revant, Breda, the Netherlands (Dr van Ranst and Mr Beesems). Both T. Koudstaal and M. Wapenaar contributed equally and share first authorship for the article.
J Cardiopulm Rehabil Prev. 2019 Nov;39(6):397-402. doi: 10.1097/HCR.0000000000000443.
Pulmonary arterial hypertension (PAH) is characterized by right ventricular failure, leading to exertional dyspnea, skeletal muscle weakness, and poor quality of life (QOL). Apart from treatment with PAH-specific drugs, guidelines recommend pulmonary rehabilitation (PR). Clinical PR programs have shown improvement in functional capacity and QOL. However, little is known about the effectiveness of an outpatient PR program. The aim of our study was to assess effectiveness of a multidisciplinary outpatient PR program.
Patients with PAH or chronic thromboembolic pulmonary hypertension (CTEPH), who were in a stable condition on optimized drug therapy, followed a 10-wk outpatient program in a rehabilitation center. The PR program was designed to improve exercise capacity and health status by means of low load cycling, walking, and muscle training twice a week combined with psychological counseling. QOL was measured by the Cambridge Pulmonary Hypertension Outcome Review (CAMPHOR) questionnaire.
Twenty-one patients (13 women) with PAH (n = 16) or CTEPH (n = 5) completed the study. All patients were in New York Heart Association (NYHA) functional class III, and their mean age was 45 ± 16 yr. After PR, the mean cycling endurance time increased by 4.4 min (P < .001), 6-min walk distance by 12.2 m (P < .05), and maximum inspiratory pressure by 5.8 cm H2O (P = .01). Skeletal muscle function increased significantly. The CAMPHOR questionnaire demonstrated significant decrease in symptoms and improvement in QOL. Soluble biomarkers did not show any change before and after PR.
Outpatient PR could be an effective instrument to improve exercise capacity and health status in patients with PAH or CTEPH.
肺动脉高压（PAH）的特征是右心室衰竭，导致运动时呼吸困难、骨骼肌无力和生活质量（QOL）差。除了使用 PAH 特异性药物治疗外，指南还建议进行肺康复（PR）。临床 PR 计划已显示出对功能能力和 QOL 的改善。然而，对于门诊 PR 计划的有效性知之甚少。我们的研究目的是评估多学科门诊 PR 计划的效果。
处于优化药物治疗稳定状态的 PAH 或慢性血栓栓塞性肺动脉高压（CTEPH）患者在康复中心接受了 10 周的门诊计划。PR 计划旨在通过低负荷自行车运动、步行和肌肉训练来改善运动能力和健康状况，每周两次，并结合心理咨询。QOL 通过剑桥肺动脉高压结果回顾（CAMPHOR）问卷进行测量。
21 名患者（13 名女性）完成了研究，其中包括 16 名 PAH 患者和 5 名 CTEPH 患者。所有患者均处于纽约心脏协会（NYHA）功能 III 级，平均年龄为 45 ± 16 岁。PR 后，自行车耐力时间平均增加了 4.4 分钟（P <.001），6 分钟步行距离增加了 12.2 米（P <.05），最大吸气压力增加了 5.8 厘米 H2O（P =.01）。骨骼肌功能显著增强。CAMPHOR 问卷显示症状显著减轻，QOL 得到改善。可溶性生物标志物在 PR 前后均未显示任何变化。
门诊 PR 可能是改善 PAH 或 CTEPH 患者运动能力和健康状况的有效手段。
