Ribeiro Indyanara C, Sieczkowska Sofia M, Jashchenko Renata, Jara Daniela, da Silva Gonçalves Bos Denielli, De Souza Rogério, Carvalho Celso R F, De Angelis Kátia, Paula-Ribeiro Marcelle
Applied Physiology and Nutrition Research Group, School of Physical Education and Sport, University of São Paulo (USP), São Paulo, Brazil.
Laboratory of Assessment and Conditioning in Rheumatology, USP Faculty of Medicine Clinics Hospital (HCFMUSP), São Paulo, Brazil.
Eur Respir Rev. 2025 Sep 3;34(177). doi: 10.1183/16000617.0102-2025. Print 2025 Jul.
Pulmonary hypertension is a pathophysiological disorder with poor prognosis. Exercise intolerance and lower physical activity levels are common features of pulmonary hypertension and affect patients' quality of life. Exercise training effectively improves clinical outcomes in this population, but access to rehabilitation centres is often limited. A home-based exercise training component could be an accessible and cost-effective alternative, but the efficacy and safety of this approach in pulmonary hypertension remain unclear.
We conducted a systematic review and meta-analysis of studies retrieved from six international databases. The studies evaluated home-based exercise interventions in patients with pulmonary hypertension, including both stand-alone and hybrid setups, and assessed safety, efficacy (exercise capacity, cardiorespiratory outcomes and functional class) and adherence.
We included 19 studies. Compared with inactive controls, home-based exercise training improved the 6-min walk distance (mean difference (MD) 54.85 m, p<0.01), peak oxygen uptake (standardised MD 0.83 mL·kg·min, p<0.01), ventilatory efficiency (MD -3.93, p<0.01) and quality of life scores. Improvements in clinical outcomes were comparable between home-based and centre-based interventions. No clinical worsening or exercise training-related severe adverse events were reported; however, most studies did not report health-related self-monitoring strategies at home. The level of adherence was generally high, and the drop-out rates were comparable between home-based and centre-based interventions.
Home-based exercise interventions appear to be viable alternatives to centre-based programmes for patients with pulmonary hypertension, showing comparable improvements in clinical outcomes. However, limited reporting on self-monitoring may affect the overall safety assessment. Further research is needed to determine the optimal implementation of these interventions.
肺动脉高压是一种预后不良的病理生理紊乱疾病。运动不耐受和较低的身体活动水平是肺动脉高压的常见特征，会影响患者的生活质量。运动训练能有效改善这一人群的临床结局，但进入康复中心往往受到限制。基于家庭的运动训练部分可能是一种可及且具成本效益的替代方案，但这种方法在肺动脉高压中的疗效和安全性仍不明确。
我们对从六个国际数据库检索到的研究进行了系统评价和荟萃分析。这些研究评估了肺动脉高压患者基于家庭的运动干预措施，包括独立设置和混合设置，并评估了安全性、疗效（运动能力、心肺结局和功能分级）及依从性。
我们纳入了19项研究。与不运动的对照组相比，基于家庭的运动训练改善了6分钟步行距离（平均差值（MD）54.85米，p<0.01）、峰值摄氧量（标准化MD 0.83毫升·千克·分钟，p<0.01）、通气效率（MD -3.93，p<0.01）和生活质量评分。基于家庭的干预和基于中心的干预在临床结局改善方面相当。未报告临床恶化或与运动训练相关的严重不良事件；然而，大多数研究未报告在家中与健康相关的自我监测策略。依从性水平总体较高，基于家庭的干预和基于中心的干预的退出率相当。
对于肺动脉高压患者，基于家庭的运动干预似乎是基于中心的项目的可行替代方案，在临床结局方面显示出相当的改善。然而，自我监测报告有限可能会影响整体安全性评估。需要进一步研究以确定这些干预措施的最佳实施方式。
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