Exercise and Pulmonary Arterial Hypertension

Caregiver excercise

A common question that I am asked by patients is how much activity can they safely perform.  What type of exercise is safe?  Should patients exercise?  In the past, patients with heart and lung disease were advised to avoid exercise.  We now know much better!  Not only does exercise improve your stamina, it also improves you muscle strength and sense of well-being.  During exercise, your brain releases chemicals (endorphins) that improve your mood and outlook.  Exercise also helps your bone health.

The best data supporting the benefits of exercise in pulmonary hypertension was published in 2006 (Merles et al, Circulation 2006).  Patients with PAH were randomized to either a vigorous exercise program or usual care.  After 15 weeks, six minute walk distance increased by more than 90 meters.  This improvement bested the improvement with any of our currently approved therapies.  The exercise program was rigorous and structured.  The exercise regimen consisted of stationary bicycling for 10-25 minutes, walking for 60 minutes and 30 minutes of weight lifting with light weights.  Patients did this training regimen 5 days per week.

Based on this well designed study, we have come to appreciate the benefits of exercise.  For patients with PAH, we encourage a regular exercise program that incorporates aerobic exercise for at least 30 minutes daily and lifting light weights.  Patients should gradually increase the level of exercise as they progress.

Pulmonary Rehabilitation

This is a structured, supervised exercise program that incorporates both aerobic and resistance training.  Education about medications and breathing techniques are also taught.  Insurance coverage for Pulmonary Rehab sessions has been variable.  Some plans cover the costs while others do not.  Importantly, all lung transplantation programs require participation in a pulmonary rehab program prior to and after lung transplantation.

Who Should NOT Exercise?

1.     All patients should not begin an exercise program until you have checked with your PAH doctor.

2.     If you were recently hospitalized for PAH, you should not exercise until you have talked to your treating physician.

3.     If you are having lightheadedness or fainting episodes with activity you should not exercise.

4.     If you develop chest pain during exercise you should stop and talk to your treating physician.

Do I have to participate in a formal Pulmonary Rehab program?

Many patients can develop their own exercise routine without a formal program.  I advise walking on a treadmill at 2 miles per hour for 6 minutes.  Then take a break and repeat.  Gradually increase the duration and speed.  Once you can walk for 30 minutes, you may gradually increase the incline by 0.5.  Add stationary bicycling for 10 minutes at low resistance to start.  Gradually increase the resistance and distance.

Many patients like to monitor their heart rate during exercise.  Your maximum heart rate is 220 minus your age in years.  So if you are 40 years old, your maximum heart rate is 180.  A good heart rate range for exercising is 60-80% of your maximum heart rate (for the same 40 year old this would be a heart rate range of 105-140).

Weight lifting using light weights helps improve muscle strength.  Avoid doing exercises where your head is in a downward position.  As most patients with PAH already know, bending over can causes marked light headedness.  As a general rule, if you can lift the weight 10 times easily then it is a safe weight to use.  If you have to strain to lift the weight, then it is too heavy.  Lifting heavy weights and straining can lead to reduced blood flow to your heart and cause you to pass out.

What if I use oxygen, can I still exercise?

No problem.  If you require oxygen, wear your oxygen while you are exercising.  In fact, increase your oxygen by at least 1 liter/minute and even 2 liters/minute if you are able.  When you are done exercising and have fully recovered, turn your oxygen back down to your usual flow rate.  Don’t be embarrassed to be in the gym using your oxygen.  Grab the bull by the horns and be an active part of feeling better.