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Standardized exercise training is feasible, safe, and effective in pulmonary arterial and chronic thromboembolic pulmonary hypertension : results from a large European multicentre randomized controlled trial

(2021) EUROPEAN HEART JOURNAL. 42(23). p.2284-2295
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Abstract
Aims: This prospective, randomized, controlled, multicentre study aimed to evaluate efficacy and safety of exercise training in patients with pulmonary arterial (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH). Methods and results: For the first time a specialized PAH/CTEPH rehabilitation programme was implemented in 11 centres across 10 European countries. Out of 129 enrolled patients, 116 patients (58 vs. 58 randomized into a training or usual care control group) on disease-targeted medication completed the study [85 female; mean age 53.6 +/- 12.5 years; mean pulmonary arterial pressure 46.6 +/- 15.1 mmHg; World Health Organization (WHO) functional class II 53%, III 46%; PAH n= 98; CTEPH n= 18]. Patients of the training group performed a standardized in-hospital rehabilitation with mean duration of 25 days [95% confidence interval (CI) 17-33 days], which was continued at home. The primary endpoint, change of 6-min walking distance, significantly improved by 34.1 +/- 8.3 m in the training compared with the control group (95% CI, 18-51 m; P < 0.0001). Exercise training was feasible, safe, and well-tolerated. Secondary endpoints showed improvements in quality of life (short-form health survey 36 mental health 7.3 +/- 2.5, P = 0.004), WHO-functional class (training vs. control: improvement 9:1, worsening 4:3; chi(2) P =0.027) and peak oxygen consumption (0.9 +/- 0.5 mL/min/kg, P =0.048) compared with the control group. Conclusion: This is the first multicentre and so far the largest randomized, controlled study on feasibility, safety, and efficacy of exercise training as add-on to medical therapy in PAH and CTEPH. Within this study, a standardized specialized training programme with in-hospital start was successfully established in 10 European countries.
Keywords
Cardiology and Cardiovascular Medicine, Pulmonary rehabilitation, Pulmonary hypertension, Exercise programme, QUALITY-OF-LIFE, END-POINT, WALK TEST, EFFICACY, BENEFITS, CAPACITY

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Citation

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MLA
Grünig, Ekkehard, et al. “Standardized Exercise Training Is Feasible, Safe, and Effective in Pulmonary Arterial and Chronic Thromboembolic Pulmonary Hypertension : Results from a Large European Multicentre Randomized Controlled Trial.” EUROPEAN HEART JOURNAL, vol. 42, no. 23, 2021, pp. 2284–95, doi:10.1093/eurheartj/ehaa696.
APA
Grünig, E., MacKenzie, A., Peacock, A. J., Eichstaedt, C. A., Benjamin, N., Nechwatal, R., … Johnson, M. (2021). Standardized exercise training is feasible, safe, and effective in pulmonary arterial and chronic thromboembolic pulmonary hypertension : results from a large European multicentre randomized controlled trial. EUROPEAN HEART JOURNAL, 42(23), 2284–2295. https://doi.org/10.1093/eurheartj/ehaa696
Chicago author-date
Grünig, Ekkehard, Alison MacKenzie, Andrew J Peacock, Christina A Eichstaedt, Nicola Benjamin, Robert Nechwatal, Silvia Ulrich, et al. 2021. “Standardized Exercise Training Is Feasible, Safe, and Effective in Pulmonary Arterial and Chronic Thromboembolic Pulmonary Hypertension : Results from a Large European Multicentre Randomized Controlled Trial.” EUROPEAN HEART JOURNAL 42 (23): 2284–95. https://doi.org/10.1093/eurheartj/ehaa696.
Chicago author-date (all authors)
Grünig, Ekkehard, Alison MacKenzie, Andrew J Peacock, Christina A Eichstaedt, Nicola Benjamin, Robert Nechwatal, Silvia Ulrich, Stéphanie Saxer, Maurizio Bussotti, Marinella Sommaruga, Stefano Ghio, Lina Gumbiene, Eglė Palevičiūtė, Elena Jurevičienė, Antonio Cittadini, Anna A Stanziola, Alberto M Marra, Gabor Kovacs, Horst Olschewski, Joan-Albert Barberà, Isabel Blanco, Martijn A Spruit, Frits M E Franssen, Anton Vonk Noordegraaf, Abílio Reis, Mário Santos, Sofia Gonçalves Viamonte, Heleen Demeyer, Marion Delcroix, Eduardo Bossone, and Martin Johnson. 2021. “Standardized Exercise Training Is Feasible, Safe, and Effective in Pulmonary Arterial and Chronic Thromboembolic Pulmonary Hypertension : Results from a Large European Multicentre Randomized Controlled Trial.” EUROPEAN HEART JOURNAL 42 (23): 2284–2295. doi:10.1093/eurheartj/ehaa696.
Vancouver
1.
Grünig E, MacKenzie A, Peacock AJ, Eichstaedt CA, Benjamin N, Nechwatal R, et al. Standardized exercise training is feasible, safe, and effective in pulmonary arterial and chronic thromboembolic pulmonary hypertension : results from a large European multicentre randomized controlled trial. EUROPEAN HEART JOURNAL. 2021;42(23):2284–95.
IEEE
[1]
E. Grünig et al., “Standardized exercise training is feasible, safe, and effective in pulmonary arterial and chronic thromboembolic pulmonary hypertension : results from a large European multicentre randomized controlled trial,” EUROPEAN HEART JOURNAL, vol. 42, no. 23, pp. 2284–2295, 2021.
@article{8693299,
  abstract     = {{Aims: This prospective, randomized, controlled, multicentre study aimed to evaluate efficacy and safety of exercise training in patients with pulmonary arterial (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH).

Methods and results: For the first time a specialized PAH/CTEPH rehabilitation programme was implemented in 11 centres across 10 European countries. Out of 129 enrolled patients, 116 patients (58 vs. 58 randomized into a training or usual care control group) on disease-targeted medication completed the study [85 female; mean age 53.6 +/- 12.5 years; mean pulmonary arterial pressure 46.6 +/- 15.1 mmHg; World Health Organization (WHO) functional class II 53%, III 46%; PAH n= 98; CTEPH n= 18]. Patients of the training group performed a standardized in-hospital rehabilitation with mean duration of 25 days [95% confidence interval (CI) 17-33 days], which was continued at home. The primary endpoint, change of 6-min walking distance, significantly improved by 34.1 +/- 8.3 m in the training compared with the control group (95% CI, 18-51 m; P < 0.0001). Exercise training was feasible, safe, and well-tolerated. Secondary endpoints showed improvements in quality of life (short-form health survey 36 mental health 7.3 +/- 2.5, P = 0.004), WHO-functional class (training vs. control: improvement 9:1, worsening 4:3; chi(2) P =0.027) and peak oxygen consumption (0.9 +/- 0.5 mL/min/kg, P =0.048) compared with the control group.

Conclusion: This is the first multicentre and so far the largest randomized, controlled study on feasibility, safety, and efficacy of exercise training as add-on to medical therapy in PAH and CTEPH. Within this study, a standardized specialized training programme with in-hospital start was successfully established in 10 European countries.}},
  author       = {{Grünig, Ekkehard and MacKenzie, Alison and Peacock, Andrew J and Eichstaedt, Christina A and Benjamin, Nicola and Nechwatal, Robert and Ulrich, Silvia and Saxer, Stéphanie and Bussotti, Maurizio and Sommaruga, Marinella and Ghio, Stefano and Gumbiene, Lina and Palevičiūtė, Eglė and Jurevičienė, Elena and Cittadini, Antonio and Stanziola, Anna A and Marra, Alberto M and Kovacs, Gabor and Olschewski, Horst and Barberà, Joan-Albert and Blanco, Isabel and Spruit, Martijn A and Franssen, Frits M E and Vonk Noordegraaf, Anton and Reis, Abílio and Santos, Mário and Viamonte, Sofia Gonçalves and Demeyer, Heleen and Delcroix, Marion and Bossone, Eduardo and Johnson, Martin}},
  issn         = {{0195-668X}},
  journal      = {{EUROPEAN HEART JOURNAL}},
  keywords     = {{Cardiology and Cardiovascular Medicine,Pulmonary rehabilitation,Pulmonary hypertension,Exercise programme,QUALITY-OF-LIFE,END-POINT,WALK TEST,EFFICACY,BENEFITS,CAPACITY}},
  language     = {{eng}},
  number       = {{23}},
  pages        = {{2284--2295}},
  title        = {{Standardized exercise training is feasible, safe, and effective in pulmonary arterial and chronic thromboembolic pulmonary hypertension : results from a large European multicentre randomized controlled trial}},
  url          = {{http://dx.doi.org/10.1093/eurheartj/ehaa696}},
  volume       = {{42}},
  year         = {{2021}},
}

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