Pulmonary Hypertension and Exercise: Learning Your Limitations and Restrictions

Pulmonary Hypertension and Exercise: Learning Your Limitations and Restrictions
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About Pulmonary Hypertension

Pulmonary hypertension (PH) is a type of high blood pressure which specifically affects the lung vasculature. It causes an increase in pressure in the arteries, capillaries and veins involved in gas exchange in the lungs. This can result from blockage, destruction or stenosis in these blood vessels. Also, the right ventricle of the heart must pump harder to continue the flow of blood to the lungs. Overtime, this causes the severity of the disorder to progress. Treatment for PH does little more than slow the progression, except, perhaps, in the drastic cases of heart-lung transplants, which are options for younger patients.

The World Health Organization (WHO) has determined five groups for PH based on the location being affected by the disorder. The first group is pulmonary arterial hypertension (PAH), which can be caused by a number of reasons. It was recently revised in order to include pulmonary veno-occlusive hypertension (PVOH) and pulmonary capillary hemangiomatosis (PCH). The second group is PH due to left heart disease, which include diastolic and systolic dysfunction and diseases of the coronary valves. The third group is PH resulting from lung diseases such as chronic obstructive pulmonary disease (COPD) or interstitial lung disease, among others. The fourth group is chronic thromboembolic pulmonary hypertension (CTEPH). The fifth group is PH from either several or unclear factors.

Pulmonary hypertension and exercise are ostensibly linked. The WHO and the New York Heart Association (NYHA) have determined a set of functional classes which determine the severity and progression of PAH.

Class I

Individuals with Class I pulmonary hypertension are generally free from activity restrictions. Symptoms like shortness of breath (SOB) and fatigue are fairly minimal. At this stage in the progression of PH, physicians recommend a regular exercise program to counter the effects and advancement of the disorder. Patients are urged to monitor their physical signs to avoid any possible detrimental effects. Common suggestions include stop or lower the intensity of exercise should you become fatigued or out of breath and keep suitably hydrated for the weather and amount of exercise being performed.

Class II

For patients with Class II PH, exercise becomes a slightly more difficult task. During rest patients in this class are comfortable, but strenuous exercise or that which lasts a long duration may exacerbate the symptoms of PH. Class II PH patients are suggested to participate in activities and exercise that maintains the heart rate at less than 65 percent of their maximum heart rate. Exercises should be moderately paced and lower impact, however, activities such as weightlifting and isometric exercises should be avoided, as they tend to cause large increases in pulmonary arterial pressure.

Class III

Patients diagnosed with Class III PH may find it difficult to perform most daily activities. Any exercise should be mild and coupled with plenty of rest. Patients should also continue taking any medications that have been prescribed for them. It is important that patients in this class do participate in mild physical activity; studies have shown the positive correlation between physical exercise and psychological well-being. Patients that do not exercise at all at this stage have presented anxiety disorders and depression, as well as rapid progression of their illness, when compared to those who have engaged in regular exercise programs. Exercises for this class should include short duration, slowly paced activities.

Class IV

Patients with severe PH are usually extremely limited in physical abilities. Regular exercise is generally not an option for these patients. Any physical activity causes symptoms to become worse, and many of these patients experience symptoms while resting. At this stage of progression, signs of right-heart failure are present, and physical strain of any sort causes discomfort in the patient.

References

Mayo Clinic: Pulmonary Hypertension

Journal of the American College of Cardiology: Clinical Classification of Pulmonary Hypertension

Journal of the American College of Cardiology: Updated Clinical Classification of Pulmonary Hypertension

Cleveland Clinic: Pulmonary Hypertension: Causes, Symptoms, Diagnosis, Treatment

American Heart Association: Pulmonary Hypertension

Jornal Brasileiro do Pneumologia: Assessment of Exercise Capacity in Pulmonary Hypertension

National Heart Lung and Blood Institute: Pulmonary Hypertension, Diagnosis

American Heart Association Journals: Exercise Pathophysiology in Patients with Primary Pulmonary Hypertension

Medscape CME: The Classification of Pulmonary Arterial Hypertension