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• W1979518225 abstract "Exercise training, as a rehabilitation added-on to disease-targeted medical therapy, may have beneficial effects to improve the exercise capacity and quality of life (QoL) in patients with pulmonary arterial hypertension (PAH) and inoperable chronic thromboembolic pulmonary hypertension (CTEPH) [1Mereles D. Ehlken N. Kreuscher S. et al.Exercise and respiratory training improve exercise capacity and quality of life in patients with severe chronic pulmonary hypertension.Circulation. 2006; 114: 1482-1489Crossref PubMed Scopus (498) Google Scholar, 2Nagel C. Prange F. Guth S. et al.Exercise training improves exercise capacity and quality of life in patients with inoperable or residual chronic thromboembolic pulmonary hypertension.PLoS One. 2012; 7: e41603Crossref PubMed Scopus (73) Google Scholar, 3Chan L. Chin L.M. Kennedy M. et al.Benefits of intensive treadmill exercise training on cardiorespiratory function and quality of life in patients with pulmonary hypertension.Chest. 2013; 143: 333-343Crossref PubMed Scopus (142) Google Scholar, 4Ley S. Fink C. Risse F. et al.Magnetic resonance imaging to assess the effect of exercise training on pulmonary perfusion and blood flow in patients with pulmonary hypertension.Eur. Radiol. 2013; 23: 324-331Crossref PubMed Scopus (64) Google Scholar, 5Becker-Grünig T. Klose H. Ehlken N. et al.Efficacy of exercise training in pulmonary arterial hypertension associated with congenital heart disease.Int. J. Cardiol. 2013; 168: 375-381Abstract Full Text Full Text PDF PubMed Scopus (102) Google Scholar, 6Grünig E. Maier F. Ehlken N. et al.Exercise training in pulmonary arterial hypertension associated with connective tissue diseases.Arthritis Res. Ther. 2012; 14: R148Crossref PubMed Scopus (86) Google Scholar, 7Grünig E. Lichtblau M. Ehlken N. et al.Safety and efficacy of exercise training in various forms of pulmonary hypertension.Eur. Respir. J. 2012; 40: 84-92Crossref PubMed Scopus (173) Google Scholar, 8Weinstein A.A. Chin L.M. Keyser R.E. et al.Effect of aerobic exercise training on fatigue and physical activity in patients with pulmonary arterial hypertension.Respir. Med. 2013; 107: 778-784Abstract Full Text Full Text PDF PubMed Scopus (113) Google Scholar, 9Fox B.D. Kassirer M. Weiss I. et al.Ambulatory rehabilitation improves exercise capacity in patients with pulmonary hypertension.J. Card. Fail. 2011; 17: 196-200Abstract Full Text Full Text PDF PubMed Scopus (86) Google Scholar, 10Mainguy V. Maltais F. Saey D. et al.Effects of a rehabilitation program on skeletal muscle function in idiopathic pulmonary arterial hypertension.J. Cardiopulm. Rehabil. Prev. 2010; 30: 319-323Crossref PubMed Scopus (80) Google Scholar, 11Martínez-Quintana E. Miranda-Calderín G. Ugarte-Lopetegui A. Rodríguez-González F. Rehabilitation program in adult congenital heart disease patients with pulmonary hypertension.Congenit. Heart Dis. 2010; 5: 44-50Crossref PubMed Scopus (67) Google Scholar, 12Ehlken N. Verduyn C. Tiede H. et al.Economic evaluation of exercise training in patients with pulmonary hypertension.Lung. 2014; 192: 359-366Crossref PubMed Scopus (32) Google Scholar]. However, there were inconsistent conclusions about the effects of exercise training. Other studies revealed that exercise training did not cause significant improvement in 6-min walk distance (6MWD), peak maximum oxygen consumption (peak VO2), or QoL [1Mereles D. Ehlken N. Kreuscher S. et al.Exercise and respiratory training improve exercise capacity and quality of life in patients with severe chronic pulmonary hypertension.Circulation. 2006; 114: 1482-1489Crossref PubMed Scopus (498) Google Scholar, 9Fox B.D. Kassirer M. Weiss I. et al.Ambulatory rehabilitation improves exercise capacity in patients with pulmonary hypertension.J. Card. Fail. 2011; 17: 196-200Abstract Full Text Full Text PDF PubMed Scopus (86) Google Scholar, 11Martínez-Quintana E. Miranda-Calderín G. Ugarte-Lopetegui A. Rodríguez-González F. Rehabilitation program in adult congenital heart disease patients with pulmonary hypertension.Congenit. Heart Dis. 2010; 5: 44-50Crossref PubMed Scopus (67) Google Scholar, 13De Man F.S. Handoko M.L. Groepenhoff H. et al.Effects of exercise training in patients with idiopathic pulmonary arterial hypertension.Eur. Respir. J. 2009; 34: 669-675Crossref PubMed Scopus (168) Google Scholar]. Therefore, the idea that exercise training is beneficial for patients with pulmonary hypertension (PH) is still controversial. Thus, we aim to ascertain the current effectiveness of exercise rehabilitation for PH by performing a random effects meta-analysis. We searched PubMed, EMBASE, and the Cochrane Collaboration database using the keywords “exercise training” or “rehabilitation”, “physical training” or “physical exercise” and “pulmonary hypertension”. The search was limited to English language articles published by October 20, 2014. We included randomized and observational control studies comparing exercise endurance and QoL in patients treated with exercise training versus non-exercise patients (controlled studies) and observational studies comparing exercise endurance and QoL in patients after exercise training versus baseline (uncontrolled studies). Study inclusion criteria were: stable and compensated under medical therapy adult patients (≥18 years) with diagnosis of PAH and/or CTEPH received exercise training. At baseline, after 3 weeks and the longer short-term (10, 12, or 15 weeks), patients received a physical examination, 6MWD, cardiopulmonary exercise testing (CPET) and the QoL SF-36 questionnaire. Two reviewers independently extracted data from eligible studies. We extracted data pertaining to baseline characteristics of study subjects, exercise training program, duration and follow-up, 6MWD, parameters of CPET, and QoL questionnaire SF36 score. 6MWD was reported in all studies. CPET and SF36 score were reported explicitly and clearly in part of the studies. For controlled studies, the difference in change of 6MWD (Δ6MWD) with exercise training versus control was pooled across studies and analyzed using random-effects meta-analysis models with inverse variance weighting. Separate models were constructed for 3 weeks and the longer short-term (10, 12, or 15 weeks) of follow-up. For uncontrolled studies, the 6MWD, parameters of CPET and QoL questionnaire SF36 score after exercise training versus baseline were pooled, stratified, and analyzed using the same meta-analysis models. The magnitude of heterogeneity present was estimated using the I2 statistic, an estimate of the proportion of the total observed variance that is attributed to between study variance. Pooled effects on 6MWD, CPET and SF36 score were presented as weighted mean differences (MD) with corresponding 95% confidence intervals (CI). We considered p < 0.05 significant. Throughout, values are presented as mean ± SD unless otherwise stated. Analyses were performed using the Cochrane Collaboration Review Manager (version 5.2, Cochrane Collaboration, Copenhagen, Denmark). There were 2 randomized controlled trials (n = 50), 4 observational controlled studies with a control group (n = 77), and 6 observational studies without a control group (n = 322) (Table 1). 10 studies included patients with PAH and CTEPH [1Mereles D. Ehlken N. Kreuscher S. et al.Exercise and respiratory training improve exercise capacity and quality of life in patients with severe chronic pulmonary hypertension.Circulation. 2006; 114: 1482-1489Crossref PubMed Scopus (498) Google Scholar, 3Chan L. Chin L.M. Kennedy M. et al.Benefits of intensive treadmill exercise training on cardiorespiratory function and quality of life in patients with pulmonary hypertension.Chest. 2013; 143: 333-343Crossref PubMed Scopus (142) Google Scholar, 4Ley S. Fink C. Risse F. et al.Magnetic resonance imaging to assess the effect of exercise training on pulmonary perfusion and blood flow in patients with pulmonary hypertension.Eur. Radiol. 2013; 23: 324-331Crossref PubMed Scopus (64) Google Scholar, 5Becker-Grünig T. Klose H. Ehlken N. et al.Efficacy of exercise training in pulmonary arterial hypertension associated with congenital heart disease.Int. J. Cardiol. 2013; 168: 375-381Abstract Full Text Full Text PDF PubMed Scopus (102) Google Scholar, 6Grünig E. Maier F. Ehlken N. et al.Exercise training in pulmonary arterial hypertension associated with connective tissue diseases.Arthritis Res. Ther. 2012; 14: R148Crossref PubMed Scopus (86) Google Scholar, 8Weinstein A.A. Chin L.M. Keyser R.E. et al.Effect of aerobic exercise training on fatigue and physical activity in patients with pulmonary arterial hypertension.Respir. Med. 2013; 107: 778-784Abstract Full Text Full Text PDF PubMed Scopus (113) Google Scholar, 9Fox B.D. Kassirer M. Weiss I. et al.Ambulatory rehabilitation improves exercise capacity in patients with pulmonary hypertension.J. Card. Fail. 2011; 17: 196-200Abstract Full Text Full Text PDF PubMed Scopus (86) Google Scholar, 10Mainguy V. Maltais F. Saey D. et al.Effects of a rehabilitation program on skeletal muscle function in idiopathic pulmonary arterial hypertension.J. Cardiopulm. Rehabil. Prev. 2010; 30: 319-323Crossref PubMed Scopus (80) Google Scholar, 11Martínez-Quintana E. Miranda-Calderín G. Ugarte-Lopetegui A. Rodríguez-González F. Rehabilitation program in adult congenital heart disease patients with pulmonary hypertension.Congenit. Heart Dis. 2010; 5: 44-50Crossref PubMed Scopus (67) Google Scholar], 2 studies included patients with only CTEPH [2Nagel C. Prange F. Guth S. et al.Exercise training improves exercise capacity and quality of life in patients with inoperable or residual chronic thromboembolic pulmonary hypertension.PLoS One. 2012; 7: e41603Crossref PubMed Scopus (73) Google Scholar, 7Grünig E. Lichtblau M. Ehlken N. et al.Safety and efficacy of exercise training in various forms of pulmonary hypertension.Eur. Respir. J. 2012; 40: 84-92Crossref PubMed Scopus (173) Google Scholar], and 1 study included patients with COPD-PH, ILD-PH and others besides PAH and CTEPH [[14]Grünig E. Ehlken N. Ghofrani A. et al.Effect of exercise and respiratory training on clinical progression and survival in patients with severe chronic pulmonary hypertension.Respiration. 2011; 81: 394-401Crossref PubMed Scopus (127) Google Scholar]. The exercise training program was in largely part similar including bicycle, walking, dumbbell, respiratory and mental training, although 2 studies included patients that received only treadmill walking over 10 weeks [3Chan L. Chin L.M. Kennedy M. et al.Benefits of intensive treadmill exercise training on cardiorespiratory function and quality of life in patients with pulmonary hypertension.Chest. 2013; 143: 333-343Crossref PubMed Scopus (142) Google Scholar, 8Weinstein A.A. Chin L.M. Keyser R.E. et al.Effect of aerobic exercise training on fatigue and physical activity in patients with pulmonary arterial hypertension.Respir. Med. 2013; 107: 778-784Abstract Full Text Full Text PDF PubMed Scopus (113) Google Scholar], and another study was a 3 week study investigating patients with PAH and CTEPH [[4]Ley S. Fink C. Risse F. et al.Magnetic resonance imaging to assess the effect of exercise training on pulmonary perfusion and blood flow in patients with pulmonary hypertension.Eur. Radiol. 2013; 23: 324-331Crossref PubMed Scopus (64) Google Scholar] (Table 1).Table 1Baseline characteristics of all included studies.Study/first author (journal) [Ref.]YearType of studyControl patients (F), nTraining patients (F), nPatients characteristicsAgeExercise trainingDuration and follow-upControl patientsTraining patientsRandomized control trialLey et al. [4]Ley S. Fink C. Risse F. et al.Magnetic resonance imaging to assess the effect of exercise training on pulmonary perfusion and blood flow in patients with pulmonary hypertension.Eur. Radiol. 2013; 23: 324-331Crossref PubMed Scopus (64) Google Scholar2013Randomized control trial10 (6)10 (8)16 PAH, 4 CTEPHWHO FC II–III54 ± 1447 ± 8Bicycle, walking, dumbbell and respiratory training3 weeks inhospitalMereles et al. [1]Mereles D. Ehlken N. Kreuscher S. et al.Exercise and respiratory training improve exercise capacity and quality of life in patients with severe chronic pulmonary hypertension.Circulation. 2006; 114: 1482-1489Crossref PubMed Scopus (498) Google Scholar2006Randomized control trial15 (10)15 (10)24 PAH, 6 CTEPHWHO FC II–IV47 ± 1253 ± 14Bicycle, walking, dumbbell, respiratory and mental training3 weeks inhospital and 12 weeks at homeObservational control studiesChan et al. [3]Chan L. Chin L.M. Kennedy M. et al.Benefits of intensive treadmill exercise training on cardiorespiratory function and quality of life in patients with pulmonary hypertension.Chest. 2013; 143: 333-343Crossref PubMed Scopus (142) Google Scholar2013Prospective cohort13 (13)10 (10)PAHWHO FC II–III56 ± 953 ± 13Treadmill walking10 weeks in a rehabilitation centerFox et al. [9]Fox B.D. Kassirer M. Weiss I. et al.Ambulatory rehabilitation improves exercise capacity in patients with pulmonary hypertension.J. Card. Fail. 2011; 17: 196-200Abstract Full Text Full Text PDF PubMed Scopus (86) Google Scholar2011Prospective cohort11 (10)11 (5)20 PAH, 2 CTEPHNYHA II–III57 ± 446 ± 5Bicycle, treadmill walking, step climbing, resistance and home training12 weeks in a rehabilitation centerMartínez-Quintana et al. [11]Martínez-Quintana E. Miranda-Calderín G. Ugarte-Lopetegui A. Rodríguez-González F. Rehabilitation program in adult congenital heart disease patients with pulmonary hypertension.Congenit. Heart Dis. 2010; 5: 44-50Crossref PubMed Scopus (67) Google Scholar2010Prospective cohort4 (1)4 (2)CHD-PAHNYHA II–IV33 ± 623 ± 7Bicycle, resistance, educational lesson and home training12 weeks in a rehabilitation unitWeinstein et al. [8]Weinstein A.A. Chin L.M. Keyser R.E. et al.Effect of aerobic exercise training on fatigue and physical activity in patients with pulmonary arterial hypertension.Respir. Med. 2013; 107: 778-784Abstract Full Text Full Text PDF PubMed Scopus (113) Google Scholar2013Prospective cohort13 (13)11 (11)PAHWHO FC I–IV53 ± 953 ± 12Treadmill walking10 weeks in a rehabilitation centerObservational studiesBecker-Grünig et al. [5]Becker-Grünig T. Klose H. Ehlken N. et al.Efficacy of exercise training in pulmonary arterial hypertension associated with congenital heart disease.Int. J. Cardiol. 2013; 168: 375-381Abstract Full Text Full Text PDF PubMed Scopus (102) Google Scholar2013Prospective cohort–20 (16)CHD-PAHWHO FC II–III–48 ± 11Bicycle, dumbbell, respiratory and mental training3 weeks inhospital and 12 weeks at homeGrünig et al. (AR&T) [6]Grünig E. Maier F. Ehlken N. et al.Exercise training in pulmonary arterial hypertension associated with connective tissue diseases.Arthritis Res. Ther. 2012; 14: R148Crossref PubMed Scopus (86) Google Scholar2012Prospective cohort–21 (20)CTD-PAHWHO FC II–IV–52 ± 18Bicycle, dumbbell, respiratory and mental training3 weeks inhospital and 12 weeks at homeGrünig et al. (ERJ) [7]Grünig E. Lichtblau M. Ehlken N. et al.Safety and efficacy of exercise training in various forms of pulmonary hypertension.Eur. Respir. J. 2012; 40: 84-92Crossref PubMed Scopus (173) Google Scholar2012Prospective cohort–183 (126)133 PAH, 31 CTEPH, 19 othersWHO FC II–III–53 ± 15Bicycle, dumbbell, respiratory and mental training3 weeks inhospital and 12 weeks at homeGrünig et al. (R) [14]Grünig E. Ehlken N. Ghofrani A. et al.Effect of exercise and respiratory training on clinical progression and survival in patients with severe chronic pulmonary hypertension.Respiration. 2011; 81: 394-401Crossref PubMed Scopus (127) Google Scholar2011Prospective cohort–58 (42)47 PAH, 6 CTEPH, 1 COPD-PH, 2 ILD-PH, 2 othersWHO FC II–IV–51 ± 12Bicycle, dumbbell, respiratory and mental training3 weeks inhospital and 12 weeks at homeMainguy et al. [10]Mainguy V. Maltais F. Saey D. et al.Effects of a rehabilitation program on skeletal muscle function in idiopathic pulmonary arterial hypertension.J. Cardiopulm. Rehabil. Prev. 2010; 30: 319-323Crossref PubMed Scopus (80) Google Scholar2010Prospective cohort–5 (4)IPAHWHO FC II–III–40 ± 15Bicycle, treadmill walking and single muscles training12 weeks in a rehabilitation centerNagel et al. [2]Nagel C. Prange F. Guth S. et al.Exercise training improves exercise capacity and quality of life in patients with inoperable or residual chronic thromboembolic pulmonary hypertension.PLoS One. 2012; 7: e41603Crossref PubMed Scopus (73) Google Scholar2012Prospective cohort–35 (16)CTEPHWHO FC II–IV–61 ± 15Bicycle, dumbbell, respiratory and mental training3 weeks inhospital and 12 weeks at homeAR&T = Arthritis Research & Therapy; CHD = congenital heart disease; CTD = connective tissue disease; CTEPH = chronic thromboembolic pulmonary hypertension; ERJ = European Respiratory Journal; IPAH = idiopathic pulmonary arterial hypertension; NYHA = New York Heart Association class; PAH = pulmonary arterial hypertension; PH = pulmonary hypertension; R = Respiratory; WHO FC = World Health Organization Functional Class. Open table in a new tab AR&T = Arthritis Research & Therapy; CHD = congenital heart disease; CTD = connective tissue disease; CTEPH = chronic thromboembolic pulmonary hypertension; ERJ = European Respiratory Journal; IPAH = idiopathic pulmonary arterial hypertension; NYHA = New York Heart Association class; PAH = pulmonary arterial hypertension; PH = pulmonary hypertension; R = Respiratory; WHO FC = World Health Organization Functional Class. There was an increase in Δ6MWD of 62.2 m (95% CI: 45.6 to 78.8, p < 0.0001) after 12 weeks of exercise in controlled studies (Fig. 1A ). 6MWD was similarly enhanced at 3 weeks to 64.6 m (95% CI: 45.9 to 83.3) and at 12 or 15 weeks to 63.7 m (95% CI: 31.7 to 95.8) in uncontrolled studies (for both, p < 0.0001). There was a low amount of heterogeneity among studies (Fig. 1B). The improvement in 6MWD is therefore not only significant but can also be regarded as clinically relevant. Regarding follow-up assessments, CPET can quantify cardiopulmonary exercise capacity in a more differentiated way than 6MWD. In 1 RCT and 5 observational studies, there was a marked increase in peak VO2 per kg at 3 weeks of 1.3 mL/min/kg (95% CI: 0.8 to 1.9) and at 10, 12 or 15 weeks of 1.7 mL/min/kg (95% CI: 1.1 to 2.3) compared with pre-exercise (for both, p < 0.00001) (Fig. 2A ). Workload was significantly increased at 3 weeks to 13.1 W (95% CI: 8.9 to 17.4) and at 12 or 15 weeks to 17.0 W (95% CI: 12.3 to 21.7) after exercise (for both, p < 0.0001) (Fig. 2B). Longer short-term exercise training (12 or 15 weeks) made a similar increase in VO2 at AT of 109 mL/min (95% CI: 63.8 to 154.2, p < 0.00001) (Fig. 2C). The change in VO2 at AT compared to baseline after 3 weeks was not significant (Fig. 2C). In these studies, HR rest significantly decreased to −2.9 beats/min (95% CI: −4.9 to −0.9, p = 0.005) at 3 weeks and did not changed at 10, 12 or 15 weeks (Fig. 2D). No heterogeneity was apparent among studies (Fig. 2). These data indicated that exercise training exerts pulmonary vasodilatation and improves exercise capacity in patients with PH. However, other parameters of CPET, such as EqCO2 at AT, oxygen pulse, HR max and borg scale, showed no obvious improvement after exercise in our analysis. This can be explained by inconsistent training protocols, different study populations and different baseline values of the included studies. In addition, some protocol did not include the respiratory exercise training [3Chan L. Chin L.M. Kennedy M. et al.Benefits of intensive treadmill exercise training on cardiorespiratory function and quality of life in patients with pulmonary hypertension.Chest. 2013; 143: 333-343Crossref PubMed Scopus (142) Google Scholar, 8Weinstein A.A. Chin L.M. Keyser R.E. et al.Effect of aerobic exercise training on fatigue and physical activity in patients with pulmonary arterial hypertension.Respir. Med. 2013; 107: 778-784Abstract Full Text Full Text PDF PubMed Scopus (113) Google Scholar, 10Mainguy V. Maltais F. Saey D. et al.Effects of a rehabilitation program on skeletal muscle function in idiopathic pulmonary arterial hypertension.J. Cardiopulm. Rehabil. Prev. 2010; 30: 319-323Crossref PubMed Scopus (80) Google Scholar]. Respiratory exercise is essential and might improve the weakness of respiratory muscles in patients. Compared with baseline, after 15 weeks of training, the total QoL SF-36 score improved (MD: 6.6 points, 95% CI: 4.3 to 8.9) in 4 observational studies (p < 0.0001) where physical functioning (MD: 10.4 points, 95% CI: 5.0 to 15.9), role-physical (MD: 12.1 points, 95% CI: 1.2 to 23.0) and social functioning (MD: 11.6 points, 95% CI: 5.2 to 17.9) increased as well as role-emotional (MD: 14.3 points, 95% CI: 6.2 to 22.4) (for all, p < 0.05). There was a low amount of heterogeneity among these studies (Fig. 3). There was no alteration in body pain, general health, vitality and mental health in these studies (Fig. 3). Patients only experienced a shorter-term exercise, which may contribute to these results. Another reason may be that there were no random controlled trials or observational studies that provide enough data about QoL. QoL improvement in the observational study indicated that QoL is only partly affected by physical fitness and that many other unknown factors influence the patient's health. However, these results are considered to be clinically meaningful. It is the first systematic review and meta-analysis of the published exercise training in PH patients. This study population is composed of only 449 patients, which is a small number for a meta-analysis. Most of the included studies were observational studies and thus may be affected by con-founding by indication and/or selection bias [2Nagel C. Prange F. Guth S. et al.Exercise training improves exercise capacity and quality of life in patients with inoperable or residual chronic thromboembolic pulmonary hypertension.PLoS One. 2012; 7: e41603Crossref PubMed Scopus (73) Google Scholar, 3Chan L. Chin L.M. Kennedy M. et al.Benefits of intensive treadmill exercise training on cardiorespiratory function and quality of life in patients with pulmonary hypertension.Chest. 2013; 143: 333-343Crossref PubMed Scopus (142) Google Scholar, 5Becker-Grünig T. Klose H. Ehlken N. et al.Efficacy of exercise training in pulmonary arterial hypertension associated with congenital heart disease.Int. J. Cardiol. 2013; 168: 375-381Abstract Full Text Full Text PDF PubMed Scopus (102) Google Scholar, 6Grünig E. Maier F. Ehlken N. et al.Exercise training in pulmonary arterial hypertension associated with connective tissue diseases.Arthritis Res. Ther. 2012; 14: R148Crossref PubMed Scopus (86) Google Scholar, 7Grünig E. Lichtblau M. Ehlken N. et al.Safety and efficacy of exercise training in various forms of pulmonary hypertension.Eur. Respir. J. 2012; 40: 84-92Crossref PubMed Scopus (173) Google Scholar, 8Weinstein A.A. Chin L.M. Keyser R.E. et al.Effect of aerobic exercise training on fatigue and physical activity in patients with pulmonary arterial hypertension.Respir. Med. 2013; 107: 778-784Abstract Full Text Full Text PDF PubMed Scopus (113) Google Scholar, 9Fox B.D. Kassirer M. Weiss I. et al.Ambulatory rehabilitation improves exercise capacity in patients with pulmonary hypertension.J. Card. Fail. 2011; 17: 196-200Abstract Full Text Full Text PDF PubMed Scopus (86) Google Scholar, 10Mainguy V. Maltais F. Saey D. et al.Effects of a rehabilitation program on skeletal muscle function in idiopathic pulmonary arterial hypertension.J. Cardiopulm. Rehabil. Prev. 2010; 30: 319-323Crossref PubMed Scopus (80) Google Scholar, 14Grünig E. Ehlken N. Ghofrani A. et al.Effect of exercise and respiratory training on clinical progression and survival in patients with severe chronic pulmonary hypertension.Respiration. 2011; 81: 394-401Crossref PubMed Scopus (127) Google Scholar], and inclusion was restricted to published studies and may therefore be affected by publication bias. It represents, however, most of the published experience of exercise training in patients with PH. In conclusion, the current available data suggests that short-term exercise training improves exercise capacity, ventilatory efficiency and QoL in patients with PH. Nonetheless, large randomized controlled trials with long-term follow-up are needed to confirm the sustained efficacy and safety of exercise training in this patient population and other classifications of PH patients." @default.
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• W1979518225 title "Exercise training for pulmonary hypertension: A systematic review and meta-analysis" @default.
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