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Recommendations for Exercise in Patients with PAH

Consensus Statement
Issued by the Scientific Leadership Council

This information is for general information only. These guidelines may not apply to your individual situation. You should rely on the information and instructions given specifically to you by your PH specialist and/or the nurses at your PH Center. This information is general in nature and may not apply to your specific situation. It is not intended as legal, medical or other professional advice, and should not be relied upon as a substitute for consultations with qualified professionals who are familiar with your individual needs.

There are no published data in the medical literature regarding routine exercise in patients with PAH. However, there are considerable data available from studies evaluating the effects of exercise in patients with left heart failure. The data suggest that physical activity and a regular exercise program are helpful in maintaining muscle tone, physical (and mental) well-being, and in some cases, improving long-term survival. There are also some data suggesting that physical inactivity may be detrimental to patients with left heart failure. Because right heart failure in PAH leads to effects on the body similar to that seen with left heart failure, exercise in PAH patients may have similar benefits. However, the actual benefit of exercise in patients with PAH has not been well-studied. In general, several important points can be made about exercise in PAH:

1. Many PAH specialists agree that some form of exercise is not harmful for PAH patients, and may be helpful.

2. Patients with PAH should speak with their doctor before beginning any exercise program.

3. Patients with PAH should not over-exercise at any time. In other words, do not exercise to the point where symptoms such as light-headedness, chest pain, or severe shortness of breath develop. To determine how much exercise is reasonable, each patient should talk with his/her PH specialist to develop an individualized exercise plan.

4. Exercise such as light resistance training of small muscle groups (no heavy lifting), and light to moderate aerobic activity (walking, swimming, etc.) are the recommended forms of exercise for PAH patients.

5. Except in those PAH patients with minimal or no symptoms, it is inadvisable to exercise upper and lower limbs at the same time (for example, as with a NordicTrack machine).

6. In general, patients with severe limitation of activity and/or a history of dizziness and/or fainting during exercise should not continue with, or plan to begin, a regular exercise program.

7. A clinic or hospital-based exercise facility to perform regular exercise should be considered when starting an exercise program, but is not required.

8. Outdoor exercise should be avoided during hot or humid weather or very cold weather.

In summary, a regular exercise program is likely to be helpful for patients with PAH, and probably not harmful, provided patients discuss the type of activity with their PH specialist prior to starting any exercise program.