Ask a PH Specialist

Question: What recommendations would you give a PH patient interested in alternative forms of exercise like yoga?


Exercise is important and valuable for everyone, but especially for patients with PH. Of course, PH patients do have to consider exercise from a perspective of safety first. You should always talk to your PH team before starting any new form of exercise. Beginning a new exercise program is ideally done when you are stable on medical therapy and have been tested to determine whether you have oxygen requirements with exertion.

Know that there is a version of exercise that will be right for you, regardless of your physical ability. It may take some trial and error to find it, but it will be worth finding. Do your research. Get to know what is available in your area; you might be surprised. The popularity of alternative forms of exercise is increasing every year, and even your local senior center or YMCA might host a yoga class!

Set reasonable goals. The beauty of alternative forms of exercise like yoga and Tai Chi for PH patients is that they truly allow you to work at your own pace, while slowly expanding the possibility of what your body can do. The mind-body aspect with a focus on breathing allows for the calming of your nervous system, can reduce stress and improve your mood as well as your body. Just participating in the deep breathing exercises may be all you do the first time and that’s alright. Slowly building on your achievements each time is preferable to starting out too fast and then burning out.

Start slow. Read the descriptions of classes offered in your area. If you’re considering yoga, look for classes that are low intensity, involve stretching and a focus on breathing exercises rather than an advanced class. Avoid classes described as “high intensity” or “designed to make you sweat” (like hot yoga). Look instead for classes advertised as “Gentle Flow” or “Restorative.” These are designed for those looking for a gentle and serene practice. These classes will focus on balance and meditation and tend to be more appropriate for those battling chronic illness. The poses are easier on the body and would be safe for a PH patient to perform. Balancing poses help to strengthen leg muscles, increase flexibility and improve concentration. An example of a safe balancing pose for PH patients is the tree pose with the hands on the hips.

Chair yoga is a gentle way to try yoga positions while seated, which is ideal for those just getting started or those with joint issues like arthritis. Though finding a chair yoga class is more challenging, utilize the Internet or your local library to research poses and try them out with a work-out partner. Once you learn a few, you can do them at home! Just always make sure to have someone around in case you need help.

Talk to the instructor before class. Yoga teachers are accustomed to modifying poses for different injuries their students may have and conditions like pregnancy. Many yoga classes involve seated postures. If you find a class in your area, ask the teacher if you can use a chair rather than a mat.

Because you can’t expect every instructor to know which poses to avoid in every medical condition, you have to be ready to educate them. Let the instructor know that you are to avoid inversions. This way, when an inverted posture comes up, the instructor can advise you on how to modify the pose. Inversions are poses that involve having your head below the level of your heart. Examples are downward facing dog, half moon and side-angle. These poses result in more blood flow to the heart and lungs, which can cause an unsafe increase in pulmonary pressure and should be avoided by PH patients.

Know that you should also avoid poses that require the arms to be raised above the head. You can modify any pose by placing your hands on your hips or down at your sides.

It’s important to know that in any yoga class, each student is encouraged to rest in child’s pose whenever they need a break. You won’t be the only one resting. Take advantage of this and listen to your body.

With these tips in mind, you’ll soon find yourself engaged in a safe, restorative and rewarding practice.

Additional PHA Alternative Exercise Resource

Answer provided by Rana Awdish, MD, Senior Staff Physician, Department of Pulmonary & Critical Care Medicine, Pulmonary Hypertension Program, Henry Ford Hospital, Detroit, Mich.

This article was first published in Pathlight Winter 2012.

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