Ann Rehabil Med.  2020 Dec;44(6):468-480. 10.5535/arm.20100.

Exercise Program Improves Functional Capacity and Quality of Life in Uncorrected Atrial Septal Defect-Associated Pulmonary Arterial Hypertension: A Randomized-Control Pilot Study

• Rakhmawati A
• Achmad IN
• Hartopo AB
• Anggrahini DW
• Arso IA
• Emoto N
• Dinarti LK

• KMID: 2510814
• DOI: http://doi.org/10.5535/arm.20100

Abstract

Objective
To assess the effect of combined hospital and home-based exercise programs on functional capacity and quality of life (QoL) among uncorrected atrial septal defect-associated pulmonary arterial hypertension (ASD-PAH) patients.
Methods
This study was a randomized controlled trial with uncorrected ASD-PAH patients as the subjects. They were allocated randomly into control and exercise groups. Exercise group subjects performed hospital and home-based exercise programs, completing baseline 6-minute walking test (6MWT) and EQ-5D-3L QoL test (Utility Index and EQ-VAS scores), and were followed up for 12 weeks. The primary outcomes were 6MWT distance and EQ-5D-3L score at week 12. The N-terminal pro B-type natriuretic peptide (NT-proBNP) level was also assessed. A repeated-measure ANOVA was performed to detect endpoint differences over time.
Results
The exercise group contained 20 subjects and control group contained 19. In total, 19 exercise group subjects and 16 control group subjects completed the protocol. The 6MWT distance, Utility Index score, and EQ-VAS score incrementally improved significantly in the exercise group from baseline until week 12, with mean differences of 76.7 m (p<0.001), 0.137 (p<0.001) and 15.5 (p<0.001), respectively. Compared with the control group, the exercise group had significantly increased 6MWT distance and utility index score at week 12. The EQ-VAS score increased in the exercise group at week 12. The NT-proBNP level decreased at week 12 in the exercise group.
Conclusion
Combined hospital and home-based exercise program added to PAH-targeted therapy, improving functional capacity and QoL in uncorrected ASD-PAH patients.

Keyword

Heart septal defects; Atrial; Pulmonary arterial hypertension; Exercise therapy; Quality of life; Physical functional performance

Figure

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  Fig. 1. The schematic flowchart of the study.

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  Fig. 2. The CONSORT diagram of subject enrollment and study. ASD, atrial septal defect ; PAH, pulmonary arterial hypertension.

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  Fig. 3. The significant improvement of functional capacity from baseline to week 12 follow-up in the exercise group. 6MWT, 6-minute walking test.

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  Fig. 4. The significant incremental improvement of quality of life by Utility Index score from baseline to week 12 follow-up in the exercise group.

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  Fig. 5. The significant incremental improvement of quality of life by EQ-VAS (EuroQol visual analog scale) score from baseline to week 12 follow-up in the exercise group.

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  Fig. 6. The N-terminal pro B-type natriuretic peptide (NTproBNP) level at baseline and week 12 follow-up in the control group (2,187.2±594.2 pg/mL vs. 2,225.4±576.4 pg/mL; p=0.777) and the exercise group (3,390.4±1,325.4 pg/mL vs. 3,113.6±1,310.8 pg/mL; p=0.232) did not significantly change. In the exercise group, the NT-proBNP level tended to decrease with mean absolute changes of -276.8 pg/mL.

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