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How Much Can Someone With Pulmonary Hypertension Exercise?
Pulmonary hypertension (PH) is a type of high blood 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.
Over time, 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.
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 PH 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 prescibed 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.
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 Insitute: Pulmonary Hypertension, Diagnosis
American Heart Association Journals: Exercise Pathophysiology in Patients with Primary
Pulmonary Hypertension
Medscape CME: The Classification of Pulmonary Arterial Hypertension