Körperliches Training bei pulmonaler Hypertonie – ein systematisches Review mit Metaanalyse

Zusammenfassung

Hintergrund Pulmonale Hypertonie (PH) ist definiert als ein Anstieg des mittleren pulmonal-arteriellen Drucks auf > 20 mmHg in Ruhe, der auf Dauer zu einer Rechtsherzinsuffizienz führen kann. Bis vor einigen Jahren wurde PH-Patienten wegen der Befürchtung einer möglichen Symptomverschlechterung und dem Auftreten unerwünschter, belastungsassoziierter klinischer Ereignisse von körperlichem Training abgeraten.

Methoden Drei elektronische Datenbanken wurden mit folgenden Suchbegriffen nach randomisiert, kontrollierten Studien durchsucht, in denen eine Trainingsintervention bei PH-Patienten untersucht wurde: „pulmonary hypertension ODER „pulmonary arterial hypertension“ UND „exercise“ ODER „pulmonary rehabilitation“ UND „randomized“.

Ergebnisse In dieser Metaanalyse konnten Daten von 5 Studien mit insgesamt 187 PH-Patienten eingeschlossen werden, welche 3- bis 12-wöchige Trainingsprogramme (z. B. 10 – 45 Minuten Ergometertraining; 60 – 80 % der maximalen Herzfrequenz) absolvierten. Patienten in den Trainingsgruppen wiesen im Vergleich zur Kontrollgruppe signifikante (p < 0,001) Verbesserungen ihrer körperlichen Belastbarkeit auf: 6-Minuten-Gehtest: + 45 m [95 % KI: 26 m – 64 m] oder maximale Sauerstoffaufnahme VO ₂ peak + 2,3 ml/kg/min [95 % KI: 1,8 ml/kg/min – 2,9 ml/kg/min]. Auch Komponenten der körperlichen und psychischen Lebensqualität verbesserten sich signifikant. Ernsthafte, unerwünschte Ereignisse im Rahmen der Trainingsinterventionen wurden nicht beobachtet.

Schlussfolgerung Ein individuell angepasstes Trainingsprogramm bei stabilen PH-Patienten kann nach zuvor optimierter medikamentöser Therapie die körperliche Belastbarkeit und Lebensqualität ohne nachweisbare klinische Gefährdung verbessern. Diese Einschätzungen basieren bisher nur auf kleinen Fallzahlen und größere, randomisierte Studien mit unterschiedlichen PH-Schweregraden sind dringend notwendig.

Abstract

Background Pulmonary hypertension (PH) is defined as an elevation of mean pulmonary-arterial pressure by > 20 mmHg at rest, which may lead to right heart failure. Physical exercise has not been regularly recommended for PH patients for fear of symptom deterioration or occurrence of exercise-induced adverse events.

Methods Three electronic databases were searched for randomized, controlled trials investigating exercise training in PH patients using the following keywords: “pulmonary hypertension” OR “pulmonary arterial hypertension” AND “exercise” OR “pulmonary rehabilitation” AND “randomized”.

Results Five studies involving 187 PH patients were included in this systematic review. Exercise programs lasted for 3 – 12 weeks (e. g. endurance training for 10 – 45 minutes; 60 – 80 % of the peak heart rate). PH patients significantly improved exercise capacity compared to controls in 6-minute walk distance (+ 45 m; 95 % CI: 26 m – 64 m) or peak oxygen consumption (+ 2.3 ml/kg/min; 95 % CI: 1.8 – 2.9 ml/kg/min), both p < 0.001. Also, physical and mental quality of life improved significantly by exercise training. No exercise-induced adverse events were observed.

Conclusion Supervised exercise training can safely and significantly improve physical performance and quality of life in clinically stable PH patients with optimal drug treatment. However, larger studies including a wider range of PH are mandatory.

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