Impact of sex on exercise training effects in pulmonary hypertension

Objectives: Standardized exercise training is an evidence-based therapy option for patients with pulmonary arterial hypertension (PAH). Sex differences in PAH pathophysiology and treatment response have recently been reported. The impact of sex on therapy response to exercise training is still unknown.

Methods: In this study clinical characteristics of exercise training effects including exercise capacity and hemodynamics were analysed and compared between men and women. Data was derived from randomised controlled trials, controlled trials and cohort studies on exercise training conducted in Heidelberg. Follow-up data was collected after 3 weeks in-house and after 12 weeks of continuation of training in a private setting.

Results: At the start of rehabilitation (n=359; 51% moderate or severe impairment of right ventricular pump function), male PAH patients (n=101) were significantly older (p=0.015), had more severe symptoms (WHO functional class p<0.001), presented with a better lung function (higher vital capacity, forced expiratory volume in one second and total lung capacity, all p<0.001) but a more enlarged right heart (right atrial and ventricular area both p<0.001) compared to female patients (n=258). They achieved a higher workload and peak oxygen consumption during spiroergometry (both p<0.001). The whole cohort significantly improved in 6-minute walking distance, peak oxygen consumption, workload, WHO functional class, NT-proBNP and right heart size after 3 weeks and 3 months (all p<0.0001). No significant differences in therapy response between male and female patients were found.

Conclusion: While the overall beneficial effect of exercise training in PAH could be underlined, there was no evidence on differences between men and women. Further research on sex and gender differences in therapy response for patients with PAH is however encouraged.

Abb. 1 Change in 6-minute walking distance from baseline to 3-months-follow-up

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Artikel online veröffentlicht:
18. März 2025