EXERCISE AND PH

It’s well-known that exercise is very beneficial for healthy individuals, increasing cardiovascular and muscular fitness, improving mood, controlling weight and lowering the risk of systemic hypertension and heart disease. Exercise may help lower the risk of chronic illnesses such as diabetes. There have also been several published articles showing increased walk distance in PAH patients undergoing cardiopulmonary rehabilitation programs.

However, relatively little is known about the risks and benefits of exercise for pulmonary hypertension patients. Exercise is important in maintaining a healthy lifestyle, but the symptoms of PH under exertion make it difficult for many patients to find the right type of activity. Many PH patients become short of breath under mild to moderate exertion, but feel fine at rest. Those who experience shortness of breath at rest or very mild exertion must be very closely monitored, as exercise can induce fainting, excess stress to the right side of the heart, and other problems.

Because of the varying severity of PH from patient to patient (and other health-related factors), recommendations on exercise for PH patients are different for each individual, and may change over time depending on symptoms and response to treatment. Your PH specialist can help you create an exercise program that works for you. Always speak with your PH doctor before performing strenuous labor or beginning an exercise regimen.

Healthy exercise programs might include:

• Cardiovascular activities such as walking, biking and swimming. Walking on an incline or exercising both arms and legs simultaneously can produce a greater increase in blood pressure than lighter exercise, and so these exercises should be avoided or attempted conservatively.
• Activities focusing on muscle tone, such as stretching or arm and leg lifts. Light functional resistance exercises may be considered for some individuals, but should be done below shoulder or heart height and with frequent breaks.

If approved to perform an exercise regimen, follow these guidelines to have a safe and enjoyable workout:

• Do not over-exert. Activity should be stopped at the first sign of symptoms such as lightheadedness, fatigue, chest pressure, palpitations or excessive shortness of breath.
• Use a recovery time of five to ten minutes, without exhaustion or worsening of symptoms, to help you measure how much activity is appropriate.
• Avoid activity in outdoor temperature extremes. Generally, cold, heat, humidity, high elevation or a concomitant illness will worsen your exercise tolerance and warrants additional caution.

Additional Resources

Consensus Statement on Exercise by the PHA Scientific Leadership Council  
Read these general guidelines on exercise for PH patients before considering an exercise regimen.

Live Well, Get Moving (PDF)
Physical therapist Chris Wells offers tips on maximizing the effectiveness of exercise and offers a sample exercise program (not to be substituted for an individual evaluation and regimen provided by your doctor).

Lifestyle Modification and Exercise Dos and Don’ts (PDF)
Quick tips for getting the most out of your workout.

What To Expect During Pulmonary Rehabilitation
Basic overview of pulmonary rehabilitation from the NHLBI.