Pulmonary Rehabilitation's Role in Pulmonary Hypertension

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Pulmonary rehabilitation (PR) should be considered an adjunct therapy for the pulmonary hypertension (PH) patient. The definition of PR published by the American Thoracic Society (ATS)/European Respiratory Society (ERS) in 2006 states: “Pulmonary rehabilitation is evidence-based, multidisciplinary, and comprehensive intervention for patients with chronic respiratory disease who are symptomatic and often have decreased daily life activities. Integrated into the individualized treatment of the patient, pulmonary rehabilitation is designed to reduce symptoms, optimize functional status, increase participation, and reduce health care costs through stabilizing or reversing systemic manifestations of the disease.” This definition applies to the PH patient with the ultimate goal of optimizing his or her quality of life through assessment, education, and therapeutic exercise. The PH patient's success in PR starts with a strong partnership between the referring PH clinic and the local PR program.

Pulmonary rehabilitation is not just exercise or education but must have the essential components including respiratory and nutritional assessment, education, therapeutic exercise, psychosocial intervention, and long-term adherence. In fact, the typical PR program may meet 3 times a week, over an 8- to 12-week period of time, include approximately 10 to 15 hours of education and 30 hours of therapeutic exercise. The commitment by the PH patient is great but so are the benefits. The success of the PR program is also measured by the strength of the PR's medical director who guides the multidisciplinary team in evidence-based practice.

The PR goals for the PH patient are not that different from the goals of PH medical management: improve cardiovascular endurance, increase exercise performance, enhance ability to perform activities of daily living (ADL), improve quality of life, reduce hospitalizations, and decrease symptoms—especially dyspnea through breathing retraining and ensuring adequate oxygenation at rest and with activity.

The table lists the components of standard PR that should be addressed with the PH patient plus additional areas of concern for PH-specific PR. The initial assessment allows the PR program to develop an individualized treatment plan for the 40+ hours of PR treatment.

Table. Comparison of PR and PH-Specific PR Components

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Pulmonary rehabilitation can play a critical role in optimizing the treatment and quality of life for the PH patient. Pulmonary rehabilitation should become a standard of medical care for the PH patient through collaboration with PH clinics.

To find a PR program in your state go to the American Association of Respiratory Care Web site, http://www.yourlunghealth.org/finding_care/qrc/pulm_care/index.cfm or the American Association of Cardiovascular and Pulmonary Rehabilitation Web site, http://www.aacvpr.org/Resources/SearchableCertifiedProgramDirectory/tabid/113/Default.aspx.