Exercise Training in Group 2 Pulmonary Hypertension: Which Intensity and What Modality

Prog Cardiovasc Dis. 2016 Jul-Aug;59(1):87-94. doi: 10.1016/j.pcad.2015.11.005. Epub 2015 Nov 10.


Pulmonary hypertension (PH) due to left-sided heart disease (LSHD) is a common and disconcerting occurrence. For example, both heart failure (HF) with preserved and reduced ejection fraction (HFpEF and HFrEF) often lead to PH as a consequence of a chronic elevation in left atrial filling pressure. A wealth of literature demonstrates the value of exercise training (ET) in patients with LSHD, which is particularly robust in patients with HFrEF and growing in patients with HFpEF. While the effects of ET have not been specifically explored in the LSHD-PH phenotype (i.e., composite pathophysiologic characteristics of patients in this advanced disease state), the overall body of evidence supports clinical application in this subgroup. Moderate intensity aerobic ET significantly improves peak oxygen consumption, quality of life and prognosis in patients with HF. Resistance ET significantly improves muscle strength and endurance in patients with HF, which further enhance functional capacity. When warranted, inspiratory muscle training and neuromuscular electrical stimulation are becoming recognized as important components of a comprehensive rehabilitation program. This review will provide a detailed account of ET programing considerations in patients with LSHD with a particular focus on those concomitantly diagnosed with PH.

Keywords: Aerobic exercise; Functional capacity; Inspiratory muscle training; Pulmonary hypertension; Resistance exercise.

Publication types

  • Review

MeSH terms

  • Exercise Therapy / methods*
  • Exercise Tolerance / physiology*
  • Heart Failure / complications
  • Heart Failure / physiopathology
  • Heart Failure / rehabilitation
  • Humans
  • Hypertension, Pulmonary / ethnology
  • Hypertension, Pulmonary / physiopathology
  • Hypertension, Pulmonary / rehabilitation*
  • Quality of Life*
  • Stroke Volume