Pulmoner Hipertansiyon ve Spor
Özet
Pulmoner hipertansiyonu (PH) olan hastalarda görülen en önemli problemlerden biri egzersiz kapasitesinin azalmasıdır. Egzersiz kapasitesinin azalması, PH hastalarında işlevsellik açısından önemli bir engeldir ve yaşam kalitesinin düşmesine neden olur. Güncel pediatrik PH kılavuzlarında yüksek riskli gruptaki çocukların rekabetçi sporlara katılması riskli görülmüştür. Bununla birlikte PH’lı hastaların klinik durumlarının ve egzersiz kapasitelerinin ayrıntılı seri değerlendirilmesinden sonra, kişiye özel profesyonel ekip tarafından verilen ve takip edilen egzersiz eğitim programlarının umut verici sonuçları olduğu gösterilmiştir. Özellikle çocuklar bu konuda özelleşmiş fizyoterapistler ile egzersiz eğitimi ve fiziksel aktivite danışmanlığı programlarına dahil edilmelidir.
Referanslar
Humbert M, Kovacs G, Hoeper M, et al. M. 2022 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension: Developed by the task force for the diagnosis and treatment of pulmonary hypertension of the European Society of Cardiology (ESC) and the European Respiratory Society (ERS). Endorsed by the International Society for Heart and Lung Transplantation (ISHLT) and the European Reference Network on rare respiratory diseases (ERN-LUNG). European heart journal,2022; 43(38), 3618-3731. doi: 10.1183/13993003.00879-2022.
Pelliccia A, Sharma S, Gati S et al. 2020 ESC Guidelines on sports cardiology and exercise in patients with cardiovascular disease: The Task Force on sports cardiology and exercise in patients with cardiovascular disease of the European Society of Cardiology (ESC). European heart journal, 2021, 42(1), 17-96.
Hansmann G, Koestenberger M, Alastalo TP, et al. 2019 updated consensus statement on the diagnosis and treatment of pediatric pulmonary hypertension: The European Pediatric Pulmonary Vascular Disease Network (EPPVDN), endorsed by AEPC, ESPR and ISHLT. The Journal of Heart and Lung Transplantation, 2019, 38(9), 879-901. doi: 10.1016/j.healun.2019.06.022.
Tuder RM, Archer SL, Dorfmüller P, et al. Relevant issues in the pathology and pathobiology of pulmonary hypertension. J Am Coll Cardiol. 2013 Dec 24;62(25 Suppl):D4-12. doi: 10.1016/j.jacc.2013.10.025. PMID: 24355640; PMCID: PMC3970402.
Vonk-Noordegraaf A, Haddad F, Chin KM, et al. Right heart adaptation to pulmonary arterial hypertension: physiology and pathobiology. Journal of the American College of Cardiology, 2013 62(25S), D22-D33. doi: 10.1016/j.jacc.2013.10.027.
Lewis GD, Bossone E, Naeije R, et al. Pulmonary vascular hemodynamic response to exercise in cardiopulmonary diseases. Circulation, 2013, 128(13), 1470-1479. doi: 10.1161/CIRCULATIONAHA.112.000667.
Holverda S, Gan CTJ, Marcus JT, et al. Impaired stroke volume response to exercise in pulmonary arterial hypertension. Journal of the American College of Cardiology, 2006, 47(8), 1732-1733.doi: 10.1016/j.jacc.2006.01.048.
Bauer R, Dehnert C, Schoene P et al. Skeletal muscle dysfunction in patients with idiopathic pulmonary arterial hypertension. Respir Med. 2007 Nov;101(11):2366-9. doi: 10.1016/j.rmed.2007.06.014. Epub 2007 Aug 6. PMID: 17689235.
Sun XG, Hansen JE, Oudiz RJ, et al. Exercise pathophysiology in patients with primary pulmonary hypertension. Circulation, 2001, 104(4), 429-435. doi: 10.1161/hc2901.093198.
Bratel T, Lagerstrand L, Brodin LÅ, et al. Ventilation–perfusion relationships in pulmonary arterial hypertension: effect of intravenous and inhaled prostacyclin treatment. Respiratory physiology & neurobiology, 2007, 158(1), 59-69. doi: 10.1016/j.resp.2007.03.003.
Fowler RM, Gain KR, Gabbay E. Exercise intolerance in pulmonary arterial hypertension. Pulmonary medicine, 2012. doi: 10.1155/2012/359204.
Löwe B, Gräfe K, Ufer C, Kroenke K, Grünig E, Herzog W, Borst MM. Anxiety and depression in patients with pulmonary hypertension. Psychosom Med. 2004 Nov-Dec;66(6):831-6. doi: 10.1097/01.psy.0000145593.37594.39. PMID: 15564346.
Pıeles GE., et al. Paediatric exercise training in prevention and treatment. Archives of disease in childhood, 2013, archdischild-2013-303826.
Sun XG, et al. Pulmonary function in primary pulmonary hypertension. Journal of the American College of Cardiology, 2003, 41.6: 1028-1035.
Aslan GK, Akinci B, Yeldan I, Okumus G. Respiratory muscle strength in patients with pulmonary hypertension: The relationship with exercise capacity, physical activity level, and quality of life. Clin Respir J. 2018 Feb;12(2):699-705. doi: 10.1111/crj.12582. Epub 2016 Dec 9. PMID: 27860259.
Wensel R, Opitz CF, Anker SD, et al. mel M, Hetzer R, Ewert R. Assessment of survival in patients with primary pulmonary hypertension: importance of cardiopulmonary exercise testing. Circulation. 2002 Jul 16;106(3):319-24. doi: 10.1161/01.cir.0000022687.18568.2a. PMID: 12119247.
Dilek K, Yıldız H. Dispne semptomunun değerlendirilmesinde dispne ölçeklerinin etkinlikleri ve kullanım sıklıkları. Gümüşhane Üniversitesi Sağlık Bilimleri Dergisi, 2013, 2.1: 137-149.
Biber Ç. Pulmoner Rehabilitasyonda Dispne Algısının Değerlendirmesi. Güncel Göğüs Hastalıkları Serisi, 2019, 7.1: 19-25.
Mereles D, Ehlken N, Kreuscher S, et al. Exercise and respiratory training improve exercise capacity and quality of life in patients with severe chronic pulmonary hypertension. Circulation, 2006, 114(14), 1482-1489. doi: 10.1161/ 106.618397
McLaughlin VV, Archer SL, Badesch DB, et al. American College of Cardiology Foundation Task Force on Expert Consensus Documents; American Heart Association; American College of Chest Physicians; American Thoracic Society, Inc; Pulmonary Hypertension Association. ACCF/AHA 2009 expert consensus document on pulmonary hypertension a report of the American College of Cardiology Foundation Task Force on Expert Consensus Documents and the American Heart Association developed in collaboration with the American College of Chest Physicians; American Thoracic Society, Inc.; and the Pulmonary Hypertension Association. J Am Coll Cardiol. 2009 Apr 28;53(17):1573-619. doi: 10.1016/j.jacc.2009.01.004. PMID: 19389575.
Babu AS, Padmakumar R, Maiya AG, et al. Effects of exercise training on exercise capacity in pulmonary arterial hypertension: a systematic review of clinical trials. Heart, Lung and Circulation, 2016, 25(4), 333-341. doi: 10.1016/j.hlc.2015.10.015.
Buys R, Avila A, Cornelissen VA. Exercise training improves physical fitness in patients with pulmonary arterial hypertension: a systematic review and meta-analysis of controlled trials. BMC pulmonary medicine, 2015, 15(1), 1-9. doi: 10.1186/s12890-015-0031-1.
Pandey A, Garg S, Khunger M, et al. Efficacy and safety of exercise training in chronic pulmonary hypertension: systematic review and meta-analysis. Circulation: Heart Failure, 2015. 8(6), 1032-1043.
Galiè N, Humbert M, Vachiery JL, et al. 2015 ESC/ERS guidelines for the diagnosis and treatment of pulmonary hypertension: the joint task force for the diagnosis and treatment of pulmonary hypertension of the European Society of Cardiology (ESC) and the European Respiratory Society (ERS): endorsed by: Association for European Paediatric and Congenital Cardiology (AEPC), International Society for Heart and Lung Transplantation (ISHLT). European heart journal, 2016, 37(1), 67-119
Zöller D, Siaplaouras J, Apitz A, Bride P, Kaestner M, Latus H, Schranz D, Apitz C. Home Exercise Training in Children and Adolescents with Pulmonary Arterial Hypertension: A Pilot Study. Pediatr Cardiol. 2017 Jan;38(1):191-198. doi: 10.1007/s00246-016-1501-9. Epub 2016 Nov 14. PMID: 27841007.
Becker-Grünıg T., et al. Efficacy of exercise training in pulmonary arterial hypertension associated with congenital heart disease. International journal of cardiology, 2013, 168.1: 375-381.
Richter MJ, Grimminger J, Krüger B, Ghofrani HA, Mooren FC, Gall H, Pilat C, Krüger K. Effects of exercise training on pulmonary hemodynamics, functional capacity and inflammation in pulmonary hypertension. Pulm Circ. 2017 Feb 1;7(1):20-37. doi: 10.1086/690553. PMID: 28680563; PMCID: PMC5448538.
Chia KS, Wong PK, Faux SG, McLachlan CS, Kotlyar E. The benefit of exercise training in pulmonary hypertension: a clinical review. Intern Med J. 2017 Apr;47(4):361-369. doi: 10.1111/imj.13159. PMID: 27338855.
Weinstein AA, Chin LM, Keyser RE, Kennedy M, Nathan SD, Woolstenhulme JG et al. Effect of aerobic exercise training on fatigue and physical activity in patients with pulmonary arterial hypertension. Respir Med 2013; 107: 778–84
Zöller D, Siaplaouras J, Apitz A, Bride P, Kaestner M, Latus H, Schranz D, Apitz C. Home Exercise Training in Children and Adolescents with Pulmonary Arterial Hypertension: A Pilot Study. Pediatr Cardiol. 2017 Jan;38(1):191-198. doi: 10.1007/s00246-016-1501-9. Epub 2016 Nov 14. PMID: 27841007.
Kabitz HJ, Bremer HC, Schwoerer A, Sonntag F, Walterspacher S, Walker DJ et al. The combination of exercise and respiratory training improves respiratory muscle function in pulmonary hypertension. Lung 2014
Chan L, Chin LM, Kennedy M, Woolstenhulme JG, Nathan SD, Weinstein AA et al. Benefits of intensive treadmill exercise training on cardiorespiratory function and quality of life in patients with pulmonary hypertension. Chest 2013; 143: 333–43.
Referanslar
Humbert M, Kovacs G, Hoeper M, et al. M. 2022 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension: Developed by the task force for the diagnosis and treatment of pulmonary hypertension of the European Society of Cardiology (ESC) and the European Respiratory Society (ERS). Endorsed by the International Society for Heart and Lung Transplantation (ISHLT) and the European Reference Network on rare respiratory diseases (ERN-LUNG). European heart journal,2022; 43(38), 3618-3731. doi: 10.1183/13993003.00879-2022.
Pelliccia A, Sharma S, Gati S et al. 2020 ESC Guidelines on sports cardiology and exercise in patients with cardiovascular disease: The Task Force on sports cardiology and exercise in patients with cardiovascular disease of the European Society of Cardiology (ESC). European heart journal, 2021, 42(1), 17-96.
Hansmann G, Koestenberger M, Alastalo TP, et al. 2019 updated consensus statement on the diagnosis and treatment of pediatric pulmonary hypertension: The European Pediatric Pulmonary Vascular Disease Network (EPPVDN), endorsed by AEPC, ESPR and ISHLT. The Journal of Heart and Lung Transplantation, 2019, 38(9), 879-901. doi: 10.1016/j.healun.2019.06.022.
Tuder RM, Archer SL, Dorfmüller P, et al. Relevant issues in the pathology and pathobiology of pulmonary hypertension. J Am Coll Cardiol. 2013 Dec 24;62(25 Suppl):D4-12. doi: 10.1016/j.jacc.2013.10.025. PMID: 24355640; PMCID: PMC3970402.
Vonk-Noordegraaf A, Haddad F, Chin KM, et al. Right heart adaptation to pulmonary arterial hypertension: physiology and pathobiology. Journal of the American College of Cardiology, 2013 62(25S), D22-D33. doi: 10.1016/j.jacc.2013.10.027.
Lewis GD, Bossone E, Naeije R, et al. Pulmonary vascular hemodynamic response to exercise in cardiopulmonary diseases. Circulation, 2013, 128(13), 1470-1479. doi: 10.1161/CIRCULATIONAHA.112.000667.
Holverda S, Gan CTJ, Marcus JT, et al. Impaired stroke volume response to exercise in pulmonary arterial hypertension. Journal of the American College of Cardiology, 2006, 47(8), 1732-1733.doi: 10.1016/j.jacc.2006.01.048.
Bauer R, Dehnert C, Schoene P et al. Skeletal muscle dysfunction in patients with idiopathic pulmonary arterial hypertension. Respir Med. 2007 Nov;101(11):2366-9. doi: 10.1016/j.rmed.2007.06.014. Epub 2007 Aug 6. PMID: 17689235.
Sun XG, Hansen JE, Oudiz RJ, et al. Exercise pathophysiology in patients with primary pulmonary hypertension. Circulation, 2001, 104(4), 429-435. doi: 10.1161/hc2901.093198.
Bratel T, Lagerstrand L, Brodin LÅ, et al. Ventilation–perfusion relationships in pulmonary arterial hypertension: effect of intravenous and inhaled prostacyclin treatment. Respiratory physiology & neurobiology, 2007, 158(1), 59-69. doi: 10.1016/j.resp.2007.03.003.
Fowler RM, Gain KR, Gabbay E. Exercise intolerance in pulmonary arterial hypertension. Pulmonary medicine, 2012. doi: 10.1155/2012/359204.
Löwe B, Gräfe K, Ufer C, Kroenke K, Grünig E, Herzog W, Borst MM. Anxiety and depression in patients with pulmonary hypertension. Psychosom Med. 2004 Nov-Dec;66(6):831-6. doi: 10.1097/01.psy.0000145593.37594.39. PMID: 15564346.
Pıeles GE., et al. Paediatric exercise training in prevention and treatment. Archives of disease in childhood, 2013, archdischild-2013-303826.
Sun XG, et al. Pulmonary function in primary pulmonary hypertension. Journal of the American College of Cardiology, 2003, 41.6: 1028-1035.
Aslan GK, Akinci B, Yeldan I, Okumus G. Respiratory muscle strength in patients with pulmonary hypertension: The relationship with exercise capacity, physical activity level, and quality of life. Clin Respir J. 2018 Feb;12(2):699-705. doi: 10.1111/crj.12582. Epub 2016 Dec 9. PMID: 27860259.
Wensel R, Opitz CF, Anker SD, et al. mel M, Hetzer R, Ewert R. Assessment of survival in patients with primary pulmonary hypertension: importance of cardiopulmonary exercise testing. Circulation. 2002 Jul 16;106(3):319-24. doi: 10.1161/01.cir.0000022687.18568.2a. PMID: 12119247.
Dilek K, Yıldız H. Dispne semptomunun değerlendirilmesinde dispne ölçeklerinin etkinlikleri ve kullanım sıklıkları. Gümüşhane Üniversitesi Sağlık Bilimleri Dergisi, 2013, 2.1: 137-149.
Biber Ç. Pulmoner Rehabilitasyonda Dispne Algısının Değerlendirmesi. Güncel Göğüs Hastalıkları Serisi, 2019, 7.1: 19-25.
Mereles D, Ehlken N, Kreuscher S, et al. Exercise and respiratory training improve exercise capacity and quality of life in patients with severe chronic pulmonary hypertension. Circulation, 2006, 114(14), 1482-1489. doi: 10.1161/ 106.618397
McLaughlin VV, Archer SL, Badesch DB, et al. American College of Cardiology Foundation Task Force on Expert Consensus Documents; American Heart Association; American College of Chest Physicians; American Thoracic Society, Inc; Pulmonary Hypertension Association. ACCF/AHA 2009 expert consensus document on pulmonary hypertension a report of the American College of Cardiology Foundation Task Force on Expert Consensus Documents and the American Heart Association developed in collaboration with the American College of Chest Physicians; American Thoracic Society, Inc.; and the Pulmonary Hypertension Association. J Am Coll Cardiol. 2009 Apr 28;53(17):1573-619. doi: 10.1016/j.jacc.2009.01.004. PMID: 19389575.
Babu AS, Padmakumar R, Maiya AG, et al. Effects of exercise training on exercise capacity in pulmonary arterial hypertension: a systematic review of clinical trials. Heart, Lung and Circulation, 2016, 25(4), 333-341. doi: 10.1016/j.hlc.2015.10.015.
Buys R, Avila A, Cornelissen VA. Exercise training improves physical fitness in patients with pulmonary arterial hypertension: a systematic review and meta-analysis of controlled trials. BMC pulmonary medicine, 2015, 15(1), 1-9. doi: 10.1186/s12890-015-0031-1.
Pandey A, Garg S, Khunger M, et al. Efficacy and safety of exercise training in chronic pulmonary hypertension: systematic review and meta-analysis. Circulation: Heart Failure, 2015. 8(6), 1032-1043.
Galiè N, Humbert M, Vachiery JL, et al. 2015 ESC/ERS guidelines for the diagnosis and treatment of pulmonary hypertension: the joint task force for the diagnosis and treatment of pulmonary hypertension of the European Society of Cardiology (ESC) and the European Respiratory Society (ERS): endorsed by: Association for European Paediatric and Congenital Cardiology (AEPC), International Society for Heart and Lung Transplantation (ISHLT). European heart journal, 2016, 37(1), 67-119
Zöller D, Siaplaouras J, Apitz A, Bride P, Kaestner M, Latus H, Schranz D, Apitz C. Home Exercise Training in Children and Adolescents with Pulmonary Arterial Hypertension: A Pilot Study. Pediatr Cardiol. 2017 Jan;38(1):191-198. doi: 10.1007/s00246-016-1501-9. Epub 2016 Nov 14. PMID: 27841007.
Becker-Grünıg T., et al. Efficacy of exercise training in pulmonary arterial hypertension associated with congenital heart disease. International journal of cardiology, 2013, 168.1: 375-381.
Richter MJ, Grimminger J, Krüger B, Ghofrani HA, Mooren FC, Gall H, Pilat C, Krüger K. Effects of exercise training on pulmonary hemodynamics, functional capacity and inflammation in pulmonary hypertension. Pulm Circ. 2017 Feb 1;7(1):20-37. doi: 10.1086/690553. PMID: 28680563; PMCID: PMC5448538.
Chia KS, Wong PK, Faux SG, McLachlan CS, Kotlyar E. The benefit of exercise training in pulmonary hypertension: a clinical review. Intern Med J. 2017 Apr;47(4):361-369. doi: 10.1111/imj.13159. PMID: 27338855.
Weinstein AA, Chin LM, Keyser RE, Kennedy M, Nathan SD, Woolstenhulme JG et al. Effect of aerobic exercise training on fatigue and physical activity in patients with pulmonary arterial hypertension. Respir Med 2013; 107: 778–84
Zöller D, Siaplaouras J, Apitz A, Bride P, Kaestner M, Latus H, Schranz D, Apitz C. Home Exercise Training in Children and Adolescents with Pulmonary Arterial Hypertension: A Pilot Study. Pediatr Cardiol. 2017 Jan;38(1):191-198. doi: 10.1007/s00246-016-1501-9. Epub 2016 Nov 14. PMID: 27841007.
Kabitz HJ, Bremer HC, Schwoerer A, Sonntag F, Walterspacher S, Walker DJ et al. The combination of exercise and respiratory training improves respiratory muscle function in pulmonary hypertension. Lung 2014
Chan L, Chin LM, Kennedy M, Woolstenhulme JG, Nathan SD, Weinstein AA et al. Benefits of intensive treadmill exercise training on cardiorespiratory function and quality of life in patients with pulmonary hypertension. Chest 2013; 143: 333–43.
