Effects of Different Types of Physical Training in Patients With Pulmonary Arterial Hypertension.

NCT ID: NCT03476629

Last Updated: 2020-11-04

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

UNKNOWN

Clinical Phase

NA

Total Enrollment

45 participants

Study Classification

INTERVENTIONAL

Study Start Date

2016-01-10

Study Completion Date

2020-12-10

Brief Summary

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Although there has been some progress in pharmacological management of PAH, limited functional capacity and low survival still persist, but there is evidence that exercise training can be accomplished without adverse effects or damage to cardiac function and pulmonary hemodynamics. Specifically, improvements in symptoms, exercise capacity, peripheral muscle function and quality of life. Training programs need to be better studied and well defined, and their physiological effects during physical training and functional capacity.

The aim of this study is to compare the effects of different training exercises on physical performance indicators.

Detailed Description

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Pulmonary arterial hypertension (PAH) is characterized by pathological changes in the pulmonary vasculature which cause an increase in pulmonary vascular resistance (PVR), restricting the flow of blood through the pulmonary circulation. It is a serious illness, progressive and usually fatal which causes significant functional limitation, mainly due to dyspnea. In order to maintain the flow of blood, pulmonary artery pressure (PAP) increases and the disease progresses leading to right ventricular dysfunction and right heart failure.

Regardless of the cause of PAH, the pulmonary arteries and arterioles have reduced capacity, and increases in cardiac output during exercise is limited. As a result, the delivery of oxygen to peripheral muscles is impaired, contributing to the symptoms of fatigue and dyspnea. While the limitation of the cardiac output to meet peripheral oxygen demand during exercise largely reduces exercise capacity, musculoskeletal dysfunction may also be involved in the exercise limitation in patients with PAH. Changes such as, muscle atrophy, decreased oxidative enzymes and a greater number of type II muscle fibers lead to an early lactic acidosis and decreased functional capacity. A modest evidence exists that exercise training can be done without adverse effects or damage to cardiac and / or pulmonary hemodynamics however, the effectiveness PAH requires more research.

Conditions

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Pulmonary Arterial Hypertension Cardiovascular Diseases Respiratory Disease Hypertension, Pulmonary Pulmonary Hypertension

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

CROSSOVER

Primary Study Purpose

TREATMENT

Blinding Strategy

QUADRUPLE

Participants Caregivers Investigators Outcome Assessors

Study Groups

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Combined Training

Combined Training with 2 types of physical activity

Group Type EXPERIMENTAL

Physical activity

Intervention Type OTHER

Effects of different physical activity programs

Standard Training

Physical activity with aerobic exercise

Group Type EXPERIMENTAL

Physical activity

Intervention Type OTHER

Effects of different physical activity programs

Respiratory Muscle Training

Respiratory muscle performance

Group Type EXPERIMENTAL

Physical activity

Intervention Type OTHER

Effects of different physical activity programs

Interventions

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Physical activity

Effects of different physical activity programs

Intervention Type OTHER

Eligibility Criteria

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Inclusion Criteria

* Having confirmed diagnosis of PAH, based on elevated pressure in the pulmonary artery measured by catheterization of the heart at rest, with WHO functional (World Health Organization's - Functional Assessment for Pulmonary Hypertension - modified after New York Heart Association Functional Classification (NYHA) functional classification) classes I, II, III or IV to capture PAH patients with pré-capillary involvement;
* Clinically stable with no previous hospitalizations in the last four weeks;
* Receiving PAH specific drug therapy for at least 3 months before the study began.

Exclusion Criteria

* Use of continuous oxygen therapy;
* Significant musculoskeletal disease or pain / claudication members;
* Neurologic or cognitive impairment, psychiatric disorders or psychological mood (making it difficult for patients to understand the required tests);
* History of moderate or severe chronic lung disease;
* PAH patients with post-capillary involvement.
* Cardiac disease associated with cardiac failure, angina and / or unstable heart rhythm.
Minimum Eligible Age

20 Years

Maximum Eligible Age

70 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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University of Miami

OTHER

Sponsor Role collaborator

Faculdade de Ciências Médicas da Santa Casa de São Paulo

OTHER

Sponsor Role collaborator

University of Nove de Julho

OTHER

Sponsor Role lead

Responsible Party

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LUCIANA MARIA MALOSA SAMPAIO

Professor of the Postgraduate Program in Rehabilitation Sciences

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Luciana Malosá Sampaio, Professor

Role: PRINCIPAL_INVESTIGATOR

University of Nove de Julho

Locations

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Santa Casa de São Paulo Hospital

São Paulo, São Paulo, Brazil

Site Status RECRUITING

Countries

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Brazil

Central Contacts

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Luciana Malosá Sampaio, Professor

Role: CONTACT

+551133859241

Etiene Farah Teixeira de Carvalho, Phd

Role: CONTACT

+551133859241

Facility Contacts

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Flávia Navarro, Dr

Role: primary

References

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Desai SA, Channick RN. Exercise in patients with pulmonary arterial hypertension. J Cardiopulm Rehabil Prev. 2008 Jan-Feb;28(1):12-6. doi: 10.1097/01.HCR.0000311502.57022.73.

Reference Type BACKGROUND
PMID: 18277824 (View on PubMed)

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Reference Type BACKGROUND
PMID: 18204173 (View on PubMed)

Gabbay E, Reed A, Williams TJ. Assessment and treatment of pulmonary arterial hypertension: an Australian perspective in 2006. Intern Med J. 2007 Jan;37(1):38-48. doi: 10.1111/j.1445-5994.2006.01242.x.

Reference Type BACKGROUND
PMID: 17199843 (View on PubMed)

Rubin LJ. Primary pulmonary hypertension. N Engl J Med. 1997 Jan 9;336(2):111-7. doi: 10.1056/NEJM199701093360207. No abstract available.

Reference Type BACKGROUND
PMID: 8988890 (View on PubMed)

Galie N, Humbert M, Vachiery JL, Gibbs S, Lang I, Torbicki A, Simonneau G, Peacock A, Vonk Noordegraaf A, Beghetti M, Ghofrani A, Gomez Sanchez MA, Hansmann G, Klepetko W, Lancellotti P, Matucci M, McDonagh T, Pierard LA, Trindade PT, Zompatori M, Hoeper M; ESC Scientific Document Group. 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). Eur Heart J. 2016 Jan 1;37(1):67-119. doi: 10.1093/eurheartj/ehv317. Epub 2015 Aug 29. No abstract available.

Reference Type BACKGROUND
PMID: 26320113 (View on PubMed)

Arena R, Lavie CJ, Milani RV, Myers J, Guazzi M. Cardiopulmonary exercise testing in patients with pulmonary arterial hypertension: an evidence-based review. J Heart Lung Transplant. 2010 Feb;29(2):159-73. doi: 10.1016/j.healun.2009.09.003. Epub 2009 Dec 6.

Reference Type BACKGROUND
PMID: 19969471 (View on PubMed)

Naeije R. Breathing more with weaker respiratory muscles in pulmonary arterial hypertension. Eur Respir J. 2005 Jan;25(1):6-8. doi: 10.1183/09031936.04.00121004. No abstract available.

Reference Type BACKGROUND
PMID: 15640315 (View on PubMed)

Bauer R, Dehnert C, Schoene P, Filusch A, Bartsch P, Borst MM, Katus HA, Meyer FJ. 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.

Reference Type BACKGROUND
PMID: 17689235 (View on PubMed)

Mainguy V, Maltais F, Saey D, Gagnon P, Martel S, Simon M, Provencher S. Effects of a rehabilitation program on skeletal muscle function in idiopathic pulmonary arterial hypertension. J Cardiopulm Rehabil Prev. 2010 Sep-Oct;30(5):319-23. doi: 10.1097/HCR.0b013e3181d6f962.

Reference Type BACKGROUND
PMID: 20410828 (View on PubMed)

de Man FS, Handoko ML, Groepenhoff H, van 't Hul AJ, Abbink J, Koppers RJ, Grotjohan HP, Twisk JW, Bogaard HJ, Boonstra A, Postmus PE, Westerhof N, van der Laarse WJ, Vonk-Noordegraaf A. Effects of exercise training in patients with idiopathic pulmonary arterial hypertension. Eur Respir J. 2009 Sep;34(3):669-75. doi: 10.1183/09031936.00027909.

Reference Type BACKGROUND
PMID: 19720810 (View on PubMed)

Meyer FJ, Lossnitzer D, Kristen AV, Schoene AM, Kubler W, Katus HA, Borst MM. Respiratory muscle dysfunction in idiopathic pulmonary arterial hypertension. Eur Respir J. 2005 Jan;25(1):125-30. doi: 10.1183/09031936.04.00095804.

Reference Type BACKGROUND
PMID: 15640333 (View on PubMed)

Kabitz HJ, Schwoerer A, Bremer HC, Sonntag F, Walterspacher S, Walker D, Schaefer V, Ehlken N, Staehler G, Halank M, Klose H, Ghofrani HA, Hoeper MM, Gruenig E, Windisch W. Impairment of respiratory muscle function in pulmonary hypertension. Clin Sci (Lond). 2008 Jan;114(2):165-71. doi: 10.1042/CS20070238.

Reference Type BACKGROUND
PMID: 17764445 (View on PubMed)

Velez-Roa S, Ciarka A, Najem B, Vachiery JL, Naeije R, van de Borne P. Increased sympathetic nerve activity in pulmonary artery hypertension. Circulation. 2004 Sep 7;110(10):1308-12. doi: 10.1161/01.CIR.0000140724.90898.D3. Epub 2004 Aug 30.

Reference Type BACKGROUND
PMID: 15337703 (View on PubMed)

Mereles D, Ehlken N, Kreuscher S, Ghofrani S, Hoeper MM, Halank M, Meyer FJ, Karger G, Buss J, Juenger J, Holzapfel N, Opitz C, Winkler J, Herth FF, Wilkens H, Katus HA, Olschewski H, Grunig E. Exercise and respiratory training improve exercise capacity and quality of life in patients with severe chronic pulmonary hypertension. Circulation. 2006 Oct 3;114(14):1482-9. doi: 10.1161/CIRCULATIONAHA.106.618397. Epub 2006 Sep 18.

Reference Type BACKGROUND
PMID: 16982941 (View on PubMed)

Other Identifiers

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PAH Rehabilitation

Identifier Type: -

Identifier Source: org_study_id