The quality of evidence is downgraded by study limitations (unclear allocation concealment) and by indirectness (differences between the outcomes of interest and those reported: only short-term outcomes reported).
A Cochrane review included 6 studies with a total of 206 subjects with pulmonary hypertension (PH). Data was extracted from 5 studies. Most participants had pulmonary arterial hypertension (PAH; Group 1 PH) or chronic thromboembolic PH. Mean age of participants ranged from 47 to 56 years, and all participants were stable on medical therapy. Study duration ranged from 3 to 15 weeks. Exercise programmes included both inpatient- and outpatient-based rehabilitation that incorporated both upper and lower limb exercise.
The mean increase in 6-minute walk distance following exercise training compared to control was well in excess of the minimal important difference of 30 metres (MD 60.12 m, 95% CI 30.17 to 90.07 m, statistical heterogeneity I2=64%; 5 studies, n=165). The mean peak oxygen uptake was 2.4 ml/kg/minute higher (95% CI 1.4 to 3.4 ml/kg/min; 4 studies, n=145) and the mean peak power in the intervention groups was 16.4 W higher (95% CI 10.9 to 22.0 W; 4 studies, n=145) compared to control group. The mean change in HRQoL for the SF-36 physical component score was 4.63 points higher (95% CI 0.80 to 8.47 points; 2 studies, n=33) and for the SF-36 mental component score was 4.17 points higher (95% CI 0.01 to 8.34 points; 2 studies, n=33). No studies reported effects on time to clinical worsening or mortality. All outcomes were short term, measured immediately following the rehabilitation period. One study reported a single adverse event, where a participant stopped exercise training due to lightheadedness.
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