The Effects of Exercise Training in Patients With Persistent Dyspnea Following Pulmonary Embolism: A Randomized Controlled Trial

Øyvind Jervan; Stacey Haukeland-Parker; Jostein Gleditsch; Mazdak Tavoly; Frederikus A Klok; Kjetil Steine; Hege Hølmo Johannessen; Martijn A Spruit; Dan Atar; René Holst; Anders Erik Astrup Dahm; Per Anton Sirnes; Knut Stavem; Waleed Ghanima

doi:10.1016/j.chest.2023.04.042

The Effects of Exercise Training in Patients With Persistent Dyspnea Following Pulmonary Embolism: A Randomized Controlled Trial

Chest. 2023 Oct;164(4):981-991. doi: 10.1016/j.chest.2023.04.042. Epub 2023 May 5.

Authors

Affiliations

¹ Department of Cardiology, Østfold Hospital, Kalnes, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway. Electronic address: Oyvind.Jervan@so-hf.no.
² Department of Physical Medicine and Rehabilitation, Østfold Hospital, Kalnes, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
³ Department of Radiology, Østfold Hospital, Kalnes, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
⁴ Department of Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden.
⁵ Department of Medicine, Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, The Netherlands.
⁶ Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Department of Cardiology, Akershus University Hospital, Lørenskog, Norway.
⁷ Department of Physical Medicine and Rehabilitation, Østfold Hospital, Kalnes, Norway; Department of Health and Welfare, Østfold University College, Fredrikstad, Norway.
⁸ Department of Research and Development, Ciro, Horn, The Netherlands; Department of Respiratory Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands; NUTRIM School of Nutrition and Translational Research in Metabolism, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands.
⁹ Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Department of Cardiology, Oslo University Hospital Ullevål, Oslo, Norway.
¹⁰ Department of Biostatistics, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway.
¹¹ Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Department of Hematology, Akershus University Hospital, Lørenskog, Norway.
¹² Østlandske Hjertesenter, Moss, Norway.
¹³ Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Department of Pulmonary Medicine, Akershus University Hospital, Lørenskog, Norway; Health Services Research Unit, Akershus University Hospital, Lørenskog, Norway.
¹⁴ Clinic of Internal Medicine, Østfold Hospital, Kalnes, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Department of Hematology, Oslo University Hospital, Oslo, Norway.

PMID: 37149257
DOI: 10.1016/j.chest.2023.04.042

Abstract

Background: Persistent dyspnea, functional limitations, and reduced quality of life (QoL) are common following pulmonary embolism (PE). Rehabilitation is a potential treatment option, but the scientific evidence is limited.

Research question: Does an exercise-based rehabilitation program improve exercise capacity in PE survivors with persistent dyspnea?

Study design and methods: This randomized controlled trial was conducted at two hospitals. Patients with persistent dyspnea following PE diagnosed 6 to 72 months earlier, without cardiopulmonary comorbidities, were randomized 1:1 to either the rehabilitation or the control group. The rehabilitation program consisted of two weekly sessions of physical exercise for 8 weeks and one educational session. The control group received usual care. The primary end point was the difference in Incremental Shuttle Walk Test between groups at follow-up. Secondary end points included differences in the Endurance Shuttle Walk Test (ESWT), QoL (EQ-5D and Pulmonary Embolism-QoL questionnaires) and dyspnea (Shortness of Breath questionnaire).

Results: A total of 211 subjects were included: 108 (51%) were randomized to the rehabilitation group and 103 (49%) to the control group. At follow-up, participants allocated to the rehabilitation group performed better on the ISWT compared with the control group (mean difference, 53.0 m; 95% CI, 17.7-88.3; P = .0035). The rehabilitation group reported better scores on the Pulmonary Embolism-QoL questionnaire (mean difference, -4%; 95% CI, -0.09 to 0.00; P = .041) at follow-up, but there were no differences in generic QoL, dyspnea scores, or the ESWT. No adverse events occurred during the intervention.

Interpretation: In patients with persistent dyspnea following PE, those who underwent rehabilitation had better exercise capacity at follow-up than those who received usual care. Rehabilitation should be considered in patients with persistent dyspnea following PE. Further research is needed, however, to assess the optimal patient selection, timing, mode, and duration of rehabilitation.

Clinical trial registration: ClinicalTrials.gov; No.: NCT03405480; URL: www.

Clinicaltrials: gov.

Keywords: dyspnea; exercise training; pulmonary embolism; quality of life; rehabilitation.

Publication types

Randomized Controlled Trial
Research Support, Non-U.S. Gov't

MeSH terms

Dyspnea / etiology
Dyspnea / rehabilitation
Exercise
Exercise Therapy
Exercise Tolerance
Humans
Pulmonary Disease, Chronic Obstructive* / complications
Pulmonary Embolism* / complications
Quality of Life

Associated data

ClinicalTrials.gov/NCT03405480