Open AccessA prescribed walking regimen plus arginine supplementation improves function and quality of life for patients with pulmonary arterial hypertension: a pilot study
Author(s) -
Brown Mary Beth,
Kempf Attie,
Collins Catherine M.,
Long Gary M.,
Owens Matthew,
Gupta Shikha,
Hellman Yaron,
Wong Vincent,
Farber Mark,
Lahm Tim
Publication year - 2017
Publication title -
pulmonary circulation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.791
H-Index - 40
ISSN - 2045-8940
DOI - 10.1177/2045893217743966
Subject(s) - medicine , regimen , adverse effect , anaerobic exercise , quality of life (healthcare) , concomitant , heart rate , cardiology , vo2 max , treadmill , pulmonary hypertension , physical therapy , blood pressure , nursing
Current evidence suggests that exercise training is beneficial in pulmonary arterial hypertension (PAH). Unfortunately, the standard supervised, hospital‐based programs limit patient accessibility to this important intervention. Our proof‐of‐concept study aimed to provide insight into the usefulness of a prescribed walking regimen along with arginine supplementation to improve outcomes for patients with PAH. Twelve PAH patients (all women) in New York Heart Association (NYHA) functional class (FC) II (n = 7) or III (n = 5) and in stable condition for ≥ 3 months were enrolled. Patients performed home‐ and fitness‐center‐ based walking at 65–75% heart rate (HR) reserve for 45 min, six sessions/week for 12 weeks. Concomitant L‐arginine supplementation (6000 mg/day) was provided to maximize beneficial endothelial training adaptations. Cardiopulmonary exercise testing, 6‐min walk testing (6MWT), echocardiography, laboratory studies, and quality of life (QoL) survey (SF‐36) were performed at baseline and 12 weeks. Eleven patients completed the study (72 session adherence rate = 96 ± 3%). Objective improvement was demonstrated by the 6MWT distance (increased by 40 ± 13 m, P = 0.01), VO 2 max (increased by 2 ± 0.7 mL/kg/min, P = 0.02), time‐to‐VO 2 max (increased by 2.5 ± 0.6 min, P = 0.001), VO 2 at anaerobic threshold (increased by 1.3 ± 0.5 mL/kg/min, P = 0.04), HR recovery (reduced by 68 ± 23% in slope, P = 0.01), and SF‐36 subscales of Physical Functioning and Energy/Fatigue (increased by 70 ± 34% and 74 ± 34%, respectively, P < 0.05). No adverse events occurred, and right ventricular function and brain natriuretic peptide levels remained stable, suggesting safety of the intervention. This proof‐of‐concept study indicates that a simple walking regimen with arginine supplementation is a safe and efficacious intervention for clinically stable PAH patients, with gains in objective function and QoL measures. Further investigation in a randomized controlled trial is warranted.