Skip to main content Skip to main navigation menu Skip to site footer

Role of exercise training in pulmonary hypertension: a review article

  • Muhammad Ridwan ,
  • Herlina Dimiati ,
  • Cut Jaswanita Eka Putri ,
  • Yopie Afriandi Habibie ,
  • Hesti Anandini Sariningrum ,


Pulmonary hypertension is a cardiovascular disease with high mortality and morbidity affecting various aspects, including prognosis and quality of life. Limiting physical exercise in patients with pulmonary hypertension was initially suggested because it worsened the patient's clinical condition.  Recently clinicians have begun to focus on the role of physical activity in patients with pulmonary hypertension. Despite limitations of literature that describe the role of physical exercise in pulmonary hypertension,  this paper is expected to provide an overview and the extent of implementing physical exercise in health centers. In our review, the data collection for eligible articles was conducted from 1st January 2011 until 4th January 2021 using the PubMed database undertaken English language. The search algorithm used in this paper is "Exercise" OR "Physical Activity" AND "Pulmonary Hypertension." Manual search methods were also has been used to find the topic-related articles. According to our synthesis of physical exercise in patients with pulmonary hypertension, it is safe to apply under the supervision of cardiac rehabilitation experts. Initial assessment, exercise capacity adjustment, and monitoring during physical exercise are essential to avoid adverse events during exercise. Regular physical exercise over 12 weeks can increase exercise capacity, improve quality of life, improve prognostic and life expectancy. Otherwise, the application of physical exercise under ten weeks does not always show significant results, and the application for less than eight weeks shows unsatisfactory results. In conclusion, the use of physical exercise in pulmonary hypertension has not been optimally utilized in cardiac rehabilitation centers


  1. Radi B, Joesoef AH, Kusmana D. Rehabilitasi Kardiovaskular Di Indonesia. 2009;30(2):43–5.
  2. Coombes JS, Law J, Lancashire B, Fassett RG. "Exercise Is Medicine." Asia Pacific J Public Heal [Internet]. 2013;27(2):NP600–5. Available from:
  3. Thompson WR, Sallis R, Joy E, Jaworski CA, Stuhr RM, Trilk JL. Exercise Is Medicine. Am J Lifestyle Med [Internet]. 2020;14(5):511–23. Available from:
  4. Nazzareno Galiè, Marc Humbert, Jean-Luc Vachiery, Simon Gibbs, Irene Lang, Adam Torbicki, Gérald Simonneau, Andrew Peacock, Anton Vonk Noordegraaf, Maurice Beghetti, Ardeschir Ghofrani, Miguel Angel Gomez Sanchez, Georg Hansmann, Walter Klepetko, Patrizio Lancellotti, Marco Matucci, Theresa McDonagh, Luc A. Pierard, Pedro T. Trindade, Maurizio Zompatori and Marius Hoeper. 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). Eur Respir J [Internet]. 2015;46(6):1855–6. Available from:
  5. Sharma S, Pelliccia A, Gati S. The' Ten Commandments' for the 2020 ESC Guidelines on Sports Cardiology and Exercise in Patients with Cardiovascular Disease. Eur Heart J [Internet]. 2020; Available from:
  6. Sutantri S. Current status and future directions of cardiac rehabilitation program: a review of the literature. J Heal Technol Assess Midwifery [Internet]. 2019;2(2):59–68. Available from:
  7. Dalal HM, Doherty P, Taylor RS. Cardiac rehabilitation. BMJ [Internet]. 2015;h5000. Available from:
  8. Wenger NK. Current Status of Cardiac Rehabilitation. J Am Coll Cardiol [Internet]. 2008;51(17):1619–31. Available from:
  9. Hoeper MM, Huscher D, Ghofrani HA, Delcroix M, Distler O, Schweiger C, et al. Elderly patients diagnosed with idiopathic pulmonary arterial hypertension: Results from the COMPERA registry. Int J Cardiol [Internet]. 2013;168(2):871–80. Available from:
  10. Wouters EFM, Posthuma R, Koopman M, Liu W-Y, Sillen MJ, Hajian B, et al. An update on pulmonary rehabilitation techniques for patients with chronic obstructive pulmonary disease. Expert Rev Respir Med [Internet]. 2020;14(2):149–61. Available from:
  11. Caspersen CJ, Powell KE, Christenson GM. Physical activity, exercise, and physical fitness: definitions and distinctions for health-related research. Public Health Rep [Internet]. 1985;100(2):126–31. Available from:
  12. Piggin J. What Is Physical Activity? A Holistic Definition for Teachers, Researchers and Policy Makers. Front Sport Act Living [Internet]. 2020;2. Available from:
  13. New Physical Activity Guidelines from the World Health Organization. Back Lett [Internet]. 2021;36(2):16. Available from:
  14. Grady D, Weiss M, Hernandez-Sanchez J, Pepke-Zaba J. Medication and patient factors associated with adherence to pulmonary hypertension targeted therapies. Pulm Circ [Internet]. 2017;8(1):204589321774361. Available from:
  15. Karapolat H. Effects of cardiopulmonary rehabilitation on pulmonary arterial hypertension: A prospective, randomized study. Turkish J Phys Med Rehabil [Internet]. 2019;65(3):278–86. Available from:
  16. Simonneau G, Galiè N, Rubin LJ, Langleben D, Seeger W, Domenighetti G, et al. Clinical classification of pulmonary hypertension. J Am Coll Cardiol [Internet]. 2004;43(12):S5–12. Available from:
  17. Marra AM, Egenlauf B, Bossone E, Eichstaedt C, Grünig E, Ehlken N. Principles of Rehabilitation and Reactivation: Pulmonary Hypertension. Respiration [Internet]. 2015;89(4):265–73. Available from:
  18. Pandey A, Garg S, Khunger M, Garg S, Kumbhani DJ, Chin KM, et al. Efficacy and Safety of Exercise Training in Chronic Pulmonary Hypertension. Circ Hear Fail [Internet]. 2015;8(6):1032–43. Available from:
  19. Bauer R, Dehnert C, Schoene P, Filusch A, Bärtsch P, Borst MM, et al. Skeletal muscle dysfunction in patients with idiopathic pulmonary arterial hypertension. Respir Med [Internet]. 2007;101(11):2366–9. Available from:
  20. Mainguy V, Maltais F, Saey D, Gagnon P, Martel S, Simon M, et al. Peripheral muscle dysfunction in idiopathic pulmonary arterial hypertension. Thorax [Internet]. 2009;65(2):113–7. Available from:
  21. Zhang X, Xu D. Effects of exercise rehabilitation training on patients with pulmonary hypertension. Pulm Circ [Internet]. 2020;10(3):204589402093712. Available from:
  22. Wang H, Zhou H, Zou Y, Liu Q, Guo C, Gao G, et al. Resveratrol modulates angiogenesis through the GSK3?/?-catenin/TCF-dependent pathway in human endothelial cells. Biochem Pharmacol [Internet]. 2010;80(9):1386–95. Available from:
  23. Tuder RM, Stacher E, Robinson J, Kumar R, Graham BB. Pathology of Pulmonary Hypertension. Clin Chest Med [Internet]. 2013;34(4):639–50. Available from:
  24. Almagro P, Boixeda R, Diez-Manglano J, Gómez-Antúnez M, López-García F, Recio J.

    Insights into Chronic Obstructive Pulmonary Disease as Critical Risk Factor for Cardiovascular Disease

    . Int J Chron Obstruct Pulmon Dis [Internet]. 2020;Volume 15:755–64. Available from:
  25. Goto C, Nishioka K, Umemura T, Jitsuiki D, Sakagutchi A, Kawamura M, et al. Acute Moderate-Intensity Exercise Induces Vasodilation Through an Increase in Nitric Oxide Bioavailiability in Humans. Am J Hypertens [Internet]. 2007;20(8):825–30. Available from:
  26. Mainguy V, Maltais F, Saey D, Gagnon P, Martel S, Simon M, et al. Effects of a Rehabilitation Program on Skeletal Muscle Function in Idiopathic Pulmonary Arterial Hypertension. J Cardiopulm Rehabil Prev [Internet]. 2010;30(5):319–23. Available from:
  27. Harbaum L, Renk E, Yousef S, Glatzel A, Lüneburg N, Hennigs JK, et al. Acute effects of exercise on the inflammatory state in patients with idiopathic pulmonary arterial hypertension. BMC Pulm Med [Internet]. 2016;16(1). Available from:
  28. Palermo P, Corrà U. Exercise Prescriptions for Training and Rehabilitation in Patients with Heart and Lung Disease. Ann Am Thorac Soc [Internet]. 2017;14(Supplement_1):S59–66. Available from:
  29. Waller L, Krüger K, Conrad K, Weiss A, Alack K. Effects of Different Types of Exercise Training on Pulmonary Arterial Hypertension: A Systematic Review. J Clin Med [Internet]. 2020;9(6):1689. Available from:
  30. Ehlken N, Lichtblau M, Klose H, Weidenhammer J, Fischer C, Nechwatal R, et al. Exercise training improves peak oxygen consumption and haemodynamics in patients with severe pulmonary arterial hypertension and inoperable chronic thrombo-embolic pulmonary hypertension: a prospective, randomized, controlled trial. Eur Heart J [Internet]. 2015;37(1):35–44. Available from:
  31. Pandey A, Parashar A, Kumbhani DJ, Agarwal S, Garg J, Kitzman D, et al. Exercise Training in Patients With Heart Failure and Preserved Ejection Fraction. Circ Hear Fail [Internet]. 2015;8(1):33–40. Available from:
  32. Mereles D, Ehlken N, Kreuscher S, Ghofrani S, Hoeper MM, Halank M, et al. Exercise and Respiratory Training Improve Exercise Capacity and Quality of Life in Patients With Severe Chronic Pulmonary Hypertension. Circulation [Internet]. 2006;114(14):1482–9. Available from:
  33. Nagel C, Prange F, Guth S, Herb J, Ehlken N, Fischer C, et al. Exercise Training Improves Exercise Capacity and Quality of Life in Patients with Inoperable or Residual Chronic Thromboembolic Pulmonary Hypertension. PLoS One [Internet]. 2012;7(7):e41603. Available from:
  34. Grünig E, Lichtblau M, Ehlken N, Ghofrani HA, Reichenberger F, Staehler G, et al. Safety and efficacy of exercise training in various forms of pulmonary hypertension. Eur Respir J [Internet]. 2012;40(1):84–92. Available from:
  35. Ganderton L, Jenkins S, Gain K, Fowler R, Winship P, Lunt D, et al. Short term effects of exercise training on exercise capacity and quality of life in patients with pulmonary arterial hypertension: protocol for a randomised controlled trial. BMC Pulm Med [Internet]. 2011;11(1). Available from:
  36. Chan L, Chin LMK, 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 [Internet]. 2013;143(2):333–43. Available from:
  37. Weinstein AA, Chin LMK, 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 [Internet]. 2013;107(5):778–84. Available from:
  38. Woolstenhulme JG, Guccione AA, Herrick JE, Collins JP, Nathan SD, Chan L, et al. Left Ventricular Function Before and After Aerobic Exercise Training in Women With Pulmonary Arterial Hypertension. J Cardiopulm Rehabil Prev [Internet]. 2019;39(2):118–26. Available from:
  39. Aslan GK, Ak?nc? B, Yeldan I, Okumus G. A randomized controlled trial on inspiratory muscle training in pulmonary hypertension: Effects on respiratory functions, functional exercise capacity, physical activity, and quality of life. Hear Lung [Internet]. 2020;49(4):381–7. Available from:
  40. Johnson MK, Peacock AJ. Treating Pulmonary Arterial Hypertension With Exercise: The Role of Rehabilitative Medicine. Adv Pulm Hypertens [Internet]. 2019;18(2):56–62. Available from:
  41. Akizuki M, Serizawa N, Izoe Y, Ito O, Kohzuki M. Pulmonary Rehabilitation in Patients With Pulmonary Hypertension. Pulm Res Respir Med – Open J [Internet]. 2017;SE(2):S1–6. Available from:

How to Cite

Ridwan, M., Dimiati, H., Putri, C. J. E., Habibie, Y. A., & Sariningrum, H. A. (2021). Role of exercise training in pulmonary hypertension: a review article. Bali Medical Journal, 10(2), 768–774.




Search Panel

Muhammad Ridwan
Google Scholar
BMJ Journal

Herlina Dimiati
Google Scholar
BMJ Journal

Cut Jaswanita Eka Putri
Google Scholar
BMJ Journal

Yopie Afriandi Habibie
Google Scholar
BMJ Journal

Hesti Anandini Sariningrum
Google Scholar
BMJ Journal