313
was able to delay the onset of RV failure [ 28 ]. The impact of ExT on the cardiovas-
cular system is also dependent on the exercise modality [ 40 ]. While concentric ExT
(running in a treadmill with a slope ≥0°) conferred cardiac protection in different
studies using either MCT or hypoxia, it seems that eccentric exercise (running in a
treadmill with a negative slope), despite being safe in PAH, does not improve RV
function [ 34 ]. Future studies should address the impact of different modalities and
intensities in order to determine which exercise program provides better benefits.
Another important aspect to consider is the time point where ExT is initiated.Table 17.2 and Fig. 17.1 show that while starting ExT before [ 24 , 29 , 31 ] or at early
disease stages of PAH [ 25 , 27 , 32 ] may be required for maximal benefits, beginning
in latter stages may limit [ 27 ] or even worsen cardiac function [ 33 ]. Three possible
implications emerge from these observations. First, ExT can be useful as a preven-
tive strategy for the management of the disease since its early diagnosis and could
be prescribed to those patients with less severe hemodynamic derangement and
right ventricle dysfunction. Second, this could be particularly important for those at
increased risk, such as in the familial form of PAH. The familial form is inherited as
an autosomal dominant trait and is associated with a pattern of “genetic anticipa-
tion,” a worsening of disease in subsequent generations, manifested by greater
severity or earlier onset [ 9 ]. Finally, clinical trials looking at the impact of exercise
Fig. 17.1 Distribution of exercise sessions in relation to the time point where the stimulus for
Pulmonary Arterial Hypertension was induced
17 Exercise Training in Pulmonary Hypertension and Right Heart Failure: Insights...