| Abstract | Uvod: Pacijenti s plućnom hipertenzijom imaju smanjen funkcionalni kapacitet i kvalitetu života. Rezultati istraživanja u zadnjem desetljeću iskazala su benefit nadzirane i monitorirane kardiopulmonalne rehabilitacije. Mnoga istraživanja objavila su da je kardiopulmonalna rehabilitacija siguran postupak koja povećava funkcionalni kapacitet pacijentima i kvalitetu života.
Metode: Pregledni rad proveden je pretragom biomedicinske baze Medline (PubMed, PubMed Central), multidisciplinarne baze Scopus, Cochrane Database i Hrčak. Pretraživana je literatura od 2014. godine na dalje. Zadnji datum pretrage bio je 27.07.2024. 11 istraživanja uključeno je u pregledni rad. Podaci primarnih i sekundarnih ishoda izvučeni su iz 8 randomizirana kontrolirana istraživanja. Primarni ishodi su šest minutni test hoda, maksimalna snaga inspiratorne muskulature i kvaliteta života. Sekundarni ishodi su nalaz transezofagijskog ultrazvuka i biomarker srčanog popuštanja. Ukupan broj sudionika je 294, 153 pacijenata koji su provodili kardiopulmonalnu rehabilitaciju spram 141 pacijenata kontrolne grupe. Srednja dobna vrijednost je bila od 37 do 57 godina, većina sudionika je ženskog roda, plućne arterijske hipertenzije. Program kardiopulmonalne rehabilitacije je provedena u bolničkim i van bolničkim uvjetima, kontrolna skupina nije provodila vježbe. Najčešće je uključivala aerobne vježbe, vježbe snage i inspiratorno mišićni trening. Duljina trajanja programa bila je od 6 tjedana do 6 mjeseci.
Rezultati: Primarni ishodi: 6MWD mean promjena interventne grupe (n = 118) bila je +35 m, (24 - 49 m) vs. mean promjena kontrolne grupe (n = 106) - 21 m (- 23 - 15 m) 6 istraživanja, 224 sudionika; niske razine dokaza. Mean promjena Pimax u interventnoj grupi (n = 48) bila je +26,31 cmH2O (17,8 - 35cmH2O), mean promjena u kontrolnoj grupi (n = 43) bila je +4 cmH2O (3 – 5,41 cmH2O), 3 istraživanja, 91 sudionika; niske razine dokaza. HRQoL: QoL SF-36 mentalna komponenta (MCS), mean promjena interventne grupe (n = 89) bila je 4 bodova (3 - 5) vs. mean promjena u kontrolnoj grupi (n=79) bila je - 3,1 bodova. QoL SF-36 fizička komponenta (PCS), interventna grupa (n = 89) imala je povećanje za 6,85 bodova (4 – 9,7) vs. mean promjena u kontrolnoj grupi (n = 79) bila je 0,5 - 2 bodova, 4 istraživanja, 168 sudionika; razina dokaza umjerene izvjesnosti. NHP Mean promjena u interventnoj grupi (n = 14) bila je - 2,63 bodova vs. kontrolne (n = 15) mean promjena bila je 0,69 bodova, 1 istraživanje, 29 sudionika; umjerena razina dokaza. IPAQ Mean promjena interventne grupe (n
= 15) bila je 157 bodova vs. kontrolne grupe (n = 12), - 22,75 bodova i MLHFQ mean promjena interventnoj grupi bila je - 0,87 bodova vs. mean promjena u kontrolnoj grupi bila je - 2,91 bodova, 1 istraživanje, 27 sudionika; umjerena razina dokaza. Sekundarni ishodi: ultrazvuk srca (TTE) mean promjena RVSP interventne grupe (n=35) bila je 2,9 mmHg (- 12,05 – 17,92 mmHg) vs. kontrolne grupe (n = 35), - 5,7 mmHg, 3 istraživanja, 70 sudionika; niska razina dokaza. Mean promjena SPAP u interventnoj grupi (n=12) bila je – 4mmHg vs. kontrolne (n=12) bila je – 11mmHg i mean promjena LVEF(%), RVEF (%), LVEDD (mm), LVESD (mm) obiju skupina bile su bez značajne promjene, 1 istraživanje, 24 sudionika; niska razina dokaza. Mean promjena interventne grupe (n = 20), EF bila je + 17,74 (%), 1 istraživanje, 20 sudionika; niska razina dokaza. Mean promjena NT proBNP interventne grupe (n = 65) bila je - 38 pg/mL vs. mean promjena kontrolne (n = 57), + 104,5 pg/mL, 2 istraživanja, 122 sudionika; niska razina dokaza.
Zaključak: Kod pacijenata s plućnom hipertenzijom, nadzirana kardiopulmonalna rehabilitacija mogle bi povećati kapacitet vježbanja, snagu inspiratorne muskulature i poboljšati mentalnu i fizičku komponentu kvalitete života. Kardiopulmonalne vježbe na biciklu/traci mogle bi smanjiti vrijednosti RVSP (mmHg) kod pacijenata s plućnom hipertenzijom i povećati EF (%) s kroničnim zatajenjem srca. Kardiopulmonalne vježbe mogla bi smanjiti rezultat biomarkera srčanog popuštanja. Sigurnost dokaza je smanjena zbog nedosljednosti u podacima i pristranosti izvedbe. Potrebna su daljnja istraživanja koja bi zahvatila sve klasifikacije plućne hipertenzije, uzrokovane bolestima lijeve strane srca, bolesti pluća odnosno hipoksije i plućnu hipertenziju s više ozbiljnih oboljenja. |
| Abstract (english) | Introduction: Patients with pulmonary hypertension have reduced functional capacity and quality of life. Research results in the last decades have shown the benefits of supervised and monitored cardiopulmonary rehabilitation. Many studies have reported that a cardiopulmonary rehabilitation is a safe procedure that increases patient functional capacity and quality of life.
Methods: The review was conducted by searching the biomedical database Medline (Pubmed, Pubmed Central), the multidisciplinary database Scopus, the Cochrane Database and Hrčak. 11 studies were included in the review. Data on primary and secondary outcomes were extracted from 8 randomised controlled trials. Primary outcomes were six minute walk test, maximal inspiratory power and quality of life. Secondary outcomes were transthoracic echocardiogram and N-terminal-pro brain natriuretic peptide. The total number of participants were 294, 153 patients who performed cardiopulmonary rehabilitation to 141 patients of control group. The mean age was from 37 to 57 years, most of participants were female, pulmonary arterial hypertension. The cardiopulmonary rehabilitation program was carried in-hospital and out hospital conditions, the control group did not perform exercises. It most often included aerobic exercises, strength exercises and inspiratory muscle training. The duration of the program was from 6 weeks to 6 months.
Results: Primary outcomes: 6MWD mean change in the intervention group (n = 118) + 35 m, (24 – 49 m) vs. mean change of the control group (n = 106) was -21 m (- 23 – 15 m) 6 studies, 224 participants; low level of evidence. Pimax mean change in the intervention group (n = 48) was + 26,31 cmH20 (17,8 - 35cmH20), the mean change in the control group (n = 43) was + 4cmH20 (3 - 5,41cmH20), 3 studies, 91 participants: low level of evidence. HRQoL: QoL SF-36 mental component (MCS), mean change of intervention group (n = 89) intervention group was 4 points (3 - 5) vs. mean change in the control group was - 3,1 point. QoL SF-36 physical component (PCS), intervention group (n = 89) was 6,85 points (4 - 9,7) vs. mean change in the control group (n = 79) was 0,5 -2 points, 4 studies, 168 participants: moderate certainty level of evidence. NHP The mean change in the intervention group (n = 14) was -2,63 points vs. the
control group (n = 15), the mean change was 0,69 points, 1 study, 29 participants; moderate level of evidence. IPAQ mean change in the intervention group (n = 15) was 157 mean change in the control group (n = 12) was – 22,75 points and MLHFQ mean change in the intervention group was -0,87 points vs. mean change in the control group was -2,91 points, 1 study, 27 participants; moderate level of evidence. Secondary outcomes: heart ultrasound (TTE) mean change in RVSP intervention group (n = 35) was 2,9 mmHg (- 12,05 – 17,92 mmHg) vs. control group (n = 35), - 5,7 mmHg, 3 studies, 70 participants; low level of evidence. Mean change SPAP in the intervention group (n= 12) was – 4 mmHg vs. control (n=12) – 11 mmHg and mean change mean LVEF (%), RVEF (%), LVEDD (mm), LVESD (mm) were for both groups without significant changes, 1 trial, 24 participants; low level of evidence. Mean change of the intervention group (n = 20). EF was + 17,74 (%), 1 study, 20 participants; low level of evidence. Mean change of NT proBNP intervention group (n = 65) was -38 pg/mL vs. mean change in the control (n = 57), + 104,5 pg/mL, 2 studies, 122 participants: low level of evidence.
Conclusion: In patients with pulmonary hypertension supervised cardiopulmonary rehabilitation could increase exercise capacity, inspiratory muscle strength and improve mental and physical components quality of life. Cardiopulmonary exercise trainig bike/tread could reduce RVSP (mmHg) values in patients with pulmonary hypertension, increase EF (%) in patients with chronic heart failure. Cardiopulmonary exercise trainig could reduce N-terminal-pro brain natriuretic peptide. The certainity of evidence is reduced due to data inconsistencies and performance bias. Further research is needed that would cover all classifications of pulmonary hypertension, caused by diseases of the left side of heart, lung diseases or hypoxia and pulmonary hypertension with more serious diseases. |
