SPC365

Reclaiming function: functional and prognostic gains through cardiac rehabilitation in pulmonary hypertension

Session: Sessão de Comunicações Orais 08 – Reabilitação Cardíaca como terapia: recuperação funcional na doença cardiovascular avançada
Speaker: João Martins Neves

Congress: CPC 2026
Topic: J. Preventive Cardiology
Theme: 29. Rehabilitation and Sports Cardiology
Subtheme: 29.2 Cardiovascular Rehabilitation
Session Type: Comunicações Orais
FP Number: ---
Authors: João Martins Neves; Daniel Inácio Cazeiro; Gisela Afonso; Inês Aguiar-Ricardo; Pedro Alves da Silva; Nelson Cunha; Rui Plácido; Nuno Lousada; Sandra Miguel; Fausto J. Pinto; Ana Abreu

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000"><strong>Introduction:</strong></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000">Pulmonary hypertension (PH) is associated with reduced exercise tolerance and substantial morbidity. Although exercise training is recommended in PH management, the benefits of structured cardiac rehabilitation (CR) on clinical and functional outcomes remain to be fully explored.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000"><strong>Purpose:</strong></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000">To assess the impact of a structured cardiac rehabilitation program on functional performance, biomarker profiles, and clinical outcomes in patients with pulmonary hypertension</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000"><strong>Methods:</strong></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000">Prospective observational single-center study including patients with PH enrolled in a CR program between 2015 and 2025. The program comprised twice-weekly, low-to-moderate&ndash;intensity supervised exercise sessions complemented by multidisciplinary evaluations from cardiologists and physiatrists. Clinical, echocardiographic, and functional parameters were collected. Outcomes included all-cause and cardiovascular mortality, as well as cardiovascular hospitalizations.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000"><strong>Results:</strong></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000">A total of 91 patients were included (mean age 60.5?&plusmn;?15.0 years; 64.8% female). The predominant PH groups were Group 4 (37.9%) and Group 1 (31.0%). At baseline, 31.9% were on monotherapy, 27.5% on dual therapy, and 9.9% on triple therapy. Median NT-proBNP was 648?pg/mL [231&ndash;1832] and over half of the cohort did not require supplemental oxygen (54.9%).</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000">The program was associated with significant improvements in functional capacity, including 6MWT (282.3?&plusmn;?122.0?m to 360.5?&plusmn;?111.7?m, p?&lt;?0.001), IPAQ (0 [0-837] to 870 [480-870], p?&lt;?0.001), TUG (10.7 [8.7-14.6] to 10.4 [8.5-12.9], p?=?0.026), FICSIT (18.3&plusmn;7.2 to 21.5&plusmn;6.1, p?=?0.006), and muscle strength in both upper (13.0&plusmn;4.1 to 18.1&plusmn;5.1, p?&lt;?0.001) and lower limbs (11.9&plusmn;4.1 to 14.9&plusmn;4.1, p?=?0.001), as well as a reduction in NT-proBNP levels (513.5 [157.5-513.5] to 290 [126.5-290], p?=?0.048). Among echocardiographic parameters, only PSAP improved significantly (71.1?&plusmn;?25.6?mmHg to 58.0?&plusmn;?19.1?mmHg, p?=?0.002)</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000">Over a mean follow-up of 4.2 &plusmn; 3.0 years, 30 deaths (12 cardiovascular) and 45 hospitalizations (32 cardiovascular) occurred. Patients in the lowest tertile of post-CR 6-minute walk distance experienced significantly higher mortality than those in the middle and upper tertiles (p 0.025), reinforcing the established role of 6MWD as a prognostic marker in pulmonary hypertension (Figure 1) and the importance of functional gains in this population.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000"><strong>Conclusions:</strong></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000">Structured cardiac rehabilitation is a safe and effective intervention that yields meaningful improvements in functional capacity and biomarkers in patients with pulmonary hypertension. These findings align with growing evidence supporting exercise-based interventions in PH and underscore post-rehabilitation 6MWD as a robust tool for risk stratification.</span></span></span></p>

<p>&nbsp;</p>