121 Effect of UK COVID-19 public health measures on activity and quality of life in patients with pulmonary arterial hypertension

Background: Limitation of physical activity has been widely enforced to reduce COVID-19 transmission, however it is a critical measure in the prevention of cardiovascular disease. In patients with pulmonary arterial hypertension (PAH), exercise capacity relates to clinical outcomes and exercise training improves cardiopulmonary function. Here, we describe the temporal effects of UK government restriction measures on daily activity and quality of life (QoL) in patients with PAH. Methods: Patients Enrolled in The United Kingdom National Cohort Study of Idiopathic and Heritable PAH Study were implanted with insertable cardiac monitors (LinQ, Medtronic) in the clinic setting. Data were transmitted and reviewed in accordance with established clinical protocols. Standard questionnaires were administered remotely to assess QoL (EmPHasis-10), anxiety (GAD-7) and depression (PHQ-9). Results: Median age of the 26 patients was 49 years, 23 (88%) were female and 5 (19%) had heritable PAH with mutations in BMPR2. At enrolment 10 (38.5%) patients were low risk (<5% 1-year mortality), 10 (38.5%) were intermediate risk (5-10%) and 6 (23%) were high risk (>10%). The mean duration from insertion to census date was 21.1 weeks (SD 5.7). No complications were reported. Completeness of remote monitoring data was 100%. Following lockdown, mean activity was reduced compared to pre-lockdown levels (3.16 vrs 2.68 hours/day, -0.48 hours, 95%CI -0.27- -0.69, 16%, p<0.0001). This reduction was present each week following lockdown. Although not statistically significant the greatest reduction in activity was observed in patients in the low-risk group. Following lockdown QoL was reduced (26 (18-38) vrs 32 (17-47), p<0.01) and anxiety (1 (0-9) vrs 10 (5-18), p<0.001) and depression scores increased (3 (1-16) vrs 11 (3-17), p<0.001) compared to pre-lockdown levels. No change in day or night heart rate, or heart rate variability was observed and no patients developed COVID-19. Conclusion: In this cohort of patients with PAH, protective health measures were effective in preventing COVID-19 in patients thought to be highly vulnerable. However, these measures resulted in reduced daily activity and QoL and were associated increased anxiety and depression indicators.

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EXPRESS: Association of daily physical activity with psychosocial aspects and functional capacity in patients with Pulmonary Arterial Hypertension: a cross-sectional study

Pulmonary Circulation ◽

10.1177/2045894021999955 ◽

2021 ◽

pp. 204589402199995

Author(s):

Layse Nakazato Lima ◽

Felipe Mendes ◽

Ilma Paschoal ◽

Daniela Oliveira ◽

Marcos Mello Moreira ◽

...

Keyword(s):

Quality Of Life ◽

Physical Activity ◽

Pulmonary Arterial Hypertension ◽

Arterial Hypertension ◽

Functional Capacity ◽

Daily Physical Activity ◽

Cross Sectional ◽

Pulmonary Arterial ◽

The Mean

Pulmonary arterial hypertension (PAH) impairs exercise tolerance and daily physical activity (PA). Aside from the hemodynamic limitations, physical, cognitive and emotional factors may play a relevant and as yet unexplored role. We investigated whether there is an association between the PA level and psychological disorders, health-related quality of life, and daily activities. We also searched for an association of the PA level with clinical factors and functional capacity. This was an analytical, cross-sectional, observational study conducted in a Brazilian University Hospital. Twenty stable PAH subjects wore an accelerometer for a week and completed an activity diary. They answered the quality of life questionnaire (SF-36), as well as the anxiety and depression scale (HADS), and the Manchester Respiratory Activities of Daily Living questionnaire (MRADL). Transthoracic echocardiography, the 6-Minute walk test (6MWT), the 1-minute sit-to-stand test (STST), and spirometry were performed. For statistical analysis we used Chi-square tests or Fisher's test as appropriate and the Mann-Whitney test to compare numerical values between two groups. The relationship between the parameters was assessed using the Spearman correlation test. The mean age was 44.3 years, 80% were women, 80% had idiopathic PAH, and 20% had connective tissue disease . The mean daily step count was 4,280 Â± 2,351, and the mean activity time was 41.6 Â± 19.3 minutes. The distance covered (6MWT) was 451.5 m, and the number of movements (1-STST) was 23.8. Thirty percent scored positive for anxiety, and 15% for depression (HADS). There was a significant correlation between accelerometer data and walking distance (6MWT), number of movements (1-STST), level of daily physical activity (MRADL), and depression symptoms. Our findings support the hypothesis that other aspects beyond physical and hemodynamic ones might impact the daily physical activity of patients with PAH.

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Effect of Pulmonary Arterial Hypertension-Specific Therapies on Health-Related Quality of Life

CHEST Journal ◽

10.1378/chest.13-2634 ◽

2014 ◽

Vol 146 (3) ◽

pp. 686-708 ◽

Cited By ~ 28

Author(s):

Gilles Rival ◽

Yves Lacasse ◽

Sylvie Martin ◽

Sébastien Bonnet ◽

Steeve Provencher

Keyword(s):

Quality Of Life ◽

Pulmonary Arterial Hypertension ◽

Arterial Hypertension ◽

Health Related Quality ◽

Related Quality ◽

Health Related ◽

Pulmonary Arterial

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A prescribed walking regimen plus arginine supplementation improves function and quality of life for patients with pulmonary arterial hypertension: a pilot study

Pulmonary Circulation ◽

10.1177/2045893217743966 ◽

2017 ◽

Vol 8 (1) ◽

pp. 204589321774396 ◽

Cited By ~ 5

Author(s):

Mary Beth Brown ◽

Attie Kempf ◽

Catherine M. Collins ◽

Gary M. Long ◽

Matthew Owens ◽

...

Keyword(s):

Quality Of Life ◽

Pulmonary Arterial Hypertension ◽

Arterial Hypertension ◽

Current Evidence ◽

Proof Of Concept ◽

Concept Study ◽

Sf 36 ◽

Pulmonary Arterial ◽

Arginine Supplementation

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), VO2max (increased by 2 ± 0.7 mL/kg/min, P = 0.02), time-to-VO2max (increased by 2.5 ± 0.6 min, P = 0.001), VO2 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.

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