Skip to main content

Advertisement

SpringerLink
Log in

Exercise Capacity Affects Quality of Life in Patients with Pulmonary Hypertension

  • Published:
Lung Aims and scope Submit manuscript

Abstract

Background

The objective of this prospective study was to evaluate the impact of exercise capacity, mental disorders, and hemodynamics on quality-of-life (QoL) parameters in patients with pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH).

Methods

Sixty-three patients with invasively diagnosed PAH (n = 48) or CTEPH (n = 15) underwent a broad panel of assessments, including cardiopulmonary exercise testing (CPET), 6-minute walking distance (6-MWD), World Health Organization functional class (WHO-FC), and assessment of hemodynamics. QoL was evaluated by the 36-item Medical Outcome Study Short Form Health Survey Questionnaire (SF-36). Exercise capacity, hemodynamics, age, gender, and mental disorders (anxiety and depression) were assessed for association with QoL subscores by uni- and multivariate regression analyses.

Results

Exercise capacity, WHO-FC, oxygen therapy, symptoms of right heart failure, right atrial pressure, and mental disorders were significantly associated with QoL (p < 0.05). In the stepwise backward selection multivariate analysis, depression remained an independent parameter in seven of eight subscales of the SF-36. Furthermore, peak oxygen uptake (peakVO2) during CPET, 6-MWD, anxiety, long-term oxygen therapy, right heart failure, and age remained independent factors for QoL. Hemodynamic parameters at rest did not independently correlate with any domain of the SF-36 QoL subscores.

Conclusions

Mental disorders, exercise capacity, long-term oxygen therapy, right heart failure, and age play important role in the quality of life in patients with PAH and CTEPH.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Simonneau G, Robbins IM, Beghetti M, Channick RN, Delcroix M, Denton CP et al (2009) Updated clinical classification of pulmonary hypertension. J Am Coll Cardiol 54(1):S43–S54. doi:10.1016/j.jacc.2009.04.012

    Article  PubMed  Google Scholar 

  2. Galiè N, Hoeper MM, Humbert M, Torbicki A, Vachiery JL, Barbera JA et al (2009) Guidelines for the diagnosis and treatment of pulmonary hypertension. Eur Respir J 34(6):1219–1263. doi:10.1183/09031936.00139009

    Article  PubMed  Google Scholar 

  3. Condliffe R, Kiely DG, Gibbs JSR, Corris PA, Peacock AJ, Jenkins DP et al (2009) Prognostic and aetiological factors in chronic thromboembolic pulmonary hypertension. Eur Respir J 33(2):332–337. doi:10.1183/09031936.00092008

    Article  PubMed  CAS  Google Scholar 

  4. Saouti N, de Man F, Westerhof N, Boonstra A, Twisk J, Postmus PE et al (2009) Predictors of mortality in inoperable chronic thromboembolic pulmonary hypertension. Respir Med 103(7):1013–1019. doi:10.1016/j.rmed.2009.01.017

    Article  PubMed  Google Scholar 

  5. Wensel R, Opitz CF, Anker SD, Winkler J, Höffken G, Kleber FX et al (2002) Assessment of survival in patients with primary pulmonary hypertension: importance of cardiopulmonary exercise testing. Circulation 106(3):319–324. doi:10.1161/01.CIR.0000022687.08568.2A

    Article  PubMed  Google Scholar 

  6. Cenedese E, Speich R, Dorschner L, Ulrich S et al (2006) Measurement of quality of life in pulmonary hypertension and its significance. Eur Respir J 28:808–815. doi:10.1183/09037936.06.00130405

    Article  PubMed  CAS  Google Scholar 

  7. Grünig E, Lichtblau M, Ehlken N, Ghofrani HA et al (2012) Safety and efficacy of exercise training in various forms of pulmonary hypertension. Eur Respir J 40:84–92. doi:10.1183/09031936.00123711

    Article  PubMed  Google Scholar 

  8. Grünig E, Ehlken N, Ghofrani A, Staehler G et al (2011) Effect of exercise and respiratory training on clinical progression and survival in patients with severe chronic pulmonary hypertension. Respiration 81:394–401. doi:10.1159/000322475

    Article  PubMed  Google Scholar 

  9. Strange G, Keogh AM, Williams TJ, Wlodaeczyk J, McNeil K, Gabby E (2008) Bosentan therapy in patients with pulmonary arterial hypertension: the relationship between improvements in 6 minute walk distance and quality of life. Respirology 13:674–682. doi:10.1111/j.1440-1843.2008.01326.x

    Article  PubMed  Google Scholar 

  10. Pepke-Zaba J, Beardsworth A, Chan M, Angalakuditi M (2009) Tadalafil therapy and health-related quality of life in pulmonary arterial hypertension. Curr Med Res Opin 25:2479–2485. doi:10.1185/03007990903210066

    Article  PubMed  CAS  Google Scholar 

  11. Simonneau G, Rubin LJ, Galie N, Barst RJ et al (2008) Addition of sildenafil to long-term intravenous epoprostenol therapy in patients with pulmonary arterial hypertension. Ann Intern Med 149:521–530

    Article  PubMed  Google Scholar 

  12. Chua R, Keogh AM, Byth K, O’Loughlin A (2006) Comparison and validation of three measures of quality of life in patients with pulmonary hypertension. Intern Med J 36(11):705–710. doi:10.1111/j.1445-5994.2006.01169.x

    Article  PubMed  CAS  Google Scholar 

  13. Zlupko M, Harhay MO, Gallop R, Shin J, Archer-Chicko C, Patel R et al (2008) Evaluation of disease-specific health-related quality of life in patients with pulmonary arterial hypertension. Respir Med 102(10):1431–1438. doi:10.1016/j.rmed.2008.04.016

    Article  PubMed  Google Scholar 

  14. Löwe B, Gräfe K, Ufer C, Kroenke K, Grünig E, Herzog W et al (2004) Anxiety and depression in patients with pulmonary hypertension. Psychosom Med 66(6):831–836. doi:10.1097/01.psy.0000145593.37594.39

    Article  PubMed  Google Scholar 

  15. McCollister DH, Beutz M, McLaughlin V, Rumsfeld J, Masoudi FA, Tripputi M et al (2010) Depressive symptoms in pulmonary arterial hypertension: prevalence and association with functional status. Psychosomatics 51(4):339–347

    PubMed  Google Scholar 

  16. McHorney CA, Ware JE, Lu JFR, Sherbourne CD (1994) The MOS 36-item short-form Health Survey (SF-36): tests of data quality, scaling assumptions, and reliability across diverse patient groups. Med Care 32(1):40–66. doi:10.1097/00005650-199401000-00004

    Article  PubMed  CAS  Google Scholar 

  17. Bullinger M (1995) German translation and psychometric testing of the SF-36 Health Survey: preliminary results from the IQOLA project. Soc Sci Med 41(10):1359–1366. doi:10.1016/0277-9536(95)00115-N

    Article  PubMed  CAS  Google Scholar 

  18. American Thoracic Society (2002) ATS Statement: guidelines for the six-minute walk test. Am J Respir Crit Care Med 166(1):111–117. doi:10.1164/rccm.166/1/111

    Article  Google Scholar 

  19. Chemla D, Castelain V, Herve P, Lecarpentier Y, Brimioulle S (2002) Haemodynamic evaluation of pulmonary hypertension. Eur Respir J 20(5):1314–1331. doi:10.1183/09031936.02.00068002

    Article  PubMed  CAS  Google Scholar 

  20. Zigmond AS, Snaith RP (1983) The hospital anxiety and depression scale. Acta Psychiatr Scand 67(6):361–370. doi:10.1111/j.1600-0447.1983.tb09716.x

    Article  PubMed  CAS  Google Scholar 

  21. Herrmann C, Buss U, Snaith R (1995) Hospital anxiety and depression scale (HADS-D) (German version). Huber, Bern

    Google Scholar 

  22. Hinz A, Schwarz R (2001) Angst und Depression in der Allgemeinbevölkerung. Psychother Psychosom Med Psychol 51:193–200

    Article  PubMed  CAS  Google Scholar 

  23. Wensel R, Francis DP, Meyer FJ, Opitz CF et al (in press) Incremental prognostic value of cardiopulmonary exercise testing and resting haemodynamics in pulmonary arterial hypertension. Int J Cardiol. doi:10.1016/j.ijcard.2012.03.135

  24. Looper KJ, Pierre A, Dunkley DM, Sigal JJ, Langleben D (2009) Depressive symptoms in relation to physical functioning in pulmonary hypertension. J Psychosom Res 66(3):221–225. doi:10.1016/j.jpsychores.2008.09.014

    Article  PubMed  Google Scholar 

  25. Wittchen HU, Einsle F (2012) Depression, anxiety and somatic complaints - is it all psychosomatic? Medicographia 34(3):307–314

    Google Scholar 

  26. Wilkens H, Grimminger F, Hoeper M, Staehler G, Ehlken B, Plesnila-Frank C et al (2010) Burden of pulmonary arterial hypertension in Germany. Respir Med 104(6):902–910. doi:10.1016/j.rmed.2010.01.002

    Article  PubMed  CAS  Google Scholar 

  27. Shafazand S, Goldstein MK, Doyle RL, Hlatky MA, Gould MK (2004) Health-related quality of life in patients with pulmonary arterial hypertension. Chest 126(5):1452–1459. doi:10.1378/chest.126.5.1452

    Article  PubMed  Google Scholar 

  28. White J, Hopkins RO, Glissmeyer EW, Kitterman N, Elliott CG (2006) Cognitive, emotional, and quality of life outcomes in patients with pulmonary arterial hypertension. Respir Res 7(55):1–10. doi:10.1186/1465-9921-7-55

    Google Scholar 

  29. Parry GD, Cooper CL, Moore JM, Yadegarfar G, Campbell MJ, Esmonde L et al (2012) Cognitive behavioural intervention for adults with anxiety complications of asthma: prospective randomised trial. Respir Med 106(6):802–810. doi:10.1016/j.rmed.2012.02.006

    Article  PubMed  Google Scholar 

  30. Cuijpers P, Muñoz RF, Clarke GN, Lewinsohn PM (2009) Psychoeducational treatment and prevention of depression: the “coping with depression” course thirty years later. Clin Psychol Rev 29(5):449–458. doi:10.1016/j.cpr.2009.04.005

    Article  PubMed  Google Scholar 

  31. Jonkers CCM, Lamers F, Bosma H, Metsemakers JFM, van Eijk JTM (2012) The effectiveness of a minimal psychological intervention on self-management beliefs and behaviors in depressed chronically ill elderly persons: a randomized trial. Int Psychogeriatr 24(2):288–297. doi:10.1017/S1041610211001748

    Article  PubMed  Google Scholar 

  32. Rubenfire M, Lippo G, Bodini BD, Blasi F, Allegra L, Bossone E (2009) Evaluating health-related quality of life, work ability, and disability in pulmonary arterial hypertension: an unmet need. Chest 136(2):597–603. doi:10.1378/chest.08-1260

    Article  PubMed  Google Scholar 

  33. Ganderton L, Jenkins S, McKenna SP, Gain K, Fowler R, Twiss J, Gabbay E (2011) Validation of the Cambridge pulmonary hypertension outcome review (CAMPHOR) for the Australian and New Zealand population. Respirology 16:1235–1240. doi:10.1111/j.1440-1843.2011.02030.x

    Article  PubMed  Google Scholar 

  34. Cima K, Twiss J, Speich R, McKenna SP, Grünig E, Kähler CM, Ehlken N, Treder U, Crawford SR, Huber LC, Ulrich S (2012) The German adaptation of the Cambridge pulmonary hypertension outcome review (CAMPHOR). Health Qual Life 10:110. doi:10.1186/1477-7525-10-110

    Article  Google Scholar 

Download references

Acknowledgments

This study was funded by an unrestricted Grant from the pharmaceutical corporation Bayer Vital GmbH (formerly Schering).

Conflict of interest

The authors have no conflicts of interest to disclose.

Author information

Authors and Affiliations

  1. Department of Internal Medicine I, Carl Gustav Carus University Hospital, Technical University of Dresden, Fetscherstrasse 74, 01309, Dresden, Germany

    Michael Halank, Martin Kolditz & Gert Höffken

  2. Institute of Clinical Psychology and Psychotherapy, Technical University of Dresden, Dresden, Germany

    Franziska Einsle & Gesine Wieder

  3. Department of Nuclear Medicine, Carl Gustav Carus University Hospital of the Technical University of Dresden, Dresden, Germany

    Stephanie Lehman

  4. Department of Internal Medicine, Schwarzwald-Baar Klinikum, Donaueschingen, Germany

    Hinrich Bremer

  5. Department of Internal Medicine B, Ernst-Moritz-Arndt University, Greifswald, Germany

    Ralf Ewert

  6. Department of Respiratory Medicine, Saarland University Hospital, Homburg, Saar, Germany

    Heinrike Wilkens

  7. Division of Internal Medicine, Department of Respiratory Medicine and Gastroenterology, Klinikum Harlaching, Munich, Germany

    F. Joachim Meyer

  8. Centre for Pulmonary Hypertension, Thoraxclinic at University Hospital, Heidelberg, Germany

    Ekkehard Grünig

  9. Department of Pulmonary Medicine, University Hospital, Leipzig, Germany

    Hans-Jürgen Seyfarth

  10. Institute of Psychoanalysis, Psychotherapy and Psychosomatic Medicine, Saarland University Hospital, Homburg, Saar, Germany

    Volker Köllner

  11. Department of Psychosomatic Medicine, Mediclin Bliestal Kliniken, Blieskastel, Germany

    Volker Köllner

Authors
  1. Michael Halank
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Franziska Einsle
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Stephanie Lehman
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Hinrich Bremer
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Ralf Ewert
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Heinrike Wilkens
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. F. Joachim Meyer
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Ekkehard Grünig
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Hans-Jürgen Seyfarth
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Martin Kolditz
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Gesine Wieder
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Gert Höffken
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Volker Köllner
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Michael Halank.

Additional information

M. Halank and F. Einsle contributed equally to this work.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Halank, M., Einsle, F., Lehman, S. et al. Exercise Capacity Affects Quality of Life in Patients with Pulmonary Hypertension. Lung 191, 337–343 (2013). https://doi.org/10.1007/s00408-013-9472-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00408-013-9472-6

Keywords

Search

Navigation