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Exercise and diet improve functional status in PAH

Presented by
Dr Gustavo Heresi, Cleveland Clinic, OH, USA
ATS 2024
A 12-week outpatient cardiovascular exercise program together with a diet improved right ventricular function, exercise capacity, and quality-of-life in patients with pulmonary arterial hypertension (PAH).

“PAH is a cardiopulmonary disease with no cure,” Dr Gustavo Heresi (Cleveland Clinic, OH, USA) started his presentation. “This condition, with pulmonary vasoconstriction, vascular remodelling, fibrosis, inflammation, thrombosis, and right ventricular failure, is associated with high 5-year mortality rates.” He further explained that low HDL cholesterol and glucose intolerance are prevalent in patients with PAH. “And patients with these attributes have worse survival outcomes [1].” Dr Heresi and colleagues hypothesised that a diet and exercise intervention would improve insulin sensitivity and right ventricular function in patients with PAH [2]. The PHINE study (NCT03288025) randomised 30 patients with PAH 1:1 to standard-of-care or a supervised exercise protocol, 5 times per week, plus weekly diet counselling (LoGIx/Mediterranean). The primary endpoint was insulin sensitivity at 12 weeks.

The investigators observed no differences between the 2 study arms regarding insulin sensitivity or right ventricular strain. They did however notice an improved right ventricular function measured by tricuspid annular plane systolic excursion (TAPSE)– in the intervention arm (delta 0.3 cm; P=0.028). Furthermore, the intervention group outperformed the control group for peak VO2 (delta 3.7 mL/kg/min; P=0.0004) and 6-minute walking distance (delta 37 m; P=0.064). “The participants in the intervention arm also reported a significantly improved PAH-related quality-of-life and more frequently displayed an improvement in NYHA functional class,” mentioned Dr Heresi.

“We noticed various health-related improvements in patients with PAH who followed an exercise and diet intervention. Notably, these improvements were independent of insulin sensitivity, suggesting that insulin resistance is not a pathobiological pathway in PAH,” argued Dr Heresi. “The findings of this study illustrate that exercise and diet should be incorporated in the PAH treatment armamentarium.”

    1. Heresi GA, et al. Am J Respir Crit Care Med. 2010;182(5):661-668.
    2. Heresi GA, et al. Pulmonary arterial hypertension improvement with nutrition and exercise (PHINE): a randomized controlled trial. Late-breaking abstracts: science that will impact clinical care. ATS 2024, 17–22 May, San Diego, USA.

Medical writing support was provided by Robert van den Heuvel.

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