Exercise Program Improves Functional Capacity and Quality of Life in Uncorrected Atrial Septal Defect-Associated Pulmonary Arterial Hypertension: A Randomized-Control Pilot Study

Objective To assess the effect of combined hospital and home-based exercise programs on functional capacity and quality of
life (QoL) among uncorrected atrial septal defect-associated pulmonary arterial hypertension (ASD-PAH) patients.
Methods This study was a randomized controlled trial with uncorrected ASD-PAH patients as the subjects. They were
allocated randomly into control and exercise groups. Exercise group subjects performed hospital and home-based exercise
programs, completing baseline 6-minute walking test (6MWT) and EQ-5D-3L QoL test (Utility Index and EQ-VAS scores), and
were followed up for 12 weeks. The primary outcomes were 6MWT distance and EQ-5D-3L score at week 12. The N-terminal
pro B-type natriuretic peptide (NT-proBNP) level was also assessed. A repeated-measure ANOVA was performed to detect end-
point differences over time.
Results The exercise group contained 20 subjects and control group contained 19. In total, 19 exercise group subjects and
16 control group subjects completed the protocol. The 6MWT distance, Utility Index score, and EQ-VAS score incrementally
improved significantly in the exercise group from baseline until week 12, with mean differences of 76.7 m (p<0.001), 0.137
(p<0.001) and 15.5 (p<0.001), respectively. Compared with the control group, the exercise group had significantly increased
6MWT distance and utility index score at week 12. The EQ-VAS score increased in the exercise group at week 12. The NT-
proBNP level decreased at week 12 in the exercise group.
Conclusion Combined hospital and home-based exercise program added to PAH-targeted therapy, improving functional
capacity and QoL in uncorrected ASD-PAH patients.
Keywords Heart septal defects, Atrial, Pulmonary arterial hypertension, Exercise therapy, Quality of life, Physical functional
performance