Exercise Rehab Helpful After Pulmonary Embolism

Exercise rehabilitation may confer functional improvements to patients struggling to breathe following a pulmonary embolism (PE), a randomized controlled trial found.

Patients with persistent dyspnea in the two-center study who were assigned to rehabilitation scored significantly higher on the Incremental Shuttle Walk Test (ISWT) compared with controls (difference 53 m, 95% CI 17.7-88.3, P=0.0035), reported Øyvind Jervan, MD, of the Østfold Hospital Trust in Grålum, Norway, and coauthors.

Whether that between-group difference "is clinically relevant, can be debated," the group wrote in CHEST, but added that "previous studies have pointed at mean group differences of 40-62 m as clinically meaningful."

Rehabilitation patients also had higher scores on the Pulmonary Embolism Quality of Life questionnaire (PEMB-QoL) than their control group counterparts (difference -0.04, 95% CI -0.09-0.00, P=0.041).

"In patients with persistent dyspnoea following PE, those who underwent rehabilitation had better exercise capacity at follow-up than those who received usual care," the group wrote. "Rehabilitation should be considered in patients with persistent dyspnoea following PE, though further research is needed to assess the optimal patient selection, timing, mode and duration of rehabilitation."

There were no significant differences seen between the two groups on the Endurance Shuttle Walk Test (ESWT), the generic quality of life (QoL) test, or in their dyspnea scores.

"This is to date the largest randomized trial assessing the effect of rehabilitation after PE, demonstrating a positive effect on exercise capacity and QoL in subjects with persistent dyspnoea," Jervan and colleagues wrote. "Several recent studies have shown promising results of rehabilitation after PE. However, most of these studies have been small or have not included a control group, and there is great variation regarding time, mode, and duration of intervention. The present study adds to the growing evidence of the benefits of rehabilitation after PE."

A 2020 study also attested to the safety of exercise post-PE, demonstrating the importance of physical activity following PE.

Due to the limited evidence, current guidelines from the European Respiratory Society and the American Society of Hematology make passing mention of personal exercise following acute PE. Some may recommend that exercise begin slowly and gently, comprising mainly walking, and gradually build in the weeks post-PE, according to the North American Thrombosis Forum.

In the present study, rehabilitation consisted of two 1-hour exercise sessions per week, for a total of 8 weeks. Rehabilitation sessions featured a warm-up, endurance training, resistance training, and a cool-down at a supervised outpatient location. An at-home exercise regimen was also given to patients, to complete one to two times a week. Patients also attended a single educational session that discussed PE and its associated anatomy and physiology.

A total of 211 patients were included in the study. Median patient age was 57 years, and the study population was 56% male.

Dividing patients by the time from PE diagnosis, groups starting rehabilitation 6 to 12 months post-PE and those diagnosed at a time earlier than that (up to 72 months post-PE) both showed significant improvements on the ISWT.

Researchers did note that patients in the rehabilitation group were somewhat younger than those in the control group (55 vs 60 years), but had worse performance on their baseline ISWT (680 vs 730 m). ISWT scores improved to 790 and 760 m, respectively, following the intervention.

The researchers who conducted the ESWT and ISWT were blinded to the patient's assigned treatment group.

However, the authors noted that ISWT data were "subject to a considerable ceiling effect" and that patients had varying time differences between their PE and the start of the trial. Several patients either did not complete or withdrew from the study.

Investigators also included possible gaps in hospital records, limits on the types of rehabilitation used, and sample size as limitations of the study.

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