Exercise for Pulmonary Arterial Hypertension

Overseen By Claire E Child, DPT, MPH

Age: 18+

Sex: Any

Trial Phase: Phase 3

Sponsor: University of Washington

Must be taking: PAH medications

Must not be taking: Intravenous inotropes

Disqualifiers: Hypertension, Liver disease, Heart failure, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Pivotal Trial (Near Approval) This treatment is in the last trial phase before FDA approval

Prior Safety Data This treatment has passed at least one previous human trial

Compensation: Varies

Number of Visits: Unknown

Duration: 24 weeks

10 Participants Needed

Trial Summary

Will I have to stop taking my current medications?

The trial requires that you continue taking your current medications for pulmonary arterial hypertension (PAH) throughout the study.

What data supports the effectiveness of the treatment Home exercise program for Pulmonary Arterial Hypertension?

Research shows that both home-based and supervised exercise programs can improve exercise capacity, quality of life, and symptoms in patients with pulmonary arterial hypertension. Although most studies focus on supervised programs, home-based exercise has also been shown to have positive effects on function and quality of life. ^{1 2 3 4 5}

Is exercise safe for people with pulmonary arterial hypertension?

Research shows that exercise programs, when carefully supervised and monitored, are generally safe for people with pulmonary arterial hypertension. Studies have reported improvements in symptoms and quality of life without significant adverse events. ^{3 6 7 8 9}

How does the home exercise program treatment for pulmonary arterial hypertension differ from other treatments?

The home exercise program for pulmonary arterial hypertension is unique because it focuses on individually tailored exercises that patients can do at home, improving their exercise capacity and daily physical activity. Unlike traditional medical treatments, this approach emphasizes rehabilitation and long-term care, offering a new way to enhance quality of life and functional capacity for patients. ^{3 10 11 12 13}

What is the purpose of this trial?

Ten patients with PAH who are stable and eligible to initiate sotatercept therapy will participate in a 26 week study that consists of a 24-week intervention period where patients will receive complimentary sotatercept as prescribed, plus a tailored, progressive home exercise program with wrist-worn fitness tracker and oxygen saturation monitoring.

Research Team

Mary Beth Brown, PT, PhD

Principal Investigator

University of Washington

Eligibility Criteria

This trial is for adults over 18 with Pulmonary Arterial Hypertension (PAH) who are stable on PAH therapy for more than 90 days and need to start sotatercept treatment. Participants must be able to follow the study schedule, consent to it, and engage in a home exercise program. Excluded are those with other types of pulmonary hypertension, certain heart conditions, uncontrolled high blood pressure, recent serious cardiovascular events or procedures.

Inclusion Criteria

Baseline RHC documenting minimum PVR of ≥ 5 WU and PCWP or left ventricular end-diastolic pressure of ≤ 15 mmHg

Ability to adhere to study visit schedule and understand and comply with all protocol requirements

Ability to understand and provide written informed consent

Exclusion Criteria

My condition is classified under PH WHO Groups 2, 3, 4, or 5.

Baseline platelet count < 50,000/mm3

Pregnant or breastfeeding females

Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Participants receive sotatercept therapy and engage in a tailored, progressive home exercise program with wrist-worn fitness tracker and oxygen saturation monitoring

24 weeks

Baseline and final in-person visits, remote monitoring at two interim assessment timepoints

Follow-up

Participants are monitored for safety and effectiveness after treatment

4 weeks

Long-term follow-up

Measurement fidelity for the innovative 'remote Six Minute Walk Test (6MWT)'

18 months

Treatment Details

Interventions

• Home exercise program

Trial Overview The study tests a combination of sotatercept medication and a tailored home exercise program monitored remotely using fitness trackers and oxygen saturation devices over 24 weeks. The aim is to see how this combined approach affects patients with PAH.

Participant Groups

Group I: Exercise Arm Experimental Treatment 1 Intervention

Patients with PAH on sotatercept plus a tailored, progressive home exercise program with wrist-worn fitness tracker and oxygen saturation monitoring

Who Is Running the Clinical Trial?

University of Washington

Lead Sponsor

Trials

1,858

Recruited

2,023,000+

Findings from Research

A 12-week text message-based intervention significantly increased daily step counts in patients with pulmonary arterial hypertension (PAH), with an average increase of 1,409 steps compared to a decrease of 149 steps in the control group.

The intervention also led to improvements in quality of life and reductions in visceral fat, suggesting that mobile health strategies can effectively promote physical activity in PAH patients, although no significant change was observed in the six-minute walk test.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A Mobile Health Intervention to Increase Physical Activity in Pulmonary Arterial Hypertension. Hemnes, AR., Silverman-Lloyd, LG., Huang, S., et al.[2022]

In a study of 30 patients with pulmonary arterial hypertension (PAH), both hospital-based and home-based cardiopulmonary rehabilitation programs did not show significant improvements in functional status, quality of life, depression severity, or hemodynamic parameters after eight weeks.

The findings suggest that short-term cardiopulmonary rehabilitation may not be effective for patients with PAH, indicating a need for longer rehabilitation programs to potentially achieve better outcomes.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Effects of cardiopulmonary rehabilitation on pulmonary arterial hypertension: A prospective, randomized study. Karapolat, H., Çınar, ME., Tanıgör, G., et al.[2022]

A specialized exercise training and rehabilitation program is recommended as an effective add-on treatment for patients with pulmonary arterial hypertension, showing significant improvements in symptoms, exercise capacity, and quality of life across over 470 patients in various studies.

The safety profile of these exercise programs is acceptable, with some studies indicating excellent survival rates over 1 to 2 years, although most studies had small sample sizes and were not designed to measure long-term clinical outcomes.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Principles of rehabilitation and reactivation: pulmonary hypertension. Marra, AM., Egenlauf, B., Bossone, E., et al.[2015]

A 6-week outpatient exercise training program significantly improved exercise tolerance and health-related quality of life in two individuals with pulmonary arterial hypertension (PAH), with no adverse effects reported.

Both subjects showed notable increases in oxygen consumption and distance walked in the six-minute walk test, indicating enhanced aerobic capacity and overall well-being.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Exercise training in patients with pulmonary arterial hypertension: a case report. Shoemaker, MJ., Wilt, JL., Dasgupta, R., et al.[2021]

A 12-week pilot study involving 16 patients with pulmonary arterial hypertension (PAH) showed that outpatient exercise programs, including multidisciplinary rehabilitation and home walking, may improve hemodynamic function and quality of life.

The study found improvements in right ventricular function, pulmonary artery pressure, and muscle strength, indicating that exercise is feasible and safe for PAH patients, but further research is needed to confirm these benefits due to the small sample size.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The exercise in pulmonary arterial hypertension (ExPAH) study: A randomized controlled pilot of exercise training and multidisciplinary rehabilitation in pulmonary arterial hypertension. Chia, KSW., Shiner, CT., Brown, K., et al.[2022]

A 12-week home-based physiotherapy program significantly improved exercise capacity in patients with pulmonary arterial hypertension (PAH), as evidenced by a notable increase in the 6-minute walk test (6MWT) distance by 51.8 meters after the program and 75.5 meters at a 6-month follow-up.

Participants in the physiotherapy group also showed significant increases in daily physical activity levels, particularly in low-intensity and moderate-intensity activities, while the control group did not experience any improvements.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Individually tailored home-based physiotherapy program makes sustainable improvement in exercise capacity and daily physical activity in patients with pulmonary arterial hypertension. Butāne, L., Spilva-Ekerte, L., Šablinskis, M., et al.[2022]

Exercise-based rehabilitation is emerging as a beneficial treatment for patients with pulmonary arterial hypertension (PAH), aimed at improving their functional capacity and quality of life.

A review of ongoing trials revealed 57 registered studies on exercise training for PAH, with seven meeting inclusion criteria, indicating a growing recognition of the importance of rehabilitation alongside traditional medical management.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A review of ongoing trials in exercise based rehabilitation for pulmonary arterial hypertension. Babu, AS., Padmakumar, R., Maiya, AG.[2023]

A 16-week home exercise training program was feasible and well-tolerated in 9 children and adolescents with low-risk pulmonary arterial hypertension (PAH), with no adverse events reported.

Participants showed significant improvements in exercise capacity, including increased treadmill running distance and oxygen consumption at the anaerobic threshold, suggesting that home-based training can be beneficial for young patients with PAH.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Home Exercise Training in Children and Adolescents with Pulmonary Arterial Hypertension: A Pilot Study. Zöller, D., Siaplaouras, J., Apitz, A., et al.[2018]

This randomized controlled trial will assess the effects of an 8-week exercise program on muscle power and mass in patients with pulmonary artery hypertension (PAH), involving at least 48 participants.

The study aims to evaluate various health outcomes, including exercise capacity and quality of life, which will help understand the benefits of exercise in managing PAH.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Rationale and Design of a Randomized Controlled Trial Evaluating Whole Muscle Exercise Training Effects in Outpatients with Pulmonary Arterial Hypertension (WHOLEi+12). Sanchis-Gomar, F., González-Saiz, L., Sanz-Ayan, P., et al.[2022]

References

1. United States pubmed.ncbi.nlm.nih.gov

A Mobile Health Intervention to Increase Physical Activity in Pulmonary Arterial Hypertension. [2022]

2. Turkey pubmed.ncbi.nlm.nih.gov

Effects of cardiopulmonary rehabilitation on pulmonary arterial hypertension: A prospective, randomized study. [2022]

3. Switzerland pubmed.ncbi.nlm.nih.gov

Principles of rehabilitation and reactivation: pulmonary hypertension. [2015]

4. India pubmed.ncbi.nlm.nih.gov

Effects of home-based exercise training on functional outcomes and quality of life in patients with pulmonary hypertension: A randomized clinical trial. [2020]

5. United States pubmed.ncbi.nlm.nih.gov

Exercise training in patients with pulmonary arterial hypertension: a case report. [2021]

6. England pubmed.ncbi.nlm.nih.gov

Standardized exercise training is feasible, safe, and effective in pulmonary arterial and chronic thromboembolic pulmonary hypertension: results from a large European multicentre randomized controlled trial. [2022]

7. United States pubmed.ncbi.nlm.nih.gov

The exercise in pulmonary arterial hypertension (ExPAH) study: A randomized controlled pilot of exercise training and multidisciplinary rehabilitation in pulmonary arterial hypertension. [2022]

8. England pubmed.ncbi.nlm.nih.gov

Short term effects of exercise training on exercise capacity and quality of life in patients with pulmonary arterial hypertension: protocol for a randomised controlled trial. [2021]

9. United States pubmed.ncbi.nlm.nih.gov

Exercise training and rehabilitation in pulmonary arterial hypertension: rationale and current data evaluation. [2014]

10. England pubmed.ncbi.nlm.nih.gov

Individually tailored home-based physiotherapy program makes sustainable improvement in exercise capacity and daily physical activity in patients with pulmonary arterial hypertension. [2022]

11. India pubmed.ncbi.nlm.nih.gov

A review of ongoing trials in exercise based rehabilitation for pulmonary arterial hypertension. [2023]

12. United States pubmed.ncbi.nlm.nih.gov

Home Exercise Training in Children and Adolescents with Pulmonary Arterial Hypertension: A Pilot Study. [2018]

13. United States pubmed.ncbi.nlm.nih.gov

Rationale and Design of a Randomized Controlled Trial Evaluating Whole Muscle Exercise Training Effects in Outpatients with Pulmonary Arterial Hypertension (WHOLEi+12). [2022]