Exercise capacity, dyspnea, and quality of life 6 months after exercise-based rehabilitation in patients with persistent dyspnea following pulmonary embolism

Abstract

Background: Exercise is safe and effective in the short-term following pulmonary embolism. To date, little is known about the long-term effects.

Objectives: The aim of the study was to investigate whether the effects of exercise-based rehabilitation are maintained 6 months after completion in patients with persistent dyspnea following pulmonary embolism when compared with usual care.

Methods: A 2-center, randomized controlled trial compared 8 weeks of exercise-based rehabilitation with usual care. Patients were reassessed postintervention and 6 months later. Exercise capacity was measured with the incremental shuttle walk test (ISWT). Dyspnea was assessed with the Shortness of Breath Questionnaire, and health-related quality of life was assessed with disease-specific (Pulmonary Embolism Quality of Life Questionnaire) and generic questionnaires.

Results: In total, 159 of 211 randomized patients attended follow-up 6 months postintervention. The significant improvement on the ISWT in the rehabilitation group was maintained at the 6-month follow-up (96 m; SE: 15 m; 95% CI: 66, 127). There were no changes on the ISWT in the control group at either time point. From postintervention to 6×-month follow-up, the rehabilitation group had further improvements in dyspnea compared with the control group (-3 points; SE: 1.4; 95% CI: -6, -1; P = .02). Health-related quality of life improved in both groups although superior improvements were seen in the rehabilitation group.

Conclusion: The improvement in exercise capacity after 8 weeks of exercise-based rehabilitation in patients with pulmonary embolism and persistent dyspnea was maintained at the 6-month follow-up, while no improvement was observed in the control group, highlighting the relevance of offering rehabilitation to these patients.

Keywords: dyspnea; exercise capacity; pulmonary embolism; rehabilitation; venous thromboembolism.

Figure 1

Study recruitment and follow-up ∗Some participants were excluded for multiple reasons. CTEPH, chronic thromboembolic pulmonary hypertension; PE, pulmonary embolism.

Figure 2

The predicted mean performance on the incremental shuttle walk test (in meters) at baseline, postintervention, and 6-month follow-up by group (for men at the age of 58 years). Predicted values of incremental shuttle walk distance for men aged 58 years (mean age among the sample) are shown. Other ages will merely imply vertical shifts of the graphs, while the structure would remain unchanged. Vertical lines represent 95% CIs.