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Pulmonary Arterial HypertensionPAHNCT03476629

Effects of Different Types of Physical Training in Patients With Pulmonary Arterial Hypertension.

A study testing Physical activity in people with Pulmonary Arterial Hypertension and Cardiovascular Diseases, run by University of Nove de Julho at 1 site in Brazil.

Unknown status

Status not confirmed. The sponsor has not verified this record for over two years, so it may be out of date.

Official record
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Trial summary

Although there has been some progress in pharmacological management of PAH, limited functional capacity and low survival still persist, but there is evidence that exercise training can be accomplished without adverse effects or damage to cardiac function and pulmonary hemodynamics. Read more about this study

Who is it for?
Ages 20 to 70 years
What is being tested?
Physical activity
Could I receive a placebo?
No, everyone receives an active treatment
How many people
45 participants
Where
1 siteBrazil
Study dates
10 Jan 2016to 10 Dec 2020
Phase
Interventional
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 20 to 70 years
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Having confirmed diagnosis of PAH, based on elevated pressure in the pulmonary artery measured by catheterization of the heart at rest, with WHO functional (World Health Organization's - Functional Assessment for Pulmonary Hypertension - modified after New York Heart Association Functional Classification (NYHA) functional classification) classes I, II, III or IV to capture PAH patients with pré-capillary involvement;
  • Clinically stable with no previous hospitalizations in the last four weeks;
  • Receiving PAH specific drug therapy for at least 3 months before the study began.

Who cannot join

  • Use of continuous oxygen therapy;
  • Significant musculoskeletal disease or pain / claudication members;
  • Neurologic or cognitive impairment, psychiatric disorders or psychological mood (making it difficult for patients to understand the required tests);
  • History of moderate or severe chronic lung disease;
  • PAH patients with post-capillary involvement.
  • Cardiac disease associated with cardiac failure, angina and / or unstable heart rhythm.

Trial locations and contacts

1 site in 1 country.

Luciana Malosá Sampaio, Professor contact

+551133859241

lucianamalosa@gmail.com

Etiene Farah Teixeira de Carvalho, Phd contact

+551133859241

eti_farah@hotmail.com

Brazil1 site, 1 recruiting
  • Santa Casa de São Paulo Hospital

    São Paulo, São Paulo

    Flávia Navarro, Dr

    Recruiting

Other trials in Brazil

About this study

Official title: Effects of Combined Training Versus Aerobic Training Versus Respiratory Muscle Training in Patients With Pulmonary Hypertension: A Randomized, Controlled Clinical Trial.

Although there has been some progress in pharmacological management of PAH, limited functional capacity and low survival still persist, but there is evidence that exercise training can be accomplished without adverse effects or damage to cardiac function and pulmonary hemodynamics. Specifically, improvements in symptoms, exercise capacity, peripheral muscle function and quality of life. Training programs need to be better studied and well defined, and their physiological effects during physical training and functional capacity.

The aim of this study is to compare the effects of different training exercises on physical performance indicators.

Read the detailed description

Pulmonary arterial hypertension (PAH) is characterized by pathological changes in the pulmonary vasculature which cause an increase in pulmonary vascular resistance (PVR), restricting the flow of blood through the pulmonary circulation. It is a serious illness, progressive and usually fatal which causes significant functional limitation, mainly due to dyspnea. In order to maintain the flow of blood, pulmonary artery pressure (PAP) increases and the disease progresses leading to right ventricular dysfunction and right heart failure.

Regardless of the cause of PAH, the pulmonary arteries and arterioles have reduced capacity, and increases in cardiac output during exercise is limited. As a result, the delivery of oxygen to peripheral muscles is impaired, contributing to the symptoms of fatigue and dyspnea. While the limitation of the cardiac output to meet peripheral oxygen demand during exercise largely reduces exercise capacity, musculoskeletal dysfunction may also be involved in the exercise limitation in patients with PAH. Changes such as, muscle atrophy, decreased oxidative enzymes and a greater number of type II muscle fibers lead to an early lactic acidosis and decreased functional capacity. A modest evidence exists that exercise training can be done without adverse effects or damage to cardiac and / or pulmonary hemodynamics however, the effectiveness PAH requires more research.

Being tested
Physical activity
Keywords
Cardiopulmonary Exercise Test, Rehabilitation, Distance Traveled, Functional Capacity, Autonomic Nervous System
Medical subject headings
Pulmonary Arterial Hypertension, Cardiovascular Diseases, Respiration Disorders, Hypertension, Pulmonary

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

Study groups in NCT03476629
Study groupRoleWhat they receive
Combined TrainingExperimentalCombined Training with 2 types of physical activity
Receives: Other: Physical activity
Standard TrainingExperimentalPhysical activity with aerobic exercise
Receives: Other: Physical activity
Respiratory Muscle TrainingExperimentalRespiratory muscle performance
Receives: Other: Physical activity

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Functional exercise capacity

    Oxygen consumption measurement during cardiopulmonary test

    Measured: Change from Baseline to 15 weeks

  2. 6 Minute Walking Test

    Distance in meters

    Measured: Change from Baseline to 15 weeks

  3. Incremental shuttle walking test

    Distance in meters

    Measured: Change from Baseline to 15 weeks

Secondary outcomes (8)
  1. Autonomic Nervous System

    Assesment by Heat Rate Variability analysis

    Measured: Change from Baseline to 15 weeks

  2. Respiratory Muscle Strength

    Assesment by Test of Incremental Respiratory Endurance

    Measured: Change from Baseline to 15 weeks

  3. Musculoskeletal Function

    Assesment by peripheral muscular strength testing.

    Measured: Change from Baseline to 15 weeks

  4. Change of laboratory parameters, metabolic profile assessment and systemic inflammatory.

    IL-1beta, IL-1ra, IL-6, IL-8, IL-10 and TNF-alfa (pg/ml)

    Measured: Change from Baseline to 15 weeks

  5. Exhaled Nitric Oxide

    The fraction of eNO (exhaled nitric oxide) in air will be measured by chemiluminescence

    Measured: Change from Baseline to 15 weeks

  6. Lung function (physiological parameter)

    Forced vital capacity and liters in 1 second, Total lung capacity, diffusion of carbon dioxide

    Measured: Change from Baseline to 15 weeks

  7. Physical Activity Questionnaire (IPAQ)

    The level of physical activity will be assessed using the international questionnaire short-version physical activity (IPAQ). The continuous score allows assessing energy expenditure expressed in MET minutes/week. The IPAQ categorical classifies include: Insufficiently active (does not perform any physical activity); Sufficiently active (conducts vigorous activity at least three days a week >600 MET - 1400 MET); Very active (performs more than three days per week of vigorous activity 1500 MET - 3000 MET)

    Measured: Change from Baseline to 15 weeks

  8. Endothelial function

    Endothelial function will be assessed by flow-mediated dilation (FMD)

    Measured: Change from Baseline to 15 weeks

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted26 Mar 2018
  2. Study start10 Jan 2016
  3. Primary completion10 Jul 2017
  4. Study completion10 Dec 2020 (estimated)

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Crossover
Masking
Quadruple blind
Who is masked
Participant, Care provider, Investigator, Outcomes assessor
Enrolment
45 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT03476629
Sponsor's protocol ID
PAH Rehabilitation
Acronym
PAH
Status last verified
Nov 2020
First submitted
28 Feb 2018
Last updated
4 Nov 2020
Results posted
No
Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
Undecided

Publications

  • Desai SA, Channick RN. Exercise in patients with pulmonary arterial hypertension. J Cardiopulm Rehabil Prev. 2008 Jan-Feb;28(1):12-6. doi: 10.1097/01.HCR.0000311502.57022.73.

    PubMed 18277824
  • Schannwell CM, Steiner S, Strauer BE. Diagnostics in pulmonary hypertension. J Physiol Pharmacol. 2007 Nov;58 Suppl 5(Pt 2):591-602.

    PubMed 18204173
  • Gabbay E, Reed A, Williams TJ. Assessment and treatment of pulmonary arterial hypertension: an Australian perspective in 2006. Intern Med J. 2007 Jan;37(1):38-48. doi: 10.1111/j.1445-5994.2006.01242.x.

    PubMed 17199843
  • Rubin LJ. Primary pulmonary hypertension. N Engl J Med. 1997 Jan 9;336(2):111-7. doi: 10.1056/NEJM199701093360207. No abstract available.

    PubMed 8988890
  • Galie N, Humbert M, Vachiery JL, Gibbs S, Lang I, Torbicki A, Simonneau G, Peacock A, Vonk Noordegraaf A, Beghetti M, Ghofrani A, Gomez Sanchez MA, Hansmann G, Klepetko W, Lancellotti P, Matucci M, McDonagh T, Pierard LA, Trindade PT, Zompatori M, Hoeper M; ESC Scientific Document Group. 2015 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension: The Joint Task Force for the Diagnosis and Treatment of Pulmonary Hypertension of the European Society of Cardiology (ESC) and the European Respiratory Society (ERS): Endorsed by: Association for European Paediatric and Congenital Cardiology (AEPC), International Society for Heart and Lung Transplantation (ISHLT). Eur Heart J. 2016 Jan 1;37(1):67-119. doi: 10.1093/eurheartj/ehv317. Epub 2015 Aug 29. No abstract available.

    PubMed 26320113
  • Arena R, Lavie CJ, Milani RV, Myers J, Guazzi M. Cardiopulmonary exercise testing in patients with pulmonary arterial hypertension: an evidence-based review. J Heart Lung Transplant. 2010 Feb;29(2):159-73. doi: 10.1016/j.healun.2009.09.003. Epub 2009 Dec 6.

    PubMed 19969471
  • Naeije R. Breathing more with weaker respiratory muscles in pulmonary arterial hypertension. Eur Respir J. 2005 Jan;25(1):6-8. doi: 10.1183/09031936.04.00121004. No abstract available.

    PubMed 15640315
  • Bauer R, Dehnert C, Schoene P, Filusch A, Bartsch P, Borst MM, Katus HA, Meyer FJ. Skeletal muscle dysfunction in patients with idiopathic pulmonary arterial hypertension. Respir Med. 2007 Nov;101(11):2366-9. doi: 10.1016/j.rmed.2007.06.014. Epub 2007 Aug 6.

    PubMed 17689235
  • Mainguy V, Maltais F, Saey D, Gagnon P, Martel S, Simon M, Provencher S. Effects of a rehabilitation program on skeletal muscle function in idiopathic pulmonary arterial hypertension. J Cardiopulm Rehabil Prev. 2010 Sep-Oct;30(5):319-23. doi: 10.1097/HCR.0b013e3181d6f962.

    PubMed 20410828
  • de Man FS, Handoko ML, Groepenhoff H, van 't Hul AJ, Abbink J, Koppers RJ, Grotjohan HP, Twisk JW, Bogaard HJ, Boonstra A, Postmus PE, Westerhof N, van der Laarse WJ, Vonk-Noordegraaf A. Effects of exercise training in patients with idiopathic pulmonary arterial hypertension. Eur Respir J. 2009 Sep;34(3):669-75. doi: 10.1183/09031936.00027909.

    PubMed 19720810
  • Meyer FJ, Lossnitzer D, Kristen AV, Schoene AM, Kubler W, Katus HA, Borst MM. Respiratory muscle dysfunction in idiopathic pulmonary arterial hypertension. Eur Respir J. 2005 Jan;25(1):125-30. doi: 10.1183/09031936.04.00095804.

    PubMed 15640333
  • Kabitz HJ, Schwoerer A, Bremer HC, Sonntag F, Walterspacher S, Walker D, Schaefer V, Ehlken N, Staehler G, Halank M, Klose H, Ghofrani HA, Hoeper MM, Gruenig E, Windisch W. Impairment of respiratory muscle function in pulmonary hypertension. Clin Sci (Lond). 2008 Jan;114(2):165-71. doi: 10.1042/CS20070238.

    PubMed 17764445
  • Velez-Roa S, Ciarka A, Najem B, Vachiery JL, Naeije R, van de Borne P. Increased sympathetic nerve activity in pulmonary artery hypertension. Circulation. 2004 Sep 7;110(10):1308-12. doi: 10.1161/01.CIR.0000140724.90898.D3. Epub 2004 Aug 30.

    PubMed 15337703
  • Mereles D, Ehlken N, Kreuscher S, Ghofrani S, Hoeper MM, Halank M, Meyer FJ, Karger G, Buss J, Juenger J, Holzapfel N, Opitz C, Winkler J, Herth FF, Wilkens H, Katus HA, Olschewski H, Grunig E. Exercise and respiratory training improve exercise capacity and quality of life in patients with severe chronic pulmonary hypertension. Circulation. 2006 Oct 3;114(14):1482-9. doi: 10.1161/CIRCULATIONAHA.106.618397. Epub 2006 Sep 18.

    PubMed 16982941

Questions about this trial

What is this clinical trial studying?

A study testing Physical activity in people with Pulmonary Arterial Hypertension and Cardiovascular Diseases, run by University of Nove de Julho at 1 site in Brazil.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 3 inclusion and 6 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: status not confirmed, as of the sponsor's last update on 4 Nov 2020. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in Brazil. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

Results are not available in the source record.

How can a doctor refer a patient or contact the research team?

Contact Luciana Malosá Sampaio, Professor (+551133859241, lucianamalosa@gmail.com), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Functional exercise capacity (time frame: Change from Baseline to 15 weeks). The study lists 3 primary outcomes in all. It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT03476629, which also lists 14 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 4 Nov 2020.

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