The effect of an outpatient exercise training rehabilitation programme on haemodynamics and cardiac magnetic resonance parameters of right ventricular function in patients with pulmonary arterial hypertension: the ExPAH trial.

Outpatient rehabilitation exercise training program. a) This involves participants attending a physiotherapy department for an exercise training programme. b) Sessions are twice weekly for 12 weeks (i.e. total of 24 sessions). c) Each session runs for one hour. d) Sessions are run by physiotherapist. e) Exercises involve: aerobic training (treadmill or cycle), respiratory muscle training and light weight training f) intensity of Borg RPE of 12-13. g) Format is small group (maximum of 5 participants to one phyisotherapist). h) Monitoring of adherence will be via record of attendance and exercises performed. Participants randomised to the training group will also have 3 structured telephone education sessions with the study psychologist (of 20 minutes duration each). These sessions will include education on managing hyperventilation, anxiety during dyspnea, and skills training (progressive muscle relaxation). These will be done at approximately week3, 6 and 9. In addition, Sydney based participants will have the option of undergoing an exercise right heart catheterisation (RHC). These participants will have exactly the same outcome measures and undergo the same randomisation process. They will have haemodynamics, measured by RHC at rest and during exercise. The only difference is that after the initial standard haemodynamic measurements, the participant is asked to pedal at a certain work rate (for example, 60 rpm). The workload is then increased by 10W every 3 minutes, as tolerated by the participant, to a maximum of 40W, as described by Provencher, S., et al., Changes in exercise haemodynamics during treatment in pulmonary arterial hypertension. Eur Respir J, 2008. 32(2): p. 393-8. Participants for this sub-study will be voluntary (all participants to the study based in Sydney will be asked if they wish to participate in the sub-study).