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Exercising When You Have Pulmonary Hypertension

Because pulmonary arterial hypertension (PAH) often causes shortness of breath, swelling, and fatigue, exercise may seem like the last thing you should do. But the right kind -- with your doctor's OK -- can help symptoms and boost quality of life.

How Exercise Helps

Almost any way you slice it, exercise is good medicine.

"We call sitting the new smoking," says Eugene Chung, MD, chair of the American College of Cardiology Sports and Exercise Cardiology Leadership Council and professor of internal medicine at the University of Michigan. "If you live a predominantly sedentary lifestyle, the biggest bang for your buck, health-wise, is to get up and start moving around more often."

Regular exercise helps the heart and body work smarter, not harder. It keeps your blood vessels in good shape and eases inflammation. All these have a positive impact on PAH.

Here's how: PAH stresses the right ventricle of your heart. This stress starts a cascade of changes in your body. One of those is a bump in adrenaline, the hormone that triggers your "fight or flight" response.

"Exercise has been shown in multiple studies to help with decreasing inflammation and train the heart to respond to the adrenaline surge," says Chung.

This improves your peak exercise heart rate. That's how many beats per minute your heart can safely pump when exercising. It also lowers your blood pressure, which helps keep the cascade of changes from happening in the first place.

In short, exercise helps break the cycle of worsening PAH symptoms.

Best Ways to Move

"Any exercise program should be started in consultation with your doctors, and you should be followed regularly," says Chung.

Your doctor understands your limitations and can tell you what's OK. Ideally, you'll exercise under the supervision of a cardiopulmonary rehabilitation program. As for the type of exercise that's best, Chung says they focus on aerobic activity. That's the kind that gets your heart pumping, not isometric moves that make you hold your muscle in a contracted position or high resistance exercise like weightlifting.

To get your blood pumping, you can try:

Walking. Get your steps in on a treadmill or by taking a brisk stroll around your neighborhood. Aim for 1-hour sessions three times a week.

Swimming. Working out in water tones your muscles without straining your joints. You can do water aerobics or simply swim laps.

Cycling. Elliptical bikes and recumbent bikes are a safe way to cycle without risking a fall.

Other types of exercise include:

Yoga. Although there isn't much research about the direct benefits of yoga on PAH, its slow and mindful stretching reduces stress and lowers inflammation in your body.

Light resistance training. You can keep your muscles flexible and strong by using light weights (soup cans can work well) or just body weight. A rehabilitation specialist can teach you moves such as chair squats, wall pushups, calf raises, bicep curls, and more.

It's important not to lift heavy weights because it can worsen symptoms.

"If you were to push it and do more high-intensity weightlifting, there's a chance that, depending on the cause of pulmonary hypertension, you could put increased strain on the right side of the heart," says  Chung.

You're more likely to hold your breath as you lift as well, which raises the pressure in your chest cavity.

What to Watch For

Like with any exercise routine, be on the lookout for signs you've done too much. Keep these safety tips in mind:

Exercise at a time of day when you feel best and have the most energy.

Don't work out solo: Try to sweat it out with a buddy.

Never hold your breath while working out.

Always warm up before you work out and cool down afterward.

Start small and do more once your body is ready.

Tell your doctor about any concerning side effects, like swelling or more shortness of breath than usual.

Christie E. Beckley

The Harvard School of Public Health appointed Mary B. Rice, a pulmonary and critical care physician and associate professor at Harvard Medical School, as the next director of its Center for Climate, Health, and the Global Environment. She will lead C-CHANGE starting Oct. 1.

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