Visa-versa! Breaking Instead of Pushing the Pedals-A
Condition: Pulmonary Hypertension
MeSH terms: Hypertension, Pulmonary; Hypertension
Study type: Interventional

Summary: 
      Eccentric muscle work is defined as lengthening of a muscle while applying force. It was
      shown that with eccentric work, muscles are able to perform four times as much power compared
      to usual concentric work, which results in huge training gain with a highly decreased oxygen
      demand and thus lower cardiovascular load. Pulmonary hypertension (PH) is a chronic condition
      associated with significant reduced exercise capacity and increased morbidity and mortality,
      resulting in reduced quality of life. Physical training has been shown to be beneficial in
      PH, even in severely limited patients. However, due to cardiopulmonary constraints in PH,
      training intensities may be very low, so that many patients are physically almost unable to
      perform exercise on a high enough level to maintain muscle mass. A low body muscle not only
      feeds the vicious cycle of decreasing exercise capacity, but also has many deleterious
      metabolic and immunological consequences which further increase disability and decrease
      quality of life in PH. Thus, eccentric training, which allows to gain muscle mass with a low
      stress to the cardiopulmonary unit may to be highly beneficial for patients with PH and
      allied cardiopulmonary disease, such as chronic obstructive pulmonary disease (COPD) and
      heart failure. Therefore, the objective of the trial is, to compare differences in oxygen
      uptake (peak VO2 [l/min]) and other physiological measures during similar cardiopulmonary
      exercise test protocols of eccentric- vs. concentric cycling in PH- patients and comparators
      with or without other cardiopulmonary diseases.
    

Detailed description: 
      Eccentric muscle work is when a muscle lengthens while applying force. Although eccentric
      muscle work is part of everyday life, e.g. whilst descending, it is not integrated in modern
      training protocols and its underlying physiological mechanisms are still incompletely
      understood. It was shown that muscles are able to perform four times as much power
      eccentrically compared to common concentric muscle work with a comparably very low oxygen
      demand and thus cardiovascular load. Thus, eccentric training may be of special interest for
      patients with cardiopulmonary diseases. Since much higher training intensities are achieved
      eccentrically, the training increase after a few weeks of eccentric training is huge compared
      to ordinary concentric training. In addition, it has been observed that these high
      intensities applied eccentrically lead also to a concentric gain in strength and are
      therefore transferable to everyday activities. Physical training has been shown to be
      beneficial in almost every cardiovascular disease, even in severely limited patients.
      However, training intensities may be very low in some patients with advanced cardiopulmonary
      disease, so some patients are physically almost unable to perform exercise on a beneficial
      level. Thus, for this collective, eccentric training may to be a very intriguing option.
      Patients with pulmonary vascular diseases such as pulmonary arterial and chronic
      thromboembolic pulmonary hypertension (PH) per definition reveal an elevated pulmonary artery
      pressure (PAP) along with an increased pulmonary vascular resistance (PVR). However, also
      other common diseases, such as left heart disease (LHD) or chronic obstructive pulmonary
      disease (COPD) are often associated with PH. The cardinal symptoms of PH is dyspnea on
      exertion leading to limited exercise performance, daily activity and quality of life.
      PH-patients also benefit from structured exercise training, but training intensities might be
      limited in patients with advanced disease. A few studies have investigated eccentric
      exercising in cardiopulmonary patients but none in PH. Most of these studies are in patients
      with coronary heart disease- (CHD) or COPD, including only few participants and often studies
      did not followed sound methodologies, such as randomized-controlled trial (RCT) protocols
      However, even in the hitherto limited patients´ investigated, eccentric training was assessed
      beneficial, feasible and safe.

      The physiological cardiopulmonary response to eccentric exercising has not been investigated
      in patients with PH and the physiological basis to investigate such training opportunities is
      completely lacking.

      The aim of this project is to investigate the cardiopulmonary effects of eccentric exercise
      in using solid randomized-controlled research protocols in cardiopulmonary diseases with
      focus on PH in order to provide a basis to the question of whether this promising training
      method could become established in cardiopulmonary rehabilitation, especially in patients
      with advanced disease and pulmonary hypertension.
    

Intervention name(s): 15 minutes eccentric cycling; 15 minutes concentric (normal) cycling
Intervention type(s): Procedure; Procedure
Intervention description(s): The exposure to eccentric exercise will be individualized-intensity stepwise incremental cycle exercise starting at 50 Watt with individually tailored increments every 5 minutes.; The exposure to concentric exercise will be individualized-intensity stepwise incremental cycle exercise starting at 50 Watt with individually tailored increments every 5 minutes.
Allocation: Randomized
Intervention model: Crossover Assignment
Masking: None (Open Label)
Primary purpose: Treatment