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To understand the effect and safety of a 12-week cardiopulmonary rehabilitation program on the functional capacity, activities of daily living (ADL) abilities, psychological status, and quality of life (QoL) of an adult patient with pulmonary arterial hypertension (PAH) caused by atrial septal defect (ASD). Considering that PAH can cause heart failure, it is important that beside medicamentous therapy, we give an appropriate rehabilitation program to increase functional capacity and to prevent progressivity of symptoms.
A case report of a female patient, age 44 years, diagnosed with PAH, who underwent an ASD closure procedure 3 years ago. Patient's chief complaint was fatigue and dyspnea d' effort. The 6-minute walking test indicated a functional capacity of 3.36 metabolic equivalents (METS). Examination using Lawton and Brody's Instrumental Activity of Daily Living (IADL) Scale showed decrease function in shopping, food preparation, and laundry. Hamilton Rating Scale for Depression indicated mild depression. Quality of life was assessed with the 36-Item Short Form Survey (SF-36).
Cardiopulmonary rehabilitation program consisted of a supervised exercise program and psychological counseling. Exercise program consisted of flexibility exercises for the muscles of the trunk, and upper and lower extremities, including chest expansion exercises. Aerobic exercise using a cycle ergometer 3 times a week with an intensity of 50% heart rate reserve (HRR) for 20 minutes, progressing to70% HRR for 40 minutes in 12 weeks. Resistance exercise using free weights for the upper extremities 3 times a week with an intensity 30-40% of one-repetition maximum.
Evaluation was done at the end of 6 and 12 weeks. After 6 weeks there was a decrease of her complaints and an increase of functional capacity, and exercise with threshold inspiratory muscle training was added to the program.
At some points of the program, the patient wanted to stop caused by lack of motivation and self-confidence and social problems, so that through the program psychological support and counseling was needed, but she completed the program.
After 12 weeks there was a decrease of her complaints. Functional capacity increased from 3.36 to 4.39 METS after 6 weeks and 5.32 METS after 12 weeks. All components of IADL scale, depression scale, and SF-36 showed improvement. During the whole program there were no adverse effects.
A supervised cardiopulmonary rehabilitation program of 12 weeks is proven safe, and resulted in an increase in functional capacity, ADL abilities, psychological status, and QoL in an adult patient with PAH.