Effects of a physical training protocol on heart rate kinetics and heart rate variability indexes in patients with pulmonary arterial hypertension

Heart rate variability (HRV) in pulmonary arterial hypertension patients (PAH) exhibits relevant changes in the indexes of assessment of the autonomic nervous system (ANS). Evaluating heart responses through the behavior of heart rate kinetics during rest and at rest-exercise transition becomes essential, bringing information about the integrity of the ANS. A training protocol can bring positive changes in autonomic modulation positively affecting the prognosis in patients with PAH. The aim of this study was to evaluate the HRV index before and after a rehabilitation program in patients with PAH. Fifteen clinical stable PAH patients were included in this study (aged 48.6 ± 19.1), WHO functional class II-III, mean pulmonary artery pressure (PAPm) 45 ± 14 mmHg, they underwent a combined training program (aerobic training and resistance training). HRV was analyzed before and after an 8-week rehabilitation program collected at rest for 10 minutes in the supine and standing positions and during Endurance Shuttle Walk Test using the frequency and time domain as well as non-linear variables. After the combined training, there was improvement in sympathetic, parasympathetic activity and supine-vagal balance in supine position (LF=64.5±17.5 / 48.6±17.5; HF=35.5±17.4 / 51.4±17.5 and LF/HF=2.87±2.83 / 1.2±0.85nu) and standing position (LF=68.3±17.0 / 74.0±11.6; HF=32.4±16.3 / 26.0±11.6 and LF/HF=3.4±3.7 / 3.7±2.5nu) and on-kinetics of heart rate, in pre-training compared to post-training (Tau(s) 164.4±73.9 / 92.9±59.4; TD(s) 26.8±11.3 / 17.08±7.3). Patients with PAH showed improved autonomic modulation and on-kinetics after combined training.