Abstract Body (Do not enter title and authors here): Background: Survivors of acute pulmonary embolism (PE) experience impaired physical capacity and quality of life (QoL). Cardiopulmonary rehabilitation is considered to improve exercise capacity and QoL in patients with chronic thromboembolic pulmonary hypertension (CTEPH). However, there is a paucity of data on the efficiency and safety of rehabilitation for patients with acute PE.
Hypothesis: Cardiopulmonary rehabilitation is likely to be safe and effective in acute PE survivors and CTEPH patients.
Aims: We aimed to evaluate the efficiency and safety of cardiopulmonary rehabilitation among patients with acute PE and CTEPH.
Methods: The relevant literature was retrieved using the PubMed, Embase, and Cochrane Library databases published up to September 2023. We were particularly interested in effect of rehabilitation on exercise capacity and QoL among acute PE survivors. We conducted a meta-analysis on randomized controlled trials comparing exercise training with usual care in patients with acute PE. The primary outcome was a change in Incremental Shuttle Walking Test (ISWT), a standardized walking test to assess exercise capacity, and QoL. We also reviewed the effect of exercise training on pulmonary function tests and right ventricular function.
Results: A total number of 581 adults with PE from nine studies were included in this systematic review. Among these, 505 were patients with acute PE in seven of the studies, while the remaining two studies included CTEPH patients, involving 76 participants. Our systematic review suggested that rehabilitation was safe and effective for both acute PE survivors and CTEPH patients. In the pooled analysis of two RCTs examining the efficiency of rehabilitation for patients with acute PE, ISWT significantly improved (SMD= 42.33, 95% CI = 14.56 to 70.11) after rehabilitation. There was no significant improvement in the QoL of patients with PE before and after rehabilitation, as assessed by the EQ-5D questionnaire (SMD= 0.03, 95% CI = 0.00 to 0.05). Moreover, the exercise training proved to be safe, with no major adverse events reported during the training sessions.
Conclusion: Cardiopulmonary rehabilitation may improve exercise capacity and was well tolerated among acute PE Survivors. Our data also support the concept that rehabilitation could be part of a comprehensive PE treatment plan. However, more large-scale multicenter studies are needed to confirm the effectiveness and safety of exercise training these patients.