Date of Award


Degree Type

Selective Evidence-Based Medicine Review

Degree Name

Master of Science in Health Sciences - Physician Assistant


Physician Assistant Studies

Department Chair

John Cavenagh, MBA, PhD, PA-C


OBJECTIVE: The objective of this selective EBM review is to determine whether or not “Does a structured exercise intervention of at least ten weeks improve the distance walked in a 6 minute walking test (6MWT) in patients with pulmonary arterial hypertension currently on optimized medical control compared to patients who do not exercise?” STUDY DESIGN: Systematic review of two randomized controlled trials and a prospective case study published between 2006-2013, all English language. DATA SOURCES: Two randomized controlled studies and a prospective uncontrolled trial which studied the effects of a structured exercise program of at least 10 weeks duration were obtained using PubMed. OUTCOMES MEASURED: The outcome of each study was the distance (measured in meters) that each patient was able to walk during the 6 minute walking test as compared to their baseline at the beginning of the study. The average of these participants were then used to compare the control group versus the intervention group RESULTS: Two randomized controlled trials and a uncontrolled prospective study were used in this review. Mereles et al showed a difference between the control and exercise group to be a mean of 111 m (95% CI, 65 to 139; P<0.001) after 15 weeks. Chat et al found that there was a statistically significant mean increase of 45m with a 95% CI of 9- 80m (p=0.003) in the exercise intervention group, and determined the number needed to treat was 3 using dichotomous data. Grunig et al showed a significant mean increase from baseline to 3-week testing (64 +/- 47m, p<0.001) and again from baseline to 15- week (71 +/- 35m, p<0.003), with no control group studied. CONCLUSIONS: All three studies demonstrated statistically significant improvement in the distance walked in the six minute walking test after a structured exercise intervention as compared to baseline testing, as well as compared to a control group. A structured exercise intervention in patients with pulmonary arterial hypertension should be considered as a useful addition to medical therapy.