Functional Capacity Dropped Among Patients With PAH Following COVID-19 Lockdown

A Belgian study compared exercise performance before and after COVID-19 lockdown measures were swiftly implemented in the country among patients with preexisting pulmonary arterial hypertension (PAH).

Results from several 6-minute walking tests (6MWTs) performed before and after COVID-19 lockdown measures were implemented in Belgium from March to June 2020 show reduced physical activity may have led to a reduction in functional capacity among patients with preexisting pulmonary arterial hypertension (PAH).

These findings were published in Pulmonary Circulation from the observational analysis of 63 clinically stable patients living with PAH who had data from at least 4 consecutive 6MWTs performed between 2019 and 2020 and were receiving care at the Pulmonary Vascular Diseases and Heart Failure Clinic, CUB – Hôpital Erasme, Brussels, Belgium. In addition to 6MWT distance (6MWD), data on heart rate, oxygen saturation, and Borg score were collected.

“Patients with pre‐existing chronic diseases were considered more difficult to manage in cases of COVID‐19 infection. Accordingly, they were prompted to carefully reduce individual infection risks,” the study authors wrote. “Therefore, it is conceivable that deconditioning could have significantly impacted their exercise capacity and might act as a confounding factor in evaluation of their functional status.”

Significant reductions in mean distance were seen on 2 fronts, with patients excluded from this analysis if they had less than four 6MWTs between January 2019 and November 2020.

When evaluating the pooled mean distance from the three 6MWTs performed immediately before lockdown began in March 2020 with the first test administered right after lockdown measures were lifted in June 2020, there was a 14-m reduction in distance seen (P = .004) after lockdown. In addition, total distance dropped from 447 meters in March 2020 to 434 meters in June 2020 (P = .024), with the investigators classifying this as a “significant average loss, highlighting a decrease in exercise capacity likely due to the lockdown.”

Most of the patients who had PAH were on a doublet therapy regimen (57%) and complained of class II (66%) or III (31%) New York Heart Association (NYHA) exertional dyspnea. The remaining 3% were asymptomatic.

The investigators also noticed that 6MWT time trended downward subsequent to June 2020, following relative time consistency from January 2019 to March 2020. Further, distance covered in the test remained at a lower level for 3 to 6 months after lockdown measures were lifted. Mean (SD) distances measured in 2 tests were 436 (14) meters among 53 patients and 405 (14) meters among 46 patients.

Significant changes were not seen in heart rate (1.37 bpm; P = .4749), oxygen saturation (–0.68%; P = .2912), or Borg score (–0.06 points; P = .8040) or in measures typically indicative of disease progression (eg, NYHA functional class, weight levels, NTproBNP level, echocardiographic characteristics, tricuspid annular plane systolic excursion). During lockdown, no patients included in this analysis required hospitalization or medical therapy increases.

“Despite constant clinical stability and the absence of signs of disease progression, PAH patients were less performing at 6MWT after 3 months of reduced physical activity,” the authors concluded. “Additionally, the deleterious effects of deconditioning seemed to persist thereafter, as witnessed by the stable reduction of 6MWD over time.”

Still, the authors emphasize exercising caution when interpreting their findings, chiefly because the full extent of functional worsening among patients with PAH during the pandemic is not yet known.


Baratto C, Dewachter C, Caravita S, et al. Impact of COVID-19 lockdown on exercise capacity in PAH patients. Pulm Circ. Published online July 1, 2022. doi:10.1002/pul2.12089