Advances in Aerobic Exercise for Pulmonary Arterial Hypertension: Mechanisms of Action and Clinical Insights

Pulmonary arterial hypertension (PAH) is a progressive disease characterized by elevated pulmonary artery pressure and pulmonary vascular resistance, leading to right heart failure and death in severe cases. PAH is classified as Group 1 pulmonary hypertension (PH). Although Groups 2 and 3 PH are more common, this review focuses primarily on PAH. Currently, there are three main classes of targeted drugs in clinical practice, and their main mechanism is to dilate pulmonary artery vessels. These drugs can delay the progression of PAH and improve the quality of life. However, the long-term prognosis is still not optimistic. At present, patients with PAH still need a multi-drug combination and comprehensive treatment. Aerobic exercise, as a non-pharmacological adjunctive therapy, is believed to have a positive impact on PAH treatment when performed regularly in patients with stable conditions. With the widespread application of aerobic exercise in the treatment of cardiovascular diseases, increasing research is exploring its potential in adjunctive therapy for PAH. Studies suggest that exercise-based rehabilitation incorporating aerobic exercise, when added to optimized PAH-targeted therapy, may improve exercise capacity, quality of life, and selected cardiopulmonary or hemodynamic parameters in clinically stable patients with PAH. However, evidence for reversal of pulmonary vascular remodeling or mortality benefit remains limited. This review summarizes the clinical evidence and mechanisms of aerobic exercise specifically in PAH.