Exercise and pulmonary embolism: a systematic review of exercise safety, feasibility and effectiveness

Long-term survivors of pulmonary embolism (PE) exhibit decreased exercise capacity, dyspnoea and a diminished quality of life. Exercise may represent a beneficial strategy for ameliorating persistent symptoms following PE.

Is exercise training beneficial for improving exercise capacity and quality of life in patients with PE? Additionally, is it safe and feasible?

The aim of this systematic review was to evaluate the safety, feasibility and efficacy of exercise training in improving exercise capacity and quality of life in patients with PE. In order to comprehensively assess the available evidence, we conducted a systematic review using a combination of free-text terms and medical subject headings according to database requirements in PubMed, Medline, Web of Science, Scopus, Embase and the Cochrane Library from inception until 17 September 2024.

We included a total of nine trials including 583 patients, including 391 in the interventional group and 190 in the control group. The difference in the average adverse event rates between the exercise group (0.5%) and the control group (0%) was not significant. The overall recruitment rate was approximately 51% (range: 38-65%), the withdrawal rate was approximately 5% (range: 0-13%) and the adherence rate was 87% (range: 61-100%). The studies reported average improvements in peak oxygen consumption (exercise group: 7.55 mL·kg^-1·min^-1; control group: 1.95 mL·kg^-1·min^-1), incremental shuttle walk test distance (exercise group: 142 m; control group: 69.5 m), vitality scores (exercise group: 13.95; control group: 3.95), and role emotional scores (exercise group: 12.05; control group: -0.1). However, due to considerable discrepancies in the scoring systems, an average improvement in Pulmonary Embolism Quality of Life questionnaire score could not be determined. Notably, no improvement in dyspnoea was reported.

This systematic review indicates that exercise training seems to be safe and feasible for patients with PE. It appears to enhance patients' exercise capacity and quality of life, although its impact on alleviating dyspnoea remains limited. However, given the absence of large-scale randomised controlled trials, these findings should be interpreted with caution.