Clinical Decisions

Exercise after Pulmonary Embolism

Exercise after pulmonary embolism can be complicated. There are several reasons for this. First, pulmonary embolism affects the heart and the lungs. So, when we need more energy for activity and exercise, the heart and lungs may not be able to ramp up properly. But there are other reasons. Sometimes, a pulmonary embolism will affect the right side of the heart. If the pressure increases, this can limit our ability to exercise, and even make exercise after pulmonary embolism dangerous. So if you suffered a PE, it is important to plan activity correctly.

Why is Exercise after Pulmonary Embolism a Problem?

Pulmonary embolism affects the heart and the lungs. Obviously, when we are active, the heart pumps more rapidly and more forcefully. Also, we may breath more rapidly to allow more efficient air exchange. But if we suffered a PE, both these functions may not work properly.

A second problem is more complicated to explain. You may remember the heart has two sides: left and right. A pulmonary embolism will affect the right side of the heart. Sometimes, it will cause the right side of the heart to become dilated and to reduce the pumping activity of the heart muscle. Also, sometimes it will cause the pressure to go up in the right side of the heart. While this does not always happen, if it does it can be a problem for exercising. This is because we know that exercise may increase the pressure in the right side of the heart as well. If the pressure goes up to quickly it can be dangerous. So exercise can be dangerous if the PE caused the pressures to go up.

Are Physical Limitations after PE Common?

The truth is we do not know how common physical limitations are after PE. But we do have some clues. A few groups of researchers took patients after significant pulmonary embolism and tested them for their exercise ability. They used a special test called cardiopulmonary exercise testing, or CPET. This is a very accurate test that can measure the heart, lung and muscle function during exercise. What the researchers found was that many people had limitations. But the surprise was the cause for the limitations. Sometimes, it was the heart and lungs. But sometimes it was the muscles. It turns out that a PE causes deconditioning very quickly. This basically means that people after a PE may become “out of shape” very quickly and may need to build up their stamina again.

How can I Exercise after Pulmonary Embolism Safely?

There is no one answer to this. But basically, you need to factor in your condition, the severity of the PE and the intensity of exercise.

If you were in great shape before the PE, the PE was not very severe, you feel great now and the amount of exercise you are looking at is mild, then it will probably be safe.

But if any one of these is not true, then you may need more guidance. The most accurate way to assess your ability to exercise safely is with a cardiopulmonary exercise test, like I described above.

But this kind of testing may not be available for everyone. So there are a few rules of thumb. First, you want to make sure that the right side of your heart is working properly. The easiest way to test for this is with an echocardiogram (a “heart ultrasound”). If there is any issue with he heart, you will need guidance from a cardiologist or a specialist in pulmonary hypertension. Another “quick and dirty” rule, is your ability to perform your daily routine. If you are limited with “normal” activities, then ramping up without guidance may not be the best move.

Not All Exercise is the Same

Remember that not all exercise is the same. First, there is a matter of intensity. Walking briskly is not the same as running up a hill. Also, the duration of exercise changes. For instance, One person may enjoy short sessions while another may want to keep going for hours.

But there is another factor which is the effect exercise has on the pressure in your heart and lungs. Isometric exercise such as weight lifting or “HIT” sessions will increase these pressure abruptly. On the other hand, low intensity aerobic exercise like easy jogging will not do this. Obviously, after PE we should prefer the aerobic exercise. If you enjoy the shorter, high-intensity type of exercise, you will often need guidance.

Is there Value for Rehabilitation?

The truth is we don’t know. We do know that cardiac rehabilitation works after a “heart attack” (myocardial infarction). And, we know that pulmonary rehabilitation works for people with chronic lung disease. But no one has tested the value of any of these for PE patients. Having said that, my opinion is that it does work. So, I do send my patients for rehabilitation when they have limitations and my experience has been very positive with the results.

Dr. Ido Weinberg

Dr. Ido Weinberg is a Vascular Medicine specialist at Massachusetts General Hospital. He is President-Elect of the Society for Vascular Medicine. Dr. Weinberg treats hundreds of patients with blood clots every year. He publishes extensively on blood clots and he speaks frequently about blood clots in international conferences.

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