Upper Extremity Exercise Capacity in adolescent and young adult with pulmonary arterial hypertension: The Role of Muscle Function

Year 2025, Volume: 3 Issue: 3, 124 - 133, 10.09.2025

Jan Dik , Ceyhun Topcuoğlu , Naciye Vardar Yaglı , Ebru Aypar , Dursun Alehan , Melda Saglam

Abstract

Background:
Pulmonary arterial hypertension (PAH) impairs aerobic capacity through combined cardiopulmonary and skeletal muscle dysfunction. However, upper extremity aerobic performance and muscle-related parameters correlates have not been widely explored in PAH population.
Objective: To investigate the relationship between maximal workload achieved during an arm ergometer test and peripheral muscle parameters in adolescents and young adults with PAH.
Methods:
Eighteen PAH patients were evaluated; two were excluded due to protocol deviations, resulting in a final sample of 16 participants (mean age: 20.4 ± 8.2 years; 9 females). Maximum workload (watts) was assessed via an arm ergometer test. Handgrip strength was measured using a handgrip dynamometer, and shoulder abduction strength with a digital dynamometer ; both were converted to percent predicted using age- and sex-adjusted normative equations. Fat-free mass (FFM) was calculated from body composition using bioelectrical impedance analysis. Surface electromyography (EMG) of the anterior deltoid was recorded during the first and end stage of the exercise and expressed as % maximal voluntary isometric contraction (MVIC), in accordance with Surface EMG for the Non-Invasive Assessment of Muscles (SENIAM) standards. Brain Natriuretic Peptide (BNP) levels were obtained from recent clinical records. Spearman correlation was used to evaluate associations.
Results:
Maximal workload was positively correlated with FFM (r = 0.615, p = 0.011), shoulder abduction strength (r = 0.535, p = 0.033), and handgrip strength (r = 0.648, p = 0.014). It was negatively correlated with BNP (r = –0.728, p = 0.005) and the maximum %MVIC value of anterior deltoid EMG obtained from the first 15 seconds of the initial arm ergometer test stage (r = –0.602, p = 0.014). A negative correlation was also observed with EMG from the final stage, though it did not reach statistical significance (r=–0.442, p=0.086).
Conclusion:
Upper extremity aerobic performance in PAH is significantly associated with muscle strength, mass, and activation, as well as cardiac stress. These results highlight the clinical relevance of specifically assessing upper extremity aerobic performance as a meaningful indicator of functional status in PAH.

Keywords

Upper Extremity , Motor Activity , Electromyography , Muscle Strength , Pulmonary Hypertension

Ethical Statement

This study was approved by the Hacettepe University Non-Interventional Ethics Committee (Ethics Committee No: GO 22/39). All participants provided informed consent prior to their inclusion in the study.

Supporting Institution

Hacettepe University, Faculty of Physical Therapy and Rehabilitation; Hacettepe University, Faculty of Medicine, Department of Pediatrics, Division of Pediatric Cardiology

Thanks

The authors would like to express their sincere gratitude to Prof. Dr. Melda Sağlam for her supervision and scientific contribution throughout the study. The authors also thank Prof. Dr. Dursun Alehan and Prof. Dr. Ebru Aypar from the Division of Pediatric Cardiology for their clinical support, and all the staff and participants who contributed to this study.

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