Rehabilitation to improve exercise capacity and quality of life after pulmonary embolism

<b>Background:</b> The scientific evidence regarding rehabilitation following pulmonary embolism (PE) is limited. <b>Aim:</b> Our aim was to determine the effect of exercise-based rehabilitation compared to usual care on exercise capacity in PE survivors with persistent dyspnoea. <b>Methods:</b> We conducted an RCT at two hospitals in Norway. Patients with persistent dyspnoea 6–72 months after acute PE, were randomized 1:1 to rehabilitation or usual care. The rehabilitation consisted of two weekly sessions of physical exercise for 8 weeks, and one educational session. The primary endpoint was the difference in Incremental Shuttle Walk Test (ISWT) between groups at follow-up. Secondary endpoints were differences in Endurance Shuttle Walk Test (ESWT), Quality of life (QoL; EQ-5D and Pulmonary Embolism-QoL questionnaires) and dyspnoea (Shortness of Breath questionnaire). <b>Results:</b> Of 211 subjects included, 108 (51%) were randomized to rehabilitation and 103 (49%) to usual care. At follow-up, participants in the rehabilitation group performed better on the ISWT than controls (mean difference 53.0 m, 95% CI: 17.7–88.3, P=0.0035). The rehabilitation group reported better score on the Pulmonary Embolism-QoL (0–100% scale); mean difference -4% (95% CI: -9%–0%, P=0.041), but there were no differences in generic QoL, dyspnoea scores, or the ESWT. No adverse events occurred during the intervention. <b>Conclusions:</b> In patients with persistent dyspnoea following PE, those who underwent rehabilitation had better exercise capacity at follow-up than those receiving usual care. Rehabilitation following PE is promising, but further research is needed to assess the optimal patient selection, timing, mode and duration of rehabilitation.