PH patients in high-altitude areas reported perceived improvements in dyspnea and fatigue after engaging in pulmonary rehabilitation, but implementation remained constrained by environmental constraints, insufficient professional guidance, and limited patient awareness, with strong preferences expressed for telemedicine, educational materials, and community-based programs.
Key Findings
Results
Just over half of surveyed PH patients in high-altitude areas reported engaging in pulmonary rehabilitation exercises.
206 PH patients completed a questionnaire survey at a tertiary hospital in Xining, Qinghai Province
53.88% of patients reported engaging in breathing exercises or physical training
The study used a mixed-methods design combining quantitative survey with semi-structured interviews of 11 patients
The setting is a high-altitude area where chronic hypoxia worsens pulmonary hypertension
Results
The majority of patients who engaged in pulmonary rehabilitation perceived improvements in dyspnea and fatigue.
Among the 111 participants who reported engaging in PR exercises, 90.09% perceived improvement in dyspnea
87.39% of those engaging in PR perceived improvement in fatigue
These findings were based on self-reported perceptions, not objective clinical measurements
Qualitative interviews were broadly consistent with quantitative results regarding perceived symptom improvement
Results
High-altitude environmental constraints were the most commonly reported barrier to pulmonary rehabilitation participation.
54.85% of patients cited high-altitude environmental constraints as a leading obstacle
41.75% reported lack of professional guidance as a barrier
35.92% cited technical complexity such as mastering breathing training techniques as a barrier
Qualitative interviews identified three main themes: current PR practices and perceived symptom changes, barriers to PR implementation, and support needs related to PR, with eight subthemes
Results
Patients expressed strong preferences for telemedicine consultations, disease education manuals, and family nursing skills training as forms of support.
82.04% of patients most wanted telemedicine consultations
65.05% wanted disease education manuals
61.65% wanted family nursing skills training
Qualitative findings also revealed that patients called for structured discharge planning, community-led rehabilitation, and remote follow-up options
Results
Qualitative analysis identified three overarching themes related to pulmonary rehabilitation experiences in high-altitude PH patients.
The three main themes were: current PR practices and perceived symptom changes, barriers to PR implementation, and support needs related to PR
Eight subthemes were identified within these three themes
Qualitative data were analyzed using thematic analysis
Qualitative findings were 'broadly consistent with and complementary to the quantitative results'
11 patients participated in semi-structured interviews
Background
The study found an absence of research capturing patients' firsthand experiences with pulmonary rehabilitation in high-altitude settings.
Chronic hypoxia at high altitudes worsens pulmonary hypertension, leading to earlier symptom onset, more frequent exacerbations, and diminished quality of life
Research capturing patients' firsthand experiences with PR in high-altitude settings is 'largely absent'
The study was conducted at a tertiary hospital in Xining, Qinghai Province, a high-altitude region
The authors note that implementing PR in high-altitude settings presents 'a range of multifaceted challenges'
Conclusions
The authors concluded that standardized inpatient PR education and structured discharge planning are needed to support continuity of rehabilitation from hospital to home.
Findings highlight the need to 'strengthen standardized inpatient PR education and structured discharge planning'
The study aims to 'inform the development and future evaluation of context-specific PR strategies for patients with PH living at high altitude'
Multiple barriers were identified as impeding consistent participation despite reported symptom improvement
Community-based programs and improved discharge planning were among the patient-expressed preferences
What This Means
This research suggests that people living with pulmonary hypertension (high blood pressure in the lungs) at high altitudes face unique and significant challenges when trying to participate in pulmonary rehabilitation — structured programs of exercise and breathing training designed to improve symptoms. The study surveyed 206 patients and interviewed 11 in depth at a hospital in Qinghai Province, China, a high-altitude region. About half of patients were engaging in some form of rehabilitation, and among those who did, the vast majority reported feeling less breathless and less fatigued. However, many patients were not consistently participating, held back primarily by the harsh high-altitude environment itself, a lack of professional guidance, and difficulty mastering complex breathing techniques.
This research also suggests that patients have clear ideas about what would help them: the most desired form of support was telemedicine consultations (wanted by over 80% of respondents), followed by written educational materials about their disease, and training for family members in caregiving skills. Patients in the in-depth interviews further emphasized the need for better planning when leaving the hospital, community-based rehabilitation programs closer to home, and ongoing remote follow-up from healthcare providers.
The practical implications of these findings point to a gap between what patients need and what current healthcare systems in high-altitude areas provide. This research suggests that hospitals could better prepare patients for rehabilitation before they go home, and that building community-level programs and remote care options — such as telehealth — could help people with pulmonary hypertension in these challenging environments maintain their rehabilitation routines and potentially improve their quality of life.
Li W, Ke X, Ma J, Jin R, Zhao H, Zheng Y, et al.. (2026). Patients' perspectives on pulmonary rehabilitation for pulmonary hypertension in high-altitude areas: a mixed-methods study.. Frontiers in public health. https://doi.org/10.3389/fpubh.2026.1869309