Interventions Against Insulin Resistance in Pulmonary Arterial Hypertension

Inclusion Criteria:• Adults aged 18 or older. * Diagnosed with idiopathic, heritable, or drug- or toxin-associated pulmonary arterial hypertension (PAH) according to World Health Organization consensus recommendations. * Stable PAH-specific medication regimen for three months prior to enrollment. Subjects with only a single diuretic adjustment in the prior three months will be included. Adjustments in IV prostacyclin for side effect management are allowed. * Subjects must own a Bluetooth capable modern smartphone capable of receiving and sending text messages and an active data plan. * WHO Functional Class I-III * Ambulatory Exclusion Criteria: * Prohibited from normal activity due to wheelchair bound status, bed bound status, reliance on a cane/walker, activity-limiting angina, activity-limiting osteoarthritis, or other condition that limits activity * Pregnancy * Diagnosis of PAH etiology other than idiopathic, heritable, or associated with drugs or toxins * FEV1\> or = 65% predicted AND normal chest imaging * WHO Functional class IV heart failure * Requirement of \> 1 diuretic adjustment in the prior 30 days * Preferred form of activity is not measured by an activity tracker (swimming, ice skating, stair master, or activities on wheels such as bicycling or rollerblading) * Type I diabetes mellitus * Prior diagnosis of cirrhosis * Untreated hypo- or hyper-thyroidism * estimated glomerular filtration rate (eGFR) by modification of diet in renal disease (MDRD) \<60 millili…