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Respiratory Muscles and Chemoreflex Sensitivity in Heart Failure: A Breath of Fresh Air. Can J Cardiol 2017; 33:433-436. [PMID: 28343606 DOI: 10.1016/j.cjca.2017.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Revised: 02/07/2017] [Accepted: 02/07/2017] [Indexed: 11/23/2022] Open
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Almeida GPL, Trombetta IC, Cepeda FX, Hatanaka E, Curi R, Mostarda C, Irigoyen MC, Barreto-Filho JAS, Krieger EM, Consolim-Colombo FM. The Role of Acute Intermittent Hypoxia in Neutrophil-Generated Superoxide, Sympathovagal Balance, and Vascular Function in Healthy Subjects. Front Physiol 2017; 8:4. [PMID: 28167915 PMCID: PMC5253395 DOI: 10.3389/fphys.2017.00004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Accepted: 01/04/2017] [Indexed: 11/27/2022] Open
Abstract
Introduction: Recurrent hypoxia (HPX), a hallmark of the obstructive sleep apnea (OSA), impairs autonomic balance, and increases arterial blood pressure (BP). Oxidative stress is one of the mechanisms involved in these alterations. The cumulative effect of acute intermittent HPX and the chronicity may determine whether the response crosses the threshold from having protective value to pathology. However, the impact of acute intermittent HPX–reoxygenation on markers of oxidative stress in healthy individuals remains to be fully understood. Objective: To analyze the effects of the acute intermittent HPX on the generation of neutrophil-derived superoxide, sympathovagal balance, and vascular function in healthy subjects. Methods: We applied six cycles of intermittent HPX (10% O2 and 90% N2) for 5 min followed by 2 min of room-air in 15 healthy volunteers (34 ± 2 years; 22.3 ± 0.46 kg/m2), without OSA (polysomnography), during wakefulness. During the experimental protocol, we recorded O2 saturation, end-tidal CO2, heart rate (HR), systolic, and diastolic BP, cardiac output (CO) and peripheral resistance (PR). Cardiac sympathovagal balance was determined by HR variability analysis (low frequency and high frequency bands, LF/HF). Superoxide generation in polymorphonuclear neutrophil cells were established using relative luminescence units (PMNs RLU) at baseline (pre-HPX) and immediately after hypoxia induction (post-HPX6). Results: The studied subjects had normal levels of BP, plasma glucose, lipid profile, and inflammatory marker (C-reactive protein). Acute intermittent HPX increased HR, systolic BP, CO, and decreased PR. Additionally, acute intermittent HPX increased PMNs RLU, measured post-HPX6 (470 ± 50 vs. 741 ± 135, P < 0.05). We found a similar increase in LF/HF post-HPX6 (0.91 ± 0.11 vs. 2.85 ± 0.40, P < 0.05). PR was diminished from pre-HPX to post-HPX6 (1.0 ± 0.03 vs. 0.85 ± 0.06, P < 0.05). Further analysis showed significant association between O2 saturation and PMNs RLU (R = −0.62, P = 0.02), and with LF/HF (R = −0.79, P = 0.02) post-HPX6. In addition, an association was found between PMNs RLU and PR post-HPX6 (R = 0.58, P = 0.04). Conclusion: Acute exposure to intermittent HPX not only increased superoxide generation in neutrophils, but also impaired cardiac sympathovagal balance in healthy subjects. These data reinforce the role of intermittent HPX in superoxide generation on neutrophils, which may lead to an impairment in peripheral vascular resistance.
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Affiliation(s)
- Germana P L Almeida
- Heart Institute do Hospital das Clínicas da Faculdade de Medicina da Universidade de São PauloSão Paulo, Brazil; Departamento de Medicina Clínica, Federal University of CearáCeará, Brazil
| | - Ivani C Trombetta
- Graduate Program in Medicine, Uninove, Universidade Nove de Julho São Paulo, Brazil
| | - Felipe X Cepeda
- Heart Institute do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo São Paulo, Brazil
| | - Elaine Hatanaka
- Instituto de Ciências da Atividade Física e Esportes, Universidade Cruzeiro do Sul São Paulo, Brazil
| | - Rui Curi
- Department of Physiology and Biophysics, Institute of Biomedical Sciences, University of São Paulo São Paulo, Brazil
| | - Cristiano Mostarda
- Programa de Pós-Graduação em Saúde do Adulto e da Criança, Federal University of Maranhão Maranhão, Brazil
| | - Maria C Irigoyen
- Heart Institute do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo São Paulo, Brazil
| | | | - Eduardo M Krieger
- Heart Institute do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo São Paulo, Brazil
| | - Fernanda M Consolim-Colombo
- Heart Institute do Hospital das Clínicas da Faculdade de Medicina da Universidade de São PauloSão Paulo, Brazil; Graduate Program in Medicine, Uninove, Universidade Nove de JulhoSão Paulo, Brazil
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Jaenisch RB, Quagliotto E, Chechi C, Calegari L, Dos Santos F, Borghi-Silva A, Dal Lago P. Respiratory Muscle Training Improves Chemoreflex Response, Heart Rate Variability, and Respiratory Mechanics in Rats With Heart Failure. Can J Cardiol 2016; 33:508-514. [PMID: 28132741 DOI: 10.1016/j.cjca.2016.11.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Revised: 10/25/2016] [Accepted: 11/01/2016] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND The aim of the present report was to evaluate respiratory muscle training (RMT) effects on hemodynamic function, chemoreflex response, heart rate variability, and respiratory mechanics in rats with heart failure (HF rats). METHODS Wistar rats were divided into 4 groups: sedentary-sham (Sed-Sham, n = 8), respiratory muscle trained-sham (RMT-Sham, n = 8), sedentary-HF (Sed-HF, n = 8) and respiratory muscle trained-HF (RMT-HF, n = 8). Animals were submitted to an RMT protocol performed 30 minutes per day, 5 days per week for 6 weeks, whereas the sedentary animals did not exercise. RESULTS In HF rats, RMT promoted the reduction of left ventricular end-diastolic pressure, right ventricular hypertrophy, and pulmonary edema. Moreover, RMT produced a reduction in pressure response during chemoreflex activation, sympathetic modulation, and sympathetic vagal balance in addition to an increase in parasympathetic modulation. Also after RMT, HF rats demonstrated a reduction in respiratory system resistance, tissue resistance, Newtonian resistance, respiratory system compliance, and quasistatic compliance. CONCLUSIONS These findings suggested that 6 weeks of RMT in HF rats promoted beneficial adaptations in hemodynamics, autonomic function, and respiratory mechanics and attenuated pressure response evoked by chemoreflex activation in HF rats.
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Affiliation(s)
- Rodrigo B Jaenisch
- Post Graduation Program in Health Sciences, Laboratory of Experimental Physiology, Federal University of Health Sciences of Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil; Cardiopulmonary Physiotherapy Laboratory, Physiotherapy Department, Federal University of São Carlos, São Carlos, São Paulo, Brazil
| | - Edson Quagliotto
- Post Graduation Program in Health Sciences, Laboratory of Experimental Physiology, Federal University of Health Sciences of Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
| | - Chalyne Chechi
- Post Graduation Program in Health Sciences, Laboratory of Experimental Physiology, Federal University of Health Sciences of Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
| | - Leonardo Calegari
- Post Graduation Program in Health Sciences, Laboratory of Experimental Physiology, Federal University of Health Sciences of Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
| | - Fernando Dos Santos
- Laboratory of Experimental Hypertension, University of São Paulo, São Paulo, São Paulo, Brazil
| | - Audrey Borghi-Silva
- Cardiopulmonary Physiotherapy Laboratory, Physiotherapy Department, Federal University of São Carlos, São Carlos, São Paulo, Brazil
| | - Pedro Dal Lago
- Post Graduation Program in Health Sciences, Laboratory of Experimental Physiology, Federal University of Health Sciences of Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil; Post Graduation Program in Rehabilitation Sciences, Federal University of Health Sciences of Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil.
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54
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Schein A, Correa A, Casali KR, Schaan BD. Are glucose levels, glucose variability and autonomic control influenced by inspiratory muscle exercise in patients with type 2 diabetes? Study protocol for a randomized controlled trial. Trials 2016; 17:38. [PMID: 26790405 PMCID: PMC4719684 DOI: 10.1186/s13063-016-1156-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Accepted: 01/05/2016] [Indexed: 01/27/2023] Open
Abstract
Background Physical exercise reduces glucose levels and glucose variability in patients with type 2 diabetes. Acute inspiratory muscle exercise has been shown to reduce these parameters in a small group of patients with type 2 diabetes, but these results have yet to be confirmed in a well-designed study. The aim of this study is to investigate the effect of acute inspiratory muscle exercise on glucose levels, glucose variability, and cardiovascular autonomic function in patients with type 2 diabetes. Methods/design This study will use a randomized clinical trial crossover design. A total of 14 subjects will be recruited and randomly allocated to two groups to perform acute inspiratory muscle loading at 2 % of maximal inspiratory pressure (PImax, placebo load) or 60 % of PImax (experimental load). Discussion Inspiratory muscle training could be a novel exercise modality to be used to decrease glucose levels and glucose variability. Trial registration ClinicalTrials.gov NCT02292810.
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Affiliation(s)
- Aso Schein
- Exercise Pathophysiology Research Laboratory, Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil.
| | - Aps Correa
- Exercise Pathophysiology Research Laboratory, Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil. .,Faculty of Health Sciences, University of Sydney, Lidcombe, New South Wales, Australia.
| | - Karina Rabello Casali
- Institute of Science and Technology, Universidade Federal de São Paulo, São Paulo, Brazil.
| | - Beatriz D Schaan
- Exercise Pathophysiology Research Laboratory, Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil. .,Graduate Program in Endocrinology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil. .,Endocrine Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil.
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55
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Sanchis-Gomar F, González-Saiz L, Sanz-Ayan P, Fiuza-Luces C, Quezada-Loaiza CA, Flox-Camacho A, Santalla A, Munguía-Izquierdo D, Santos-Lozano A, Pareja-Galeano H, Ara I, Escribano-Subías P, Lucia A. Rationale and Design of a Randomized Controlled Trial Evaluating Whole Muscle Exercise Training Effects in Outpatients with Pulmonary Arterial Hypertension (WHOLEi+12). Cardiovasc Drugs Ther 2015; 29:543-550. [PMID: 26521182 DOI: 10.1007/s10557-015-6623-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND AIMS Physical exercise is an important component in the management of pulmonary artery hypertension (PAH). The aim of this randomized controlled trial (RCT) is to determine the effects of an 8-week intervention combining muscle resistance, aerobic and inspiratory pressure load exercises in PAH outpatients. METHODS The RCT will be conducted from September 2015 to September 2016 following the recommendations of the Consolidated Standards of Reported Trials (CONSORT), with a total sample size of n ≥ 48 (≥24 participants/group). We will determine the effects of the intervention on: (i) skeletal-muscle power and mass (primary end points); and (ii) NT-proBNP, cardiopulmonary exercise testing variables (VO2peak, ventilatory equivalent for CO2 at the anaerobic threshold (VE/VCO2 at the AT), end-tidal pressure of CO2 at the anaerobic threshold (PETCO2 at the AT), 6-min walking distance (6MWD), maximal inspiratory pressure (PImax), health-related quality of life (HRQoL), objectively-assessed spontaneous levels of physical activity, and safety (secondary end points). CONCLUSIONS AND PERSPECTIVES This trial will provide insight into biological mechanisms of the disease and indicate the potential benefits of exercise in PAH outpatients, particularly on muscle power.
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Affiliation(s)
- Fabian Sanchis-Gomar
- Research Institute Hospital 12 de Octubre ('i + 12'), Edificio actividades ambulatorias, 6ª planta. Avda. de Córdoba s/n, 28041, Madrid, Spain.
| | - Laura González-Saiz
- Research Institute Hospital 12 de Octubre ('i + 12'), Edificio actividades ambulatorias, 6ª planta. Avda. de Córdoba s/n, 28041, Madrid, Spain
| | - Paz Sanz-Ayan
- Department of Rehabilitation, Hospital Universitario 12 de Octubre, Avda. de Córdoba s/n, 28041 Madrid, Spain
| | - Carmen Fiuza-Luces
- Research Institute Hospital 12 de Octubre ('i + 12'), Edificio actividades ambulatorias, 6ª planta. Avda. de Córdoba s/n, 28041, Madrid, Spain
| | - Carlos A Quezada-Loaiza
- Cardiology Department, Hospital Universitario 12 de Octubre, Avda. de Córdoba s/n, 28041 Madrid, Spain
| | - Angela Flox-Camacho
- Cardiology Department, Hospital Universitario 12 de Octubre, Avda. de Córdoba s/n, 28041 Madrid, Spain
| | - Alfredo Santalla
- Research Institute Hospital 12 de Octubre ('i + 12'), Edificio actividades ambulatorias, 6ª planta. Avda. de Córdoba s/n, 28041, Madrid, Spain.,Department of Sports and Computer Science, Section of Physical Education and Sports, Universidad Pablo de Olavide, ES-41013 Seville, Spain
| | - Diego Munguía-Izquierdo
- Department of Sports and Computer Science, Section of Physical Education and Sports, Universidad Pablo de Olavide, ES-41013 Seville, Spain
| | - Alejandro Santos-Lozano
- Research Institute Hospital 12 de Octubre ('i + 12'), Edificio actividades ambulatorias, 6ª planta. Avda. de Córdoba s/n, 28041, Madrid, Spain.,Department of Health Sciences, European University Miguel de Cervantes, C/Padre Julio Chevalier, 47012, Valladolid, Spain
| | - Helios Pareja-Galeano
- Research Institute Hospital 12 de Octubre ('i + 12'), Edificio actividades ambulatorias, 6ª planta. Avda. de Córdoba s/n, 28041, Madrid, Spain.,European University, C/Tajo S/N, Urbanización El Bosque, 28670 Villaviciosa de Odón, Madrid, Spain
| | - Ignacio Ara
- Growth, Exercise, Nutrition and Development (GENUD) Toledo Research Group, Universidad de Castilla-La Mancha, Avda Carlos III s/n, 45071 Toledo, Spain
| | - Pilar Escribano-Subías
- Cardiology Department, Hospital Universitario 12 de Octubre, Avda. de Córdoba s/n, 28041 Madrid, Spain
| | - Alejandro Lucia
- Research Institute Hospital 12 de Octubre ('i + 12'), Edificio actividades ambulatorias, 6ª planta. Avda. de Córdoba s/n, 28041, Madrid, Spain.,European University, C/Tajo S/N, Urbanización El Bosque, 28670 Villaviciosa de Odón, Madrid, Spain
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Abstract
Breathing exercises (BE) and inspiratory muscle training (IMT) have been demonstrated to improve ventilation and ventilation-to-perfusion matching, and to improve exercise, functional performance, and many pathophysiologic manifestations of heart failure (HF). This article provides an extensive review of BE and IMT in patients with HF and identifies several key areas in need of further investigation, including the role of expiratory muscle training, IMT targeted at various locations of inspiration (early, mid, or late inspiration), and alteration of the ratio of inspiratory time to total breath time, all of which have substantial potential to improve many pathophysiologic manifestations of HF.
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Affiliation(s)
- Lawrence P Cahalin
- Department of Physical Therapy, Leonard M. Miller School of Medicine, University of Miami, Miami, 5915 Ponce de Leon Boulevard, Coral Gables, FL 33146-2435, USA.
| | - Ross A Arena
- Department of Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago, 1919 West Taylor Street, Room 459, Chicago, IL 60612, USA
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Manders E, Rain S, Bogaard HJ, Handoko ML, Stienen GJM, Vonk-Noordegraaf A, Ottenheijm CAC, de Man FS. The striated muscles in pulmonary arterial hypertension: adaptations beyond the right ventricle. Eur Respir J 2015; 46:832-42. [PMID: 26113677 DOI: 10.1183/13993003.02052-2014] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2015] [Accepted: 05/19/2015] [Indexed: 11/05/2022]
Abstract
Pulmonary arterial hypertension (PAH) is a fatal lung disease characterised by progressive remodelling of the small pulmonary vessels. The daily-life activities of patients with PAH are severely limited by exertional fatigue and dyspnoea. Typically, these symptoms have been explained by right heart failure. However, an increasing number of studies reveal that the impact of the PAH reaches further than the pulmonary circulation. Striated muscles other than the right ventricle are affected in PAH, such as the left ventricle, the diaphragm and peripheral skeletal muscles. Alterations in these striated muscles are associated with exercise intolerance and reduced quality of life. In this Back to Basics article on striated muscle function in PAH, we provide insight into the pathophysiological mechanisms causing muscle dysfunction in PAH and discuss potential new therapeutic strategies to restore muscle dysfunction.
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Affiliation(s)
- Emmy Manders
- Dept of Pulmonology, VU University Medical Center, Institute for Cardiovascular Research, Amsterdam, The Netherlands Dept of Physiology, VU University Medical Center, Institute for Cardiovascular Research, Amsterdam, The Netherlands
| | - Silvia Rain
- Dept of Pulmonology, VU University Medical Center, Institute for Cardiovascular Research, Amsterdam, The Netherlands
| | - Harm-Jan Bogaard
- Dept of Pulmonology, VU University Medical Center, Institute for Cardiovascular Research, Amsterdam, The Netherlands
| | - M Louis Handoko
- Dept of Pulmonology, VU University Medical Center, Institute for Cardiovascular Research, Amsterdam, The Netherlands Dept of Cardiology, VU University Medical Center, Institute for Cardiovascular Research, Amsterdam, The Netherlands
| | - Ger J M Stienen
- Dept of Physiology, VU University Medical Center, Institute for Cardiovascular Research, Amsterdam, The Netherlands Dept of Physics and Astronomy, VU University, Amsterdam, The Netherlands
| | - Anton Vonk-Noordegraaf
- Dept of Pulmonology, VU University Medical Center, Institute for Cardiovascular Research, Amsterdam, The Netherlands
| | - Coen A C Ottenheijm
- Dept of Physiology, VU University Medical Center, Institute for Cardiovascular Research, Amsterdam, The Netherlands
| | - Frances S de Man
- Dept of Pulmonology, VU University Medical Center, Institute for Cardiovascular Research, Amsterdam, The Netherlands
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Kaminski DM, Schaan BD, da Silva AMV, Soares PP, Lago PD. Inspiratory muscle training in patients with diabetic autonomic neuropathy: a randomized clinical trial. Clin Auton Res 2015; 25:263-6. [PMID: 25982993 DOI: 10.1007/s10286-015-0291-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2014] [Accepted: 03/05/2015] [Indexed: 11/28/2022]
Abstract
AIMS AND METHODS We evaluated the effects of an 8-week inspiratory muscle training (IMT, n = 5) or placebo IMT (P-IMT, n = 5) on maximal respiratory pressures, pulmonary function, functional capacity, and cardiac autonomic control in patients with type 2 diabetes and diabetic autonomic neuropathy (DAN). RESULTS AND CONCLUSIONS The IMT group had a greater increase in maximum inspiratory pressure as compared to P-IMT (p < 0.05). The IMT improved inspiratory muscle strength in patients with DAN.
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Affiliation(s)
- Diogo Machado Kaminski
- Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil.,Instituto de Cardiologia/Fundação, Universitária de Cardiologia do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Beatriz D Schaan
- Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil. .,Serviço de Endocrinologia, Hospital de Clinicas de Porto Alegre, Rua Ramiro Barcelos, 2350, prédio 12, 4º andar, Porto Alegre, RS, Brazil. .,Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil.
| | | | | | - Pedro Dal Lago
- Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, RS, Brazil
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59
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Sympathetic neural adaptations to exercise training in humans. Auton Neurosci 2015; 188:36-43. [DOI: 10.1016/j.autneu.2014.10.020] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Revised: 07/28/2014] [Accepted: 10/13/2014] [Indexed: 12/31/2022]
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Montemezzo D, Fregonezi GA, Pereira DA, Britto RR, Reid WD. Influence of Inspiratory Muscle Weakness on Inspiratory Muscle Training Responses in Chronic Heart Failure Patients: A Systematic Review and Meta-Analysis. Arch Phys Med Rehabil 2014; 95:1398-407. [DOI: 10.1016/j.apmr.2014.02.022] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Revised: 02/20/2014] [Accepted: 02/21/2014] [Indexed: 12/31/2022]
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Adamopoulos S, Schmid JP, Dendale P, Poerschke D, Hansen D, Dritsas A, Kouloubinis A, Alders T, Gkouziouta A, Reyckers I, Vartela V, Plessas N, Doulaptsis C, Saner H, Laoutaris ID. Combined aerobic/inspiratory muscle training vs. aerobic training in patients with chronic heart failure: The Vent-HeFT trial: a European prospective multicentre randomized trial. Eur J Heart Fail 2014; 16:574-82. [PMID: 24634346 DOI: 10.1002/ejhf.70] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2013] [Revised: 12/19/2013] [Accepted: 01/03/2014] [Indexed: 12/15/2022] Open
Abstract
AIMS Vent-HeFT is a multicentre randomized trial designed to investigate the potential additive benefits of inspiratory muscle training (IMT) on aerobic training (AT) in patients with chronic heart failure (CHF). METHODS AND RESULTS Forty-three CHF patients with a mean age of 58 ± 12 years, peak oxygen consumption (peak VO2 ) 17.9 ± 5 mL/kg/min, and LVEF 29.5 ± 5% were randomized to an AT/IMT group (n = 21) or to an AT/SHAM group (n = 22) in a 12-week exercise programme. AT involved 45 min of ergometer training at 70-80% of maximum heart rate, three times a week for both groups. In the AT/IMT group, IMT was performed at 60% of sustained maximal inspiratory pressure (SPImax ) while in the AT/SHAM group it was performed at 10% of SPImax , using a computer biofeedback trainer for 30 min, three times a week. At baseline and at 3 months, patients were evaluated for exercise capacity, lung function, inspiratory muscle strength (PImax ) and work capacity (SPImax ), quality of life (QoL), LVEF and LV diameter, dyspnoea, C-reactive protein (CRP), and NT-proBNP. IMT resulted in a significantly higher benefit in SPImax (P = 0.02), QoL (P = 0.002), dyspnoea (P = 0.004), CRP (P = 0.03), and NT-proBNP (P = 0.004). In both AT/IMT and AT/SHAM groups PImax (P < 0.001, P = 0.02), peak VO2 (P = 0.008, P = 0.04), and LVEF (P = 0.005, P = 0.002) improved significantly; however, without an additional benefit for either of the groups. CONCLUSION This randomized multicentre study demonstrates that IMT combined with aerobic training provides additional benefits in functional and serum biomarkers in patients with moderate CHF. These findings advocate for application of IMT in cardiac rehabilitation programmes.
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Affiliation(s)
- Stamatis Adamopoulos
- Heart Failure Unit, Stress Testing & Rehabilitation, Onassis Cardiac Surgery Center, Athens, Greece
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Cahalin LP, Arena R, Guazzi M, Myers J, Cipriano G, Chiappa G, Lavie CJ, Forman DE. Inspiratory muscle training in heart disease and heart failure: a review of the literature with a focus on method of training and outcomes. Expert Rev Cardiovasc Ther 2013; 11:161-77. [PMID: 23405838 DOI: 10.1586/erc.12.191] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Evidence to date strongly suggests that poor inspiratory muscle performance is associated with dyspnea, poor exercise tolerance and poor functional status in patients with heart failure (HF). A growing body of literature has examined the effects of inspiratory muscle training (IMT) in HF patients with the majority of studies reporting favorable effects on several of the above limitations and a substantial number of related deficiencies due to inadequate inspiration and inspiratory muscle strength and endurance. The domains and manifestations of HF, which were significantly improved by IMT in one or more of the 18 out of 19 studies of IMT, included dyspnea, quality of life, balance, peripheral muscle strength and blood flow, peripheral muscle sympathetic nervous activity, heart rate, respiratory rate, peak VO₂, 6-min walk test distance, ventilation, VE/VCO₂ slope, oxygen uptake efficiency, circulatory power, recovery oxygen kinetics and several indices of cardiac performance. This paper will also review the available IMT literature with a focus on methods of IMT and clinical outcomes. Key differences between available IMT methods will be highlighted with a goal to improve IMT efforts and decrease the pathophysiological manifestations of heart disease and HF.
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Affiliation(s)
- Lawrence P Cahalin
- Department of Physical Therapy, Leonard M. Miller School of Medicine, University of Miami, 5915 Ponce de Leon Blvd. 5th Floor, Miami, Coral Gables, FL 33146-2435, USA.
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63
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Autonomic changes in young smokers: acute effects of inspiratory exercise. Clin Auton Res 2013; 23:201-7. [DOI: 10.1007/s10286-013-0202-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2013] [Accepted: 06/07/2013] [Indexed: 10/26/2022]
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