Respiratory Muscle Strength in the Physically Active Elderly

Impact of 12-Month Late-in-Life Exercise Training on Cardiopulmonary Reserve, Static Cardiac Structure, and Function: A Randomized Clinical Trial

OBJECTIVE

Although the cardiac benefits of maintaining a lifelong exercise routine are undisputed, to what extent late-in-life exercise training can ameliorate cardiac aging remains unclear. We examined the impact of a 12-month exercise training program on cardiac reserve, static cardiac structure, and cardiac function in older adults.

DESIGN

This study was a single-center, randomized trial using Zelen design. Participants in the center-based exercise (CBE) group underwent an individualized multicomponent exercise training program.

SETTING AND PARTICIPANTS

In total, 120 community-dwelling older adults aged 65-85 years were evenly divided into a CBE group and a control group.

METHODS

The primary outcome indicator was absolute change in peak oxygen uptake (peakVO2) per kilogram from baseline to 12 months. The secondary outcome indicators were the absolute changes in other cardiopulmonary exercise test indices and cardiac magnetic resonance parameters. This study has been registered at the Chinese Clinical Trial Registry Network (ChiCTR2400081824).

RESULTS

In total, 47 older adults in the control group and 49 in the CBE group ultimately completed the 12-month follow-up and were analyzed. Of all participants, 52 (46.4%) were men, and the mean age was 71.22 ± 4.55 years. The absolute change in peakVO2/kg was significantly different between the CBE and control groups by +3.32 mL/kg/min (95% CI 2.10-4.53; P < .001), and a sex-related difference was observed. Additionally, the right ventricular peak filling and ejection rate improved to a greater degree in the CBE than control group (+65.57 mL/s, P = .006; +56.39 mL/s, P = .026, respectively).

CONCLUSIONS AND IMPLICATIONS

A 12-month exercise training program started later in life was effective in improving cardiopulmonary reserve, and men showed a better response to training than women. The right ventricular function increased after late-in-life exercise training.

Associations of Cardiorespiratory Fitness and Muscular Endurance Fitness With Pulmonary Function in Physically Active Young Adults

RATIONALE

While the beneficial effects of physical fitness on general health are well-documented, the specific relationship between different types of physical fitness, particularly cardiorespiratory fitness (CRF) and muscular endurance fitness (MEF), and lung function in physically active young adults remains less explored.

OBJECTIVE

This study investigated the relationship between CRF and MEF, and their correlation with lung function in physically active young adults.

METHODS

This cross-sectional study involved a cohort of 1227 physically active young adults without lung diseases. Lung function was assessed using FEV1, FVC, and FEV1/FVC measurements. The 3000-m run was used to assess CRF, and the 2-min push-up and sit-up tests were used to assess MEF. Multivariable linear regression analysis was used to evaluate the relationships between these fitness measures and lung function, adjusting for potential covariates.

RESULTS

Enhanced CRF was associated with superior FEV1 and FVC after adjusting for covariates (β=-.078, p=.015 for FEV1; β=-.086, p=.009 for FVC). Push-ups were positively associated with FEV1 (β=.102, p=.014), but not with FVC. In contrast, sit-ups showed no significant correlation with lung function in the fully adjusted model.

CONCLUSION

The study demonstrated a clear association between improved physical fitness and better lung function in physically active young adults, with various exercises showing distinct associations with lung metrics. Notably, push-ups were particularly associated with higher FEV1. A future prospective study is necessary to determine whether routine exercises, such as push-ups, might lead to greater lung function.

Influence of physical exercise on respiratory muscle function in older adults: A systematic review and meta-analysis

Respiratory function decreases with aging. The literature showed that non-ventilatory specific exercise could have a positive impact on respiratory muscles. A systematic literature review was conducted to assess the effects of non-ventilatory specific exercise on maximal inspiratory (MIP) and expiratory pressure (MEP) and peak expiratory flow (PEF) in older adults. The included 9 trials investigated the effects of resistance training, yoga, Pilates, physical activity based on walking, and whole-body vibration training. The meta-analysis showed no statistically significant differences in MIP, MEP, and PEF after implementation of a non-ventilatory specific exercise program in older individuals. Between-study heterogeneity was substantial for MIP and MEP outcomes but it was not statistically significant for PEF. Further RCTs will be necessary to determine the effects of physical exercise interventions. PROSPERO registry CRD42023478262.

Relationship Between Diaphragm Thickness, Thickening Fraction, Dome Excursion, and Respiratory Pressures in Healthy Subjects: An Ultrasound Study

PURPOSE

Diaphragm ultrasonography is used to identify causes of diaphragm dysfunction. However, its correlation with pulmonary function tests, including maximal inspiratory (MIP) and expiratory pressures (MEP), remains unclear. This study investigated this relationship by measuring diaphragm thickness, thickening fraction (TF), and excursion (DE) using ultrasonography, and their relationship to MIP and MEP. It also examined the influence of age, sex, height, and BMI on these measures.

METHODS

We recruited healthy Japanese volunteers and conducted pulmonary function tests and diaphragm ultrasonography in a seated position. Diaphragm ultrasonography was performed during quiet breathing (QB) and deep breathing (DB) to measure the diaphragm thickness, TF, and DE. A multivariate analysis was conducted, adjusting for age, sex, height, and BMI.

RESULTS

Between March 2022 and January 2023, 109 individuals (56 males) were included from three facilities. The mean (standard deviation) MIP and MEP [cmH2O] were 72.2 (24.6) and 96.9 (35.8), respectively. Thickness [mm] at the end of expiration was 1.7 (0.4), TF [%] was 50.0 (25.9) during QB and 110.7 (44.3) during DB, and DE [cm] was 1.7 (0.6) during QB and 4.4 (1.4) during DB. Multivariate analysis revealed that only DE (DB) had a statistically significant relationship with MIP and MEP (p = 0.021, p = 0.008). Sex, age, and BMI had a statistically significant influence on relationships between DE (DB) and MIP (p = 0.008, 0.048, and < 0.001, respectively).

CONCLUSION

In healthy adults, DE (DB) has a relationship with MIP and MEP. Sex, age, and BMI, but not height, are influencing factors on this relationship.

Interest of thoracic ultrasound after cardiac surgery or interventional cardiology

Thoracic ultrasound has attracted much interest in detecting pleural effusion or pulmonary consolidation after cardiac surgery. In 2016, Trovato reported, in the World Journal of Cardiology, the interest of using, in addition to echocardiography, thoracic ultrasound. In this editorial, we highlight the value of assessing diaphragm function after cardiac surgery and interventional cardiology procedures. Various factors are able to impair diaphragm function after such interventions. Diaphragm motion may be decreased by chest pain secondary to sternotomy, pleural effusion or impaired muscle function. Hemidiaphragmatic paralysis may be secondary to phrenic nerve damage complicating cardiac surgery or atrial fibrillation ablation. Diagnosis may be delayed. Indeed, respiratory troubles induced by diaphragm dysfunction are frequently attributed to pre-existing heart disease or pulmonary complications secondary to surgery. In addition, elevated hemidiaphragm secondary to diaphragm dysfunction is sometimes not observed on chest X-ray performed in supine position in the intensive care unit. Analysis of diaphragm function by ultrasound during the recovery period appears essential. Both hemidiaphragms can be studied by two complementary ultrasound methods. The mobility of each hemidiaphragms is measured by M-mode ultrasonography. In addition, recording the percentage of inspiratory thickening provides important information about the quality of muscle function. These two approaches make it possible to detect hemidiaphragm paralysis or dysfunction. Such a diagnosis is important because persistent diaphragm dysfunction after cardiac surgery has been shown to be associated with adverse respiratory outcome. Early respiratory physiotherapy is able to improve respiratory function through strengthening of the inspiratory muscles i.e. diaphragm and accessory inspiratory muscles.

Association of Diaphragm Thickness and Respiratory Muscle Strength With Indices of Sarcopenia

OBJECTIVE

To evaluate the relationship between respiratory muscle strength, diaphragm thickness (DT), and indices of sarcopenia.

METHODS

This study included 45 healthy elderly volunteers (21 male and 24 female) aged 65 years or older. Sarcopenia indices, including hand grip strength (HGS) and body mass index-adjusted appendicular skeletal muscle (ASM/BMI), were measured using a hand grip dynamometer and bioimpedance analysis, respectively. Calf circumference (CC) and gait speed were also measured. Maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP) were obtained using a spirometer, as a measure of respiratory muscle strength. DT was evaluated through ultrasonography. The association between indices of sarcopenia, respiratory muscle strength, and DT was evaluated using Spearman's rank correlation test, and univariate and multiple regression analysis.

RESULTS

ASM/BMI (r=0.609, p<0.01), CC (r=0.499, p<0.01), HGS (r=0.759, p<0.01), and gait speed (r=0.319, p<0.05) were significantly correlated with DT. In the univariate linear regression analysis, MIP was significantly associated with age (p=0.003), DT (p<0.001), HGS (p=0.002), CC (p=0.013), and gait speed (p=0.026). MEP was significantly associated with sex (p=0.001), BMI (p=0.033), ASM/BMI (p=0.003), DT (p<0.001), HGS (p<0.001), CC (p=0.001) and gait speed (p=0.004). In the multiple linear regression analysis, age (p=0.001), DT (p<0.001), and ASM/BMI (p=0.008) showed significant association with MIP. DT (p<0.001) and gait speed (p=0.050) were associated with MEP.

CONCLUSION

Our findings suggest that respiratory muscle strength is associated with DT and indices of sarcopenia. Further prospective studies with larger sample sizes are needed to confirm these findings.

Beneficial effects of walking-based home program for improving cardio-respiratory performance and physical activity in sarcopenic older people: a randomized controlled trial

BACKGROUND

Sarcopenia is an age-related loss of muscle mass, decline in physical performance, and/or loss of muscle strength. Improving physical activity (PA) is associated with a reduced risk of sarcopenia. Additionally, the World Health Organization 2020 guidelines recommend 150 minutes/week of moderate-intensity or 75 minutes/week of vigorous PA plus resistance exercise twice a week. An increase in walking steps/day also enhances PA.

AIM

The study explored the benefits of a pedometer-based walking program plus a resistance exercise program in older adults with sarcopenia.

DESIGN

A randomized control trial.

SETTING

In community dwelling.

POPULATION

Older individuals with sarcopenia.

METHODS

Screening for sarcopenia was defined according to the Asian Working Group of Sarcopenia criteria in 2019, which is composed of the skeletal muscle mass index (SMI), muscle strength, and physical performance. Bioimpedance analysis, handgrip strength, and gait speed were measured for the SMI, muscle strength, and physical performance, respectively. to explore the effectiveness of a pedometer-based walking program plus TheraBand resistance exercise over 12 weeks. The intervention group was required to wear a pedometer and walk 7 500 steps/day for 5 days/week and perform the TheraBand resistance exercise twice a week, while the control group continued their routine daily activities. Respiratory muscle strength, functional capacity (i.e., 6-minute walk test), and PA were assessed before and after the 12-week program. To evaluate the benefits of the home-based walking program plus resistance exercise, two-way mixed ANOVAs were performed.

RESULTS

Sixty older individuals with sarcopenia aged ≥60 years were enrolled; however, a total of 57 older adults (28 in the invention group and 29 in the control group) completed the study. Inspiratory muscle strength, functional capacity, and PA increased between and within groups after the 12-week program (all P<0.05). Furthermore, muscle strength and physical performance improved in the intervention group after the 12-week program but not in the control group.

CONCLUSIONS

A pedometer-based intervention program with TheraBand resistance exercise could improve cardio-respiratory performance and PA among older Thai individuals with sarcopenia. Further study needs to consider type of exercise and dietary supplements.

CLINICAL REHABILITATION IMPACT

Increasing the number of steps walked per day may reduce the risk of developing sarcopenia in older people.

Effects of a new respiratory muscle training device in community-dwelling elderly men: an open-label, randomized, non-inferiority trial

Background

Respiratory muscle training (RMT) has various clinical benefits in older adults; however, the low adherence to training remains a challenging issue. The present study aimed to confirm the efficacy of a new device that combines inspiratory muscle training and a positive expiratory pressure (IMT/PEP) compared to that of a Threshold IMT device (Philips Respironics Inc), and to determine whether home-based training differed from rehabilitation center training.

Methods

This four-arm, multicenter, parallel, non-inferiority trial randomized 80 active community-dwelling older men (mean age = 72.93 ± 5.02 years) to center-based groups (new IMT/PEP device or Threshold IMT device; 16 supervised sessions) or home-based groups (new IMT/PEP device or Threshold IMT device; 2 supervised sessions and individual sessions). Participants in all groups performed RMT twice a day for 8 weeks. Assessments were performed at baseline and post-training. The primary outcomes were maximum inspiratory pressure and maximal expiratory pressure. The secondary outcomes included forced vital capacity and forced expiratory volume in the first second, peak cough flow, diaphragm thickness, VO₂ peak, the International Physical Activity Questionnaire score, electromyographic activities of the sternocleidomastoid muscle, and skeletal muscle mass and phase angle as measured by bioimpedance analysis. In addition, rates of adherence to each protocol were also compared.

Results

Among all groups, the maximal inspiratory pressure was improved post-training, while the maximal expiratory pressure showed improvement only in the IMT/PEP groups. The overall non-inferiority of the IMT/PEP device was thus validated. A statistically significant improvement in diaphragm thickness was found. However, no consistent improvement was shown in other secondary outcomes. No significant difference in training adherence rate between protocols was observed (mean adherence rate of 91–99%).

Conclusion

Compared to the Threshold IMT, the new IMT/PEP device did not result in a significant difference in maximal inspiratory pressure but did improve maximal expiratory pressure in older men. The IMT/PEP device’s improved usability, which is associated with exercise adherence, provided distinct advantages in this cohort. If proper education is first provided, home-based RMT alone may provide sufficient effects in older individuals.

Trial registration

This trial was registered in the database cris.nih.go.kr (registration number KCT0003901) on 10/05/2019.

Does Regular Physical Activity Mitigate the Age-Associated Decline in Pulmonary Function?

Whereas the negative effects of aging and smoking on pulmonary function are undisputed, the potential favorable effects of physical activity on the aging process of the otherwise healthy lung remain controversial. This question is of particular clinical relevance when reduced pulmonary function compromises aerobic exercise capacity (maximal oxygen consumption) and thus contributes to an increased risk of morbidity and mortality. Here, we discuss whether and when the aging-related decline in pulmonary function limits maximal oxygen consumption and whether, how, and to what extent regular physical activity can slow down this aging process and preserve pulmonary function and maximal oxygen consumption. Age-dependent effects of reduced pulmonary function (i.e., FEV₁, the volume that has been exhaled after the first second of forced expiration) on maximal oxygen consumption have been observed in several cross-sectional and longitudinal studies. Complex interactions between aging-related cellular and molecular processes affecting the lung, and structural and functional deterioration of the cardiovascular and respiratory systems account for the concomitant decline in pulmonary function and maximal oxygen consumption. Consequently, if long-term regular physical activity mitigates some of the aging-related decline in pulmonary function (i.e., FEV₁ decline), this could also prevent a steep fall in maximal oxygen consumption. In contrast to earlier research findings, recent large-scale longitudinal studies provide growing evidence for the beneficial effects of physical activity on FEV₁. Although further confirmation of those effects is required, these findings provide powerful arguments to start and/or maintain regular physical activity.

Determinants of dynamic inspiratory muscle strength in healthy trained elderly

BACKGROUND

The S-Index assessed by means of electronic devices is a measure of Inspiratory Muscle Strength (IMS) that highly correlates with the maximal inspiratory pressure (MIP). The variables involved when using regression models for the prediction of IMS/MIP depend on both the sample characteristics and the device or protocol used. In light of the scarce information on the influence of physical activity (PA) on IMS in healthy older adults (OA), together with the incorporation of new assessment devices, the objectives of this research are: 1) to determine which factors influence the IMS in a group of trained OA, using a portable electronic device; and 2) to propose a regression model to improve its assessment and training.

METHODS

One hundred and fifty-nine individuals were assessed for body composition, lung capacity, IMS, and PA. A total of 92 individuals (72.73 ± 4.99 years) were considered for the final sample.

RESULTS

Using age, sex, and weight as control variables, forced expiratory volume in the first second (FEV₁) is the variable which is most likely to be included in the model (80%), without physical fitness appearing to be decisive. In the absence of spirometric variables, cardiorespiratory fitness (6MWT) takes on this role in a predictive model (16%).

CONCLUSIONS

This is the first study proposing IMS predictive formulas considering spirometry and/or physical fitness results for a Spanish, healthy, and trained OAs population. A predictive formula including also the spirometric variables (mainly the FEV₁) might better predict the inspiratory muscle strength. In addition, physical and respiratory functions confirm to be different, so it is necessary for the inspiratory muscles to be trained in a specific way.

Relationship between respiratory muscle strength and grip strength in institutionalized and community-dwelling older adults

OBJECTIVE: To evaluate the relationship between respiratory muscle strength and grip strength in institutionalized and community-dwelling older adults. METHODS: This cross-sectional study had 64 voluntary participants, and 33 were institutionalized and 31 lived in the community. Maximal inspiratory pressure, maximal expiratory pressure, peak expiratory flow, grip strength, anthropometric data, and physical activity level were assessed. RESULTS: In the institutionalized group, there was no correlation between respiratory variables and grip strength, but maximal expiratory pressure was the respiratory predictor most strongly associated with grip strength (p = 0.04). In the community-dwelling group, there was a correlation between maximal inspiratory pressure and grip strength (r = 0.54), maximal expiratory pressure and grip strength (r = 0.62), and peak expiratory flow and grip strength (r = 0.64); peak expiratory flow and maximal expiratory pressure were the respiratory predictors most strongly associated with grip strength (p < 0.05). In a joint group analysis, there was an association between maximal inspiratory pressure and grip strength (r = 0.40), maximal expiratory pressure and grip strength (r = 0.57), and peak expiratory flow and grip strength (r = 0.57); peak expiratory flow and maximal expiratory pressure were the respiratory predictors most strongly associated with grip strength (p < 0.05). CONCLUSIONS: Peak expiratory flow and maximal expiratory pressure seem to be good predictors of grip strength in community-dwelling older adults, but this relationship does not seem to be maintained in institutionalized patients, possibly because of a greater loss of respiratory function.

Avaliação da força muscular respiratória em adultos cantores de coral e não cantores

RESUMO Um bom desempenho musical exige dos cantores alta habilidade do sistema respiratório, uma vez que, durante o canto, a musculatura respiratória produz o aumento e diminuição da caixa torácica. O objetivo deste estudo foi verificar e comparar a força muscular respiratória de indivíduos adultos cantores de coral e não cantores. Trata-se de uma pesquisa transversal, composta por indivíduos com idade entre 18 a 45 anos, de ambos os sexos, sedentários e não tabagistas, distribuídos entre dois grupos: indivíduos cantores de coral (GC; n=23) e indivíduos não cantores (GNC; n=23). Os grupos foram avaliados quanto à força muscular inspiratória (pressão inspiratória máxima - PImáx.) e expiratória (pressão expiratória máxima - PEmáx.) por meio da manovacuometria. Indivíduos do GC apresentaram valores maiores da PImáx. (p=0,049) e PEmáx. (p<0,001) quando comparados ao GNC. Além disso, identificou-se que os valores da PImáx. têm magnitude de efeito e poder moderados (d=0,56; poder=0,59), e os valores da PEmáx. magnitude de efeito moderado e poder elevado (d=0,77; poder=0,82). Essa diferença das medidas de PImáx. e PEmáx. entre GNC e GC foi também observada ao se considerar os valores dos percentuais dos preditos (p<0,05). A partir das análises realizadas, conclui-se que cantores adultos de coral apresentam maior força muscular inspiratória e expiratória quando comparados a não cantores.

Association of respiratory function with physical performance, physical activity, and sedentary behavior in older adults

[Purpose] The associations between respiratory function, physical performance, physical activity, and sedentary behavior in older adults remain to be elucidated. This study aimed to investigate the associations of lung volume and respiratory muscle strength with physical performance, physical activity, and sedentary behavior in older adults. [Participants and Methods] In 62 ambulatory community-dwelling older adults, lung volumes (forced vital capacity and forced expiratory volume in 1s), respiratory muscle strength (maximum inspiratory and expiratory muscle pressures), physical performance (Timed Up and Go test and 30 s chair stand test), physical activity (steps and locomotive and non-locomotive physical activity), and sedentary behavior (percent sedentary time) were assessed. [Results] The percent sedentary time, 30-s chair stand test performance, and non-locomotive moderate-to-vigorous physical activity were independently associated with forced vital capacity, maximum inspiratory pressure, and maximum expiratory pressure, respectively. [Conclusion] The preliminary findings suggest that lung volumes and respiratory muscle strength may be differently affected by physical performance, physical activity, and sedentary behavior in ambulatory older adults.

Diaphragmatic Ultrasound Correlates with Inspiratory Muscle Strength and Pulmonary Function in Healthy Subjects

Diaphragm ultrasound (DUS) has been used to identify diaphragm dysfunction. However, its correlations with respiratory strength and lung function are unclear, even in healthy patients. A total of 64 healthy patients (30 males) had lung function and inspiratory strength (maximal inspiratory pressure and sniff nasal inspiratory pressure) measured. Gastric and oesophageal pressures were measured in a subgroup (n = 40). DUS was characterized by mobility (quiet breathing [QB] and deep breathing [DB]) and thickness (at functional residual capacity [Th_FRC] and total lung capacity [Th_TLC]). We calculated the thickening fraction (TF). During QB, DUS was similar between sexes. However, during DB, females had lower mobility, thickness and TF than males. Mobility at DB, Th_TLC and TF significantly correlated with lung function and inspiratory strength. These correlations were affected by sex. DUS correlated with inspiratory gastric pressure. In healthy patients, DUS correlated with lung function and inspiratory strength during DB. Significant differences between genders were noticeable when DUS was performed during DB.

Effect of chest and abdominal wall mobility and respiratory muscle strength on forced vital capacity in older adults

This study investigated by sex the effect of chest and abdominal wall mobility and respiratory muscle strength on forced vital capacity (FVC) in older adults. FVC, respiratory muscle strength, and chest and abdominal wall mobility were assessed in 154 community-dwelling older adults. As an index of the chest and abdominal wall mobility, chest (upper and lower chest) and total (upper chest, lower chest, and abdomen) scale values were measured using the breathing movement scale. Subjects with a restrictive spirometric pattern showed significantly lower chest and total scale values in both sexes, maximal inspiratory strength in women, and maximal expiratory strength in men. Chest and total scale values were significantly associated with FVC in the multiple regression analysis. The receiver operating characteristic analysis showed fair to good specificity of chest and total scale values for detecting a restrictive spirometric pattern. The results show that chest and abdominal wall mobility is closely associated with FVC in community-dwelling older adults without airflow limitation.

Relationship between lung function and grip strength in older hospitalized patients: a pilot study

OBJECTIVE

Older people with reduced respiratory muscle strength may be misclassified as having COPD on the basis of spirometric results. We aimed to evaluate the relationship between lung function and grip strength in older hospitalized patients without known airways disease.

METHODS

Patients in acute medical wards were recruited who were aged ≥70 years; no history, symptoms, or signs of respiratory disease; Mini Mental State Examination ≥24; willing and able to consent to participate; and able to perform hand grip and forced spirometry. Data including lung function (forced expiratory volume in 1 second [FEV1], forced vital capacity [FVC], FEV1/FVC, peak expiratory flow rate [PEFR], and slow vital capacity [SVC]), grip strength, age, weight, and height were recorded. Data were analyzed using descriptive statistics and linear regression unadjusted and adjusted (for age, height, and weight).

RESULTS

A total of 50 patients (20 men) were recruited. Stronger grip strength in men was significantly associated with greater FEV1, but this was attenuated by adjustment for age, height, and weight. Significant positive associations were found in women between grip strength and both PEFR and SVC, both of which remained robust to adjustment.

CONCLUSION

The association between grip strength and PEFR and SVC may reflect stronger patients generating higher intrathoracic pressure at the start of spirometry and pushing harder against thoracic cage recoil at end-expiration. Conversely, patients with weaker grip strength had lower PEFR and SVC. These patients may be misclassified as having COPD on the basis of spirometric results.

Correlation between thoracolumbar curvatures and respiratory function in older adults

Aging is associated with alterations in thoracolumbar curvatures and respiratory function. Research information regarding the correlation between thoracolumbar curvatures and a comprehensive examination of respiratory function parameters in older adults is limited. The aim of the present study was to examine the correlation between thoracolumbar curvatures and respiratory function in community-dwelling older adults. Thoracolumbar curvatures (thoracic and lumbar) were measured using a motion tracker. Respiratory function parameters such as lung function, respiratory rate, respiratory muscle strength and respiratory muscle thickness (diaphragm and intercostal) were measured using a spirometer, triaxial accelerometer, respiratory pressure meter and ultrasound imaging, respectively. Sixty-eight community-dwelling older males and females from Kuala Lumpur, Malaysia, with mean (standard deviation) age of 66.63 (5.16) years participated in this cross-sectional study. The results showed that mean (standard deviation) thoracic curvature angle and lumbar curvature angles were -46.30° (14.66°) and 14.10° (10.58°), respectively. There was a significant negative correlation between thoracic curvature angle and lung function (forced expiratory volume in 1 second: r=-0.23, P<0.05; forced vital capacity: r=-0.32, P<0.05), quiet expiration intercostal thickness (r=-0.22, P<0.05) and deep expiration diaphragm muscle thickness (r=-0.21, P<0.05). The lumbar curvature angle had a significant negative correlation with respiratory muscle strength (r=-0.29, P<0.05) and diaphragm muscle thickness at deep inspiration (r=-0.22, P<0.05). However, respiratory rate was correlated neither with thoracic nor with lumbar curvatures. The findings of this study suggest that increase in both thoracic and lumbar curvatures is correlated with decrease in respiratory muscle strength, respiratory muscle thickness and some parameters of lung function. Clinically, both thoracic and lumbar curvatures, respiratory muscles and lung function should be taken into consideration in the holistic management of respiratory function among older adults.

Diaphragm assessment by two dimensional speckle tracking imaging in normal subjects

BACKGROUND

Conventionally, ultrasonographic assessment of diaphragm contractility has involved measuring respiratory changes in diaphragm thickness (thickening fraction) using B-mode or caudal displacement with M-mode. Two-dimensional speckle-tracking has been increasingly used to assess muscle deformation ('strain') in echocardiography. We sought to determine in a pilot study if this technology could be utilized to analyze diaphragmatic contraction.

METHODS

Fifty healthy adult volunteers with normal exercise capacity underwent ultrasound imaging. A linear array transducer was used for the assessment of diaphragm thickness, thickening fraction (TF), and strain in the right anterior axillary line at approximately the ninth intercostal space. A phased array transducer was applied subcostally for the assessment of diaphragm displacement on the right mid-clavicular line. Diaphragmatic images were recorded from the end of expiration through the end of inspiration at 60 % maximal inspiratory capacity. Diaphragm strain was analyzed off-line by speckle tracking imaging. Blinded inter- and intra-rater variability was tested in 10 cases.

RESULTS

Mean right diaphragm thickness at end-expiration (±SD: standard deviation) was 0.24 cm (±0.1), with TF of 45.1 % (±12) at 60 % peak inspiratory effort. Mean right diaphragm caudal displacement was 4.9 cm (±1). Mean right diaphragm strain was -40.3 % (±9). A moderate correlation was seen between longitudinal strain and TF (R(2) 0.44, p < 0.0001). A weak correlation was seen between strain and caudal displacement (R(2) 0.14, p < 0.01), and an even weaker correlation was seen between caudal displacement and TF (R(2) 0.1, p = 0.04). Age, gender, and body mass index were not significantly associated with right diaphragm strain or TF. Although inter- and intra-rater variability was overall good for TF, caudal displacement, and strain (inter-rater R(2); 0.8, 0.9, and 0.7, respectively [p < 0.01], intra-rater R(2); 0.9, 0.7, and 0.9, respectively [p < 0.01]), strain values did have a slightly lower inter-rater repeatability.

CONCLUSIONS

Diaphragmatic strain estimated by speckle tracking imaging was associated with conventional ultrasound measures of diaphragmatic function (TF and caudal displacement). Further clinical studies are warranted to investigate its clinical utility.

Maximal expiratory pressure and Valsalva manoeuvre do not produce similar cardiovascular responses in healthy men

NEW FINDINGS

What is the central question of this study? This is the first study to evaluate and describe the cardiovascular responses during maximal expiratory pressure compared with the Valsalva manoeuvre, and whether those responses are similar. What is the main finding and its importance? This study showed that the duration of the manoeuvres appears to be responsible for the different physiological mechanisms involved in the cardiovascular responses to each manoeuvre and that the intensity of expiratory effort was related to the response in maximal expiratory pressure. These results are important to identify the risks to which subjects are exposed when performing these manoeuvres. The main purpose of this study was to compare the cardiovascular responses between the Valsalva manoeuvre (VM) and maximal expiratory pressure (MEP) and to evaluate the effect of age on these responses. Twenty-eight healthy men were evaluated and divided into two groups, younger (n = 15, 25 ± 5 years) and middle aged (n = 13, 50 ± 5 years), and they performed the VM and MEP measurement. The VM consisted of an expiratory effort (40 mmHg) against a manometer for 15 s, and the MEP was performed according to American Thoracic Society guidelines. The cardiovascular responses were analysed at rest, isotime (3 s), peak, nadir and recovery, and the cardiovascular variations (Δ) were calculated as peak or isotime minus resting values. For the statistical analysis, we used two-way ANOVA (P < 0.05). We observed that MEP and the VM generate similar changes in cardiac output (P > 0.05), but MEP presents higher values for mean arterial pressure (MAPPeak , MAPIsotime , ΔMAP and ΔMAPIsotime ) than those observed in the VM (P < 0.05). The execution time of the manoeuvres (VM ∼15 s and MEP ∼5 s) appears to be largely responsible for the activation of different physiological mechanisms involved in the cardiovascular control for each manoeuvre, and the intensity of expiratory effort is related to the higher response of MAP and peripheral vascular resistance (PVRIsotime and ΔPVRIsotime ) during MEP (P < 0.05). Moreover, it appears that age affects only the heart rate and PVR responses (P < 0.05), which were higher in the young and middle-aged group, respectively. Based on these findings, we can conclude that MEP and the VM do not generate similar cardiovascular responses, except for cardiac output.

Correlation Between Abdominal Muscle Thickness and Maximal Expiratory Pressure

OBJECTIVES

The activity of abdominal muscles mainly produces high expiratory pressure. These include the rectus abdominis, external oblique, internal oblique, and transverse abdominis muscles. The purpose of this study was to determine whether maximal expiratory pressure is associated with each abdominal muscle thickness at rest.

METHODS

Thirty-nine healthy male volunteers (mean age ± SD, 20.7 ± 2.7 years) participated in the study. The thickness of the right rectus abdominis, external oblique, internal oblique, and transverse abdominis muscles was measured by B-mode sonography in the supine position. The maximal expiratory pressure was obtained with a spirometer in the sitting position. The correlations between each abdominal muscle thickness and maximal expiratory pressure were determined by the Pearson correlation coefficient.

RESULTS

The correlation coefficient between the rectus abdominis muscle and maximal expiratory pressure was 0.571 (P< .001). Correlation coefficients between the external oblique, internal oblique, and transverse abdominis muscles and maximal expiratory pressure were 0.297 (P = .066), 0.267 (P = .100), and 0.022 (P = .894), respectively.

CONCLUSIONS

Our results indicate that the rectus abdominis muscle thickness might be more highly correlated with expiratory pressure production than the external oblique, internal oblique, and transverse abdominis muscle thickness.

Correlation between Peak Expiratory Flow and Abdominal Muscle Thickness

[Purpose] The purpose of this study was to determine whether forced expiration is correlated with abdominal muscle thickness. [Subjects] Twenty-three healthy male volunteers participated in this study. [Methods] The peak expiratory flow (PEF) was obtained using a peak flow meter with subjects in the sitting position. The thicknesses of the right rectus abdominis, external oblique, internal oblique, and transverse abdominis muscles were measured using B-mode ultrasonography at the end of a relaxed expiration in the supine position. [Results] Among the abdominal muscles, only the thickness of the external oblique muscle displayed a significant correlation with PEF. [Conclusion] It appears that the thickness of the external oblique muscle might be associated with PEF during forced expiration.

[Cost-consequence analysis of respiratory preventive intervention among institutionalized older people: randomized controlled trial]

INTRODUCTION

The institutionalized elderly with functional impairment show a greater decline in respiratory muscle (RM) function. The aims of the study are to evaluate outcomes and costs of RM training using Pranayama in institutionalized elderly people with functional impairment.

MATERIAL AND METHODS

A randomized controlled trial was conducted on institutionalized elderly people with walking limitation (n=54). The intervention consisted of 6 weeks of Pranayama RM training (5 times/week). The outcomes were measured at 4 time points, and were related to RM function: the maximum respiratory pressures and the maximum voluntary ventilation. Perceived satisfaction in the experimental group (EG) was assessed by means of an ad hoc questionnaire. Direct and indirect costs were estimated from the social perspective.

RESULTS

The GE showed a significant improvement related with strength (maximum respiratory pressures) and endurance (maximum voluntary ventilation) of RM. Moreover, 92% of the EG reported a high satisfaction. The total social costs, direct and indirect, amounted to Euro 21,678.

CONCLUSIONS

This evaluation reveals that RM function improvement is significant, that intervention is well tolerated and appreciated by patients, and the intervention costs are moderate.

Associations between muscle strength, spirometric pulmonary function and mobility in healthy older adults

Pathological obstruction in lungs leads to severe decreases in muscle strength and mobility in patients suffering from chronic obstructive pulmonary disease. The purpose of this study was to investigate the interdependency between muscle strength, spirometric pulmonary functions and mobility outcomes in healthy older men and women, where skeletal muscle and pulmonary function decline without interference of overt disease. A total of 135 69- to 81-year-old participants were recruited into the cross-sectional study, which was performed as a part of European study MyoAge. Full, partial and no mediation models were constructed to assess the interdependency between muscle strength (handgrip strength, knee extension torque, lower extremity muscle power), spirometric pulmonary function (FVC, FEV1 and FEF50) and mobility (6-min walk and Timed Up and Go tests). The models were adjusted for age, sex, total fat mass, body height and site of enrolment. Partial mediation models, indicating both direct and pulmonary function mediated associations between muscle strength and mobility, fitted best to the data. Greater handgrip strength was significantly associated with higher FVC, FEV1 and FEF50 (p < 0.05). Greater muscle power was significantly associated with better performance in mobility tests. Results suggest that decline in mobility with aging may be caused by decreases in both muscle strength and power but also mediated through decreases in spirometric pulmonary function. Future longitudinal studies are warranted to better understand how loss of function and mass of the respiratory muscles will affect pulmonary function among older people and how these changes are linked to mobility decline.

Physical activity and respiratory muscle strength in elderly: a systematic review

Introduction The aging will inevitably bring some kind of functional decline in elderly, sarcopenia in this sense stands out because it damages the muscle function and extend also to the respiratory muscles. Objective Systematically review studies that have sought to compare the strength of respiratory muscles between sedentary and physically active elderly in training programs nonspecific respiratory musculature. Materials and methods From the descriptors motor activity, respiratory muscles and elderly, the databases LILACS, MedLine, Cochrane, PEDro, Scirus and Redalyc were consulted. Results Of 1.263 experiments available in said databases, 12 were recovered and 6 were selected due they meet all the inclusion criteria and selection requirements. Conclusion Physical activity programs offered by the selected studies led physically active elderly to have respiratory muscle strength statistically higher than the sedentary. However, this condition did not expressed itself as security to these elderly to present strength levels above of the minimum predictive of normality.

Comparação da força muscular respiratória entre os subgrupos de fragilidade em idosas da comunidade

A fragilidade é composta por um tripé constituído por: sarcopenia, disfunção imunológica e desregulação neuroendócrina. A sarcopenia é definida como uma diminuição na força e na potência muscular, sendo que os músculos respiratórios também são afetados. O objetivo foi comparar a força muscular respiratória (FMR) em idosas residentes na comunidade, classificadas como não frágeis (NF), pré-frágeis (PF) e frágeis (F) e correlacionar a FMR com a força de preensão manual (FPM). O estudo foi do tipo transversal, com uma amostra de conveniência composta por 106 idosas. As participantes foram classificadas quanto ao fenótipo de fragilidade. A FMR foi avaliada por meio da pressão inspiratória máxima (PImáx) e da pressão expiratória máxima (PEmáx). Foram encontradas diferenças significativas da FMR entre os grupos NF e F (PImáx: p=0,001 e PEmáx: p<0,001) e entre os grupos PF e F (PImáx: p<0,001 e PEmáx: p<0,001). Em relação à FPM, foram observadas diferenças significativas entre todos os grupos (p<0,001). Houve correlação entre FMR e FPM apenas no grupo frágil. Desta forma, a FPM pode ser importante na prática clínica para diferenciar os subgrupos de fragilidade e identificar a perda de força muscular, incluindo a perda da FMR.

Efeitos da estimulação diafragmática elétrica transcutânea na função pulmonar em idosos

INTRODUÇÃO: O envelhecimento promove mudanças em diversos sistemas orgânicos, inclusive no respiratório, evidenciando alterações nos centros reguladores da ventilação, nos quimiorreceptores, na densidade óssea da caixa torácica, além de diminuição da força dos músculos inspiratórios. OBJETIVO: Avaliar o efeito de um programa de treinamento específico da musculatura respiratória por meio da estimulação diafragmática elétrica transcutânea (EDET) sobre a função pulmonar de idosos. MÉTODO: 21 idosos foram divididos em dois grupos: controle (GC), composto por sete indivíduos com idade de 69,86±3,48 anos, e grupo EDET (EDET), composto por 14 voluntários com idade de 71,36±4,73 anos, submetidos ao treinamento com EDET durante duas semanas. Avaliaram-se os volumes e capacidades pulmonares, como volume corrente (VC), volume minuto (VM), capacidade inspiratória (CI) e capacidade vital (CV) por meio da ventilometria e a força da musculatura respiratória antes da primeira e após a décima sessão, por meio da avaliação das pressões respiratórias máximas. Utilizaram-se os testes de Wilcoxon e Mann-Whitney para as devidas comparações estatísticas, sendo adotado um nível de significância de 5%. RESULTADOS: O grupo EDET apresentou incremento na pressão inspiratória máxima (PImáx), na pressão expiratória máxima (PEmáx) e no volume corrente (VC) após o treinamento. CONCLUSÃO: O treinamento muscular mediante utilização da EDET promoveu melhora da força muscular respiratória e do volume corrente. Registro de ensaio clínico: RBR-5dmpkr.

Capacidade funcional submáxima e força muscular respiratória entre idosas praticantes de hidroginástica e dança: um estudo comparativo

O exercício físico é uma estratégia eficaz para prevenir e retardar as perdas funcionais do envelhecimento, mas há poucos estudos indicando qual a melhor modalidade para incrementar o status funcional do idoso. OBJETIVO: Comparar a força muscular respiratória (FMR) e a capacidade funcional submáxima de idosas praticantes de hidroginástica e dança. MATERIAL e MÉTODOS: Estudo transversal com idosas do sexo feminino (n=46), praticantes de hidroginástica (Grupo Hidroginástica - GH; n=23) e dança (Grupo Dança - GD; n=23). Para medida da prática de atividade física, foi utilizado o International Physical Activit Questionnarie (IPAQ-versão curta); a FMR foi avaliada por meio da pressão inspiratória máxima (PImax) e da pressão expiratória máxima (PEmax), e a medida da capacidade funcional submáxima, realizada pelo Teste da Caminhada dos Seis Minutos (TC6m). RESULTADOS: O GD apresentou maior PImax (84 ± 12,49 cmH2O) quando comparado ao GH (63,35 ± 10,47 cmH2O) (p< 0,0001), e a PEmax não variou significativamente entre os grupos (p= 0,08). Quanto à distância percorrida no TC6m, o GD (616,53 ± 60,81 m) obteve melhor desempenho que o GH (446,65 ± 48,67 m) (p< 0,0001). Quanto ao nível de atividade física, o GD apresentou 19 idosas (82,61%) muito ativas e quatro (17,39%) ativas, e o GH apresentou oito idosas (30,76%) muito ativas e 15 (69,23%) ativas. CONCLUSÃO: As idosas praticantes de dança evidenciaram maior força muscular inspiratória e capacidade funcional submáxima, possivelmente devido ao maior nível de atividade física e também pelo fato de a dança ser uma modalidade essencialmente aeróbia.

Comparação da cifose torácica e capacidade funcional de mulheres idosas com e sem osteoporose

A diminuição da densidade mineral óssea das vértebras, própria do processo de envelhecimento e que pode ser agravada pela osteoporose, determina uma diminuição da região anterior dos corpos vertebrais, resultando em compressão e colapso dessas vértebras, com maior estreitamento dos discos e espaços intervertebrais. Essas novas condições interferem no funcionamento normal de órgãos e sistemas do organismo. O objetivo foi avaliar o grau de cifose torácica e a capacidade funcional de mulheres idosas com e sem osteoporose. Foram avaliadas 30 idosas ativas fisicamente, sendo 20 sem osteoporose ( GSO: 65,1± 4,67 anos) e 10 idosas com osteoporose (GCO: 68,6± 6,46anos). Foram avaliados a medida da cifose torácica, teste de caminhada de seis minutos (TC6'), Timed Up and go (TUG) e força dos músculos respiratórios (PImáx e PEmáx). Os dados obtidos foram analisados utilizando o teste t de Student. O nível de significância utilizado foi de 5% (α£ 0,05). Houve diferença significativa entre os grupos sem (GSO) e com osteoporose (GCO) somente no TC6'(GSO: 426,63±46,36 m; GCO: 392,64±36,68 m , α =0,02). As outras variáveis analisadas não apresentaram diferença significativa (Cifose torácica: α = 0,17; TUG: α =0,49; PImax: α =0,45; PEmax: α =0,19). A osteoporose não influenciou o grau de cifose torácica, a força dos músculos respiratórios e mobilidade das idosas. Entretanto, o desempenho no TC6' foi influenciado negativamente pela osteoporose.

Heritability estimates of endophenotypes of long and health life: the Long Life Family Study

BACKGROUND

Identification of gene variants that contribute to exceptional survival may provide critical biologic information that informs optimal health across the life span.

METHODS

As part of phenotype development efforts for the Long Life Family Study, endophenotypes that represent exceptional survival were identified and heritability estimates were calculated. Principal components (PCs) analysis was carried out using 28 physiologic measurements from five trait domains (cardiovascular, cognition, physical function, pulmonary, and metabolic).

RESULTS

The five most dominant PCs accounted for 50% of underlying trait variance. The first PC (PC1), which consisted primarily of poor pulmonary and physical function, represented 14.3% of the total variance and had an estimated heritability of 39%. PC2 consisted of measures of good metabolic and cardiovascular function with an estimated heritability of 27%. PC3 was made up of cognitive measures (h(2) = 36%). PC4 and PC5 contained measures of blood pressure and cholesterol, respectively (h(2) = 25% and 16%).

CONCLUSIONS

These PCs analysis-derived endophenotypes may be used in genetic association studies to help identify underlying genetic mechanisms that drive exceptional survival in this and other populations.

Assessment of physical fitness for esophageal surgery, and targeting interventions to optimize outcomes

This review examines how higher levels of physiological reserve and fitness can help the patient endure the demands of esophageal surgery. Lung function, body composition, cardiac function, inflammatory mediators and exercise performance are all determinants of fitness. Physical fitness, both as an independent risk factor and through its effect on other risk factors, has been found to be significantly associated with the risk of developing postoperative pulmonary complications (PPCs) in patients following esophagectomy. Respiratory dysfunction preoperatively poses the dominant risk of developing complications, and PPCs are the most common causes of morbidity and mortality. The incidence of PPCs is between 15 and 40% with an associated 4.5-fold increase in operative mortality leading to approximately 45% of all deaths post-esophagectomy. Cardiac complications are the other principal postoperative complications, and pulmonary and cardiac complications are reported to account for up to 70% of postoperative deaths after esophagectomy. Risk reduction in patients planned for surgery is key in attaining optimal outcomes. The goal of this review was to discuss the risk factors associated with the development of postoperative pulmonary complications and how these may be modified prior to surgery with a specific focus on the pulmonary complications associated with esophageal resection. There are few studies that have examined the effect of modifying physical fitness pre-esophageal surgery. The data to date would indicate a need to develop targeted interventions preoperatively to increase physical function with the aim of decreasing postoperative complications.

Prevalence of reduced respiratory muscle strength in institutionalized elderly people

CONTEXT AND OBJECTIVES

Respiratory muscle strength is relevant to the clinical situation of elderly patients, particularly those presenting with respiratory or cardiac diseases. The objectives of this study were to evaluate the respiratory muscle strength of institutionalized elderly women, compare this with predicted values for the Brazilian population and calculate the correlation with age and anthropometric characteristics.

DESIGN AND SETTING

Cross-sectional study at the Department of Physiotherapy of Universidade Camilo Castelo Branco.

METHODS

The participants were 56 institutionalized elderly women (74.87 +/- 10.55 years of age), evaluated in eight institutions in three cities in the central region of the State of São Paulo, between January 2005 and March 2006. They were separated into three subgroups according to age: 60-69 years (n = 20), 70-79 (n = 18) and 80-89 years (n = 18). Maximal respiratory pressures were obtained using a manovacuometer. The values obtained were compared between subgroups and with predicted values. Correlation analysis was used to evaluate age, weight, height and body mass index in relation to maximal respiratory pressures. The significance level was P < 0.05.

RESULTS

No significant differences in maximal respiratory pressures were seen between the three subgroups. The maximal respiratory pressures were significantly lower in the three subgroups, compared with predicted values. Negative correlations between maximal respiratory pressures and age and positive correlations in relation to weight, height and body mass index were found.

CONCLUSIONS

Respiratory muscle strength was markedly reduced in institutionalized 60 to 89-year-old women and the values demonstrated correlations with age and anthropometric characteristics.

Midlife women's attitudes toward physical activity

OBJECTIVE

To explore attitudes toward physical activity among a multiethnic group of midlife women.

DESIGN

A qualitative cross-sectional study using an online forum. RECRUITMENT SETTINGS: Internet communities/groups for midlife women and for ethnic minorities.

PARTICIPANTS

A multiethnic group of 15 midlife women.

INSTRUMENTS

Ten online forum topics on attitudes toward physical activity and seven on ethnic-specific contexts.

DATA ANALYSIS

Thematic analysis, involving line-by-line coding, categorization, and theme extraction.

RESULTS

Six themes across all ethnic groups emerged from the data analysis process, although there were some ethnic differences in details related to each theme. The themes were (a) gendered experience, (b) physical activity as all body movements, (c) no time for physical activity, (d) environment matters, (e) health concerns made me do it, and (f) need a companion.

CONCLUSIONS

Nurses need to consider and further investigate the influence of women's multiple roles, cultural factors, and environmental factors on physical activity in order to promote physical activity of midlife women.