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Chen Q, Wu X, Huang Y, Chen L. Internet of Things-Based Home Respiratory Muscle Training for Patients with Chronic Obstructive Pulmonary Disease: A Randomized Clinical Trial. Int J Chron Obstruct Pulmon Dis 2024; 19:1093-1103. [PMID: 38800522 PMCID: PMC11128236 DOI: 10.2147/copd.s454804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 05/14/2024] [Indexed: 05/29/2024] Open
Abstract
Purpose Whether Internet of Things (IoT)-based home respiratory muscle training (RMT) benefits patients with comorbid chronic obstructive pulmonary disease (COPD) remains unclear. Therefore, this study aims to evaluate the effectiveness of IoT-based home RMT for patients with COPD. Patients and Methods Seventy-eight patients with stable COPD were randomly divided into two groups. The control group received routine health education, while the intervention group received IoT-based home RMT (30 inspiratory muscle training [IMT] and 30 expiratory muscle training [EMT] in different respiratory cycles twice daily for 12 consecutive weeks). Assessments took place pre-intervention and 12 weeks post-intervention, including lung function tests, respiratory muscle strength tests, the mMRC dyspnea scale, CAT questionnaires, the HAMA scale, and 6-month COPD-related readmission after intervention. Results Seventy-four patients with COPD were analyzed (intervention group = 38, control group = 36), and the mean age and FEV1 of the patients were 68.65 ± 7.40 years, 1.21 ± 0.54 L. Compared to those of the control population, the intervention group exhibited higher FEV1/FVC (48.23 ± 10.97 vs 54.32 ± 10.31, p = 0.016), MIP (41.72 ± 7.70 vs 47.82 ± 10.99, p = 0.008), and MEP (42.94 ± 7.85 vs 50.29 ± 15.74, p = 0.013); lower mMRC (2.00 [2.00-3.00] vs 1.50 [1.00-2.00], p < 0.001), CAT (17.00 [12.00-21.75] vs 11.00 [9.00-13.25], p < 0.001), and HAMA (7.00 [5.00-9.00] vs 2.00 [1.00-3.00], p < 0.001) scores; and a lower incidence rate of 6-month readmission (22% vs 5%, p = 0.033). Conclusion Compared with no intervention, IoT-based home RMT may be a more beneficial intervention for patients with COPD.
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Affiliation(s)
- Qiong Chen
- Respiratory Medicine Department, Xiamen Haicang Hospital, Xiamen, Fujian, People’s Republic of China
| | - Xuejuan Wu
- Respiratory Medicine Department, Xiamen Haicang Hospital, Xiamen, Fujian, People’s Republic of China
| | - Yanjin Huang
- Nursing Department, Xiamen Haicang Hospital, Xiamen, Fujian, People’s Republic of China
| | - Lingling Chen
- Respiratory Medicine Department, Xiamen Haicang Hospital, Xiamen, Fujian, People’s Republic of China
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Kuronen I, Heinijoki J, Sovijärvi A. Effects of low workload respiratory training with steam inhalation on lung function in stable asthma: A controlled clinical study. Clin Physiol Funct Imaging 2024; 44:100-111. [PMID: 37749950 DOI: 10.1111/cpf.12856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 09/15/2023] [Accepted: 09/22/2023] [Indexed: 09/27/2023]
Abstract
To investigate effects of low workload respiratory muscle training (RMT) on respiratory muscle power and lung function in asthmatics, we recruited asthmatic persons who performed a 4-week training programme. The training included 20 daily ex- and inhalations with counter pressure 30% from the individual maximal expiratory pressure (MEP). Lung function was measured before and after the training programme and a follow-up period. The study also included several subjective endpoints for respiratory symptoms. A significant increase in a training group (n = 27) compared with a control group (n = 20) was seen in MEP (+12.4%, vs. +3.5%, p = 0.086), maximal inspiratory pressure (MIP) (+21.1% vs. +0.82%, p = 0.023), slow vital capacity (VC) (+3.7% vs. +1.5%, p = 0.023) and in forced expiratory time (FET, +15.5%, vs. -5.0%, p = 0.022). After being a control for group A, also group B performed similar RMT as group A. In the combined group (A and B, n = 47) MEP (11.3%, p = 0.003), MIP (19.73%, p < 0.001), VC (4.1%, p < 0.001) and FET (14.7%, p < 0.001) increased significantly from the baseline. Changes in other lung function variables were not indicative. On a scale of 1-5, the subjects perceived improvement in reduction of mucus secretion in the airways (median 3, p < 0.001), alleviation of coughing (median 3, p < 0.001) and reduction in dyspnoea (median 3, p < 0.001). As a conclusion, low workload respiratory training of 4 weeks improved respiratory muscle power and increased VC in patients with stable asthma.
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Affiliation(s)
| | | | - Anssi Sovijärvi
- Department of Clinical Physiology, University of Helsinki, Helsinki, Finland
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Beaumont M, Couasnon C, Péran L, Berriet AC, Ber CL, Pichon R. Determination of the minimal important difference for inspiratory muscle strength in people with severe and very severe COPD. Clin Rehabil 2023; 37:1521-1532. [PMID: 37186772 DOI: 10.1177/02692155231174124] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
OBJECTIVE Inspiratory muscle training is recommended for people with chronic obstructive pulmonary disease (COPD) with inspiratory muscle weakness. Clinical interpretation of changes in inspiratory muscle strength could be helped by the determination of cut-off values. The aim of this study was to estimate the minimal important difference for inspiratory muscle strength assessed with maximal inspiratory pressure (MIP) in people with COPD. DESIGN Post hoc analysis of a randomized controlled trial (EMI2 study) including people with severe to very severe COPD undergoing a pulmonary rehabilitation program was conducted. The determination of the minimal important difference was realized using both anchor-based and distribution-based methods. SETTING The study includes patients admitted to the rehabilitation program unit of the Centre Hospitalier des Pays de Morlaix (Morlaix, France) between March 5, 2014 and September 8, 2016. PARTICIPANTS Seventy-three people with severe to very severe COPD (age 62.2 ± 8.0 years, forced expiratory volume in 1 s 36.4 ± 9.5% of theoretical) were analyzed. INTERVENTION Patients followed a standardized pulmonary rehabilitation program 5 days a week for 4 weeks. The program included aerobic training, ground-based outdoor walking training, and strengthening of lower and upper limb muscles. MAIN MEASURES At the end of the pulmonary rehabilitation program, MIP improved by 14.8 ± 14.9 cmH2O (p < 0.05). Regarding the anchor-based method, only the modified Medical Research Council was selected as an appropriate anchor. The receiver operating characteristic curve analysis reported a minimal important difference of 13.5 cmH2O (sensibility: 75% specificity: 67.5%). Using distribution-based methods, the estimate of minimal important difference was 7.9 cmH2O (standard error of measurement method) and 10.9 cmH2O (size effect method). RESULTS The estimations proposed by this study ranged from 7.9 to 13.5 cmH2O. CONCLUSIONS The measurement of minimal important difference is a simple tool for assessing the changes of inspiratory muscle strength during a pulmonary rehabilitation program. We propose a minimal important difference of 13.5 cmH2O for the improvement of MIP. Further studies are needed to confirm this estimation.ClinicalTrials.gov identifier: NCT02074813.
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Affiliation(s)
- Marc Beaumont
- Pulmonary Rehabilitation Unit, Morlaix Hospital Centre, Morlaix, France
- Inserm, Univ Brest, CHRU Brest, UMR 1304, GETBO, Brest, France
| | - Charles Couasnon
- Institut de formation en Pédicurie-Podologie, Ergothérapie, Masso-Kinésithérapie (IFEPK), Rennes, France
| | - Loic Péran
- Pulmonary Rehabilitation Unit, Morlaix Hospital Centre, Morlaix, France
| | | | - Catherine Le Ber
- Pulmonary Rehabilitation Unit, Morlaix Hospital Centre, Morlaix, France
| | - Romain Pichon
- Institut de formation en Pédicurie-Podologie, Ergothérapie, Masso-Kinésithérapie (IFEPK), Rennes, France
- Université Rennes 2 - laboratoire M2S EA7470, Bruz, France
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Chen TA, Mao ST, Lin HC, Liu WT, Tam KW, Tsai CY, Kuan YC. Effects of inspiratory muscle training on blood pressure- and sleep-related outcomes in patients with obstructive sleep apnea: a meta-analysis of randomized controlled trials. Sleep Breath 2023; 27:1953-1966. [PMID: 36576599 DOI: 10.1007/s11325-022-02773-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 12/03/2022] [Accepted: 12/19/2022] [Indexed: 12/29/2022]
Abstract
PURPOSE Obstructive sleep apnea (OSA) is frequently accompanied by hypertension, resulting in cardiovascular comorbidities. Continuous positive airway pressure is a standard therapy for OSA but has poor adherence. Inspiratory muscle training (IMT) may reduce airway collapsibility and sympathetic output, which may decrease OSA severity and blood pressure. In this meta-analysis of randomized controlled trials (RCTs), we evaluated the efficacy of IMT in patients with OSA. METHODS We searched PubMed, EMBASE, Cochrane Library, Web of Science, and ClinicalTrials.gov databases for relevant RCTs published before November 2022. RESULTS Seven RCTs with a total of 160 patients with OSA were included. Compared with the control group, the IMT group exhibited significantly lower systolic and diastolic blood pressure (mean difference [MD]: - 10.77 and - 4.58 mmHg, respectively), plasma catecholamine levels (MD: - 128.64 pg/mL), Pittsburgh Sleep Quality Index (MD: - 3.06), and Epworth Sleepiness Scale score (MD: - 4.37). No significant between-group differences were observed in the apnea-hypopnea index, forced vital capacity (FVC), ratio of forced expiratory volume in 1 s to FVC, or adverse effects. The data indicate comprehensive evidence regarding the efficacy of IMT for OSA. However, the level of certainty (LOC) remains low. CONCLUSION IMT improved blood pressure- and sleep-related outcomes without causing adverse effects and may thus be a reasonable option for lowering blood pressure in patients with OSA. However, additional studies with larger sample sizes and rigorous study designs are warranted to increase the LOC.
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Affiliation(s)
- Tzu-Ang Chen
- Department of General Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Sheng-Ting Mao
- Department of Obstetrics and Gynecology, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Huei-Chen Lin
- Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, Tainan City, Taiwan
- Department of Long-Term Care, College of Health Technology, National Taipei University of Nursing and Health Sciences, Taipei City, Taiwan
| | - Wen-Te Liu
- School of Respiratory Therapy, College of Medicine, Taipei Medical University, Taipei City, Taiwan
- Division of Pulmonary Medicine, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
- Sleep Center, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Ka-Wai Tam
- Center for Evidence-Based Health Care, Department of Medical Research, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
- Shared Decision Making Resource Center, Department of Medical Research, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
- Cochrane Taiwan, Taipei Medical University, Taipei City, Taiwan
- Division of General Surgery, Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei City, Taiwan
- Division of General Surgery, Department of Surgery, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Cheng-Yu Tsai
- Sleep Center, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
- Department of Civil and Environmental Engineering, Imperial College London, London, UK
| | - Yi-Chun Kuan
- Sleep Center, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan.
- Center for Evidence-Based Health Care, Department of Medical Research, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan.
- Cochrane Taiwan, Taipei Medical University, Taipei City, Taiwan.
- Taipei Neuroscience Institute, Taipei Medical University, Taipei City, Taiwan.
- Department of Neurology, Shuang Ho Hospital, Taipei Medical University, 291 Zhongzheng Road, Zhonghe District, New Taipei City, 23561, Taiwan.
- Department of Neurology, School of Medicine, College of Medicine, Taipei Medical University, Taipei City, Taiwan.
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei City, Taiwan.
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Troosters T, Janssens W, Demeyer H, Rabinovich RA. Pulmonary rehabilitation and physical interventions. Eur Respir Rev 2023; 32:32/168/220222. [PMID: 37286219 DOI: 10.1183/16000617.0222-2022] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 03/23/2023] [Indexed: 06/09/2023] Open
Abstract
Pulmonary rehabilitation has established a status of evidence-based therapy for patients with symptomatic COPD in the stable phase and after acute exacerbations. Rehabilitation should have the possibility of including different disciplines and be offered in several formats and lines of healthcare. This review focusses on the cornerstone intervention, exercise training, and how training interventions can be adapted to the limitations of patients. These adaptations may lead to altered cardiovascular or muscular training effects and/or may improve movement efficiency. Optimising pharmacotherapy (not the focus of this review) and oxygen supplements, whole-body low- and high-intensity training or interval training, and resistance (or neuromuscular electrical stimulation) training are important training modalities for these patients in order to accommodate cardiovascular and ventilatory impairments. Inspiratory muscle training and whole-body vibration may also be worthwhile interventions in selected patients. Patients with stable but symptomatic COPD, those who have suffered exacerbations and patients waiting for or who have received lung volume reduction or lung transplantation are good candidates. The future surely holds promise to further personalise exercise training interventions and to tailor the format of rehabilitation to the individual patient's needs and preferences.
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Affiliation(s)
- Thierry Troosters
- KU Leuven, Department of Rehabilitation Sciences, Leuven, Belgium
- Respiratory Division, University Hospitals Leuven, Leuven, Belgium
| | - Wim Janssens
- Respiratory Division, University Hospitals Leuven, Leuven, Belgium
- KU Leuven, Department of Chronic Disease and Metabolism, Leuven, Belgium
| | - Heleen Demeyer
- KU Leuven, Department of Rehabilitation Sciences, Leuven, Belgium
- Respiratory Division, University Hospitals Leuven, Leuven, Belgium
- Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium
| | - Roberto A Rabinovich
- University of Edinburgh, MRC Centre for Information Research, Edinburgh, UK
- Respiratory Department, Royal Infirmary of Edinburgh, Edinburgh, UK
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Ammous O, Feki W, Lotfi T, Khamis AM, Gosselink R, Rebai A, Kammoun S. Inspiratory muscle training, with or without concomitant pulmonary rehabilitation, for chronic obstructive pulmonary disease (COPD). Cochrane Database Syst Rev 2023; 1:CD013778. [PMID: 36606682 PMCID: PMC9817429 DOI: 10.1002/14651858.cd013778.pub2] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND Inspiratory muscle training (IMT) aims to improve respiratory muscle strength and endurance. Clinical trials used various training protocols, devices and respiratory measurements to check the effectiveness of this intervention. The current guidelines reported a possible advantage of IMT, particularly in people with respiratory muscle weakness. However, it remains unclear to what extent IMT is clinically beneficial, especially when associated with pulmonary rehabilitation (PR). OBJECTIVES: To assess the effect of inspiratory muscle training (IMT) on chronic obstructive pulmonary disease (COPD), as a stand-alone intervention and when combined with pulmonary rehabilitation (PR). SEARCH METHODS We searched the Cochrane Airways trials register, CENTRAL, MEDLINE, Embase, PsycINFO, Cumulative Index to Nursing and Allied Health Literature (CINAHL) EBSCO, Physiotherapy Evidence Database (PEDro) ClinicalTrials.gov, and the World Health Organization International Clinical Trials Registry Platform on 20 October 2021. We also checked reference lists of all primary studies and review articles. SELECTION CRITERIA We included randomized controlled trials (RCTs) that compared IMT in combination with PR versus PR alone and IMT versus control/sham. We included different types of IMT irrespective of the mode of delivery. We excluded trials that used resistive devices without controlling the breathing pattern or a training load of less than 30% of maximal inspiratory pressure (PImax), or both. DATA COLLECTION AND ANALYSIS We used standard methods recommended by Cochrane including assessment of risk of bias with RoB 2. Our primary outcomes were dyspnea, functional exercise capacity and health-related quality of life. MAIN RESULTS: We included 55 RCTs in this review. Both IMT and PR protocols varied significantly across the trials, especially in training duration, loads, devices, number/ frequency of sessions and the PR programs. Only eight trials were at low risk of bias. PR+IMT versus PR We included 22 trials (1446 participants) in this comparison. Based on a minimal clinically important difference (MCID) of -1 unit, we did not find an improvement in dyspnea assessed with the Borg scale at submaximal exercise capacity (mean difference (MD) 0.19, 95% confidence interval (CI) -0.42 to 0.79; 2 RCTs, 202 participants; moderate-certainty evidence). We also found no improvement in dyspnea assessed with themodified Medical Research Council dyspnea scale (mMRC) according to an MCID between -0.5 and -1 unit (MD -0.12, 95% CI -0.39 to 0.14; 2 RCTs, 204 participants; very low-certainty evidence). Pooling evidence for the 6-minute walk distance (6MWD) showed an increase of 5.95 meters (95% CI -5.73 to 17.63; 12 RCTs, 1199 participants; very low-certainty evidence) and failed to reach the MCID of 26 meters. In subgroup analysis, we divided the RCTs according to the training duration and mean baseline PImax. The test for subgroup differences was not significant. Trials at low risk of bias (n = 3) demonstrated a larger effect estimate than the overall. The summary effect of the St George's Respiratory Questionnaire (SGRQ) revealed an overall total score below the MCID of 4 units (MD 0.13, 95% CI -0.93 to 1.20; 7 RCTs, 908 participants; low-certainty evidence). The summary effect of COPD Assessment Test (CAT) did not show an improvement in the HRQoL (MD 0.13, 95% CI -0.80 to 1.06; 2 RCTs, 657 participants; very low-certainty evidence), according to an MCID of -1.6 units. Pooling the RCTs that reported PImax showed an increase of 11.46 cmH2O (95% CI 7.42 to 15.50; 17 RCTs, 1329 participants; moderate-certainty evidence) but failed to reach the MCID of 17.2 cmH2O. In subgroup analysis, we did not find a difference between different training durations and between studies judged with and without respiratory muscle weakness. One abstract reported some adverse effects that were considered "minor and self-limited". IMT versus control/sham Thirty-seven RCTs with 1021 participants contributed to our second comparison. There was a trend towards an improvement when Borg was calculated at submaximal exercise capacity (MD -0.94, 95% CI -1.36 to -0.51; 6 RCTs, 144 participants; very low-certainty evidence). Only one trial was at a low risk of bias. Eight studies (nine arms) used the Baseline Dyspnea Index - Transition Dyspnea Index (BDI-TDI). Based on an MCID of +1 unit, they showed an improvement only with the 'total score' of the TDI (MD 2.98, 95% CI 2.07 to 3.89; 8 RCTs, 238 participants; very low-certainty evidence). We did not find a difference between studies classified as with and without respiratory muscle weakness. Only one trial was at low risk of bias. Four studies reported the mMRC, revealing a possible improvement in dyspnea in the IMT group (MD -0.59, 95% CI -0.76 to -0.43; 4 RCTs, 150 participants; low-certainty evidence). Two trials were at low risk of bias. Compared to control/sham, the MD in the 6MWD following IMT was 35.71 (95% CI 25.68 to 45.74; 16 RCTs, 501 participants; moderate-certainty evidence). Two studies were at low risk of bias. In subgroup analysis, we did not find a difference between different training durations and between studies judged with and without respiratory muscle weakness. Six studies reported theSGRQ total score, showing a larger effect in the IMT group (MD -3.85, 95% CI -8.18 to 0.48; 6 RCTs, 182 participants; very low-certainty evidence). The lower limit of the 95% CI exceeded the MCID of -4 units. Only one study was at low risk of bias. There was an improvement in life quality with CAT (MD -2.97, 95% CI -3.85 to -2.10; 2 RCTs, 86 participants; moderate-certainty evidence). One trial was at low risk of bias. Thirty-two RCTs reported PImax, showing an improvement without reaching the MCID (MD 14.57 cmH2O, 95% CI 9.85 to 19.29; 32 RCTs, 916 participants; low-certainty evidence). In subgroup analysis, we did not find a difference between different training durations and between studies judged with and without respiratory muscle weakness. None of the included RCTs reported adverse events. AUTHORS' CONCLUSIONS IMT may not improve dyspnea, functional exercise capacity and life quality when associated with PR. However, IMT is likely to improve these outcomes when provided alone. For both interventions, a larger effect in participants with respiratory muscle weakness and with longer training durations is still to be confirmed.
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Affiliation(s)
- Omar Ammous
- Faculty of Medicine, University of Sfax, Sfax, Tunisia
| | - Walid Feki
- Department of Respiratory Medicine, Hedi Chaker University Hospital, University of Sfax, Sfax, Tunisia
| | - Tamara Lotfi
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Canada
| | | | - Rik Gosselink
- Department of Rehabilitation Sciences, Faculty of Movement and Rehabilitation Sciences, University Hospitals Leuven, Leuven, Belgium
| | - Ahmed Rebai
- Centre of Biotechnology of Sfax, University of Sfax, Sfax, Tunisia
| | - Samy Kammoun
- Department of Respiratory Medicine, Hedi Chaker University Hospital, University of Sfax, Sfax, Tunisia
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Abstract
BACKGROUND Delayed onset muscle soreness (DOMS) is caused by unaccustomed exercise, especially eccentric exercise, and is highly likely to cause skeletal muscle injury. It mainly manifests as ultrastructural changes in skeletal muscle, as well as decreased muscle strength, muscle soreness, swelling, and elevated levels of creatine kinase (CK). Vibration training (VT) has been attracting increasing attention as a new type of rehabilitation therapy. It can effectively minimize the occurrence and relieve the symptoms of DOMS, reduce muscle stiffness and soreness, and reduce serum concentrations of CK and lactate dehydrogenase (LDH). This article systematically assessed the impact of VT on the mitigation of DOMS through a meta-analysis to provide updated evidence-based information. METHODS Electronic databases such as China Knowledge Network, VIP Electronics, PubMed, EBSCO, and Web of Science were searched to identify randomized controlled trials of VT on DOMS. Searches were performed from database creation to November 2021. The quality of the literature was assessed using the Cochrane Manual for the Systematic Review of Interventions, and meta-analyses were performed using RevMan 5.4 software. RESULTS VT intervention in DOMS was shown to effectively reduce subjective pain, improve pain tolerance, and accelerate the reduction of serum CK and LDH concentrations. Subgroup analysis of different test time periods showed that subjective pain decreased more significantly after 48 hours than after the other 2 time periods, and pain tolerance increased more significantly after 72 hours than the other 2 time periods; serum CK was significantly increased after 24 and 48 hours of intervention, but showed no significant change compared with the control group after 72 hours. Serum LDH decreased significantly after 24 hours of intervention, but there was no significant difference compared with the control group after 48 hours or 72 hours. CONCLUSION VT effectively reduced the subjective pain sensation after DOMS, increased the pain threshold, reduced serum LDH and CK concentrations, and accelerated muscle damage repair compared with control interventions. However, the effect of improving the range of motion of the joints is not clear and should be studied further. REGISTRATION number: INPLASY2021120115.
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Affiliation(s)
- Yikun Yin
- College of Physical and Health Education, Guangxi Normal University, Guilin, China
| | - Jialin Wang
- Institute of Sports Medicine and Health, Chengdu Sport University, Chengdu, China
| | - Kangqi Duan
- College of Physical and Health Education, Guangxi Normal University, Guilin, China
| | - Hejia Cai
- College of Physical and Health Education, Guangxi Normal University, Guilin, China
| | - Junzhi Sun
- Institute of Sports Medicine and Health, Chengdu Sport University, Chengdu, China
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Cheng YY, Lin SY, Hsu CY, Fu PK. Respiratory Muscle Training Can Improve Cognition, Lung Function, and Diaphragmatic Thickness Fraction in Male and Non-Obese Patients with Chronic Obstructive Pulmonary Disease: A Prospective Study. J Pers Med 2022; 12:jpm12030475. [PMID: 35330474 PMCID: PMC8955729 DOI: 10.3390/jpm12030475] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 03/05/2022] [Accepted: 03/13/2022] [Indexed: 12/25/2022] Open
Abstract
Patients with chronic obstructive pulmonary disease (COPD) are frequently comorbid with mild cognitive impairment (MCI). Whether respiratory muscle training (RMT) is helpful for patients with COPD comorbid MCI remains unclear. Inspiratory muscle training (IMT) with or without expiratory muscle training (EMT) was performed. Patients were randomly assigned to the full training group (EMT + IMT) or the simple training group (IMT only). A total of 49 patients completed the eight-week course of RMT training. RMT significantly improved the maximal inspiratory pressure (MIP), the diaphragmatic thickness fraction and excursion, lung function, scores in the COPD assessment test (CAT), modified Medical Research Council (mMRC) scale scores, and MMSE. The between-group difference in the full training and single training group was not significant. Subgroup analysis classified by the forced expiratory volume in one second (FEV1) level of patients showed no significant differences in MIP, lung function, cognitive function, and walking distance. However, a significant increase in diaphragmatic thickness was found in patients with FEV1 ≥ 30%. We suggest that patients with COPD should start RMT earlier in their disease course to improve physical activity.
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Affiliation(s)
- Yuan-Yang Cheng
- Department of Physical Medicine and Rehabilitation, Taichung Veterans General Hospital, Taichung 407219, Taiwan;
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung 402010, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei 11221, Taiwan;
| | - Shih-Yi Lin
- School of Medicine, National Yang Ming Chiao Tung University, Taipei 11221, Taiwan;
- Center for Geriatrics and Gerontology, Taichung Veterans General Hospital, Taichung 40705, Taiwan
| | - Chiann-Yi Hsu
- Biostatistics Task Force of Taichung Veterans General Hospital, Taichung 407219, Taiwan;
| | - Pin-Kuei Fu
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung 402010, Taiwan
- Department of Critical Care Medicine, Taichung Veterans General Hospital, Taichung 407219, Taiwan
- Integrated Care Center of Interstitial Lung Disease, Taichung Veterans General Hospital, Taichung 407219, Taiwan
- College of Human Science and Social Innovation, Hungkuang University, Taichung 433304, Taiwan
- Correspondence: ; Tel.: +886-937-701-592
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9
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Liaw MY, Lin MC, Leong CP, Wang LY, Pong YP, Yang TH, Huang YC. Electromyographic study assessing swallowing function in subacute stroke patients with respiratory muscle weakness. Medicine (Baltimore) 2021; 100:e27780. [PMID: 35049172 PMCID: PMC9191609 DOI: 10.1097/md.0000000000027780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Accepted: 10/28/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Dysphagia has been reported to be associated with the descent of the hyolaryngeal complex. Further, suprahyoid muscles play a greater role than infrahyoid muscles in elevation of the hyolarngeal complex. Respiratory muscle training (RMT) can improve lung function, and expiratory muscle strength training can facilitate elevation of the hyoid bone and increase the motor unit recruitment of submental muscles during normal swallowing. This study aimed to investigate the surface electromyography (sEMG) of the swallowing muscles, bilaterally, and the effect of RMT on swallowing muscles in stroke patients with respiratory muscle weakness. METHODS Forty patients with first episode of unilateral stroke were included in this retrospective controlled trial. After exclusion of 11 patients with respiratory muscle strength stronger than 70% of the predicted value, 15 were allocated to the RMT group and 14 to the control group. However, eventually, 11 patients in RMT group and 11 patients in control group completed the study. The sEMG of the orbicularis oris, masseter, submental, and infrahyoid muscles were recorded during dry swallowing, water swallowing (2 mL), and forced exhalation against a threshold breathing trainer set at different intensities, at baseline and after 6-week RMT. RESULTS Regarding the sEMG of submental muscles, there were significant between-group differences on the latency of the unaffected side (P = .048), significant change from baseline force on the unaffected side (P = .035), and significant between-side difference (P = .011) in the RMT group during dry swallowing. Significant change in the duration from baseline was observed on the affected side of the RMT group when blowing was set at 50% maximal expiratory pressure (MEP; P = .015), and on the unaffected side of the control group when blowing set at 15% MEP (P = .005). Significant difference was observed in the duration between 50% MEP and 15% MEP after 6-week program in the control group (P = .049). CONCLUSIONS A 6-week RMT can improve the electric signal of the affected swallowing muscles with more effect on the unaffected side than on the affected side during dry swallowing. Furthermore, RMT with 50% MEP rather than 15% MEP can facilitate greater submental muscle activity on the affected side in stroke patients with respiratory muscle weakness.
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Affiliation(s)
- Mei-Yun Liaw
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital Kaohsiung Medical Center, Chang Gung University College of Medicine, Taiwan
- Chang Gung Respirology Center of Excellence, Taiwan
| | - Meng-Chih Lin
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Department of Respiratory Therapy, Chang Gung Memorial Hospital Kaohsiung Medical Center, Chang Gung University College of Medicine, Taiwan
- Chang Gung Respirology Center of Excellence, Taiwan
| | - Chau-Peng Leong
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital Kaohsiung Medical Center, Chang Gung University College of Medicine, Taiwan
| | - Lin-Yi Wang
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital Kaohsiung Medical Center, Chang Gung University College of Medicine, Taiwan
| | - Ya-Ping Pong
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital Kaohsiung Medical Center, Chang Gung University College of Medicine, Taiwan
| | - Tsung-Hsun Yang
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital Kaohsiung Medical Center, Chang Gung University College of Medicine, Taiwan
- Chang Gung Respirology Center of Excellence, Taiwan
| | - Yu-Chi Huang
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital Kaohsiung Medical Center, Chang Gung University College of Medicine, Taiwan
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10
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Mori Y, Yamano Y, Kataoka K, Yokoyama T, Matsuda T, Kimura T, Ogawa T, Watanabe F, Kondoh Y. Pulmonary rehabilitation for idiopathic pleuroparenchymal fibroelastosis: A retrospective study on its efficacy, feasibility, and safety. Respir Investig 2021; 59:849-858. [PMID: 34561207 DOI: 10.1016/j.resinv.2021.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 07/23/2021] [Accepted: 08/07/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND The beneficial effects of pulmonary rehabilitation (PR) for patients with idiopathic pleuroparenchymal fibroelastosis (IPPFE) remain unknown. This study aimed to examine the efficacy, feasibility, and safety of PR for IPPFE. METHODS We retrospectively investigated 25 patients with IPPFE referred for PR between April 2007 and March 2017. The PR mainly consisted of a 10-week exercise training program. The primary outcome was a change in 6-min walk distance (6MWD). Secondary outcomes included changes in dyspnea (transition dyspnea index [TDI]), anxiety and depression (hospital anxiety and depression scale [HADS]), and health-related quality of life (HRQoL) (St George's respiratory questionnaire [SGRQ]). RESULTS Thirteen patients participated in the PR program (PRP). Recurrent pneumothorax was the most common reason for patients not participating in the PRP. Four patients discontinued the PRP due to the recurrence of pneumothorax, new onset of pneumomediastinum, stroke, and another reason, respectively. Nine patients completed the PRP. Significant improvement was observed in 6MWD (median [interquartile range], 90 m [55-116 m]; P = 0.033). Clinically important improvements in the 6MWD, and TDI, HADS-anxiety, HADS-depression, and SGRQ total domain scores were observed in seven (78%), five (56%), four (44%), four (44%), and five (56%) of the nine patients, respectively. CONCLUSIONS Patients with IPPFE benefited from PR in terms of exercise capacity, dyspnea, anxiety, depression, and HRQoL. Pneumothorax and pneumomediastinum may impede the implementation of a PRP for patients with IPPFE. While careful patient selection is required, PR may be an efficacious non-pharmacological approach for managing disabilities in patients with IPPFE.
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Affiliation(s)
- Yuta Mori
- Department of Respiratory Medicine and Allergy, Tosei General Hospital, 160 Nishioiwake-cho, Seto, Aichi, 489-8642, Japan; Department of Respiratory Medicine, Ogaki Municipal Hospital, 4-86 Minaminokawa-cho, Ogaki, Gifu, 503-8502, Japan
| | - Yasuhiko Yamano
- Department of Respiratory Medicine and Allergy, Tosei General Hospital, 160 Nishioiwake-cho, Seto, Aichi, 489-8642, Japan
| | - Kensuke Kataoka
- Department of Respiratory Medicine and Allergy, Tosei General Hospital, 160 Nishioiwake-cho, Seto, Aichi, 489-8642, Japan
| | - Toshiki Yokoyama
- Department of Respiratory Medicine and Allergy, Tosei General Hospital, 160 Nishioiwake-cho, Seto, Aichi, 489-8642, Japan
| | - Toshiaki Matsuda
- Department of Respiratory Medicine and Allergy, Tosei General Hospital, 160 Nishioiwake-cho, Seto, Aichi, 489-8642, Japan
| | - Tomoki Kimura
- Department of Respiratory Medicine and Allergy, Tosei General Hospital, 160 Nishioiwake-cho, Seto, Aichi, 489-8642, Japan
| | - Tomoya Ogawa
- Department of Rehabilitation, Tosei General Hospital, 160 Nishioiwake-cho, Seto, Aichi, 489-8642, Japan
| | - Fumiko Watanabe
- Department of Rehabilitation, Tosei General Hospital, 160 Nishioiwake-cho, Seto, Aichi, 489-8642, Japan
| | - Yasuhiro Kondoh
- Department of Respiratory Medicine and Allergy, Tosei General Hospital, 160 Nishioiwake-cho, Seto, Aichi, 489-8642, Japan.
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11
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Human A, Morrow BM. Inspiratory muscle training in children and adolescents living with neuromuscular diseases: A pre-experimental study. SOUTH AFRICAN JOURNAL OF PHYSIOTHERAPY 2021; 77:1577. [PMID: 34522820 PMCID: PMC8424756 DOI: 10.4102/sajp.v77i1.1577] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 06/28/2021] [Indexed: 11/23/2022] Open
Abstract
Background Children with neuromuscular diseases (NMD) are at risk of morbidity and mortality because of progressive respiratory muscle weakness and ineffective cough. Inspiratory muscle training (IMT) aims to preserve or improve respiratory muscle strength, thereby reducing morbidity and improving health-related quality of life (HRQoL). Objectives To describe the safety and feasibility of a 6-week IMT programme using an electronic threshold device (Powerbreathe®). Any adverse events and changes in functional ability, spirometry, peak expiratory cough flow (PECF), inspiratory muscle strength and HRQoL (Pediatric Quality of Life [PedsQL]) were recorded. Methods A convenience sample of eight participants (n = 4 boys; median [interquartile range {IQR}] age: 12.21 [9.63–16.05] years) with various NMD were included in a pre-experimental, observational pre-test post-test feasibility study. Training consisted of 30 breaths, twice daily, 5 days a week, for 6 weeks. Results There were significant pre- to post-intervention improvements in upper limb function and coordination (p = 0.03) and inspiratory muscle strength: maximum inspiratory mouth pressure (Pimax) (p = 0.01); strength-index (p = 0.02); peak inspiratory flow (PIF) (p = 0.02), with no evidence of change in spirometry, PECF or HRQoL. No adverse events occurred and participant satisfaction and adherence levels were high. Conclusion Inspiratory muscle training (at an intensity of 30% Pimax) appears safe, feasible and acceptable, in a small sample of children and adolescents with NMD and was associated with improved inspiratory muscle strength, PIF and upper limb function and coordination. Clinical implications Larger, longer-term randomised controlled trials are warranted to confirm the safety and efficacy of IMT as an adjunct respiratory management strategy in children with NMD.
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Affiliation(s)
- Anri Human
- Department of Physiotherapy, Faculty of Healthcare Sciences, Sefako Makgatho Health Sciences University, Garankuwa, Pretoria, South Africa.,Department of Health and Rehabilitation Sciences, Faculty of Health Sciences, University of Cape Town, Observatory, South Africa
| | - Brenda M Morrow
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, University of Cape Town, Rondebosch, South Africa
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12
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Beaumont M, Le Tallec F, Villiot-Danger E. [Inspiratory muscle training during pulmonary rehabilitation]. Rev Mal Respir 2021; 38:754-767. [PMID: 33879382 DOI: 10.1016/j.rmr.2021.04.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 04/04/2021] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Inspiratory muscle training (IMT) is part of the management of patients with pulmonary diseases during rehabilitation. Since the last recommendations of the Société de pneumologie de langue française, several studies have focused on the role of inspiratory muscle training during pulmonary rehabilitation. BACKGROUND IMT, in comparison to standard care or sham-IMT, improves the strength and endurance of the inspiratory muscles, decreases dyspnoea during the activities of daily living, improves walking distance and quality of life. However, the different studies did not show an additional effect of IMT during a pulmonary rehabilitation program compared to a rehabilitation program without IMT, with regard to improvement of exercise capacity and quality of life. OUTLOOK One study showed an improvement in dyspnoea of effort, but these results are yet to be confirmed. Finally, it seems appropriate to associate IMT with an exercise-training program before chest or abdominal surgery, even if further studies are necessary. CONCLUSION During a pulmonary rehabilitation program, IMT does not provide additional benefits. However, when patients cannot perform a global exercise training, IMT has shown benefit. IMT provides additional benefits in pre-operative programs.
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Affiliation(s)
- M Beaumont
- Service de réhabilitation respiratoire, centre hospitalier des Pays de Morlaix, Morlaix, France; Laboratoire GETBO (EA3878), CIC Inserm 1412, centre hospitalier universitaire de Brest, Brest, France.
| | - F Le Tallec
- Service de kinésithérapie, centre hospitalier privé Saint-Grégoire, Rennes, France
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13
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Pancar Z. Effect of Inspiratory Muscle Training with Royal Jelly Supplement on Iron Metabolism in Cigarette Addicts. Eurasian J Med 2021; 53:15-18. [PMID: 33716524 DOI: 10.5152/eurasianjmed.2020.20271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 10/07/2020] [Indexed: 11/22/2022] Open
Abstract
Objective The strength or weakness of the respiratory muscles compared with other skeletal muscles owing to their more specialized structures is considered as an indicator or cause of a disease. This study aimed to investigate the effects of inspiratory muscle training with royal jelly (RJ) supplement on iron metabolism in cigarette addicts. Materials and Methods A total of 40 male volunteers participated in the study who were divided into 4 groups before the study as follows: smoker control group (n=10), inspiratory muscle training (IMT) group (n=10), RJ group (n=10), and RJ+IMT (n=10) group. Blood samples were taken from all the participants for analysis of iron, iron binding, and total iron binding capacity. Maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP) measurements for the groups to perform training were carried out with 40% of their MIP values. The training sessions were carried out at the same time every day for 4 weeks (5 days per week). Results The Statistical Package for Social Sciences version 22.0 program was used for statistical analyses. The results of the analysis found that the iron, iron binding, and total iron binding capacities were in favor of post-tests in the RJ supplement IMT, and RJ+IMT groups compared with those in the control group (p<0.05). There was a statistically significant difference between the RJ supplement, IMT, and RJ+IMT groups compared with the control group (p<0.05). Conclusion Therefore, it could be concluded that the IMT and RJ supplements positively affected these parameters by altering the iron metabolism of the cigarette addicts.
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Affiliation(s)
- Zarife Pancar
- Department of Sport, Gaziantep University School of Sport Science, Gaziantep, Turkey
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14
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Zhang F, Zhong Y, Qin Z, Li X, Wang W. Effect of muscle training on dyspnea in patients with chronic obstructive pulmonary disease: A meta-analysis of randomized controlled trials. Medicine (Baltimore) 2021; 100:e24930. [PMID: 33655957 PMCID: PMC7939163 DOI: 10.1097/md.0000000000024930] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 02/04/2021] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Rehabilitation training is beneficial for patients with chronic obstructive pulmonary disease (COPD). This study was aimed at evaluating the efficacy of muscle training on dyspnea. METHODS We used 5 common databases for conducting a meta-analysis included PubMed, the Cochrane Library, Science Direct, Web of Science and Clinical Trials.gov, and eligible randomized controlled trials (RCTs) were included. The main results of include studies were dyspnea of patients who had a clinical diagnosis of COPD measured using Borg score and Medical Research Council (MRC) or modified Medical Research Council (mMRC) scale as the criteria before and after intervention. The intervention measures included respiratory or expiratory muscles or upper limb (UL) or lower limb (LL) training. The mean differences (MD) with the 95% confidence interval (CI) were considered for summary statistics. We also assessed risk of bias using the Cochrane collaboration's tool, and the value of I2 was applied to evaluate the heterogeneity of the trials. RESULTS Fourteen RCTs with 18 interventions (n = 860 participants) were included. Muscle training significantly improved dyspnea during exercise and in the daily life of patients with COPD (MD, 95% CI: -0.58, -0.84 to -0.32, P < .0001 and -0.44, -0.65 to -0.24, P < .0001, respectively). In the subgroup analyses, the trials that used respiratory muscle and UL trainings significantly improved dyspnea during exercise (MD, 95% CI: -0.72, -1.13 to -0.31, P = .0005 and -0.53, -0.91 to -0.15, P = .007, respectively). The studies also showed that the participants in the rehabilitation group, who received respiratory muscle and UL trainings, had a significant improvement of dyspnea in daily life (MD, 95% CI: -0.38, -0.67 to -0.09, P = .01 and -0.51, -0.80 to -0.22, P = .0007, respectively). CONCLUSION There were some limitations that most of the subjects in this study were patients with moderate to severe COPD and were male, and the training period and duration were different. The analyses revealed that respiratory muscle and UL trainings can improve dyspnea in patients with COPD during exercise and in daily life.
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Affiliation(s)
- Fang Zhang
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital
| | - Yaping Zhong
- Department of Environmental Health, School of Public Health, China Medical University, Shenyang, Liaoning Province, People's Republic of China
| | - Zheng Qin
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital
| | - Xiaomeng Li
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital
| | - Wei Wang
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital
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15
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Saher T, Moiz J, Bhati P, Ali M, Talwar D. Effect of inspiratory muscle training in hypercapnic chronic obstructive pulmonary disease patients during acute care: a randomised clinical trial. COMPARATIVE EXERCISE PHYSIOLOGY 2021. [DOI: 10.3920/cep200017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Weakness of respiratory muscles along with respiratory failure is a common finding in chronic obstructive pulmonary disease (COPD) patients which leads to dyspnoea and hence decreased functional capacity. Despite a sound theoretical rationale regarding the potential role of inspiratory muscles, the role of inspiratory muscle training (IMT) along with the conventional non-invasive ventilation (NIV) on important clinical outcomes has not been investigated in these patients during acute care. 34 hypercapnic stable COPD patients were randomly allocated to one of the interventions that lasted for 10 days: IMT with NIV (n=17), and NIV alone (n=17). IMT was administered 2 times in a day (15 min each time) by threshold loading at an intensity starting from 30% and progressed to 60% of their maximal inspiratory effort (PImax). NIV was given at an optimal pressure titrated for each patient for at least >8 h per day. Outcome measures (respiratory muscle strength, respiratory failure, dyspnoea, and functional capacity) were assessed before and after 10 days of intervention. Clinical characteristics and outcome variables of patients were similar between the groups at baseline. Addition of IMT led to a significantly greater increase in respiratory muscle strength (P=0.01), reduction in dyspnea (modified medical research council dyspnea scale, P=0.001); improved outcomes of respiratory failure (PaCO2, P=0.03; PaO2, P=0.002) and improved functional capacity (6 min walk distance, P=0.001) as compared to NIV alone. A short duration IMT program in addition to NIV was found to be effective in improving respiratory muscle strength, perception of dyspnoea, functional capacity and respiratory failure in hypercapnic COPD patients.
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Affiliation(s)
- T. Saher
- Centre for Physiotherapy and Rehabilitation Sciences, Jamia Millia Islamia, New Delhi, 110025, India
| | - J.A. Moiz
- Centre for Physiotherapy and Rehabilitation Sciences, Jamia Millia Islamia, New Delhi, 110025, India
| | - P. Bhati
- Faculty of Physiotherapy, Shree Guru Gobind Singh Tricentenary University, Gurugram, Haryana, 122505, India
| | - M.S. Ali
- Department of Pulmonary Rehabilitation, Metro Centre for Respiratory Diseases, Metro Hospital and Multispecialty Institute, Noida, Uttar Pradesh, 201301, India
| | - D. Talwar
- Department of Pulmonology Allergy Sleep and Critical Care Medicine, Metro Centre for Respiratory Diseases, Metro Hospital and Multispecialty Institute, Noida, Uttar Pradesh, 201301, India
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16
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Scheffers LE, Helbing WA, Utens EMWJ, Dieleman GC, Dulfer K, Noske J, van den Broek EA, Walet S, Olieman JF, Escher JC, Pijnenburg MW, van der Ploeg AT, van den Berg LE. Study Protocol of the Exercise Study: Unraveling Limitations for Physical Activity in Children With Chronic Diseases in Order to Target Them With Tailored Interventions-A Randomized Cross Over Trial. Front Pediatr 2021; 9:791701. [PMID: 35118031 PMCID: PMC8805206 DOI: 10.3389/fped.2021.791701] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 12/09/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction: Physical activity is associated with many physiological and psychological health benefits across the lifespan. Children with a chronic disease often have lower levels of daily physical activity, and a decreased exercise capacity compared to healthy peers. In order to learn more about limitations for physical activity, we investigate children with four different chronic diseases: children with a Fontan circulation, children with Broncho Pulmonary Dysplasia (BPD), Pompe disease and inflammatory bowel disease (IBD). Each of these diseases is likely to interfere with physical activity in a different way. Knowing the specific limitations for physical activity would make it possible to target these, and increase physical activity by a personalized intervention. The aim of this study is to first investigate limitations for physical activity in children with various chronic diseases. Secondly, to measure the effects of a tailored exercise intervention, possibly including a personalized dietary advice and/or psychological counseling, on exercise capacity, endurance, quality of life, fatigue, fear for exercise, safety, muscle strength, physical activity levels, energy balance, and body composition. Methods and Analysis: This randomized crossover trial will aim to include 72 children, aged 6-18 years, with one of the following diagnosis: a Fontan circulation, BPD, Pompe disease and IBD. Eligible patients will participate in the 12-week tailored exercise intervention and are either randomized to start with a control period or start with the intervention. The tailored 12-week exercise interventions, possibly including a personalized dietary advice and/or psychological counseling, will be designed based on the found limitations for physical activity in each disease group during baseline measurements by the Rotterdam Exercise Team. Effects of the tailored training interventions will be measured on the following endpoints: exercise capacity (measured by cardiopulmonary exercise test), endurance, physical activity levels, muscle strength, quality of life, fatigue, fear for exercise, disease activity, cardiac function (in children with a Fontan circulation), energy balance, and body composition. Ethics and Dissemination: Conducted according to the Declaration of Helsinki and Good Clinical Practice. Medical-ethical approval was obtained. Trial Registration Number: NL8181, https://www.trialregister.nl/trial/8181.
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Affiliation(s)
- Linda E Scheffers
- Department of Pediatric Gastroenterology, Erasmus MC-Sophia Children's Hospital, Rotterdam, Netherlands.,Respiratory Medicine and Allergology, Department of Pediatrics, University Medical Center, Erasmus MC-Sophia Children's Hospital, Rotterdam, Netherlands.,Center for Lysosomal and Metabolic Diseases, Erasmus MC University Medical Center, Rotterdam, Netherlands.,Department of Pediatric Cardiology, Erasmus MC-Sophia Children's Hospital, Rotterdam, Netherlands
| | - Willem A Helbing
- Department of Pediatric Cardiology, Erasmus MC-Sophia Children's Hospital, Rotterdam, Netherlands.,Division of Pediatric Cardiology, Department of Pediatrics, Radboud University Medical Center, Amalia Children's Hospital, Nijmegen, Netherlands
| | - Elisabeth M W J Utens
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC-Sophia Children's Hospital, Rotterdam, Netherlands.,Research Institute of Child Development and Education, University of Amsterdam, Amsterdam, Netherlands.,Department of Child and Adolescent Psychiatry, Amsterdam University Medical Center/Levvel, Amsterdam, Netherlands
| | - Gwen C Dieleman
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC-Sophia Children's Hospital, Rotterdam, Netherlands
| | - Karolijn Dulfer
- Intensive Care Unit, Department of Paediatrics and Paediatric Surgery, Erasmus Medical Centre-Sophia Children's Hospital, Rotterdam, Netherlands
| | - Josefien Noske
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC-Sophia Children's Hospital, Rotterdam, Netherlands
| | - Eline A van den Broek
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC-Sophia Children's Hospital, Rotterdam, Netherlands
| | - Sylvia Walet
- Division of Dietetics, Department of Internal Medicine, Erasmus MC, Rotterdam, Netherlands
| | - Joanne F Olieman
- Division of Dietetics, Department of Internal Medicine, Erasmus MC, Rotterdam, Netherlands
| | - Johanna C Escher
- Department of Pediatric Gastroenterology, Erasmus MC-Sophia Children's Hospital, Rotterdam, Netherlands
| | - Marielle W Pijnenburg
- Respiratory Medicine and Allergology, Department of Pediatrics, University Medical Center, Erasmus MC-Sophia Children's Hospital, Rotterdam, Netherlands
| | - Ans T van der Ploeg
- Center for Lysosomal and Metabolic Diseases, Erasmus MC University Medical Center, Rotterdam, Netherlands
| | - Linda E van den Berg
- Center for Lysosomal and Metabolic Diseases, Erasmus MC University Medical Center, Rotterdam, Netherlands.,Department of Pediatric Cardiology, Erasmus MC-Sophia Children's Hospital, Rotterdam, Netherlands
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17
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Ammous O, Feki W, Lotfi T, Khamis AM, Rebai A, Kammoun S. Inspiratory muscle training, with or without concomitant pulmonary rehabilitation, for chronic obstructive pulmonary disease (COPD). Hippokratia 2020. [DOI: 10.1002/14651858.cd013778] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Omar Ammous
- Faculty of Medicine; University of Sfax; Sfax Tunisia
| | - Walid Feki
- Department of Respiratory Medicine; University of Sfax; Sfax Tunisia
| | - Tamara Lotfi
- Department of Health Research Methods, Evidence and Impact; McMaster University; Hamilton Canada
| | | | - Ahmed Rebai
- Center of Biotechnology; University of Sfax; Sfax Tunisia
| | - Samy Kammoun
- Department of Respiratory Medicine; University of Sfax; Sfax Tunisia
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18
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Zhou W, Woo S, Larson JL. Effects of perioperative exercise interventions on lung cancer patients: An overview of systematic reviews. J Clin Nurs 2020; 29:4482-4504. [DOI: 10.1111/jocn.15511] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 08/28/2020] [Accepted: 09/11/2020] [Indexed: 12/18/2022]
Affiliation(s)
- Weijiao Zhou
- School of Nursing University of Michigan Ann Arbor MI USA
| | - Seoyoon Woo
- School of Nursing University of Michigan Ann Arbor MI USA
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19
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Ferrer-Sargues FJ, Peiró-Molina E, Salvador-Coloma P, Carrasco Moreno JI, Cano-Sánchez A, Vázquez-Arce MI, Insa Albert B, Sepulveda Sanchis P, Cebrià i Iranzo MÀ. Cardiopulmonary Rehabilitation Improves Respiratory Muscle Function and Functional Capacity in Children with Congenital Heart Disease. A Prospective Cohort Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17124328. [PMID: 32560441 PMCID: PMC7345179 DOI: 10.3390/ijerph17124328] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 06/10/2020] [Accepted: 06/14/2020] [Indexed: 02/07/2023]
Abstract
Critical surgical and medical advances have shifted the focus of congenital heart disease (CHD) patients from survival to achievement of a greater health-related quality of life (HRQoL). HRQoL is influenced, amongst other factors, by aerobic capacity and respiratory muscle strength, both of which are reduced in CHD patients. This study evaluates the influence of a cardiopulmonary rehabilitation program (CPRP) on respiratory muscle strength and functional capacity. Fifteen CHD patients, ages 12 to 16, with reduced aerobic capacity in cardiopulmonary exercise testing (CPET) were enrolled in a CPRP involving strength and aerobic training for three months. Measurements for comparison were obtained at the start, end, and six months after the CPRP. A significant improvement of inspiratory muscle strength was evidenced (maximum inspiratory pressure 21 cm H2O, 23%, p < 0.01). The six-minute walking test showed a statistically and clinically significant rise in walked distance (48 m, p < 0.01) and a reduction in muscle fatigue (1.7 out of 10 points, p = 0.017). These results suggest CPRP could potentially improve respiratory muscle function and functional capacity, with lasting results, in children with congenital heart disease, but additional clinical trials must be conducted to confirm this finding.
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Affiliation(s)
- Francisco José Ferrer-Sargues
- Department of Physiotherapy, Universidad Cardenal Herrera CEU, CEU Universities, 46115 Valencia, Spain; (F.J.F.-S.); (P.S.-C.)
| | - Esteban Peiró-Molina
- Pediatric Cardiology Section, Hospital Universitari i Politècnic La Fe, 46026 Valencia, Spain; (E.P.-M.); (J.I.C.M.); (A.C.-S.); (B.I.A.)
- Regenerative Medicine and Heart Transplantation Unit, Instituto de Investigación Sanitaria La Fe, 46026 Valencia, Spain
| | - Pablo Salvador-Coloma
- Department of Physiotherapy, Universidad Cardenal Herrera CEU, CEU Universities, 46115 Valencia, Spain; (F.J.F.-S.); (P.S.-C.)
| | - José Ignacio Carrasco Moreno
- Pediatric Cardiology Section, Hospital Universitari i Politècnic La Fe, 46026 Valencia, Spain; (E.P.-M.); (J.I.C.M.); (A.C.-S.); (B.I.A.)
- Regenerative Medicine and Heart Transplantation Unit, Instituto de Investigación Sanitaria La Fe, 46026 Valencia, Spain
| | - Ana Cano-Sánchez
- Pediatric Cardiology Section, Hospital Universitari i Politècnic La Fe, 46026 Valencia, Spain; (E.P.-M.); (J.I.C.M.); (A.C.-S.); (B.I.A.)
| | - María Isabel Vázquez-Arce
- Rehabilitation and Physical Medicine service, Hospital Universitari i Politècnic La Fe, 46026 Valencia, Spain;
- Universidad San Vicente Mártir, 46001 Valencia, Spain
| | - Beatriz Insa Albert
- Pediatric Cardiology Section, Hospital Universitari i Politècnic La Fe, 46026 Valencia, Spain; (E.P.-M.); (J.I.C.M.); (A.C.-S.); (B.I.A.)
| | - Pilar Sepulveda Sanchis
- Regenerative Medicine and Heart Transplantation Unit, Instituto de Investigación Sanitaria La Fe, 46026 Valencia, Spain
- Correspondence: (P.S.S.); (M.À.C.I.)
| | - Maria Àngels Cebrià i Iranzo
- Rehabilitation and Physical Medicine service, Hospital Universitari i Politècnic La Fe, 46026 Valencia, Spain;
- Department of Physiotherapy, Universitat de València, 46010 Valencia, Spain
- Correspondence: (P.S.S.); (M.À.C.I.)
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Inspiratory Muscle Training in Obstructive Sleep Apnea Associating Diabetic Peripheral Neuropathy: A Randomized Control Study. BIOMED RESEARCH INTERNATIONAL 2020; 2020:5036585. [PMID: 32626744 PMCID: PMC7306097 DOI: 10.1155/2020/5036585] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 05/15/2020] [Accepted: 06/01/2020] [Indexed: 02/07/2023]
Abstract
Objective This work is aimed at assessing the effects of inspiratory muscle training on lung functions, inspiratory muscle strength, and aerobic capacity in diabetic peripheral neuropathy (DPN) patients with obstructive sleep apnea (OSA). Methods A randomized control study was performed on 55 patients diagnosed with DPN and OSA. They were assigned to the training group (IMT, n = 28) and placebo training group (P-IMT, n = 27). Inspiratory muscle strength, lung functions, and aerobic capacity were evaluated before and after 12 weeks postintervention. An electronic inspiratory muscle trainer was conducted, 30 min a session, three times a week for 12 consecutive weeks. Results From seventy-four patients, 55 have completed the study program. A significant improvement was observed in inspiratory muscle strength (p < 0.05) in the IMT group while no changes were observed in the P-IMT group (p > 0.05). No changes were observed in the lung function in the two groups (p > 0.05). Also, VO2max and VCO2max changed significantly after training in the IMT group (p < 0.05) while no changes were observed in the P-IMT group (p > 0.05). Other cardiopulmonary exercise tests did not show any significant change in both groups (p > 0.05). Conclusions Based on the outcomes of the study, it was found that inspiratory muscle training improves inspiratory muscle strength and aerobic capacity without a notable effect on lung functions for diabetic patients suffering from DPN and OSA.
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Yilmaz C, Bostancı Ö, Bulut S. Effect of Respiratory Muscle Training on Pitch Range and Sound Duration in Brass Instrument Players and Singers. J Voice 2020; 36:76-82. [PMID: 32451252 DOI: 10.1016/j.jvoice.2020.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 04/09/2020] [Accepted: 04/13/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE Effective use of respiratory organs is important for musicians. Therefore, the impact of Respiratory Muscle Training (RMT) on phonation is open to research. The aim of this study was to investigate the measurable effects of RMT on blowing in brass instrumental and on voice performance in singers. METHODS Thirty musicians were recruited and separated into a four groups. The brass instrumental and singers groups were further subdivided into control and RMT groups for a 4 week RMT intervention giving a total four groups: singers experimental (SE; n:10), singers control (SC; n:10), brass instrument players experimental (BIPE; n:5), and BIPC (n:5). The groups selected from the musicians of Samsun State Opera and Ballet Directorate and Samsun Metropolitan Municipality Band Team participated in the study. RESULTS After 4 weeks of RMT application in the study groups, significant increase in all parameters except Forced vital capacity/Forced expiratory volume in 1 second was observed in the values of pulmonary function tests and respiratory muscle strength in subjects with SE and BIPE (P < 0.05). The most significant results of this study are that in addition to changes in the duration of phonation (SE 36%), high-pitch (SE 79%, BIPE 27%) and low-pitch sounds (BIPE 61% and SE 42%), the SE (15%) and BIPE (3%) groups reached higher pitches in the high-pitch notes. CONCLUSIONS It was determined that performance of the highest and lowest pitch sounds within a vocal register in a single breath and phonation times can be improved by RMT.
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Affiliation(s)
- Coşkun Yilmaz
- Ondokuz Mayıs University, Graduate School of Health Sciences, Samsun, Turkey.
| | - Özgür Bostancı
- Ondokuz Mayıs University, Yasar Dogu Sport Science Faculty, Department of Physical Education and Sports, Samsun, Turkey
| | - Seyhan Bulut
- Ondokuz Mayıs University, State Conservatory, Department of Music, Samsun, Turkey
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22
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Nóbrega-Júnior JCN, Dornelas de Andrade A, de Andrade EAM, Andrade MDA, Ribeiro ASV, Pedrosa RP, Ferreira APDL, de Lima AMJ. Inspiratory Muscle Training in the Severity of Obstructive Sleep Apnea, Sleep Quality and Excessive Daytime Sleepiness: A Placebo-Controlled, Randomized Trial. Nat Sci Sleep 2020; 12:1105-1113. [PMID: 33293881 PMCID: PMC7719323 DOI: 10.2147/nss.s269360] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Accepted: 09/01/2020] [Indexed: 11/28/2022] Open
Abstract
PURPOSE Exercise programs have been considered as an adjuvant treatment in obstructive sleep apnea (OSA). However, few studies have focused on the effects of the inspiratory muscle training (IMT) in reducing the severity and the symptoms of OSA. PATIENTS AND METHODS A randomized controlled trial was conducted and approved by the local Ethics Committee. All subjects signed the informed consent form and were randomized into 2 groups: a) IMT group (n = 8), 8 weeks of IMT with 75% of maximal inspiratory pressure (MIP) and b) placebo group (n = 8): subjects performed IMT without load. RESULTS IMT group showed reduction in the apnea-hypopnea index (AHI) (p = 0.01), in the Berlin questionnaire score (p = 0.001) and an increase in inspiratory muscle strength (p = 0.018). IMT group demonstrated a reduction in the AHI (31.7 ± 15.9 events/h vs 29.9 ± 15.8 events/h; p <0.001), in the Berlin questionnaire scores (2.6 ± 0.5 vs 1.2 ± 0.5; p = 0.016), Pittsburgh Sleep Quality Index (PSQI) score (7.2 ± 3.6 vs 3.7 ± 1.3; p = 0.008), in the Epworth Sleepiness Scale (ESS) (12.5 ± 4.0 vs 7.7 ± 3.0; p = 0.008) and increase in MIP (83.6 ± 26.5 cmH2O and 127.9 ± 32.5 cmH2O; p = 0.010). CONCLUSION The IMT promotes discrete changes in the AHI and improves sleep quality and excessive daytime sleepiness in OSA. Moreover, IMT is a cheap, useful and simple home-based training program and can be considered as an adjunct therapy for OSA patients.
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Affiliation(s)
| | | | | | | | | | - Rodrigo Pinto Pedrosa
- Sleep and Heart Laboratory, Pronto Socorro Cardiológico de Pernambuco (PROCAPE)- University of Pernambuco, Recife, Pernambuco, Brazil
| | | | - Anna Myrna Jaguaribe de Lima
- Department of Physical Therapy Federal University of Pernambuco, Recife, Pernambuco, Brazil.,Department of Morphology and Animal Physiology, Federal Rural University of Pernambuco, Recife, Pernambuco, Brazil
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23
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Nolan CM, Rochester CL. Exercise Training Modalities for People with Chronic Obstructive Pulmonary Disease. COPD 2019; 16:378-389. [PMID: 31684769 DOI: 10.1080/15412555.2019.1637834] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Exercise training confers health benefits for people with chronic obstructive pulmonary disease (COPD). This article reviews the evidence for several exercise training modalities shown to be beneficial among individuals with COPD. These modalities include aerobic, resistance, nonlinear periodized, upper limb and balance training, as well as yoga, Tai Chi, inspiratory muscle training, whole body vibration training and neuromuscular electrical stimulation. The literature pertaining to each modality was critically reviewed, and information on the rationale, mechanism(s) of action (where known), benefits, and exercise prescription is described to facilitate easy implementation into clinical practice.
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Affiliation(s)
- Claire M Nolan
- Harefield Respiratory Research Unit, Royal Brompton and Harefield NHS Foundation Trust, UK.,Harefield Pulmonary Rehabilitation Unit, Royal Brompton and Harefield NHS Foundation Trust, UK
| | - Carolyn L Rochester
- Section of Pulmonary, Critical Care and Sleep Medicine, Yale University School of Medicine, New Haven, CT, USA.,VA Connecticut Healthcare System, West Haven, CT, USA
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Xu L, Ye T, Li J, Hu Y, Xu W, Wang K, Ou C, Chen X. Identification of relevant variables and construction of a multidimensional index for predicting mortality in COPD patients. Int J Chron Obstruct Pulmon Dis 2019; 14:1703-1711. [PMID: 31534324 PMCID: PMC6682173 DOI: 10.2147/copd.s215219] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Accepted: 06/25/2019] [Indexed: 11/23/2022] Open
Abstract
Background and objective The Body mass index, airflow Obstruction, Dyspnea, and Exercise (BODE) index is a well-known metric for chronic obstructive pulmonary disease (COPD), but it is inadequate for predicting mortality. This study proposed a new index that combines inspiratory muscle training with the BODE index and verified its ability to predict mortality in patients with COPD. Methods Cox regression identified predictors of mortality, which were then included in the new index. The receiver operating characteristic (ROC) curve verified the ability of the new index to predict mortality. The Kaplan-Meier curves compared the survival rates of patients with different scores on the new index. Results Among the 326 patients, 48 died during follow-up (1–59 months). Cox regression showed that the fat-free mass index (FFMI), forced expiratory volume in one second/the predicted value (FEV1%), modified Medical Research Council (mMRC) score, six-minute–walk test (6MWT) distance, and maximal inspiratory pressure were predictors of mortality (P<0.05); these variables were included in the FODEP index. The AUC of the FODEP index (0.860, 95% CI: 95% CI: 0.817–0.896) was greater than that of the BODE index (0.778, 95% CI: 0.729–0.822). The Kaplan-Meier curves suggested that as the FODEP score increased, so did the risk of morality in patients with COPD. The cumulative survival in the group with the highest FODEP-value was significantly lower than that in the other groups (P<0.01). Conclusion The FODEP index was more effective than the BODE index at predicting the risk of mortality in patients with COPD.
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Affiliation(s)
- Limei Xu
- Department of Pulmonary and Critical Care Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, People's Republic of China
| | - Tiaofei Ye
- Department of Pulmonary and Critical Care Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, People's Republic of China
| | - Jiahui Li
- Department of Pulmonary and Critical Care Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, People's Republic of China
| | - Yuhe Hu
- Department of Pulmonary and Critical Care Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, People's Republic of China
| | - Wenhui Xu
- Department of Pulmonary and Critical Care Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, People's Republic of China
| | - Kai Wang
- Department of Pulmonary and Critical Care Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, People's Republic of China
| | - Chunquan Ou
- State Key Laboratory of Organ Failure Research, Department of Biostatistics, Guangdong Provincial Key Laboratory of Tropical Disease Research, School of Public Health, Southern Medical University, Guangzhou, People's Republic of China
| | - Xin Chen
- Department of Pulmonary and Critical Care Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, People's Republic of China
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Wang J, Guo S, Zeng M, Yu P, Mo W. Observation of the curative effect of device-guided rehabilitation on respiratory function in stable patients with chronic obstructive pulmonary disease. Medicine (Baltimore) 2019; 98:e14034. [PMID: 30813125 PMCID: PMC6408035 DOI: 10.1097/md.0000000000014034] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) is a serious lung disease for individuals in middle age and especially in old people. The study was aimed to observe the curative effect of device-guided rehabilitation on respiratory functions in stable COPD patients. METHODS Sixty-seven stable COPD patients were enrolled and assigned to the experiment group (n = 36) and the control group (n = 31). The conventional pulmonary rehabilitation treatments, including pursed lips breathing (PLB) and abdominal breathing training, were applied in the control group. Respiratory muscle training of the experiment group was performed using the respiratory endurance training device combined with traditional techniques. Both groups were assessed by 6-minute walk test (6MWT), COPD assessment test (CAT), body mass index, airflow obstruction, dyspnea, and exercise capacity (BODE) index. Besides, the pulmonary function (FVC%, FEVl%) were measured at 6 months before and after treatment. RESULTS After treatment, the 6MWT, CAT, BODE index were significantly increased compared with pre-treatment in both groups (P < .01), but not FVC% and FEVl%. Compared with the control group, the combination therapy in the experiment group could significantly improve the 6MWT (P = .0094), CAT (P = .0071) and BODE index (P = .0064) as well as the changes of 6MWT (P < .01), CAT (P < .01), and BODE index (P < .01) before and after treatment. CONCLUSIONS The traditional respiratory training combined with device-guided pulmonary rehabilitation can improve the respiratory muscle function and athletic ability in stable COPD patients.
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Affiliation(s)
- Jing Wang
- Taikang Yanyuan Rehabilitation Hospital, Beijing
| | - Shuai Guo
- Shanghai Key Laboratory of Intelligent Manufacturing and Robotics, Shanghai University, Shanghai
| | - Ming Zeng
- Rehabilitation Center, Jiaxing Second Hospital, The Second Affiliated Hospital of Jiaxing University, Jiaxing, Zhejiang Province
| | - Peng Yu
- Department of Pain Medicine, Kunming LIH Skycity Rehabilitation Hospital, Kunming, Yunnan Province
| | - Weiqiang Mo
- Respiratory Department, Jiaxing Second Hospital, The Second Affiliated Hospital of Jiaxing University, Jiaxing, Zhejiang Province, China
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Reychler G, Liistro G, Piérard GE, Hermanns-Lê T, Manicourt D. Inspiratory muscle strength training improves lung function in patients with the hypermobile Ehlers-Danlos syndrome: A randomized controlled trial. Am J Med Genet A 2018; 179:356-364. [PMID: 30569502 DOI: 10.1002/ajmg.a.61016] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Revised: 11/02/2018] [Accepted: 11/20/2018] [Indexed: 01/31/2023]
Abstract
As exertional inspiratory dyspnea is a common disabling complaint in hypermobile Ehlers-Danlos syndrome (hEDS) often also known as joint hypermobility syndrome (JHS), we investigated inspiratory muscle (IM) strength in patients with hEDS, and we assessed the effects of IM training (IMT) on IM strength, lung function, and exercise capacity. A prospective evaluation of IM strength followed by a randomized controlled trial of IMT was performed in women with hEDS. Sniff nasal inspiratory pressure (SNIP) was used to routinely measure IM strength and IMT was carried out using a pressure threshold device. IM strength (main outcome), cardiopulmonary function, exercise capacity, and emotional distress of both the treated and control groups were evaluated at the start and at the end of the 6-week training period. IM strength was reduced (<80% of predicted) in 77% of patients (80/104). Lung function was normal, although 24% of patients had a higher forced expiratory vital capacity (FVC) than normal and 12% of patients had a higher total lung capacity (TLC) than normal. Both the IMT and control groups (n = 20) had similar baseline characteristics. Significant changes were noted only in the IMT group after IMT. At the end of the program, IMT improved SNIP (20%) (before: 41 ± 17 cm H2 O [28, 53] vs. after: 49 ± 18 cm H2 O [34;65]), six-minute walking distance (6MWD) (60 m) (455 ± 107 m [379,532] vs. 515 ± 127 m [408, 621]), and forced expiratory volume in one second (FEV1) (285 mL) (94 ± 14% pred [84,104] vs. 103 ± 11% pred [94, 112]). IM strength is significantly reduced in patients with hEDS. IMT improved IM strength, lung function, and exercise capacity. Our findings suggest that IMT should be added to usual care.
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Affiliation(s)
- Gregory Reychler
- Institut de Recherche Expérimentale et Clinique (IREC), Pôle de Pneumologie, ORL & Dermatologie, Université Catholique de Louvain, Brussels, Belgium.,Service de Pneumologie, Cliniques universitaires Saint-Luc, Brussels, Belgium.,Service de Médecine Physique et Réadaptation, Cliniques universitaires Saint-Luc, Brussels, Belgium
| | - Giuseppe Liistro
- Institut de Recherche Expérimentale et Clinique (IREC), Pôle de Pneumologie, ORL & Dermatologie, Université Catholique de Louvain, Brussels, Belgium.,Service de Pneumologie, Cliniques universitaires Saint-Luc, Brussels, Belgium
| | - Gérald E Piérard
- Laboratory of Skin Bioengineering and Imaging, Department of Dermatopathology, University of Liège, University Hospital of Liège, Belgium
| | - Trinh Hermanns-Lê
- Laboratory of Skin Bioengineering and Imaging, Department of Dermatopathology, University of Liège, University Hospital of Liège, Belgium
| | - Daniel Manicourt
- Laboratory of Human Molecular Genetics (GEHU), de Duve Institute (DDUV), Université catholique de Louvain (UCLouvain), Belgium.,Department of Rheumatology, University Hospital St Luc, Brussels, Belgium
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27
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Xu W, Li R, Guan L, Wang K, Hu Y, Xu L, Zhou L, Chen R, Chen X. Combination of inspiratory and expiratory muscle training in same respiratory cycle versus different cycles in COPD patients: a randomized trial. Respir Res 2018; 19:225. [PMID: 30458805 PMCID: PMC6245535 DOI: 10.1186/s12931-018-0917-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Accepted: 10/18/2018] [Indexed: 11/24/2022] Open
Abstract
Background Difference between combined inspiratory and expiratory muscle training in same respiratory cycle or different cycles remained unclarified. We explored the difference between both patterns of combined trainings in patients with COPD. Methods In this randomized, open-label, controlled trial, stable COPD subjects trained for 48 minutes daily, for 8 weeks, using a monitoring device for quality control. Ninety-two subjects were randomly and equally assigned for sham training, inspiratory muscle training(IMT), combined inspiratory and expiratory muscle training in same cycle(CTSC) or combined inspiratory and expiratory muscle training in different cycles(CTDC). Respiratory muscle strength, as the primary endpoint, was measured before and after training. Registry: ClinicalTrials.gov (identifier: NCT02326181). Results Respiratory muscle training improved maximal inspiratory pressure(PImax), while no significant difference was found in PImax among IMT, CTSC and CTDC. Maximal expiratory pressure(PEmax) in CTSC and CTDC was greater than IMT(P = 0.026, and P=0.04, respectively) and sham training (P = 0.001). IMT, CTSC, and CTDC shortened inhalation and prolonged exhalation(P < 0.01). Subjects with respiratory muscle weakness in IMT and CTDC exhibited greater increase in PImax than those without. IMT, CTSC and CTDC showed no difference in symptoms and quality of life scales among themselves(P > 0.05). Conclusion Both patterns of CTSC and CTDC improved inspiratory and expiratory muscle strength, while IMT alone only raised PImax. Respiratory muscle training might change the respiratory cycles, and be more beneficial for COPD patients with inspiratory muscle weakness.
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Affiliation(s)
- Wenhui Xu
- Department of Respiratory Medicine, Zhujiang Hosptial, Southern Medical University, 253 Gongye Road, Guangzhou, 510282, China
| | - Rui Li
- Department of Respiratory Medicine, Zhujiang Hosptial, Southern Medical University, 253 Gongye Road, Guangzhou, 510282, China
| | - Lili Guan
- Department of Respiratory Medicine, The State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, First Affiliated Hospital of Guangzhou Medical University, 151 Yanjiang Road, Guangzhou, 510120, China
| | - Kai Wang
- Department of Respiratory Medicine, Zhujiang Hosptial, Southern Medical University, 253 Gongye Road, Guangzhou, 510282, China
| | - Yuhe Hu
- Department of Respiratory Medicine, Zhujiang Hosptial, Southern Medical University, 253 Gongye Road, Guangzhou, 510282, China
| | - Limei Xu
- Department of Respiratory Medicine, Zhujiang Hosptial, Southern Medical University, 253 Gongye Road, Guangzhou, 510282, China
| | - Luqian Zhou
- Department of Respiratory Medicine, The State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, First Affiliated Hospital of Guangzhou Medical University, 151 Yanjiang Road, Guangzhou, 510120, China
| | - Rongchang Chen
- Department of Respiratory Medicine, The State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, First Affiliated Hospital of Guangzhou Medical University, 151 Yanjiang Road, Guangzhou, 510120, China.
| | - Xin Chen
- Department of Respiratory Medicine, Zhujiang Hosptial, Southern Medical University, 253 Gongye Road, Guangzhou, 510282, China.
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Ozalp O, Inal‐Ince D, Cakmak A, Calik‐Kutukcu E, Saglam M, Savci S, Vardar‐Yagli N, Arikan H, Karakaya J, Coplu L. High‐intensity inspiratory muscle training in bronchiectasis: A randomized controlled trial. Respirology 2018; 24:246-253. [DOI: 10.1111/resp.13397] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 07/24/2018] [Accepted: 08/08/2018] [Indexed: 11/27/2022]
Affiliation(s)
- Ozge Ozalp
- Faculty of Health Sciences, Department of Physiotherapy and RehabilitationHacettepe University Ankara Turkey
| | - Deniz Inal‐Ince
- Faculty of Health Sciences, Department of Physiotherapy and RehabilitationHacettepe University Ankara Turkey
| | - Aslihan Cakmak
- Faculty of Health Sciences, Department of Physiotherapy and RehabilitationHacettepe University Ankara Turkey
| | - Ebru Calik‐Kutukcu
- Faculty of Health Sciences, Department of Physiotherapy and RehabilitationHacettepe University Ankara Turkey
| | - Melda Saglam
- Faculty of Health Sciences, Department of Physiotherapy and RehabilitationHacettepe University Ankara Turkey
| | - Sema Savci
- School of Physiotherapy and RehabilitationDokuz Eylül University Izmir Turkey
| | - Naciye Vardar‐Yagli
- Faculty of Health Sciences, Department of Physiotherapy and RehabilitationHacettepe University Ankara Turkey
| | - Hülya Arikan
- Faculty of Health Sciences, Department of Physiotherapy and RehabilitationHacettepe University Ankara Turkey
| | - Jale Karakaya
- Faculty of Medicine, Department of BiostatisticsHacettepe University Ankara Turkey
| | - Lütfi Coplu
- Faculty of Medicine, Department of Chest MedicineHacettepe University Ankara Turkey
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Effects of Resistance Training of Peripheral Muscles Versus Respiratory Muscles in Older Adults With Sarcopenia Who are Institutionalized: A Randomized Controlled Trial. J Aging Phys Act 2018; 26:637-646. [PMID: 29431561 DOI: 10.1123/japa.2017-0268] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
This study compares the effects of two resistance training programs in peripheral and respiratory musculature on muscle mass and strength and physical performance and identifies the appropriate muscle mass parameter for assessing the intervention effects. Thirty-seven institutionalized older Spanish adults with sarcopenia were analyzed: control group (n = 17), respiratory muscle training group (n = 9), and peripheral muscle training group (n = 11). Measured outcomes were appendicular skeletal muscle mass (ASM/height2, ASM/weight, and ASM/BMI), isometric knee extension, arm flexion and handgrip strength, maximal inspiratory and expiratory pressures, and gait speed pre- and postintervention. Trained groups participated in a 12-week program and improved in maximum static inspiratory pressure, maximum static expiratory pressure, knee extension, and arm flexion (p < .05), whereas nonsignificant changes were found in gait speed and ASM indexes pre- and postintervention in the three groups. In conclusion, resistance training improved skeletal muscle strength in the studied population, and any ASM index was found to be appropriate for detecting changes after physical interventions.
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30
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Medeiros AICD, Brandão DC, Souza RJPD, Fuzari HKB, Barros CESR, Barbosa JBN, Leite JC, Cavalcanti FCB, Dornelas de Andrade A, de Melo Marinho PÉ. Effects of daily inspiratory muscle training on respiratory muscle strength and chest wall regional volumes in haemodialysis patients: a randomised clinical trial. Disabil Rehabil 2018; 41:3173-3180. [DOI: 10.1080/09638288.2018.1485181] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
| | | | | | | | | | | | - Jéssica Costa Leite
- Department of Physical Therapy, Universidade Federal de Pernambuco, Recife, Brazil
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31
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Bissett B, Leditschke IA, Green M, Marzano V, Collins S, Van Haren F. Inspiratory muscle training for intensive care patients: A multidisciplinary practical guide for clinicians. Aust Crit Care 2018; 32:249-255. [PMID: 30007823 DOI: 10.1016/j.aucc.2018.06.001] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Revised: 05/29/2018] [Accepted: 06/01/2018] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVES To describe a multidisciplinary approach to inspiratory muscle training (IMT) for patients in the intensive care unit (ICU). BACKGROUND Inspiratory muscle weakness is a known consequence of prolonged mechanical ventilation, and there is emerging evidence that specific IMT can ameliorate this weakness. However, IMT is not yet standard practice in many ICUs, possibly because of the wide variety of methods reported and a lack of published practical guidelines. While the optimal parameters for IMT are yet to be established, we share our detailed methodology which has been shown to be safe in selected ventilator-dependent patients and is the only approach which has been shown to increase quality of life in ICU patients. METHODS Patients who have experienced invasive mechanical ventilation for at least 7 days can commence IMT in either the ventilator-dependent phase or when weaned from mechanical ventilation. Intensity should be prescribed based on maximum inspiratory pressure, which is measurable through the tracheostomy or endotracheal tube via the ventilator or a respiratory pressure meter. Using a removable threshold device, we recommend high-intensity training (5 sets of 6 breaths at a minimum of 50% of maximum inspiratory pressure) performed once per day, supervised by the physiotherapist, with intensity increased daily such that patients can only just complete the 6th breath in each set. RESULTS Using this high-intensity approach, IMT is likely to improve not only inspiratory muscle strength but also quality of life in patients recently weaned from mechanical ventilation of 7 days' duration or longer. Effective IMT requires a multidisciplinary approach to maximise feasibility, with doctors, nurses, and therapists working closely to optimise conditions for successful IMT. CONCLUSIONS This multidisciplinary approach to implement IMT in ICU patients should assist clinicians in translating best-available evidence into practice, with the potential to enhance patient recovery.
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Affiliation(s)
- Bernie Bissett
- Discipline of Physiotherapy, University of Canberra, Canberra Hospital, Canberra, Australia; Physiotherapy Department, Canberra Hospital, Canberra, Australia.
| | - I Anne Leditschke
- Intensive Care Unit, Mater Health, Mater Research Institute, University of Queensland, Brisbane, Australia
| | - Margot Green
- Physiotherapy Department, Canberra Hospital, Canberra, Australia
| | - Vince Marzano
- Physiotherapy Department, Canberra Hospital, Canberra, Australia
| | | | - Frank Van Haren
- Intensive Care Unit, Canberra Hospital, Canberra, Australia; School of Medicine, Australian National University, Canberra, Australia; Faculty of Health, University of Canberra, Canberra, Australia
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The efficiency of inspiratory muscle training in patients with ankylosing spondylitis. Rheumatol Int 2018; 38:1713-1720. [DOI: 10.1007/s00296-018-4093-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Accepted: 06/19/2018] [Indexed: 12/25/2022]
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Balbás-Álvarez L, Candelas-Fernández P, Del Corral T, La Touche R, López-de-Uralde-Villanueva I. Effect of Manual Therapy, Motor Control Exercise, and Inspiratory Muscle Training on Maximum Inspiratory Pressure and Postural Measures in Moderate Smokers: A Randomized Controlled Trial. J Manipulative Physiol Ther 2018; 41:372-382. [DOI: 10.1016/j.jmpt.2017.11.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Accepted: 11/29/2017] [Indexed: 10/28/2022]
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Beaumont M, Forget P, Couturaud F, Reychler G. Effects of inspiratory muscle training in COPD patients: A systematic review and meta-analysis. CLINICAL RESPIRATORY JOURNAL 2018; 12:2178-2188. [DOI: 10.1111/crj.12905] [Citation(s) in RCA: 92] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Revised: 02/13/2018] [Accepted: 04/04/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Marc Beaumont
- Pulmonary Rehabilitation Unit, Morlaix Hospital Centre; European University of Occidental Brittany; Brest France
| | - Patrice Forget
- Department of Anesthesiology and Perioperative Medicine; Universitair Ziekenhuis Brussel; Brussels Belgium
| | - Francis Couturaud
- Department of Internal Medicine and Chest Diseases, EA3878 (G.E.T.B.O.), CIC INSERM 0502; University Hospital of Brest, European University of Occidental Brittany; Brest France
| | - Gregory Reychler
- Institut de Recherche Expérimentale et Clinique (IREC), Pôle de Pneumologie, ORL & Dermatologie; Université Catholique de Louvain; Brussels Belgium
- Service de Pneumologie, Cliniques Universitaires Saint-Luc; Brussels Belgium
- Cliniques Universitaires Saint-Luc, De Médecine Physique Et Réadaptation Service; Brussels Belgium
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Effectiveness of inspiratory muscle training on sleep and functional capacity to exercise in obstructive sleep apnea: a randomized controlled trial. Sleep Breath 2017; 22:631-639. [PMID: 29124630 DOI: 10.1007/s11325-017-1591-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Revised: 10/18/2017] [Accepted: 11/01/2017] [Indexed: 01/07/2023]
Abstract
PURPOSE The aim of this study was to evaluate the effectiveness of inspiratory muscle training (IMT) on sleep and functional capacity to exercise in subjects with obstructive sleep apnea (OSA). METHODS This is a controlled, randomized, double-blind study conducted in 16 OSA patients divided into two groups: training (IMT: n = 8) and placebo-IMT (P-IMT: n = 8). IMT was conducted during 12 weeks with a moderate load (50-60% of maximal inspiratory pressure-MIP), while P-IMT used a load < 20% of MPI. Total daily IMT time for both groups was 30 min, 7 days per week, twice a day. RESULTS There was no difference comparing IMT to P-IMT group after training for lung function (p > 0.05) and respiratory muscle strength (p > 0.05). Maximal oxygen uptake (VO2Max) was not significantly different between IMT and P-IMT group (mean difference - 1.76, confidence interval (CI) - 7.93 to 4.41, p = 0.71). The same was observed for the other ventilatory and cardiometabolic variables measured (p > 0.05). A significant improvement in sleep quality was found when Pittsburgh Sleep Quality Index (PSQI) values of IMT and P-IMT group after training were compared (mean difference: 3.7, confidence interval 95% (CI95%) 0.6 to 6.9, p = 0.02) but no significant changes were seen in daytime sleepiness between both groups after the intervention (mean difference: 3.4, CI 95%: - 3.3 to 10.0; p = 0.29). CONCLUSION According to these results, 12 weeks of moderate load IMT resulted in improved sleep quality, but there were no significant repercussions on functional capacity to exercise or excessive daytime sleepiness.
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Schaper-Magalhães F, Pinho JF, Capuruço CAB, Rodrigues-Machado MG. Positive end-expiratory pressure attenuates hemodynamic effects induced by an overload of inspiratory muscles in patients with COPD. Int J Chron Obstruct Pulmon Dis 2017; 12:2943-2954. [PMID: 29062231 PMCID: PMC5638594 DOI: 10.2147/copd.s138737] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Inspiratory muscle training (IMT) using a Threshold® device is commonly used to improve the strength and endurance of inspiratory muscles. However, the effect of IMT, alone or with positive end-expiratory pressure (PEEP), on hemodynamic parameters in patients with chronic obstructive pulmonary disease (COPD) remains unknown. OBJECTIVE To assess the effects of an overload of inspiratory muscles using IMT fixed at 30% of the maximal inspiratory pressure (MIP), and IMT associated with 5 cmH2O of PEEP (IMT + PEEP), on the echocardiographic parameters in healthy subjects and patients with COPD. METHODS Twenty patients with COPD (forced expiratory volume in 1 second 53.19±24.71 pred%) and 15 age-matched healthy volunteers were evaluated using spirometry, MIP, the COPD assessment test (CAT), and the modified Medical Research Council (mMRC) dyspnea scale. The E- (fast-filling phase) and A- (atrial contraction phase) waves were evaluated at the tricuspid and mitral valves during inspiration and expiration in the following sequence: at basal conditions, using IMT, and using IMT + PEEP. RESULTS Patients with COPD had reduced MIPs versus the control group. Ten patients had CAT scores <10 and 12 patients had mMRC scores <2. E-wave values at the mitral valve were significantly decreased with IMT during the inspiratory phase in both groups. These effects were normalized with IMT + PEEP. During the expiratory phase, use of IMT + PEEP normalized the reduction in E-wave values in the COPD group. During inspiration at the tricuspid valve, reduction in E-wave values during IMT was normalized by IMT + PEEP in COPD group. During the expiratory phase, the value of the E-waves was significantly reduced with overload of the inspiratory muscles in both groups, and these effects were normalized with IMT + PEEP. A-waves did not change under any conditions. CONCLUSION Acute hemodynamic effects induced by overloading of the inspiratory muscles were attenuated and/or reversed by the addition of PEEP in COPD patients.
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Affiliation(s)
- Flavia Schaper-Magalhães
- Medical Sciences Faculty of Minas Gerais, Post-Graduation Program in Health Sciences, Belo Horizonte, Brazil
| | - José Felippe Pinho
- Medical Sciences Faculty of Minas Gerais, Post-Graduation Program in Health Sciences, Belo Horizonte, Brazil
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Wang K, Zeng GQ, Li R, Luo YW, Wang M, Hu YH, Xu WH, Zhou LQ, Chen RC, Chen X. Cycle ergometer and inspiratory muscle training offer modest benefit compared with cycle ergometer alone: a comprehensive assessment in stable COPD patients. Int J Chron Obstruct Pulmon Dis 2017; 12:2655-2668. [PMID: 28919733 PMCID: PMC5593419 DOI: 10.2147/copd.s140093] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Cycle ergometer training (CET) has been shown to improve exercise performance of the quadriceps muscles in patients with COPD, and inspiratory muscle training (IMT) may improve the pressure-generating capacity of the inspiratory muscles. However, the effects of combined CET and IMT remain unclear and there is a lack of comprehensive assessment. MATERIALS AND METHODS Eighty-one patients with COPD were randomly allocated to three groups: 28 received 8 weeks of CET + IMT (combined training group), 27 received 8 weeks of CET alone (CET group), and 26 only received 8 weeks of free walking (control group). Comprehensive assessment including respiratory muscle strength, exercise capacity, pulmonary function, dyspnea, quality of life, emotional status, nutritional status, and body mass index, airflow obstruction, and exercise capacity index were measured before and after the pulmonary rehabilitation program. RESULTS Respiratory muscle strength, exercise capacity, inspiratory capacity, dyspnea, quality of life, depression and anxiety, and nutritional status were all improved in the combined training and CET groups when compared with that in the control group (P<0.05) after pulmonary rehabilitation program. Inspiratory muscle strength increased significantly in the combined training group when compared with that in the CET group (ΔPImax [maximal inspiratory pressure] 5.20±0.89 cmH2O vs 1.32±0.91 cmH2O; P<0.05). However, there were no significant differences in the other indices between the two groups (P>0.05). Patients with weakened respiratory muscles in the combined training group derived no greater benefit than those without respiratory muscle weakness (P>0.05). There were no significant differences in these indices between the patients with malnutrition and normal nutrition after pulmonary rehabilitation program (P>0.05). CONCLUSION Combined training is more effective than CET alone for increasing inspiratory muscle strength. IMT may not be useful when combined with CET in patients with weakened inspiratory muscles. Nutritional status had slight impact on the effects of pulmonary rehabilitation. A comprehensive assessment approach can be more objective to evaluate the effects of combined CET and IMT.
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Affiliation(s)
- Kai Wang
- Department of Respiratory Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Guang-Qiao Zeng
- Department of Respiratory Medicine, The State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Disease, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Rui Li
- Department of Respiratory Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Yu-Wen Luo
- Department of Respiratory Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Mei Wang
- Department of Respiratory Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Yu-He Hu
- Department of Respiratory Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Wen-Hui Xu
- Department of Respiratory Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Lu-Qian Zhou
- Department of Respiratory Medicine, The State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Disease, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Rong-Chang Chen
- Department of Respiratory Medicine, The State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Disease, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Xin Chen
- Department of Respiratory Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, China
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Chuang HY, Chang HY, Fang YY, Guo SE. The effects of threshold inspiratory muscle training in patients with chronic obstructive pulmonary disease: A randomised experimental study. J Clin Nurs 2017; 26:4830-4838. [PMID: 28382660 DOI: 10.1111/jocn.13841] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/17/2017] [Indexed: 11/29/2022]
Abstract
AIMS AND OBJECTIVES To investigate the effects of threshold inspiratory muscle training in patients with stages II through IV chronic obstructive pulmonary disease using maximum inspiratory pressure, baseline dyspnoea index, 6-minute walk test and quality of life. BACKGROUND A threshold inspiratory muscle training device provides pressure for inspiratory muscle strength, but there is limited information on the effects of threshold inspiratory muscle training starting at low pressure training. DESIGN Randomised experimental design. METHODS A total of 55 patients completed this study between September 2013-April 2014. The experimental group (n = 27) was provided medical treatment and routine care, along with five sessions of threshold inspiratory muscle training per week (21-30 min per session), accompanied by a progressive increase in the pressure threshold over a period of 8 weeks. The control group (n = 28) was provided medical treatment and routine care only, without intervention. In the inferential analysis, p values <.05 were considered to indicate statistical significance. RESULTS After 8 weeks in the experimental group, mean maximum inspiratory pressure improved by -17.6 ± 0.18 cmH2 O, mean 6-minute walk test improved by 47.8 ± 1.46 m, and the baseline dyspnoea index increased from 4.48 ± 2.12 points to 9.0 ± 2.27 points. These data and quality of life were statistically different between the experimental and the control groups (p < .05). CONCLUSIONS The threshold inspiratory muscle training can reduce patients' difficulties with respect to daily activities, thereby reducing the burden on the family, and improving prognosis in patients with moderate-to-very severe chronic obstructive pulmonary disease.
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Affiliation(s)
| | - Hsiao-Yun Chang
- Department of Nursing, Fooyin University, Kaohsiung City, Taiwan
| | - Yueh-Yen Fang
- Department of Nursing, Fooyin University, Kaohsiung City, Taiwan
| | - Su-Er Guo
- Graduate Institute of Nursing, College of Nursing, Chang Gung University of Science and Technology (CGUST), Pu-tz, Taiwan.,Chronic Diseases and Health Promotion Research Center, CGUST, Pu-tz, Taiwan
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Chia KSW, Faux SG, Wong PKK, Holloway C, Assareh H, McLachlan CS, Kotlyar E. Randomised controlled trial examining the effect of an outpatient exercise training programme on haemodynamics and cardiac MR parameters of right ventricular function in patients with pulmonary arterial hypertension: the ExPAH study protocol. BMJ Open 2017; 7:e014037. [PMID: 28167746 PMCID: PMC5293990 DOI: 10.1136/bmjopen-2016-014037] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
INTRODUCTION Pulmonary hypertension (PH) is a potentially life-threatening condition characterised by elevated pulmonary artery pressure. Early stage PH patients are often asymptomatic. Disease progression is associated with impairment of right ventricular function and progressive dyspnoea. Current guidelines recommend exercise training (grade IIa, level B). However, many questions remain regarding the mechanisms of improvement, intensity of supervision and optimal frequency, duration and intensity of exercise. This study will assess the effect of an outpatient rehabilitation programme on haemodynamics and cardiac right ventricular function in patients with pulmonary arterial hypertension (PAH), a subgroup of PH. METHODS AND ANALYSIS This randomised controlled trial involves both a major urban tertiary and smaller regional hospital in New South Wales, Australia. The intervention will compare an outpatient rehabilitation programme with a control group (home exercise programme). Participants will be stable on oral PAH-specific therapy. The primary outcome measure will be right ventricular ejection fraction measured by cardiac MRI. Secondary outcomes will include haemodynamics measured by right heart catheterisation, endurance, functional capacity, health-related quality of life questionnaires and biomarkers of cardiac function and inflammation. ETHICS APPROVAL AND DISSEMINATION Ethical approval has been granted by St Vincent's Hospital, Sydney (HREC/14/SVH/341). Results of this study will be disseminated through presentation at scientific conferences and in scientific journals. TRIAL REGISTRATION NUMBER ACTRN12615001041549; pre-results.
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Affiliation(s)
- Karen S W Chia
- University of New South Wales Rural Clinical School, Coffs Harbour, New South Wales, Australia
- Coffs Harbour Health Campus, Coffs Harbour, New South Wales, Australia
| | - Steven G Faux
- Sacred Heart Rehabilitation, St Vincent's Health, Coffs Harbour, New South Wales, Australia
- University of New South Wales, Coffs Harbour, New South Wales, Australia
- St Vincent's Hospital Sydney, Coffs Harbour, New South Wales, Australia
| | - Peter K K Wong
- University of New South Wales Rural Clinical School, Coffs Harbour, New South Wales, Australia
- Coffs Harbour Health Campus, Coffs Harbour, New South Wales, Australia
- Mid-North Coast Arthritis Clinic, Coffs Harbour, New South Wales, Australia
| | - Cameron Holloway
- University of New South Wales, Coffs Harbour, New South Wales, Australia
- St Vincent's Hospital Sydney, Coffs Harbour, New South Wales, Australia
| | - Hassan Assareh
- University of New South Wales Rural Clinical School, Coffs Harbour, New South Wales, Australia
- Epidemiology and Health Analytics Department, Western Sydney Local Health District, Coffs Harbour, New South Wales, Australia
| | - Craig S McLachlan
- University of New South Wales Rural Clinical School, Coffs Harbour, New South Wales, Australia
| | - Eugene Kotlyar
- University of New South Wales, Coffs Harbour, New South Wales, Australia
- St Vincent's Hospital Sydney, Coffs Harbour, New South Wales, Australia
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Place du kinésithérapeute dans le traitement de la dyspnée. MEDECINE INTENSIVE REANIMATION 2016. [DOI: 10.1007/s13546-016-1247-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Volpe MS, Aleixo AA, Almeida PRMND. Influence of inspiratory muscle training on weaning patients from mechanical ventilation: a systematic review. FISIOTERAPIA EM MOVIMENTO 2016. [DOI: 10.1590/0103-5150.029.001.ar02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Abstract Introduction: The inability of respiratory muscles to generate force and endurance is recognized as an important cause of failure in weaning patients from invasive mechanical ventilation (IMV). Thus, inspiratory muscle training (IMT) might be an interesting treatment option for patients with prolonged IMV weaning. Objective: The aim of this systematic literature review was to evaluate the effectiveness of inspiratory muscle training in weaning patients from mechanical ventilation and to identify the most effective type of training for this particular purpose. Methods: We searched PubMed, LILACS, PEDro and Web of Science for randomized clinical trials published in English or Portuguese from January 1990 until March 2015. Results: Eighty-nine studies were identified of which five were selected. A total of 267 patients participated in the five randomized clinical trials analyzed here. IMV duration before onset of training varied greatly among subjects. Three studies performed IMT using a threshold device and two studies used adjustments of ventilator pressure sensitivity. Four studies have shown that IMT resulted in a significant increase in inspiratory maximal pressure. Only two studies, however, have reported that IMT resulted in higher success rates in weaning patients from IMV. One study has found that patients showed a shorter ventilator weaning duration after IMT. Conclusion: IMT using pressure threshold devices results in increased inspiratory muscle strength and can therefore be considered a more effective treatment option and with the potential to optimize ventilator weaning success in patients at risk of prolonged IMV.
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Bavarsad MB, Shariati A, Eidani E, Latifi M. The effect of home-based inspiratory muscle training on exercise capacity, exertional dyspnea and pulmonary function in COPD patients. IRANIAN JOURNAL OF NURSING AND MIDWIFERY RESEARCH 2015; 20:613-8. [PMID: 26457101 PMCID: PMC4598910 DOI: 10.4103/1735-9066.164588] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Background: Chronic obstructive pulmonary disease (COPD) is currently the fourth cause of mortality worldwide. Patients with COPD experience periods of dyspnea, fatigue, and disability, which impact on their life. The objective of this study was to investigate the effect of short-term inspiratory muscle training on exercise capacity, exertional dyspnea, and pulmonary lung function. Materials and Methods: A randomized, controlled trial was performed. Thirty patients (27 males, 3 females) with mild to very severe COPD were randomly assigned to a training group (group T) or to a control group (group C). Patients in group T received training for 8 weeks (15 min/day for 6 days/week) with flow-volumetric inspiratory exerciser named (Respivol). Each patient was assessed before and after 8 weeks of training for the following clinical parameters: exercise capacity by 6-min walking test (6MWT), exertional dyspnea by Borg scale, and pulmonary lung function by spirometry. Patients used training together with medical treatment. The data were analyzed using paired t-test and independent t-test. Results: Results showed statistically significant increase in 6MWT at the end of the training from 445.6 ± 22.99 to 491.06 ± 17.67 meters? (P < 0.001) and statistically significant decrease in dyspnea from 3.76 ± 0.64 to 1.13 ± 0.36 (P = 0.0001) in the training group but not in the control group. The values for exercise capacity and dyspnea improved after 8 weeks in group T in comparison with group C (P = 0.001 and P = 0.0001, respectively). No changes were observed in any measure of pulmonary function in both groups. Conclusions: Short-term inspiratory muscle training has beneficial effects on exercise capacity and exertional dyspnea in COPD patients.
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Affiliation(s)
- Maryam Bakhshandeh Bavarsad
- Department of Nursing, School of Nursing and Midwifery, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Abdolali Shariati
- Department of Nursing, School of Nursing and Midwifery, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Esmaeil Eidani
- Pulmonary Unit, Department of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Mahmud Latifi
- Department of Statistics, School of Public Health, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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Bonnevie T, Villiot-Danger JC, Gravier FE, Dupuis J, Prieur G, Médrinal C. Inspiratory muscle training is used in some intensive care units, but many training methods have uncertain efficacy: a survey of French physiotherapists. J Physiother 2015; 61:204-9. [PMID: 26365266 DOI: 10.1016/j.jphys.2015.08.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Revised: 05/29/2015] [Accepted: 08/11/2015] [Indexed: 12/15/2022] Open
Abstract
QUESTIONS How common is inspiratory muscle training by physiotherapists in the intensive care unit (ICU)? Which patients receive the training? What methods are used to administer the training? Is maximal inspiratory pressure used to evaluate the need for the training and the patient's outcome after training? DESIGN Cross-sectional survey of all ICUs in France. PARTICIPANTS Two hundred and sixty-five senior physiotherapists. RESULTS The response rate was 99% among eligible units. Therapist experience in ICU was significantly associated with the use of inspiratory muscle training (p=0.02). Therapists mainly used inspiratory muscle training either systematically or specifically in patients who failed to wean from mechanical ventilation. The training was used significantly more in non-sedated patients (p<0.0001). The most commonly nominated technique that respondents claimed to use to apply the training was controlled diaphragmatic breathing (83% of respondents), whereas 13% used evidence-based methods. Among those who applied some form of inspiratory muscle training, 16% assessed maximal inspiratory pressure. Six respondents (2%, 95% CI 1 to 5) used both an evidence-based method to administer inspiratory muscle training and the recommended technique for assessment of inspiratory muscle strength. CONCLUSION Most physiotherapists in French ICUs who apply inspiratory muscle training use methods of uncertain efficacy without assessment of maximal inspiratory pressure. Further efforts need to be made in France to disseminate information regarding evidence-based assessment and techniques for inspiratory muscle training in the ICU. The alignment of inspiratory muscle training practice with evidence could be investigated in other regions.
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Affiliation(s)
- Tristan Bonnevie
- ADIR Association, Bois-Guillaume; Service de réanimation chirurgicale; Université de Picardie Jules Verne, Amiens
| | | | - Francis-Edouard Gravier
- ADIR Association, Bois-Guillaume; Service réanimation médicale, CHU-Hôpitaux de Rouen, Rouen
| | | | - Guillame Prieur
- Université de Picardie Jules Verne, Amiens; Service de réanimation médico-chirurgicale, Groupe hospitalier du Havre, Montivilliers, France
| | - Clément Médrinal
- Université de Picardie Jules Verne, Amiens; Service de réanimation médico-chirurgicale, Groupe hospitalier du Havre, Montivilliers, France
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Mukharlyamov FY, Sycheva MG, Rassulova MA. [The application of cardiorespiratory training in the framework of the comprehensive programs for the medical rehabilitation of the patients presenting with chronic obstructive pulmonary disease]. VOPROSY KURORTOLOGII, FIZIOTERAPII, I LECHEBNOĬ FIZICHESKOĬ KULTURY 2015; 92:52-61. [PMID: 26036089 DOI: 10.17116/kurort2015252-61] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This article is concerned with the modern concepts of chronic obstructive pulmonary disease. Also, it presents the international definition of "pulmonary rehabilitation". Especially much attention is given to the physical rehabilitation as one of the main and fundamental components of medical rehabilitation of the patients presenting with chronic obstructive pulmonary disease. The up-to-date approaches to the application of fitness gymnastics for the purpose of scientific research and clinical practice are considered with special reference to the combination of cyclic, static, and dynamic loads with the use of relevant modern equipment. The data on the effectiveness and safety of these rehabilitative technologies are discussed in the context of their application for further research in the field of rehabilitative medicine. Recommendations are proposed on the implementation of these methods in the current practical work.
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Affiliation(s)
- F Yu Mukharlyamov
- GBUZ 'Moskovskij nauchno-prakticheskij tsentr meditsinskoj reabilitatsii, vosstanovitel'noj i sportivnoj meditsiny' Departamenta zdravoohranenija Moskvy, ul. Zemljanoj val, 53, Moskva, Rossijskaja Federatsija, 105120
| | - M G Sycheva
- GBUZ 'Moskovskij nauchno-prakticheskij tsentr meditsinskoj reabilitatsii, vosstanovitel'noj i sportivnoj meditsiny' Departamenta zdravoohranenija Moskvy, ul. Zemljanoj val, 53, Moskva, Rossijskaja Federatsija, 105120
| | - M A Rassulova
- GBUZ 'Moskovskij nauchno-prakticheskij tsentr meditsinskoj reabilitatsii, vosstanovitel'noj i sportivnoj meditsiny' Departamenta zdravoohranenija Moskvy, ul. Zemljanoj val, 53, Moskva, Rossijskaja Federatsija, 105120
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Nakai H, Tsujimoto K, Fuchigami T, Ohmatsu S, Osumi M, Nakano H, Fukui M, Morioka S. Effect of anticipation triggered by a prior dyspnea experience on brain activity. J Phys Ther Sci 2015; 27:635-9. [PMID: 25931697 PMCID: PMC4395681 DOI: 10.1589/jpts.27.635] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Accepted: 10/07/2014] [Indexed: 11/29/2022] Open
Abstract
[Purpose] Oxygenated hemoglobin (oxy-Hb) concentrations in the prefrontal cortex are
closely associated with dyspnea. Dyspnea is influenced not only by physical activity, but
also by visual stimuli, and several studies suggest that oxy-Hb concentrations change in
response to certain external stimuli. However, the effects of internal psychological
states on dyspnea have not been reported. This study explored the influence of
anticipation triggered by previous episodes of dyspnea on brain activity. [Subjects] The
subjects were 15 healthy volunteers with a mean age of 25.0 ± 3.0 years. [Methods] The
subjects were shown a variety of photographs and instructed to expect breathing resistance
matched to the affective nature of the particular photograph. After viewing the images,
varying intensities of breathing resistance that were identical to, easier than, or harder
than those shown in the images were randomly administered to the subjects; in fact, the
image and resistance were identical 33% of the time and discordant 66% of the time.
[Results] The concentrations of oxy-Hb in the right medial prefrontal cortex (rMPFC)
increased significantly with an inspiratory pressure that was 30% of the maximum intensity
in the subjects shown a pleasant image compared to the concentrations in subjects shown an
unpleasant image. Moreover, rMPFC activity was significantly correlated with the magnitude
of the dyspnea experienced. [Conclusion] These results suggest that a correlation exists
between increased oxy-Hb in the rMPFC and the effects of expectations on dyspnea.
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Affiliation(s)
- Hideki Nakai
- Department of Rehabilitation, Higashi Osaka Hospital, Japan
| | | | | | - Satoko Ohmatsu
- Department of Neurorehabilitation, Graduate School of Health Science, Kio University, Japan
| | - Michihiro Osumi
- Department of Neurorehabilitation, Graduate School of Health Science, Kio University, Japan
| | - Hideki Nakano
- Department of Neurorehabilitation, Graduate School of Health Science, Kio University, Japan
| | - Manami Fukui
- Department of Rehabilitation Medicine, Higashi Osaka Hospital, Japan
| | - Shu Morioka
- Department of Neurorehabilitation, Graduate School of Health Science, Kio University, Japan
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Nikoletou D, Man WDC, Mustfa N, Moore J, Rafferty G, Grant RL, Johnson L, Moxham J. Evaluation of the effectiveness of a home-based inspiratory muscle training programme in patients with chronic obstructive pulmonary disease using multiple inspiratory muscle tests. Disabil Rehabil 2015; 38:250-9. [PMID: 25885668 DOI: 10.3109/09638288.2015.1036171] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To evaluate the effectiveness of a home-based inspiratory muscle training (IMT) programme using multiple inspiratory muscle tests. METHOD Sixty-eight patients (37 M) with moderate to severe chronic obstructive pulmonary disease (COPD) (Mean [SD], FEV1 36.1 [13.6]% pred.; FEV1/FVC 35.7 [11.2]%) were randomised into an experimental or control group and trained with a threshold loading device at intensity >30% maximum inspiratory pressure (PImax) or <15% PImax, respectively, for 7 weeks. Thirty-nine patients (23 M) completed the study. The following measures were assessed pre- and post-IMT: PImax, sniff inspiratory nasal pressure (SNIP), diaphragm contractility (Pdi,tw), incremental shuttle walk test (ISWT), respiratory muscle endurance (RME), chronic respiratory disease questionnaire (CRDQ), the hospital anxiety and depression scale (HADS) and the SF-36. Between-group changes were assessed using one-way analysis of variance (ANOVA). RESULTS PImax and perception of well-being improved significantly post-IMT [p = 0.04 and <0.05 in four domains, respectively]. This was not reflected in SNIP [p = 0.7], Pdi,tw [p = 0.8], RME [p = 0.9] or ISWT [p = 0.5]. CONCLUSIONS A seven-week, community-based IMT programme, with realistic use of health-care resources, improves PImax and perception of well-being but a different design may be required for improvement in other measures. Multiple tests provide a more comprehensive evaluation of changes in muscle function post-IMT. IMPLICATIONS FOR REHABILITATION A seven-week, home-based inspiratory muscle training programme improves maximal inspiratory pressure and perception of well-being in patients with moderate to severe COPD but not sniff nasal inspiratory pressure or diaphragm contractility, respiratory muscle endurance and exercise capacity. Multiple tests are recommended for a more comprehensive assessment of changes in muscle function following inspiratory muscle training programmes. Therapists need to explore different community-based inspiratory muscle training regimes for COPD patients and identify the optimal exercise protocol that is likely to lead to improvements in diaphragm contractility and exercise capacity.
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Affiliation(s)
- Dimitra Nikoletou
- a Division of Asthma , Allergy and Lung Biology, King's College London , London , UK .,b Faculty of Health , Social Care and Education, Kingston and St. George's University , London , UK
| | - William D-C Man
- a Division of Asthma , Allergy and Lung Biology, King's College London , London , UK .,c NIHR Biomedical Research Unit for Advanced Lung Disease, Royal Brompton & Harefield NHS Foundation Trust and Imperial College London , London , UK
| | - Naveed Mustfa
- a Division of Asthma , Allergy and Lung Biology, King's College London , London , UK .,d Department of Respiratory Medicine , University Hospital of North Staffordshire NHS Trust , London , UK , and
| | - Julie Moore
- e King's College Hospital NHS Trust , London , UK
| | - Gerrard Rafferty
- a Division of Asthma , Allergy and Lung Biology, King's College London , London , UK
| | - Robert L Grant
- b Faculty of Health , Social Care and Education, Kingston and St. George's University , London , UK
| | - Lorna Johnson
- a Division of Asthma , Allergy and Lung Biology, King's College London , London , UK
| | - John Moxham
- a Division of Asthma , Allergy and Lung Biology, King's College London , London , UK
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Reyes A, Cruickshank T, Nosaka K, Ziman M. Respiratory muscle training on pulmonary and swallowing function in patients with Huntington's disease: a pilot randomised controlled trial. Clin Rehabil 2014; 29:961-73. [PMID: 25552526 DOI: 10.1177/0269215514564087] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2014] [Accepted: 11/22/2014] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To examine the effects of 4-month of respiratory muscle training on pulmonary and swallowing function, exercise capacity and dyspnoea in manifest patients with Huntington's disease. DESIGN A pilot randomised controlled trial. SETTING Home based training program. PARTICIPANTS Eighteen manifest Huntington's disease patients with a positive genetic test and clinically verified disease expression, were randomly assigned to control group (n=9) and training group (n=9). INTERVENTION Both groups received home-based inspiratory (5 sets of 5 repetitions) and expiratory (5 sets of 5 repetitions) muscle training 6 times a week for 4 months. The control group used a fixed resistance of 9 centimeters of water, and the training group used a progressively increased resistance from 30% to 75% of each patient's maximum respiratory pressure. MAIN MEASURES Spirometric indices, maximum inspiratory pressure, maximum expiratory pressure, six minutes walk test, dyspnoea, water-swallowing test and swallow quality of life questionnaire were assessed before, at 2 and 4 months after training. RESULTS The magnitude of increases in maximum inspiratory (d=2.9) and expiratory pressures (d=1.5), forced vital capacity (d=0.8), forced expiratory volume in 1 second (d=0.9) and peak expiratory flow (d=0.8) was substantially greater for the training group in comparison to the control group. Changes in swallowing function, dyspnoea and exercise capacity were small (d ≤ 0.5) for both groups without substantial differences between groups. CONCLUSIONS A home-based respiratory muscle training program appeared to be beneficial to improve pulmonary function in manifest Huntington's disease patients but provided small effects on swallowing function, dyspnoea and exercise capacity.
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Affiliation(s)
- Alvaro Reyes
- School of Medical Sciences, Edith Cowan University, Joondalup, WA, Australia
| | - Travis Cruickshank
- School of Medical Sciences, Edith Cowan University, Joondalup, WA, Australia
| | - Kazunori Nosaka
- School of Exercise and Health Sciences, Centre for Exercise and Sports Science Research, Edith Cowan University, Joondalup, WA, Australia
| | - Mel Ziman
- School of Medical Sciences, Edith Cowan University, Joondalup, WA, Australia School of Pathology and Laboratory Medicine, University of Western Australia, Crawley, WA, Australia
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Cebrià I Iranzo MDÀ, Tortosa-Chuliá MÁ, Igual-Camacho C, Sancho P, Galiana L, Tomás JM. [Cost-consequence analysis of respiratory preventive intervention among institutionalized older people: randomized controlled trial]. Rev Esp Geriatr Gerontol 2014; 49:203-209. [PMID: 24417971 DOI: 10.1016/j.regg.2013.11.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2013] [Revised: 11/13/2013] [Accepted: 11/19/2013] [Indexed: 06/03/2023]
Abstract
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.
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Affiliation(s)
- Maria Dels Àngels Cebrià I Iranzo
- Departament de Fisioteràpia, Universitat de València, Valencia, España; Servicio de Rehabilitación, Hospital Universitari i Politècnic La Fe, Valencia, España.
| | | | - Celedonia Igual-Camacho
- Departament de Fisioteràpia, Universitat de València, Valencia, España; Servicio de Rehabilitación, Hospital Clínic Universitari, Valencia, España
| | - Patricia Sancho
- Departament de Metodologia de les Ciències del Comportament, Universitat de València, Valencia, España
| | - Laura Galiana
- Departament de Metodologia de les Ciències del Comportament, Universitat de València, Valencia, España
| | - José Manuel Tomás
- Departament de Metodologia de les Ciències del Comportament, Universitat de València, Valencia, España
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Cebrià i Iranzo MDÀ, Arnall DA, Camacho CI, Tomás JM. Effects of Inspiratory Muscle Training and Yoga Breathing Exercises on Respiratory Muscle Function in Institutionalized Frail Older Adults. J Geriatr Phys Ther 2014; 37:65-75. [DOI: 10.1519/jpt.0b013e31829938bb] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Corhay JL, Dang DN, Van Cauwenberge H, Louis R. Pulmonary rehabilitation and COPD: providing patients a good environment for optimizing therapy. Int J Chron Obstruct Pulmon Dis 2013; 9:27-39. [PMID: 24368884 PMCID: PMC3869834 DOI: 10.2147/copd.s52012] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is an obstructive and progressive airway disease associated with an important reduction in daily physical activity and psychological problems that contribute to the patient's disability and poor health-related quality of life (HRQoL). Nowadays, pulmonary rehabilitation (PR) plays an essential role in the management of symptomatic patients with COPD, by breaking the vicious circle of dyspnea-decreased activity-deconditioning-isolation. Indeed the main benefits of comprehensive PR programs for patients with COPD include a decrease in symptoms (dyspnea and fatigue), improvements in exercise tolerance and HRQoL, reduction of health care utilization (particularly bed-days), as well as an increase in physical activity. Several randomized studies and meta-analyses greatly established the benefits of PR, which additionally, is recommended in a number of influential guidelines. This review aimed to highlight the impact of PR on COPD patients, focusing on the clinical usefulness of PR, which provides patients a good support for change.
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Affiliation(s)
- Jean-Louis Corhay
- Department of Pneumology, Centre Hospitalier Universitaire du Sart-Tilman Liège, Liège, Belgium
| | - Delphine Nguyen Dang
- Department of Pneumology, Centre Hospitalier Universitaire du Sart-Tilman Liège, Liège, Belgium
| | - Hélène Van Cauwenberge
- Department of Pneumology, Centre Hospitalier Universitaire du Sart-Tilman Liège, Liège, Belgium
| | - Renaud Louis
- Department of Pneumology, Centre Hospitalier Universitaire du Sart-Tilman Liège, Liège, Belgium
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