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Zacarias Rondinel T, Bocchi L, Cipriano Júnior G, Chiappa GRDS, Martins GDS, Mateus SRM, Cahalin LP, Cipriano GFB. Diaphragm thickness and mobility elicited by two different modalities of inspiratory muscle loading in heart failure participants: A randomized crossover study. PLoS One 2024; 19:e0302735. [PMID: 38787839 PMCID: PMC11125520 DOI: 10.1371/journal.pone.0302735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 04/02/2024] [Indexed: 05/26/2024] Open
Abstract
OBJECTIVES To analyze diaphragmatic thickness, at end-inspiration and end-expiration, diaphragmatic thickening index and mobility via US under two different modalities of inspiratory muscle loading, in two different modalities of inspiratory muscle loading and different load intensities at full-vital capacity maneuvers and the relationship between diaphragmatic thickness with pulmonary function tests in participants with HF. METHODS This randomized crossover trial, enrolled with 17 HF subjects, evaluated diaphragm thickness (Tdi, mm), fractional thickness (TFdi, %), and mobility (mm) US during low and high intensities (30% and 60% of maximal inspiratory pressure-MIP) with two modalities of inspiratory muscle loading mechanical threshold loading (MTL) and tapered flow-resistive loading (TFRL). RESULTS Both MTL and TFRL produced a increase in Tdi, but only with high intensity loading compared to baseline-2.21 (0.26) vs. 2.68 (0.33) and 2.73 (0.44) mm; p = .01. TFdi was greater than baseline under all conditions, except during low intensity of TFRL. Diaphragm mobility was greater than baseline under all conditions, and high intensity of TFRL elicited greater mobility compared to all other conditions. Additionally, baseline Tdi was moderately correlated with pulmonary function tests. CONCLUSIONS MTL and TFRL modalities elicit similar increases in diaphragm thickness at loads, but only during high intensity loading it was greater than baseline. Diaphragm mobility was significantly greater than baseline under both loads and devices, and at high intensity compared to low intensity, although TFRL produced greater mobility compared to modalities of inspiratory muscle loading. There is an association between diaphragm thickness and pulmonary function tests.
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Affiliation(s)
- Tatiana Zacarias Rondinel
- Science and Technology in Health Program, University of Brasília, Brasília, Distrito Federal, Brazil
| | - Lilian Bocchi
- Physical Therapy Department, Science of Rehabilitation Program, University of Brasília, Brasília, Distrito Federal, Brazil
| | - Gerson Cipriano Júnior
- Physical Therapy Department, Science of Rehabilitation Program, University of Brasília, Brasília, Distrito Federal, Brazil
| | | | - Gabriela de Sousa Martins
- Physical Therapy Department, Science of Rehabilitation Program, University of Brasília, Brasília, Distrito Federal, Brazil
| | | | - Lawrence Patrick Cahalin
- Department of Physical Therapy, Leonard M. Miller School of Medicine, University of Miami, Coral Gables, Florida, United States of America
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Patel L, Dhruve R, Keshvani N, Pandey A. Role of exercise therapy and cardiac rehabilitation in heart failure. Prog Cardiovasc Dis 2024; 82:26-33. [PMID: 38199321 DOI: 10.1016/j.pcad.2024.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Accepted: 01/07/2024] [Indexed: 01/12/2024]
Abstract
Heart failure (HF) is a common cause of hospitalization and death, and the hallmark symptoms of HF, including dyspnea, fatigue, and exercise intolerance, contribute to poor patient quality of life (QoL). Cardiac rehabilitation (CR) is a comprehensive disease management program incorporating exercise training, cardiovascular risk factor management, and psychosocial support. CR has been demonstrated to effectively improve patient functional status and QoL among patients with HF. However, CR participation among patients with HF is poor. This review details the mechanisms of dyspnea and exercise intolerance among patients with HF, the physiologic and clinical improvements observed with CR, and the key components of a CR program for patients with HF. Furthermore, unmet needs and future strategies to improve patient participation and engagement in CR for HF are reviewed.
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Affiliation(s)
- Lajjaben Patel
- Division of Cardiology, Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX, USA
| | - Ritika Dhruve
- Division of Cardiology, Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX, USA
| | - Neil Keshvani
- Division of Cardiology, Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX, USA
| | - Ambarish Pandey
- Division of Cardiology, Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX, USA.
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Bortsova MA, Demchenko EA, Fedotov PA, Ganenko OS, Osipova MA, Korneva LO, Musaeva BB, Sazonova YV, Simonenko MA, Sitnikova MY. Tolerability of an Individualized Physical Rehabilitation Program in Patients Dependent on Inotropic Support With End-Stage Chronic Heart Failure. KARDIOLOGIIA 2023; 63:36-45. [PMID: 38088111 DOI: 10.18087/cardio.2023.11.n2528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 07/31/2023] [Indexed: 12/18/2023]
Abstract
Aim To assess the tolerability of an individualized physical rehabilitation program (PRP) in inotrope-dependent patients with end-stage chronic heart failure (CHF).Material and methods This prospective randomized study included 120 men aged 18-65 years with left ventricular ejection fraction ≤30 % and blood pressure ≥90 / 60 mm Hg. Patients who have received dobutamine or dopamine for ≥2 weeks were randomized into two groups: group 1, 40 patients who participated in the PRP and group 2, 40 patients who did not participate in the PRP. Group 3 included 40 patients without inotropic support who participated in the PRP.Results Patients of groups 1 and 3 attended >80 % of the scheduled classes without developing life-threatening adverse events (AEs) associated with exercise (E). After 6 months of the study, the exercising patients achieved a comparable (average) E intensity: 44 [35; 50]% and 45 [40;52]% of heart rate reserve and Borg scale scores 14 [12; 14] and 13 [11; 14] in groups 1 and 3, respectively (p>0.05). Initially, after 3 and 6 months at the peak of physical activity in groups 1 and 3, there was no decrease in arterial blood oxygen saturation according to pulse oximetry (SpO2) <93 %. At baseline, lactate levels in central venous blood at rest were normal in all groups. After 6 months, the lactate concentration was 1.1 mmol / l in group 1, 2.3 mmol / l in group 2, and 1.4 mmol / l in group 3 (р1-2=0.005; p2-3=0.008, respectively). At the E peak at baseline, after 3 and 6 months, comparable increases in lactate not exceeding 3 mmol / l were detected in groups 1 and 3.Conclusion The study allowed assessment of the tolerability of individualized PRP performed at the aerobic level of energy supply, in inotropic-dependent patients with CHF. Individualized 6-month PRP in inotropic-dependent patients with end-stage CHF, provided safety criteria are met, is well tolerated and does not increase the number of AEs associated with CHF and physical rehabilitation (PR). Continued inotropic support with dopamine or dobutamine should not be considered as a contraindication to PR in patients with CHF in the absence of E intolerance or life-threatening AEs.
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Affiliation(s)
- M A Bortsova
- Almazov National Medical Research Center, St-Petersburg
| | - E A Demchenko
- Almazov National Medical Research Center, St-Petersburg
| | - P A Fedotov
- Almazov National Medical Research Center, St-Petersburg
| | - O S Ganenko
- Almazov National Medical Research Center, St-Petersburg
| | - M A Osipova
- Almazov National Medical Research Center, St-Petersburg
| | - L O Korneva
- Almazov National Medical Research Center, St-Petersburg
| | - B B Musaeva
- Almazov National Medical Research Center, St-Petersburg
| | - Yu V Sazonova
- Almazov National Medical Research Center, St-Petersburg
| | - M A Simonenko
- Almazov National Medical Research Center, St-Petersburg
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van Kleef ES, Langer D, van Engelen BG, Ottenheijm CA, Voermans NC, Doorduin J. Inspiratory Muscle Training in Nemaline Myopathy. J Neuromuscul Dis 2023; 10:825-834. [PMID: 37458044 PMCID: PMC10578271 DOI: 10.3233/jnd-221665] [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] [Accepted: 06/20/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND Respiratory muscle weakness is a common feature in nemaline myopathy. Inspiratory muscle training (IMT) is an intervention that aims to improve inspiratory muscle strength. OBJECTIVE The aim of this controlled before-and-after pilot study was to investigate if IMT improves respiratory muscle strength in patients with nemaline myopathy. METHODS Nine patients (7 females; 2 males, age 36.6±20.5 years) with respiratory muscle weakness and different clinical phenotypes and genotypes were included. Patients performed eight weeks of sham IMT followed by eight weeks of active threshold IMT. The patients trained twice a day five days a week for 15 minutes at home. The intensity was constant during the training after a gradual increase to 30% of maximal inspiratory pressure (MIP). RESULTS Active IMT significantly improved MIP from 43±15.9 to 47±16.6 cmH2O (p = 0.019). The effect size was 1.22. There was no significant effect of sham IMT. Sniff nasal inspiratory pressure, maximal expiratory pressure, spirometry, and diaphragm thickness and thickening showed no significant improvements. CONCLUSIONS This pilot study shows that threshold IMT is feasible in patients with nemaline myopathy and improves inspiratory muscle strength. Our findings provide valuable preliminary data for the design of a larger, more comprehensive trial.
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Affiliation(s)
- Esmee S.B. van Kleef
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Daniel Langer
- Faculty of Movement and Rehabilitation Sciences, Department of Rehabilitation Sciences, Research Group for Cardiovascular and Respiratory Rehabilitation, KU Leuven - University of Leuven, Leuven, Belgium
- Respiratory Rehabilitation and Respiratory Division, University Hospitals Leuven, Leuven, Belgium
| | - Baziel G.M. van Engelen
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Coen A.C. Ottenheijm
- Department of Physiology, Amsterdam UMC (location VUmc), Amsterdam, The Netherlands
| | - Nicol C. Voermans
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jonne Doorduin
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
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Manchado-Gobatto FB, Torres RS, Marostegan AB, Rasteiro FM, Hartz CS, Moreno MA, Pinto AS, Gobatto CA. Complex Network Model Reveals the Impact of Inspiratory Muscle Pre-Activation on Interactions among Physiological Responses and Muscle Oxygenation during Running and Passive Recovery. BIOLOGY 2022; 11:biology11070963. [PMID: 36101345 PMCID: PMC9311794 DOI: 10.3390/biology11070963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 06/11/2022] [Accepted: 06/14/2022] [Indexed: 12/05/2022]
Abstract
Simple Summary Different warm-ups can be used to improve physical and sports performance. Among these strategies, we can include the pre-activation of the inspiratory muscles. Our study aimed to investigate this pre-activation model in high-intensity running performance and recovery using an integrative computational analysis called a complex network. The participants in this study underwent four sessions. The first and second sessions were performed to explain the procedures, characterize them and determine the individualized pre-activation intensity (40% of the maximum inspiratory pressure). Subsequently, on different days, the subjects were submitted to high-intensity tethered runs on a non-motorized treadmill with monitoring of the physiological responses during and after this effort. To understand the impacts of the pre-activation of inspiratory muscles on the organism, we studied the centrality metrics obtained by complex networks, which help in the interpretation of data in a more integrated way. Our results revealed that the graphs generated by this analysis were altered when inspiratory muscle pre-activation was applied, emphasizing muscle oxygenation responses in the leg and arm. Blood lactate also played an important role, especially after our inspiratory muscle strategy. Our findings confirm that the pre-activation of inspiratory muscles promotes modulations in the organism, better integrating physiological responses, which could increase performance and improve recovery. Abstract Although several studies have focused on the adaptations provided by inspiratory muscle (IM) training on physical demands, the warm-up or pre-activation (PA) of these muscles alone appears to generate positive effects on physiological responses and performance. This study aimed to understand the effects of inspiratory muscle pre-activation (IMPA) on high-intensity running and passive recovery, as applied to active subjects. In an original and innovative investigation of the impacts of IMPA on high-intensity running, we proposed the identification of the interactions among physical characteristics, physiological responses and muscle oxygenation in more and less active muscle to a running exercise using a complex network model. For this, fifteen male subjects were submitted to all-out 30 s tethered running efforts preceded or not preceded by IMPA, composed of 2 × 15 repetitions (1 min interval between them) at 40% of the maximum individual inspiratory pressure using a respiratory exercise device. During running and recovery, we monitored the physiological responses (heart rate, blood lactate, oxygen saturation) and muscle oxygenation (in vastus lateralis and biceps brachii) by wearable near-infrared spectroscopy (NIRS). Thus, we investigated four scenarios: two in the tethered running exercise (with or without IMPA) and two built into the recovery process (after the all-out 30 s), under the same conditions. Undirected weighted graphs were constructed, and four centrality metrics were analyzed (Degree, Betweenness, Eigenvector, and Pagerank). The IMPA (40% of the maximum inspiratory pressure) was effective in increasing the peak and mean relative running power, and the analysis of the complex networks advanced the interpretation of the effects of physiological adjustments related to the IMPA on exercise and recovery. Centrality metrics highlighted the nodes related to muscle oxygenation responses (in more and less active muscles) as significant to all scenarios, and systemic physiological responses mediated this impact, especially after IMPA application. Our results suggest that this respiratory strategy enhances exercise, recovery and the multidimensional approach to understanding the effects of physiological adjustments on these conditions.
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Affiliation(s)
- Fúlvia Barros Manchado-Gobatto
- Laboratory of Applied Sport Physiology, School of Applied Sciences, University of Campinas, Limeira 13484-350, Brazil; (A.B.M.); (F.M.R.); (C.A.G.)
- Correspondence:
| | - Ricardo Silva Torres
- Department of ICT and Natural Sciences, Norwegian University of Science and Technology, 6009 Ålesund, Norway;
| | - Anita Brum Marostegan
- Laboratory of Applied Sport Physiology, School of Applied Sciences, University of Campinas, Limeira 13484-350, Brazil; (A.B.M.); (F.M.R.); (C.A.G.)
| | - Felipe Marroni Rasteiro
- Laboratory of Applied Sport Physiology, School of Applied Sciences, University of Campinas, Limeira 13484-350, Brazil; (A.B.M.); (F.M.R.); (C.A.G.)
| | - Charlini Simoni Hartz
- Postgraduate Program in Human Movement Sciences, Methodist University of Piracicaba, Piracicaba 13400-000, Brazil; (C.S.H.); (M.A.M.)
| | - Marlene Aparecida Moreno
- Postgraduate Program in Human Movement Sciences, Methodist University of Piracicaba, Piracicaba 13400-000, Brazil; (C.S.H.); (M.A.M.)
| | - Allan Silva Pinto
- Department of Sport Sciences, Faculty of Physical Education, University of Campinas, Campinas 13083-851, Brazil;
- Brazilian Synchrotron Light Laboratory, Brazilian Center for Research in Energy and Materials, Campinas 13083-970, Brazil
| | - Claudio Alexandre Gobatto
- Laboratory of Applied Sport Physiology, School of Applied Sciences, University of Campinas, Limeira 13484-350, Brazil; (A.B.M.); (F.M.R.); (C.A.G.)
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Exercise Training and Interventions for Coronary Artery Disease. J Cardiovasc Dev Dis 2022; 9:jcdd9050131. [PMID: 35621842 PMCID: PMC9146277 DOI: 10.3390/jcdd9050131] [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: 03/25/2022] [Revised: 04/18/2022] [Accepted: 04/24/2022] [Indexed: 12/22/2022] Open
Abstract
Coronary artery disease (CAD) may be considered a main cause of mortality and the prevalence of CAD is increasing nowadays, leading to high health costs in many countries. Despite the fact of the regression of the atherosclerotic plaque, the decrease in blood viscosity and the growth of collateral vessels have been proposed as improvements that CAD patients may obtain under exercise performance. Thus, the present narrative review aimed to carry out a brief specific analysis of the results achieved when performing endurance, strength or inspiratory muscle training. Exercise attenuates certain pathophysiological processes of this disease, such as endothelial dysfunction or the vulnerability of atherosclerotic plaques, and produces improvements in functional capacity and muscle strength, among others. Within the different exercise modalities, the most important parameter to be considered seems to be the total caloric expenditure, and not so much the modality itself. As such, in cardiac rehabilitation, when prescribing exercise, we should possibly focus on the modality that obtains more adherence in patients. To conclude, it must be highlighted that total caloric expenditure is not being taken into account when comparing interventions and this relevant information should be considered in future studies.
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Shei RJ, Paris HL, Sogard AS, Mickleborough TD. Time to Move Beyond a "One-Size Fits All" Approach to Inspiratory Muscle Training. Front Physiol 2022; 12:766346. [PMID: 35082689 PMCID: PMC8784843 DOI: 10.3389/fphys.2021.766346] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Accepted: 12/13/2021] [Indexed: 11/13/2022] Open
Abstract
Inspiratory muscle training (IMT) has been studied as a rehabilitation tool and ergogenic aid in clinical, athletic, and healthy populations. This technique aims to improve respiratory muscle strength and endurance, which has been seen to enhance respiratory pressure generation, respiratory muscle weakness, exercise capacity, and quality of life. However, the effects of IMT have been discrepant between populations, with some studies showing improvements with IMT and others not. This may be due to the use of standardized IMT protocols which are uniformly applied to all study participants without considering individual characteristics and training needs. As such, we suggest that research on IMT veer away from a standardized, one-size-fits-all intervention, and instead utilize specific IMT training protocols. In particular, a more personalized approach to an individual's training prescription based upon goals, needs, and desired outcomes of the patient or athlete. In order for the coach or practitioner to adjust and personalize a given IMT prescription for an individual, factors, such as frequency, duration, and modality will be influenced, thus inevitably affecting overall training load and adaptations for a projected outcome. Therefore, by integrating specific methods based on optimization, periodization, and personalization, further studies may overcome previous discrepancies within IMT research.
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Affiliation(s)
- Ren-Jay Shei
- Global Medical Department, Mallinckrodt Pharmaceuticals Company, Hampton, NJ, United States
| | - Hunter L Paris
- Department of Sports Medicine, Pepperdine University, Malibu, CA, United States
| | - Abigail S Sogard
- Department of Kinesiology, School of Public Health-Bloomington, Indiana University, Bloomington, IN, United States
| | - Timothy D Mickleborough
- Department of Kinesiology, School of Public Health-Bloomington, Indiana University, Bloomington, IN, United States
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Begot I, Gomes WJ, Rocco IS, Bublitz C, Gonzaga LRA, Bolzan DW, Santos VB, Moreira RSL, Breda JR, Almeida DRD, Arena R, Guizilini S. Inspiratory Muscle Weakness is Related to Poor Short-Term Outcomes for Heart Transplantation. Braz J Cardiovasc Surg 2021; 36:308-317. [PMID: 33438847 PMCID: PMC8357387 DOI: 10.21470/1678-9741-2020-0344] [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] [Indexed: 02/02/2023] Open
Abstract
INTRODUCTION In heart transplantation (HT) recipients, several factors are critical to promptly adopting appropriate rehabilitation strategies and may be important to predict outcomes way after surgery. This study aimed to determine preoperative patient-related risk factors that could adversely affect the postoperative clinical course of patients undergoing HT. METHODS Twenty-one hospitalized patients with heart failure undergoing HT were evaluated according to respiratory muscle strength and functional capacity before HT. Mechanical ventilation (MV) time, reintubation rate, and intensive care unit (ICU) length of stay were recorded, and assessed postoperatively. RESULTS Inspiratory muscle strength as absolute and percentpredicted values were strongly correlated with MV time (r=-0.61 and r=-0.70, respectively, at P<0.001). Concerning ICU length of stay, only maximal inspiratory pressure (MIP) absolute and percent-predicted values were significantly associated. The absolute |MIP| was significantly negatively correlated with ICU length of stay (r=-0.58 at P=0.006) and the percent-predicted MIP was also significantly negatively correlated with ICU length of stay (r=-0.68 at P=0.0007). No associations were observed between preoperative functional capacity, age, sex, and clinical characteristics and MV time and ICU length of stay in the cohort included in this study. Patients with respiratory muscle weakness had a higher prevalence of prolonged MV, reintubation, and delayed ICU length of stay. CONCLUSION An impairment of preoperative MIP was associated with poorer short-term outcomes following HT. As such, inspiratory muscle strength is an important clinical preoperative marker in patients undergoing HT.
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Affiliation(s)
- Isis Begot
- Cardiology Postgraduate Program, Federal University of Sao Paulo, Sao Paulo, Sao Paulo, Brazil
| | - Walter J Gomes
- Cardiology Postgraduate Program, Federal University of Sao Paulo, Sao Paulo, Sao Paulo, Brazil.,Cardiology and Cardiovascular Surgery Disciplines, Sao Paulo Hospital, Escola Paulista de Medicina, Federal University of Sao Paulo, Sao Paulo, Sao Paulo, Brazil
| | - Isadora S Rocco
- Cardiology Postgraduate Program, Federal University of Sao Paulo, Sao Paulo, Sao Paulo, Brazil
| | - Caroline Bublitz
- Cardiology Postgraduate Program, Federal University of Sao Paulo, Sao Paulo, Sao Paulo, Brazil.,Cardiology and Cardiovascular Surgery Disciplines, Sao Paulo Hospital, Escola Paulista de Medicina, Federal University of Sao Paulo, Sao Paulo, Sao Paulo, Brazil
| | - Laion R A Gonzaga
- Cardiology Postgraduate Program, Federal University of Sao Paulo, Sao Paulo, Sao Paulo, Brazil
| | - Douglas W Bolzan
- Cardiology Postgraduate Program, Federal University of Sao Paulo, Sao Paulo, Sao Paulo, Brazil
| | | | | | - João R Breda
- Cardiology Postgraduate Program, Federal University of Sao Paulo, Sao Paulo, Sao Paulo, Brazil
| | | | - Ross Arena
- Department of Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, Illinois, United States of America
| | - Solange Guizilini
- Department of Human Motion Sciences, Federal University of Sao Paulo, São Paulo, Brazil
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Arutyunov AG, Kolesnikova EA, Ilyina KV, Rylova AK, Arutyunov GP, Scherbacova NV, Kulagina NP. Selection of the optimal respiratory muscle training mode in patients with class II-III chronic heart failure. ACTA ACUST UNITED AC 2021; 61:69-75. [PMID: 33734046 DOI: 10.18087/cardio.2021.2.n1356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 10/11/2020] [Accepted: 12/19/2020] [Indexed: 11/18/2022]
Abstract
Aim To study the effect of various types of respiratory muscle training (RMT) in patients with functional class (FC) II-III chronic heart failure (CHF) and more than 70% preserved diaphragm muscle mass.Material and methods 53 patients (28 men and 25 women) aged 50-75 years with NYHA FC II-III ischemic heart disease (IHD) and arterial hypertension with more than 70% preserved diaphragm muscle mass of >70% were randomized to one of four RMT types: static loads, dynamic loads, their combination, and breathing without applied resistance as a control. Peak oxygen consumption (VO2 peak) and maximum inspiratory pressure (MIP) were evaluated at baseline and in 6 months.Results All study groups showed significant improvement of physical endurance indexes compared to baseline values (р<0.05). In pairwise comparison, the groups significantly differed (р<0.01). The greatest improvement was observed for patients of dynamic and combined training groups. Furthermore, in the combined training group, results were significantly higher than in the group of isolated dynamic loads. The most significant (р <0.01), positive changes in the force of inspiratory muscles were observed in groups of dynamic and combined trainings with the best results displayed by patients of the combined training group.Conclusion With preserving more than 70 % of diaphragm muscle tissue (as determined by MIP >60 cm H2O), a combination of static and dynamic RMT is most effective for patients with FC II-III CHF.
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Affiliation(s)
- A G Arutyunov
- Pirogov Russian National Research Medical University (RNRMU), Moscow, Russia
| | - E A Kolesnikova
- Pirogov Russian National Research Medical University (RNRMU), Moscow, Russia
| | - K V Ilyina
- Pirogov Russian National Research Medical University (RNRMU), Moscow, Russia Сity clinical hospital №4, Moscow, Russia
| | - A K Rylova
- Pirogov Russian National Research Medical University (RNRMU), Moscow, Russia
| | - G P Arutyunov
- Pirogov Russian National Research Medical University (RNRMU), Moscow, Russia
| | - N V Scherbacova
- Pirogov Russian National Research Medical University (RNRMU), Moscow, Russia
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10
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(The expiratory muscle training in patients with chronic heart failure). COR ET VASA 2021. [DOI: 10.33678/cor.2020.095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Unraveling the Role of Respiratory Muscle Metaboloreceptors under Inspiratory Training in Patients with Heart Failure. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18041697. [PMID: 33578776 PMCID: PMC7916511 DOI: 10.3390/ijerph18041697] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 02/01/2021] [Accepted: 02/06/2021] [Indexed: 12/15/2022]
Abstract
Exercise intolerance may be considered a hallmark in patients who suffer from heart failure (HF) syndrome. Currently, there is enough scientific evidence regarding functional and structural deterioration of skeletal musculature in these patients. It is worth noting that muscle weakness appears first in the respiratory muscles and then in the musculature of the limbs, which may be considered one of the main causes of exercise intolerance. Functional deterioration and associated atrophy of these respiratory muscles are related to an increased muscle metaboreflex leading to sympathetic–adrenal system hyperactivity and increased pulmonary ventilation. This issue contributes to increased dyspnea and/or fatigue and decreased aerobic function. Consequently, respiratory muscle weakness produces exercise limitations in these patients. In the present review, the key role that respiratory muscle metaboloreceptors play in exercise intolerance is accurately addressed in patients who suffer from HF. In conclusion, currently available scientific evidence seems to affirm that excessive metaboreflex activity of respiratory musculature under HF is the main cause of exercise intolerance and sympathetic–adrenal system hyperactivity. Inspiratory muscle training seems to be a useful personalized medicine intervention to reduce respiratory muscle metaboreflex in order to increase patients’ exercise tolerance under HF condition.
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Hornikx M, Buys R, Cornelissen V, Deroma M, Goetschalckx K. Effectiveness of high intensity interval training supplemented with peripheral and inspiratory resistance training in chronic heart failure: a pilot study. Acta Cardiol 2020; 75:339-347. [PMID: 31125296 DOI: 10.1080/00015385.2019.1591676] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Background: Cardiac rehabilitation (CR) is an evidence-based therapy in chronic heart failure (CHF). There is still debate about the optimal training protocol in CHF. The use of high intensity interval training (HIIT) supplemented with peripheral (PRT) and inspiratory resistance training (IRT) might be more beneficial because of the higher impact on the peripheral and inspiratory muscles, with less symptoms of dyspnoea and lower amount of dropouts as a result. We compared our standard exercise-based CR programme, mainly consisting of moderate intensity interval training to a programme combining HIIT, PRT and IRT (resistance training supplemented HIIT (RHIIT) programme).Design: Randomised controlled pilot study.Methods: Twenty patients with CHF were randomised on a 1:1 basis to the standard or RHIIT programme. At baseline and after 3 months, peak exercise capacity (VO2peak), peripheral (QF) and inspiratory respiratory muscle strength (MIP), quality of life (QOL) and physical activity were measured.Results: The RHIIT programme resulted in a significantly larger improvement in QF (ΔQF RHIIT programme: 19.3 ± 11.8 vs standard programme: -6.89 ± 19.0 Nm (p < .01)) and MIP (ΔMIP RHIIT programme: -44.9 ± 29.9 vs standard programme: 0.56 ± 19.4 cmH2O (p < .01)). Both programmes equally improved in VO2peak (p = .91), whereas ventilatory efficiency and physical activity remained stable.Conclusion: HIIT supplemented with PRT and IRT might be applicable as standard protocol in CHF. Larger studies are warranted to confirm our findings. The RHIIT programme resulted in similar training effects in VO2peak in a shorter training period. This might be beneficial in a chronic patient population such as CHF, where adherence is difficult.
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Affiliation(s)
- Miek Hornikx
- Department of Rehabilitation Sciences, KU Leuven-University of Leuven, University Hospitals Leuven, Leuven, Belgium
| | - Roselien Buys
- Department of Rehabilitation Sciences, KU Leuven-University of Leuven, University Hospitals Leuven, Leuven, Belgium
| | - Veronique Cornelissen
- Department of Rehabilitation Sciences, KU Leuven-University of Leuven, University Hospitals Leuven, Leuven, Belgium
| | - Michel Deroma
- Department of Rehabilitation Sciences, KU Leuven-University of Leuven, University Hospitals Leuven, Leuven, Belgium
| | - Kaatje Goetschalckx
- Department of Cardiovascular Sciences, KU Leuven-University of Leuven, University Hospitals Leuven, Leuven, Belgium
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13
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Fernandez-Rubio H, Becerro-de-Bengoa-Vallejo R, Rodríguez-Sanz D, Calvo-Lobo C, Vicente-Campos D, Chicharro JL. Inspiratory Muscle Training in Patients with Heart Failure. J Clin Med 2020; 9:jcm9061710. [PMID: 32498445 PMCID: PMC7356942 DOI: 10.3390/jcm9061710] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 05/28/2020] [Accepted: 05/28/2020] [Indexed: 12/13/2022] Open
Abstract
Background: Prior systematic reviews and meta-analysis addressed that inspiratory muscle training (IMT) improved inspiratory muscle weakness, cardiorespiratory fitness and quality of life similar to conventional exercise training as a first alternative in deconditioned patients with heart failure (HF) lead to a better adaptation to posterior exercise training. The heterogeneity and variability in a wide range of new studies about this topic led to the necessity of an updated and comprehensive narrative review. The present review aimed to analyze and update the most relevant studies about IMT in patients who suffer from HF. Methods: A narrative review was carried out about IMT in HF patients including 26 experimental studies divided into 21 clinical trials and 5 quasi-experimental studies identified through database searching in PubMed, Cochrane and PEDro. Results: There is enough evidence to state that IMT produces improvements in functional capacity of patients with HF. Nevertheless, there is not enough evidence to support that IMT could improve cardiovascular parameters, blood biomarkers or quality of life in these patients. Conclusions: Thus, IMT may be recommended to improve functional capacity in patients who suffer from HF; nevertheless, more evidence is needed regarding cardiovascular parameters, biomarkers and quality of life. Furthermore, mortality or HF hospitalization was not evaluated and most studies were not longer than 3 months. According to IMT protocols and study designs heterogeneity and mid-term follow-up, further investigations through high-quality long-term randomized clinical trials should be performed to achieve systematic reviews and meta-analysis to support strong evidence for IMT in HF patients.
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Affiliation(s)
- Hugo Fernandez-Rubio
- Facultad de Enfermería, Fisioterapia y Podología, Universidad Complutense de Madrid, 28040 Madrid, Spain; (H.F.-R.); (R.B.-d.-B.-V.); (D.R.-S.)
| | - Ricardo Becerro-de-Bengoa-Vallejo
- Facultad de Enfermería, Fisioterapia y Podología, Universidad Complutense de Madrid, 28040 Madrid, Spain; (H.F.-R.); (R.B.-d.-B.-V.); (D.R.-S.)
| | - David Rodríguez-Sanz
- Facultad de Enfermería, Fisioterapia y Podología, Universidad Complutense de Madrid, 28040 Madrid, Spain; (H.F.-R.); (R.B.-d.-B.-V.); (D.R.-S.)
| | - César Calvo-Lobo
- Facultad de Enfermería, Fisioterapia y Podología, Universidad Complutense de Madrid, 28040 Madrid, Spain; (H.F.-R.); (R.B.-d.-B.-V.); (D.R.-S.)
- Correspondence: ; Tel.: +34-913-941-532
| | - Davinia Vicente-Campos
- Facultad de Ciencias de la Salud, Universidad Francisco de Vitoria, Pozuelo de Alarcón, 28223 Madrid, Spain;
| | - J. L. Chicharro
- Grupo FEBIO, Universidad Complutense de Madrid, 28040 Madrid, Spain;
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14
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Del Buono MG, Arena R, Borlaug BA, Carbone S, Canada JM, Kirkman DL, Garten R, Rodriguez-Miguelez P, Guazzi M, Lavie CJ, Abbate A. Exercise Intolerance in Patients With Heart Failure: JACC State-of-the-Art Review. J Am Coll Cardiol 2020; 73:2209-2225. [PMID: 31047010 DOI: 10.1016/j.jacc.2019.01.072] [Citation(s) in RCA: 230] [Impact Index Per Article: 57.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Accepted: 01/21/2019] [Indexed: 02/07/2023]
Abstract
Exercise intolerance is the cardinal symptom of heart failure (HF) and is of crucial relevance, because it is associated with a poor quality of life and increased mortality. While impaired cardiac reserve is considered to be central in HF, reduced exercise and functional capacity are the result of key patient characteristics and multisystem dysfunction, including aging, impaired pulmonary reserve, as well as peripheral and respiratory skeletal muscle dysfunction. We herein review the different modalities to quantify exercise intolerance, the pathophysiology of HF, and comorbid conditions as they lead to reductions in exercise and functional capacity, highlighting the fact that distinct causes may coexist and variably contribute to exercise intolerance in patients with HF.
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Affiliation(s)
- Marco Giuseppe Del Buono
- VCU Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia; Department of Cardiovascular and Thoracic Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - Ross Arena
- Department of Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, Illinois; Total Cardiology Research Network, Calgary, Alberta, Canada
| | - Barry A Borlaug
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | - Salvatore Carbone
- VCU Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia
| | - Justin M Canada
- VCU Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia
| | - Danielle L Kirkman
- Department of Kinesiology and Health Sciences, Virginia Commonwealth University, Richmond, Virginia
| | - Ryan Garten
- Department of Kinesiology and Health Sciences, Virginia Commonwealth University, Richmond, Virginia
| | - Paula Rodriguez-Miguelez
- Department of Kinesiology and Health Sciences, Virginia Commonwealth University, Richmond, Virginia
| | - Marco Guazzi
- Cardiology University Department, Heart Failure Unit, University of Milan, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Carl J Lavie
- Department of Cardiovascular Diseases, Ochsner Clinical School, New Orleans, Louisiana
| | - Antonio Abbate
- VCU Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia.
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15
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Shoemaker MJ, Dias KJ, Lefebvre KM, Heick JD, Collins SM. Physical Therapist Clinical Practice Guideline for the Management of Individuals With Heart Failure. Phys Ther 2020; 100:14-43. [PMID: 31972027 DOI: 10.1093/ptj/pzz127] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2019] [Revised: 04/15/2019] [Accepted: 06/10/2019] [Indexed: 12/12/2022]
Abstract
The American Physical Therapy Association (APTA), in conjunction with the Cardiovascular and Pulmonary Section of APTA, have commissioned the development of this clinical practice guideline to assist physical therapists in their clinical decision making when managing patients with heart failure. Physical therapists treat patients with varying degrees of impairments and limitations in activity and participation associated with heart failure pathology across the continuum of care. This document will guide physical therapist practice in the examination and treatment of patients with a known diagnosis of heart failure. The development of this clinical practice guideline followed a structured process and resulted in 9 key action statements to guide physical therapist practice. The level and quality of available evidence were graded based on specific criteria to determine the strength of each action statement. Clinical algorithms were developed to guide the physical therapist in appropriate clinical decision making. Physical therapists are encouraged to work collaboratively with other members of the health care team in implementing these action statements to improve the activity, participation, and quality of life in individuals with heart failure and reduce the incidence of heart failure-related re-admissions.
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Affiliation(s)
- Michael J Shoemaker
- Department of Physical Therapy, Grand Valley State University, 301 Michigan NE, Suite 200, Grand Rapids, MI 49503 (USA). Dr Shoemaker is a board-certified clinical specialist in geriatric physical therapy
| | - Konrad J Dias
- Physical Therapy Program, Maryville University of St Louis, St Louis, Missouri. Dr Dias is a board-certified clinical specialist in cardiovascular and pulmonary physical therapy
| | - Kristin M Lefebvre
- Department of Physical Therapy, Concordia University St Paul, St Paul, Minnesota. Dr Lefebvre is a board-certified clinical specialist in cardiovascular and pulmonary physical therapy
| | - John D Heick
- Department of Physical Therapy, Northern Arizona University, Flagstaff, Arizona. Dr Heick is a board-certified clinical specialist in orthopaedic physical therapy, neurologic physical therapy, and sports physical therapy
| | - Sean M Collins
- Physical Therapy Program, Plymouth State University, Plymouth, New Hampshire
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16
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Wang MH, Yeh ML. Respiratory training interventions improve health status of heart failure patients: A systematic review and network meta-analysis of randomized controlled trials. World J Clin Cases 2019; 7:2760-2775. [PMID: 31616691 PMCID: PMC6789387 DOI: 10.12998/wjcc.v7.i18.2760] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 07/04/2019] [Accepted: 07/27/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Prior studies indicate that doing breathing exercises improves physical performance and quality of life (QoL) in heart failure patients. However, these effects remain unclear and contradictory.
AIM To determine the effects of machine-assisted and non-machine-assisted respiratory training on physical performance and QoL in heart failure patients.
METHODS This was a systematic review and network meta-analysis study. A literature search of electronic databases was conducted for randomized controlled trials (RCTs) on heart failure. Respiratory training interventions were grouped as seven categories: IMT_Pn (inspiratory muscle training without pressure or < 10% maximal inspiratory pressure, MIP), IMT_Pl (inspiratory muscle training with low pressure, 10%-15% MIP), IMT_Pm (inspiratory muscle training with medium pressure, 30%-40% MIP), IMT_Ph (inspiratory muscle training with high pressure, 60% MIP or MIP plus aerobics), Aerobics (aerobic exercise or weight training), Qi_Ex (tai chi, yoga, and breathing exercise), and none. The four outcomes were heart rate, peak oxygen uptake (VO2 peak), 6-min walking distance test (6MWT), and Minnesota Living with Heart Failure QoL. The random-effects model, side-splitting model, and the surface under the cumulative ranking curve (SUCRA) were used to test and analyze the data.
RESULTS A total of 1499 subjects from 31 RCT studies were included. IMT_Ph had the highest effect sizes for VO2 peak and 6MWT, IMT_Pm highest for QoL, and Qi_Ex highest for heart rate. Aerobics had the second highest for VO2 peak, Qi_Ex second highest for 6MWT, and IMT_Ph second highest for heart rate and QoL.
CONCLUSION This study supports that high- and medium-intensity machine-assisted training improves exercise capacity and QoL in hospital-based heart failure patients. After hospital discharge, non-machine-assisted training continuously improves cardiac function.
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Affiliation(s)
- Mei-Hua Wang
- School of Nursing, National Taipei University of Nursing and Health Sciences, Taipei 11219, Taiwan
| | - Mei-Ling Yeh
- School of Nursing, National Taipei University of Nursing and Health Sciences, Taipei 11219, Taiwan
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17
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Sobanski PZ, Alt-Epping B, Currow DC, Goodlin SJ, Grodzicki T, Hogg K, Janssen DJA, Johnson MJ, Krajnik M, Leget C, Martínez-Sellés M, Moroni M, Mueller PS, Ryder M, Simon ST, Stowe E, Larkin PJ. Palliative care for people living with heart failure: European Association for Palliative Care Task Force expert position statement. Cardiovasc Res 2019; 116:12-27. [DOI: 10.1093/cvr/cvz200] [Citation(s) in RCA: 64] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 04/19/2019] [Accepted: 08/02/2019] [Indexed: 01/12/2023] Open
Abstract
Abstract
Contrary to common perception, modern palliative care (PC) is applicable to all people with an incurable disease, not only cancer. PC is appropriate at every stage of disease progression, when PC needs emerge. These needs can be of physical, emotional, social, or spiritual nature. This document encourages the use of validated assessment tools to recognize such needs and ascertain efficacy of management. PC interventions should be provided alongside cardiologic management. Treating breathlessness is more effective, when cardiologic management is supported by PC interventions. Treating other symptoms like pain or depression requires predominantly PC interventions. Advance Care Planning aims to ensure that the future treatment and care the person receives is concordant with their personal values and goals, even after losing decision-making capacity. It should include also disease specific aspects, such as modification of implantable device activity at the end of life. The Whole Person Care concept describes the inseparability of the physical, emotional, and spiritual dimensions of the human being. Addressing psychological and spiritual needs, together with medical treatment, maintains personal integrity and promotes emotional healing. Most PC concerns can be addressed by the usual care team, supported by a PC specialist if needed. During dying, the persons’ needs may change dynamically and intensive PC is often required. Following the death of a person, bereavement services benefit loved ones. The authors conclude that the inclusion of PC within the regular clinical framework for people with heart failure results in a substantial improvement in quality of life as well as comfort and dignity whilst dying.
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Affiliation(s)
- Piotr Z Sobanski
- Palliative Care Unit and Competence Centre, Department of Internal Medicine, Spital Schwyz, Waldeggstrasse 10, 6430 Schwyz, Switzerland
| | - Bernd Alt-Epping
- Department of Palliative Medicine, University Medical Center Göttingen Georg August University, Robertkochstrasse 40, 37075 Göttingen, Germany
| | - David C Currow
- University of Technology Sydney, Broadway, Ultimo, Sydney, 2007 New South Wales, Australia
- Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT), Faculty of Health, University of Technology Sydney, Ultimo, Sydney, New South Wales, Australia
| | - Sarah J Goodlin
- Department of Medicine-Geriatrics, Portland Veterans Affairs Medical Center and Patient-cantered Education and Research, 3710 SW US Veterans Rd, Portland, 97239 OR, USA
| | - Tomasz Grodzicki
- Department of Internal Medicine and Gerontology, Jagiellonian University Medical College, 31-531 Kraków, Śniadeckich 10, Poland
| | | | - Daisy J A Janssen
- Department of Research and Education, CIRO, Hornerheide 1, 6085 NM Horn, The Netherlands
- Department of Health Services Research, CAPHRI School for Public Health and Primary Care, Faculty of Health Medicine and Life Sciences, Maastricht University, Duboisdomein 30, 6229 GT, Maastricht, The Netherlands
| | - Miriam J Johnson
- Wolfson Palliative Care Research Centre, Allam Medical Building University of Hull, Cottingham Road, Hull, HU6 7RX, UK
| | - Małgorzata Krajnik
- Department of Palliative Care, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, Skłodowskiej-Curie 9, 85-094 Bydgoszcz, Poland
| | - Carlo Leget
- University of Humanistic Studies, Chair Care Ethics, Kromme Nieuwegracht 29, Utrecht, The Netherlands
| | - Manuel Martínez-Sellés
- Department of Cardiology, Hospital Universitario Gregorio Marañón, CIBERCV, Universidad Europea, Universidad Complutense, C/ Dr. Esquerdo, 46, 28007 Madrid, Spain
| | - Matteo Moroni
- S.S.D. Cure Palliative, sede di Ravenna, AUSL Romagna, Via De Gasperi 8, 48121 Ravenna, Italy
| | - Paul S Mueller
- Mayo Clinic Health System, Mayo Clinic Collage of Medicine and Science, 700 West Avennue South, La Crosse, 54601 Wisconsin, USA
| | - Mary Ryder
- School of Nursing, Midwifery & Health Systems, University College Dublin, Ireland St. Vincent’s University Hospital Dublin,Belfield, Dublin 4, Ireland
| | - Steffen T Simon
- Department of Palliative Medicine, Medical Faculty of the Universityof Cologne, Köln, Germany
- Centre for Integrated Oncology Cologne/Bonn (CIO), Medical Faculty ofthe University of Cologne, Kerpener Strasse 62, 50924 Köln, Germany
| | | | - Philip J Larkin
- Service des soins palliatifs Lausanne University Hospital, CHUV, Centre hospitalier univeritaire vaudois, Lausanne Switzerland
- Institut universitaire de formation et de recherche en soins – IUFRS, Faculté de viologie et de medicine – FBM, Lausanne, Switzerland
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18
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Hossein Pour AH, Gholami M, Saki M, Birjandi M. The effect of inspiratory muscle training on fatigue and dyspnea in patients with heart failure: A randomized, controlled trial. Jpn J Nurs Sci 2019; 17:e12290. [PMID: 31429207 DOI: 10.1111/jjns.12290] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Revised: 04/18/2019] [Accepted: 06/27/2019] [Indexed: 12/30/2022]
Abstract
AIM Fatigue and dyspnea are debilitating symptoms in patients with heart failure (HF). The purpose of this study was to evaluate the effects of inspiratory muscle training (IMT) on dyspnea, fatigue and the New York Heart Association (NYHA) functional classification in patients with HF. METHODS In this prospective, randomized, controlled trial, 84 patients with HF (NYHA classes II-III/IV) with a mean age of 56.62 ± 9.56 years were randomly assigned to a 6-week IMT (n = 42) or a sham IMT (n = 42) program. The IMT was performed at 40% of the maximal inspiratory pressure (MIP) in the IMT group and at 10% in the sham group. The main outcomes were assessed at baseline and after the intervention and included dyspnea severity scale (Modified Medical Research Council [MMRC], Fatigue Severity Scale [FSS] and the NYHA functional classification (based on the presenting symptoms). RESULTS The between-group analysis showed significant improvements in dyspnea, fatigue and the NYHA functional classification in the IMT group compared to the sham group (P < .05). The within-group analysis showed significant improvements in dyspnea (from 2.63 ± 0.79 to 1.38 ± 0.66, P < .001), fatigue (from 43.36 ± 8.5 to 28.95 ± 9.11, P < .001) and the NYHA functional classification (from 2.73 ± 0.5 to 2.1 ± 0.6, P = .001) in the IMT group, while fatigue and dyspnea increased significantly in the sham group. CONCLUSIONS The 6-week home-based IMT was found to be an effective and safe tool for reducing dyspnea and fatigue and improving the NYHA functional classification.
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Affiliation(s)
| | - Mohammad Gholami
- School of Nursing and Midwifery, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Mandana Saki
- Social Determinants of Health Research Center, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Mehdi Birjandi
- Department of Biostatistics and Epidemiology, School of Health and Nutrition, Lorestan University of Medical Sciences, Khorramabad, Iran
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19
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Shei RJ, Dekerlegand RL, Mackintosh KA, Lowman JD, McNarry MA. Inspiration for the Future: The Role of Inspiratory Muscle Training in Cystic Fibrosis. SPORTS MEDICINE-OPEN 2019; 5:36. [PMID: 31396726 PMCID: PMC6687783 DOI: 10.1186/s40798-019-0210-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Accepted: 07/31/2019] [Indexed: 11/10/2022]
Abstract
Cystic fibrosis (CF) is an inherited, multi-system, life-limiting disease characterized by a progressive decline in lung function, which accounts for the majority of CF-related morbidity and mortality. Inspiratory muscle training (IMT) has been proposed as a rehabilitative strategy to treat respiratory impairments associated with CF. However, despite evidence of therapeutic benefits in healthy and other clinical populations, the routine application of IMT in CF can neither be supported nor refuted due to the paucity of methodologically rigorous research. Specifically, the interpretation of available studies regarding the efficacy of IMT in CF is hampered by methodological threats to internal and external validity. As such, it is important to highlight the inherent risk of bias that differences in patient characteristics, IMT protocols, and outcome measurements present when synthesizing this literature prior to making final clinical judgments. Future studies are required to identify the characteristics of individuals who may respond to IMT and determine whether the controlled application of IMT can elicit meaningful improvements in physiological and patient-centered clinical outcomes. Given the equivocal evidence regarding its efficacy, IMT should be utilized on a case-by-case basis with sound clinical reasoning, rather than simply dismissed, until a rigorous evidence-based consensus has been reached.
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Affiliation(s)
- Ren-Jay Shei
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Alabama at Birmingham, 1918 University Boulevard, Birmingham, AL, 35294-0006, USA. .,Gregory Fleming James Cystic Fibrosis Research Center, University of Alabama at Birmingham, Birmingham, AL, USA.
| | - Robert L Dekerlegand
- Department of Physical Therapy, College of Rehabilitation Sciences, Jefferson (Philadelphia University and Thomas Jefferson University), Philadelphia, PA, USA
| | - Kelly A Mackintosh
- Applied Sports Science Technology and Medicine Research Centre (A-STEM), College of Engineering, Swansea University, Swansea, UK
| | - John D Lowman
- Gregory Fleming James Cystic Fibrosis Research Center, University of Alabama at Birmingham, Birmingham, AL, USA.,Department of Physical Therapy, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Melitta A McNarry
- Applied Sports Science Technology and Medicine Research Centre (A-STEM), College of Engineering, Swansea University, Swansea, UK
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20
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Rehder-Santos P, Minatel V, Milan-Mattos JC, Signini ÉDF, de Abreu RM, Dato CC, Catai AM. Critical inspiratory pressure - a new methodology for evaluating and training the inspiratory musculature for recreational cyclists: study protocol for a randomized controlled trial. Trials 2019; 20:258. [PMID: 31064379 PMCID: PMC6505302 DOI: 10.1186/s13063-019-3353-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2018] [Accepted: 04/03/2019] [Indexed: 11/13/2022] Open
Abstract
Background Inspiratory muscle training (IMT) has brought great benefits in terms of improving physical performance in healthy individuals. However, there is no consensus regarding the best training load, as in most cases the maximal inspiratory pressure (MIP) is used, mainly the intensity of 60% of MIP. Therefore, prescribing an IMT protocol that takes into account inspiratory muscle strength and endurance may bring additional benefits to the commonly used protocols, since respiratory muscles differ from other muscles because of their greater muscular resistance. Thus, IMT using critical inspiratory pressure (PThC) can be an alternative, as the calculation of PThC considers these characteristics. Therefore, the aim of this study is to propose a new IMT protocol to determine the best training load for recreational cyclists. Methods Thirty recreational cyclists (between 20 and 40 years old) will be randomized into three groups: sham (SG), PThC (CPG) and 60% of MIP, according to age and aerobic functional capacity. All participants will undergo the following evaluations: pulmonary function test (PFT), respiratory muscle strength test (RMS), cardiopulmonary exercise test (CPET), incremental inspiratory muscle endurance test (iIME) (maximal sustained respiratory pressure for 1 min (PThMAX)) and constant load test (CLT) (95%, 100% and 105% of PThMÁX) using a linear load inspiratory resistor (PowerBreathe K5). The PThC will be calculated from the inspiratory muscle endurance time (TLIM) and inspiratory loads of each CLT. The IMT will last 11 weeks (3 times/week and 55 min/session). The session will consist of 5-min warm-up (50% of the training load) and three sets of 15-min breaths (100% of the training load), with a 1-min interval between them. RMS, iIME, CLT and CPET will be performed beforehand, at week 5 and 9 (to adjust the training load) and after training. PFT will be performed before and after training. The data will be analyzed using specific statistical tests (parametric or non-parametric) according to the data distribution and their respective variances. A p value <0.05 will be considered statistically significant. Discussions It is expected that the results of this study will enable the training performed with PThC to be used by health professionals as a new tool to evaluate and prescribe IMT. Trial registration ClinicalTrials.gov, NCT02984189. Registered on 6 December 2016. Electronic supplementary material The online version of this article (10.1186/s13063-019-3353-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Patricia Rehder-Santos
- Cardiovascular Physical Therapy Laboratory, Nucleus of Research in Physical Exercise, Department of Physical Therapy, Federal University of São Carlos, Via Washington Luiz, km 235, CP: 676, São Carlos, São Paulo, 13565-905, Brazil
| | - Vinicius Minatel
- Cardiovascular Physical Therapy Laboratory, Nucleus of Research in Physical Exercise, Department of Physical Therapy, Federal University of São Carlos, Via Washington Luiz, km 235, CP: 676, São Carlos, São Paulo, 13565-905, Brazil
| | - Juliana Cristina Milan-Mattos
- Cardiovascular Physical Therapy Laboratory, Nucleus of Research in Physical Exercise, Department of Physical Therapy, Federal University of São Carlos, Via Washington Luiz, km 235, CP: 676, São Carlos, São Paulo, 13565-905, Brazil
| | - Étore De Favari Signini
- Cardiovascular Physical Therapy Laboratory, Nucleus of Research in Physical Exercise, Department of Physical Therapy, Federal University of São Carlos, Via Washington Luiz, km 235, CP: 676, São Carlos, São Paulo, 13565-905, Brazil
| | - Raphael Martins de Abreu
- Cardiovascular Physical Therapy Laboratory, Nucleus of Research in Physical Exercise, Department of Physical Therapy, Federal University of São Carlos, Via Washington Luiz, km 235, CP: 676, São Carlos, São Paulo, 13565-905, Brazil
| | - Carla Cristina Dato
- Nutrition Course, Central University of Paulista, São Carlos, São Paulo, Brazil
| | - Aparecida Maria Catai
- Cardiovascular Physical Therapy Laboratory, Nucleus of Research in Physical Exercise, Department of Physical Therapy, Federal University of São Carlos, Via Washington Luiz, km 235, CP: 676, São Carlos, São Paulo, 13565-905, Brazil.
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21
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Pastva AM, Walker JKL. Commentary: Central-acting therapeutics alleviate respiratory weakness caused by heart failure-induced ventilatory overdrive. Front Physiol 2018; 9:554. [PMID: 29875676 PMCID: PMC5975101 DOI: 10.3389/fphys.2018.00554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Accepted: 04/30/2018] [Indexed: 11/13/2022] Open
Affiliation(s)
- Amy M. Pastva
- Duke University School of Medicine, Duke University, Durham, NC, United States
| | - Julia K. L. Walker
- Duke University School of Medicine, Duke University, Durham, NC, United States
- Duke University School of Nursing, Duke University, Durham, NC, United States
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Lage SM, Britto RR, Brandão DC, Pereira DAG, Andrade ADD, Parreira VF. Can diaphragmatic breathing modify chest wall volumes during inspiratory loaded breathing in patients with heart failure? Braz J Phys Ther 2018; 22:452-458. [PMID: 29752160 DOI: 10.1016/j.bjpt.2018.04.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Revised: 03/25/2018] [Accepted: 04/04/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Some inspiratory muscle training protocols for patients with heart failure report the request of diaphragmatic breathing during inspiratory loaded breathing. However, it is unclear whether this condition modifies the chest wall volumes. OBJECTIVE The primary purpose was to evaluate chest wall volumes during inspiratory loaded breathing as well as during inspiratory loaded breathing associated with diaphragmatic breathing in patients with heart failure. METHODS Sixteen men with heart failure functional class I to III, aged 50(SD=7) years were evaluated. Volumes of the pulmonary rib cage, abdominal rib cage and abdomen, as well as other breathing pattern variables, were assessed by optoelectronic plethysmography during quiet breathing, inspiratory loaded breathing, and inspiratory loaded breathing associated with diaphragmatic breathing. RESULTS Chest wall tidal volume significantly increased from quiet breathing 0.53(SD=0.14)L to inspiratory loaded breathing 1.33(SD=0.48)L and to inspiratory loaded breathing associated with diaphragmatic breathing 1.36(SD=0.48)L. A significant volume variation was observed on the three compartments (p<0.05 for all). During inspiratory loaded breathing associated with diaphragmatic breathing, patients showed increased abdominal volume compared to quiet breathing [0.28(SD=0.05) to 0.83(SD=0.47)L, p<0.001]; as well as from inspiratory loaded breathing [0.63(SD=0.23) to 0.83(SD=0.47)L, p=0.044]. No significant changes were observed between the two inspiratory loaded breathing conditions on the percentages of the contribution of each chest wall compartment for the tidal volume, respiratory rate, minute ventilation, and duty cycle. CONCLUSION When inspiratory loaded breathing was associated with diaphragmatic breathing, a higher volume in the abdominal compartment was obtained without significant changes in other breathing pattern variables.
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Affiliation(s)
- Susan Martins Lage
- Universidade Federal de Minas Gerais (UFMG), Rehabilitation Sciences Post Graduation Program, Belo Horizonte, MG, Brazil
| | - Raquel Rodrigues Britto
- Universidade Federal de Minas Gerais (UFMG), Department of Physical Therapy, Belo Horizonte, MG, Brazil
| | - Daniella Cunha Brandão
- Universidade Federal de Pernambuco (UFPE), Department of Physical Therapy, Recife, PE, Brazil
| | | | | | - Verônica Franco Parreira
- Universidade Federal de Minas Gerais (UFMG), Department of Physical Therapy, Belo Horizonte, MG, Brazil.
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Abstract
Integrative medicine (IM) has developed an increasingly significant role in health care worldwide, including cardiovascular diseases (CVD). This review describes the commonly used IM in CVD, with particular attention placed with dietary supplements and mind-body therapies. More rigorous research continues to be needed to determine the mechanisms and efficacy of IM cardiovascular morbidity and mortality. Health care providers will need to develop skills in open communication and nonjudgmental dialogue around IM use in discussing treatment plans with their patients.
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Affiliation(s)
- Darshan Mehta
- Osher Center for Integrative Medicine, Brigham and Women's Hospital, Harvard Medical School, 900 Commonwealth Avenue East, 3rd Floor, Boston, MA 02215, USA; Benson-Henry Institute for Mind-Body Medicine, Massachusetts General Hospital, 151 Merrimac Street, 4th Floor, Boston, MA 02114, USA.
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Alpert CM, Smith MA, Hummel SL, Hummel EK. Symptom burden in heart failure: assessment, impact on outcomes, and management. Heart Fail Rev 2018; 22:25-39. [PMID: 27592330 DOI: 10.1007/s10741-016-9581-4] [Citation(s) in RCA: 158] [Impact Index Per Article: 26.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Evidence-based management has improved long-term survival in patients with heart failure (HF). However, an unintended consequence of increased longevity is that patients with HF are exposed to a greater symptom burden over time. In addition to classic symptoms such as dyspnea and edema, patients with HF frequently suffer additional symptoms such as pain, depression, gastrointestinal distress, and fatigue. In addition to obvious effects on quality of life, untreated symptoms increase clinical events including emergency department visits, hospitalizations, and long-term mortality in a dose-dependent fashion. Symptom management in patients with HF consists of two key components: comprehensive symptom assessment and sufficient knowledge of available approaches to alleviate the symptoms. Successful treatment addresses not just the physical but also the emotional, social, and spiritual aspects of suffering. Despite a lack of formal experience during cardiovascular training, symptom management in HF can be learned and implemented effectively by cardiology providers. Co-management with palliative medicine specialists can add significant value across the spectrum and throughout the course of HF.
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Affiliation(s)
- Craig M Alpert
- Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Michael A Smith
- Department of Clinical Pharmacy, University of Michigan College of Pharmacy, Ann Arbor, MI, USA.,Department of Pharmacy Services, University of Michigan Health System, Ann Arbor, MI, USA
| | - Scott L Hummel
- Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, MI, USA.,VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - Ellen K Hummel
- VA Ann Arbor Healthcare System, Ann Arbor, MI, USA. .,Department of Internal Medicine, Division of Geriatric and Palliative Medicine, University of Michigan, Ann Arbor, MI, USA. .,University of Michigan Frankel Cardiovascular Center, 1500 East Medical Center Dr., SPC 5233, Ann Arbor, MI, 48109-5233, USA.
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Respiratory Muscle Weakness in Patients with Heart Failure: Time to Make It a Standard Clinical Marker and a Need for Novel Therapeutic Interventions? J Card Fail 2018; 24:217-218. [PMID: 29499323 DOI: 10.1016/j.cardfail.2018.02.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Revised: 02/16/2018] [Accepted: 02/16/2018] [Indexed: 12/19/2022]
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Wu J, Kuang L, Fu L. Effects of inspiratory muscle training in chronic heart failure patients: A systematic review and meta-analysis. CONGENIT HEART DIS 2018; 13:194-202. [PMID: 29423938 DOI: 10.1111/chd.12586] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Revised: 12/10/2017] [Accepted: 12/26/2017] [Indexed: 12/12/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the effects of inspiratory muscle training (IMT) in chronic heart failure (CHF) patients. DESIGN We searched MEDLINE, EMBASE, Cochrane Library, CINHAL, and CBMdisc to collect controlled trials on the application of inspiratory muscle training in CHF patients from the establishment of these databases to November 2016. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data, and assessed the quality of literature. Meta-analysis was conducted by software RevMan5.3. RESULTS Eight studies involving 302 patients were identified. Meta-analysis indicated that IMT significantly improved PImax , VE /VCO2 slope and dyspnea (weighted mean difference [WMD] = 16.52, 95% CI: 13.87-19.17, P < .01; WMD = -5.78, 95% CI: -7.72 to -3.85, P < .01; SMD = -0.95, 95% CI: -1.5 to -0.39, P < .01), and descriptive results showed that long-term IMT (≥6 weeks) can improve the quality of life of CHF patients, and patients in IMT group also have a significant improvement in 6-minute walking distance test (6-MWD). CONCLUSION IMT can improve pulmonary function, exercise tolerance, and quality of life of CHF patients and relieve the symptom of dyspnea.
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Affiliation(s)
- Jing Wu
- Shanghai Jiao Tong University School of Nursing, Shanghai, People's Republic of China
| | - Li Kuang
- Shanghai Jiao Tong University School of Nursing, Shanghai, People's Republic of China
| | - Lijuan Fu
- Department of Cardiothoracic Surgery, Shanghai Children's Medical Center Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
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28
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Wong ML, Anderson RG, Garcia K, Housmann EM, McHale E, Goldberger GS, Cahalin LP. The effect of inspiratory muscle training on respiratory variables in a patient with ankylosing spondylitis: A case report. Physiother Theory Pract 2017; 33:805-814. [PMID: 28715240 DOI: 10.1080/09593985.2017.1346023] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Ankylosing Spondylitis (AS) presents with both musculoskeletal and cardiorespiratory pathophysiological manifestations. Inspiratory muscle training (IMT) may be a useful intervention to address deficits in respiratory and functional status. CASE DESCRIPTION A 25-year-old male with AS initially sought treatment for low back and right hip pain, but 7 weeks of IMT was also provided due to abnormal respiratory performance. OUTCOMES At baseline, the patient presented with a resting respiratory rate (RR) of 14.5 breaths/minute, tidal volume (TV) of 0.76 L, minute ventilation (VE) of 10.87 L/min, and end tidal CO2 (PetCO2) of 30.56 mmHg. Baseline exercise test results revealed a VO2max of 44 ml/kg/min and VE to CO2 output (VE/VCO2) slope of 30. Baseline MIP, SMIP, and MEP were 54 cm H2O, 507 PTU, and 87 cm H2O, respectively, and increased to 176 cm H2O, 807 PTU, and 151 cm H2O, respectively, after IMT. The VO2max increased to 51 ml/kg/min with decreases in the VE/VCO2 slope (29), resting RR (12 breaths/minute), resting TV (0.52 L), and resting VE (6.83 L/min) after IMT. Improvements during postural challenges were also observed. DISCUSSION This case demonstrates the clinical utility of respiratory gas analysis and respiratory performance measures to identify functional deficits and manage a patient with AS. The improvements in respiratory performance at rest, during postural challenges, and during maximal exercise after a relatively short period of IMT highlights the role IMT may have to improve functional status in patients with AS. Further investigation of IMT in patients with AS is warranted.
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Affiliation(s)
- Marlon L Wong
- a Department of Physical Therapy , Leonard M. Miller School of Medicine, University of Miami , Miami , FL , USA
| | - Rachael G Anderson
- a Department of Physical Therapy , Leonard M. Miller School of Medicine, University of Miami , Miami , FL , USA
| | - Kelsey Garcia
- a Department of Physical Therapy , Leonard M. Miller School of Medicine, University of Miami , Miami , FL , USA
| | - Elissa M Housmann
- a Department of Physical Therapy , Leonard M. Miller School of Medicine, University of Miami , Miami , FL , USA
| | - Erin McHale
- a Department of Physical Therapy , Leonard M. Miller School of Medicine, University of Miami , Miami , FL , USA
| | - Gregory S Goldberger
- a Department of Physical Therapy , Leonard M. Miller School of Medicine, University of Miami , Miami , FL , USA
| | - Lawrence P Cahalin
- a Department of Physical Therapy , Leonard M. Miller School of Medicine, University of Miami , Miami , FL , USA
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29
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The role of the inspiratory muscle weakness in functional capacity in hemodialysis patients. PLoS One 2017; 12:e0173159. [PMID: 28278163 PMCID: PMC5344350 DOI: 10.1371/journal.pone.0173159] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2016] [Accepted: 02/15/2017] [Indexed: 12/20/2022] Open
Abstract
Introduction Inspiratory muscle function may be affected in patients with End-Stage Renal Disease (ESRD), further worsening the functional loss in these individuals. However, the impact of inspiratory muscle weakness (IMW) on the functional capacity (FC) of hemodialysis patients remains unknown. Thus, the present study aimed to evaluate the impact of IMW on FC in ESRD patients undergoing hemodialysis. Materials and methods ESRD patients on hemodialysis treatment for more than six months were evaluated for inspiratory muscle strength and FC. Inspiratory muscle strength was evaluated based on maximal inspiratory pressure (MIP). IMW was defined as MIP values less than 70% of the predicted value. FC was evaluated using the Incremental Shuttle Walk test (ISWT). Patients whose predicted peak oxygen uptake (VO2peak) over the distance walked during the ISWT was less than 16mL/kg/min were considered to have FC impairment. Associations between variables were assessed by linear and logistic regression, with adjustment for age, sex, body mass index (BMI), presence of diabetes and hemoglobin level. Receiver-operating characteristic (ROC) analysis was used to determine different cutoff values of the MIP for normal inspiratory muscle strength and FC. Results Sixty-five ERSD patients (67.7% male), aged 48.2 (44.5–51.9) years were evaluated. MIP was an independent predictor of the distance walked during the ISWT (R2 = 0.44). IMW was an independent predictor of VO2peak < 16mL/kg/min. (OR = 5.7; p = 0.048) in adjusted logistic regression models. ROC curves showed that the MIP cutoff value of 82cmH2O had a sensitivity of 73.5% and specificity of 93.7% in predicting normal inspiratory strength and a sensitivity and specificity of 76.3% and 70.4%, respectively, in predicting VO2peak ≥ 16mL/kg/min. Conclusions IMW is associated with reduced FC in hemodialysis patients. Evaluation of the MIP may be important to functional monitoring in clinical practice and can help in the stratification of patients eligible to perform exercise testing.
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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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Ding R. Exercise-Based Rehabilitation for Heart Failure: Clinical Evidence. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2017; 1000:31-49. [PMID: 29098614 DOI: 10.1007/978-981-10-4304-8_3] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
People with heart failure experience marked reduction in their exercise capacity which has detrimental effects on their activities of daily living, health-related quality of life, and ultimately their hospital ad-mission rate and mortality. Numerous cardiac rehabilitation studies have demonstrated functional benefits, improvement in quality of life and clinical outcomes from exercise training in patients with HFrEF. Based on evidences, the American College of Cardiology/American Heart Association, European Society of Cardiology, and National Institute for Health and Care Excellence(NICE) consistently recommend exercise-based cardiac rehabilitation(CR) as an effective and safe adjunct for patients with stable class II to III heart failure (HF) who do not have advanced arrhythmias and who do not have other limitations to exercise. This recommendation applies to patients with HFrEF as well as to patients with HFpEF besides patients with class IV HF, although the data are not as robust for patients with HFpEF. In this article, the clinical evidence on effects of exercise for HFrEF and HFpEF as well as end-stage heart failure were separately reviewed.
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Affiliation(s)
- Rongjing Ding
- Department of Cardiology, Peking University People's Hospital, Beijing, 100044, People's Republic of China.
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Physiological and functional failure in chronic obstructive pulmonary disease, congestive heart failure and cancer: a debilitating intersection of sarcopenia, cachexia and breathlessness. Curr Opin Support Palliat Care 2016; 10:236-41. [DOI: 10.1097/spc.0000000000000222] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Arena R, Lavie CJ, Borghi-Silva A, Daugherty J, Bond S, Phillips SA, Guazzi M. Exercise Training in Group 2 Pulmonary Hypertension: Which Intensity and What Modality. Prog Cardiovasc Dis 2015; 59:87-94. [PMID: 26569571 DOI: 10.1016/j.pcad.2015.11.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Accepted: 11/09/2015] [Indexed: 12/29/2022]
Abstract
Pulmonary hypertension (PH) due to left-sided heart disease (LSHD) is a common and disconcerting occurrence. For example, both heart failure (HF) with preserved and reduced ejection fraction (HFpEF and HFrEF) often lead to PH as a consequence of a chronic elevation in left atrial filling pressure. A wealth of literature demonstrates the value of exercise training (ET) in patients with LSHD, which is particularly robust in patients with HFrEF and growing in patients with HFpEF. While the effects of ET have not been specifically explored in the LSHD-PH phenotype (i.e., composite pathophysiologic characteristics of patients in this advanced disease state), the overall body of evidence supports clinical application in this subgroup. Moderate intensity aerobic ET significantly improves peak oxygen consumption, quality of life and prognosis in patients with HF. Resistance ET significantly improves muscle strength and endurance in patients with HF, which further enhance functional capacity. When warranted, inspiratory muscle training and neuromuscular electrical stimulation are becoming recognized as important components of a comprehensive rehabilitation program. This review will provide a detailed account of ET programing considerations in patients with LSHD with a particular focus on those concomitantly diagnosed with PH.
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Affiliation(s)
- Ross Arena
- Department of Physical Therapy and Integrative Physiology Laboratory, College of Applied Health Sciences, University of Illinois Chicago, Chicago, IL, USA.
| | - Carl J Lavie
- Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Clinical School - The University of Queensland School of Medicine, New Orleans, LA, USA
| | - Audrey Borghi-Silva
- Cardiopulmonary Physiotherapy Laboratory, Federal University of São Carlos, São Paulo, Brazil
| | - John Daugherty
- Department of Biomedical and Health Information Sciences, College of Applied Science, University of Illinois at Chicago, Chicago, IL, USA
| | - Samantha Bond
- Department of Biomedical and Health Information Sciences, College of Applied Science, University of Illinois at Chicago, Chicago, IL, USA
| | - Shane A Phillips
- Department of Physical Therapy and Integrative Physiology Laboratory, College of Applied Health Sciences, University of Illinois Chicago, Chicago, IL, USA
| | - Marco Guazzi
- Cardiology, I.R.C.C.S. Policlinico San Donato, University of Milano, San Donato Milanese, Milano, Italy
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Bordoni B, Marelli F. The fascial system and exercise intolerance in patients with chronic heart failure: hypothesis of osteopathic treatment. J Multidiscip Healthc 2015; 8:489-94. [PMID: 26586951 PMCID: PMC4634836 DOI: 10.2147/jmdh.s94702] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Chronic heart failure is a progressive, debilitating disease, resulting in a decline in the quality of life of the patient and incurring very high social economic costs. Chronic heart failure is defined as the inability of the heart to meet the demands of oxygen from the peripheral area. It is a multi-aspect complex disease which impacts negatively on all of the body systems. Presently, there are no texts in the modern literature that associate the symptoms of exercise intolerance of the patient with a dysfunction of the fascial system. In the first part of this article, we will discuss the significance of the disease, its causes, and epidemiology. The second part will explain the pathological adaptations of the myofascial system. The last section will outline a possible osteopathic treatment for patients with heart failure in order to encourage research and improve the general curative approach for the patient.
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Affiliation(s)
- Bruno Bordoni
- Don Carlo Gnocchi Foundation, Department of Cardiology, IRCCS Santa Maria Nascente, Milan, Italy ; School CRESO, Osteopathic Centre for Research and Studies, Falconara Marittima, AN, Italy ; School CRESO, Osteopathic Centre for Research and Studies, Castellanza, VA, Italy
| | - F Marelli
- School CRESO, Osteopathic Centre for Research and Studies, Falconara Marittima, AN, Italy ; School CRESO, Osteopathic Centre for Research and Studies, Castellanza, VA, Italy
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Myers J, Arena R, Cahalin LP, Labate V, Guazzi M. Cardiopulmonary Exercise Testing in Heart Failure. Curr Probl Cardiol 2015; 40:322-72. [DOI: 10.1016/j.cpcardiol.2015.01.009] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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