1
|
Aktan R, Tertemiz KC, Yiğit S, Özalevli S, Ozgen Alpaydin A, Uçan ES. Effects of home-based telerehabilitation-assisted inspiratory muscle training in patients with idiopathic pulmonary fibrosis: A randomized controlled trial. Respirology 2024. [PMID: 39129185 DOI: 10.1111/resp.14810] [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: 03/05/2024] [Accepted: 07/24/2024] [Indexed: 08/13/2024]
Abstract
BACKGROUND AND OBJECTIVE There are few studies that have used inspiratory muscle training (IMT) as an intervention for patients with isolated idiopathic pulmonary fibrosis (IPF). This study aimed to investigate and interpret the effects of home-based telerehabilitation-assisted IMT in patients with IPF. METHODS Twenty-eight participants with IPF took part in the study. Lung function tests, functional exercise capacity by 6-min walk distance (6MWD), dyspnoea perception by modified medical research council dyspnoea scale (mMRC), and inspiratory muscle strength by maximal inspiratory pressure (MIP) were assessed. IMT was performed twice a day, 7 days/week, for 8 weeks. The intervention group (n = 14) performed IMT at 50% of their baseline MIP while the control group (n = 14) performed IMT without applied resistance. Loading intensity was progressed by keeping the load at 4-6 on a modified Borg scale for the highest tolerable perceived respiratory effort for each patient. RESULTS Dyspnoea based on mMRC score (p < 0.001, η2 effect size = 0.48) significantly decreased within the intervention group compared with the control group. There were significant increases in the intervention group compared to the control group based on 6MWD (p < 0.001, η2 effect size = 0.43), MIP (p = 0.006, η2 effect size = 0.25) and MIP % predicted (p = 0.008, η2 effect size = 0.25). CONCLUSION The findings of this study suggest that an 8-week home-based telerehabilitation-assisted IMT intervention produced improvements in inspiratory muscle strength, leading to improvements in functional exercise capacity and dyspnoea.
Collapse
Affiliation(s)
- Rıdvan Aktan
- Department of Physiotherapy, Izmir University of Economics, Izmir, Turkey
| | - Kemal Can Tertemiz
- Department of Chest Diseases, Faculty of Medicine, Dokuz Eylül University, Izmir, Turkey
| | - Salih Yiğit
- Department of Chest Diseases, Faculty of Medicine, Dokuz Eylül University, Izmir, Turkey
| | - Sevgi Özalevli
- Faculty of Physical Therapy and Rehabilitation, Dokuz Eylül University, Izmir, Turkey
| | - Aylin Ozgen Alpaydin
- Department of Chest Diseases, Faculty of Medicine, Dokuz Eylül University, Izmir, Turkey
| | - Eyüp Sabri Uçan
- Department of Chest Diseases, Faculty of Medicine, Dokuz Eylül University, Izmir, Turkey
| |
Collapse
|
2
|
Hoffman M. Inspiratory muscle training in interstitial lung disease: a systematic scoping review. J Bras Pneumol 2021; 47:e20210089. [PMID: 34495175 PMCID: PMC8979670 DOI: 10.36416/1806-3756/e20210089] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Accepted: 04/28/2021] [Indexed: 11/25/2022] Open
Abstract
Inspiratory muscle training (IMT) has been described as one of the components of the treatment of chronic lung conditions such as obstructive and restrictive lung diseases. Although the number of studies showing results of IMT in patients with interstitial lung disease (ILD) is scarce when compared with studies in patients with COPD, evidence points to benefits of IMT in this population. This scoping review aimed to explore the role and the rationale of IMT in patients with ILD and to gather recent evidence on the effects of IMT in this population. The studies included in this review showed improvements in respiratory muscle function, quality of life, exercise capacity and dyspnea after ILD patients participated in programs that included stand-alone IMT or combined with pulmonary rehabilitation. There is still a gap in the literature to allow a clear conclusion on the indications of IMT as part of ILD treatment because of poor research design and small numbers of participants. Therefore, although IMT seems to have a positive effect in patients with ILD, current evidence prevents us from drawing a definite conclusion. Further studies need to be conducted using better research methodology to demonstrate and confirm the positive effects of IMT.
Collapse
Affiliation(s)
- Mariana Hoffman
- . Department of Allergy, Immunology and Respiratory Medicine, Monash University, Melbourne (VIC) Australia
| |
Collapse
|
3
|
Archiza B, Welch JF, Geary CM, Allen GP, Borghi-Silva A, Sheel AW. Temporal characteristics of exercise-induced diaphragmatic fatigue. J Appl Physiol (1985) 2017; 124:906-914. [PMID: 29357497 DOI: 10.1152/japplphysiol.00942.2017] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
There is evidence suggesting diaphragmatic fatigue (DF) occurs relatively early during high-intensity exercise; however, studies investigating the temporal characteristics of exercise-induced DF are limited by incongruent methodology. Eight healthy adult males (25 ± 5 yr) performed a maximal incremental exercise test on a cycle ergometer on day 1. A constant-load time-to-exhaustion (TTE) exercise test was conducted on day 2 at 60% delta between the calculated gas exchange threshold and peak work rate. Two additional constant-load exercise tests were performed at the same intensity on days 3 and 4 in a random order to either 50 or 75% TTE. DF was assessed on days 2, 3, and 4 by measuring transdiaphragmatic twitch pressure (Pdi,tw) in response to cervical magnetic stimulation. DF was present after 75 and 100% TTE (≥20% decrease in Pdi,tw). The magnitude of fatigue was 15.5 ± 5.7%, 23.6 ± 6.4%, and 35.0 ± 12.1% at 50, 75, and 100% TTE, respectively. Significant differences were found between 100 to 75 and 50% TTE (both P < 0.01), and 75 to 50% TTE ( P < 0.01). There was a significant relationship between the magnitude of fatigue and cumulative diaphragm force output ( r = 0.785; P < 0.001). Ventilation, the mechanical work of breathing (WOB), and pressure-time products were not different between trials ( P > 0.05). Our data indicate that exercise-induced DF presents a relatively late onset and is proportional to the cumulative WOB; thus the ability of the diaphragm to generate pressure progressively declines throughout exercise. NEW & NOTEWORTHY The notion that diaphragmatic fatigue (DF) occurs relatively early during exercise is equivocal. Our results indicate that DF occurs during high-intensity endurance exercise in healthy men and its magnitude is strongly related to the amount of pressure and work generated by respiratory muscles. Thus we conclude that the work of breathing is the major determinant of exercise-induced DF.
Collapse
Affiliation(s)
- Bruno Archiza
- School of Kinesiology, University of British Columbia , Vancouver, British Columbia , Canada.,Department of Physical Therapy, Federal University of São Carlos, São Carlos, São Paolo, Brazil
| | - Joseph F Welch
- School of Kinesiology, University of British Columbia , Vancouver, British Columbia , Canada
| | - Caitlin M Geary
- School of Kinesiology, University of British Columbia , Vancouver, British Columbia , Canada
| | - Grayson P Allen
- School of Kinesiology, University of British Columbia , Vancouver, British Columbia , Canada
| | - Audrey Borghi-Silva
- Department of Physical Therapy, Federal University of São Carlos, São Carlos, São Paolo, Brazil
| | - A William Sheel
- School of Kinesiology, University of British Columbia , Vancouver, British Columbia , Canada
| |
Collapse
|
4
|
Abstract
During dynamic exercise, the healthy pulmonary system faces several major challenges, including decreases in mixed venous oxygen content and increases in mixed venous carbon dioxide. As such, the ventilatory demand is increased, while the rising cardiac output means that blood will have considerably less time in the pulmonary capillaries to accomplish gas exchange. Blood gas homeostasis must be accomplished by precise regulation of alveolar ventilation via medullary neural networks and sensory reflex mechanisms. It is equally important that cardiovascular and pulmonary system responses to exercise be precisely matched to the increase in metabolic requirements, and that the substantial gas transport needs of both respiratory and locomotor muscles be considered. Our article addresses each of these topics with emphasis on the healthy, young adult exercising in normoxia. We review recent evidence concerning how exercise hyperpnea influences sympathetic vasoconstrictor outflow and the effect this might have on the ability to perform muscular work. We also review sex-based differences in lung mechanics.
Collapse
Affiliation(s)
- Andrew William Sheel
- The School of Kinesiology, The University of British Columbia, Vancouver, Canada.
| | | |
Collapse
|
5
|
Biometric approximation of diaphragmatic contractility during sustained hyperpnea. Respir Physiol Neurobiol 2011; 176:90-7. [DOI: 10.1016/j.resp.2011.01.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2010] [Revised: 01/26/2011] [Accepted: 01/27/2011] [Indexed: 11/20/2022]
|
6
|
Walker DJ, Walterspacher S, Schlager D, Ertl T, Roecker K, Windisch W, Kabitz HJ. Characteristics of diaphragmatic fatigue during exhaustive exercise until task failure. Respir Physiol Neurobiol 2011; 176:14-20. [DOI: 10.1016/j.resp.2011.01.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2010] [Revised: 01/11/2011] [Accepted: 01/24/2011] [Indexed: 10/18/2022]
|
7
|
Kabitz HJ, Walker D, Schwoerer A, Walterspacher S, Sonntag F, Schlager D, Roecker K, Windisch W. Diaphragmatic fatigue is counterbalanced during exhaustive long-term exercise. Respir Physiol Neurobiol 2010; 172:106-13. [DOI: 10.1016/j.resp.2010.04.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2009] [Revised: 04/29/2010] [Accepted: 04/30/2010] [Indexed: 10/19/2022]
|
8
|
Verges S, Renggli AS, Notter DA, Spengler CM. Effects of different respiratory muscle training regimes on fatigue-related variables during volitional hyperpnoea. Respir Physiol Neurobiol 2009; 169:282-90. [DOI: 10.1016/j.resp.2009.09.005] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2009] [Revised: 09/04/2009] [Accepted: 09/07/2009] [Indexed: 10/20/2022]
|
9
|
Abstract
Over the past 13 years, Noakes and his colleagues have argued repeatedly for the existence of a 'Central Governor', a specific brain centre that provides a feed-forward regulation of the intensity of vigorous effort in order to conserve homeostasis, protecting vital organs such as the brain, heart and skeletal muscle against damage from hyperthermia, ischaemia and other manifestations of catastrophic failure. This brief article reviews evidence concerning important corollaries of the hypothesis, examining the extent of evolutionary pressures for the development of such a mechanism, the effectiveness of protection against hyperthermia and ischaemia during exhausting exercise, the absence of peripheral factors limiting peak performance (particularly a plateauing of cardiac output and oxygen consumption) and proof that electromyographic activity is limiting exhausting effort. As yet, there is a lack of convincing experimental evidence to support these corollaries of the hypothesis; furthermore, some findings, such as the rather consistent demonstration of an oxygen consumption plateau in young adults, argue strongly against the limiting role of a 'Central Governor'.
Collapse
Affiliation(s)
- Roy J Shephard
- Faculty of Physical Education and Health, University of Toronto, Toronto, Ontario, Canada.
| |
Collapse
|
10
|
Kabitz HJ, Walker D, Sonntag F, Walterspacher S, Kirchberger A, Burgardt V, Roecker K, Windisch W. Post-exercise diaphragm shielding: A novel approach to exercise-induced diaphragmatic fatigue. Respir Physiol Neurobiol 2008; 162:230-7. [DOI: 10.1016/j.resp.2008.07.022] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2008] [Revised: 07/23/2008] [Accepted: 07/24/2008] [Indexed: 10/21/2022]
|
11
|
Independence of exercise-induced diaphragmatic fatigue from ventilatory demands. Respir Physiol Neurobiol 2008; 161:101-7; discussion 108-10. [DOI: 10.1016/j.resp.2007.11.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2007] [Revised: 11/10/2007] [Accepted: 11/16/2007] [Indexed: 11/21/2022]
|
12
|
Noakes TD. Commentary on “Independence of exercise-induced diaphragmatic fatigue from ventilatory demands” by Kabitz et al. Respir Physiol Neurobiol 2008. [DOI: 10.1016/j.resp.2007.12.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
|
13
|
Kabitz HJ, Walker D, Prettin S, Walterspacher S, Sonntag F, Dreher M, Windisch W. Non-invasive ventilation applied for recovery from exercise-induced diaphragmatic fatigue. Open Respir Med J 2008; 2:16-21. [PMID: 19340320 PMCID: PMC2606644 DOI: 10.2174/1874306400802010016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2007] [Revised: 01/25/2008] [Accepted: 02/01/2008] [Indexed: 11/25/2022] Open
Abstract
Background: Exercise-induced diaphragmatic fatigue (DF) is conventionally considered to reflect impaired diaphragm function resulting from load imposed on the diaphragm during exercise and is known to be reduced by the application of non-invasive ventilation (NIV) during heavy-intensity exercise testing (HEET). On that physiological condition NIV applied for diaphragm unloading during recovery from exercise should be capable of accelerating recovery from DF and therewith prolonging exercise time to exhaustion and limiting the development of DF during a subsequent HEET compared to recovery during spontaneous breathing. Methods: Seven highly-trained subjects (V’O2max 62.7±7.8 ml/kg/min) performed four HEET at 85% V’O2max with 60 min of recovery during I spontaneous breathing and II NIV between two HEET. Results: Twitch transdiaphragmatic pressure (TwPdi) during supramaximal magnetic phrenic nerve stimulation decreased (p<0.04) following first HEET and subsequently completely recovered (p>0.2) during I and II. Following second HEET TwPdi comparably decreased (I 0.24±0.21 vs II 0.32±0.29 kPa; p=0.17). Exercise time to exhaustion during second HEET was equal during I and II (I 514±49 vs II 511±92 s; p=0.88). Conclusions: In conclusion, NIV applied for diaphragm unloading during recovery following HEET does neither affect recovery from DF nor subsequent exercise performance thereby providing further evidence that DF might reflect post-exercise diaphragm shielding rather than impaired diaphragm function.
Collapse
Affiliation(s)
- Hans-Joachim Kabitz
- Department of Pneumologya, University Hospital Freiburg, Killianstrasse 5, D-79106 Freiburg, Germany.
| | | | | | | | | | | | | |
Collapse
|
14
|
|
15
|
Noakes TD, Marino FE. Arterial oxygenation, central motor output and exercise performance in humans. J Physiol 2007; 585:919-21; author reply 923-4. [PMID: 17962324 DOI: 10.1113/jphysiol.2007.145110] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
|