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Mizusawa H, Matsumoto H, Shiraishi M, Sugiya R, Takeda Y, Noguchi M, Kimura T, Ishikawa A, Nishiyama O, Higashimoto Y. Evaluation of patients with chronic obstructive pulmonary disease by maximal inspiratory pressure and diaphragmatic excursion with ultrasound sonography. Respir Investig 2024; 62:234-239. [PMID: 38237482 DOI: 10.1016/j.resinv.2023.12.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 12/13/2023] [Accepted: 12/28/2023] [Indexed: 02/24/2024]
Abstract
BACKGROUND Decreased respiratory muscle strength and muscle mass is key in diagnosing respiratory sarcopenia. However, the role of reduced diaphragm activity, expressed as the maximal level of diaphragmatic excursion (DEmax), in diagnosing respiratory sarcopenia in patients with chronic obstructive pulmonary disease (COPD) remains unclear. This study aimed to characterize patients with COPD and low DEmax and maximal inspiratory pressure (MIP), a measure of inspiratory muscle strength, and assess the role of DEmax in respiratory sarcopenia. METHODS Patients with COPD underwent spirometry, exercise tolerance (VO2peak) test, and MIP measurement. DEmax and sternocleidomastoid thickness at the maximal inspiratory level (TscmMIL) were assessed using ultrasound sonography. RESULTS Overall, 58 patients with COPD (median age, 76 years; median %FEV1, 51.3 %) were included, 28 of whom showed a %MIP of ≥80 %, defined as having preserved MIP. Based on the %MIP of 80 % and median value of DEmax (48.0 mm) as thresholds, the patients were stratified into four groups: both-high (n = 18), %MIP-alone low (n = 11), DEmax-alone low (n = 10), and both-low (n = 19) groups. The both-low group exhibited the lowest %FEV1, Δinspiratory capacity, VO2peak, and TscmMIL, and these values were significantly lower than those of the both-high group. Except for %FEV1, these values were significantly lower in the both-low group than in the %MIP-alone low group despite adjusting DEmax level for body mass index. CONCLUSION Measuring DEmax along with MIP can characterize patients with COPD, reduced exercise capacity, and decreased accessory respiratory muscle mass and can help diagnose respiratory sarcopenia.
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Affiliation(s)
- Hiroki Mizusawa
- Faculty of Medicine, Department of Rehabilitation Medicine, Kindai University Hospital, 377-2 Ohno-higashi, Osakasayama-city, 589-5811,Osaka-Sayama (Osaka Pref), Japan; Department of Public Health, Graduate School of Health Sciences, Kobe University, Kobe (Hyogo Pref), Japan. 7-10-2 Tomogaoka, Kobe-city, 654-0142, Japan.
| | - Hisako Matsumoto
- Faculty of Medicine, Department of Respiratory Medicine and Allergology, School of Medicine, Kindai University, Osaka-Sayama (Osaka Pref), Japan. 377-2 Ohno-higashi, Osakasayama-city, 589-5811, Japan
| | - Masashi Shiraishi
- Faculty of Medicine, Department of Rehabilitation Medicine, Kindai University Hospital, 377-2 Ohno-higashi, Osakasayama-city, 589-5811,Osaka-Sayama (Osaka Pref), Japan
| | - Ryuji Sugiya
- Faculty of Medicine, Department of Rehabilitation Medicine, Kindai University Hospital, 377-2 Ohno-higashi, Osakasayama-city, 589-5811,Osaka-Sayama (Osaka Pref), Japan
| | - Yu Takeda
- Faculty of Medicine, Department of Rehabilitation Medicine, Kindai University Hospital, 377-2 Ohno-higashi, Osakasayama-city, 589-5811,Osaka-Sayama (Osaka Pref), Japan
| | - Masaya Noguchi
- Faculty of Medicine, Department of Rehabilitation Medicine, Kindai University Hospital, 377-2 Ohno-higashi, Osakasayama-city, 589-5811,Osaka-Sayama (Osaka Pref), Japan
| | - Tamotsu Kimura
- Faculty of Medicine, Department of Rehabilitation Medicine, Kindai University Hospital, 377-2 Ohno-higashi, Osakasayama-city, 589-5811,Osaka-Sayama (Osaka Pref), Japan
| | - Akira Ishikawa
- Department of Public Health, Graduate School of Health Sciences, Kobe University, Kobe (Hyogo Pref), Japan. 7-10-2 Tomogaoka, Kobe-city, 654-0142, Japan
| | - Osamu Nishiyama
- Faculty of Medicine, Department of Respiratory Medicine and Allergology, School of Medicine, Kindai University, Osaka-Sayama (Osaka Pref), Japan. 377-2 Ohno-higashi, Osakasayama-city, 589-5811, Japan
| | - Yuji Higashimoto
- Faculty of Medicine, Department of Respiratory Medicine and Allergology, School of Medicine, Kindai University, Osaka-Sayama (Osaka Pref), Japan. 377-2 Ohno-higashi, Osakasayama-city, 589-5811, Japan; Faculty of Medicine, Department of Rehabilitation Medicine, School of Medicine, Kindai University, Osaka-Sayama (Osaka Pref), Japan. 377-2 Ohno-higashi, Osakasayama-city, 589-5811, Japan
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Dreessen L, Debain A, Lieten S, Bravenboer B, Vermeiren S, Vella-Azzopardi R, Knoop V, Costenoble A, Smeys C, Iranyeza RA, Van der Meulen KEY, Vanderhelst E, Schuermans D, Bautmans I. Respiratory Muscle Strength Is Related to Handgrip Performance in Community-Dwelling Persons Aged 80+ from the BUTTERFLY Study. Gerontology 2024; 70:526-535. [PMID: 38316117 DOI: 10.1159/000536361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 01/13/2024] [Indexed: 02/07/2024] Open
Abstract
INTRODUCTION This study aimed to evaluate the association of respiratory muscle strength with sarcopenia and its indicators in the oldest old. METHODS Maximum inspiratory pressure (MIP), maximum expiratory pressure (MEP), and sarcopenia-related factors (handgrip strength and appendicular lean mass) were evaluated in a cohort of n = 286 (45.5% female) non-frail, community-dwelling persons aged 83.6 ± 3.0 years (age range 80-97 years). RESULTS The sample presented a sarcopenia prevalence of 32.2%. Sarcopenic subjects showed comparable MIP and MEP as non-sarcopenic ones (female: MIP 43.9 ± 18.9 vs. 50.3 ± 19.5, p = 0.053; MEP 63.0 ± 23.0 vs. 69.2 ± 19.1, p = 0.067; male: MIP, 65.1 ± 24.4 vs. 64.4 ± 23.9, p = 0.433; MEP 87.7 ± 33.3 vs. 93.8 ± 30.9, p = 0.124). Statistically significant but very low associations were found between grip strength and MIP (r = 0.193 for male, p < 0.05 and r = 0.257 for female participants, p < 0.01) and MEP (r = 0.200 for male, p < 0.01 and r = 0.191 for female participants, p < 0.05). Lean mass was significantly correlated to MIP and MEP in female (r = 0.253, p < 0.01 and r = 0.343, p < 0.01, respectively), whereas this association was not found in male participants. Grip strength was the only statistically significant predictor of MEP (r2 = 0.212, p < 0.001), while MIP was independently predicted by age, male sex, and grip strength (r2 = 0.177, p < 0.001). CONCLUSIONS Peripheral muscle strength is a statistically significant, albeit weak predictor for respiratory muscle strength in well-functioning, community-dwelling persons aged 80+. When confronted to a low grip strength, one should be aware of concomitant respiratory muscle weakness, as this is a known risk factor for atelectasis and pneumonia. Given the relatively low association with handgrip strength, respiratory muscle strength testing might be indicated.
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Affiliation(s)
- Lisa Dreessen
- Department of Geriatric Medicine, Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium
| | - Aziz Debain
- Department of Geriatric Medicine, Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium
- Gerontology Department and Vrije Universiteit Brussel (VUB), Brussels, Belgium
- Frailty in Ageing (FRIA) Research Department, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Siddhartha Lieten
- Department of Geriatric Medicine, Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium
| | - Bert Bravenboer
- Department of Geriatric Medicine, Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium
| | - Sofie Vermeiren
- Gerontology Department and Vrije Universiteit Brussel (VUB), Brussels, Belgium
- Frailty in Ageing (FRIA) Research Department, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Roberta Vella-Azzopardi
- Gerontology Department and Vrije Universiteit Brussel (VUB), Brussels, Belgium
- Frailty in Ageing (FRIA) Research Department, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Veerle Knoop
- Gerontology Department and Vrije Universiteit Brussel (VUB), Brussels, Belgium
- Frailty in Ageing (FRIA) Research Department, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Axelle Costenoble
- Gerontology Department and Vrije Universiteit Brussel (VUB), Brussels, Belgium
- Frailty in Ageing (FRIA) Research Department, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Celeste Smeys
- Department of Geriatric Medicine, Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium
- Gerontology Department and Vrije Universiteit Brussel (VUB), Brussels, Belgium
- Frailty in Ageing (FRIA) Research Department, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Rock-Ange Iranyeza
- Department of Geriatric Medicine, Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium
- Gerontology Department and Vrije Universiteit Brussel (VUB), Brussels, Belgium
- Frailty in Ageing (FRIA) Research Department, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Kristof E Y Van der Meulen
- Department of Geriatric Medicine, Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium
- Gerontology Department and Vrije Universiteit Brussel (VUB), Brussels, Belgium
- Frailty in Ageing (FRIA) Research Department, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Eef Vanderhelst
- Department of Respiratory Medicine, Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium
| | - Daniel Schuermans
- Department of Respiratory Medicine, Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium
| | - Ivan Bautmans
- Department of Geriatric Medicine, Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium
- Gerontology Department and Vrije Universiteit Brussel (VUB), Brussels, Belgium
- Frailty in Ageing (FRIA) Research Department, Vrije Universiteit Brussel (VUB), Brussels, Belgium
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Santos AO, Fernandes MH, Pedreira RBS, Brito TA, Coqueiro RDS, Carneiro JAO. [Maximum expiratory pressure is a good predictor of the incidence of the frailty syndrome in elderly men]. CIENCIA & SAUDE COLETIVA 2022; 27:3249-3260. [PMID: 35894335 DOI: 10.1590/1413-81232022278.02562022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 04/26/2022] [Indexed: 11/22/2022] Open
Abstract
This article aims to investigate the association between maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP) with the incidence of frailty syndrome (FS), in addition to testing the predictive ability of MIP and MEP to discriminate FS in elderly adults, according to sex. It is a longitudinal study with a five-year follow-up period (2014-2019), carried out with 104 elderly adults registered in the Family Health Strategy of a municipality in Bahia. The incidence of frailty syndrome was diagnosed according to criteria proposed by Fried et al., using data from 2019, after a five-year follow-up. The MIP and MEP were evaluated according to the recommendations of the Brazilian Society of Pulmonology and Phthisiology data in 2014 (baseline data). The total incidence of frailty syndrome was 16.3% (95%CI: 9.2-23.6), with 13.6% (95%CI: 4.56-22.55) in women and 20% (95%CI: 7.85-32.15) in men. The mean values of MIP and MEP were, respectively, 60,8±21,2 cmH2O and 76,7±23,1 cmH2O in women, and 79,5±27,0 cmH2O and 114,7±29,8 cmH2O in men. The frailty syndrome was associated with MEP in elderly adult men (adjusted RR: 0.96; 95%CI: 0.95-0.98; P-value: 0.002), indicating that the increase of 1cmH2O in MEP reduces by 4% the risk of developing the syndrome.
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Affiliation(s)
- Ariana Oliveira Santos
- Universidade Estadual do Sudoeste da Bahia. Av. José Moreira Sobrinho s/n, Jequiezinho. 45205-490 Jequié BA Brasil.
| | - Marcos Henrique Fernandes
- Universidade Estadual do Sudoeste da Bahia. Av. José Moreira Sobrinho s/n, Jequiezinho. 45205-490 Jequié BA Brasil.
| | | | - Thaís Alves Brito
- Universidade Estadual do Sudoeste da Bahia. Av. José Moreira Sobrinho s/n, Jequiezinho. 45205-490 Jequié BA Brasil.
| | - Raildo da Silva Coqueiro
- Universidade Estadual do Sudoeste da Bahia. Av. José Moreira Sobrinho s/n, Jequiezinho. 45205-490 Jequié BA Brasil.
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Emanuelsson EB, Berry DB, Reitzner SM, Arif M, Mardinoglu A, Gustafsson T, Ward SR, Sundberg CJ, Chapman MA. MRI characterization of skeletal muscle size and fatty infiltration in long-term trained and untrained individuals. Physiol Rep 2022; 10:e15398. [PMID: 35854646 PMCID: PMC9296904 DOI: 10.14814/phy2.15398] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 06/21/2022] [Accepted: 07/02/2022] [Indexed: 06/15/2023] Open
Abstract
This study investigated body composition measures in highly trained and untrained individuals using whole-body magnetic resonance imaging (MRI). Additionally, correlations between these measures and skeletal muscle gene expression were performed. Thirty-six individuals were included: endurance-trained males (ME, n = 8) and females (FE, n = 7), strength-trained males (MS, n = 7), and untrained control males (MC, n = 8) and females (FC, n = 6). MRI scans were performed, and resting M. vastus lateralis (VL) biopsies were subjected to RNA sequencing. Liver fat fraction, visceral adipose tissue volume (VAT), total body fat, and total lean tissue were measured from MRI data. Additionally, cross-sectional area (CSA) and fat signal fraction (FSF) were calculated from Mm. pectoralis, M. erector spinae and M. multifidus combined, Mm. quadriceps, and Mm. triceps surae (TS). Liver fat fraction, VAT, and total body fat relative to body weight were lower in ME and FE compared with corresponding controls. MS had a larger CSA across all four muscle groups and lower FSF in all muscles apart from TS compared with MC. ME had a lower FSF across all muscle groups and a larger CSA in all muscles except TS than MC. FE athletes showed a higher CSA in Mm. pectoralis and Mm. quadriceps and a lower CSA in TS than FC with no CSA differences found in the back muscles investigated. Surprisingly, the only difference in FSF between FE and FC was found in Mm. pectoralis. Lastly, correlations between VL gene expression and VL CSA as well as FSF showed that genes positively correlated with CSA revealed an enrichment of the oxidative phosphorylation and thermogenesis pathways, while the genes positively correlated with FSF showed significant enrichment of the spliceosome pathway. Although limited differences were found with training in females, our study suggests that both regular endurance and resistance training are useful in maintaining muscle mass, reducing adipose tissue deposits, and reducing muscle fat content in males.
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Affiliation(s)
- Eric B. Emanuelsson
- Department of Physiology and PharmacologyKarolinska InstitutetStockholmSweden
| | - David B. Berry
- Department of NanoengineeringUniversity of California San DiegoLa JollaCaliforniaUSA
- Department of Orthopaedic SurgeryUniversity of California San DiegoLa JollaCaliforniaUSA
- Department of RadiologyUniversity of California San DiegoLa JollaCaliforniaUSA
| | - Stefan M. Reitzner
- Department of Physiology and PharmacologyKarolinska InstitutetStockholmSweden
- Department for Women's and Children's HealthKarolinska InstitutetStockholmSweden
| | - Muhammad Arif
- Science for Life LaboratoryKTH – Royal Institute of TechnologyStockholmSweden
| | - Adil Mardinoglu
- Science for Life LaboratoryKTH – Royal Institute of TechnologyStockholmSweden
- Centre for Host–Microbiome InteractionsFaculty of Dentistry, Oral & Craniofacial Sciences, King's College LondonLondonUK
| | - Thomas Gustafsson
- Department of Laboratory MedicineKarolinska InstitutetHuddingeSweden
- Unit of Clinical PhysiologyKarolinska University HospitalStockholmSweden
| | - Samuel R. Ward
- Department of Orthopaedic SurgeryUniversity of California San DiegoLa JollaCaliforniaUSA
- Department of RadiologyUniversity of California San DiegoLa JollaCaliforniaUSA
- Department of BioengineeringUniversity of California San DiegoLa JollaCaliforniaUSA
| | - Carl Johan Sundberg
- Department of Physiology and PharmacologyKarolinska InstitutetStockholmSweden
- Department of Laboratory MedicineKarolinska InstitutetHuddingeSweden
- Department of Learning, Informatics, Management and EthicsKarolinska InstitutetStockholmSweden
| | - Mark A. Chapman
- Department of Physiology and PharmacologyKarolinska InstitutetStockholmSweden
- Department of Integrated EngineeringUniversity of San DiegoSan DiegoCaliforniaUSA
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Bhammar DM, Balmain BN, Babb TG, Bernhardt V. Sex differences in the ventilatory responses to exercise in mild-moderate obesity. Exp Physiol 2022; 107:965-977. [PMID: 35771362 PMCID: PMC9357174 DOI: 10.1113/ep090309] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 06/20/2022] [Indexed: 11/08/2022]
Abstract
NEW FINDINGS What is the central question of the study? What are the sex differences in ventilatory responses during exercise in adults with obesity. What is the main finding and its importance? Tidal volume and expiratory flows are lower in females when compared with males at higher levels of ventilation despite small increases in end-expiratory lung volumes. Since dyspnea on exertion is a frequent complaint, particularly in females with obesity, careful attention should be paid to unpleasant respiratory symptoms and mechanical ventilatory constraints before prescribing exercise. ABSTRACT Obesity is associated with altered ventilatory responses, which may be exacerbated in females due to the functional consequences of sex-related morphological differences in the respiratory system. This study examined sex differences in ventilatory responses during exercise in adults with obesity. Healthy adults with obesity (n = 73; 48 females) underwent pulmonary function testing, underwater weighing, magnetic resonance imaging, a graded exercise test to exhaustion, and two constant work rate exercise tests; one at a fixed work rate (60W for females and 105W for males) and one at a relative intensity (50% of peak oxygen uptake, V̇O2peak ). Metabolic, respiratory, and perceptual responses were assessed during exercise. Compared with males, females used a smaller proportion of their ventilatory capacity at peak exercise (69.13 ± 14.49 vs. 77.41 ± 17.06 % maximum voluntary ventilation, P = 0.0374). Females also utilized a smaller proportion of their forced vital capacity (FVC) at peak exercise (tidal volume: 48.51±9.29 vs. 54.12±10.43 %FVC, P = 0.0218). End-expiratory lung volumes were 2-4% higher in females compared with males during exercise (P<0.05), while end-inspiratory lung volumes were similar. Since the males were initiating inspiration from a lower lung volume, they experienced greater expiratory flow limitation during exercise. Ratings of perceived breathlessness during exercise were similar between females and males at comparable levels of ventilation. In summary, sex differences in the manifestations of obestity-related mechanical ventilatory constraints were observed. Since dyspnea on exertion is a common complaint in patients with obesity, particularly in females, exercise prescriptions should be tailored with the goal of minimizing unpleasant respiratory sensations. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Dharini M Bhammar
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas and UT Southwestern Medical Center, Dallas, TX, USA.,Center for Tobacco Research, Division of Medical Oncology, Department of Internal Medicine, The Ohio State University, Columbus, OH, USA
| | - Bryce N Balmain
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas and UT Southwestern Medical Center, Dallas, TX, USA
| | - Tony G Babb
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas and UT Southwestern Medical Center, Dallas, TX, USA
| | - Vipa Bernhardt
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas and UT Southwestern Medical Center, Dallas, TX, USA.,Department of Health & Human Performance, Texas A&M University - Commerce, Commerce, TX, USA
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Effect of Test Interface on Respiratory Muscle Activity and Pulmonary Function During Respiratory Testing in Healthy Adults. Cardiopulm Phys Ther J 2022; 33:87-95. [PMID: 36148286 PMCID: PMC9488548 DOI: 10.1097/cpt.0000000000000183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Purpose The mouthpiece is the standard interface for spirometry tests. Although the use of a mouthpiece can be challenging for patients with orofacial weakness, maintaining a proper seal with a facemask can be an issue for healthy individuals during forceful efforts. We compared respiratory muscle activity and tests using a mouthpiece and facemask in healthy adults to investigate whether they can be used interchangeably. Methods In this observational study, subjects (n=12) completed forced vital capacity, maximal respiratory pressure, and peak cough flow with a mouthpiece and facemask. Root mean square values of the genioglossus, diaphragm, scalene, and sternocleidomastoid were compared between conditions. Results When switching from a mouthpiece to a facemask, significantly higher values were seen for peak cough flow (average bias= -54.36 L/min, p<0.05) and the difference seen with MEP and MIP were clinically significant (average bias: MEP=27.33, MIP=-5.2). Additionally, submental activity was significantly greater when MIP was conducted with a mouthpiece. No significant differences were seen in respiratory muscle activity during resting breathing or spirometry. Conclusion There are clinically significant differences with cough and MEP tests and neck muscles are activated differently based on interface. Considering the small sample size, our findings suggest a facemask may be used to complete some PFTs.
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Sajjadi E, Seven YB, Ehrbar JG, Wymer JP, Mitchell GS, Smith BK. Acute intermittent hypoxia and respiratory muscle recruitment in people with amyotrophic lateral sclerosis: A preliminary study. Exp Neurol 2022; 347:113890. [PMID: 34624328 PMCID: PMC9488543 DOI: 10.1016/j.expneurol.2021.113890] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 09/28/2021] [Accepted: 10/03/2021] [Indexed: 01/03/2023]
Abstract
Respiratory failure is the main cause of death in amyotrophic lateral sclerosis (ALS). Since no effective treatments to preserve independent breathing are available, there is a critical need for new therapies to preserve or restore breathing ability. Since acute intermittent hypoxia (AIH) elicits spinal respiratory motor plasticity in rodent ALS models, and may restore breathing ability in people with ALS, we performed a proof-of-principle study to investigate this possibility in ALS patients. Quiet breathing, sniff nasal inspiratory pressure (SNIP) and maximal inspiratory pressure (MIP) were tested in 13 persons with ALS and 10 age-matched controls, before and 60 min post-AIH (15, 1 min episodes of 10% O2, 2 min normoxic intervals) or sham AIH (continuous normoxia). The root mean square (RMS) of the right and left diaphragm, 2nd parasternal, scalene and sternocleidomastoid muscles were monitored. A vector analysis was used to calculate summated vector magnitude (Mag) and similarity index (SI) of collective EMG activity during quiet breathing, SNIP and MIP maneuvers. AIH facilitated tidal volume and minute ventilation (treatment main effects: p < 0.05), and Mag (ie. collective respiratory muscle activity; p < 0.001) during quiet breathing in ALS and control subjects, but there was no effect on SI during quiet breathing. SNIP SI decreased in both groups post-AIH (p < 0.005), whereas Mag was unchanged (p = 0.09). No differences were observed in SNIP or MIP post AIH in either group. Discomfort was not reported during AIH by any subject, nor were adverse events observed. Thus, AIH may be a safe way to increase collective inspiratory muscle activity during quiet breathing in ALS patients, although a single AIH presentation was not sufficient to significantly increase peak inspiratory pressure generation. These preliminary results provide evidence that AIH may improve breathing function in people with ALS, and that future studies of prolonged, repetitive AIH protocols are warranted.
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Affiliation(s)
- Elaheh Sajjadi
- Breathing Research and Therapeutics Center, University of Florida, Gainesville, FL, USA, 32610,McKnight Brain Institute, University of Florida, Gainesville, FL, USA, 32610,Department of Physical Therapy, University of Florida, Gainesville, FL, USA, 32610
| | - Yasin B. Seven
- Breathing Research and Therapeutics Center, University of Florida, Gainesville, FL, USA, 32610,McKnight Brain Institute, University of Florida, Gainesville, FL, USA, 32610,Department of Physical Therapy, University of Florida, Gainesville, FL, USA, 32610
| | - Jessica G Ehrbar
- Department of Physical Therapy, University of Florida, Gainesville, FL, USA, 32610
| | - James P. Wymer
- Breathing Research and Therapeutics Center, University of Florida, Gainesville, FL, USA, 32610,McKnight Brain Institute, University of Florida, Gainesville, FL, USA, 32610,Neurology, University of Florida, Gainesville, FL, USA, 32610
| | - Gordon S. Mitchell
- Breathing Research and Therapeutics Center, University of Florida, Gainesville, FL, USA, 32610,McKnight Brain Institute, University of Florida, Gainesville, FL, USA, 32610,Department of Physical Therapy, University of Florida, Gainesville, FL, USA, 32610
| | - Barbara K. Smith
- Breathing Research and Therapeutics Center, University of Florida, Gainesville, FL, USA, 32610,Department of Physical Therapy, University of Florida, Gainesville, FL, USA, 32610,Pediatrics, University of Florida, Gainesville, FL, USA, 32610
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Malone IG, Nosacka RL, Nash MA, Otto KJ, Dale EA. Electrical epidural stimulation of the cervical spinal cord: implications for spinal respiratory neuroplasticity after spinal cord injury. J Neurophysiol 2021; 126:607-626. [PMID: 34232771 PMCID: PMC8409953 DOI: 10.1152/jn.00625.2020] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 06/07/2021] [Accepted: 06/27/2021] [Indexed: 01/15/2023] Open
Abstract
Traumatic cervical spinal cord injury (cSCI) can lead to damage of bulbospinal pathways to the respiratory motor nuclei and consequent life-threatening respiratory insufficiency due to respiratory muscle paralysis/paresis. Reports of electrical epidural stimulation (EES) of the lumbosacral spinal cord to enable locomotor function after SCI are encouraging, with some evidence of facilitating neural plasticity. Here, we detail the development and success of EES in recovering locomotor function, with consideration of stimulation parameters and safety measures to develop effective EES protocols. EES is just beginning to be applied in other motor, sensory, and autonomic systems; however, there has only been moderate success in preclinical studies aimed at improving breathing function after cSCI. Thus, we explore the rationale for applying EES to the cervical spinal cord, targeting the phrenic motor nucleus for the restoration of breathing. We also suggest cellular/molecular mechanisms by which EES may induce respiratory plasticity, including a brief examination of sex-related differences in these mechanisms. Finally, we suggest that more attention be paid to the effects of specific electrical parameters that have been used in the development of EES protocols and how that can impact the safety and efficacy for those receiving this therapy. Ultimately, we aim to inform readers about the potential benefits of EES in the phrenic motor system and encourage future studies in this area.
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Affiliation(s)
- Ian G Malone
- Department of Electrical and Computer Engineering, University of Florida, Gainesville, Florida
- Breathing Research and Therapeutics Center (BREATHE), University of Florida, Gainesville, Florida
| | - Rachel L Nosacka
- Department of Physiology and Functional Genomics, University of Florida, Gainesville, Florida
| | - Marissa A Nash
- Department of Physiology and Functional Genomics, University of Florida, Gainesville, Florida
| | - Kevin J Otto
- Department of Electrical and Computer Engineering, University of Florida, Gainesville, Florida
- Breathing Research and Therapeutics Center (BREATHE), University of Florida, Gainesville, Florida
- J. Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, Gainesville, Florida
- Department of Neuroscience, University of Florida, Gainesville, Florida
- Department of Neurology, University of Florida, Gainesville, Florida
- Department of Materials Science and Engineering, University of Florida, Gainesville, Florida
- McKnight Brain Institute, University of Florida, Gainesville, Florida
| | - Erica A Dale
- Breathing Research and Therapeutics Center (BREATHE), University of Florida, Gainesville, Florida
- Department of Physiology and Functional Genomics, University of Florida, Gainesville, Florida
- Department of Neuroscience, University of Florida, Gainesville, Florida
- McKnight Brain Institute, University of Florida, Gainesville, Florida
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Stępień A, Osiak T, Rekowski W, Wit A. Neck and Trunk Muscle Strength in Children With Spinal Muscular Atrophy Is Lower Than in Healthy Controls and Depends on Disease Type. Front Neurol 2021; 12:628414. [PMID: 33995241 PMCID: PMC8120107 DOI: 10.3389/fneur.2021.628414] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 03/16/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Neck and trunk muscle strength and relationship with motor function in individuals with spinal muscular atrophy (SMA) is not investigated well. Information on maximum muscle strength that children with SMA may develop considerably expands the possibilities of assessing the effectiveness of pharmacological treatment methods and therapeutic procedures. This study sought to assess neck and trunk muscle strength in patients with SMA and to compare it with values noted in healthy children. Methods: The study involved 56 individuals with SMA aged 5–16 not treated pharmacologically, including 9 patients with SMA type 1 (SMA1), 27 with SMA type 2 (SMA2), and 20 with SMA type 3 (SMA3). The control group included 111 healthy individuals aged 5–16. Neck and trunk muscle strength was assessed by means of a maximum voluntary isometric contraction method with the use of a handheld digital muscle tester MICROFET2. Moreover, relative strength was also calculated by standardising the maximum voluntary isometric contraction according to body mass. The Kruskal–Wallis test, Mann–Whitney U-test, and Spearman's rank correlation were used for statistical analysis. Results: The reliability of the neck and trunk muscle strength measurements with the handheld digital muscle tester was excellent with ICC > 0.9. The values of muscle strength in SMA groups were significantly lower than in the control group. The values of relative torque of the neck muscles expressed in percentage values calculated with regard to the control group were at the level of 47.6–51.6% in SMA1 group, 54.8–58.1% in SMA2 group and 80.6–90.3% in SMA3 group. The percentage values for upper and lower trunk muscle strength were at the level of 42.6–68.4% in SMA1 group, 56.9–75.4% in SMA2 group and 76.7–94.8% in SMA3 group. Conclusion: Handheld dynamometry provides reliable measures of neck and trunk muscle strength in SMA children. Neck and trunk muscle strength in children with SMA is lower than in healthy controls and depends on disease type, which confirms the theory based on clinical observations. Further, study is needed to investigate the effect of pharmacological treatment on the strength of the neck/trunk muscles, and relationship between neck and trunk muscle strength and motor capabilities.
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Affiliation(s)
- Agnieszka Stępień
- Department of Rehabilitation, Józef Piłsudski University of Physical Education, Warsaw, Poland.,ORTHOS Functional Rehabilitation Centre, Warsaw, Poland
| | - Tomasz Osiak
- Department of Rehabilitation, Józef Piłsudski University of Physical Education, Warsaw, Poland
| | - Witold Rekowski
- Department of Rehabilitation, Józef Piłsudski University of Physical Education, Warsaw, Poland
| | - Andrzej Wit
- Department of Rehabilitation, Józef Piłsudski University of Physical Education, Warsaw, Poland
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Davidson J, Tsopanoglou SP, Dourado VZ, Nunes Dos Santos AM, Goulart AL, Amorim CF, Solé D. Pattern of respiratory muscle activity during exercise tests in children born prematurely. J Bodyw Mov Ther 2020; 24:78-83. [PMID: 32826012 DOI: 10.1016/j.jbmt.2020.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Preterm children display only slightly lower exercise capacity than term children do during their development, despite their previous cardiopulmonary impairments. This raises doubts about the role of the respiratory muscles' influence on exercise capacity. This study aimed to compare respiratory muscle activity in preterm and term children using an exercise test. METHODS This cross-sectional study involved comparison of 35 term children and 39 matched preterm children aged 6-9 years, who were born prematurely with a birth weight <1500 g. An adapted treadmill incremental test was utilized and surface electromyography of the sternocleidomastoid (SCM), upper trapezius (UT), and rectus abdominis (RA) muscles was performed. The root mean square was calculated every minute and compared between and within groups. A Monte Carlo simulation was also applied, and the area under the curve was calculated to evaluate the differences between groups. RESULTS During the entire exercise, the SCM muscle activity was higher in preterm children with a larger area under the curve than in the term children. There was no difference in the RA and UT muscle activity between groups throughout the test. CONCLUSION The results suggest a greater contribution of the SCM muscle sin preterm children's performance than in term children's performance during high-intensity exercises. TRIAL REGISTRATION Brazilian Clinical Trial Registry (ReBec) - RBR-89hr2h.
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Affiliation(s)
- Josy Davidson
- Neonatal Division, Department of Pediatrics, Federal University of São Paulo, São Paulo, SP, Brazil.
| | | | - Victor Zuniga Dourado
- Department of Human Movement Sciences, Laboratory of Human Motricity, Federal University of São Paulo, Santos, SP, Brazil
| | | | - Ana Lucia Goulart
- Neonatal Division, Department of Pediatrics, Federal University of São Paulo, São Paulo, SP, Brazil
| | - Cesar Ferreira Amorim
- Physical Therapy Master Program, University of the City of Sao Paulo (UNICID), São Paulo, Brazil
| | - Dirceu Solé
- Allergy, Clinical Immunology and Rheumatology Division, Department of Pediatrics, Federal University of São Paulo, São Paulo, SP, Brazil
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Sekiguchi H, Minei A, Noborikawa M, Kondo Y, Tamaki Y, Fukuda T, Hanashiro K, Kukita I. Difference in electromyographic activity between the trapezius muscle and other neck accessory muscles under an increase in inspiratory resistive loading in the supine position. Respir Physiol Neurobiol 2020; 281:103509. [PMID: 32739461 DOI: 10.1016/j.resp.2020.103509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 07/26/2020] [Accepted: 07/27/2020] [Indexed: 10/23/2022]
Abstract
The activity of the trapezius muscle is reportedly higher than that of other neck accessory muscles under a condition of increased inspiratory pressure in the standing position. The present study aimed to compare the activity of the trapezius muscle with those of the scalene and sternocleidomastoid muscles under a condition of increased inspiratory pressure in the supine position. This study included 40 subjects, and the muscle activity was measured using surface electromyography. Regarding the results, there was a significant difference in the muscle activity between the trapezius muscle and the scalene and sternocleidomastoid muscles (p = 0.003) in both men and women. Post-hoc analysis showed significant differences between trapezius and the other muscles. Moreover, there was no difference between the scalene and sternocleidomastoid muscles (p = 0.596). The increase in the change in electromyography activity of the muscle is greater in the trapezius muscle than in other muscles when the level of inspiratory pressure increases in the supine position.
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Affiliation(s)
- Hiroshi Sekiguchi
- Department of Emergency and Critical Care Medicine, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan.
| | - Akira Minei
- Department of Rehabilitation, University of the Ryukyu Hospital, Okinawa, Japan
| | - Masako Noborikawa
- Department of Laboratory, Tomishiro Central Hospital, Okinawa, Japan
| | - Yutaka Kondo
- Department of Emergency Medicine, Juntendo University Urayasu Hospital, Chiba, Japan
| | - Yuichiro Tamaki
- Department of Emergency and Critical Care Medicine, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Tatsuma Fukuda
- Department of Emergency and Critical Care Medicine, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Kazuhiko Hanashiro
- Department of Nursing, Faculty of Human Health Sciences, Meio University, Okinawa, Okinawa, Japan
| | - Ichiro Kukita
- Department of Emergency and Critical Care Medicine, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
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