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Metcalfe RS, Swinton PA, Mackintosh KA, Berg RMG, Shelley J, Saynor ZL, Hudson J, Duckers J, Lewis K, Davies GA, McNarry MA. Heterogeneous Treatment Effects after Inspiratory Muscle Training during Recovery from Postacute COVID-19 Syndrome. Med Sci Sports Exerc 2023; 55:1761-1769. [PMID: 37170947 DOI: 10.1249/mss.0000000000003207] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
PURPOSE The objective of this study is to investigate whether heterogeneous treatment effects occur for changes in inspiratory muscle strength, perceived dyspnea, and health-related quality of life after 8 wk of unsupervised home-based inspiratory muscle training (IMT) in adults with postacute coronavirus disease 2019 (COVID-19) syndrome. METHODS In total, 147 adults with self-reported prior COVID-19 either completed an 8-wk home-based IMT intervention ( n = 111, 92 females, 48 ± 11 yr, 9.3 ± 3.6 months postacute COVID-19 infection) or acted as "usual care" wait list controls ( n = 36, 34 females, 49 ± 12 yr, 9.4 ± 3.2 months postacute COVID-19 infection). RESULTS Applying a Bayesian framework, we found clear evidence of heterogeneity of treatment response for inspiratory muscle strength: the estimated difference between standard deviations (SD) of the IMT and control groups was 22.8 cm H 2 O (75% credible interval (CrI), 4.7-37.7) for changes in maximal inspiratory pressure (MIP) and 86.8 pressure time units (75% CrI, 55.7-116.7) for sustained MIP (SMIP). Conversely, there were minimal differences in the SD between the IMT and the control group for changes in perceived dyspnea and health-related quality of life, providing no evidence of heterogeneous treatment effects. Higher cumulative power during the IMT intervention was related to changes in MIP ( β = 10.9 cm H 2 O (95% CrI, 5.3-16.8) per 1 SD) and SMIP ( β = 63.7 (32.2-95.3) pressure time units per 1 SD), clearly indicating an IMT dose response for changes in inspiratory muscle strength. Older age (>50 yr), a longer time postacute COVID-19 (>3 months), and greater severity of dyspnea at baseline were also associated with smaller improvements in inspiratory muscle strength. CONCLUSIONS Heterogeneous individual responses occurred after an 8-wk home-based IMT program in people with postacute COVID-19 syndrome. Consistent with standard exercise theory, larger improvements in inspiratory muscle strength are strongly related to a greater cumulative dose of IMT.
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Affiliation(s)
- Richard S Metcalfe
- Applied Sports, Technology, Exercise and Medicine (A-STEM) Research Centre, Swansea University, Swansea, UNITED KINGDOM
| | - Paul A Swinton
- School of Health Sciences, Robert Gordon University, Aberdeen, UNITED KINGDOM
| | - Kelly A Mackintosh
- Applied Sports, Technology, Exercise and Medicine (A-STEM) Research Centre, Swansea University, Swansea, UNITED KINGDOM
| | | | | | - Zoe L Saynor
- Physical Activity, Health and Rehabilitation Thematic Research Group, School of Sport, Health and Exercise Science, Faculty of Science and Health, University of Portsmouth, Portsmouth, UNITED KINGDOM
| | - Joanne Hudson
- Applied Sports, Technology, Exercise and Medicine (A-STEM) Research Centre, Swansea University, Swansea, UNITED KINGDOM
| | - Jamie Duckers
- All Wales Adult CF Centre, Cardiff and Vale University Health Board, Cardiff, UNITED KINGDOM
| | | | | | - Melitta A McNarry
- Applied Sports, Technology, Exercise and Medicine (A-STEM) Research Centre, Swansea University, Swansea, UNITED KINGDOM
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Formiga MF, Dosbaba F, Hartman M, Batalik L, Senkyr V, Radkovcova I, Richter S, Brat K, Cahalin LP. Role of the Inspiratory Muscles on Functional Performance From Critical Care to Hospital Discharge and Beyond in Patients With COVID-19. Phys Ther 2023; 103:pzad051. [PMID: 37247250 DOI: 10.1093/ptj/pzad051] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 01/04/2023] [Accepted: 02/19/2023] [Indexed: 05/31/2023]
Abstract
OBJECTIVE The role of inspiratory muscle performance in functional performance in patients with coronavirus disease 2019 (COVID-19) is poorly understood. The purpose of this study was to perform a longitudinal examination of inspiratory and functional performance from intensive care unit (ICU) discharge (ICUD) to hospital discharge (HD) and symptoms at HD and 1 month after HD in patients with COVID-19. METHODS Thirty patients (19 men, 11 women) with COVID-19 were included. Examination of inspiratory muscle performance at ICUD and HD was performed with an electronic manometer, which provided the maximal inspiratory pressure (MIP) and several other inspiratory measures. Examination of dyspnea and functional performance was performed at ICUD and HD with the Modified Borg Dyspnea Scale and the 1-minute sit-to-stand test (1MSST), respectively. RESULTS The mean age was 71 (SD = 11) years, the mean length of ICU stay was 9 (SD = 6) days, and the mean length of hospital stay was 26 (SD = 16) days. Most of the patients were diagnosed with severe COVID-19 (76.7%) and had a mean Charlson Comorbidity Index of 4.4 (SD = 1.9), reflecting high comorbidity. The mean MIP of the entire cohort increased minimally from ICUD to HD (from 36 [SD = 21] to 40 [SD = 20] cm H2O), reflecting predicted values for men and women at ICUD and HD of 46 (25%) to 51 (23%) and 37 (24%) to 37 (20%), respectively. The 1MSTS score increased significantly from ICUD to HD (9.9 [SD = 7.1] vs 17.7 [SD = 11.1]) for the entire cohort but remained far below population-based reference values (2.5th percentile) for the majority of patients at ICUD and HD. At ICUD, MIP was found to be a significant predictor of a favorable change in 1MSTS performance (β = 0.308; odds ratio = 1.36) at HD. CONCLUSION A significant reduction in inspiratory and functional performance exists in patients with COVID-19 at both ICUD and HD, with a greater MIP at ICUD being a significant predictor of a greater 1MSTS score at HD. IMPACT This study shows that inspiratory muscle training may be an important adjunct after COVID-19.
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Affiliation(s)
- Magno F Formiga
- Programa Pós-Graduação em Fisioterapia e Funcionalidade, Faculdade de Medicina, Universidade Federal do Ceará, Fortaleza, Ceará, Brazil
| | - Filip Dosbaba
- Department of Rehabilitation, University Hospital Brno, Brno, South Moravia, Czech Republic
| | - Martin Hartman
- Department of Rehabilitation, University Hospital Brno, Brno, South Moravia, Czech Republic
- Department of Rehabilitation and Sports Medicine, 2nd Faculty of Medicine, Charles University, University Hospital Motol, Prague, Czech Republic
| | - Ladislav Batalik
- Department of Rehabilitation, University Hospital Brno, Brno, South Moravia, Czech Republic
- Department of Public Health, Faculty of Medicine, Masaryk University Brno, Brno, South Moravia, Czech Republic
| | - Vojtech Senkyr
- Department of Rehabilitation, University Hospital Brno, Brno, South Moravia, Czech Republic
| | - Ivana Radkovcova
- Department of Rehabilitation, University Hospital Brno, Brno, South Moravia, Czech Republic
| | - Svatopluk Richter
- Department of Radiology and Nuclear Medicine, University Hospital Brno, Brno, South Moravia, Czech Republic
| | - Kristian Brat
- Department of Respiratory Diseases, University Hospital Brno, Brno South Moravia, Czech Republic
| | - Lawrence P Cahalin
- Department of Physical Therapy, University of Miami Miller School of Medicine, Coral Gables, Florida, USA
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Dosbaba F, Hartman M, Batalik L, Senkyr V, Radkovcova I, Richter S, Brat K, Cahalin LP, Formiga MF. A comprehensive examination of inspiratory muscle performance from the intensive care unit to hospital discharge in patients with COVID-19. Heart Lung 2023; 60:95-101. [PMID: 36934476 PMCID: PMC10008810 DOI: 10.1016/j.hrtlng.2023.03.007] [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: 07/01/2022] [Revised: 03/06/2023] [Accepted: 03/10/2023] [Indexed: 03/14/2023]
Abstract
BACKGROUND The two most common symptoms associated with COVID-19 are dyspnea and fatigue. One possible cause of such symptoms may be inspiratory muscle weakness. OBJECTIVES The purpose of this study was to examine inspiratory muscle performance (IMP) from intensive care unit discharge (ICUD) to hospital discharge (HD) in patients with COVID-19 hypothesizing that IMP would be markedly depressed at both ICUD and HD. METHODS IMP was examined at ICUD and HD via the PrO2 device (PrO2 Health, Smithfield, RI) which provided the maximal inspiratory pressure (MIP), sustained MIP (SMIP), inspiratory duration (ID), and fatigue index test (FIT). Patient symptoms were assessed at ICUD, HD, and 1-month post-HD. RESULTS 30 patients (19 men, 11 women) with COVID-19 were included. The mean±SD age, BMI, and length of ICU and hospital stay was 71±11 yrs, 27.9 ± 6.3 kg/m, 9 ± 6 days, and 26±16 days, respectively. The mean±SD MIP, SMIP, ID, and FIT of the entire cohort at ICUD vs HD were 36±21 vs 40±20 cm H2O, 231±157 vs 297±182 PTU, 8.8 ± 4.2 vs 9.5 ± 4.6 s, and 9.0 ± 9.4 vs 13.1 ± 12.3, respectively, with only SMIP and FIT significantly greater at HD (p=.006 and 0.03, respectively). SMIP at HD was significantly related to resting dyspnea at HD (r=-0.40; p=.02). The SMIP and FIT of men were found to increase significantly from ICUD to HD, but no measure of IMP in the women increased significantly from ICUD to HD. At least one COVID-19-related symptom was present 1 month after HD with the most persistent symptoms being fatigue, cough, and dyspnea in 47%, 40%, and 37% of the patients, respectively. CONCLUSIONS A significant reduction in IMP exists in patients with COVID-19 at both ICUD and HD and no measure of IMP in women was observed to increase significantly from ICUD to HD. Impaired inspiratory muscle endurance rather than strength was associated with greater dyspnea at HD.
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Affiliation(s)
- Filip Dosbaba
- Department of Rehabilitation, University Hospital Brno, Brno 62500, Czech Republic.
| | - Martin Hartman
- Department of Rehabilitation, University Hospital Brno, Brno 62500, Czech Republic; Department of Rehabilitation and Sports Medicine, 2nd Faculty of Medicine, Charles University, University Hospital Motol, Prague, Czech Republic
| | - Ladislav Batalik
- Department of Rehabilitation, University Hospital Brno, Brno 62500, Czech Republic; Department of Public Health, Faculty of Medicine, Masaryk University Brno, Brno 62500, Czech Republic
| | - Vojtech Senkyr
- Department of Rehabilitation, University Hospital Brno, Brno 62500, Czech Republic
| | - Ivana Radkovcova
- Department of Rehabilitation, University Hospital Brno, Brno 62500, Czech Republic
| | - Svatopluk Richter
- Department of Radiology and Nuclear Medicine, University Hospital Brno, Brno 62500, Czech Republic
| | - Kristian Brat
- Department of Respiratory Diseases, University Hospital Brno, Brno 62500, Czech Republic
| | - Lawrence P Cahalin
- Department of Physical Therapy, University of Miami Miller School of Medicine, Coral Gables, FL, United States
| | - Magno F Formiga
- Faculdade de Medicina, Departamento de Fisioterapia, Universidade Federal do Ceará, Fortaleza, Ceará, Brazil.
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Palermo AE, Nash MS, Kirk-Sanchez NJ, Cahalin LP. Adherence to and impact of home-based high-intensity IMT in people with spinal cord injury: a pilot study. Spinal Cord Ser Cases 2022; 8:85. [PMID: 36309488 PMCID: PMC9617741 DOI: 10.1038/s41394-022-00551-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 10/10/2022] [Accepted: 10/12/2022] [Indexed: 11/29/2022] Open
Abstract
Study design The pilot study was completed in 5 phases (Control and 4 phases of IMT) incorporating assessments at Baseline 1 (BL1), BL2, Follow-up 1 (F1), F2, F3, and F4. Objective To assess the adherence and impact of a daily high-intensity (80% of max) inspiratory muscle training (IMT) home program with once weekly supervision for people with spinal cord injury (SCI). Setting Assessments: research institution or zoom. IMT: participant’s home. Methods Participants completed daily IMT in IMT Phase 1 and 2, once weekly in IMT Phase 3, self-selected frequency in IMT Phase 4. All phases had one weekly supervised session except IMT Phase 4. Primary outcomes included adherence and a difficulty score [DS (0- not difficult to 10- the most difficult)]. Secondary outcomes included respiratory function and seated balance. Results Data from 10 people with chronic SCI (>1 year) (Cervical level of injury: 6, AIS: A-B, injury duration: 10.9 years 95% CI [3.9, 18.1]) were used in the analysis. Participants completed 69% of their training days in IMT Phase 1 and 65% overall reporting an average DS of 7.4 ± 1.4. Only one participant completed training during IMT Phase 4. One participant’s training load was reduced due to suspected overtraining. Maximal inspiratory pressure (MIP), sustained MIP (SMIP), and total power (TP), improved significantly (p < 0.05) from BL2 to F1. Conclusion Our data suggest that people with SCI can perform high-intensity IMT at home to improve inspiratory performance. It is strongly recommended that participants be intermittently monitored for adherence and safety. ClinicalTrials.gov Registration number: NCT04210063.
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Affiliation(s)
- Anne E Palermo
- Neuroscience Research Australia, Sydney, NSW, Australia. .,University of New South Wales, Sydney, NSW, Australia.
| | - Mark S Nash
- University of Miami Miller School of Medicine, Department of Physical Therapy and The Miami Project to Cure Paralysis, Miami, FL, USA
| | - Neva J Kirk-Sanchez
- University of Miami Miller School of Medicine, Department of Physical Therapy, Miami, FL, USA
| | - Lawrence P Cahalin
- University of Miami Miller School of Medicine, Department of Physical Therapy, Miami, FL, USA
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Palermo AE, Kirk-Sanchez NJ, Garcia KL, Nash MS, Cahalin LP. Inspiratory Muscle Performance Is Related to Seated Balance Function in People With Spinal Cord Injury: An Observational Study. Arch Phys Med Rehabil 2022; 103:1303-1310. [PMID: 34922931 DOI: 10.1016/j.apmr.2021.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 11/14/2021] [Accepted: 11/16/2021] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To examine the relationship between inspiratory muscle performance (IMP) and functional sitting balance (FSB) in persons with chronic spinal cord injury (SCI). We hypothesized that a moderate correlation would be found between IMP and FSB and that individuals with better balance would have better IMP. DESIGN The SCI-specific modification of the Function in Sitting Test (FIST-SCI) measured FSB. The IMP measures included (1) maximal inspiratory pressure (MIP), (2) sustained MIP (SMIP), and (3) inspiratory duration. Upper extremity motor score (UEMS) and level of injury (LOI) were taken from International Standards for Neurological Classification of Spinal Cord Injury examinations. Spearman correlational analyses assessed relationships among these factors in the sample (N=37). Mann-Whitney U tests explored differences between 2 comparison group pairs (tetraplegia group [TG] vs paraplegia group [PG]; independent transfer group [ITG] vs assisted transfer group [ATG]). Regression analysis examined variables predictive of FSB in the TG. SETTING Research facility. PARTICIPANTS Volunteers with tetraplegia (n=21, American Spinal Injury Association Impairment Scale (AIS) A=8, B=7, C=6) and paraplegia (n=16, AIS A=9, B=4, C=3) (N=37). INTERVENTION Not applicable. MAIN OUTCOME MEASURES IMP, LOI, UEMS, FIST-SCI. RESULTS UEMS, MIP, SMIP, and LOI had moderate to high correlations with FIST-SCI scores (ρ=0.720 (P<.001), 0.480 (P=.003), 0.467 (P=.004), 0.527 (P=.001), respectively). UEMS, MIP, and FIST-SCI scores were higher in the PG and ITG than the TG and ATG, respectively (PG vs. TG P values=<.001, .008, .002, respectively, and ITG vs. ATG P values=<.001, .032, <.001, respectively). Further, SMIP and UEMS predicted FIST-SCI balance scores in the TG, accounting for 55% of total variance (P<.001) (FIST-SCI=11.88+0.03 [SMIP]+0.425 [UEMS]). CONCLUSIONS The relationship between IMP and balance appears preserved after SCI. FSB was predicted, in part, via UEMS and SMIP in the TG. Future research should focus on the effect of SCI-based breathing interventions on FSB.
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Affiliation(s)
- Anne E Palermo
- Department of Physical Therapy, University of Miami Miller School of Medicine, Miami, Florida; Miami Project to Cure Paralysis, University of Miami Miller School of Medicine, Miami, Florida.
| | - Neva J Kirk-Sanchez
- Department of Physical Therapy, University of Miami Miller School of Medicine, Miami, Florida
| | - Kelsey L Garcia
- Department of Physical Therapy, University of Miami Miller School of Medicine, Miami, Florida; Department of Rehabilitation, Jackson Health Systems, Miami, Florida
| | - Mark S Nash
- Department of Physical Therapy, University of Miami Miller School of Medicine, Miami, Florida; Miami Project to Cure Paralysis, University of Miami Miller School of Medicine, Miami, Florida
| | - Lawrence P Cahalin
- Department of Physical Therapy, University of Miami Miller School of Medicine, Miami, Florida
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Inspiratory Muscle Performance and Anthropometric Measures-Novel Assessments Related to Pulmonary Function in People with Spinal Cord Injury: A Pilot Study. Arch Phys Med Rehabil 2021; 103:441-450. [PMID: 34656550 DOI: 10.1016/j.apmr.2021.09.008] [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: 05/10/2021] [Revised: 08/04/2021] [Accepted: 09/09/2021] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To investigate the feasibility and validity of using the novel axillary:umbilical (A:U) ratio and sustained maximal inspiratory pressure (SMIP) as supplementary measures in the assessment of respiratory function in people with spinal cord injury. DESIGN Pilot study with a single day of data collection. All measurements were taken with participants in their personal wheelchairs to best represent normal functioning and positioning for each individual. SETTING Research institution. PARTICIPANTS A convenience sample of 30 community dwelling volunteers with chronic spinal cord injury (C2-T12, American Spinal Injury Association Impairment Scale A-D) participated. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Participants underwent anthropometric measurements (trunk height, abdominal circumference, axillary circumference) and assessment of inspiratory muscle performance, incluidng maximal inspiratory pressure, SMIP, and inspiratory duration, as well as standard pulmonary function tests. RESULTS The A:U ratio and SMIP were recorded for all participants. The SMIP was significantly related to more respiratory performance measures than the maximal inspiratory pressure (P<.05) and the A:U ratio was significantly related to more respiratory performance measures than any other anthropometric measure (P<.05). Additionally, an A:U ratio cutoff point detected individuals with a peak expiratory flow ≥ 80% of their predicted value with a sensitivity and specificity of 85.7% and 91.3%, respectively (area under the curve: 0.92). CONCLUSIONS It is feasible to capture the A:U Ratio and SMIP in individuals with spinal cord injury. Further, the strong significant relationships of SMIP and the A:U ratio to respiratory performance measures suggests their clinical importance in the pulmonary assessment and risk stratification of people with chronic spinal cord injury.
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Kakavas S, Kotsiou OS, Perlikos F, Mermiri M, Mavrovounis G, Gourgoulianis K, Pantazopoulos I. Pulmonary function testing in COPD: looking beyond the curtain of FEV1. NPJ Prim Care Respir Med 2021; 31:23. [PMID: 33963190 PMCID: PMC8105397 DOI: 10.1038/s41533-021-00236-w] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Accepted: 03/15/2021] [Indexed: 02/03/2023] Open
Abstract
Chronic obstructive pulmonary disease (COPD) management remains challenging due to the high heterogeneity of clinical symptoms and the complex pathophysiological basis of the disease. Airflow limitation, diagnosed by spirometry, remains the cornerstone of the diagnosis. However, the calculation of the forced expiratory volume in the first second (FEV1) alone, has limitations in uncovering the underlying complexity of the disease. Incorporating additional pulmonary function tests (PFTs) in the everyday clinical evaluation of COPD patients, like resting volume, capacity and airway resistance measurements, diffusion capacity measurements, forced oscillation technique, field and cardiopulmonary exercise testing and muscle strength evaluation, may prove essential in tailoring medical management to meet the needs of such a heterogeneous patient population. We aimed to provide a comprehensive overview of the available PFTs, which can be incorporated into the primary care physician's practice to enhance the efficiency of COPD management.
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Affiliation(s)
- Sotirios Kakavas
- Critical Care Department, Sismanogleio General Hospital, Athens, Greece
| | - Ourania S Kotsiou
- Department of Respiratory Medicine, University of Thessaly, School of Medicine, University General Hospital of Larisa, Thessaly, Greece
| | - Fotis Perlikos
- Department of Respiratory Medicine, Evangelismos General Hospital, Athens, Greece
| | - Maria Mermiri
- Department of Emergency Medicine, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larisa, Greece.
| | - Georgios Mavrovounis
- Department of Emergency Medicine, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larisa, Greece
| | - Konstantinos Gourgoulianis
- Department of Respiratory Medicine, University of Thessaly, School of Medicine, University General Hospital of Larisa, Thessaly, Greece
| | - Ioannis Pantazopoulos
- Department of Emergency Medicine, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larisa, Greece
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Palermo AE, Cahalin LP, Nash MS. A case for inspiratory muscle training in SCI: potential role as a preventative tool in infectious respiratory diseases like COVID-19. Spinal Cord Ser Cases 2020; 6:87. [PMID: 32943611 PMCID: PMC7494979 DOI: 10.1038/s41394-020-00337-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 08/27/2020] [Accepted: 08/31/2020] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION Respiratory complications (RC) are a leading cause of death after spinal cord injury (SCI) due to compromised immune function and respiratory muscle weakness. Thus, individuals with SCI are at high risk of developing COVID-19 related RC. Results of a SCI clinical trial showed a supervised respiratory muscle training (RMT) program decreased risk of developing RC. The feasibility of conducting unsupervised RMT is not well documented. Four publications (n = 117) were identified in which unsupervised RMT was performed. Significant improvements in respiratory outcomes were reported in two studies: Maximal Inspiratory and Expiratory Pressure (MIP40% and MEP25%, respectively), Peak Expiratory Flow (PEF9%), seated and supine Forced Vital Capacity (FVC23% and 26%, respectively), and Peak Cough Flow (28%). This review and case report will attempt to show that an inspiratory muscle training (IMT) home exercise program (HEP) is feasible and may prepare the respiratory system for RC associated with COVID-19 in patients with SCI. CASE PRESENTATION A 23-year-old with tetraplegia (P1), history of mechanical ventilation, and hospitalization for RC, completed 27 IMT HEP sessions in one month. MIP and sustained MIP (SMIP) increased from baseline by 28% and 26.5%, respectively. Expiratory volumes and rates also improved (FVC, FEV1, and PEF: 11.7%, 8.3%, and 14.2%, respectively). DISCUSSION The effects of COVID-19 on patients with SCI remains inconclusive, but recent literature and the results of this case suggest that unsupervised IMT is feasible and may limit the severity of RC in patients with SCI who contract COVID-19.
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Affiliation(s)
- Anne E Palermo
- Department of Physical Therapy, The Miami Project to Cure Paralysis, The University of Miami Miller School of Medicine, Miami, FL, USA.
| | - Lawrence P Cahalin
- Department of Physical Therapy, The University of Miami Miller School of Medicine, Miami, FL, USA
| | - Mark S Nash
- The Miami Project to Cure Paralysis, The University of Miami Miller School of Medicine, Miami, FL, USA
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Formiga MF, Dosbaba F, Hartman M, Batalik L, Plutinsky M, Brat K, Ludka O, Cahalin LP. Novel versus Traditional Inspiratory Muscle Training Regimens as Home-Based, Stand-Alone Therapies in COPD: Protocol for a Randomized Controlled Trial. Int J Chron Obstruct Pulmon Dis 2020; 15:2147-2155. [PMID: 32982207 PMCID: PMC7494397 DOI: 10.2147/copd.s266234] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 08/11/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Subjects with COPD frequently develop considerable weakness and deconditioning of the inspiratory musculature, which can be corrected with inspiratory muscle training (IMT). While rehabilitation centers may be able to provide IMT as part of the rather complex management of COPD, there is currently a lack of rehabilitation services in the Czech Republic. Remote IMT may then benefit subjects with COPD who are unable to attend or do not have access to rehabilitation programs. We aim at evaluating the utility of the test of incremental respiratory endurance (TIRE) as an at-home IMT method in subjects with COPD, while comparing the effectiveness of this novel training approach to the outcomes of traditional, threshold loading IMT protocols. METHODS/DESIGN This prospective, randomized controlled trial will comprise 8 weeks of at-home IMT sessions with remote supervision followed by 4 months of unsupervised, independent IMT. Eligible subjects will be randomly assigned to one of the following three distinct home-based IMT protocols: (1) TIRE, (2) Threshold loading, and (3) Sham training. Subjects allocated to the TIRE group will train once daily using an advanced IMT electronic system (PrO2), while the other two groups will receive threshold devices. Study outcomes will include measures of inspiratory muscle strength and endurance, pulmonary function, COPD-specific symptomatology, functional exercise capacity, surrogate markers of mortality risk, mental health status and health-related quality of life. DISCUSSION While we acknowledge the value of threshold loading IMT protocols, we believe that the TIRE training method has the potential to provide additional clinical benefits in COPD given its sophisticated remote tracking system and ability to modulate all aspects of muscular performance, including not only strength but also endurance, power and work capacity, allowing users to achieve considerably higher inspiratory pressures throughout the full range of inspiration when compared to other more traditionally used IMT methods.
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Affiliation(s)
- Magno F Formiga
- Departamento de Fisioterapia, Universidade Estadual da Paraíba, Campina Grande, PB, Brazil
| | - Filip Dosbaba
- Department of Rehabilitation, University Hospital Brno, Brno, Czech Republic
- Correspondence: Filip Dosbaba; Ladislav Batalik Department of Rehabilitation, University Hospital Brno, Jihlavska 20, Brno62500, Czech Republic Email ;
| | - Martin Hartman
- Department of Rehabilitation, University Hospital Brno, Brno, Czech Republic
| | - Ladislav Batalik
- Department of Rehabilitation, University Hospital Brno, Brno, Czech Republic
| | - Marek Plutinsky
- Department of Respiratory Diseases, University Hospital Brno, Brno, Czech Republic
- Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Kristian Brat
- Department of Respiratory Diseases, University Hospital Brno, Brno, Czech Republic
- Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Ondrej Ludka
- Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Lawrence P Cahalin
- Department of Physical Therapy, University of Miami – Miller School of Medicine, Coral Gables, FL, USA
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Larribaut J, Gruet M, McNarry MA, Mackintosh KA, Verges S. Methodology and reliability of respiratory muscle assessment. Respir Physiol Neurobiol 2019; 273:103321. [PMID: 31629881 DOI: 10.1016/j.resp.2019.103321] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 10/11/2019] [Accepted: 10/14/2019] [Indexed: 11/26/2022]
Abstract
The optimal method for respiratory muscle endurance (RME) assessment remains unclear. This study assessed the test-retest reliability of two RME-test methodologies. Fifteen healthy adults attended the laboratory on four occasions, separated by 5 ± 2 days, and completed each test in a random, "one on two" order. They performed spirometry testing, maximal respiratory pressure assessment and two different RME tests: an inspiratory resistive breathing (IRB) and an isocapnic hyperpnea endurance (IHE) test. Typical error, expressed as coefficient of variation, for IRB maximal inspiratory pressure (MIP) and IHE maximal ventilation were 12.21 (8.85-19.67) % and 10.73 (7.78-17.29) %, respectively. Intraclass correlation coefficients for the same parameters were 0.83 (0.46-0.94) and 0.80 (0.41-0.93), respectively. No correlations were found between RME parameters derived from the IHE and IRB tests (all p > 0.05). Significant positive correlations were found between both IRB and IHE outcomes and spirometry parameters, MIP and maximal expiratory pressure (p < 0.05). Given these results, IRB and IHE appear to be suitable for RME testing in healthy people, although they may reflect different physiological mechanisms (respiratory mechanics and respiratory muscle capacity for IHE test vs. inspiratory muscle capacity for IRB test). Future studies are therefore warranted that compare IRB and IHE tests in clinical settings.
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Affiliation(s)
- J Larribaut
- HP2 Laboratory, INSERM, Grenoble Alpes University, Grenoble, France
| | - M Gruet
- LAMHESS, Université de Toulon, France; Unité de Recherche Impact de l'Activité Physique sur la Santé, UR IAPS n°201723207F, France.
| | - M A McNarry
- A-STEM, Swansea University, Swansea, Wales, UK
| | | | - S Verges
- HP2 Laboratory, INSERM, Grenoble Alpes University, Grenoble, France
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