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Kesebir J, Gozubatık Celik RG, Zenginler Y, Yüksel B, Sen A, Akinci B. Do proprioceptive neuromuscular facilitation techniques improve respiratory parameters and swallowing in people with multiple sclerosis: A randomized-controlled study. Mult Scler Relat Disord 2024; 85:105534. [PMID: 38489949 DOI: 10.1016/j.msard.2024.105534] [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: 11/23/2023] [Revised: 02/27/2024] [Accepted: 03/01/2024] [Indexed: 03/17/2024]
Abstract
AIM This study aims to investigate the effects of Proprioceptive Neuromuscular Facilitation (PNF) techniques on respiratory parameters, swallowing, functional capacity, fatigue, and quality of life in people with Multiple Sclerosis (PwMS). METHOD Thirty-four PwMS were included and randomized into the PNF Group (mean age: 43.23±10.55/years) or Control Group (mean age:38.47±8.18/years). In the PNF group, head-neck, upper extremity, trunk, and breathing techniques were applied three days/eight weeks. The control group continued home-based breathing exercises. Forced expiratory volume in one second (FEV1), forced vital capacity (FVC), FEV1/FVC, peak expiratory flow (PEF), forced expiratory flow 25-75 % (%FEF 25-75), peak cough flow (PCF), maximal inspiratory (MIP) and expiratory pressures (MEP) were and two minutes walking test (2MWT) were measured. Dysphagia in Multiple Sclerosis (DYMUS), Eating Assessment Tool (EAT-10), Fatigue Severity Scale (FSS) and Multiple Sclerosis Quality of Life (MusiQoL) were questioned. RESULTS After treatment, MIP, MEP,%FEV1/FVCpred,%PEFpred,%FEF 25-75pred, PCF, DYMUS, EAT-10, FSS, and MUSIQoL were improved in the PNF group while MIP, MEP, PCF, DYMUS, EAT-10, MUSIQoL, and 2 MWT were improved in the control group (p < 0.05 for all). In the between-group analysis of the mean differences, the%FEV1pred was significantly different in favor of the PNF Group (p = 0.011), and MIP was significantly different in favor of the Control Group (p = 0.013). DISCUSSION The PNF techniques can improve respiratory muscle strength, respiratory functions, cough efficiency, swallowing functions, and quality of life in mild to moderate PwMS. However, these improvements were not superior except for%FEV1pred compared to home-based breathing exercises.
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Affiliation(s)
- Julide Kesebir
- Biruni University, Vocational School, Department of Occupational Therapy, Istanbul, Turkey
| | - Rabia Gokcen Gozubatık Celik
- Prof Mazhar Osman Bakırköy Psychiatric and Neurological Diseases Hospital, Department of Neurology, Istanbul, Turkey
| | - Yonca Zenginler
- Istanbul University-Cerrahpasa, Faculty of Health Science, Department of Physiotherapy and Rehabilitation, Turkey
| | - Burcu Yüksel
- Prof Mazhar Osman Bakırköy Psychiatric and Neurological Diseases Hospital, Department of Neurology, Istanbul, Turkey
| | - Aysu Sen
- Prof Mazhar Osman Bakırköy Psychiatric and Neurological Diseases Hospital, Department of Neurology, Istanbul, Turkey
| | - Buket Akinci
- Biruni University, Faculty of Health Science, Department of Physiotherapy and Rehabilitation (English), Turkey.
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Aguilar-Zafra S, Fabero-Garrido R, Del Corral T, López-de-Uralde-Villanueva I. Reliability and Minimal Detectable Change for Respiratory Muscle Strength Measures in Individuals With Multiple Sclerosis. J Neurol Phys Ther 2024; 48:94-101. [PMID: 38015070 DOI: 10.1097/npt.0000000000000462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
Abstract
BACKGROUND AND PURPOSE The test-retest reliability and minimal detectable changes (MDCs) for respiratory muscle strength measures have not been determined in individuals with multiple sclerosis (MS). This study determined the test-retest reliability and MDCs for specific respiratory muscle strength measures, as well as their associations with health-related quality of life (HRQoL), disability, dyspnea, and physical activity level measures in this population. In addition, the study examined differences in respiratory muscle strength between different degrees of disability. METHODS Sixty-one individuals with MS attended 2 appointments separated by 7 to 10 days. Respiratory muscle strength was evaluated by maximal inspiratory and expiratory pressures (MIP/MEP), HRQoL by EuroQol-5D-5L (index and visual analog scale [EQ-VAS]), disability by the Expanded Disability Status Scale, dyspnea by the Medical Research Council scale, and physical activity levels by the International Physical Activity Questionnaire. RESULTS Respiratory muscle strength measures had excellent test-retest reliability (ICC ≥ 0.92). The MDC for MIP is 15.42 cmH 2 O and for MEP is 17.84 cmH 2 O. Participants with higher respiratory muscle strength (MIP/MEP cmH 2 O and percentage of predicted values) had higher HRQoL ( r = 0.54-0.62, P < 0.01, EQ-5D-5L index; r = 0.30-0.42, P < 0.05, EQ-VAS); those with higher expiratory muscle strength (cmH 2 O and percentage of predicted values) had lower levels of disability ( r ≤ -0.66) and dyspnea ( r ≤ -0.61). There were differences in respiratory muscle strength between different degrees of disability ( P < 0.01; d ≥ 0.73). DISCUSSION AND CONCLUSION Respiratory muscle strength measures provide excellent test-retest reliability in individuals with MS. MDCs can be interpreted and applied in the clinical setting. Low respiratory muscle strength can contribute to a poor HRQoL; specifically, expiratory muscle strength appears to have the strongest influence on disability status and dyspnea.
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Affiliation(s)
- Sandra Aguilar-Zafra
- Departamento de Fisioterapia, Facultad de Ciencias de la Salud, Motion in Brains Research Group, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Spain, and Téxum S.L. Physiotherapy Center, Coslada, Madrid, Spain (S.A.Z.); Department of Radiology, Rehabilitation and Physiotherapy, Faculty of Nursing, Physiotherapy and Podiatry, Complutense University of Madrid, Madrid, Spain (R.F.G.); and Department of Radiology, Rehabilitation and Physiotherapy, Faculty of Nursing, Physiotherapy and Podiatry, Universidad Complutense de Madrid, IdISSC, Madrid, Spain (T.d.C., I.L.d.U.V.)
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Peñailillo L, Miranda-Fuentes C, Gutiérrez S, García-Vicencio S, Jannas-Vela S, Acevedo CC, Peñailillo RS. Systemic Inflammation but not Oxidative Stress Is Associated with Physical Performance in Moderate Chronic Obstructive Pulmonary Disease. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2024; 1450:121-130. [PMID: 37548871 DOI: 10.1007/5584_2023_784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/08/2023]
Abstract
Chronic obstructive pulmonary disease (COPD) patients manifest muscle dysfunction and impaired muscle oxidative capacity, which result in reduced exercise capacity and poor health status. The aim of this study was to compare the physical performance, systemic inflammation, and oxidative stress of patients with moderate COPD, and to associate physical performance with inflammatory and oxidative stress plasma markers. Twenty CONTROL (n = 10) and moderate COPD (n = 10) patients participated in this study. Systematic inflammation and oxidative stress plasma markers, maximal aerobic capacity (VO2peak), and maximal isometric strength (MVIC) of the knee extensor (KE) muscles were measured. VO2peak was 31.3% greater in CONTROL compared to COPD (P = 0.006). The MVIC strength of the KE was 43.9% greater in CONTROL compared to COPD (P = 0.002). Tumor necrosis factor-alpha (TNF-α) was 79.6% greater in COPD compared to CONTROL (P < 0.001). Glutathione peroxidase activity (GPx) activity was 27.5% lesser in COPD compared to CONTROL (P = 0.05). TNF-α concentration was correlated with KE MVC strength (R = -0.48; P = 0.045) and VO2peak (R = -0.58; P = 0.01). Meanwhile, malondialdehyde (MDA) and GPx activity were not associated with KE strength or VO2peak (P = 0.74 and P = 0.14, respectively). COPD patients showed lesser muscle strength and aerobic capacity than healthy control individuals. Furthermore, patients with COPD showed greater systemic inflammation and lesser antioxidant capacity than healthy counterparts. A moderate association was evident between levels of systemic inflammation and physical performance variables.
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Affiliation(s)
- Luis Peñailillo
- Exercise and Rehabilitation Sciences Institute, School of Physical Therapy, Faculty of Rehabilitation Sciences, Universidad Andres Bello, Santiago, Chile
| | - Claudia Miranda-Fuentes
- Exercise and Rehabilitation Sciences Institute, School of Physical Therapy, Faculty of Rehabilitation Sciences, Universidad Andres Bello, Santiago, Chile
| | - Sebastián Gutiérrez
- Exercise and Rehabilitation Sciences Institute, School of Physical Therapy, Faculty of Rehabilitation Sciences, Universidad Andres Bello, Santiago, Chile
| | - Sebastián García-Vicencio
- LBEPS, Univ Evry, IRBA, Université Paris Saclay, Evry, France
- Human Motion Analysis, Humanfab, Aix-en-Provence, France
| | | | - Cristian Campos Acevedo
- Exercise and Rehabilitation Sciences Institute, School of Physical Therapy, Faculty of Rehabilitation Sciences, Universidad Andres Bello, Santiago, Chile
| | - Reyna S Peñailillo
- Laboratory of Reproductive Biology, Faculty of Medicine, Centre for Biomedical Research, Universidad de Los Andes, Santiago, Chile.
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Murrieta-Álvarez I, A Fernández-Gutiérrez J, A Pérez C, León-Peña AA, Reyes-Cisneros ÓA, Benítez-Salazar JM, Sánchez-Bonilla D, Olivares-Gazca JC, Fernández-Lara D, Pérez-Padilla R, Ruiz-Delgado GJ, Ruiz-Argüelles GJ. Impaired lung function in multiple sclerosis: a single-center observational study in 371 persons. Neurol Sci 2023; 44:4429-4439. [PMID: 37410269 DOI: 10.1007/s10072-023-06914-6] [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: 12/05/2022] [Accepted: 06/15/2023] [Indexed: 07/07/2023]
Abstract
INTRODUCTION Abnormal lung function in people with multiple sclerosis (PwMS) could be considered as the result of muscle weakness or MS-specific structural central nervous system (CNS) abnormalities as a precipitant factor for the worsening of motor impairment or cognitive symptoms. METHODS This is a cross-sectional observational study in PwMS. Forced spirometry was conducted, and normative metrics of forced vital capacity (FVC), forced expiratory volume in the first second (FEV1), and the relation FEV1/FVC were calculated. Qualitative and quantitative brain magnetic resonance imaging (MRI) examinations were carried out. RESULTS A total of 371 PwMS were included in the study. Of those, 196 (53%) had RRMS, 92 (25%) SPMS, and 83 (22%) PPMS. Low FVC and FEV1 was present in 16 (8%), 16 (19%), and 23 (25%) of the patients in the RRMS, PPMS, and SPMS, respectively. PwMS with T2-FLAIR lesions involving the corpus callosum (CC) had a significantly higher frequency of abnormally low FVC and FEV1 (OR 3.62; 95% CI 1.33-9.83; p = 0.012) than patients without lesions in that region. This association remained significant in the RRMS group (OR 10.1; 95% CI 1.3-67.8; p 0.031) when the model excluded PPMS and SPMS. According to our study, for every increase of 1 z score of FVC, we observed an increase of 0.25 cm3 of hippocampal volume (β 0.25; 95% CI 0.03-0.47; p 0.023) and 0.43 cm3 of left hippocampus volume (β 0.43; 95% CI 0.16-0.71; p 0.002). CONCLUSIONS We observed an incremental prevalence of abnormally low pulmonary function tests that parallels a sequence from more early relapsing courses to long-standing progressive courses (RRMS to PPMS or SPMS).
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Affiliation(s)
- Iván Murrieta-Álvarez
- Clínica Ruiz, Centro de Hematología y Medicina Interna, Puebla, México
- Universidad Popular Autónoma del Estado de Puebla, Puebla, México
- Baylor College of Medicine, Houston, TX, USA
| | - José A Fernández-Gutiérrez
- Clínica Ruiz, Centro de Hematología y Medicina Interna, Puebla, México
- Universidad Popular Autónoma del Estado de Puebla, Puebla, México
| | | | | | - Óscar A Reyes-Cisneros
- Clínica Ruiz, Centro de Hematología y Medicina Interna, Puebla, México
- Universidad Anáhuac Puebla, Tlaxcalancingo, México
| | - José M Benítez-Salazar
- Universidad Popular Autónoma del Estado de Puebla, Puebla, México
- Houston Methodist Hospital, Houston, TX, USA
| | - Daniela Sánchez-Bonilla
- Clínica Ruiz, Centro de Hematología y Medicina Interna, Puebla, México
- Universidad Popular Autónoma del Estado de Puebla, Puebla, México
| | | | | | | | - Guillermo J Ruiz-Delgado
- Clínica Ruiz, Centro de Hematología y Medicina Interna, Puebla, México
- Universidad Popular Autónoma del Estado de Puebla, Puebla, México
- Laboratorios Ruiz SYNLAB, Puebla, México
| | - Guillermo J Ruiz-Argüelles
- Clínica Ruiz, Centro de Hematología y Medicina Interna, Puebla, México.
- Universidad Popular Autónoma del Estado de Puebla, Puebla, México.
- Laboratorios Ruiz SYNLAB, Puebla, México.
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Park TS, Tak YJ, Ra Y, Kim J, Han SH, Kim SH, Shin Y, Shin MJ, Kang JH. Reference Respiratory Muscle Strength Values and a Prediction Equation Using Physical Functions for Pulmonary Rehabilitation in Korea. J Korean Med Sci 2023; 38:e325. [PMID: 37846788 PMCID: PMC10578989 DOI: 10.3346/jkms.2023.38.e325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 06/13/2023] [Indexed: 10/18/2023] Open
Abstract
BACKGROUND In Korea, tests for evaluating respiratory muscle strength are based on other countries' clinical experience or standards, which can lead to subjective evaluations. When evaluating respiratory function based on the standards of other countries, several variables, such as the race and cultures of different countries, make it difficult to apply these standards. The purpose of this study was to propose objective respiratory muscle strength standards and predicted values for healthy Korean adults based on age, height, weight, and muscle strength, by measuring maximal inspiratory pressure (MIP), maximal expiratory pressure (MEP), and peak cough flow (PCF). METHODS This cross-sectional study analyzed MIP, MEP, and PCF in 360 people, each group comprising 30 adult men and women aged 20-70, diagnosed as healthy after undergoing medical check-ups at a general hospital. Hand grip strength (HGS) and the five times sit-to-stand test (FTSST) results were also recorded. Correlations among respiratory muscle strength, participant demographics, and overall muscle strength were evaluated using Pearson's correlation analysis. The predicted values of respiratory muscle strength were calculated using multiple regression analysis. RESULTS Respiratory muscle strength differed from the values reported in studies from other countries. In the entire samples, both MIP and MEP had the highest correlations with peak HGS (r = 0.643, r = 0.693; P < 0.05), while PCF had the highest correlation with forced expiratory volume in 1 s (r = 0.753; P < 0.05). Age, body mass index, peak HGS, and FTSST results were independent variables affecting respiratory muscle strength. A predictive equation for respiratory muscle strength was developed using the multiple regression equation developed in this study. CONCLUSION Respiratory muscle strength index may differ by country. For more accurate diagnoses, standard values for each country are required. This study presents reference values for Korea, and a formula for estimation is proposed when no respiratory muscle strength measurement equipment is available. TRIAL REGISTRATION Clinical Research Information Service Identifier: KCT0006778.
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Affiliation(s)
- Tae Sung Park
- Department of Convergence Medical Institute of Technology, Pusan National University Hospital, Busan, Korea
- Department of Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
- Department of Physical Therapy, College of Health Sciences, Catholic University of Pusan, Busan, Korea
| | - Young Jin Tak
- Department of Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
- Department of Family Medicine, Pusan National University Hospital, Busan, Korea
- Department of Family Medicine, Pusan National University School of Medicine, Busan, Korea
| | - Youngjin Ra
- Department of Family Medicine, Pusan National University Hospital, Busan, Korea
| | - Jinmi Kim
- Department of Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
- Department of Biostatistics, Clinical Trial Center, Pusan National University Hospital, Busan, Korea
| | - Sang Hun Han
- Department of Rehabilitation Medicine, Pusan National University Hospital, Busan, Korea
| | - Sang Hun Kim
- Department of Rehabilitation Medicine, Pusan National University Hospital, Busan, Korea
| | - YongBeom Shin
- Department of Rehabilitation Medicine, Pusan National University Hospital, Busan, Korea
- Department of Rehabilitation Medicine, Pusan National University School of Medicine, Busan, Korea
| | - Myung-Jun Shin
- Department of Convergence Medical Institute of Technology, Pusan National University Hospital, Busan, Korea
- Department of Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
- Department of Rehabilitation Medicine, Pusan National University Hospital, Busan, Korea
- Department of Rehabilitation Medicine, Pusan National University School of Medicine, Busan, Korea.
| | - Jong Ho Kang
- Department of Physical Therapy, College of Health Sciences, Catholic University of Pusan, Busan, Korea.
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Antonsson M, Johansson K, Bonde Dalemo A, Ivehorn Axelsson C, Burge Å, Lesueur U, Hartelius L. Effect of expiratory muscle strength training on voice and speech: An exploratory study in persons with Parkinson's disease or multiple sclerosis. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2023:1-18. [PMID: 37787640 DOI: 10.1080/17549507.2023.2243402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE This study explored how respiration, voice, and speech were affected following expiratory muscle strength training (EMST) and maintenance training in persons with Parkinson's disease (PD) or multiple sclerosis (MS). METHOD Nine participants with PD and six with MS participated in a randomised study, where the effects of EMST, sham, and maintenance treatment were investigated. Outcome measures included maximum expiratory pressure (MEP); maximum phonation time (MPT); intelligibility; verbal diadochokinesis (DDK); speech rate; a self-report form on voice, speech, and communication; and open questions about how the participants experienced the intervention. Group comparisons were performed within and between groups. RESULT The PD and the MS groups both improved significantly in MEP, and this improvement remained after 3 months of maintenance EMST. An improvement was also seen in DDK. Post-EMST, 33% of the PD group and 80% of the MS group reported a positive effect on communication. CONCLUSION The results of this study support previous evidence that EMST has positive effects on expiratory pressure in persons with PD or MS, but its effect on voice and speech remains unclear. Since subjective reports of the intervention and effects on communication were predominantly positive, further research is needed on larger groups to explore appropriate outcome measures.
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Affiliation(s)
- Malin Antonsson
- Speech and Language Pathology Unit, Institute of Neuroscience and Physiology, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Kerstin Johansson
- Division of Speech Language Pathology, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Anna Bonde Dalemo
- Speech and Language Pathology Unit, Skaraborg Hospital, Gothenburg, Region Västra Götaland, Sweden, and
| | - Cornelia Ivehorn Axelsson
- Speech and Language Pathology Unit, Skaraborg Hospital, Gothenburg, Region Västra Götaland, Sweden, and
| | - Åsa Burge
- Department of Neurology, Angered Hospital, Region Västra Götaland, Sweden
| | - Ulrike Lesueur
- Department of Neurology, Angered Hospital, Region Västra Götaland, Sweden
| | - Lena Hartelius
- Speech and Language Pathology Unit, Institute of Neuroscience and Physiology, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
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Razi O, Teixeira AM, Tartibian B, Zamani N, Knechtle B. Respiratory issues in patients with multiple sclerosis as a risk factor during SARS-CoV-2 infection: a potential role for exercise. Mol Cell Biochem 2023; 478:1533-1559. [PMID: 36411399 PMCID: PMC9684932 DOI: 10.1007/s11010-022-04610-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 11/04/2022] [Indexed: 11/23/2022]
Abstract
Coronavirus disease-2019 (COVID-19) is associated with cytokine storm and is characterized by acute respiratory distress syndrome (ARDS) and pneumonia problems. The respiratory system is a place of inappropriate activation of the immune system in people with multiple sclerosis (MS), and this may cause damage to the lung and worsen both MS and infections.The concerns for patients with multiple sclerosis are because of an enhance risk of infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The MS patients pose challenges in this pandemic situation, because of the regulatory defect of autoreactivity of the immune system and neurological and respiratory tract symptoms. In this review, we first indicate respiratory issues associated with both diseases. Then, the main mechanisms inducing lung damages and also impairing the respiratory muscles in individuals with both diseases is discussed. At the end, the leading role of physical exercise on mitigating respiratory issues inducing mechanisms is meticulously evaluated.
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Affiliation(s)
- Omid Razi
- Department of Exercise Physiology, Faculty of Physical Education and Sport Sciences, Razi University, Kermanshah, Iran
| | - Ana Maria Teixeira
- Research Center for Sport and Physical Activity, Faculty of Sport Sciences and Physical Education, University of Coimbra, Coimbra, Portugal
| | - Bakhtyar Tartibian
- Department of Exercise Physiology, Faculty of Physical Education and Sports Sciences, Allameh Tabataba’i University, Tehran, Iran
| | - Nastaran Zamani
- Department of Biology, Faculty of Science, Payame-Noor University, Tehran, Iran
| | - Beat Knechtle
- Institute of Primary Care, University of Zurich, Zurich, Switzerland
- Medbase St. Gallen Am Vadianplatz, Vadianstrasse 26, 9001 St. Gallen, Switzerland
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Silva-Santos S, Monteiro AM, Barbosa TM, Teixeira JE, Branquinho L, Ferraz R, Forte P. Associations between Coronavirus and Immune Response, Cardiorespiratory Fitness Rehabilitation and Physical Activity: A Brief Report. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4651. [PMID: 36901661 PMCID: PMC10001454 DOI: 10.3390/ijerph20054651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 02/24/2023] [Accepted: 03/02/2023] [Indexed: 06/18/2023]
Abstract
COVID-19 has serious effects on cardiorespiratory capacity. In this sense, physical activity has been identified as beneficial in the treatment of cardiorespiratory diseases due to its anti-inflammatory and immunosuppressive benefits. To date, no study has been found on cardiorespiratory capacity and rehabilitation in patients cured after COVID-19. Thus, this brief report aims to relate the benefits of physical activity to cardiorespiratory function after COVID-19. It is important to know how different levels of physical activity can be related to the different symptoms of COVID-19. In view of this, the objectives of this brief report were to: (1) explore the theoretical associations between COVID-19 symptoms and physical activity; (2) compare the cardiorespiratory function of non-COVID-19 participants and post-COVID-19 patients; and (3) propose a physical activity program to improve the cardiorespiratory fitness of post-COVID-19 patients. Thus, we note that moderate-intensity physical activity (i.e., walking) has a greater beneficial effect on immune function, whereas vigorous activity (i.e., marathon running) tends to temporarily reduce immune function through an imbalance of cytokine types I and II in the hours and days after exercise. However, there is no consensus in the literature in this regard, since other investigations suggest that high-intensity training can also be beneficial, not causing clinically relevant immunosuppression. Physical activity has been shown to be beneficial in improving the clinical conditions most frequently associated with severe COVID-19. Thus, it is possible to infer that physically active individuals seem to be less exposed to the dangers of severe COVID-19 compared to non-active individuals through the benefits of physical activity in strengthening the immune system and fighting infections. The current study demonstrates that physical activity appears to be beneficial in improving the clinical conditions most often associated with severe COVID-19.
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Affiliation(s)
- Sandra Silva-Santos
- Department of Sports, Higher Institute of Educational Sciences of the Douro, 4500-708 Penafiel, Portugal
- CI-ISCE/ISCE Douro, 4500-708 Penafiel, Portugal
- Research Center in Sports Performance, Recreation, Innovation and Technology (SPRINT-IPVC), Polytechnic Institute of Viana do Castelo, 4960-320 Viana do Castelo, Portugal
| | - António M. Monteiro
- Department of Sport Sciences, Polytechnic Institute of Bragança, 5300-252 Bragança, Portugal
- Research Center in Sports, Health and Human Development, CIDESD, 6201-001 Covilhã, Portugal
| | - Tiago M. Barbosa
- Department of Sport Sciences, Polytechnic Institute of Bragança, 5300-252 Bragança, Portugal
- Research Center in Sports, Health and Human Development, CIDESD, 6201-001 Covilhã, Portugal
| | - José E. Teixeira
- Department of Sport Sciences, Polytechnic Institute of Bragança, 5300-252 Bragança, Portugal
- Research Center in Sports, Health and Human Development, CIDESD, 6201-001 Covilhã, Portugal
- Department of Sport Sciences, Polytechnic Institute of Guarda, 6300-559 Guarda, Portugal
| | - Luís Branquinho
- Department of Sports, Higher Institute of Educational Sciences of the Douro, 4500-708 Penafiel, Portugal
- CI-ISCE/ISCE Douro, 4500-708 Penafiel, Portugal
- Research Center in Sports, Health and Human Development, CIDESD, 6201-001 Covilhã, Portugal
| | - Ricardo Ferraz
- Research Center in Sports, Health and Human Development, CIDESD, 6201-001 Covilhã, Portugal
- Department of Sport Sciences, University of Beira Interior, 6201-001 Covilhã, Portugal
| | - Pedro Forte
- Department of Sports, Higher Institute of Educational Sciences of the Douro, 4500-708 Penafiel, Portugal
- CI-ISCE/ISCE Douro, 4500-708 Penafiel, Portugal
- Department of Sport Sciences, Polytechnic Institute of Bragança, 5300-252 Bragança, Portugal
- Research Center in Sports, Health and Human Development, CIDESD, 6201-001 Covilhã, Portugal
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Charro PD, Santana LL, Seki KLM, Moro Junior N, Domingos JA, Christofoletti G. Motor and respiratory functions are main challenges to patients with multiple sclerosis. FISIOTERAPIA EM MOVIMENTO 2023. [DOI: 10.1590/fm.2023.36101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Abstract Introduction People with multiple sclerosis (MS) present wide and varied symptoms. Objective To investigate the impact of MS on subjects’ motor and respiratory functions. Methods One hundred one participants were enrolled in this study. The subjects had previous diagnosis of relapsing-remittent MS (n = 48) or presented no neurologic diseases (n = 53, control group). Assess-ments involved mobility (Timed Get Up and Go) and balance (Berg Balance Scale) tests. A force platform was used to evaluate postural stabilometry. Respiratory functions were assessed with a portable spirometer and a digital manovacuometer. Data analyses were carried out with Student´s t-tests, chi-square, and Pearson correlation index. Significance was set at 5%. Results Compared to control peers, participants with MS showed higher motor dysfunctions affecting mobility, balance, and postural stability. Spirometry indicated normal parameters for pulmonary flows and lung capacities in both groups. The manovacuometer, differently, pointed to a respiratory muscle weakness in 48% of participants with MS. Correlation analyses highlighted that respiratory functions are more associated to dynamic than to static motor tests. Conclusion Pathological changes in MS lead to motor dysfunction on mobility, balance and postural stability. Respiratory tests showed normal pulmonary flows and lung capacities in patients with MS, but with commitment of respiratory muscle strength. Respiratory functions were more impacted by dynamic tasks rather than static motor tasks.
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Watson K, Egerton T, Sheers N, Retica S, McGaw R, Clohessy T, Webster P, Berlowitz DJ. Respiratory muscle training in neuromuscular disease: a systematic review and meta-analysis. Eur Respir Rev 2022; 31:31/166/220065. [DOI: 10.1183/16000617.0065-2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 09/01/2022] [Indexed: 12/03/2022] Open
Abstract
BackgroundNeuromuscular disease causes a progressive decline in ventilatory function which respiratory muscle training may address. Previous systematic reviews have focussed on single diseases, whereas this study systematically reviewed the collective evidence for respiratory muscle training in children and adults with any neuromuscular disease.MethodsSeven databases were searched for randomised controlled trials. Three reviewers independently reviewed eligibility, extracted characteristics, results, determined risk of bias and combined results using narrative synthesis and meta-analysis.Results37 studies (40 publications from 1986–2021, n=951 participants) were included. Respiratory muscle training improved forced vital capacity (standardised mean difference (SMD) 0.40 (95% confidence interval 0.12–0.69)), maximal inspiratory (SMD 0.53 (0.21–0.85)) and maximal expiratory pressure (SMD 0.70 (0.35–1.04)) compared to control (usual care, sham or alternative treatment). No impact on cough, dyspnoea, voice, physical capacity or quality of life was detected. There was high degree of variability between studies.DiscussionStudy heterogeneity (children and adults, different diseases, interventions, dosage and comparators) suggests that the results should be interpreted with caution. Including all neuromuscular diseases increased the evidence pool and tested the intervention overall.ConclusionsRespiratory muscle training improves lung volumes and respiratory muscle strength in neuromuscular disease, but confidence is tempered by limitations in the underlying research.
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Ghannadi S, Noormohammadpour P, Mazaheri R, Sahraian MA, Mansournia MA, Pourgharib Shahi MH, Salmasi Fard AH, Abolhasani M. Effect of eight weeks respiratory muscle training on respiratory capacity, functional capacity and quality of life on subjects with mild to moderate relapsing-remitting multiple sclerosis: A single-blinded randomized controlled trial. Mult Scler Relat Disord 2022; 68:104208. [PMID: 36219925 DOI: 10.1016/j.msard.2022.104208] [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: 03/06/2022] [Revised: 09/25/2022] [Accepted: 10/01/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Multiple Sclerosis (MS) is a chronic inflammatory disease of the nervous system leading to muscle weakness, including the respiratory muscles that cause pulmonary complications, impair functional capacity, increased fatigue, and as a result decreases the quality of life. AIM The purpose of the present study is to examine the influence of 8 weeks of respiratory muscle training (RMT) on pulmonary function and respiratory muscle strength in MS patients. METHODS The present study was a single-blind, randomized controlled trial that was conducted on 36 (27 Female, 9 Male) relapsing-remitting MS patients who were definitively diagnosed by a neurologist and randomly were divided into intervention and control groups. Both groups were educated on lifestyle modification with an emphasis on regular physical activity. In addition, the intervention group was prescribed eight weeks of respiratory muscle training with a threshold resistance device, daily, twice a day for three sets of 15 repetitions per set. Maximal expiratory pressure (PImax), maximal expiratory pressure (PEmax), spirometric indices, functional tests (six-minute walk test, timed up and go test), fatigue questionnaire, and questionnaire of quality of life were assessed before and after trials. RESULTS A total of 36 patients (75% female; mean age 38.00(8.86) years; BMI 26.56(2.64) kg/m2) were included in the study. The strength of inspiratory and expiratory muscles, respiratory function, fatigue, and quality of life were significantly improved in the intervention group (p<0.005). In addition, there was a significant improvement in the rate of fatigue and quality of life in all their dimensions (p<0.005). Only in the six-minute walk test, no significant improvement was seen in the intervention group compared to the control group (p = 0.262). CONCLUSION Findings could help therapists to provide MS patients with more effective respiratory muscle training protocols to maximize the benefits of rehabilitation.
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Affiliation(s)
- Shima Ghannadi
- Sports Medicine Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran; Obesity and Eating Habits Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Pardis Noormohammadpour
- Sports Medicine Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Reza Mazaheri
- Sports Medicine Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Ali Sahraian
- MS Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Ali Mansournia
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | | | | | - Maryam Abolhasani
- MS Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran.
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Cardoso R, Parola V, Neves H, Bernardes RA, Duque FM, Mendes CA, Pimentel M, Caetano P, Petronilho F, Albuquerque C, Sousa LB, Malça C, Durães R, Xavier W, Parreira P, Apóstolo J, Cruz A. Physical Rehabilitation Programs for Bedridden Patients with Prolonged Immobility: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19116420. [PMID: 35682005 PMCID: PMC9180781 DOI: 10.3390/ijerph19116420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 05/19/2022] [Accepted: 05/21/2022] [Indexed: 12/04/2022]
Abstract
Bedridden patients usually stay in bed for long periods, presenting several problems caused by immobility, leading to a long recovery process. Thus, identifying physical rehabilitation programs for bedridden patients with prolonged immobility requires urgent research. Therefore, this scoping review aimed to map existing physical rehabilitation programs for bedridden patients with prolonged immobility, the rehabilitation domains, the devices used, the parameters accessed, and the context in which these programs were performed. This scoping review, guided by the Joanna Briggs Institute’s (JBI) methodology and conducted in different databases (including grey literature), identified 475 articles, of which 27 were included in this review. The observed contexts included research institutes, hospitals, rehabilitation units, nursing homes, long-term units, and palliative care units. Most of the programs were directed to the musculoskeletal domain, predominantly toward the lower limbs. The devices used included lower limb mobilization, electrical stimulation, inclined planes, and cycle ergometers. Most of the evaluated parameters were musculoskeletal, cardiorespiratory, or vital signs. The variability of the programs, domains, devices and parameters found in this scoping review revealed no uniformity, a consequence of the personalization and individualization of care, which makes the development of a standard intervention program challenging.
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Affiliation(s)
- Remy Cardoso
- Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), 3000 Coimbra, Portugal; (H.N.); (R.A.B.); (F.M.D.); (C.A.M.); (M.P.); (F.P.); (C.A.); (L.B.S.); (P.P.); (J.A.)
- Correspondence: (R.C.); (V.P.); (A.C.)
| | - Vitor Parola
- Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), 3000 Coimbra, Portugal; (H.N.); (R.A.B.); (F.M.D.); (C.A.M.); (M.P.); (F.P.); (C.A.); (L.B.S.); (P.P.); (J.A.)
- Portugal Centre for Evidence Based Practice: A JBI Centre of Excellence (PCEBP), 3000 Coimbra, Portugal
- Correspondence: (R.C.); (V.P.); (A.C.)
| | - Hugo Neves
- Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), 3000 Coimbra, Portugal; (H.N.); (R.A.B.); (F.M.D.); (C.A.M.); (M.P.); (F.P.); (C.A.); (L.B.S.); (P.P.); (J.A.)
- Portugal Centre for Evidence Based Practice: A JBI Centre of Excellence (PCEBP), 3000 Coimbra, Portugal
| | - Rafael A. Bernardes
- Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), 3000 Coimbra, Portugal; (H.N.); (R.A.B.); (F.M.D.); (C.A.M.); (M.P.); (F.P.); (C.A.); (L.B.S.); (P.P.); (J.A.)
| | - Filipa Margarida Duque
- Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), 3000 Coimbra, Portugal; (H.N.); (R.A.B.); (F.M.D.); (C.A.M.); (M.P.); (F.P.); (C.A.); (L.B.S.); (P.P.); (J.A.)
- Portugal Centre for Evidence Based Practice: A JBI Centre of Excellence (PCEBP), 3000 Coimbra, Portugal
| | - Carla A. Mendes
- Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), 3000 Coimbra, Portugal; (H.N.); (R.A.B.); (F.M.D.); (C.A.M.); (M.P.); (F.P.); (C.A.); (L.B.S.); (P.P.); (J.A.)
| | - Mónica Pimentel
- Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), 3000 Coimbra, Portugal; (H.N.); (R.A.B.); (F.M.D.); (C.A.M.); (M.P.); (F.P.); (C.A.); (L.B.S.); (P.P.); (J.A.)
| | - Pedro Caetano
- Centro Hospitalar Universitário Cova da Beira (CHUCB), 6200 Covilhã, Portugal;
| | - Fernando Petronilho
- Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), 3000 Coimbra, Portugal; (H.N.); (R.A.B.); (F.M.D.); (C.A.M.); (M.P.); (F.P.); (C.A.); (L.B.S.); (P.P.); (J.A.)
- School of Nursing, University of Minho, 4710 Braga, Portugal
| | - Carlos Albuquerque
- Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), 3000 Coimbra, Portugal; (H.N.); (R.A.B.); (F.M.D.); (C.A.M.); (M.P.); (F.P.); (C.A.); (L.B.S.); (P.P.); (J.A.)
- Health School, Polytechnic Institute of Viseu, 3500 Viseu, Portugal
| | - Liliana B. Sousa
- Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), 3000 Coimbra, Portugal; (H.N.); (R.A.B.); (F.M.D.); (C.A.M.); (M.P.); (F.P.); (C.A.); (L.B.S.); (P.P.); (J.A.)
| | - Cândida Malça
- Mechanical Engineering Department, Institute of Engineering (ISEC), Polytechnic Institute of Coimbra (IPC), 3030 Coimbra, Portugal;
- Centre for Rapid and Sustainable Product Development (CDRSP), Polytechnic Institute of Leiria (IPL), 2430 Marinha Grande, Portugal
| | - Rúben Durães
- ORTHOS SSI, Unipessoal LDA, 4809 Guimarães, Portugal;
| | | | - Pedro Parreira
- Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), 3000 Coimbra, Portugal; (H.N.); (R.A.B.); (F.M.D.); (C.A.M.); (M.P.); (F.P.); (C.A.); (L.B.S.); (P.P.); (J.A.)
| | - João Apóstolo
- Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), 3000 Coimbra, Portugal; (H.N.); (R.A.B.); (F.M.D.); (C.A.M.); (M.P.); (F.P.); (C.A.); (L.B.S.); (P.P.); (J.A.)
- Portugal Centre for Evidence Based Practice: A JBI Centre of Excellence (PCEBP), 3000 Coimbra, Portugal
| | - Arménio Cruz
- Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), 3000 Coimbra, Portugal; (H.N.); (R.A.B.); (F.M.D.); (C.A.M.); (M.P.); (F.P.); (C.A.); (L.B.S.); (P.P.); (J.A.)
- Correspondence: (R.C.); (V.P.); (A.C.)
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Dereli M, Ozcan Kahraman B, Kahraman T. A Narrative Review of Respiratory Impairment, Assessment, and Rehabilitation in Multiple Sclerosis. DUBAI MEDICAL JOURNAL 2022. [DOI: 10.1159/000521444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
<b><i>Background:</i></b> Respiratory impairment is a problem seen in people with multiple sclerosis (pwMS) from the early stages of the disease but not frequently recognized by clinicians until the later stages. It is seen in different ways, such as respiratory muscle weakness, change in pulmonary volumes, and decrease in cough efficiency. This situation has consequences affecting individuals’ physical fitness, participation in daily life, and quality of life. <b><i>Summary:</i></b> This review explains possible respiratory impairment mechanisms, related problems, assessment, and rehabilitation approaches in pwMS. <b><i>Key Messages:</i></b> It is recommended a comprehensive assessment of respiratory functions in pwMS regardless of the disease severity and stage. In addition, pulmonary rehabilitation and other exercises can have positive effects on the respiratory functions of pwMS. In future studies, specific training parameters should be determined for pwMS to achieve optimal benefits. There is also a need for studies that apply respiratory muscle training in pwMS who have a high disease severity and limited participation in the activities of daily living.
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Félix-Lusterman CC, Joseph ME, Daniels SK. Update on Exercise-Based Rehabilitation Approaches for Neurogenic Dysphagia. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2021. [DOI: 10.1007/s40141-021-00333-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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15
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Eren F, Ozkan B, Demir A. The relationship between dysphagia, respiratory functions and anthropometry in patients with multiple sclerosis. Mult Scler Relat Disord 2021; 55:103192. [PMID: 34371272 DOI: 10.1016/j.msard.2021.103192] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 07/08/2021] [Accepted: 08/01/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND It is known that many body systems are affected as a result of dysphagia. The aim of this study is to investigate the relationship between clinical features, respiratory functions, anthropometric measurements and dysphagia in patients with multiple sclerosis (MS). METHOD Seventy-five MS patients and 50 healthy controls were included in this prospective case-control study. Disability was assessed with expanded disability status scale (EDSS), and swallowing was assessed with questionnaire for the assessment of dysphagia (solid, liquid and total) for disease. Respiratory functions were demonstrated with computerized spirometry device. Body weight, height, waist, hip, and mid-arm circumference are measured. Body mass index and body fat percentage were calculated. The relationship of all these parameters with disease activity and dysphagia was investigated. RESULTS There were 75 MS patients with a mean age of 38.40 ± 11.27 years, and 50 (66.70%) were female in the study. The all type of dysphagia scores were higher in MS patients than control group (p = 0.001). Many respiratory function test scores and only hip circumference were lower in MS patients. However, especially low forced expiratory volume-1st second (FEV1), forced vital capacity (FVC) and peak expiratory flow (PEF) values were associated with disability. In addition, dysphagia scores were higher in progressive MS patients with severe disability and high frequency attacks (p = 0.001). Increased severity of dysphagia are associated with many lower anthropometric measurements (not height-especially mid-arm circumference) and respiratory function test scores. CONCLUSION MS affects swallowing and respiratory systems functions. They are associated with MS disease activity. Dysphagia and its severity are associated with many anthropometric measurements and respiratory functions test scores.
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Affiliation(s)
- Fettah Eren
- Department of Neurology, Selcuk University Faculty of Medicine, Seven street & Number 1B, Konya 42700, Turkey.
| | - Bengu Ozkan
- Konya City Hospital, Chest Diseases Clinic, University of Health Sciences Turkey, Konya 42700, Turkey.
| | - Aysegul Demir
- Konya City Hospital, Neurology Clinic, University of Health Sciences Turkey, Konya 42700, Turkey.
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Su CL, Tam KW, Fang TP, Chiang LL, Chen HC. Effects of pulmonary rehabilitation program on amyotrophic lateral sclerosis: A meta-analysis of randomized controlled trials. NeuroRehabilitation 2021; 48:255-265. [PMID: 33814477 DOI: 10.3233/nre-210052] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Patients with amyotrophic lateral sclerosis (ALS) develop respiratory failure and progressive muscle weakness. The effects of pulmonary rehabilitation on the lung function of patients with ALS are unclear. OBJECTIVE Through this meta-analysis of randomized controlled trials (RCTs), we evaluated the effects of pulmonary rehabilitation, such as type of treatment, on patients with ALS and compared the effectiveness of this treatment. METHODS PubMed, EMBASE, Web of Science, and Cochrane databases were searched until December 2020. The methodological quality of each study was assessed using the updated Cochrane Risk of Bias tool (RoB 2.0). Data were analyzed using Review Manager version 5.4 (Cochrane Collaboration, Oxford, England), and the meta-analysis was performed in accordance with Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA) guidelines. RESULTS Of 2168 articles, 10 trials were reviewed; among these trials, two focused on respiratory training and eight on physical exercise, three of which involved a combination of aerobic and resistance training. Our meta-analysis demonstrated no difference in the ALSFRS-R score and % FVC among patients with ALS. CONCLUSIONS Respiratory training or physical exercise did not significantly affect the ALSFRS-R score and % FVC of patients with ALS. At 12 months after intervention, the ALSFRS-R score in the physical exercise group was higher than that in the usual care group. Further clinical trials are warranted to develop approaches for improving the lung function of patients with ALS.
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Affiliation(s)
- Chien-Ling Su
- Department of Thoracic Internal Medicine, Taipei Medical University-Shuang Ho Hospital, New Taipei City, Taiwan.,Department of Physical Therapy, Shu-Zen Junior College of Medicine and Management, Kaohsiung City, Taiwan.,School of Respiratory Therapy, Taipei Medical University, Taipei, Taiwan
| | - Ka-Wai Tam
- Division of General Surgery, Department of Surgery, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan.,Division of General Surgery, Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.,Cochrane Taiwan, Taipei Medical University, Taipei, Taiwan
| | - Tien-Pei Fang
- Department of Respiratory Care, Chang Gung University of Science and Technology, Chiayi, Taiwan.,Department of Respiratory Therapy, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Ling-Ling Chiang
- Department of Thoracic Internal Medicine, Taipei Medical University-Shuang Ho Hospital, New Taipei City, Taiwan.,School of Respiratory Therapy, Taipei Medical University, Taipei, Taiwan
| | - Hui-Chin Chen
- Department of Respiratory Care, Chang Gung University of Science and Technology, Chiayi, Taiwan
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Pulmonary Function and Respiratory Muscle Strength in Patients with Multiple Sclerosis. Mult Scler Int 2021; 2021:5532776. [PMID: 34221507 PMCID: PMC8219426 DOI: 10.1155/2021/5532776] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 05/27/2021] [Accepted: 06/10/2021] [Indexed: 11/30/2022] Open
Abstract
Background In patients with multiple sclerosis (MS), there is a decline in muscle strength and physical capacity due to demyelination and axonal loss in the central nervous system. In patients with advanced MS or in a later stage of the disease, also respiratory impairment may occur. The degree of pulmonary dysfunction in the earlier stages of MS has not been thoroughly described. Therefore, the primary aims of this study are to describe pulmonary function and respiratory muscle strength in patients with a moderate disease course and to identify associations between respiratory muscle strength and functional capacity. Methods A sample of 48 patients with a diagnosis of MS and mean age 56 ± 11 years was studied using a descriptive cross-sectional design. The patients had a disease duration of 24 ± 11 years and a median Expanded Disability Status Scale (EDSS) score of 4.5 (interquartile range 4.0-6.5). Pulmonary function assessed by spirometry, respiratory muscle strength, peak cough flow and peripheral oxygen saturation, subjective breathing and coughing ability, and physical capacity measured using the 6MWT were evaluated. Results The patients had normal pulmonary function with no significant abnormalities in dynamic spirometry (vital capacity 103 ± 16% predicted, forced expiratory volume in 1 second 95 ± 15% predicted). Peak expiratory flow rate 89 ± 17% predicted was in the lower limit of normal. Respiratory muscle strength, determined by maximal inspiratory (MIP) and expiratory (MEP) static pressures, was normal but with large differences between individuals. MIP ranged from 26 to 143 cmH2O (98 ± 31% predicted); the MEP values ranged from 43 to 166 cmH2O (104 ± 29% predicted), with two patients having values below the lower limit of normal. Significant positive associations between MIP as well as MEP were found in several pulmonary function variables. A significant negative association was found between EDSS score and MEP (r = −0.312, p = 0.031). Mean peak cough flow was 389 ± 70 L/min, which is comparable with the values reported for healthy adults. The patients did not experience a severely decreased ability to take deep breaths or cough. There was a moderate correlation between MEP and physical capacity, as assessed by the 6MWT (r = 0.399, p = 0.010) and between peak expiratory flow (PEF) and the 6MWT (r = 0.311, p = 0.048). Conclusion Respiratory muscle strength, pulmonary function assessed by spirometry, and peak cough flow were normal in patients with mild to moderate MS; however, there were large individual differences demonstrating low respiratory muscle strength in some patients. Significant associations between MEP and functional capacity and between MEP and disease severity were found, indicating that patients with impaired respiratory muscle strength have lower functional capacity and more severe disease.
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Is there a relationship between anxiety and depression with respiratory functions in patients with relapsing-remitting multiple sclerosis? Mult Scler Relat Disord 2021; 52:103023. [PMID: 34049218 DOI: 10.1016/j.msard.2021.103023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 04/24/2021] [Accepted: 05/07/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND Psychiatric symptoms are common in multiple sclerosis. The relationship of emotional state with respiratory function is unclear in these patients. We aimed to evaluate the relationship between the clinical characteristics, anxiety and depression status, and respiratory functions of patients with relapsing-remitting multiple sclerosis (RRMS). METHOD The research was planned as a prospective case-control study. Ninety RRMS patients and 50 healthy controls were included in the study. The MS diagnosis was confirmed according to the revised 2017 McDonald's criteria. Disability was divided into two subgroups according to the Expanded Disability Status Scale (EDSS) (under 3.5 and 3.5-5.5). Beck anxiety and Beck depression inventories evaluated. A pulmonary function test was performed with a computerized spirometry device. Forced expiratory volume-1st second (FEV1), forced vital capacity (FVC), FEV/FVC, peak expiratory flow (PEF), maximal expiratory flow (MEF), peak inspiratory flow (PIF), and maximal inspiratory flow (MIF) values were obtained. RESULTS There were 90 RRMS patients with a mean age of 38.68±10.95 years, and 58 (64.40%) were female in the study. The anxiety and depression scores of the patients were significantly higher than the control group (p=0.02, 0.002). FVC and FEV1 values were lower in patients with higher Beck depression scores (p=0.012, 0.007). FVC, FEV1, MEF50, and PIF values were lower in patients with higher Beck anxiety scores (p=0.002, 0.002, 0.030, 0.027). When EDSS and number of attacks were fixed, there was a low to moderate correlation between anxiety and FEV1-FVC (p=0.001, r=-367, -0.360 respectively), and a low negative correlation between depression and FEV1 (p=0.045, r=-0.214). CONCLUSION Anxiety and depression scores are higher in patients with RRMS. Depression and anxiety are particularly associated with low FVC and FEV1 in patients.
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Aguilar-Zafra S, Del Corral T, Montero-González N, de-Gabriel-Hierro A, López-de-Uralde-Villanueva I. Urinary incontinence and impaired physical function are associated with expiratory muscle weakness in patients with multiple sclerosis. Disabil Rehabil 2021; 44:3531-3539. [PMID: 33427502 DOI: 10.1080/09638288.2020.1867908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
PURPOSE Patients with multiple sclerosis (MS) with respiratory muscle weakness could have physical function impairments, given the functional/biomechanical link of the trunk stabilising system. Thus, clinicians could employ new treatment strategies targeting respiratory muscles to improve their physical function. This study pretends to evaluate the relationship between respiratory muscle strength, pulmonary function and pelvic floor function, and also to correlate these variables with physical function (gait function, disability and quality of life) in patients with MS. METHODS 41 patients participated in this descriptive cross-sectional study. Respiratory muscle strength [maximal respiratory pressures (MIP/MEP)], pulmonary function (forced spirometry), pelvic floor function [urinary incontinence (UI)], physical function [Timed Up & Go (TUG) test, Barthel index and health status questionnaire (SF-12)] were evaluated. RESULTS Respiratory muscle strength and pulmonary function were moderately related to UI (MIP: rho = -0.312; MEP: rho = -0.559). MEP was moderately related to physical function (TUG: rho = -0.508; Barthel index: rho = 0.418). Patients with and without expiratory muscle weakness showed differences in UI, pulmonary and physical function. CONCLUSION Patients with MS with greater deterioration in pulmonary function and respiratory muscle strength, especially expiratory muscles, showed greater deterioration in UI and physical function. Expiratory muscle weakness had a negative impact on urinary, physical and pulmonary function.Implications for rehabilitationPulmonary function is associated with urinary incontinence and gait functionality in patients with multiple sclerosis (MS).Expiratory muscle weakness is associated with impaired urinary and physical function in patients with MS.The inclusion of respiratory muscle training to the rehabilitation programs of patients with MS could improve their pelvic floor disorders and physical function.
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Affiliation(s)
- Sandra Aguilar-Zafra
- Departamento de Fisioterapia, Facultad de Ciencias de la Salud. Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, Spain.,Motion in Brains Research Group, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, Spain.,Téxum S.L Physiotherapy Center, Coslada, Madrid, Spain
| | - Tamara Del Corral
- Department of Radiology, Rehabilitation and Physiotherapy, Faculty of Nursing, Physiotherapy and Podiatry, Complutense University of Madrid, Madrid, Spain
| | - Noelia Montero-González
- Departamento de Fisioterapia, Facultad de Ciencias de la Salud. Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, Spain
| | - Almudena de-Gabriel-Hierro
- Departamento de Fisioterapia, Facultad de Ciencias de la Salud. Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, Spain
| | - Ibai López-de-Uralde-Villanueva
- Department of Radiology, Rehabilitation and Physiotherapy, Faculty of Nursing, Physiotherapy and Podiatry, Complutense University of Madrid, Madrid, Spain
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Martin-Sanchez C, Calvo-Arenillas JI, Barbero-Iglesias FJ, Fonseca E, Sanchez-Santos JM, Martin-Nogueras AM. Effects of 12-week inspiratory muscle training with low resistance in patients with multiple sclerosis: A non-randomised, double-blind, controlled trial. Mult Scler Relat Disord 2020; 46:102574. [PMID: 33296972 DOI: 10.1016/j.msard.2020.102574] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 08/27/2020] [Accepted: 10/07/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Patients with multiple sclerosis (MS) have respiratory limitations like fatigue or muscle weakness. The aim of the study was to evaluate the effectiveness of a low-intensity protocol with inspiratory muscle training (IMT) to improve respiratory strength, spirometric parameters and dyspnea in patients with MS. METHODS This study was a controlled, non-randomised, double-blind trial on 67 patients with MS distributed in 2 groups, intervention group (IG) (n = 36) and respiratory exercise group (REG) (n = 31). Over 12 weeks, 5 days/week, 15 min/day all subjects followed a respiratory training program. IG trained with IMT with low resistance (20% maximum inspiratory pressure (MIP) during the first two weeks, 30% MIP after the second week). REG followed a program involving nasal breathing and maximum exhalation. Main outcome measured was inspiratory strength (MIP); secondary outcomes were maximum expiratory pressure (MEP), spirometry, dyspnea and health-related quality of life. RESULTS After respiratory training, the intervention group improved MIP, MEP, MVV, peak expiratory flow (PEF), tidal volume (TV) and dyspnea, 51%, 36%, 21%,11%, 51% and 19% respectively (p < .001, p < .001, p < .001, p < .05, p < .05, p < .05). The control group improved MIP, MEP, MVV and PEF, 24%, 27%, 28% and 12% respectively (p < .001, p < .001, p < .001, p < .05). Improvements achieved on MIP and dyspnea were significantly higher in IG patients (p=.002, p=.046, respectively). CONCLUSION 12-week inspiratory muscle training with low resistance was more effective than conventional respiratory exercises to improve respiratory strength, spirometric parameters and dyspnea in patients with multiple sclerosis.
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Affiliation(s)
| | | | | | - Emilio Fonseca
- Medicine department, University of Salamanca, Salamanca, Spain
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Muhtaroglu M, Ertugrul Mut S, Selcuk F, Malkoc M. Evaluation of respiratory functions and quality of life in multiple sclerosis patients. Acta Neurol Belg 2020; 120:1107-1113. [PMID: 29974389 DOI: 10.1007/s13760-018-0967-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Accepted: 06/17/2018] [Indexed: 10/28/2022]
Abstract
The aim of this study was to evaluate respiratory muscle strength, respiratory functions and quality of life in multiple sclerosis (MS) patients and compare the results with the healthy volunteers. The study included a group of 24 patients diagnosed with MS (16 women, 8 men) with an EDSS score of ≤ 5, who were without clinical respiratory impairment. MS patients were compared with the healthy volunteer group (16 women, 8 men). Respiratory muscle strength and respiratory functions were evaluated with specific devices. Maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP) parameters were measured for the muscle strength. Forced vital capacity (FVC), forced expiratory volume (FEV1), FEV1/FVC, peak expiratory flow, and forced expiratory flow (FEF25-75) parameters were measured for the respiratory functions. Questionnaire SF-36 was applied to evaluate health-related quality of life. A total of 24 MS patients' respiratory function test results were compared with healthy volunteers and significant changes were found at MIP, MEP, and FEV1 parameters. Quality of life was compared between the groups and there was a significant difference in parameters related with physical performance and physical-health-related role limitations. There is an early involvement of the respiratory muscles in patients with MS, yet clinical symptoms appear in later stages. Respiratory functions should be evaluated at the earlier stage of the disease so that rehabilitation can be planned in order to reduce respiratory complications and improve the quality of life in patients.
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Evolving relationship between respiratory functions & impairment in sleep and cognition in patients with multiple sclerosis. Mult Scler Relat Disord 2020; 46:102514. [PMID: 32992131 DOI: 10.1016/j.msard.2020.102514] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Revised: 09/03/2020] [Accepted: 09/05/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND The most apparent source of disability in patients with multiple sclerosis (MS) is the physical and mental impact. The pathophysiological mechanisms of cognitive dysfunction are multifactorial although hypoventilation secondary to respiratory dysfunction may contribute to cognitive decline. METHODS This study was conducted on 146 MS patients with baseline clinical assessments including the Epworth sleepiness scale (ESS) and physical disability was assessed using the Expanded Disability Status Scale (EDSS). Cognitive testing was performed utilizing the Brief International Cognitive Assessment for Multiple Sclerosis (BICAMS) and the Perceived Deficits Questionnaire (PDQ). Respiratory functions were assessed by spirometry and the respiratory muscle functional assessment was done by maximal mouth pressure measurement. RESULTS The respiratory muscle function test had a significant negative correlation with the score of ESS and PDQ scale and a significant positive correlation with the BICAMS scale score (p < 0.001). The ESS and PDQ scores were significantly negatively correlated with forced expiratory volume in the first second (FEV1)/ forced vital capacity (FVC) (p = 0.03, 0.02), FVC supine (p = 0.03, 0.01), FVC upright- FVC supine (ΔFVC) (p < 0.001, <0.001) FEV1 (p < 0.001) and FVC (L) (p < 0.001), respectively. While the BICAMS showed a significant positive correlation with spirometry results except FVC upright. ESS scores were significantly correlated with the BICAMS and PDQ scale score (p < 0.001). CONCLUSION Among MS patients, impaired respiratory functions are significantly associated with sleep disturbance and cognitive impairment. Thus the spirometry and respiratory muscle strength assessment are necessary from the early phase of MS.
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Souto-Miranda S, Jácome C, Alves A, Machado A, Paixão C, Oliveira A, Marques A. Predictive equations of maximum respiratory mouth pressures: A systematic review. Pulmonology 2020; 27:219-239. [PMID: 32878743 DOI: 10.1016/j.pulmoe.2020.03.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 03/26/2020] [Accepted: 03/30/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Maximum inspiratory (Pimax) and expiratory (Pemax) mouth pressures are commonly used to detect respiratory muscle weakness resorting to predictive equations established for healthy people. There are several predictive equations, but they are widespread in the literature. This study aimed to review the existent predictive equations of maximum inspiratory (Pimax) and expiratory (Pemax) mouth pressures for adults. Additionally, we aimed to identify which ones were generated based on international standards. METHODS A systematic review of predictive equations of Pimax and Pemax for healthy adults was conducted. A comprehensive search was performed of Cochrane Library, EBSCO, PubMed, Scopus and Web of Science to identify studies that presented at least one equation for Pimax or Pemax developed for healthy adults. The quality of studies was assessed by two reviewers with the Quality Assessment of Diagnostic Accuracy Studies (Quadas-2). RESULTS Risk of bias was high in 8 of the 20 studies included. Forty-two Pimax and 34 Pemax equations were found, mostly using the variables age (n=39), weight (n=20) and height (n=8). These equations explained 3 to 96% of the Pimax/Pemax variance. They were developed with individuals from 11 countries (Portugal not included). Twelve Pimax and eight Pemax equations complied with international standards. CONCLUSIONS This review gathered the predictive equations that have been developed for both Pimax and Pemax, however most were generated from unstandardized procedures. Future studies should explore the suitability of these equations for populations for which specific ones are not available, such as the Portuguese population, and develop new equations if necessary.
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Affiliation(s)
- S Souto-Miranda
- Lab 3R - Respiratory Research and Rehabilitation Laboratory, School of Health Sciences (ESSUA), University of Aveiro, Aveiro, Portugal; Institute of Biomedicine (iBiMED), University of Aveiro, Aveiro, Portugal
| | - C Jácome
- Lab 3R - Respiratory Research and Rehabilitation Laboratory, School of Health Sciences (ESSUA), University of Aveiro, Aveiro, Portugal; Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine of University of Porto, Porto, Portugal
| | - A Alves
- Lab 3R - Respiratory Research and Rehabilitation Laboratory, School of Health Sciences (ESSUA), University of Aveiro, Aveiro, Portugal; Institute of Biomedicine (iBiMED), University of Aveiro, Aveiro, Portugal
| | - A Machado
- Lab 3R - Respiratory Research and Rehabilitation Laboratory, School of Health Sciences (ESSUA), University of Aveiro, Aveiro, Portugal; Institute of Biomedicine (iBiMED), University of Aveiro, Aveiro, Portugal
| | - C Paixão
- Lab 3R - Respiratory Research and Rehabilitation Laboratory, School of Health Sciences (ESSUA), University of Aveiro, Aveiro, Portugal; Institute of Biomedicine (iBiMED), University of Aveiro, Aveiro, Portugal
| | - A Oliveira
- Lab 3R - Respiratory Research and Rehabilitation Laboratory, School of Health Sciences (ESSUA), University of Aveiro, Aveiro, Portugal; Institute of Biomedicine (iBiMED), University of Aveiro, Aveiro, Portugal
| | - A Marques
- Lab 3R - Respiratory Research and Rehabilitation Laboratory, School of Health Sciences (ESSUA), University of Aveiro, Aveiro, Portugal; Institute of Biomedicine (iBiMED), University of Aveiro, Aveiro, Portugal.
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Andreu-Caravaca L, Ramos-Campo DJ, Abellán-Aynés O, Rubio-Arias JÁ. Movement Velocity as A Measure of Exercise Intensity in Persons with Multiple Sclerosis: A Validity Study. J Clin Med 2020; 9:jcm9082458. [PMID: 32751943 PMCID: PMC7464150 DOI: 10.3390/jcm9082458] [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: 06/13/2020] [Revised: 07/21/2020] [Accepted: 07/29/2020] [Indexed: 12/05/2022] Open
Abstract
Objectives: This study aims to analyse the validity (agreement between two methods) of the movement propulsive velocity (MPV) as an indicator of relative load in leg press (LP) and bench press (BP) exercises in persons with multiple sclerosis (MS). Methods: 18 persons with MS (sex = 55% male; age (mean ± SD) = 44.88 ± 10.62 years; body mass = 67.19 ± 10.63 kg; height = 1.66 ± 0.07 m; Expanded Disability Status Scale (EDSS) = 3.12 ± 1.73) performed an incremental loading test in BP and LP exercises in two separate sessions. Individual determination of the one-repetition maximum (1RM) and full load-velocity profile were obtained for each participant. Results: a significant linear relationship was observed between the %1RM load and the MPV in LP (%1RM = −133.58 × MPV + 117.44; r2 = 0.84; standard error of the estimate (SEE) = 9.38%1RM) and BP (%1RM = −95.66 × MPV + 115.26; r2 = 0.86; SEE = 9.82%1RM). In addition, no significant differences were found between the %1RM achieved directly and the %1RM obtained by the equation calculated from the linear regression (LP, p = 0.996; BP, p = 0.749). Conclusions: these results indicate that movement velocity can estimate the relative load in bench press and leg press exercises in persons MS.
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Affiliation(s)
- Luis Andreu-Caravaca
- Faculty of Sports, UCAM, Catholic University San Antonio, 30107 Murcia, Spain; (L.A.-C.); (D.J.R.-C.); (O.A.-A.)
- International Chair of Sport Medicine, UCAM, Catholic University San Antonio, 30107 Murcia, Spain
| | - Domingo Jesús Ramos-Campo
- Faculty of Sports, UCAM, Catholic University San Antonio, 30107 Murcia, Spain; (L.A.-C.); (D.J.R.-C.); (O.A.-A.)
| | - Oriol Abellán-Aynés
- Faculty of Sports, UCAM, Catholic University San Antonio, 30107 Murcia, Spain; (L.A.-C.); (D.J.R.-C.); (O.A.-A.)
- International Chair of Sport Medicine, UCAM, Catholic University San Antonio, 30107 Murcia, Spain
| | - Jacobo Ángel Rubio-Arias
- LFE Research Group, Department of Health and Human Performance, Faculty of 15 Physical Activity and Sport Science-INEF, Universidad Politécnica de Madrid, 28040 16 Madrid, Spain
- Correspondence: or ; Tel.: +34-968-27-87-57
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Respiratory Muscle Strength Training to Improve Vocal Function in Patients with Presbyphonia. J Voice 2020; 36:344-360. [PMID: 32680804 DOI: 10.1016/j.jvoice.2020.06.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 06/03/2020] [Accepted: 06/04/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVE The effects of presbyphonia are compounded by the decline in respiratory function that occurs with age. Commonly recommended exercises to optimize the use of respiratory muscles during speech, such as diaphragmatic breathing, are unlikely to be intensive enough to induce respiratory changes and impact vocal function. The objective of this study was to assess the effect of adding a targeted intervention, respiratory muscle strength training, to voice exercises in a sample of patients with presbyphonia. METHODS/DESIGN In this prospective, randomized-controlled trial, 12 participants received either (1) vocal function exercises (VFE), (2) VFE combined with inspiratory muscle strength training (IMST), or (3) VFE combined with expiratory muscle strength training (EMST). Data collected prior to and following 4 weekly intervention sessions included respiratory measures (pulmonary function and respiratory muscle strength) and voice measures (videostroboscopy, acoustic, auditory-perceptual, aerodynamic, and self-assessment measures). RESULTS Participants who received IMST improved their voice quality during connected speech (smoothed cepstral peak prominence and ratings of overall voice quality) and their scores on the three self-assessment questionnaires with large to very large within-group effect sizes (|d| = 0.82-1.61). In addition, participants in the IMST group reduced their subglottal pressure with a large effect size (d = -0.92). Participants who received EMST improved their maximum expiratory strength and smoothed cepstral peak prominence with large effect sizes (d = 0.80 and 0.99, respectively) but had limited improvements in other outcomes. Participants who received only VFE decreased their amount of vocal fold bowing, improved their voice quality on a sustained vowel (amplitude perturbation quotient), and improved their Glottal Function Index score with large effect sizes (|d| = 0.74-1.00). CONCLUSION Preliminary data indicate that adding IMST to voice exercises may lead to the greatest benefits in patients with presbyphonia by promoting improved subglottal pressure control as well as increasing air available for phonation, resulting in improved self-assessment outcomes.
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Lin SD, Butler JE, Boswell-Ruys CL, Hoang PD, Jarvis T, Gandevia SC, McCaughey EJ. The effect of abdominal functional electrical stimulation on bowel function in multiple sclerosis: a cohort study. Mult Scler J Exp Transl Clin 2020; 6:2055217320941530. [PMID: 34691757 PMCID: PMC8529907 DOI: 10.1177/2055217320941530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2019] [Revised: 05/12/2020] [Accepted: 06/09/2020] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Chronic constipation is prevalent in people with multiple sclerosis, with current treatments usually only partially effective. OBJECTIVES This study aims to evaluate the efficacy of abdominal functional electrical stimulation to reduce whole gut and colonic transit times and improve bowel and bladder-related quality of life. METHODS A total of 23 people with multiple sclerosis who fulfilled the Rome III criteria for functional constipation applied abdominal functional electrical stimulation for 1 hour per day, 5 days per week, for 6 weeks. Whole gut and colonic transit times and bowel and bladder-related quality of life were measured before and after the intervention period. RESULTS Whole gut (mean 81.3 (standard deviation 28.7) hours pre vs. 96.1 (standard deviation 53.6) hours post-intervention, P = 0.160) and colonic transit time (65.1 (31.4) vs. 74.8 (51.1) hours, P = 0.304) were unchanged following 6 weeks of abdominal functional electrical stimulation. There was a significant improvement in bowel (mean 1.78 (SD: 0.64) pre vs. 1.28 (SD: 0.54) post, P = 0.001) and bladder (50.6 (26.49) vs. 64.5 (21.92), p = 0.007) related quality of life after the intervention period. CONCLUSION While abdominal functional electrical stimulation did not reduce whole gut and colonic transit times for people with multiple sclerosis, a significant improvement in bowel and bladder-related quality of life was reported.
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Affiliation(s)
| | | | - Claire L Boswell-Ruys
- Neuroscience Research Australia, Australia
- School of Medical Sciences, University of New South Wales, Australia
| | - Phu D Hoang
- Neuroscience Research Australia, Australia
- School of Medical Sciences, University of New South Wales, Australia
- Continence Clinic, MS Limited, Australia
- Faculty of Health Sciences, Australian Catholic University, Australia
| | - Tom Jarvis
- Continence Clinic, MS Limited, Australia
- Prince of Wales Clinical School, University of New South Wales, Australia
| | - Simon C Gandevia
- Neuroscience Research Australia, Australia
- School of Medical Sciences, University of New South Wales, Australia
- Prince of Wales Clinical School, University of New South Wales, Australia
| | - Euan J McCaughey
- Neuroscience Research Australia, Australia
- School of Medical Sciences, University of New South Wales, Australia
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The Impact of Respiratory Exercises on Voice Outcomes: A Systematic Review of the Literature. J Voice 2020; 34:648.e1-648.e39. [DOI: 10.1016/j.jvoice.2019.01.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 01/22/2019] [Accepted: 01/24/2019] [Indexed: 12/14/2022]
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Huang MH, Fry D, Doyle L, Burnham A, Houston N, Shea K, Smith H, Wiske L, Goode J, Khitrik E, Kolanda M. Effects of inspiratory muscle training in advanced multiple sclerosis. Mult Scler Relat Disord 2020; 37:101492. [DOI: 10.1016/j.msard.2019.101492] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 10/22/2019] [Accepted: 10/31/2019] [Indexed: 11/29/2022]
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Rodríguez MÁ, Crespo I, del Valle M, Olmedillas H. Should respiratory muscle training be part of the treatment of Parkinson’s disease? A systematic review of randomized controlled trials. Clin Rehabil 2019; 34:429-437. [DOI: 10.1177/0269215519896054] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Objective: To determine the effectiveness of respiratory muscle training in persons with Parkinson’s disease. Data sources: PubMed/MEDLINE, EMBASE, Web of Science, Scopus and PEDro electronic databases were searched until 15 November 2019. Reference lists of included studies were hand-searched. Methods: Randomized controlled trials assessing the effects of respiratory muscle training programmes (both inspiratory and expiratory) in patients with Parkinson’s disease were included. Two reviewers independently identified eligible studies and extracted data. Method quality was appraised with the PEDro scale. Results: Five papers including three randomized controlled trials with a total of 111 patients were identified. Method appraisal showed a mean score of 5 in the PEDro scale. One study analysed inspiratory muscle training, one expiratory muscle training and two established a comparison between both of them. Statistically positive results were found in maximal inspiratory pressure ( P < 0.05 and d = 0.76), maximal expiratory pressure ( P < 0.01 and d = 1.40), perception of dyspnoea ( P < 0.01), swallowing function ( d = 0.55) and phonatory measures, without significant differences in spirometric indices. Conclusions: Respiratory muscle training may be an effective alternative for improving respiratory muscle strength, swallowing function and phonatory parameters in subjects with Parkinson’s disease. Nevertheless, the lack of primary studies about this type of training prevents obtaining robust evidence.
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Affiliation(s)
| | - Irene Crespo
- Department of Functional Biology, Universidad de Oviedo, Oviedo, Spain
- Institute of Biomedicine, Universidad de León, León, Spain
| | - Miguel del Valle
- Department of Cellular Morphology and Biology, Universidad de Oviedo, Oviedo, Spain
| | - Hugo Olmedillas
- Department of Functional Biology, Universidad de Oviedo, Oviedo, Spain
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Valenza MC, Prados-Román E, Granados-Santiago M, Torres-Sanchez I, Lopez-Lopez L, Cabrera-Martos I. Respiratory repercussions of neurological diseases and how best to manage them. Expert Rev Respir Med 2019; 14:89-102. [PMID: 31679407 DOI: 10.1080/17476348.2020.1689124] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Introduction: The high incidence of respiratory impairments in patients with neurological diseases is recognized, but the design, dosage, and effectiveness of interventions to manage them are seen as an ongoing challenge.Areas covered: This article summarizes the evidence regarding the respiratory impairments in major neurological diseases, and how to best manage them.Expert opinion: On the balance of available evidence, respiratory impairments are part of the clinical profile of neurological diseases including Multiple Sclerosis, Stroke, and Parkinson's Disease, acquiring more importance as the pathologies progress. It is recognized that knowledge gaps remain in some areas of relevance related to respiratory function and further research is required. When considering the therapeutic options, the respiratory training emerges as the approach with most evidence. However, important questions remain unsolved: what kind, how much, and how to best include respiratory interventions is uncertain. At present, respiratory programs also fail to include clinically relevant factors such as ambulation and trunk stability.
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Affiliation(s)
- Marie Carmen Valenza
- Department of Physiotherapy, Faculty of Health Sciences, University of Granada, Granada, Spain
| | - Esther Prados-Román
- Department of Physiotherapy, Faculty of Health Sciences, University of Granada, Granada, Spain
| | | | - Irene Torres-Sanchez
- Department of Physiotherapy, Faculty of Health Sciences, University of Granada, Granada, Spain
| | - Laura Lopez-Lopez
- Department of Physiotherapy, Faculty of Health Sciences, University of Granada, Granada, Spain
| | - Irene Cabrera-Martos
- Department of Physiotherapy, Faculty of Health Sciences, University of Granada, Granada, Spain
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Izumi M, Akifusa S, Ganaha S, Yamashita Y. Activities of daily living decline is a predictor of lowered coughing ability and correlates with rehabilitative effect of tongue cleaning on coughing ability. Odontology 2019; 107:393-400. [DOI: 10.1007/s10266-019-00415-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Accepted: 01/04/2019] [Indexed: 11/29/2022]
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Templeman L, Roberts F. Effectiveness of expiratory muscle strength training on expiratory strength, pulmonary function and cough in the adult population: a systematic review. Physiotherapy 2019; 106:43-51. [PMID: 32026845 DOI: 10.1016/j.physio.2019.06.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Indexed: 01/18/2023]
Abstract
BACKGROUND Respiratory muscle strength declines in certain disease states, leading to impaired cough, reduced airway clearance and an increased risk of aspiration pneumonia. Respiratory muscle training may therefore reduce this risk. OBJECTIVES To assess current evidence of expiratory muscle strength training (EMST) on maximum expiratory pressure, cough flow and spirometry. DATA SOURCES Databases including CINAHL, Medline, Science Direct and PEDRo were searched. ELIGIBILITY CRITERIA Randomised controlled trials investigating expiratory muscle strength training on maximum expiratory pressure, pulmonary function or cough in any adult population, published before December 2017. STUDY APPRAISAL Data were extracted to a trial description form and study quality evaluated by two reviewers. Meta-analysis was performed with calculation of mean differences and 95% confidence intervals. RESULTS Nine studies met inclusion criteria and ranged in size from 12 to 42 participants. Trials investigated EMST in healthy adults (2), multiple sclerosis (3), COPD (2), acute stroke (1) and spinal cord injury (1). Overall, EMST improved maximum expiratory pressure (15.95cmH2O; 95% CI: 7.77 to 24.12; P<0.01) with no significant impact on cough flow (4.63L/minute; 95%CI -27.48 to 36.74; P=0.78), forced vital capacity (-0.16L; 95%CI -0.35 to 0.02; P=0.09) or forced expiratory volume in 1second (-0.09L; 95%CI -0.10 to -0.08; P<0.001) vs control or sham training. CONCLUSIONS Meta-analysis indicated a small significant increase in maximum expiratory pressure following EMST. Improvements in maximum expiratory pressure did not lead to improvements in cough or pulmonary function. LIMITATIONS Variations in protocol design and population limited the overall effect size. Systematic Review Registration PROSPERO CRD42018104190.
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Affiliation(s)
- Lucy Templeman
- School of Health Sciences, Robert Gordon University, Garthdee Road, Aberdeen AB10 7QG, United Kingdom; NHS Grampian, Physiotherapy Outpatient Department, Woodend Hospital, Eday Road, Aberdeen AB15 6XS, United Kingdom.
| | - Fiona Roberts
- School of Health Sciences, Robert Gordon University, Garthdee Road, Aberdeen AB10 7QG, United Kingdom
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Lee K, Park D, Lee G. Progressive Respiratory Muscle Training for Improving Trunk Stability in Chronic Stroke Survivors: A Pilot Randomized Controlled Trial. J Stroke Cerebrovasc Dis 2019; 28:1200-1211. [PMID: 30712955 DOI: 10.1016/j.jstrokecerebrovasdis.2019.01.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 12/27/2018] [Accepted: 01/12/2019] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Stroke weakens the respiratory muscles, which in turn may influence the trunk stability; it is unclear whether the progressive respiratory muscle training (RMT) is effective in improving the trunk stability. The aim of this study was to investigate the effects of progressive RMT with trunk stabilization exercise (TSE) on respiratory muscles thickness, respiratory muscle functions, and trunk stability in chronic stroke survivors. METHODS This is a pilot randomized controlled trial. Chronic stroke survivors (n = 33) who were able to sit independently participated in the tstudy. The participants were allocated into the RMP with TSE group or the TSE group. The respiratory muscle thickness during resting and contraction were measured. Maximal expiratory pressure (MEP), peak expiratory flow (PEF), and forceful expiratory volume at 1 sec (FEV1) for forced expiratory muscle function and maximal inspiratory pressure (MIP), peak inspiratory flow (PIF), and vital capacity (VC) for inspiratory muscle function were examined. Trunk stability was estimated by maximal velocity and path length of the center of pressure (COP) by using a balance board with sitting posture. RESULTS The respiratory muscle thickness was significantly increased on the affected side in the RMT group than in the TSE group. The MEP, PEF, MIP, and PIF were significantly increased in the RMT group than in the TSE group; however, FEV1 and VC showed no significant differences between the 2 groups. Trunk stability for the maximal velocity of COP of extension and affected side bending was significantly increased in the RMT group than in the TSE group. In addition, the maximal path length of COP of flexion, extension, affected/less affected side bending was significantly increased in the RMT group than in the TSE group. CONCLUSIONS RMT combined with TSE can be suggested as an effective method to improve the respiratory muscle thickness, respiratory muscle functions, and trunk stability in chronic stroke survivors as opposed to TSE only.
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Affiliation(s)
- Kyeongbong Lee
- Physical Therapy Part, Physical & Rehabilitation Medicine, Samsung Medical Center, Seoul, Republic of Korea
| | - Daesung Park
- Department of Physical Therapy, Konyang University, Daejeon, Republic of Korea
| | - GyuChang Lee
- Department of Physical Therapy, Kyungnam University, Changwon, Republic of Korea.
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Reychler G, Liistro G, Piérard GE, Hermanns-Lê T, Manicourt D. Inspiratory muscle strength training improves lung function in patients with the hypermobile Ehlers-Danlos syndrome: A randomized controlled trial. Am J Med Genet A 2018; 179:356-364. [PMID: 30569502 DOI: 10.1002/ajmg.a.61016] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Revised: 11/02/2018] [Accepted: 11/20/2018] [Indexed: 01/31/2023]
Abstract
As exertional inspiratory dyspnea is a common disabling complaint in hypermobile Ehlers-Danlos syndrome (hEDS) often also known as joint hypermobility syndrome (JHS), we investigated inspiratory muscle (IM) strength in patients with hEDS, and we assessed the effects of IM training (IMT) on IM strength, lung function, and exercise capacity. A prospective evaluation of IM strength followed by a randomized controlled trial of IMT was performed in women with hEDS. Sniff nasal inspiratory pressure (SNIP) was used to routinely measure IM strength and IMT was carried out using a pressure threshold device. IM strength (main outcome), cardiopulmonary function, exercise capacity, and emotional distress of both the treated and control groups were evaluated at the start and at the end of the 6-week training period. IM strength was reduced (<80% of predicted) in 77% of patients (80/104). Lung function was normal, although 24% of patients had a higher forced expiratory vital capacity (FVC) than normal and 12% of patients had a higher total lung capacity (TLC) than normal. Both the IMT and control groups (n = 20) had similar baseline characteristics. Significant changes were noted only in the IMT group after IMT. At the end of the program, IMT improved SNIP (20%) (before: 41 ± 17 cm H2 O [28, 53] vs. after: 49 ± 18 cm H2 O [34;65]), six-minute walking distance (6MWD) (60 m) (455 ± 107 m [379,532] vs. 515 ± 127 m [408, 621]), and forced expiratory volume in one second (FEV1) (285 mL) (94 ± 14% pred [84,104] vs. 103 ± 11% pred [94, 112]). IM strength is significantly reduced in patients with hEDS. IMT improved IM strength, lung function, and exercise capacity. Our findings suggest that IMT should be added to usual care.
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Affiliation(s)
- Gregory Reychler
- Institut de Recherche Expérimentale et Clinique (IREC), Pôle de Pneumologie, ORL & Dermatologie, Université Catholique de Louvain, Brussels, Belgium.,Service de Pneumologie, Cliniques universitaires Saint-Luc, Brussels, Belgium.,Service de Médecine Physique et Réadaptation, Cliniques universitaires Saint-Luc, Brussels, Belgium
| | - Giuseppe Liistro
- Institut de Recherche Expérimentale et Clinique (IREC), Pôle de Pneumologie, ORL & Dermatologie, Université Catholique de Louvain, Brussels, Belgium.,Service de Pneumologie, Cliniques universitaires Saint-Luc, Brussels, Belgium
| | - Gérald E Piérard
- Laboratory of Skin Bioengineering and Imaging, Department of Dermatopathology, University of Liège, University Hospital of Liège, Belgium
| | - Trinh Hermanns-Lê
- Laboratory of Skin Bioengineering and Imaging, Department of Dermatopathology, University of Liège, University Hospital of Liège, Belgium
| | - Daniel Manicourt
- Laboratory of Human Molecular Genetics (GEHU), de Duve Institute (DDUV), Université catholique de Louvain (UCLouvain), Belgium.,Department of Rheumatology, University Hospital St Luc, Brussels, Belgium
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Cavalcante JGT, Silva RDE, Souza HCMD, Moraes NHLD. Análise da força muscular expiratória e respiração espontânea de indivíduos em ventilação mecânica: estudo transversal. FISIOTERAPIA E PESQUISA 2018. [DOI: 10.1590/1809-2950/17011525032018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
RESUMO Os músculos da expiração têm funções em todo o ciclo respiratório, mas não são frequentemente avaliados no desmame da ventilação mecânica. Assim, revisões e consensos não mencionam a pressão expiratória máxima (PEmáx) e o treino expiratório. Objetivou-se investigar a relação da força muscular expiratória com a respiração espontânea de indivíduos ventilados mecanicamente. Trata-se de um estudo transversal com participantes de 18 a 79 anos de idade. Foram formados os grupos PEmáx satisfatória (GPES) e PEmáx baixa (GPEB) conforme o ponto de corte de 55cmH2O e comparados a parâmetros de desmame. O GPES (n=9) teve desempenho superior ao do GPEB (n=21) no índice de respiração rápida e superficial (IRRS) (40,6±17,6rpm/L e 75,3±44,1rpm/L, respectivamente; p=0,022) e na frequência respiratória (f) (19,1±6,2rpm e 26,1±9,4rpm; p=0,044). A prevalência de PEmáx satisfatória foi pequena, observada no tamanho dos grupos. Além disso, embora a PEmáx percentual do valor predito tenha sido menor no GPEB, como esperado (67,2±15,4% vs. 45,8±14,7%; p=0,001), a pressão inspiratória máxima percentual não diferiu significantemente (82,4±21,8% vs. 67,8±18,4%; p=0,077). A PEmáx se correlacionou moderadamente com o IRRS (r=-0,406; p=0,026) e com a f (r=-0,426; p=0,017). Conclui-se que a PEmáx≥55cmH2O esteve associada à melhores valores no IRRS e na f, e que a redução da força muscular expiratória foi mais prevalente e severa que a da força muscular inspiratória.
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Kokatnur L, Rudrappa M. Diaphragmatic Palsy. Diseases 2018; 6:E16. [PMID: 29438332 PMCID: PMC5871962 DOI: 10.3390/diseases6010016] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Revised: 02/11/2018] [Accepted: 02/12/2018] [Indexed: 12/14/2022] Open
Abstract
The diaphragm is the primary muscle of respiration, and its weakness can lead to respiratory failure. Diaphragmatic palsy can be caused by various causes. Injury to the phrenic nerve during thoracic surgeries is the most common cause for diaphragmatic palsy. Depending on the cause, the symptoms of diaphragmatic palsies vary from completely asymptomatic to disabling dyspnea requiring mechanical ventilation. On pulmonary function tests, there will be a decrease in the maximum respiratory muscle power. Spirometry shows reduced lung functions and a significant drop of lung function in supine position is typical of diaphragmatic palsy. Diaphragmatic movements with respiration can be directly visualized by fluoroscopic examination. Currently, this test is being replaced by bedside thoracic ultrasound examination, looking at the diaphragmic excursion with deep breathing or sniffing. This test is found to be equally efficient, and without risks of ionizing radiation of fluoroscope. Treatment of diaphragmatic palsy depends on the cause. Surgical approach of repair of diaphragm or nonsurgical approach of noninvasive ventilation has been tried with good success. Overall prognosis of diaphragmatic palsy is good, except when it is related to neuromuscular degeneration conditions.
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Affiliation(s)
- Laxmi Kokatnur
- Department of Neurology, Louisiana State University Health Science Center, 1501 Kings Highway, Shreveport, LA 711031, USA.
- Department of Neurology, Overton Brooks VA Medical Center, 501 E Stoner Ave, Shreveport, LA 71101, USA.
- Department of Neurology, Mercy Hospital, 100 Mercy Way, Joplin, MO 64804, USA.
| | - Mohan Rudrappa
- Department of Pulmonary and Critical Care Medicine, Louisiana State University Health Science Center, 1501 Kings Highway, Shreveport, LA 711031, USA.
- Department of Pulmonary and Critical Care Medicine, Overton Brooks VA Medical Center, 501 E Stoner Ave, Shreveport, LA 71101, USA.
- Department of Pulmonary and Critical Care Medicine, Mercy Hospital, 100 Mercy Way, Joplin, MO 64804, USA.
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Rietberg MB, Veerbeek JM, Gosselink R, Kwakkel G, van Wegen EEH. Respiratory muscle training for multiple sclerosis. Cochrane Database Syst Rev 2017; 12:CD009424. [PMID: 29267988 PMCID: PMC6486138 DOI: 10.1002/14651858.cd009424.pub2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Multiple sclerosis (MS) is a chronic disease of the central nervous system, affecting approximately 2.5 million people worldwide. People with MS may experience limitations in muscular strength and endurance - including the respiratory muscles, affecting functional performance and exercise capacity. Respiratory muscle weakness can also lead to diminished performance on coughing, which may result in (aspiration) pneumonia or even acute ventilatory failure, complications that frequently cause death in MS. Training of the respiratory muscles might improve respiratory function and cough efficacy. OBJECTIVES To assess the effects of respiratory muscle training versus any other type of training or no training for respiratory muscle function, pulmonary function and clinical outcomes in people with MS. SEARCH METHODS We searched the Trials Register of the Cochrane Multiple Sclerosis and Rare Diseases of the Central Nervous System Group (3 February 2017), which contains trials from the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, CINAHL, LILACS and the trial registry databases ClinicalTrials.gov and WHO International Clinical Trials Registry Platform. Two authors independently screened records yielded by the search, handsearched reference lists of review articles and primary studies, checked trial registers for protocols, and contacted experts in the field to identify further published or unpublished trials. SELECTION CRITERIA We included randomized controlled trials (RCTs) that investigated the efficacy of respiratory muscle training versus any control in people with MS. DATA COLLECTION AND ANALYSIS One reviewer extracted study characteristics and study data from included RCTs, and two other reviewers independently cross-checked all extracted data. Two review authors independently assessed risk of bias with the Cochrane 'Risk of bias' assessment tool. When at least two RCTs provided data for the same type of outcome, we performed meta-analyses. We assessed the certainty of the evidence according to the GRADE approach. MAIN RESULTS We included six RCTs, comprising 195 participants with MS. Two RCTs investigated inspiratory muscle training with a threshold device; three RCTs, expiratory muscle training with a threshold device; and one RCT, regular breathing exercises. Eighteen participants (˜ 10%) dropped out; trials reported no serious adverse events.We pooled and analyzed data of 5 trials (N=137) for both inspiratory and expiratory muscle training, using a fixed-effect model for all but one outcome. Compared to no active control, meta-analysis showed that inspiratory muscle training resulted in no significant difference in maximal inspiratory pressure (mean difference (MD) 6.50 cmH2O, 95% confidence interval (CI) -7.39 to 20.38, P = 0.36, I2 = 0%) or maximal expiratory pressure (MD -8.22 cmH2O, 95% CI -26.20 to 9.77, P = 0.37, I2 = 0%), but there was a significant benefit on the predicted maximal inspiratory pressure (MD 20.92 cmH2O, 95% CI 6.03 to 35.81, P = 0.006, I2 = 18%). Meta-analysis with a random-effects model failed to show a significant difference in predicted maximal expiratory pressure (MD 5.86 cmH2O, 95% CI -10.63 to 22.35, P = 0.49, I2 = 55%). These studies did not report outcomes for health-related quality of life.Three RCTS compared expiratory muscle training versus no active control or sham training. Under a fixed-effect model, meta-analysis failed to show a significant difference between groups with regard to maximal expiratory pressure (MD 8.33 cmH2O, 95% CI -0.93 to 17.59, P = 0.18, I2 = 42%) or maximal inspiratory pressure (MD 3.54 cmH2O, 95% CI -5.04 to 12.12, P = 0.42, I2 = 41%). One trial assessed quality of life, finding no differences between groups.For all predetermined secondary outcomes, such as forced expiratory volume, forced vital capacity and peak flow pooling was not possible. However, two trials on inspiratory muscle training assessed fatigue using the Fatigue Severity Scale (range of scores 0-56 ), finding no difference between groups (MD, -0.28 points, 95% CI-0.95 to 0.39, P = 0.42, I2 = 0%). Due to the low number of studies included, we could not perform cumulative meta-analysis or subgroup analyses. It was not possible to perform a meta-analysis for adverse events, no serious adverse were mentioned in any of the included trials.The quality of evidence was low for all outcomes because of limitations in design and implementation as well as imprecision of results. AUTHORS' CONCLUSIONS This review provides low-quality evidence that resistive inspiratory muscle training with a resistive threshold device is moderately effective postintervention for improving predicted maximal inspiratory pressure in people with mild to moderate MS, whereas expiratory muscle training showed no significant effects. The sustainability of the favourable effect of inspiratory muscle training is unclear, as is the impact of the observed effects on quality of life.
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Affiliation(s)
- Marc B Rietberg
- VU University Medical CenterDepartment of Rehabilitation Medicine, Amsterdan Movement Sciences, MS Center AmsterdamDe Boelelaan 1118AmsterdamNetherlands1007 MB
| | - Janne M Veerbeek
- University of Zurich, University Hospital ZurichDepartment of NeurologyFrauenklinikstrasse 26ZurichSwitzerlandCH‐8091
| | - Rik Gosselink
- Universitaire Ziekenhuizen Leuven, Katholieke Universiteit LeuvenRespiratory Division and Respiratory Rehabilitation UnitTervuursevest 101LeuvenBelgium3000
| | - Gert Kwakkel
- VU University Medical CenterDepartment of Rehabilitation Medicine, Amsterdam Movement Sciences and Amsterdam, Amsterdam NeurosciencesDe Boelelaan 1118AmsterdamNetherlands1007 MB
| | - Erwin EH van Wegen
- Amsterdam Neurosciences, VU University Medical CenterDepartment of Rehabilitation Medicine, Amsterdam Movement SciencesPO Box 7057AmsterdamNetherlands1007 MB
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Levy J, Prigent H, Bensmail D. Respiratory rehabilitation in multiple sclerosis: A narrative review of rehabilitation techniques. Ann Phys Rehabil Med 2017; 61:38-45. [PMID: 29128525 DOI: 10.1016/j.rehab.2017.06.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Revised: 06/14/2017] [Accepted: 06/14/2017] [Indexed: 01/08/2023]
Abstract
BACKGROUND Respiratory disorders in multiple sclerosis (MS) are an important issue. They can occur early during the course of the disease, are associated with the neurological impairment, and can lead to pneumonia and respiratory failure, which are the main causes of death in advanced MS. Prevailing impaired expiratory muscles and cough abilities has been demonstrated in this population and might constitute a specific target for rehabilitation interventions. However, international guidelines lack recommendations regarding respiratory rehabilitation in MS. Here we performed a systematic review of the published literature related to respiratory rehabilitation in MS. METHODS We searched the databases MEDLINE via PubMed, PEDro and Cochrane Library for English or French reports of clinical trials and well-designed cohorts published up to December 2016 with no restriction on start date by using the search terms "multiple sclerosis", "respiratory rehabilitation", "respiratory muscle training", "lung volume recruitment", "cough assistance", and "mechanical in-exsufflation". Literature reviews, case reports and physiological studies were excluded. The Maastricht criteria were used to assess the quality of clinical trials. We followed the Oxford Centre for Evidence-Based Medicine guidelines to determine level of evidence and grade of recommendations. RESULTS Among the 21 reports of studies initially selected, 11 were retained for review. Seven studies were randomized controlled trials (RCTs), 2 were non-RCTs, and 2 were observational studies. Respiratory muscle training (inspiratory and/or expiratory) by use of a portable resistive mouthpiece was the most frequently evaluated technique, with 2 level-1 RCTs. Another level-1 RCT evaluated deep-breathing exercises. All reviewed studies evaluated home-based rehabilitation programs and focused on spirometric outcomes. The disparities in outcome measures among published studies did not allow for a meta-analysis and cough assistance devices were not evaluated in this population. CONCLUSION Although respiratory muscle training can improve maximal respiratory pressure in MS and lung volume recruitment can slow the decline in vital capacity, evidence is lacking to recommend specific respiratory rehabilitation programs adapted to the level of disability induced by the disease.
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Affiliation(s)
- J Levy
- Department of physical medicine and rehabilitation, Raymond-Poincaré university hospital, AP-HP, 92380 Garches, France; UMR 1179, Inserm, university of Versailles Saint-Quentin-en-Yvelines, 78180 Montigny-le-Bretonneux, France.
| | - H Prigent
- Department of physiology, Raymond-Poincaré university hospital, AP-HP, 92380 Garches, France; UMR 1179, Inserm, university of Versailles Saint-Quentin-en-Yvelines, 78180 Montigny-le-Bretonneux, France.
| | - D Bensmail
- Department of physical medicine and rehabilitation, Raymond-Poincaré university hospital, AP-HP, 92380 Garches, France; UMR 1179, Inserm, university of Versailles Saint-Quentin-en-Yvelines, 78180 Montigny-le-Bretonneux, France.
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Silverman EP, Miller S, Zhang Y, Hoffman-Ruddy B, Yeager J, Daly JJ. Effects of expiratory muscle strength training on maximal respiratory pressure and swallow-related quality of life in individuals with multiple sclerosis. Mult Scler J Exp Transl Clin 2017; 3:2055217317710829. [PMID: 28607760 PMCID: PMC5453406 DOI: 10.1177/2055217317710829] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Accepted: 04/20/2017] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Weakening and dyscoordination of expiratory muscles in multiple sclerosis (MS) can impair respiratory and swallow function. OBJECTIVE The objective of this paper is to test a novel expiratory muscle strength training (EMST) device on expiratory pressure, swallow function, and swallow-related quality-of-life (SWAL-QOL) in individuals with MS. METHODS Participants with MS were randomized to a five-week breathing practice of either positive pressure load (EMST) or near-zero pressure (sham). We compared baseline to post-treatment data according to maximum expiratory pressure (MEP), abnormal airway penetration and aspiration (PAS), and SWAL-QOL. RESULTS Both groups improved in MEP (p < 0.001). Forty percent of the EMST group improved on PAS, and 15% worsened; conversely, 21.4% of the sham group worsened and 14.3% improved. There was no group difference in overall SWAL-QOL; but the EMST group had significantly greater gain versus sham on the Burden (p = 0.014) and Pharyngeal Swallow (p = 0.022) domains. Both groups improved in SWAL-QOL domains of Fear, Burden Mental Health, but only the EMST group improved in the SWAL-QOL and domains of Pharyngeal Swallow function, and Saliva management. CONCLUSION Results suggest that strengthening of expiratory muscles can occur with repetition of focused breathing practice in the absence of high resistance. Conversely, results from the PAS and SWAL-QOL domains suggest that the high resistance of the EMST was required in order to improve the functional safety (reduced penetration/aspiration) and coordination of swallowing, specifically pharyngeal function and saliva management.
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Affiliation(s)
- Erin Pearson Silverman
- College of Medicine, Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, University of Florida, USA
| | - Sarah Miller
- Department of Pharmacology and Therapeutics, College of Medicine, University of Florida, USA
| | - Yi Zhang
- Medical University of South Carolina, USA
| | | | - James Yeager
- Department of Neurology, College of Medicine, University of Florida, USA
| | - Janis J Daly
- National Brain Rehabilitation Research Center, North Florida/South Georgia Veterans Health System, Gainesville Veterans Affairs Medical Center, USA
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Colwell KL, Bhatia R. Calculated versus Measured MVV-Surrogate Marker of Ventilatory Capacity in Pediatric CPET. Med Sci Sports Exerc 2017; 49:1987-1992. [PMID: 28489684 DOI: 10.1249/mss.0000000000001318] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Maximum voluntary ventilation (MVV), a surrogate marker of maximum ventilatory capacity, allows for measuring ventilatory reserve during cardiopulmonary exercise testing (CPET), which is necessary to assess ventilatory limitation. MVV can be measured directly during a patient maneuver or indirectly by calculating from forced expiratory volume in 1 s (FEV1 × 40). We investigated for a potential difference between calculated MVV and measured MVV in pediatric subjects, and which better represents maximum ventilatory capacity during CPET. METHODS Data were collected retrospectively from CPET conducted in pediatric subjects for exercise-induced dyspnea from January 2014 to June 2015 at Akron Children's Hospital. Subjects with neuromuscular weakness, morbid obesity, and suboptimal effort during the testing were excluded from the study. RESULTS Thirty-five subjects (mean ± SD, age = 13.8 ± 2.7 yr, range = 7-18 yr) fulfilled the criteria. Measured MVV was significantly lower than calculated MVV (89.9 ± 26.4 vs 122.4 ± 34.5 L·min; P < 0.01). The ventilatory reserve based on measured MVV was also significantly lower than ventilatory reserve based on calculated MVV (12.4% ± 19.6% vs 36.1% ± 13.2%; P < 0.01). Calculated MVV (as well as ventilatory reserve based on calculated MVV) was significantly correlated with ventilatory parameters. By contrast, no significant correlations were found between measured MVV (or ventilatory reserve based on measured MVV) and ventilatory parameters except for peak ventilation (peak V˙E). CONCLUSIONS The measured MVV was significantly lower than the calculated MVV in our pediatric subjects. The calculated MVV was a better surrogate of maximum ventilatory capacity as shown by significant correlation to other ventilatory parameters during CPET.
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Affiliation(s)
- Kelly L Colwell
- Division of Pulmonology, Department of Pediatrics, Akron Children's Hospital, Akron, OH
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Levy J, Bensmail D, Brotier-Chomienne A, Butel S, Joussain C, Hugeron C, Prigent H. Respiratory impairment in multiple sclerosis: a study of respiratory function in wheelchair-bound patients. Eur J Neurol 2017; 24:497-502. [DOI: 10.1111/ene.13231] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Accepted: 11/23/2016] [Indexed: 12/12/2022]
Affiliation(s)
- J. Levy
- Department of Physical Medicine and Rehabilitation; Raymond Poincaré University Hospital - APHP; Garches France
- UMR1179 - INSERM, Versailles Saint-Quentin-en-Yvelines University; Montigny-le-Bretonneux France
| | - D. Bensmail
- Department of Physical Medicine and Rehabilitation; Raymond Poincaré University Hospital - APHP; Garches France
- UMR1179 - INSERM, Versailles Saint-Quentin-en-Yvelines University; Montigny-le-Bretonneux France
| | - A. Brotier-Chomienne
- Department of Physical Medicine and Rehabilitation; Raymond Poincaré University Hospital - APHP; Garches France
| | - S. Butel
- Department of Physiology; Raymond Poincaré University Hospital - APHP; Garches France
| | - C. Joussain
- Department of Physical Medicine and Rehabilitation; Raymond Poincaré University Hospital - APHP; Garches France
- UMR1179 - INSERM, Versailles Saint-Quentin-en-Yvelines University; Montigny-le-Bretonneux France
| | - C. Hugeron
- Department of Physical Medicine and Rehabilitation; Raymond Poincaré University Hospital - APHP; Garches France
| | - H. Prigent
- UMR1179 - INSERM, Versailles Saint-Quentin-en-Yvelines University; Montigny-le-Bretonneux France
- Department of Physiology; Raymond Poincaré University Hospital - APHP; Garches France
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Ishida H, Kuramoto Y, Ikeda D, Watanabe S. Effects of fast expiration exercises without pressure on the respiratory muscle strength of healthy subjects. J Phys Ther Sci 2016; 28:2759-2762. [PMID: 27821930 PMCID: PMC5088121 DOI: 10.1589/jpts.28.2759] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Accepted: 06/09/2016] [Indexed: 11/24/2022] Open
Abstract
[Purpose] The aim of this investigation was to determine the effects of 4 weeks of fast expiration exercises performed without pressure on respiratory muscle strength. [Subjects and Methods] Respiratory muscle strength of the training group that performed fast expiration exercises (n=12) was compared with that of a control group that performed no exercises (n=12). The fast expiration exercises were performed using a peak expiratory flow meter device and consisted of 20 fast expiration exercises performed 3 times per week for 4 weeks. Maximal expiratory and inspiratory pressures were evaluated as respiratory muscle strength using a spirometer pre- and post- intervention. [Results] There were significant increases in maximal expiratory pressure from 76.9 ± 29.1 to 96.1 ± 37.5 cmH2O and maximal inspiratory pressure from 80.8 ± 36.6 to 95.3 ± 37.6 cmH2O in the training group, but there was no significant difference in respiratory muscle strength between pre- and post-intervention in the control group. [Conclusion] Fast expiration exercises may be beneficial for increasing respiratory muscle strength. The findings of this study should be considered when prescribing a variation of the expiratory muscle strength training, as part of a pulmonary rehabilitation program.
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Affiliation(s)
- Hiroshi Ishida
- Department of Rehabilitation, Faculty of Health Science and Technology, Kawasaki University of Medical Welfare: 288 Matsushima, Kurashiki, Okayama 701-0193, Japan
| | - Yuri Kuramoto
- Department of Rehabilitation, Faculty of Health Science and Technology, Kawasaki University of Medical Welfare: 288 Matsushima, Kurashiki, Okayama 701-0193, Japan
| | - Daiki Ikeda
- Department of Rehabilitation, Faculty of Health Science and Technology, Kawasaki University of Medical Welfare: 288 Matsushima, Kurashiki, Okayama 701-0193, Japan
| | - Susumu Watanabe
- Department of Rehabilitation, Faculty of Health Science and Technology, Kawasaki University of Medical Welfare: 288 Matsushima, Kurashiki, Okayama 701-0193, Japan
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Pedersen BK, Saltin B. Exercise as medicine - evidence for prescribing exercise as therapy in 26 different chronic diseases. Scand J Med Sci Sports 2016; 25 Suppl 3:1-72. [PMID: 26606383 DOI: 10.1111/sms.12581] [Citation(s) in RCA: 1624] [Impact Index Per Article: 203.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/16/2015] [Indexed: 12/12/2022]
Abstract
This review provides the reader with the up-to-date evidence-based basis for prescribing exercise as medicine in the treatment of 26 different diseases: psychiatric diseases (depression, anxiety, stress, schizophrenia); neurological diseases (dementia, Parkinson's disease, multiple sclerosis); metabolic diseases (obesity, hyperlipidemia, metabolic syndrome, polycystic ovarian syndrome, type 2 diabetes, type 1 diabetes); cardiovascular diseases (hypertension, coronary heart disease, heart failure, cerebral apoplexy, and claudication intermittent); pulmonary diseases (chronic obstructive pulmonary disease, asthma, cystic fibrosis); musculo-skeletal disorders (osteoarthritis, osteoporosis, back pain, rheumatoid arthritis); and cancer. The effect of exercise therapy on disease pathogenesis and symptoms are given and the possible mechanisms of action are discussed. We have interpreted the scientific literature and for each disease, we provide the reader with our best advice regarding the optimal type and dose for prescription of exercise.
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Affiliation(s)
- B K Pedersen
- The Centre of Inflammation and Metabolism and The Center for Physical Activity Research, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - B Saltin
- The Copenhagen Muscle Research Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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Ferreira GD, Costa ACC, Plentz RD, Coronel CC, Sbruzzi G. Respiratory training improved ventilatory function and respiratory muscle strength in patients with multiple sclerosis and lateral amyotrophic sclerosis: systematic review and meta-analysis. Physiotherapy 2016; 102:221-8. [DOI: 10.1016/j.physio.2016.01.002] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2015] [Accepted: 01/30/2016] [Indexed: 12/12/2022]
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Arcuri JF, Abarshi E, Preston NJ, Brine J, Pires Di Lorenzo VA. Benefits of interventions for respiratory secretion management in adult palliative care patients-a systematic review. BMC Palliat Care 2016; 15:74. [PMID: 27507303 PMCID: PMC4979117 DOI: 10.1186/s12904-016-0147-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Accepted: 08/01/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Respiratory secretions impact negatively on palliative patients. Unfortunately, a gold standard therapy is not yet available. The purpose of this study was to identify which interventions are in use to control respiratory secretions in patients with chronic disease with a poor prognosis and verify their effects on outcomes relevant for palliative care patients. METHODS A systematic review of the literature with narrative summary was conducted. We searched eight electronic databases in April (6th), 2016. Citation-tracking and reference list searches were conducted. We included randomized controlled trials, crossover trials, observational and qualitative studies regarding interventions for respiratory secretion management in adult patients with chronic diseases that met inclusion criteria indicating short prognosis. RESULTS Six randomized controlled trials, 11 observational studies, ten crossover trials and one qualitative study were found. Interventions included mechanical insufflation-exsufflation (MIE), expiratory muscle training, manually-assisted cough, tracheotomy, chest physiotherapy, suctioning, air stacking, electrical stimulation of abdominal muscles, nebulized saline, positive expiratory pressure masks, percussive ventilation, high frequency chest wall oscillations. The interventions with most promising benefits to patients in palliative care were manually-assisted cough and mechanical insufflation-exsufflation to promote expectoration and percussive ventilation to improve mucous clearance. CONCLUSION Therapies, such as manually assisted cough, mechanical insufflation-exsufflation and percussive ventilation, which aim to deal with respiratory secretion, were the most promising treatment for use in palliative care for specific diseases. Nevertheless, the evidence still needs to improve in order to identify which treatment is the best.
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Affiliation(s)
- Juliano Ferreira Arcuri
- Federal University of São Carlos, Rod Washington Luiz, km 235, Monjolinho, São Carlos, SP, CEP 13565-905, Brazil.
| | - Ebun Abarshi
- International Observatory on End of Life Care, Faculty of Health and Medicine, Furness College, Lancaster University, Bailrigg, LA1 4YG, UK
| | - Nancy J Preston
- International Observatory on End of Life Care, Faculty of Health and Medicine, Furness College, Lancaster University, Bailrigg, LA1 4YG, UK
| | - Jenny Brine
- Lancaster University Library, Lancaster University, Bailrigg, LA1 4YG, UK
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Wens I, Eijnde BO, Hansen D. Muscular, cardiac, ventilatory and metabolic dysfunction in patients with multiple sclerosis: Implications for screening, clinical care and endurance and resistance exercise therapy, a scoping review. J Neurol Sci 2016; 367:107-21. [DOI: 10.1016/j.jns.2016.05.050] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Revised: 05/11/2016] [Accepted: 05/24/2016] [Indexed: 01/03/2023]
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Abstract
Objectives: To measure respiratory functions of ambulatory patients with multiple sclerosis and compare the results with expected values from healthy general population data. Further, to study the correlation of respiratory function impairment with the multiple sclerosis-induced disability level.Subjects: Thirty-eight patients with definite diagnosis of multiple sclerosis from the multiple sclerosis outpatient clinic.Methods: The Expanded Disability Status Scale (EDSS) scores (mean 4.34±1.39) were evaluated to measure disability level. Respiratory functions tested in the laboratory included spirometric (FVC, FEV1, FEV1/FVC), maximal inspiratory (MIP) and expiratory (MEP) mouth pressure measurements. Patients were clinically assessed using a pulmonary dysfunction index (PDI) and dyspnoea index; various breathing features were also recorded.Results: With respect to expected values from healthy general population, important decreases were found in mouth pressures with MIP (77%±23%, p ≃ 0) and MEP (60%±13%, p ≃ 0) while spirometric measures were significantly but less affected (FVC 94%±12%, p < 0.01, FEV191%±16%, p < 0.001). FEV1/FVC ratios were normal. Notable increases in PDI (5.58±0.68, p ≃ 0) and dyspnoea index (0.32±0.47, p ≃ 0) were observed. Significant relationships (p < 0.01) between respiratory function impairment and the multiple sclerosis disability level could be detected for FVC, MEP and PDI.Conclusions: Multiple sclerosis clearly impairs respiratory functions; maximal mouth pressures are more severely reduced. This impairment increases with multiple sclerosis-induced disability level but is found to be independent from duration of disease.
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Affiliation(s)
- F K Mutluay
- Neurology Department, Cerrahpasa School of Medicine, Istanbul University, Turkey.
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Mutluay FK, Demir R, Ozyilmaz S, Caglar AT, Altintas A, Gurses HN. Breathing-enhanced upper extremity exercises for patients with multiple sclerosis. Clin Rehabil 2016; 21:595-602. [PMID: 17702701 DOI: 10.1177/0269215507075492] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: To explore the effectiveness of breathing-enhanced upper extremity exercises on the respiratory function of patients with multiple sclerosis.Design: Randomized controlled study of six-week duration.Subjects: Forty patients with multiple sclerosis (age 39.2 ± 7 years; Kurtzke Expanded Disability Status Scale scores: 4.51 ± 1.55) randomly divided into two groups.Methods: The training group followed a six-week home training programme designed to strengthen accessory respiratory muscles. Controls performed no exercises. All subjects submitted to baseline and post-training tests of spirometry, respiratory muscle strength and 6-minute walking. They were also assessed with pulmonary dysfunction and exertion fatigue indices.Results: Spirometry revealed clear improvement in forced expiratory volume in 1 second (FEV1) (+13%, P = 0.003) resulting in higher FEV1/FVC (forced vital capacity) (+8.5%, P = 0.03). Maximal inspiratory pressure ( PImax) increased by +7.1% but not significantly. Maximal expiratory pressure ( PEmax) and FVC were significantly higher (by +7.1%, P = 0.0066 and +4.8%, P = 0.036 respectively) with respect to baseline measures. Pulmonary dysfunction was reduced (—9%, P = 0.002) while 6-minute walking distance was longer (+16%, P = 0.029) at equal exertion fatigue level.Conclusions: The programme improved most pulmonary performance measures and had clinical significance. Its sustained application may prevent respiratory complications frequently observed in the later stages of multiple sclerosis.
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Affiliation(s)
- F K Mutluay
- Neurology Department, Cerrahpasa School of Medicine, Turkey.
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Park JS, Oh DH, Chang MY. Effect of expiratory muscle strength training on swallowing-related muscle strength in community-dwelling elderly individuals: a randomized controlled trial. Gerodontology 2016; 34:121-128. [DOI: 10.1111/ger.12234] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/13/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Ji-Su Park
- Department of Rehabilitation Science; Graduate School of Inje University; Gimhae Korea
| | - Dong-Hwan Oh
- Department of Occupational Therapy; Kyungdong University; Wonju Korea
| | - Moon-Young Chang
- Department of Occupational Therapy; College of Biomedical Science and Engineering; Inje University; Gimhae Korea
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Manouchehrinia A, Tanasescu R, Tench CR, Constantinescu CS. Mortality in multiple sclerosis: meta-analysis of standardised mortality ratios. J Neurol Neurosurg Psychiatry 2016; 87:324-31. [PMID: 25935887 DOI: 10.1136/jnnp-2015-310361] [Citation(s) in RCA: 80] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Accepted: 03/06/2015] [Indexed: 11/04/2022]
Abstract
OBJECTIVE There are inconsistent data on mortality in people with multiple sclerosis (MS). We performed a meta-analysis of all-cause, cause-specific and gender-specific crude mortality rates (CMRs), and standardised mortality ratios (SMRs) in MS, and estimated the rate of change of CMR and SMR over the past 50 years. METHODS Medline, Embase and the Cochrane Library were searched. KEYWORDS 'Multiple Sclerosis' and ('standardised mortality' or 'standardized mortality'). INCLUSION CRITERIA availability of data on the number of deaths; mean or median patient follow-up or reports of SMRs; being a longitudinal study. 12 studies were included covering the period 1949-2012 (27 423 patients; 6628 deaths; 437 832 person-years follow-up). CMR was calculated. SMRs were extracted. CMRs and natural logarithm of SMRs were pooled by the method of the inverse of the variance. Meta-regression models were used to investigate the secular trends. RESULTS Pooled CMR was 9.78/1000 person-years (95% CI 6.81 to 14.02). Pooled all-cause SMR was 2.80 (95% CI 2.74 to 2.87). All-cause SMR was 2.56 (95% CI 2.47 to 2.66) in males and 3.06 (95% CI 2.97 to 3.17) in females. SMR due to cancer was 0.89 (95% CI 0.83 to 0.97). SMRs due to cardiovascular diseases, suicide, infection and respiratory diseases were 1.29 (95% CI 1.20 to 1.38), 2.13 (95% CI 1.80 to 2.51) and 2.91 (95% CI 2.60 to 3.26). There was no trend in CMRs, all-cause, and gender-specific SMRs. CONCLUSIONS The excess mortality in MS relative to the general population has not changed over the past 50 years. Female patients with MS have higher survival disadvantage compared to that of males. Death due to cardiovascular diseases, suicide and infection is higher in patients with MS compared to the general population.
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Affiliation(s)
- Ali Manouchehrinia
- Division of Clinical Neuroscience, Clinical Neurology Research Group, University of Nottingham, Queen's Medical Centre, Nottingham, UK
| | - Radu Tanasescu
- Division of Clinical Neuroscience, Clinical Neurology Research Group, University of Nottingham, Queen's Medical Centre, Nottingham, UK Department of Neurology, Neurosurgery and Psychiatry, University of Medicine and Pharmacy Carol Davila, Colentina Hospital, Bucharest, Romania
| | - Christopher R Tench
- Division of Clinical Neuroscience, Clinical Neurology Research Group, University of Nottingham, Queen's Medical Centre, Nottingham, UK
| | - Cris S Constantinescu
- Division of Clinical Neuroscience, Clinical Neurology Research Group, University of Nottingham, Queen's Medical Centre, Nottingham, UK
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