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Meyer SE, Kimber M, Maier LE, Matenchuk B, Moldenhauer R, de Waal S, Sivak A, Davenport MH, Steinback C'. The impact of exercise training on muscle sympathetic nerve activity: a systematic review and meta-analysis. J Appl Physiol (1985) 2024; 137:429-444. [PMID: 38752285 DOI: 10.1152/japplphysiol.00060.2024] [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: 01/22/2024] [Revised: 05/03/2024] [Accepted: 05/03/2024] [Indexed: 08/17/2024] Open
Abstract
The purpose of this systematic review and meta-analysis was to examine the effects of exercise training on muscle sympathetic nerve activity (MSNA) in humans. Studies included exercise interventions [randomized controlled trials (RCTs), nonrandomized controlled trials (non-RCTs), or pre-to-post intervention] that reported on adults (≥18 yr) where MSNA was directly assessed using microneurography, and relevant outcomes were assessed [MSNA (total activity, burst frequency, burst incidence, amplitude), heart rate, blood pressure (systolic blood pressure, diastolic blood pressure, or mean blood pressure), and aerobic capacity (maximal or peak oxygen consumption)]. Forty intervention studies (n = 1,253 individuals) were included. RCTs of exercise compared with no exercise illustrated that those randomized to the exercise intervention had a significant reduction in MSNA burst frequency and incidence compared with controls. This reduction in burst frequency was not different between individuals with cardiovascular disease compared with those without. However, the reduction in burst incidence was greater in those with cardiovascular disease [9 RCTs studies, n = 234, mean difference (MD) -21.08 bursts/100 hbs; 95% confidence interval (CI) -16.51, -25.66; I2 = 63%] compared with those without (6 RCTs, n = 192, MD -10.92 bursts/100 hbs; 95% CI -4.12, -17.73; I2 = 76%). Meta-regression analyses demonstrated a dose-response relationship where individuals with higher burst frequency and incidence preintervention had a greater reduction in values post-intervention. These findings suggest that exercise training reduces muscle sympathetic nerve activity, which may be valuable for improving cardiovascular health.NEW & NOTEWORTHY This systematic review and meta-analysis suggests exercise training reduces muscle sympathetic nerve activity (MSNA), which may be valuable for improving cardiovascular health. The reduction in burst incidence was greater among individuals with cardiovascular disease when compared with those without; exercise training may be particularly beneficial for individuals with cardiovascular disease. Meta-regression analyses demonstrated a dose-response relationship, where individuals with higher sympathetic activity preintervention had greater reductions in sympathetic activity post-intervention.
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Affiliation(s)
- Sarah E Meyer
- Neurovascular Health Laboratory, Program for Pregnancy and Postpartum Health, Women and Children's Health Research Institute, Alberta Diabetes Institute, Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, Alberta, Canada
| | - Miranda Kimber
- Neurovascular Health Laboratory, Program for Pregnancy and Postpartum Health, Women and Children's Health Research Institute, Alberta Diabetes Institute, Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, Alberta, Canada
| | - Lauren E Maier
- Neurovascular Health Laboratory, Program for Pregnancy and Postpartum Health, Women and Children's Health Research Institute, Alberta Diabetes Institute, Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, Alberta, Canada
| | - Brittany Matenchuk
- Neurovascular Health Laboratory, Program for Pregnancy and Postpartum Health, Women and Children's Health Research Institute, Alberta Diabetes Institute, Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, Alberta, Canada
| | - Ramiah Moldenhauer
- Neurovascular Health Laboratory, Program for Pregnancy and Postpartum Health, Women and Children's Health Research Institute, Alberta Diabetes Institute, Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, Alberta, Canada
| | - Stephanie de Waal
- Neurovascular Health Laboratory, Program for Pregnancy and Postpartum Health, Women and Children's Health Research Institute, Alberta Diabetes Institute, Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, Alberta, Canada
| | - Allison Sivak
- H. T. Coutts Education & Physical Education Library, University of Alberta, Edmonton, Alberta, Canada
| | - Margie H Davenport
- Neurovascular Health Laboratory, Program for Pregnancy and Postpartum Health, Women and Children's Health Research Institute, Alberta Diabetes Institute, Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, Alberta, Canada
| | - Craig 'd Steinback
- Neurovascular Health Laboratory, Program for Pregnancy and Postpartum Health, Women and Children's Health Research Institute, Alberta Diabetes Institute, Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, Alberta, Canada
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Su J, Huang W, Yu P. Effect of inspiratory muscle training in esophageal cancer patients receiving esophagectomy: A meta-analysis of randomized controlled trials. PLoS One 2024; 19:e0307069. [PMID: 39012869 PMCID: PMC11251638 DOI: 10.1371/journal.pone.0307069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 06/30/2024] [Indexed: 07/18/2024] Open
Abstract
PURPOSE To identify the clinical effect of inspiratory muscle training (IMT) among esophageal cancer patients undergoing esophagectomy based on randomized controlled trials (RCTs). METHODS Several databases were searched for relevant RCTs up to August 23, 2023. Primary outcomes were respiratory muscle function, including the maximum inspiratory pressure (MIP) and maximum expiratory pressure (MEP), and pulmonary function, including the forced expiratory volume in one second % (FEV1%), forced vital capacity% (FVC%), maximal ventilator volume (MVV), FEV1/FVC% and FVC. The secondary outcomes were exercise performance, including the six-minute walk distance test (6MWT) and Borg index; mental function and quality of life, as evaluated by the Hospital Anxiety Depression Scale (HADS) and Nottingham Health Profile (NHP) score; and postoperative complications. All the statistical analyses were performed with REVMAN 5.3 software. RESULTS Eight RCTs were included in this meta-analysis, with 368 patients receiving IMT and 371 control subjects. The pooled results demonstrated that IMT could significantly enhance respiratory muscle function (MIP: MD = 7.14 cmH2O, P = 0.006; MEP: MD = 8.15 cmH2O, P<0.001) and pulmonary function (FEV1%: MD = 6.15%, P<0.001; FVC%: MD = 4.65%, P<0.001; MVV: MD = 8.66 L, P<0.001; FEV1/FVC%: MD = 5.27%, P = 0.03; FVC: MD = 0.50 L, P<0.001). Furthermore, IMT improved exercise performance (6MWT: MD = 66.99 m, P = 0.02; Borg index: MD = -1.09, P<0.001), mental function and quality of life (HADS anxiety score: MD = -2.26, P<0.001; HADS depression score: MD = -1.34, P<0.001; NHP total score: MD = -48.76, P<0.001). However, IMT did not significantly decrease the incidence of postoperative complications. CONCLUSION IMT improves clinical outcomes, such as respiratory muscle function and pulmonary function, in esophageal cancer patients receiving esophagectomy and has potential for broad applications in the clinic.
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Affiliation(s)
- Jianhua Su
- Rehabilitation Medicine Center, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Wei Huang
- Rehabilitation Medicine Center, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Pengming Yu
- Rehabilitation Medicine Center, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
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Tanriverdi A, Savci S, Ozcan Kahraman B, Odaman H, Ozpelit E, Senturk B, Ozsoy I, Baran A, Akdeniz B, Acar S, Balci A. Effects of high intensity interval-based inspiratory muscle training in patients with heart failure: A single-blind randomized controlled trial. Heart Lung 2023; 62:1-8. [PMID: 37285766 DOI: 10.1016/j.hrtlng.2023.05.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Revised: 05/04/2023] [Accepted: 05/20/2023] [Indexed: 06/09/2023]
Abstract
BACKGROUND Given the promising effects of inspiratory muscle training (IMT), determining the most appropriate IMT protocol will optimize the training benefits. OBJECTIVES The objective of this study was to determine the effects of high intensity interval-based inspiratory muscle training (H-IMT) on cardiovascular, pulmonary, physical, and psychosocial functions in patients with heart failure and reduced ejection fraction (HFrEF). METHODS Thirty-four patients with HFrEF were randomly assigned to the H-IMT or control group for 3 days/week, 8 weeks training period. The H-IMT group performed IMT at least 70% of the maximal inspiratory pressure, whereas the control group performed unloaded IMT. Each session occurred 7 sets with a total of 21 min consisting of 2-min training and 1-min interval. Heart rate variability (HRV), arterial stiffness, respiratory muscle strength and endurance, diaphragm thickness, quadriceps strength, functional capacity, frailty, dyspnea, fatigue, disease-specific health-related quality of life (HRQoL), and generic HRQoL were evaluated at baseline and after 8 weeks training period by blinded assessors. RESULTS Statistically significant between-group differences were observed in the time domain parameters of HRV, arterial stiffness, inspiratory and quadriceps muscle strength, respiratory muscle endurance, diaphragm thickness, functional capacity, frailty, dyspnea, fatigue, and disease-specific HRQoL in favor of the H-IMT group (p<0.05). CONCLUSIONS H-IMT is an effective protocol for improving cardiac autonomic function, arterial stiffness, inspiratory and quadriceps muscle strength, respiratory muscle endurance, diaphragm thickness, functional capacity, frailty, dyspnea, fatigue, and disease-specific quality of life in patients with HFrEF. CLINICAL TRIAL REGISTRATION NCT04839211.
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Affiliation(s)
- Aylin Tanriverdi
- Institute of Health Sciences, Faculty of Physical Therapy and Rehabilitation, Dokuz Eylül University, Izmir, Turkey; Faculty of Physical Therapy and Rehabilitation, Dokuz Eylül University, Izmir, Turkey.
| | - Sema Savci
- Faculty of Physical Therapy and Rehabilitation, Dokuz Eylül University, Izmir, Turkey
| | - Buse Ozcan Kahraman
- Faculty of Physical Therapy and Rehabilitation, Dokuz Eylül University, Izmir, Turkey
| | - Huseyin Odaman
- Department of Radiology, Dokuz Eylül University, Izmir, Turkey
| | - Ebru Ozpelit
- Department of Cardiology, Dokuz Eylül University, Izmir, Turkey
| | - Bihter Senturk
- Department of Cardiology, Dokuz Eylül University, Izmir, Turkey
| | - Ismail Ozsoy
- Department of Physical Therapy and Rehabilitation, Selcuk University, Konya, Turkey
| | - Agah Baran
- Klinikum Bremerhaven Reinkenheide Diagnostische und Interventionelle Radiologie, Bremerhaven, Germany
| | - Bahri Akdeniz
- Department of Cardiology, Dokuz Eylül University, Izmir, Turkey
| | - Serap Acar
- Faculty of Physical Therapy and Rehabilitation, Dokuz Eylül University, Izmir, Turkey
| | - Ali Balci
- Department of Radiology, Dokuz Eylül University, Izmir, Turkey
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Chen TA, Mao ST, Lin HC, Liu WT, Tam KW, Tsai CY, Kuan YC. Effects of inspiratory muscle training on blood pressure- and sleep-related outcomes in patients with obstructive sleep apnea: a meta-analysis of randomized controlled trials. Sleep Breath 2023; 27:1953-1966. [PMID: 36576599 DOI: 10.1007/s11325-022-02773-1] [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: 08/29/2022] [Revised: 12/03/2022] [Accepted: 12/19/2022] [Indexed: 12/29/2022]
Abstract
PURPOSE Obstructive sleep apnea (OSA) is frequently accompanied by hypertension, resulting in cardiovascular comorbidities. Continuous positive airway pressure is a standard therapy for OSA but has poor adherence. Inspiratory muscle training (IMT) may reduce airway collapsibility and sympathetic output, which may decrease OSA severity and blood pressure. In this meta-analysis of randomized controlled trials (RCTs), we evaluated the efficacy of IMT in patients with OSA. METHODS We searched PubMed, EMBASE, Cochrane Library, Web of Science, and ClinicalTrials.gov databases for relevant RCTs published before November 2022. RESULTS Seven RCTs with a total of 160 patients with OSA were included. Compared with the control group, the IMT group exhibited significantly lower systolic and diastolic blood pressure (mean difference [MD]: - 10.77 and - 4.58 mmHg, respectively), plasma catecholamine levels (MD: - 128.64 pg/mL), Pittsburgh Sleep Quality Index (MD: - 3.06), and Epworth Sleepiness Scale score (MD: - 4.37). No significant between-group differences were observed in the apnea-hypopnea index, forced vital capacity (FVC), ratio of forced expiratory volume in 1 s to FVC, or adverse effects. The data indicate comprehensive evidence regarding the efficacy of IMT for OSA. However, the level of certainty (LOC) remains low. CONCLUSION IMT improved blood pressure- and sleep-related outcomes without causing adverse effects and may thus be a reasonable option for lowering blood pressure in patients with OSA. However, additional studies with larger sample sizes and rigorous study designs are warranted to increase the LOC.
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Affiliation(s)
- Tzu-Ang Chen
- Department of General Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Sheng-Ting Mao
- Department of Obstetrics and Gynecology, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Huei-Chen Lin
- Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, Tainan City, Taiwan
- Department of Long-Term Care, College of Health Technology, National Taipei University of Nursing and Health Sciences, Taipei City, Taiwan
| | - Wen-Te Liu
- School of Respiratory Therapy, College of Medicine, Taipei Medical University, Taipei City, Taiwan
- Division of Pulmonary Medicine, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
- Sleep Center, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Ka-Wai Tam
- Center for Evidence-Based Health Care, Department of Medical Research, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
- Shared Decision Making Resource Center, Department of Medical Research, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
- Cochrane Taiwan, Taipei Medical University, Taipei City, Taiwan
- Division of General Surgery, Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei City, Taiwan
- Division of General Surgery, Department of Surgery, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Cheng-Yu Tsai
- Sleep Center, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
- Department of Civil and Environmental Engineering, Imperial College London, London, UK
| | - Yi-Chun Kuan
- Sleep Center, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan.
- Center for Evidence-Based Health Care, Department of Medical Research, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan.
- Cochrane Taiwan, Taipei Medical University, Taipei City, Taiwan.
- Taipei Neuroscience Institute, Taipei Medical University, Taipei City, Taiwan.
- Department of Neurology, Shuang Ho Hospital, Taipei Medical University, 291 Zhongzheng Road, Zhonghe District, New Taipei City, 23561, Taiwan.
- Department of Neurology, School of Medicine, College of Medicine, Taipei Medical University, Taipei City, Taiwan.
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei City, Taiwan.
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Ozcan Kahraman B, Tanriverdi A, Savci S, Odaman H, Akdeniz B, Sevinc C, Ozsoy I, Acar S, Balci A, Baran A, Ozpelit E. Effects of Inspiratory Muscle Training in Patients With Pulmonary Hypertension. Am J Cardiol 2023; 203:406-413. [PMID: 37523937 DOI: 10.1016/j.amjcard.2023.06.097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 06/23/2023] [Accepted: 06/29/2023] [Indexed: 08/02/2023]
Abstract
The study aimed to examine the effects of inspiratory muscle training (IMT) in patients with pulmonary hypertension (PH). A total of 24 patients with PH were included in the randomized controlled evaluator-blind study. IMT was performed at 40% to 60% of the maximal inspiratory pressure for 30 min/d, 7 d/wk (1 day supervised) for 8 weeks. Respiratory muscle strength, dyspnea, diaphragm thickness (DT), pulmonary functions, 24-hour ambulatory blood pressure (BP), arterial stiffness, exercise capacity, upper extremity functional exercise capacity, physical activity levels, fatigue, anxiety-depression levels, activities of daily living (ADL), and quality of life were evaluated. A total of 24 patients (treatment = 12, control = 12) completed the 8-week follow-up. There was no significant difference between the patient groups in terms of demographic and clinical characteristics (p >0.05). Considering the change between the groups in the treatment and control groups, brachial and central BP, dyspnea, respiratory muscle strength, DT in total lung capacity, knee extension muscle strength, functional exercise capacity, upper extremity functional exercise capacity, physical activity, ADL, fatigue, anxiety, and quality of life improved in favor of the IMT group (p <0.05). In conclusion, IMT has improved brachial and central BP, dyspnea, respiratory muscle strength, DT in total lung capacity, knee extension muscle strength, functional exercise capacity, upper extremity functional exercise capacity, physical activity, ADL, fatigue, anxiety, and quality of life compared with the control group. IMT is an effective method in cardiopulmonary rehabilitation for patients with PH.
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Affiliation(s)
- Buse Ozcan Kahraman
- Faculty of Physical Therapy and Rehabilitation, Dokuz Eylül University, Izmir, Turkey.
| | - Aylin Tanriverdi
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Cankırı Karatekin University, Cankırı, Turkey
| | - Sema Savci
- Faculty of Physical Therapy and Rehabilitation, Dokuz Eylül University, Izmir, Turkey
| | - Hüseyin Odaman
- Department of Radiology, Faculty of Medicine, Dokuz Eylül University, Izmir, Turkey
| | - Bahri Akdeniz
- Department of Cardiology, Faculty of Medicine, Dokuz Eylül University, Izmir, Turkey
| | - Can Sevinc
- Department of Chest Disease, Faculty of Medicine, Dokuz Eylül University, Izmir, Turkey
| | - Ismail Ozsoy
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Selcuk University, Konya, Turkey
| | - Serap Acar
- Faculty of Physical Therapy and Rehabilitation, Dokuz Eylül University, Izmir, Turkey
| | - Ali Balci
- Department of Radiology, Faculty of Medicine, Dokuz Eylül University, Izmir, Turkey
| | - Agah Baran
- Klinikum Bremerhaven Reinkenheide Diagnostic and Interventional Radiology, Bremerhaven, Germany
| | - Ebru Ozpelit
- Department of Cardiology, Faculty of Medicine, Dokuz Eylül University, Izmir, Turkey
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Zheng S, Zhang Q, Li S, Li S, Yao Q, Zheng X, Li G, Zeng Y, Chen L, Chen S, He L, Zou J, Zeng Q. Effects of inspiratory muscle training in patients with hypertension: a meta-analysis. Front Cardiovasc Med 2023; 10:1113509. [PMID: 37332584 PMCID: PMC10270119 DOI: 10.3389/fcvm.2023.1113509] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 04/28/2023] [Indexed: 06/20/2023] Open
Abstract
Objective To explore the effects of inspiratory muscle training (IMT) on hypertension and provide guidance for its clinical application as an auxiliary approach. Methods Articles published prior to July 2022 were searched in Cochrane Library, Web of Science, PubMed, Embase, CNKI, and Wanfang databases. Included were randomized controlled studies that used IMT to treat individuals with hypertension. The mean difference (MD) was computed using the Revman 5.4 software. In individuals with hypertension, the effects of IMT on systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR), and pulse pressure (PP) were compared and studied. Results There were found to be eight randomized controlled trials totaling 215 patients. According to a meta-analysis, the IMT reduced the SBP (MD: -12.55 mmHg, 95% CI: -15.78, -9.33), DBP (MD: -4.77 mmHg, 95% CI: -6.00, -3.54), HR (MD: -5.92 bpm, 95% CI: -8.72, -3.12), and PP (MD: -8.92 mmHg, 95% CI: -12.08, -5.76) in patients with hypertension. In subgroup analyses, low-intensity IMT showed a better reduction in SBP (MD: -14.47 mmHg, 95% CI: -17.60, -11.34), DBP (MD: -7.70 mmHg, 95% CI: -10.21, -5.18). Conclusion IMT may become an auxiliary means to improve the four hemodynamic indexes (SBP, DBP, HR and PP) in patients with hypertension. In subgroup analyses, low-intensity IMT was more effective in regulating blood pressure than medium-high-intensity IMT. Systematic Review Registration https://www.crd.york.ac.uk/prospero/, identifier: CRD42022300908.
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Affiliation(s)
- ShuQi Zheng
- School of Rehabilitation Sciences, Southern Medical University, Guangzhou, China
- Department of Rehabilitation Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Qi Zhang
- School of Rehabilitation Sciences, Southern Medical University, Guangzhou, China
- Department of Rehabilitation Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - ShuiYan Li
- School of Rehabilitation Sciences, Southern Medical University, Guangzhou, China
- Department of Rehabilitation Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Shilin Li
- School of Rehabilitation Sciences, Southern Medical University, Guangzhou, China
- Department of Rehabilitation Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Qiuru Yao
- School of Rehabilitation Sciences, Southern Medical University, Guangzhou, China
- School of Nursing, Southern Medical University, Guangzhou, China
| | - Xiaoyan Zheng
- School of Rehabilitation Sciences, Southern Medical University, Guangzhou, China
| | - Gege Li
- School of Rehabilitation Sciences, Southern Medical University, Guangzhou, China
- Department of Rehabilitation Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Yuting Zeng
- Department of Rehabilitation Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Ling Chen
- Department of Rehabilitation Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Shuping Chen
- School of Rehabilitation Sciences, Southern Medical University, Guangzhou, China
- Department of Rehabilitation Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Longlong He
- School of Rehabilitation Sciences, Southern Medical University, Guangzhou, China
- Department of Rehabilitation Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Jihua Zou
- School of Rehabilitation Sciences, Southern Medical University, Guangzhou, China
- Department of Rehabilitation Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, China
- Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, Hong Kong, China
| | - Qing Zeng
- School of Rehabilitation Sciences, Southern Medical University, Guangzhou, China
- Department of Rehabilitation Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, China
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Rodrigues GD, Nobrega ACLD, Soares PPDS. Respiratory training in older women: Unravelling central and peripheral hemodynamic slow oscillatory patterns. Exp Gerontol 2023; 172:112058. [PMID: 36529363 DOI: 10.1016/j.exger.2022.112058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 11/28/2022] [Accepted: 12/09/2022] [Indexed: 12/16/2022]
Abstract
We hypothesized that inspiratory muscle training (IMT) increases the respiratory-induced low-frequency oscillations of mean blood pressure (MBP) and middle cerebral artery blood velocity (MCAv), upregulating cerebrovascular function in older women. Firstly, participants were recorded with free-breathing (FB) and then breathed at a slow-paced frequency (0.1 Hz; DB test) supported by sonorous metronome feedback. Blood pressure was recorded using finger photoplethysmography method, ECG, and respiration using a thoracic belt. To obtain the MCAv a transcranial ultrasound Doppler device was used. Spectral analysis of MBP, R-R intervals, and mean MCAv time series was obtained by an autoregressive model. The transfer function analysis (TFA) was employed to calculate the coherence, gain, and phase. After that, older women were enrolled in a randomized controlled protocol, the IMT-group (n = 8; 64 ± 3 years-old) performed IMT at 50 % of maximal inspiratory pressure (MIP), and Sham-group, a placebo training at 5 % MIP (Sham-group; n = 6; 66 ± 3 years-old). Participants breathed against an inspiratory resistance twice a day for 4-weeks. DB test is repeated post IMT and Sham interventions. IMT-group, compared to Sham-group, augmented tidal volume responses to DB (Sham-group 1.03 ± 0.41 vs. IMT-group 1.61 ± 0.56 L; p = 0.04), increased respiratory-induced MBP (Sham-group 26.37 ± 4.46 vs. IMT-group 48.21 ± 3.15 mmHg2; p = 0.04) and MCAv (Sham-group 14.16 ± 31.26 vs. IMT-group 79.90 ± 21.76 cm2s-2; p = 0.03) slow oscillations, and reduced TFA gain (Sham-group 2.46 ± 1.32 vs. IMT-group 1.78 ± 1.30 cm·s-1.mmHg-1; p = 0.01). Our findings suggest that IMT increases the respiratory-induced oscillations in MBP and MCAv signals and reduces TFA gain. It seems compatible with an improved dynamic cerebrovascular regulation following IMT in older women.
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Affiliation(s)
- Gabriel Dias Rodrigues
- Department of Physiology and Pharmacology, Fluminense Federal University, Niterói, RJ, Brazil; INCT (In)Activity and Exercise, CNPq, National Institute for Science and Technology, Niterói, RJ, Brazil; Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.
| | - Antonio Claudio Lucas da Nobrega
- Department of Physiology and Pharmacology, Fluminense Federal University, Niterói, RJ, Brazil; INCT (In)Activity and Exercise, CNPq, National Institute for Science and Technology, Niterói, RJ, Brazil
| | - Pedro Paulo da Silva Soares
- Department of Physiology and Pharmacology, Fluminense Federal University, Niterói, RJ, Brazil; INCT (In)Activity and Exercise, CNPq, National Institute for Science and Technology, Niterói, RJ, Brazil
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Li H, Tao L, Huang Y, Li Z, Zhao J. Inspiratory muscle training in patients with heart failure: A systematic review and meta-analysis. Front Cardiovasc Med 2022; 9:993846. [PMID: 36337890 PMCID: PMC9626810 DOI: 10.3389/fcvm.2022.993846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 09/23/2022] [Indexed: 12/02/2022] Open
Abstract
Objective To explore the effect of inspiratory muscle training (IMT) on patients with heart failure and further explore the impact of IMT on patients with heart failure with preserved ejection fraction. Methods PubMed, EMBASE, Cochrane Library, CNKI, Wanfang and VIP databases were systematically searched. Randomized controlled trials of inspiratory muscle training in patients with heart failure were included. Revman 5.3 software was used to calculate the weighted mean difference (MD) of the combined effect size. The effects of IMT on the maximum oxygen uptake (peakVO2), maximum inspiratory pressure (PImax), ventilation efficiency (VE/VCO2), six-minute walking distance (6MWD), forced expiratory volume (FEV1), forced vital capacity (FVC) and quality of life in patients with heart failure were compared and analyzed. Results After systematic retrieval and screening, 17 studies were included in this study, and the quality of the included studies was good. The results showed that IMT could increase peakVO2 (MD 2.53; 95% CI 1. 54, 3. 51; P < 0.0001) and PImax (MD 17.25; 95% CI 13. 75, 20. 75; P < 0.00001); improve the VE/VCO2 (MD −4.22; 95% CI −6.78, −1.66; P = 0.001) and significantly improve the quality of life in patients with heart failure (MD −13.34; 95% CI −20.42, −6.26; P = 0.0002). However, the effect of IMT on 6MWD in patients with heart failure was not statistically significant (MD 74.45; 95% CI −12.88,161.79; P = 0.09), and the effect on lung function (FEV1 and FVC) was also not statistically significant (P = 0.08; P = 0.86). IMT had a more significant positive effect on peakVO2 (MD 2.98; 95% CI 1.63, 4.34; P < 0.0001) and quality of life (MD −14.52; 95% CI −18.53, −10.52; P < 0.00001) in patients with heart failure with preserved ejection fraction. Descriptive analysis suggested that IMT may positively affect dyspnoea in patients with heart failure. In addition, the choice of evaluation scale may affect the evaluation results of quality of life and dyspnoea. Conclusion IMT has a significant positive effect on respiratory status in patients with heart failure, but different dyspnoea and quality of life evaluation scales can affect the final evaluation results.
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Affiliation(s)
- Hui Li
- Department of Cardiovascular Medicine, Ruijin Hospital Luwan Branch, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lingling Tao
- Department of Ultrasound, Ruijin Hospital Luwan Branch, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yuewi Huang
- Department of Cardiovascular Medicine, Ruijin Hospital Luwan Branch, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ziyang Li
- Department of Cardiovascular Medicine, Ruijin Hospital Luwan Branch, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Ziyang Li
| | - Jianrong Zhao
- Department of Cardiovascular Medicine, Ruijin Hospital Luwan Branch, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- *Correspondence: Jianrong Zhao
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Katayıfçı N, Boşnak Güçlü M, Şen F. A comparison of the effects of inspiratory muscle strength and endurance training on exercise capacity, respiratory muscle strength and endurance, and quality of life in pacemaker patients with heart failure: A randomized study. Heart Lung 2022; 55:49-58. [PMID: 35472660 DOI: 10.1016/j.hrtlng.2022.04.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 03/20/2022] [Accepted: 04/08/2022] [Indexed: 12/22/2022]
Abstract
BACKGROUND Studies have widely investigated the effects of inspiratory muscle strength training in patients with heart failure (HF). The effects of inspiratory muscle strength or endurance training on outcomes in patients with pacemakers have not been adequately studied. OBJECTIVES The aim was to compare the effects of inspiratory muscle strength and endurance training on exercise capacity, quality of life (QoL), peripheral and respiratory muscle strength, respiratory muscle endurance, pulmonary function, dyspnea, fatigue, and physical activity levels in pacemaker patients with HF. METHODS A randomized, controlled, double-blind study was conducted. Fourteen pacemaker patients with HF received inspiratory muscle strength training (IMST) at 50% of maximal inspiratory pressure (MIP), and 18 patients received endurance training (IMET) at 30% of MIP 7 days/8 weeks. Exercise capacity [6 min. walking test (6MWT) and the Incremental Shuttle Walking Test (ISWT)], pulmonary function, respiratory muscle strength [MIP, maximal expiratory pressure (MEP)], endurance, peripheral muscle strength, dyspnea, fatigue, QoL, and physical activity level were evaluated before and after. RESULTS Demographic characteristics were similar in IMST (3F/11M, 56.92 ± 7.61y, EF: 25%, ICD/CRT:11/3) and IMET (4F/14M, 56 ± 10.77y, EF: 30%, ICD/CRT:16/2) groups (p > 0.05). Significant improvements were present in MIP, MEP, respiratory muscle endurance, peripheral muscle strength, 6MWT and ISWT walking distances, dyspnea, QoL, physical activity level, fatigue scores within groups (p ≤ 0.05). However, there were no significant differences between the groups (p > 0.05). There were no significant improvements in FEV1%, FVC%, FEV1/FVC%, and FEF25-75 within and between the groups (p > 0.05). CONCLUSIONS Inspiratory muscle strength and endurance training similarly improves respiratory and peripheral muscle strength, exercise capacity, QoL, physical activity level, and decreases dyspnea and fatigue and are safe and effective in pacemaker patients with HF. TRIAL REGISTRATION www. CLINICALTRIALS gov; study number: NCT03501355.
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Affiliation(s)
- Nihan Katayıfçı
- Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Hatay Mustafa Kemal University, Hatay 31060, Turkey.
| | - Meral Boşnak Güçlü
- Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Gazi University, Ankara, Turkey
| | - Fatih Şen
- Tayfur Ata Sökmen Faculty of Medicine, Department of Cardiology, Hatay Mustafa Kemal University, Hatay, Turkey
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10
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Saeidi M, Ravanbod R. Effects of resistance added on aerobic training on autonomic function in cardiac patients. Anatol J Cardiol 2022; 26:80-89. [PMID: 35190355 PMCID: PMC8878916 DOI: 10.5152/anatoljcardiol.2021.215] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2021] [Indexed: 08/16/2023] Open
Abstract
OBJECTIVE Autonomic imbalance in patients with chronic heart failure (CHF) and cardiovascular diseases (CVD) is characterized by reduced parasympathetic and enhanced sympathetic activity. Aerobic exercise improves autonomic function in patients with CHF and CVD. However, little is known about the effects of resistance training (RT) on cardiac autonomic function. Therefore, we aimed to investigate the effects of RT added on aerobic training on autonomic function in patients with CHF and CVD. DATA SOURCES The relevant clinical trials were searched in PubMed, Physiotherapy evidence Database (PEDro, Science Direct and Google Scholar databases using the following keywords, "resistance or strength training", "chronic heart failure", "coronary artery disease", "myocardial infarction", "hypertension", "cardiovascular disease", "heart rate variability (HRV)", "heart rate recovery (HRR)", "muscle sympathetic nerve activity (MSNA)", and "autonomic function". DATA SYNTHESIS Twelve articles with 323 subjects were eligible to be evaluated. The outcome measures included HRV, HRR, and MSNA. There were seven studies on CHF, two on CAD, and three studies on hypertension. Meta-analysis of all the studies showed that combined RT and aerobic training decreased MSNA significantly in patients with CHF and CAD (mean difference: -3.796; CI: -6.779 to 0.813; p=0.013; I2 =93.5%). No study evaluated the effects of RT or combined training on HRR. CONCLUSION We could not find sufficient data about the effects of RT alone on HRV and HRR, but the results showed that combined RT and aerobic training improved MSNA in patients with CHF and CAD, significantly. Further studies with similar methodological principles on the same patient population are needed.
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Affiliation(s)
- Marzieh Saeidi
- Department of Physiotherapy, Faculty of Medical Sciences, Tarbiat Modares University; Tehran-Iran
| | - Roya Ravanbod
- Department of Physiotherapy, Faculty of Medical Sciences, Tarbiat Modares University; Tehran-Iran
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11
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Smith JR, Taylor BJ. Inspiratory muscle weakness in cardiovascular diseases: Implications for cardiac rehabilitation. Prog Cardiovasc Dis 2022; 70:49-57. [PMID: 34688670 PMCID: PMC8930518 DOI: 10.1016/j.pcad.2021.10.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 10/18/2021] [Indexed: 01/03/2023]
Abstract
Exercise limitation is a cardinal manifestation of many cardiovascular diseases (CVD) and is associated with poor prognosis. It is increasingly well understood that exercise-based cardiac rehabilitation (CR) is an intervention that portends favorable clinical outcomes, including improvements in exercise capacity. The etiology of exercise limitation in CVD is multifactorial but is typically governed by terminal sensations of pain, fatigue, and/or breathlessness. A known but perhaps underestimated complication of CVD that contributes to breathlessness and exercise intolerance in such patients is inspiratory muscle dysfunction. For example, inspiratory muscle dysfunction, which encompasses a loss in muscle mass and/or pressure generating capacity, occurs in up to ~40% of patients with chronic heart failure and is associated with breathlessness, exertional intolerance, and worse survival in this patient population. In this review, we define inspiratory muscle weakness, detail its prevalence in a range of CVDs, and discuss how inspiratory weakness impacts physiological function and clinical outcomes in patients with CVD often referred to CR. We also evaluate the available evidence addressing the effects of exercise-based CR with and without concurrent specific inspiratory muscle training (IMT) on inspiratory muscle function, general physiological function, and clinical outcomes in patients with CVD. Finally, we consider whether the assessment of global respiratory muscle function should become standard as part of the patient intake assessment for phase II CR programs, giving practical guidance on the implementation of such measures as well as IMT as part of phase II CR.
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Affiliation(s)
- Joshua R. Smith
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester MN
| | - Bryan J. Taylor
- Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL
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12
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Time-efficient, high-resistance inspiratory muscle strength training for cardiovascular aging. Exp Gerontol 2021; 154:111515. [PMID: 34389471 DOI: 10.1016/j.exger.2021.111515] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 07/29/2021] [Accepted: 08/09/2021] [Indexed: 01/14/2023]
Abstract
Cardiovascular diseases (CVD) remain the leading cause of death in developed and developing societies and aging is the primary risk factor for CVD. Much of the increased risk of CVD in midlife/older adults (i.e., adults aged 50 years and older) is due to increases in blood pressure, vascular endothelial dysfunction and stiffening of the large elastic arteries. Aerobic exercise training is an effective lifestyle intervention to improve CV function and decrease CVD risk with aging. However, <40% of midlife/older adults meet guidelines for aerobic exercise, due to time availability-related barriers and other obstacles to adherence. Therefore, there is a need for new lifestyle interventions that not only improve CV function with aging but also promote adherence. High-resistance inspiratory muscle strength training (IMST) is an emerging, time-efficient (5 min/day) lifestyle intervention. Early research suggests high-resistance IMST may promote adherence, lower blood pressure and potentially improve vascular endothelial function. However, additional investigation will be required to more definitively establish high-resistance IMST as a healthy lifestyle intervention for CV aging. This review will summarize the current evidence on high-resistance IMST for improving CV function with aging and will identify key research gaps and future directions.
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Trevizan PF, Antunes-Correa LM, Lobo DML, Oliveira PA, de Almeida DR, Abduch MCD, Mathias Junior W, Hajjar LA, Kalil Filho R, Negrão CE. Effects of inspiratory muscle training combined with aerobic exercise training on neurovascular control in chronic heart failure patients. ESC Heart Fail 2021; 8:3845-3854. [PMID: 34184426 PMCID: PMC8497326 DOI: 10.1002/ehf2.13478] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 04/26/2021] [Accepted: 06/03/2021] [Indexed: 12/19/2022] Open
Abstract
Aims We tested the hypothesis that the effects of combined inspiratory muscle training and aerobic exercise training (IMT + AET) on muscle sympathetic nerve activity (MSNA) and forearm blood flow in patients with heart failure with reduced ejection fraction are more pronounced than the effects of AET alone. Methods and results Patients aged 30–70 years, New York Heart Association Functional Class II‐III, and left ventricular ejection fraction ≤40% were randomly assigned to four groups: IMT (n = 11), AET (n = 12), IMT + AET (n = 9), and non‐training (NT; n = 10). MSNA was recorded using microneurography. Forearm blood flow was measured by venous occlusion plethysmography and inspiratory muscle strength by maximal inspiratory pressure. IMT consisted of 30 min sessions, five times a week, for 4 months. Moderate AET consisted of 60 min sessions, three times a week for 4 months. AET (−10 ± 2 bursts/min, P = 0.03) and IMT + AET (−13 ± 4 bursts/min, P = 0.007) reduced MSNA. These responses in MSNA were not different between AET and IMT + AET groups. IMT (0.22 ± 0.08 mL/min/100 mL, P = 0.03), AET (0.27 ± 0.09 mL/min/100 mL, P = 0.01), and IMT + AET (0.35 ± 0.12 mL/min/100 mL, P = 0.008) increased forearm blood flow. No differences were found between groups. AET (3 ± 1 mL/kg/min, P = 0.006) and IMT + AET (4 ± 1 mL/kg/min, P = 0.001) increased peak oxygen consumption. These responses were similar between these groups. IMT (20 ± 3 cmH2O, P = 0.005) and IMT + AET (18 ± 3 cmH2O, P = 0.01) increased maximal inspiratory pressure. No significant changes were observed in the NT group. Conclusions IMT + AET causes no additive effects on neurovascular control in patients with heart failure with reduced ejection fraction compared with AET alone. These findings may be, in part, because few patients had inspiratory muscle weakness.
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Affiliation(s)
- Patricia F Trevizan
- Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Ligia M Antunes-Correa
- Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil.,School of Physical Education, University of Campinas (UNICAMP), São Paulo, Brazil
| | - Denise M L Lobo
- Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Patricia A Oliveira
- Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Dirceu R de Almeida
- Division of Cardiology, Department of Medicine, Federal University of São Paulo, São Paulo, Brazil
| | - Maria Cristina D Abduch
- Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Wilson Mathias Junior
- Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Ludhmila Abrahão Hajjar
- Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Roberto Kalil Filho
- Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Carlos Eduardo Negrão
- Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil.,School of Physical Education and Sport, University of São Paulo, São Paulo, Brazil
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14
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Inspiratory muscle training improves breathing pattern and sympatho-vagal balance but not spontaneous baroreflex sensitivity in older women. Respir Physiol Neurobiol 2021; 290:103672. [PMID: 33866039 DOI: 10.1016/j.resp.2021.103672] [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] [Received: 12/22/2020] [Revised: 03/23/2021] [Accepted: 04/13/2021] [Indexed: 02/02/2023]
Abstract
Even though recent studies reported a positive inspiratory muscle training (IMT) effect on cardiovascular autonomic modulation, its underlying mechanisms as the breathing pattern remain unclear. The study aimed to investigate the IMT effects on resting heart rate variability (HRV), spontaneous baroreflex sensitivity (BRS), and spontaneous breathing pattern in older women. Fourteen healthy older women participated in this study, allocated in IMT (50 % MIP; n = 8) or Sham (5% MIP; n = 6) protocols for four weeks. Blood pressure, heart rate, and ventilatory data were continuously recorded before and after interventions. After four weeks, IMT-group increased maximal inspiratory pressure and vagal-mediated HRV, following by the reduction of sympatho-mediated HRV and the inspiratory time during the spontaneous breathing cycle compared to Sham-group, but did not change BRS. Therefore, the shorter inspiratory time suggests a putative mechanism behind improved vagal-mediated HRV post-IMT in older women.
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15
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Rodrigues GD, Dal Lago P, da Silva Soares PP. Time-dependent effects of inspiratory muscle training and detraining on cardiac autonomic control in older women. Exp Gerontol 2021; 150:111357. [PMID: 33864832 DOI: 10.1016/j.exger.2021.111357] [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] [Received: 12/16/2020] [Revised: 04/06/2021] [Accepted: 04/08/2021] [Indexed: 11/26/2022]
Abstract
Inspiratory muscle training improved maximal inspiratory pressure (MIP) and vagal-mediated heart rate variability (HRV) in older women. However, it is unknown what occurs if the training is discontinued (detraining protocol). The aim of this study was to investigate the IMT and detraining effects on resting HRV in older women. Twelve healthy older women (60-72 yrs) enrolled in home-based IMT at 50% MIP (IMT-group) or placebo at 5% MIP (Sham-group) protocol for 4 weeks using a mechanical pressure threshold loading device. The participants were not engaged in any other exercise protocol at that time. During IMT and Sham interventions, the inspiratory load was adjusted weekly by the actual MIP and resting heart rate variability (HRV) evaluated. After training cessation (4 weeks of detraining), participants returned to the lab for HRV and MIP recordings. Adherence to IMT was superior to 95%. IMT increased MIP (23 ± 8 cmH2O) and vagal-mediated HRV (normalized HF; 37 ± 8%), following by the reduction of sympatho-vagal balance (LF/HF), from the second week to the end of the protocol compared to sham-group. After detraining, IMT-group reduced MIP (-23 ± 8 cmH2O) and vagal-mediated HRV (normalized HF; -38 ± 14%) returning to baseline values. In conclusion, MIP and vagal-HRV improvements induced by IMT were reversed by four weeks of detraining.
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Affiliation(s)
- Gabriel Dias Rodrigues
- Department of Physiology and Pharmacology, Fluminense Federal University, Niterói, Brazil
| | - Pedro Dal Lago
- Department of Physical Therapy, Universidade Federal de Ciências da Saúde de Porto Alegre, Brazil
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16
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Albarrati A, Taher M, Nazer R. Effect of inspiratory muscle training on respiratory muscle strength and functional capacity in patients with type 2 diabetes mellitus: A randomized clinical trial. J Diabetes 2021; 13:292-298. [PMID: 33471439 DOI: 10.1111/1753-0407.13106] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 08/12/2020] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Type 2 diabetes mellitus (T2DM) is usually associated with respiratory manifestations including inspiratory muscle weakness which affects exercise capacity. The present study aimed to determine the effect of inspiratory muscle training (IMT) on inspiratory muscle strength and exercise capacity in patients with Type 2 diabetes mellitus (T2DM). METHODS This was a randomized controlled trial in patients with type 2 diabetes mellitus with no previous cardiopulmonary or neuromuscular diseases. Patients had no back pain. Patients were randomized into interventional or placebo groups. Sniff nasal inspiratory pressure (SNIP), maximum inspiratory pressure (MIP), and six-minute walking test (6MWT) were measured at baseline and 8 weeks post incremental inspiratory muscle training. RESULTS At baseline, interventional and placebo groups were similar in age, body mass index, sex inspiratory muscle strength, and exercise capacity. After 8 weeks of incremental inspiratory muscle training at 40% of MIP, the interventional group had a significant increase in the SNIP (mean difference: 18.5 ± 5.30 cm H2O vs 2.8 ± 4.8 cm H2O) and MIP (mean difference: 19.4 ± 4.3 Vs 5.4 ± 3.6 cm H2O) compared to the placebo group, respectively. The interventional group showed improvement in the 6MWT (mean difference: 70 ± 29 m vs 34 ± 24 m) compared to the placebo group, P < .05. CONCLUSION Incremental inspiratory muscle training increased the diaphragm strength in patients with T2DM and improved exercise capacity.
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Affiliation(s)
- Ali Albarrati
- Department of Rehabilitation Health Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Mohammed Taher
- Department of Rehabilitation Health Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Kingdom of Saudi Arabia
- Faculty of Physical Therapy, Cairo University, Egypt
| | - Rakan Nazer
- Department of Cardiac Sciences, King Fahad Cardiac Center, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia
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DeLucia CM, DeBonis DR, Schwyhart SM, Bailey EF. Acute cardiovascular responses to a single bout of high intensity inspiratory muscle strength training in healthy young adults. J Appl Physiol (1985) 2021; 130:1114-1121. [PMID: 33600284 DOI: 10.1152/japplphysiol.01015.2020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
High intensity, low volume inspiratory muscle strength training (IMST) has favorable effects on casual systolic blood pressure and systemic vascular resistance. However, the acute effects of IMST on heart rate (HR), blood pressure (BP), and sympathetic regulation of vascular resistance and the trajectory of post exercise recovery are not known. We recruited 14 young adults (7 women/7 men, age: 22 ± 2 years) to perform a single bout of high intensity IMST (inspiratory resistance set at 75% of maximal inspiratory pressure) importantly, female and male subjects were matched in regard to the target inspiratory pressure and target inspiratory muscle work per breath. We recorded HR, beat-to-beat changes in BP and postganglionic, muscle sympathetic nerve activities (MSNA) continuously throughout baseline, a single bout of IMST (comprising five sets of 6 inspiratory efforts) and in recovery. We show that one bout of IMST does not effect a change in BP, however, it effects a significant increase in HR (68.4 ± 11.7 beats/min versus 85.4 ± 13.6 beats/min; P < 0.001) and a significant decline in MSNA (6.8 ± 1.1 bursts/15 s bin; P < 0.001 versus 3.6 ± 0.6 bursts/15 s bin) relative to baseline. Remarkably, among men MSNA rebounded to baseline levels within the first minute of recovery, however, in women, MSNA suppression persisted for 5 min. We show that in healthy young adults, high intensity, low volume respiratory training results in the acute suppression of MSNA. Importantly, MSNA suppression is of greater magnitude and longer duration in women than in men.NEW & NOTEWORTHY Previous studies show 6 weeks of high intensity, low volume inspiratory muscle strength training (IMST) lowers blood pressure (BP) and systemic vascular resistance in young adults. However, the acute response to IMST is unknown. We characterized BP, heart rate, and sympathetic nervous activity (SNA) in healthy young adults at baseline, during IMST, and in recovery. There was no acute effect of IMST on BP, however, there was significant IMST-related suppression of SNA that was of greater magnitude in women than men.
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Affiliation(s)
- Claire M DeLucia
- Department of Physiology University of Arizona College of Medicine, Tucson, Arizona
| | - Dean R DeBonis
- Department of Physiology University of Arizona College of Medicine, Tucson, Arizona
| | - Sarah M Schwyhart
- Department of Physiology University of Arizona College of Medicine, Tucson, Arizona
| | - E Fiona Bailey
- Department of Physiology University of Arizona College of Medicine, Tucson, Arizona
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Unraveling the Role of Respiratory Muscle Metaboloreceptors under Inspiratory Training in Patients with Heart Failure. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18041697. [PMID: 33578776 PMCID: PMC7916511 DOI: 10.3390/ijerph18041697] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 02/01/2021] [Accepted: 02/06/2021] [Indexed: 12/15/2022]
Abstract
Exercise intolerance may be considered a hallmark in patients who suffer from heart failure (HF) syndrome. Currently, there is enough scientific evidence regarding functional and structural deterioration of skeletal musculature in these patients. It is worth noting that muscle weakness appears first in the respiratory muscles and then in the musculature of the limbs, which may be considered one of the main causes of exercise intolerance. Functional deterioration and associated atrophy of these respiratory muscles are related to an increased muscle metaboreflex leading to sympathetic–adrenal system hyperactivity and increased pulmonary ventilation. This issue contributes to increased dyspnea and/or fatigue and decreased aerobic function. Consequently, respiratory muscle weakness produces exercise limitations in these patients. In the present review, the key role that respiratory muscle metaboloreceptors play in exercise intolerance is accurately addressed in patients who suffer from HF. In conclusion, currently available scientific evidence seems to affirm that excessive metaboreflex activity of respiratory musculature under HF is the main cause of exercise intolerance and sympathetic–adrenal system hyperactivity. Inspiratory muscle training seems to be a useful personalized medicine intervention to reduce respiratory muscle metaboreflex in order to increase patients’ exercise tolerance under HF condition.
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Mostarda C, Barboza CDA, Cutrim AL, Silva-Filho AC, Dias CJ, Brito-Monzani JDO, Rodrigues B. Obesity as an additional factor for autonomic imbalance and poor sleep behavior in chronic obstructive pulmonary disease: a case-control study. Clinics (Sao Paulo) 2021; 76:e1826. [PMID: 33503172 PMCID: PMC7798128 DOI: 10.6061/clinics/2021/e1826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 09/02/2020] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES We compared the autonomic modulation and sleep behavior of eutrophic and overweight patients with chronic obstructive pulmonary disease (COPD). METHODS COPD participants were divided into the overweight and eutrophic groups. Pulmonary function, blood pressure, body composition, autonomic modulation, and the Pittsburgh Sleep Quality Index score were assessed. Participants performed the six-minute walk test for functional assessment. RESULTS Spirometric variables obtained in eutrophic and overweight individuals with COPD showed no statistically different results. We observed that the SDNN index indicated lower overall variability (p=0.003), and root mean square of successive differences between normal heart beats (RMSSD) (p=0.04) indicated lower parasympathetic modulation in the overweight group than observed in the eutrophic group. The indexes of the frequency domain presented lower values of total variability (p<0.01), low frequency bands (p<0.01), and high frequency (p=0.02), suggesting a higher sympathetic modulation and reduced parasympathetic modulation of the overweight group compared to eutrophic group. The overweight group also showed reduced sleep quality than the eutrophic group. CONCLUSION Overweight COPD patients showed lower autonomic modulation and impaired sleep quality, latency, and efficiency as compared eutrophic subjects. These results reinforce the importance of weight control and the acquisition of healthy habits in this population.
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Affiliation(s)
- Cristiano Mostarda
- Laboratorio de Adaptacoes Cardiovasculares ao Exercicio (LACORE), Universidade Federal do Maranhao, Sao Luis, MA, BR
- Programa de Pos-Graduacao em Educacao Fisica, Universidade Federal do Maranhao, Sao Luis, MA, BR
- Centro de Reabilitacao Cardiopulmonar, Hospital Universitario “Presidente Dutra”, Universidade Federal do Maranhao, Sao Luis, MA, BR
| | | | - Ana Lídia Cutrim
- Laboratorio de Adaptacoes Cardiovasculares ao Exercicio (LACORE), Universidade Federal do Maranhao, Sao Luis, MA, BR
- Programa de Pos-Graduacao em Educacao Fisica, Universidade Federal do Maranhao, Sao Luis, MA, BR
| | - Antonio Carlos Silva-Filho
- Laboratorio de Adaptacoes Cardiovasculares ao Exercicio (LACORE), Universidade Federal do Maranhao, Sao Luis, MA, BR
- Programa de Pos-Graduacao em Educacao Fisica, Universidade Federal do Maranhao, Sao Luis, MA, BR
| | - Carlos José Dias
- Laboratorio de Adaptacoes Cardiovasculares ao Exercicio (LACORE), Universidade Federal do Maranhao, Sao Luis, MA, BR
- Centro de Reabilitacao Cardiopulmonar, Hospital Universitario “Presidente Dutra”, Universidade Federal do Maranhao, Sao Luis, MA, BR
| | - Janaina De Oliveira Brito-Monzani
- Laboratorio de Adaptacoes Cardiovasculares ao Exercicio (LACORE), Universidade Federal do Maranhao, Sao Luis, MA, BR
- Programa de Pos-Graduacao em Educacao Fisica, Universidade Federal do Maranhao, Sao Luis, MA, BR
| | - Bruno Rodrigues
- Faculdade de Educacao Fisica, Universidade Estadual de Campinas (UNICAMP), Campinas, SP, BR
- *Corresponding author. E-mail:
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Acute Effects of Resistance Exercise With Blood Flow Restriction in Elderly Women: A Pilot Study. J Aging Phys Act 2020; 29:361-371. [PMID: 33373977 DOI: 10.1123/japa.2020-0137] [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: 04/16/2020] [Revised: 07/02/2020] [Accepted: 07/17/2020] [Indexed: 11/18/2022]
Abstract
AIM To compare the acute effects of two resistance exercise sessions with different partial blood flow restrictions (BFR) on hemodynamic parameters and cardiac autonomic modulation in older women with metabolic syndrome. METHODS Thirty-nine older women (64.4 ± 4.5 years) were allocated into three groups: BFR0 = resistance exercise (20%, 1 maximum repetition [MR]) + 0% BFR; BFR60 = 20% 1 MR resistance exercise + 60% BFR; and BFR80 = 20% 1MR resistance exercise + 80% BFR. RESULTS A reduction of 14 mmHg (BFR60 group) and 13 mmHg (BRF80 group) was observed 48 hr after the first exercise session, while vagal modulation was increased in the BRF60 group after 24 and 48 hr. CONCLUSION A low-intensity resistance exercise session with 60% and 80% of BFR resulted in blood pressure (systolic, diastolic, and mean) reduction and positive changes on heart rate variability after 24 h of a RE session.
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Azambuja ADCM, de Oliveira LZ, Sbruzzi G. Inspiratory Muscle Training in Patients With Heart Failure: What Is New? Systematic Review and Meta-Analysis. Phys Ther 2020; 100:2099-2109. [PMID: 32936904 DOI: 10.1093/ptj/pzaa171] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/28/2020] [Indexed: 11/12/2022]
Abstract
OBJECTIVE The benefits of inspiratory muscle training (IMT) have already been demonstrated in patients with heart failure (HF), but the best mode of training and which patients benefit from this intervention are not clear. The purpose of this study was to review the effects of IMT on respiratory muscle strength, functional capacity, pulmonary function, quality of life, and dyspnea in patients with HF; IMT isolated or combined with another intervention (combined IMT), the presence of inspiratory muscle weakness, training load, and intervention time were considered. METHODS The search included the databases MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Physiotherapy Evidence Database, and LILACS database through September 2019. The review included randomized studies that assessed IMT in isolation or combined with another intervention-in comparison with a control group, a placebo, or another intervention-in patients with HF. Fourteen studies were included, 13 for meta-analysis (10 for isolated IMT and 3 for combined IMT). RESULTS Isolated IMT demonstrated an increase in maximal inspiratory pressure (MIP) (25.12 cm H2O; 95% CI = 15.29 - 34.95), 6-Minute Walk Test (81.18 m; 95% CI = 9.73 - 152.63), maximum oxygen consumption (12 weeks: 3.75 mL/kg/min; 95% CI = 2.98 to 4.51), and quality of life (-20.68; 95% CI = -29.03 to -12.32). The presence of inspiratory muscle weakness, higher loads, and longer intervention times resulted in greater increases in MIP. IMT combined with another intervention demonstrated an increase only in MIP. CONCLUSIONS Isolated IMT resulted in an increase in inspiratory muscle strength, functional capacity, and quality of life. IMT combined with another intervention resulted only in a small increase in inspiratory strength. Isolated IMT with higher loads can be considered an adjuvant intervention, especially for those who do not adhere to conventional rehabilitation and who have respiratory muscle weakness. IMPACT A systematic review was necessary to review the effects of IMT on respiratory muscle strength, lung function, functional capacity, quality of life, and dyspnea in patients with HF. Various clinical issues important for a better training prescription were considered; these included whether the performance of the training IMT as a form of isolated training benefits patients with HF, whether the combination of IMT with another intervention has additional effects, whether any patient with HF can benefit from IMT (alone or combined with another intervention), and whether only patients who already have respiratory muscle weakness benefit. Also important was establishing which training load provides the best result and the best intervention time, so that health care can be provided more efficiently. LAY SUMMARY For people with heart failure, IMT by itself, without being combined with other exercise, can improve ease of breathing, increase the amount of distance that they can walk, and improve quality of life. Inspiratory training with higher loads might be helpful for those with respiratory muscle weakness who are unable to do conventional exercise.
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Affiliation(s)
- Aline de Cassia Meine Azambuja
- Postgraduate Program in Pneumological Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil; and Postgraduate Program in Human Movement Sciences, Universidade Federal do Rio Grande do Sul
| | | | - Graciele Sbruzzi
- Postgraduate Program in Pneumological Sciences, Universidade Federal do Rio Grande do Sul, R. Felizardo, 750, CEP: 90690-200, Porto Alegre RS, Brazil; and Postgraduate Program in Human Movement Sciences, Universidade Federal do Rio Grande do Su
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22
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Laoutaris ID, Piotrowicz E, Kallistratos MS, Dritsas A, Dimaki N, Miliopoulos D, Andriopoulou M, Manolis AJ, Volterrani M, Piepoli MF, Coats AJS, Adamopoulos S. Combined aerobic/resistance/inspiratory muscle training as the 'optimum' exercise programme for patients with chronic heart failure: ARISTOS-HF randomized clinical trial. Eur J Prev Cardiol 2020; 28:1626-1635. [PMID: 33624071 DOI: 10.1093/eurjpc/zwaa091] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 08/26/2020] [Accepted: 09/18/2020] [Indexed: 12/17/2022]
Abstract
AIMS An 'optimum' universally agreed exercise programme for heart failure (HF) patients has not been found. ARISTOS-HF randomized clinical trial evaluates whether combined aerobic training (AT)/resistance training (RT)/inspiratory muscle training (IMT) (ARIS) is superior to AT/RT, AT/IMT or AT in improving aerobic capacity, left ventricular dimensions, and secondary functional outcomes. METHODS AND RESULTS Eighty-eight patients of New York Heart Association II-III, left ventricular ejection fraction ≤ 35% were randomized to an ARIS, AT/RT, AT/IMT, or AT group, exercising 3 times/week, 180 min/week for 12 weeks. Pre- and post-training, peakVO2 was evaluated with cardiopulmonary exercise testing, left ventricular dimensions using echocardiography, walking distance with the 6-min walk test (6MWT), quality of life by the Minnesota Living with HF Questionnaire (MLwHFQ), while a programme preference survey (PPS) was used. Seventy-four patients of [mean 95% (confidence interval, CI)] age 66.1 (64.3-67.9) years and peakVO2 17.3 (16.4-18.2) mL/kg/min were finally analysed. Between-group analysis showed a trend for increased peakVO2 (mL/kg/min) [mean contrasts (95% CI)] in the ARIS group [ARIS vs. AT/RT 1.71 (0.163-3.25)(.), vs. AT/IMT 1.50 (0.0152-2.99)(.), vs. AT 1.38 (-0.142 to 2.9)(.)], additional benefits in circulatory power (mL/kg/min⋅mmHg) [ARIS vs. AT/RT 376 (60.7-690)*, vs. AT/IMT 423 (121-725)*, vs. AT 345 (35.4-656)*], left ventricular end-systolic diameter (mm) [ARIS vs. AT/RT -2.11 (-3.65 to (-0.561))*, vs. AT -2.47 (-4.01 to (-0.929))**], 6MWT (m) [ARIS vs. AT/IMT 45.6 (18.3-72.9)**, vs. AT 55.2 (27.6-82.7)****], MLwHFQ [ARIS vs. AT/RT -7.79 (-11 to (-4.62))****, vs. AT -8.96 (-12.1 to (-5.84))****], and in PPS score [mean (95% CI)] [ARIS, 4.8 (4.7-5) vs. AT, 4.4 (4.2-4.7)*] [(.) P ≤ 0.1; *P ≤ 0.05; **P ≤ 0.01; ***P ≤ 0.001; ****P ≤ 0.0001]. CONCLUSION ARISTOS-HF trial recommends exercise training for 180 min/week and supports the prescription of the ARIS training regime for HF patients (Clinical Trial Registration: http://www.clinicaltrials.gov. ARISTOS-HF Clinical Trial number, NCT03013270).
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Affiliation(s)
- Ioannis D Laoutaris
- Heart Failure and Transplant Unit, Onassis Cardiac Surgery Center, 356 Sygrou Boulevard, 176 74 Athens, Greece
| | - Ewa Piotrowicz
- National Institute of Cardiology, Telecardiology Center, Alpejska 42, 04-628, Warsaw, Poland
| | - Manolis S Kallistratos
- Cardiology Department, Asklepieion General Hospital, Alpejska 42, 04-628, Athens, Greece
| | - Athanasios Dritsas
- Heart Failure and Transplant Unit, Onassis Cardiac Surgery Center, 356 Sygrou Boulevard, 176 74 Athens, Greece
| | - Niki Dimaki
- Cardiology Department, Asklepieion General Hospital, Alpejska 42, 04-628, Athens, Greece
| | - Dimitris Miliopoulos
- Heart Failure and Transplant Unit, Onassis Cardiac Surgery Center, 356 Sygrou Boulevard, 176 74 Athens, Greece
| | - Maria Andriopoulou
- Cardiology Department, Asklepieion General Hospital, Alpejska 42, 04-628, Athens, Greece
| | - Athanasios J Manolis
- Cardiology Department, Asklepieion General Hospital, Alpejska 42, 04-628, Athens, Greece
| | - Maurizio Volterrani
- Department of Medical Sciences, Centre for Clinical and Basic Research, IRCCS San Raffaele Pisana, via della Pisana 235, 00163, Rome, Italy
| | - Massimo F Piepoli
- Heart Failure Unit, Cardiac Department, G. da Saliceto Hospital, via taverna Giuseppe 49, 291121, AUSL, Piacenza, Italy
| | - Andrew J S Coats
- Department of Medical Sciences, Centre for Clinical and Basic Research, IRCCS San Raffaele Pisana, via della Pisana 235, 00163, Rome, Italy
| | - Stamatis Adamopoulos
- Heart Failure and Transplant Unit, Onassis Cardiac Surgery Center, 356 Sygrou Boulevard, 176 74 Athens, Greece
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23
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Aweto HA, Obikeh EO, Tella BA. Effects of incentive spirometry on cardiopulmonary parameters, functional capacity and glycemic control in patients with Type 2 diabetes. Hong Kong Physiother J 2020; 40:121-132. [PMID: 33005076 PMCID: PMC7526058 DOI: 10.1142/s1013702520500110] [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: 04/03/2019] [Accepted: 03/01/2020] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Patients with Type 2 diabetes mellitus (T2DM) suffer cardiopulmonary impairment and may present with weakness of the inspiratory muscles. OBJECTIVE This study was designed to determine the effects of incentive spirometry (IS) on selected cardiopulmonary parameters, functional capacity and glycemic control in patients with T2DM. METHODS Fifty-nine participants (25 males and 34 females) recruited from the out-patient clinic of the Department of Medicine of two hospitals in Lagos State, Nigeria, who were randomly assigned into two groups, completed the study. In addition to the medical management of T2DM, IS group received incentive spirometry while control group continued with the medical management of T2DM alone. Selected cardiovascular parameters, pulmonary parameters, functional capacity (using 6-min walk test) and fasting blood glucose level were assessed at baseline and at the end of eight weeks intervention period. Data were analyzed using the Statistical Package for Social Sciences (SPSS Version 21). Level of significance was set at p < 0 . 05 . RESULTS There were statistically significant improvements in all the cardiovascular parameters ( p = 0 . 001 ) of IS group except systolic blood pressure. There were significant changes in all the pulmonary parameters, functional capacity and glycemic control ( p < 0 . 05 ) of IS group while there was none in control group. There were significant differences between the mean changes of various selected outcome measures of the two groups ( p < 0 . 05 ) except for diastolic blood pressure and blood glucose level. CONCLUSION IS had positive effects in improving cardiopulmonary function, functional capacity and glycemic control in patients with T2DM.
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Affiliation(s)
- Happiness Anulika Aweto
- Department of Physiotherapy, Faculty of Clinical Sciences, College of Medicine, University of Lagos, PMB 12003, Idi-Araba, Lagos, Nigeria
| | - Esther Onyinyechi Obikeh
- Department of Physiotherapy, Faculty of Clinical Sciences, College of Medicine, University of Lagos, PMB 12003, Idi-Araba, Lagos, Nigeria
| | - Bosede Abidemi Tella
- Department of Physiotherapy, Faculty of Clinical Sciences, College of Medicine, University of Lagos, PMB 12003, Idi-Araba, Lagos, Nigeria
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24
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Sympathetic neural overdrive in congestive heart failure and its correlates: systematic reviews and meta-analysis. J Hypertens 2020; 37:1746-1756. [PMID: 30950979 DOI: 10.1097/hjh.0000000000002093] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND AND OBJECTIVES Sympathetic neural activation occurs in congestive heart failure (CHF). However, the small sample size of the microneurographic studies, heterogeneity of the patients examined, presence of comorbidities as well as confounders (including treatment) represented major weaknesses not allowing to identify the major features of the phoenomenon, particularly in mild CHF. This meta-analysis evaluated 2530 heart failure (CHF) patients recruited in 106 microneurographic studies. It was based on muscle sympathetic nerve activity (MSNA) quantification in CHF of different clinical severity, but data from less widely addressed conditions, such as ischemic vs. idiopathic, were also considered. METHODS Assessment was extended to the relationships of MSNA with venous plasma norepinephrine, heart rate (HR) and echocardiographic parameters of cardiac morphology [left ventricular (LV) end-diastolic diameter] and function (LV ejection fraction) as well. RESULTS MSNA was significantly greater (1.9 times, P < 0.001) in CHF patients as compared with healthy controls, a progressive significant increase being observed from New York Heart Association classes I-IV in unadjusted and adjusted analyses. MSNA was significantly greater in both untreated and treated CHF (P < 0.001 for both), related to left ventricular (LV) end-diastolic diameter and to a lesser extent to LV ejection fraction (r = 0.24 and -0.05, P < 0.001 and <0.01, respectively), and closely associated with HR (r = 0.66, P < 0.001) and plasma norepinephrine (r = 0.68, P < 0.001). CONCLUSION CHF is characterized by sympathetic overactivity which mirrors the degree of LV dysfunction independently of the stage of CHF, its cause and presence of confounders or pharmacological treatment. plasma norepinephrine and HR represent potentially valuable surrogate markers of sympathetic activation in the clinical setting.
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25
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Ioannou S. Functional Infrared Thermal Imaging: A Contemporary Tool in Soft Tissue Screening. Sci Rep 2020; 10:9303. [PMID: 32518287 PMCID: PMC7283266 DOI: 10.1038/s41598-020-66397-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2019] [Accepted: 05/11/2020] [Indexed: 11/09/2022] Open
Abstract
Soft tissue injury screening faces two main diagnostic challenges. One is the perceptual bias of the athlete in terms of referred pain and second injury assessment tools are not only in need of highly specialized personal but they are also financially demanding. Since ankle sprains is one of the leading soft tissue injuries, the current study was set to examine the suitability of functional infrared thermal imaging (fITI) in evaluating physiological alteration on the ankle as a result of exercise or injury. The current study consists of a case report of a patient with an ankle sprain and the behavior of temperature after a series of physiotherapy sessions. Moreover to strengthen the communication of the report, results from a healthy population sample were added to draw a deeper understanding on physiological temperature manifestations on soft tissue. Twenty participants underwent a 30-minute treadmill run with pictures of their ankles being taken during rest and after exercise. In addition the case of a patient is reported that has suffered an ankle sprain followed for a period of over a month. It was observed that the temperature of the ankles of participants that underwent physical exercise rose on average by 2.4 °C after taking into account both the medial and lateral sides of the both ankles. In addition the patient's left ankle appeared to be 2.5 °C above the temperature of the non-affected right ankle. This phenomenon of unilateral hyperthermia of the left injured side seems to start to dissipate by the 21st day following the injury, completely resolving by the 42nd day achieving bilateral isothermia in both ankles. Thermal imaging provides a reliable tool for the screening of soft tissue strain and injury. The current study further expands the literature on soft tissue screening with the use of thermal imaging, adding a quantifiable way for assessing the extend of tissue damage. The implemented method of analyses offers a suggested simple way not only in visualizing trauma but also physical strain. Nevertheless further investigations with a variety in the severity of ankle sprains need to be applied in order for thermal imaging to be used as a first line tool for the assessment and recovery of ankle sprains.
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Affiliation(s)
- Stephanos Ioannou
- Alfaisal University, College of Medicine, Department of Physiological Sciences, Riyadh, 11533, Kingdom of Saudi Arabia.
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26
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Fernandez-Rubio H, Becerro-de-Bengoa-Vallejo R, Rodríguez-Sanz D, Calvo-Lobo C, Vicente-Campos D, Chicharro JL. Inspiratory Muscle Training in Patients with Heart Failure. J Clin Med 2020; 9:jcm9061710. [PMID: 32498445 PMCID: PMC7356942 DOI: 10.3390/jcm9061710] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 05/28/2020] [Accepted: 05/28/2020] [Indexed: 12/13/2022] Open
Abstract
Background: Prior systematic reviews and meta-analysis addressed that inspiratory muscle training (IMT) improved inspiratory muscle weakness, cardiorespiratory fitness and quality of life similar to conventional exercise training as a first alternative in deconditioned patients with heart failure (HF) lead to a better adaptation to posterior exercise training. The heterogeneity and variability in a wide range of new studies about this topic led to the necessity of an updated and comprehensive narrative review. The present review aimed to analyze and update the most relevant studies about IMT in patients who suffer from HF. Methods: A narrative review was carried out about IMT in HF patients including 26 experimental studies divided into 21 clinical trials and 5 quasi-experimental studies identified through database searching in PubMed, Cochrane and PEDro. Results: There is enough evidence to state that IMT produces improvements in functional capacity of patients with HF. Nevertheless, there is not enough evidence to support that IMT could improve cardiovascular parameters, blood biomarkers or quality of life in these patients. Conclusions: Thus, IMT may be recommended to improve functional capacity in patients who suffer from HF; nevertheless, more evidence is needed regarding cardiovascular parameters, biomarkers and quality of life. Furthermore, mortality or HF hospitalization was not evaluated and most studies were not longer than 3 months. According to IMT protocols and study designs heterogeneity and mid-term follow-up, further investigations through high-quality long-term randomized clinical trials should be performed to achieve systematic reviews and meta-analysis to support strong evidence for IMT in HF patients.
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Affiliation(s)
- Hugo Fernandez-Rubio
- Facultad de Enfermería, Fisioterapia y Podología, Universidad Complutense de Madrid, 28040 Madrid, Spain; (H.F.-R.); (R.B.-d.-B.-V.); (D.R.-S.)
| | - Ricardo Becerro-de-Bengoa-Vallejo
- Facultad de Enfermería, Fisioterapia y Podología, Universidad Complutense de Madrid, 28040 Madrid, Spain; (H.F.-R.); (R.B.-d.-B.-V.); (D.R.-S.)
| | - David Rodríguez-Sanz
- Facultad de Enfermería, Fisioterapia y Podología, Universidad Complutense de Madrid, 28040 Madrid, Spain; (H.F.-R.); (R.B.-d.-B.-V.); (D.R.-S.)
| | - César Calvo-Lobo
- Facultad de Enfermería, Fisioterapia y Podología, Universidad Complutense de Madrid, 28040 Madrid, Spain; (H.F.-R.); (R.B.-d.-B.-V.); (D.R.-S.)
- Correspondence: ; Tel.: +34-913-941-532
| | - Davinia Vicente-Campos
- Facultad de Ciencias de la Salud, Universidad Francisco de Vitoria, Pozuelo de Alarcón, 28223 Madrid, Spain;
| | - J. L. Chicharro
- Grupo FEBIO, Universidad Complutense de Madrid, 28040 Madrid, Spain;
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27
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Laoutaris ID. Exercise intolerance and skeletal muscle metaboreflex activity in chronic heart failure: Do we need to recruit more muscle in exercise training? Eur J Prev Cardiol 2020; 27:1858-1861. [PMID: 32212843 DOI: 10.1177/2047487320912623] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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28
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Antunes-Correa LM, Trevizan PF, Bacurau AVN, Ferreira-Santos L, Gomes JLP, Urias U, Oliveira PA, Alves MJNN, de Almeida DR, Brum PC, Oliveira EM, Hajjar L, Kalil Filho R, Negrão CE. Effects of aerobic and inspiratory training on skeletal muscle microRNA-1 and downstream-associated pathways in patients with heart failure. J Cachexia Sarcopenia Muscle 2020; 11:89-102. [PMID: 31743617 PMCID: PMC7015255 DOI: 10.1002/jcsm.12495] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 07/26/2019] [Accepted: 08/12/2019] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The exercise intolerance in chronic heart failure with reduced ejection fraction (HFrEF) is mostly attributed to alterations in skeletal muscle. However, the mechanisms underlying the skeletal myopathy in patients with HFrEF are not completely understood. We hypothesized that (i) aerobic exercise training (AET) and inspiratory muscle training (IMT) would change skeletal muscle microRNA-1 expression and downstream-associated pathways in patients with HFrEF and (ii) AET and IMT would increase leg blood flow (LBF), functional capacity, and quality of life in these patients. METHODS Patients age 35 to 70 years, left ventricular ejection fraction (LVEF) ≤40%, New York Heart Association functional classes II-III, were randomized into control, IMT, and AET groups. Skeletal muscle changes were examined by vastus lateralis biopsy. LBF was measured by venous occlusion plethysmography, functional capacity by cardiopulmonary exercise test, and quality of life by Minnesota Living with Heart Failure Questionnaire. All patients were evaluated at baseline and after 4 months. RESULTS Thirty-three patients finished the study protocol: control (n = 10; LVEF = 25 ± 1%; six males), IMT (n = 11; LVEF = 31 ± 2%; three males), and AET (n = 12; LVEF = 26 ± 2%; seven males). AET, but not IMT, increased the expression of microRNA-1 (P = 0.02; percent changes = 53 ± 17%), decreased the expression of PTEN (P = 0.003; percent changes = -15 ± 0.03%), and tended to increase the p-AKTser473 /AKT ratio (P = 0.06). In addition, AET decreased HDAC4 expression (P = 0.03; percent changes = -40 ± 19%) and upregulated follistatin (P = 0.01; percent changes = 174 ± 58%), MEF2C (P = 0.05; percent changes = 34 ± 15%), and MyoD expression (P = 0.05; percent changes = 47 ± 18%). AET also increased muscle cross-sectional area (P = 0.01). AET and IMT increased LBF, functional capacity, and quality of life. Further analyses showed a significant correlation between percent changes in microRNA-1 and percent changes in follistatin mRNA (P = 0.001, rho = 0.58) and between percent changes in follistatin mRNA and percent changes in peak VO2 (P = 0.004, rho = 0.51). CONCLUSIONS AET upregulates microRNA-1 levels and decreases the protein expression of PTEN, which reduces the inhibitory action on the PI3K-AKT pathway that regulates the skeletal muscle tropism. The increased levels of microRNA-1 also decreased HDAC4 and increased MEF2c, MyoD, and follistatin expression, improving skeletal muscle regeneration. These changes associated with the increase in muscle cross-sectional area and LBF contribute to the attenuation in skeletal myopathy, and the improvement in functional capacity and quality of life in patients with HFrEF. IMT caused no changes in microRNA-1 and in the downstream-associated pathway. The increased functional capacity provoked by IMT seems to be associated with amelioration in the respiratory function instead of changes in skeletal muscle. ClinicalTrials.gov (Identifier: NCT01747395).
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Affiliation(s)
- Ligia M Antunes-Correa
- Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil.,School of Physical Education, University of Campinas (UNICAMP), Campinas, Brazil
| | - Patricia F Trevizan
- Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil
| | - Aline V N Bacurau
- School of Physical Education and Sport, University of São Paulo, São Paulo, Brazil
| | | | - João L P Gomes
- School of Physical Education and Sport, University of São Paulo, São Paulo, Brazil
| | - Ursula Urias
- School of Physical Education and Sport, University of São Paulo, São Paulo, Brazil
| | - Patricia A Oliveira
- Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil
| | | | - Dirceu R de Almeida
- Division of Cardiology, Department of Medicine, Federal University of São Paulo, São Paulo, Brazil
| | - Patricia C Brum
- School of Physical Education and Sport, University of São Paulo, São Paulo, Brazil
| | - Edilamar M Oliveira
- School of Physical Education and Sport, University of São Paulo, São Paulo, Brazil
| | - Ludhmila Hajjar
- Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil
| | - Roberto Kalil Filho
- Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil
| | - Carlos Eduardo Negrão
- Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil.,School of Physical Education and Sport, University of São Paulo, São Paulo, Brazil
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29
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Craighead DH, Heinbockel TC, Hamilton MN, Bailey EF, MacDonald MJ, Gibala MJ, Seals DR. Time-efficient physical training for enhancing cardiovascular function in midlife and older adults: promise and current research gaps. J Appl Physiol (1985) 2019; 127:1427-1440. [PMID: 31556835 PMCID: PMC10205162 DOI: 10.1152/japplphysiol.00381.2019] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 08/28/2019] [Accepted: 09/18/2019] [Indexed: 12/11/2022] Open
Abstract
Cardiovascular diseases (CVD) remain the leading cause of death in developed societies, and "midlife" (50-64 yr) and older (65+) men and women bear the great majority of the burden of CVD. Much of the increased risk of CVD in this population is attributable to CV dysfunction, including adverse changes in the structure and function of the heart, increased systolic blood pressure, and arterial dysfunction. The latter is characterized by increased arterial stiffness and vascular endothelial dysfunction. Conventional aerobic exercise training, as generally recommended in public health guidelines, is an effective strategy to preserve or improve CV function with aging. However, <40% of midlife and older adults meet aerobic exercise guidelines, due in part to time availability-related barriers. As such, there is a need to develop evidence-based time-efficient exercise interventions that promote adherence and optimize CV function in these groups. Two promising interventions that may meet these criteria are interval training and inspiratory muscle strength training (IMST). Limited research suggests these modes of training may improve CV function with time commitments of ≤60 min/wk. This review will summarize the current evidence for interval training and IMST to improve CV function in midlife/older adults and identify key research gaps and future directions.
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Affiliation(s)
- Daniel H Craighead
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, Colorado
| | - Thomas C Heinbockel
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, Colorado
| | - Makinzie N Hamilton
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, Colorado
| | - E Fiona Bailey
- Department of Physiology, University of Arizona College of Medicine, Tucson, Arizona
| | | | - Martin J Gibala
- Department of Kinesiology, McMaster University, Ontario, Canada
| | - Douglas R Seals
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, Colorado
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30
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Martins de Abreu R, Porta A, Rehder-Santos P, Cairo B, Donisete da Silva C, De Favari Signini É, Sakaguchi CA, Catai AM. Effects of inspiratory muscle-training intensity on cardiovascular control in amateur cyclists. Am J Physiol Regul Integr Comp Physiol 2019; 317:R891-R902. [PMID: 31596110 DOI: 10.1152/ajpregu.00167.2019] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Chronic effects of inspiratory muscle training (IMT) on autonomic function and baroreflex regulation are poorly studied. This study aims at evaluating chronic effects of different IMT intensities on cardiovascular control in amateur cyclists. A longitudinal, randomized, controlled blind study was performed on 30 recreational male cyclists undergoing IMT for 11 wk. Participants were randomly allocated into sham-trained group (SHAM, n = 9), trained group at 60% of the maximal inspiratory pressure (MIP60, n = 10), and trained group at critical inspiratory pressure (CIP, n = 11). Electrocardiogram, finger arterial pressure, and respiratory movements were recorded before (PRE) and after (POST) training at rest in supine position (REST) and during active standing (STAND). From the beat-to-beat series of heart period (HP) and systolic arterial pressure (SAP), we computed time domain markers, frequency domain indexes in the low frequency (0.04-0.15 Hz) and high frequency (HF, 0.15-0.4 Hz) bands, an entropy-based complexity index (CI), and baroreflex markers estimated from spontaneous HP-SAP sequences. Compared with SHAM, the positive effect of MIP60 over the HP series led to the HF power increase during REST (PRE: 521.2 ± 447.5 ms2; POST: 1,161 ± 878.9 ms2) and the CI rise during STAND (PRE: 0.82 ± 0.18; POST: 0.97 ± 0.13). Conversely, the negative effect of CIP took the form of the decreased HP mean during STAND (PRE: 791 ± 71 ms; POST: 737 ± 95 ms). No effect of IMT was visible over SAP and baroreflex markers. These findings suggest that moderate-intensity IMT might be beneficial when the goal is to limit cardiac sympathetic hyperactivity at REST and/or in response to STAND.
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Affiliation(s)
| | - Alberto Porta
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy.,Department of Cardiothoracic, Vascular Anesthesia and Intensive Care, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Patricia Rehder-Santos
- Department of Physical Therapy, Federal University of São Carlos, São Carlos, São Paulo, Brazil
| | - Beatrice Cairo
- Department of Cardiothoracic, Vascular Anesthesia and Intensive Care, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | | | - Étore De Favari Signini
- Department of Physical Therapy, Federal University of São Carlos, São Carlos, São Paulo, Brazil
| | - Camila Akemi Sakaguchi
- Department of Physical Therapy, Federal University of São Carlos, São Carlos, São Paulo, Brazil
| | - Aparecida Maria Catai
- Department of Physical Therapy, Federal University of São Carlos, São Carlos, São Paulo, Brazil
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Wang MH, Yeh ML. Respiratory training interventions improve health status of heart failure patients: A systematic review and network meta-analysis of randomized controlled trials. World J Clin Cases 2019; 7:2760-2775. [PMID: 31616691 PMCID: PMC6789387 DOI: 10.12998/wjcc.v7.i18.2760] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 07/04/2019] [Accepted: 07/27/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Prior studies indicate that doing breathing exercises improves physical performance and quality of life (QoL) in heart failure patients. However, these effects remain unclear and contradictory.
AIM To determine the effects of machine-assisted and non-machine-assisted respiratory training on physical performance and QoL in heart failure patients.
METHODS This was a systematic review and network meta-analysis study. A literature search of electronic databases was conducted for randomized controlled trials (RCTs) on heart failure. Respiratory training interventions were grouped as seven categories: IMT_Pn (inspiratory muscle training without pressure or < 10% maximal inspiratory pressure, MIP), IMT_Pl (inspiratory muscle training with low pressure, 10%-15% MIP), IMT_Pm (inspiratory muscle training with medium pressure, 30%-40% MIP), IMT_Ph (inspiratory muscle training with high pressure, 60% MIP or MIP plus aerobics), Aerobics (aerobic exercise or weight training), Qi_Ex (tai chi, yoga, and breathing exercise), and none. The four outcomes were heart rate, peak oxygen uptake (VO2 peak), 6-min walking distance test (6MWT), and Minnesota Living with Heart Failure QoL. The random-effects model, side-splitting model, and the surface under the cumulative ranking curve (SUCRA) were used to test and analyze the data.
RESULTS A total of 1499 subjects from 31 RCT studies were included. IMT_Ph had the highest effect sizes for VO2 peak and 6MWT, IMT_Pm highest for QoL, and Qi_Ex highest for heart rate. Aerobics had the second highest for VO2 peak, Qi_Ex second highest for 6MWT, and IMT_Ph second highest for heart rate and QoL.
CONCLUSION This study supports that high- and medium-intensity machine-assisted training improves exercise capacity and QoL in hospital-based heart failure patients. After hospital discharge, non-machine-assisted training continuously improves cardiac function.
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Affiliation(s)
- Mei-Hua Wang
- School of Nursing, National Taipei University of Nursing and Health Sciences, Taipei 11219, Taiwan
| | - Mei-Ling Yeh
- School of Nursing, National Taipei University of Nursing and Health Sciences, Taipei 11219, Taiwan
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Kurzaj M, Dziubek W, Porębska M, Rożek-Piechura K. Can Inspiratory Muscle Training Improve Exercise Tolerance and Lower Limb Function After Myocardial Infarction? Med Sci Monit 2019; 25:5159-5169. [PMID: 31296834 PMCID: PMC6642672 DOI: 10.12659/msm.914684] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Background Respiratory therapy is an integral part of treatment of cardiac patients. The aim of this study was to evaluate the effect of addition of inspiratory muscle training (IMT) to second-stage cardiac rehabilitation on exercise tolerance and function of lower extremities in patients following myocardial infarction (MI). Material/Methods This study included 90 patients (mean age 65 years) with MI who took part in the second stage of an 8-week cycle of cardiac rehabilitation (CR). They were divided into 3 groups: group I underwent CR and IMT, group II only underwent CR, and group III only underwent IMT. Groups I and II were allocated randomly according sealed opaque envelopes. The third group consisted of patients who could not participate in standard rehabilitation for various reasons. Before and after the 8-week program, participants were assessed for maximal inspiratory and expiratory pressure (PImax and PEmax) values, exercise tolerance, and knee muscle strength. Results In groups I and II, a significant increase in the PImax parameters and exercise tolerance parameters (MET) were observed. Group I had increased PEmax parameters. In group III, the same changes in the parameter values that reflect respiratory muscle function were observed. All of the examined strength parameters of the knee joint muscles demonstrated improvement in all of the investigated groups, but the biggest differences were observed in group I. Conclusions Use of IMT in the ambulatory rehabilitation program of MI patients resulted in improved rehabilitation efficacy, leading to a significant improvement in physical condition.
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Affiliation(s)
- Monika Kurzaj
- Department of Physiotherapy, University of Physical Education, Wrocław, Poland
| | - Wioletta Dziubek
- Department of Physiotherapy, University of Physical Education, Wrocław, Poland
| | - Małgorzata Porębska
- Cardiology Outpatient Clinic - Lower Silesian Center for Diagnostics and Cardiac Therapy MEDINET, Wrocław, Poland.,Center for Prevention and Rehabilitation of the "CREATOR" Non-Public Healthcare Center, Wrocław, Poland
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33
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Palau P, Domínguez E, Ramón JM, López L, Briatore AE, Tormo JP, Ventura B, Chorro FJ, Núñez J. Home-based inspiratory muscle training for management of older patients with heart failure with preserved ejection fraction: does baseline inspiratory muscle pressure matter? Eur J Cardiovasc Nurs 2019; 18:621-627. [PMID: 31148459 DOI: 10.1177/1474515119855183] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Heart failure with preserved ejection fraction is a clinical syndrome characterised by reduced exercise capacity. Some evidence has shown that a simple and home-based programme of inspiratory muscle training offers promising results in terms of aerobic capacity improvement in patients with heart failure with preserved ejection fraction. This study aimed to investigate whether the baseline inspiratory muscle function predicts the changes in aerobic capacity (measured as peak oxygen uptake; peak VO2) after a 12-week home-based programme of inspiratory muscle training in patients with heart failure with preserved ejection fraction. METHODS A total of 45 stable symptomatic patients with heart failure with preserved ejection fraction and New York Heart Association II-III received a 12-week home-based programme of inspiratory muscle training between June 2015 and December 2016. They underwent cardiopulmonary exercise testing and measurements of maximum inspiratory pressure pre and post-inspiratory muscle training. Maximum inspiratory pressure and peak VO2 were registered in both visits. Multivariate linear regression analysis was used to assess the association between changes in peak VO2 (Δ-peakVO2) and baseline predicted maximum inspiratory pressure (pp-MIP). RESULTS The median (interquartile range) age was 73 (68-77) years, 47% were women and 35.6% displayed New York Heart Association III. The mean peak VO2 at baseline and Δ-peakVO2 post-training were 10.4±2.8 ml/min/kg and +2.2±1.3 ml/min/kg (+21.3%), respectively. The median (interquartile range) of pp-MIP and Δ-MIP were 71% (64-92) and 39.2 (26.7-80.4) cmH2O, respectively. After a multivariate analysis, baseline pp-MIP was not associated with Δ-peakVO2 (β coefficient 0.005, 95% confidence interval -0.009-0.019, P=0.452). CONCLUSIONS In symptomatic and deconditioned older patients with heart failure with preserved ejection fraction, a home-based inspiratory muscle training programme improves aerobic capacity regardless of the baseline maximum inspiratory pressure.
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Affiliation(s)
- Patricia Palau
- Servicio de Cardiología. Hospital General Universitario de Castellón. Universitat Jaume I, Spain
| | - Eloy Domínguez
- Servicio de Cardiología. Hospital General Universitario de Castellón. Universitat Jaume I, Spain
| | - José María Ramón
- Servicio de Cardiología, Hospital Clínico Universitario, INCLIVA. Universitat de València. Spain
| | - Laura López
- Departamento de Fisioterapia, Universitat de València, Spain
| | - Antonio Ernesto Briatore
- Servicio de Cardiología. Hospital General Universitario de Castellón. Universitat Jaume I, Spain
| | - J Pablo Tormo
- Servicio de Cardiología. Hospital General Universitario de Castellón. Universitat Jaume I, Spain
| | - Bruno Ventura
- Servicio de Cardiología. Hospital General Universitario de Castellón. Universitat Jaume I, Spain
| | - Francisco J Chorro
- Servicio de Cardiología, Hospital Clínico Universitario, INCLIVA. Universitat de València. Spain.,Servicio de Cardiología, Hospital Clínico Universitario, CIBERCV, Spain
| | - Julio Núñez
- Servicio de Cardiología, Hospital Clínico Universitario, INCLIVA. Universitat de València. Spain.,Servicio de Cardiología, Hospital Clínico Universitario, CIBERCV, Spain
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Cipriano GF, Cipriano G, Santos FV, Güntzel Chiappa AM, Pires L, Cahalin LP, Chiappa GR. Current insights of inspiratory muscle training on the cardiovascular system: a systematic review with meta-analysis. Integr Blood Press Control 2019; 12:1-11. [PMID: 31190975 PMCID: PMC6535083 DOI: 10.2147/ibpc.s159386] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2018] [Accepted: 04/26/2019] [Indexed: 12/24/2022] Open
Abstract
Background: Cardiorespiratory limitation is a common hallmark of cardiovascular disease which is a key component of pharmacological and exercise treatments. More recently, inspiratory muscle training (IMT) is becoming an effective complementary treatment with positive effects on muscle strength and exercise capacity. We assessed the effectiveness of IMT on the cardiovascular system through autonomic function modulation via heart rate variability and arterial blood pressure. Methods: Randomized controlled trials (RCTs) were identified from searches of The Cochrane Library, MEDLINE and EMBASE to November 2018. Citations, conference proceedings and previous reviews were included without population restriction, comparing IMT intervention to no treatment, placebo or active control. Results: We identified 10 RCTs involving 267 subjects (mean age range 51–71 years). IMT programs targeted maximum inspiratory pressure (MIP) and cardiovascular outcomes, using low (n=6) and moderate to high intensity (n=4) protocols, but the protocols varied considerably (duration: 1–12 weeks, frequency: 3–14 times/week, time: 10–30 mins). An overall increase of the MIP (cmH2O) was observed (−27.57 95% CI −18.48, −37.45, I2=64%), according to weighted mean difference (95%CI), and was accompanied by a reduction of the low to high frequency ratio (−0.72 95% CI−1.40, −0.05, I2=50%). In a subgroup analysis, low- and moderate-intensity IMT treatment was associated with a reduction of the heart rate (HR) (−7.59 95% CI −13.96, −1.22 bpm, I2=0%) and diastolic blood pressure (DBP) (−8.29 [−11.64, −4.94 mmHg], I2=0%), respectively. Conclusion: IMT is an effective treatment for inspiratory muscle weakness in several populations and could be considered as a complementary treatment to improve the cardiovascular system, mainly HR and DBP. Further research is required to better understand the above findings.
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Affiliation(s)
- Graziella Fb Cipriano
- Physical Therapy Department, University of Brasilia, Brasilia, Brazil.,Department of Physical Therapy, University of Miami Miller School Of Medicine, Coral Gables, FL, USA
| | - Gerson Cipriano
- Physical Therapy Department, University of Brasilia, Brasilia, Brazil.,Department of Physical Therapy, University of Miami Miller School Of Medicine, Coral Gables, FL, USA
| | - Francisco V Santos
- Physical Therapy Department, University of Brasilia, Brasilia, Brazil.,Department of Education and Training in Oncology, Cancer Institute of São Paulo, São Paulo, Brazil
| | | | - Luigi Pires
- Centro Universitário do Planalto Central Professor Apparecido dos Santos, Brasilia, Brazil
| | - Lawrence Patrick Cahalin
- Department of Physical Therapy, University of Miami Miller School Of Medicine, Coral Gables, FL, USA
| | - Gaspar R Chiappa
- Centro Universitário do Planalto Central Professor Apparecido dos Santos, Brasilia, Brazil.,University Center, UniEvangelica, Anapolis, Goias, Brazil
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35
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Montero Ferro A, P Basso-Vanelli R, Moreira Mello RL, Sanches Garcia-Araujo A, Gonçalves Mendes R, Costa D, Gianlorenço AC. Effects of inspiratory muscle training on respiratory muscle strength, lung function, functional capacity and cardiac autonomic function in Parkinson's disease: Randomized controlled clinical trial protocol. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2019; 24:e1777. [PMID: 31090181 DOI: 10.1002/pri.1777] [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: 09/11/2018] [Revised: 02/04/2019] [Accepted: 03/17/2019] [Indexed: 11/08/2022]
Abstract
BACKGROUND Individuals with Parkinson's disease (PD), in addition to motor impairment, may evolve with respiratory and autonomic nervous system disorders. Currently, there are few studies with emphasis on muscle and pulmonary dysfunction and that verify the benefits of inspiratory muscle training (IMT) in this population. AIM The aim of this study was to evaluate whether IMT is effective for the improvement of respiratory muscle strength, lung function, thoracic mobility, functional capacity and cardiac autonomic function in PD. METHODS A randomized and controlled trial will be conducted with 26 participants with idiopathic PD, with aged between 50 and 65 years, in the Stages I to III by the Modified Hoehn and Yahr Scale. Respiratory muscle strength will be performed by manovacuometry and lung function by spirometry. Functional capacity will be evaluated by the 6-min walk test and autonomic cardiac function by heart rate variability. In addition, thoracic mobility measurement will also be performed. After the evaluations, these participants will be randomly assigned to two groups: the IMT group with Powerbreathe® , which will perform the eight series of 2 min each, with 1 min of rest between them, totaling 30 min, at 60% of the maximum inspiratory pressure and the control group, who will perform the same training protocol but with the load maintained at 9 cmH2 O. All participants will be submitted to the same motor training protocol. CONCLUSION It is expected that IMT increases the inspiratory muscle strength, contributing to the improved expiratory muscle strength, lung function, thoracic mobility, functional capacity and cardiac autonomic function in individuals with mild to moderate PD.
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Affiliation(s)
- Alyne Montero Ferro
- Post Graduate Program in Physical Therapy, Physical Therapy Department, Federal University of São Carlos-UFSCar, São Carlos, Brazil
| | - Renata P Basso-Vanelli
- Post Graduate Program in Physical Therapy, Physical Therapy Department, Federal University of São Carlos-UFSCar, São Carlos, Brazil
| | - Roberta Lorena Moreira Mello
- Post Graduate Program in Physical Therapy, Physical Therapy Department, Federal University of São Carlos-UFSCar, São Carlos, Brazil
| | - Adriana Sanches Garcia-Araujo
- Post Graduate Program in Physical Therapy, Physical Therapy Department, Federal University of São Carlos-UFSCar, São Carlos, Brazil
| | - Renata Gonçalves Mendes
- Post Graduate Program in Physical Therapy, Physical Therapy Department, Federal University of São Carlos-UFSCar, São Carlos, Brazil
| | - Dirceu Costa
- Physiotherapy Graduation and Rehabilitation Sciences Post Graduation Program, Nove de Julho University-UNINOVE, São Paulo, Brazil
| | - Anna Carolyna Gianlorenço
- Post Graduate Program in Physical Therapy, Physical Therapy Department, Federal University of São Carlos-UFSCar, São Carlos, Brazil
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Cutrim ALC, Duarte AAM, Silva-Filho AC, Dias CJ, Urtado CB, Ribeiro RM, Rigatto K, Rodrigues B, Dibai-Filho AV, Mostarda CT. Inspiratory muscle training improves autonomic modulation and exercise tolerance in chronic obstructive pulmonary disease subjects: A randomized-controlled trial. Respir Physiol Neurobiol 2019; 263:31-37. [DOI: 10.1016/j.resp.2019.03.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 03/01/2019] [Accepted: 03/07/2019] [Indexed: 01/19/2023]
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Grünig E, Eichstaedt C, Barberà JA, Benjamin N, Blanco I, Bossone E, Cittadini A, Coghlan G, Corris P, D'Alto M, D'Andrea A, Delcroix M, de Man F, Gaine S, Ghio S, Gibbs S, Gumbiene L, Howard LS, Johnson M, Jurevičienė E, Kiely DG, Kovacs G, MacKenzie A, Marra AM, McCaffrey N, McCaughey P, Naeije R, Olschewski H, Pepke-Zaba J, Reis A, Santos M, Saxer S, Tulloh RM, Ulrich S, Vonk Noordegraaf A, Peacock AJ. ERS statement on exercise training and rehabilitation in patients with severe chronic pulmonary hypertension. Eur Respir J 2018; 53:13993003.00332-2018. [DOI: 10.1183/13993003.00332-2018] [Citation(s) in RCA: 74] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Accepted: 09/12/2018] [Indexed: 12/17/2022]
Abstract
Objectives of this European Respiratory Society task force were to summarise current studies, to develop strategies for future research and to increase availability and awareness of exercise training for pulmonary hypertension (PH) patients.An evidence-based approach with clinical expertise of the task force members, based on both literature search and face-to-face meetings was conducted. The statement summarises current knowledge and open questions regarding clinical effects of exercise training in PH, training modalities, implementation strategies and pathophysiological mechanisms.In studies (784 PH patients in total, including six randomised controlled trials, three controlled trials, 10 prospective cohort studies and four meta-analyses), exercise training has been shown to improve exercise capacity, muscular function, quality of life and possibly right ventricular function and pulmonary haemodynamics. Nevertheless, further studies are needed to confirm these data, to investigate the impact on risk profiles and to identify the most advantageous training methodology and underlying pathophysiological mechanisms.As exercise training appears to be effective, cost-efficient and safe, but is scarcely reimbursed, support from healthcare institutions, commissioners of healthcare and research funding institutions is greatly needed. There is a strong need to establish specialised rehabilitation programmes for PH patients to enhance patient access to this treatment intervention.
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The elevation training mask induces modest hypoxaemia but does not affect heart rate variability during cycling in healthy adults. Biol Sport 2018; 36:105-112. [PMID: 31223186 PMCID: PMC6561228 DOI: 10.5114/biolsport.2019.79976] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Revised: 09/20/2018] [Accepted: 10/13/2018] [Indexed: 11/17/2022] Open
Abstract
This study examined the acute effects of the elevation training mask (ETM) on haemodynamics and heart rate variability (HRV) at rest, during cycling, and during recovery in healthy adults. Fifteen healthy male (N=9) and female (N=6) adults (27.0 ± 1.14 years) completed two trials with the mask (MASK) and without the mask (CON). The 40-minute cycling exercise protocol included 10-minute phases of (1) rest, (2) 50% of VO2peak cycling, (3) 70% of VO2peak cycling, and (4) recovery. Blood pressure and pulse oximetry saturation (SPO2) were measured at each phase. An Actiwave-Cardio ECG monitor (CamNtech, UK) was used to measure HRV variables including time and frequency domains. A greater response in systolic blood pressure (p=.035) was observed at rest while SPO2 (p=.033) was lower during high-intensity cycling (70% of VO2peak) in the MASK trial. The HRV indices were not different between trials during cycling. However, heart rate (p=.047) was greater while inter-beat interval and sympathovagal balance (the ratio between low-frequency and high-frequency components; ln LF/HF, p=.01) were lower in the MASK than the CON trials during recovery. Wearing an ETM during high-intensity cycling (70% of VO2peak) induces modest hypoxaemia. Although this device did not affect HRV changes during cycling, it seems to delay the cardiac-autonomic recovery from exercise. Healthy adults may be required to perform high-intensity exercise with an ETM to simulate a hypoxic environment, but future studies are needed to determine whether repeated exposure to this condition provides similar benefits as altitude training.
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Almeida LBD, Seixas MB, Trevizan PF, CamarotiLaterza M, Silva LPD, Martinez DG. Efeitos do treinamento muscular inspiratório no controle autonômico: revisão sistemática. FISIOTERAPIA E PESQUISA 2018. [DOI: 10.1590/1809-2950/17015425032018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
RESUMO A disfunção do sistema nervoso autônomo tem papel importante na fisiopatologia de diversas doenças. Uma possível maneira de melhorar o controle autonômico é o treinamento muscular inspiratório (TMI), sendo o objetivo deste estudo revisar sistematicamente a literatura disponível sobre os efeitos desta modalidade. Dois revisores buscaram ensaios clínicos controlados e randomizados nas bases de dados MEDLINE, PEDro, SciELO e LILACS, avaliando também sua qualidade metodológica (escala de PEDro). Foram encontrados 181 artigos e, após verificar os critérios de elegibilidade, foram incluídos quatro pesquisas que avaliaram o efeito do TMI sobre o controle autonômico de participantes com fatores de risco para doenças cardiovasculares, por meio da variabilidade da frequência cardíaca (VFC) e dos níveis plasmáticos de noradrenalina. O TMI melhorou o controle autonômico em três estudos, reduzindo a atividade nervosa simpática (níveis plasmáticos de noradrenalina; LF u.n. - VFC) e aumentando a atividade nervosa vagal (HF u.n. - VFC). Conclui-se que o TMI parece ser uma alternativa terapêutica para melhorar o controle autonômico.
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Elstad M, O’Callaghan EL, Smith AJ, Ben-Tal A, Ramchandra R. Cardiorespiratory interactions in humans and animals: rhythms for life. Am J Physiol Heart Circ Physiol 2018. [DOI: 10.1152/ajpheart.00701.2017] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
The cardiorespiratory system exhibits oscillations from a range of sources. One of the most studied oscillations is heart rate variability, which is thought to be beneficial and can serve as an index of a healthy cardiovascular system. Heart rate variability is dampened in many diseases including depression, autoimmune diseases, hypertension, and heart failure. Thus, understanding the interactions that lead to heart rate variability, and its physiological role, could help with prevention, diagnosis, and treatment of cardiovascular diseases. In this review, we consider three types of cardiorespiratory interactions: respiratory sinus arrhythmia (variability in heart rate at the frequency of breathing), cardioventilatory coupling (synchronization between the heart beat and the onset of inspiration), and respiratory stroke volume synchronization (the constant phase difference between the right and the left stroke volumes over one respiratory cycle). While the exact physiological role of these oscillations continues to be debated, the redundancies in the mechanisms responsible for its generation and its strong evolutionary conservation point to the importance of cardiorespiratory interactions. The putative mechanisms driving cardiorespiratory oscillations as well as the physiological significance of these oscillations will be reviewed. We suggest that cardiorespiratory interactions have the capacity to both dampen the variability in systemic blood flow as well as improve the efficiency of work done by the heart while maintaining physiological levels of arterial CO2. Given that reduction in variability is a prognostic indicator of disease, we argue that restoration of this variability via pharmaceutical or device-based approaches may be beneficial in prolonging life.
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Affiliation(s)
- Maja Elstad
- Division of Physiology, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - Erin L. O’Callaghan
- School of Physiology, Pharmacology and Neuroscience, University of Bristol, Bristol, United Kingdom
| | - Alex J. Smith
- School of Physiology, Pharmacology and Neuroscience, University of Bristol, Bristol, United Kingdom
| | - Alona Ben-Tal
- Institute of Natural and Mathematical Sciences, Massey University, Auckland, New Zealand
| | - Rohit Ramchandra
- Department of Physiology, The University of Auckland, Auckland, New Zealand
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Laoutaris ID. The ‘aerobic/resistance/inspiratory muscle training hypothesis in heart failure’. Eur J Prev Cardiol 2018; 25:1257-1262. [DOI: 10.1177/2047487318776097] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Evidence from large multicentre exercise intervention trials in heart failure patients, investigating both moderate continuous aerobic training and high intensity interval training, indicates that the ‘crème de la crème’ exercise programme for this population remains to be found. The ‘aerobic/resistance/inspiratory (ARIS) muscle training hypothesis in heart failure’ is introduced, suggesting that combined ARIS muscle training may result in maximal exercise pathophysiological and functional benefits in heart failure patients. The hypothesis is based on the decoding of the ‘skeletal muscle hypothesis in heart failure’ and on revision of experimental evidence to date showing that exercise and functional intolerance in heart failure patients are associated not only with reduced muscle endurance, indication for aerobic training (AT), but also with reduced muscle strength and decreased inspiratory muscle function contributing to weakness, dyspnoea, fatigue and low aerobic capacity, forming the grounds for the addition of both resistance training (RT) and inspiratory muscle training (IMT) to AT. The hypothesis will be tested by comparing all potential exercise combinations, ARIS, AT/RT, AT/IMT, AT, evaluating both functional and cardiac indices in a large sample of heart failure patients of New York Heart Association class II–III and left ventricular ejection fraction ≤35% ad hoc by the multicentre randomized clinical trial, Aerobic Resistance, InSpiratory Training OutcomeS in Heart Failure (ARISTOS-HF trial).
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Lage SM, Britto RR, Brandão DC, Pereira DAG, Andrade ADD, Parreira VF. Can diaphragmatic breathing modify chest wall volumes during inspiratory loaded breathing in patients with heart failure? Braz J Phys Ther 2018; 22:452-458. [PMID: 29752160 DOI: 10.1016/j.bjpt.2018.04.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Revised: 03/25/2018] [Accepted: 04/04/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Some inspiratory muscle training protocols for patients with heart failure report the request of diaphragmatic breathing during inspiratory loaded breathing. However, it is unclear whether this condition modifies the chest wall volumes. OBJECTIVE The primary purpose was to evaluate chest wall volumes during inspiratory loaded breathing as well as during inspiratory loaded breathing associated with diaphragmatic breathing in patients with heart failure. METHODS Sixteen men with heart failure functional class I to III, aged 50(SD=7) years were evaluated. Volumes of the pulmonary rib cage, abdominal rib cage and abdomen, as well as other breathing pattern variables, were assessed by optoelectronic plethysmography during quiet breathing, inspiratory loaded breathing, and inspiratory loaded breathing associated with diaphragmatic breathing. RESULTS Chest wall tidal volume significantly increased from quiet breathing 0.53(SD=0.14)L to inspiratory loaded breathing 1.33(SD=0.48)L and to inspiratory loaded breathing associated with diaphragmatic breathing 1.36(SD=0.48)L. A significant volume variation was observed on the three compartments (p<0.05 for all). During inspiratory loaded breathing associated with diaphragmatic breathing, patients showed increased abdominal volume compared to quiet breathing [0.28(SD=0.05) to 0.83(SD=0.47)L, p<0.001]; as well as from inspiratory loaded breathing [0.63(SD=0.23) to 0.83(SD=0.47)L, p=0.044]. No significant changes were observed between the two inspiratory loaded breathing conditions on the percentages of the contribution of each chest wall compartment for the tidal volume, respiratory rate, minute ventilation, and duty cycle. CONCLUSION When inspiratory loaded breathing was associated with diaphragmatic breathing, a higher volume in the abdominal compartment was obtained without significant changes in other breathing pattern variables.
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Affiliation(s)
- Susan Martins Lage
- Universidade Federal de Minas Gerais (UFMG), Rehabilitation Sciences Post Graduation Program, Belo Horizonte, MG, Brazil
| | - Raquel Rodrigues Britto
- Universidade Federal de Minas Gerais (UFMG), Department of Physical Therapy, Belo Horizonte, MG, Brazil
| | - Daniella Cunha Brandão
- Universidade Federal de Pernambuco (UFPE), Department of Physical Therapy, Recife, PE, Brazil
| | | | | | - Verônica Franco Parreira
- Universidade Federal de Minas Gerais (UFMG), Department of Physical Therapy, Belo Horizonte, MG, Brazil.
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Jaenisch RB, Stefani GP, Durante C, Chechi C, Hentschke VS, Rossato DD, Sonza A, Rhoden CR, Dal Lago P. Respiratory muscle training decreases diaphragm DNA damage in rats with heart failure. Can J Physiol Pharmacol 2018; 96:221-226. [DOI: 10.1139/cjpp-2017-0069] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Respiratory muscle training (RMT) promotes beneficial effects on respiratory mechanics, heart and lung morphological changes, and hemodynamic variables in rats with heart failure (HF). However, the relation between RMT effects and diaphragm oxidative stress remains unclear. Therefore, the aim of this study was to evaluate the RMT effects on diaphragm DNA damage in HF rats. Wistar rats were allocated into 4 groups: sedentary sham (Sed-Sham, n = 8), trained sham (RMT-Sham, n = 8), sedentary HF (Sed-HF, n = 8), and trained HF (RMT-HF, n = 8). The animals underwent a RMT protocol (30 min/day, 5 days/week for 6 weeks), whereas sedentary animals did not exercise. Groups were compared by a two-way ANOVA and Tukey’s post hoc tests. In rats with HF, RMT promoted reduction in pulmonary congestion (p < 0.0001) and left ventricular end diastolic pressure (p < 0.0001). Moreover, RMT produced a decrease in the diaphragm DNA damage in HF rats. This was demonstrated through the reduction in the percentage of tail DNA (p < 0.0001), tail moment (p < 0.01), and Olive tail moment (p < 0.001). These findings showed that a 6-week RMT protocol in rats with HF promoted an improvement in hemodynamic function and reduces diaphragm DNA damage.
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Affiliation(s)
- Rodrigo B. Jaenisch
- Laboratory of Experimental Physiology, Post Graduation Program in Health Sciences, Federal University of Health Sciences of Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
- Federal University of Santa Maria, Santa Maria, Rio Grande do Sul, Brazil
| | - Giuseppe P. Stefani
- Laboratory of Experimental Physiology, Post Graduation Program in Health Sciences, Federal University of Health Sciences of Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
| | - Camila Durante
- Laboratory of Experimental Physiology, Post Graduation Program in Health Sciences, Federal University of Health Sciences of Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
| | - Chalyne Chechi
- Laboratory of Experimental Physiology, Post Graduation Program in Health Sciences, Federal University of Health Sciences of Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
| | - Vítor S. Hentschke
- Laboratory of Experimental Physiology, Post Graduation Program in Health Sciences, Federal University of Health Sciences of Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
| | - Douglas D. Rossato
- Laboratory of Experimental Physiology, Post Graduation Program in Health Sciences, Federal University of Health Sciences of Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
| | - Anelise Sonza
- Physical Therapy Department, Santa Catarina State University, Florianópolis, Santa Catarina, Brazil
- Post Graduation Program in Rehabilitation Sciences, Federal University of Health Sciences of Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
| | - Cláudia R. Rhoden
- Laboratory of Atmospheric Pollution and Oxidative Stress, Federal University of Health Sciences of Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
| | - Pedro Dal Lago
- Laboratory of Experimental Physiology, Post Graduation Program in Health Sciences, Federal University of Health Sciences of Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
- Post Graduation Program in Rehabilitation Sciences, Federal University of Health Sciences of Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
- Physical Therapy Department, Federal University of Health Sciences of Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
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44
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Wu J, Kuang L, Fu L. Effects of inspiratory muscle training in chronic heart failure patients: A systematic review and meta-analysis. CONGENIT HEART DIS 2018; 13:194-202. [PMID: 29423938 DOI: 10.1111/chd.12586] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Revised: 12/10/2017] [Accepted: 12/26/2017] [Indexed: 12/12/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the effects of inspiratory muscle training (IMT) in chronic heart failure (CHF) patients. DESIGN We searched MEDLINE, EMBASE, Cochrane Library, CINHAL, and CBMdisc to collect controlled trials on the application of inspiratory muscle training in CHF patients from the establishment of these databases to November 2016. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data, and assessed the quality of literature. Meta-analysis was conducted by software RevMan5.3. RESULTS Eight studies involving 302 patients were identified. Meta-analysis indicated that IMT significantly improved PImax , VE /VCO2 slope and dyspnea (weighted mean difference [WMD] = 16.52, 95% CI: 13.87-19.17, P < .01; WMD = -5.78, 95% CI: -7.72 to -3.85, P < .01; SMD = -0.95, 95% CI: -1.5 to -0.39, P < .01), and descriptive results showed that long-term IMT (≥6 weeks) can improve the quality of life of CHF patients, and patients in IMT group also have a significant improvement in 6-minute walking distance test (6-MWD). CONCLUSION IMT can improve pulmonary function, exercise tolerance, and quality of life of CHF patients and relieve the symptom of dyspnea.
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Affiliation(s)
- Jing Wu
- Shanghai Jiao Tong University School of Nursing, Shanghai, People's Republic of China
| | - Li Kuang
- Shanghai Jiao Tong University School of Nursing, Shanghai, People's Republic of China
| | - Lijuan Fu
- Department of Cardiothoracic Surgery, Shanghai Children's Medical Center Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
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45
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DeLucia CM, De Asis RM, Bailey EF. Daily inspiratory muscle training lowers blood pressure and vascular resistance in healthy men and women. Exp Physiol 2018; 103:201-211. [PMID: 29178489 DOI: 10.1113/ep086641] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Accepted: 11/21/2017] [Indexed: 01/14/2023]
Abstract
NEW FINDINGS What is the central question of this study? What impact does inspiratory muscle training have on systemic vascular resistance, cardiac output and baroreflex sensitivity in adult men and women? What is the main finding and its importance? Inspiratory muscle training exerts favorable effects on blood pressure, vascular resistance and perception of stress. This exercise format is well-tolerated and equally effective whether implemented in men or women. ABSTRACT Previous work has shown that inspiratory muscle training (IMT) lowers blood pressure after a mere 6 weeks, identifying IMT as a potential therapeutic intervention to prevent or treat hypertension. Here, we explore the effects of IMT on respiratory muscle strength and select cardiovascular parameters in recreationally active men and women. Subjects were randomly assigned to IMT (n = 12, 75% maximal inspiratory pressure) or sham training (n = 13, 15% maximal inspiratory pressure) groups and underwent a 6-week intervention comprising 30 breaths day-1 , 5 days week-1 . Pre- and post-training measures included maximal inspiratory pressure and resting measures of blood pressure, cardiac output, heart rate, spontaneous cardiac baroreflex sensitivity and systemic vascular resistance. We evaluated psychological and sleep status via administration of the Cohen-Hoberman inventory of physical symptoms and the Epworth sleepiness scale. Male and female subjects in the IMT group showed declines in systolic/diastolic blood pressures (-4.3/-3.9 mmHg, P < 0.025) and systemic vascular resistance (-3.5 mmHg min l-1 , P = 0.008) at week 6. There was no effect of IMT on cardiac output (P = 0.722), heart rate (P = 0.795) or spontaneous cardiac baroreflex sensitivity (P = 0.776). The IMT subjects also reported fewer stress-related symptoms (pre- versus post-training, 12.5 ± 8.5 versus 7.2 ± 9.7, P = 0.025). Based on these results, we suggest that a short course of IMT confers significant respiratory and cardiovascular improvements and parallel (modest) psychological benefits in healthy men and women.
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Affiliation(s)
- Claire M DeLucia
- Department of Physiology, College of Medicine, University of Arizona, Tucson, AZ, USA
| | - Roxanne M De Asis
- Department of Physiology, College of Medicine, University of Arizona, Tucson, AZ, USA
| | - E Fiona Bailey
- Department of Physiology, College of Medicine, University of Arizona, Tucson, AZ, USA
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46
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Wu FM, Opotowsky AR, Denhoff ER, Gongwer R, Gurvitz MZ, Landzberg MJ, Shafer KM, Valente AM, Uluer AZ, Rhodes J. A Pilot Study of Inspiratory Muscle Training to Improve Exercise Capacity in Patients with Fontan Physiology. Semin Thorac Cardiovasc Surg 2018; 30:462-469. [DOI: 10.1053/j.semtcvs.2018.07.014] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Accepted: 07/24/2018] [Indexed: 11/11/2022]
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47
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Exercise therapy and autonomic function in heart failure patients: a systematic review and meta-analysis. Heart Fail Rev 2017; 23:91-108. [DOI: 10.1007/s10741-017-9662-z] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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48
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de Abreu RM, Rehder-Santos P, Minatel V, Dos Santos GL, Catai AM. Effects of inspiratory muscle training on cardiovascular autonomic control: A systematic review. Auton Neurosci 2017; 208:29-35. [PMID: 28916152 DOI: 10.1016/j.autneu.2017.09.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Revised: 08/24/2017] [Accepted: 09/05/2017] [Indexed: 11/26/2022]
Abstract
PURPOSE To carry out a systematic review to determine if inspiratory muscle training (IMT) promotes changes in cardiovascular autonomic responses in humans. METHODS The methodology followed the PRISMA statement for reporting systematic review analysis. MEDLINE, PEDro, SCOPUS and PubMed electronic databases were searched from the inception to March 2017. The quality assessment was performed using a PEDro scale. The articles were included if: (1) primary objective was related to the effects of IMT on the cardiovascular autonomic nervous system, and (2) randomized clinical trials and quasi-experimental studies. Exclusion criteria were reviews, short communications, letters, case studies, guidelines, theses, dissertations, qualitative studies, scientific conference abstracts, studies on animals, non-English language articles and articles addressing other breathing techniques. Outcomes evaluated were measures of cardiovascular autonomic control, represented by heart rate variability (HRV) and blood pressure variability (BPV) indexes. RESULTS The search identified 729 citations and a total of 6 studies were included. The results demonstrated that IMT performed at low intensities can chronically promote an increase in the parasympathetic modulation and/or reduction of sympathetic cardiac modulation in patients with diabetes, hypertension, chronic heart failure and gastroesophageal reflux, when assessed by HRV spectral analysis. However, there was no study which evaluated the effects of IMT on cardiovascular autonomic control assessed by BPV. CONCLUSIONS IMT can promote benefits for cardiac autonomic control, however the heterogeneity of populations associated with different protocols, few studies reported in the literature and the lack of randomized controlled trials make the effects of IMT on cardiovascular autonomic control inconclusive.
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Affiliation(s)
- Raphael Martins de Abreu
- Cardiovascular Physical Therapy Laboratory, Department of Physical Therapy, Federal University of São Carlos, São Carlos, São Paulo, Brazil
| | - Patrícia Rehder-Santos
- Cardiovascular Physical Therapy Laboratory, Department of Physical Therapy, Federal University of São Carlos, São Carlos, São Paulo, Brazil
| | - Vinicius Minatel
- Cardiovascular Physical Therapy Laboratory, Department of Physical Therapy, Federal University of São Carlos, São Carlos, São Paulo, Brazil
| | - Gabriela Lopes Dos Santos
- Laboratory of Neurological Physiotherapy Research, Department of Physical Therapy, Federal University of São Carlos, São Carlos, São Paulo, Brazil
| | - Aparecida Maria Catai
- Cardiovascular Physical Therapy Laboratory, Department of Physical Therapy, Federal University of São Carlos, São Carlos, São Paulo, Brazil.
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49
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Laohachai K, Winlaw D, Selvadurai H, Gnanappa GK, d'Udekem Y, Celermajer D, Ayer J. Inspiratory Muscle Training Is Associated With Improved Inspiratory Muscle Strength, Resting Cardiac Output, and the Ventilatory Efficiency of Exercise in Patients With a Fontan Circulation. J Am Heart Assoc 2017; 6:JAHA.117.005750. [PMID: 28862962 PMCID: PMC5586429 DOI: 10.1161/jaha.117.005750] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Patients with a Fontan circulation have reduced exercise capacity and respiratory muscle strength. Inspiratory muscle training (IMT) improves exercise capacity and quality of life in adults with heart failure. We assessed whether 6 weeks of a home-based program of IMT improves inspiratory muscle strength and the ventilatory efficiency of exercise in adolescent patients with a Fontan circulation. METHODS AND RESULTS Twenty-three adolescent participants (aged 16±2 years) with a Fontan circulation underwent 6 weeks of IMT for 30 minutes daily. Respiratory muscle strength (maximal inspiratory pressure and expiratory pressure), lung function, and exercise capacity (cardiopulmonary exercise testing) were assessed. Fourteen of 23 participants also underwent exercise cardiac magnetic resonance imaging to examine the effects of IMT on cardiac output and systemic and pulmonary blood flow. Six weeks of IMT improved maximal inspiratory pressure by 36±24 cm H2O (61±46%) with no change in maximal expiratory pressure. Ventilatory efficiency of exercise improved after 6 weeks of IMT (from 34.2±7.8 to 32.2±5.6, P=0.04). In those who underwent exercise cardiac magnetic resonance imaging, IMT increased resting cardiac output (from 4.2±1.2 to 4.5±1.0 L/min, P=0.03) and ejection fraction (from 50.1±4.3 to 52.8±6.1%, P=0.03). CONCLUSIONS Six weeks of IMT is associated with improved inspiratory muscle strength, ventilatory efficiency of exercise, and resting cardiac output in young Fontan patients. IMT may be a simple beneficial addition to the current management of Fontan patients, potentially reducing exercise intolerance and long-term morbidity and mortality.
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Affiliation(s)
- Karina Laohachai
- The Children's Hospital at Westmead, Sydney, NSW, Australia .,The University of Sydney, Sydney, NSW, Australia
| | - David Winlaw
- The Children's Hospital at Westmead, Sydney, NSW, Australia.,The University of Sydney, Sydney, NSW, Australia
| | - Hiran Selvadurai
- The Children's Hospital at Westmead, Sydney, NSW, Australia.,The University of Sydney, Sydney, NSW, Australia
| | | | - Yves d'Udekem
- The Royal Children's Hospital, Melbourne, Vic., Australia.,Murdoch Children's Research Institute, Melbourne, Vic., Australia
| | - David Celermajer
- The University of Sydney, Sydney, NSW, Australia.,The Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Julian Ayer
- The Children's Hospital at Westmead, Sydney, NSW, Australia.,The University of Sydney, Sydney, NSW, Australia
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50
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Feriani DJ, Coelho HJ, Scapini KB, de Moraes OA, Mostarda C, Ruberti OM, Uchida MC, Caperuto ÉC, Irigoyen MC, Rodrigues B. Effects of inspiratory muscle exercise in the pulmonary function, autonomic modulation, and hemodynamic variables in older women with metabolic syndrome. J Exerc Rehabil 2017; 13:218-226. [PMID: 28503537 PMCID: PMC5412498 DOI: 10.12965/jer.1734896.448] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2017] [Accepted: 03/15/2017] [Indexed: 12/22/2022] Open
Abstract
The aim of the present study was to investigate the effects of inspiratory muscle exercise (IME) on metabolic and hemodynamic parameters, cardiac autonomic modulation and respiratory function of older women with metabolic syndrome (MS). For this, sixteen older women with MS and 12 aged-matched controls participated of the present study. Two days before and 2 days after the main experiment, fasting blood samples (i.e., total cholesterol, triglycerides and blood glucose), cardiac autonomic modulation (i.e., heart rate variability), and respiratory muscle function were obtained and evaluated. The sessions of physical exercise was based on a IME, which was performed during 7 days. Each session of IME was performed during 20 min, at 30% of maximal static inspiratory pressure. In the results, MS group presented higher levels of triglycerides, blood glucose, and systolic blood pressure when compared to control group. IME was not able to change these variables. However, although MS group showed impaired respiratory muscle strength and function, as well as cardiac autonomic modulation, IME was able to improve these parameters. Thus, the data showed that seven days of IME are capable to improve respiratory function and cardiac autonomic modulation of older women with MS. These results indicate that IME can be a profitable therapy to counteracting the clinical markers of MS, once repeated sessions of acute IME can cause chronical alterations on respiratory function and cardiac autonomic modulation.
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Affiliation(s)
- Daniele Jardim Feriani
- Faculty of Physical Education, University of Campinas (UNICAMP), Campinas, Brazil.,Human Movement Laboratory, Sao Judas Tadeu University (USJT), São Paulo, Brazil
| | - Hélio José Coelho
- Faculty of Physical Education, University of Campinas (UNICAMP), Campinas, Brazil
| | - Kátia Bilhar Scapini
- Hypertension Unit, Heart Institute (InCor), Medical School of University of Sao Paulo, São Paulo, Brazil
| | | | | | | | - Marco Carlos Uchida
- Faculty of Physical Education, University of Campinas (UNICAMP), Campinas, Brazil
| | | | - Maria Cláudia Irigoyen
- Hypertension Unit, Heart Institute (InCor), Medical School of University of Sao Paulo, São Paulo, Brazil
| | - Bruno Rodrigues
- Faculty of Physical Education, University of Campinas (UNICAMP), Campinas, Brazil
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