Inspiratory training increases insulin sensitivity in elderly patients

Effects of respiratory muscle training on parasympathetic activity in diabetes mellitus

This study verified the effects of respiratory muscle training (RMT) on hemodynamics, heart rate (HR) variability, and muscle morphology in rats with streptozotocin-induced diabetes mellitus (DM). Thirty-six male Wistar rats were randomized into 4 groups and 34 completed the study: i) sham-sedentary (Sham-ST; n=9); ii) sham-RMT (Sham-RMT; n=9); iii) DM-sedentary (DM-ST; n=8); and iv) DM-RMT (DM-RMT; n=8). Hemodynamics were assessed by central cannulation, and R-R intervals were measured by electrocardiogram. In addition, the effects of RMT on the cross-sectional area of the diaphragm, anterior tibial, and soleus muscles were analyzed. The induction of DM by streptozotocin resulted in weight loss, hyperglycemia, reduced blood pressure, and attenuated left ventricular contraction and relaxation (P<0.05). We also observed a decrease in root mean square of successive differences between adjacent RR intervals (RMSSD) index and in the cross-sectional area of the muscles assessed, specifically the diaphragm, soleus, and anterior tibial muscles in diabetic rats (P<0.05). Interestingly, RMT led to an increase in RMSSD in rats with DM (P<0.05). The induction of DM produced profound deleterious changes in the diaphragmatic and peripheral muscles, as well as impairments in cardiovascular hemodynamics and autonomic control. Nevertheless, RMT may beneficially attenuate autonomic changes and improve parasympathetic modulation.

Effect of inspiratory muscle training on respiratory muscle strength and functional capacity in patients with type 2 diabetes mellitus: A randomized clinical trial

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.

Comparison between Two Inspiratory Muscle Training Protocols, Low Loads versus High Loads, in Institutionalized Elderly Women: A Double-Blind Randomized Controlled Trial

BACKGROUND

Aging results in a decline in the function of the respiratory muscles. Inspiratory muscle training is presented as a possible solution to attenuate the loss of respiratory function in the elderly. The objective of the study was to evaluate and compare the efficacy of 2 protocols with inspiratory muscle training (IMT), low loads and high loads, to improve respiratory strength, functional capacity and dyspnea in institutionalized elderly women, over 65 years.

METHODS

The study was a controlled, randomized, double-blind trial and with allocation concealment performed on 26 institutionalized elderly women distributed in 2 groups, the high-intensity group (HIG) and low-intensity group (LIG). Over an 8-week period an IMT protocol was followed 5 days/week, 15 min/day. The HIG trained with a load of 40% of the maximum inspiratory pressure (MIP) and the LIG with 20%. MIP, maximum expiratory pressure (MEP), functional capacity and dyspnea were evaluated.

RESULTS

After training, in the HIG MIP, MEP and functional capacity increased 52, 16 and 7%, respectively (p = 0.000, p = 0.001, p = 0.001) and in the LIG 30, 18 and 9%, respectively (p = 0.002, p = 0.014, p = 0.001). The improvement in MIP was significantly higher in the HIG than in the LIG (p = 0.042).

CONCLUSION

IMT with low and high loads improves respiratory muscle strength and functional capacity in institutionalized elderly women. In addition, high loads were significantly more effective to improve MIP.

Effects of incentive spirometry on cardiopulmonary parameters, functional capacity and glycemic control in patients with Type 2 diabetes

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.

Inspiratory Muscle Training on Glucose Control in Diabetes: A Randomized Clinical Trial

This study evaluated the effects of inspiratory muscle training (IMT) in glucose control and respiratory muscle function in patients with diabetes. It was a randomized clinical trial conducted at the Physiopathology Laboratory of the Hospital de Clínicas de Porto Alegre. Patients with Type 2 diabetes were randomly assigned to IMT or placebo-IMT (P-IMT), performed at 30% and 2% of maximal inspiratory pressure, respectively, every day for 12 weeks. The main outcome measures were HbA1c, glycemia, and respiratory muscle function. Thirty patients were included: 73.3% women, 59.6 ± 10.7 years old, HbA1c 8.7 ± 0.9% (71.6 ± 9.8 mmol/mol), and glycemia 181.8 ± 57.8 mg/dl (10.5 ± 3.2 mmol/L). At the end of the training, HbA1c was 8.2 ±0.3% (66.1 ± 3.3 mmol/mol) and 8.7 ± 0.3% (71.6 ± 3.3 mmol/mol) for the IMT and P-IMT groups, respectively (p = .8). Fasting glycemia decreased in both groups with no difference after training although it was lower in IMT at 8 weeks: 170.0 ± 11.4 mg/dl(9.4 ± 0.6 mmol/L) and 184.4 ± 15.0 mg/dl (10.2 ± 0.8 mmol/L) for IMT and P-IMT, respectively (p < .05). Respiratory endurance time improved in the IMT group (baseline = 325.9 ± 51.1 s and 305.0 ± 37.8 s; after 12 weeks = 441.1 ± 61.7 s and 250.7 ± 39.0 s for the IMT and P-IMT groups, respectively; p < .05). Considering that glucose control did not improve, IMT should not be used as an alternative to other types of exercise in diabetes. Higher exercise intensities or longer training periods might produce better results. The clinical trials identifier is NCT03191435.

Effects of inspiratory muscle exercise in the pulmonary function, autonomic modulation, and hemodynamic variables in older women with metabolic syndrome

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.