The Effect of Habitual Exercise on Respiratory-Muscle Function in Older Adults

Respiratory Muscle Strength Is Related to Handgrip Performance in Community-Dwelling Persons Aged 80+ from the BUTTERFLY Study

INTRODUCTION

This study aimed to evaluate the association of respiratory muscle strength with sarcopenia and its indicators in the oldest old.

METHODS

Maximum inspiratory pressure (MIP), maximum expiratory pressure (MEP), and sarcopenia-related factors (handgrip strength and appendicular lean mass) were evaluated in a cohort of n = 286 (45.5% female) non-frail, community-dwelling persons aged 83.6 ± 3.0 years (age range 80-97 years).

RESULTS

The sample presented a sarcopenia prevalence of 32.2%. Sarcopenic subjects showed comparable MIP and MEP as non-sarcopenic ones (female: MIP 43.9 ± 18.9 vs. 50.3 ± 19.5, p = 0.053; MEP 63.0 ± 23.0 vs. 69.2 ± 19.1, p = 0.067; male: MIP, 65.1 ± 24.4 vs. 64.4 ± 23.9, p = 0.433; MEP 87.7 ± 33.3 vs. 93.8 ± 30.9, p = 0.124). Statistically significant but very low associations were found between grip strength and MIP (r = 0.193 for male, p < 0.05 and r = 0.257 for female participants, p < 0.01) and MEP (r = 0.200 for male, p < 0.01 and r = 0.191 for female participants, p < 0.05). Lean mass was significantly correlated to MIP and MEP in female (r = 0.253, p < 0.01 and r = 0.343, p < 0.01, respectively), whereas this association was not found in male participants. Grip strength was the only statistically significant predictor of MEP (r2 = 0.212, p < 0.001), while MIP was independently predicted by age, male sex, and grip strength (r2 = 0.177, p < 0.001).

CONCLUSIONS

Peripheral muscle strength is a statistically significant, albeit weak predictor for respiratory muscle strength in well-functioning, community-dwelling persons aged 80+. When confronted to a low grip strength, one should be aware of concomitant respiratory muscle weakness, as this is a known risk factor for atelectasis and pneumonia. Given the relatively low association with handgrip strength, respiratory muscle strength testing might be indicated.

Association between CT-Measured Abdominal Skeletal Muscle Mass and Pulmonary Function

A relationship between lung function and sarcopenia has been suggested. This study aimed to evaluate the association between lung function and abdominal skeletal muscle mass, as measured by computed tomography (CT). The clinical records of 1907 subjects (1406 males, mean age 53.1 ± 9.2 years), who underwent routine health check-ups, including spirometry and abdominal CT, were retrospectively reviewed. The CT-measured skeletal muscle index (SMI_CT, cm²/(kg/m²) was defined as the skeletal muscle area of the third lumbar vertebrae (L3) level that is normalized by the body mass index. The mean values of forced vital capacity (FVC) and forced expiratory volume in one second (FEV1) gradually increased as the SMI_CT quartiles increased (all p for trend < 0.05). The proportions of subjects with less than 80% of the predicted FVC (%) and predicted FEV1 (%) significantly decreased as the SMI_CT quartiles increased (all p for trend < 0.05). The β regression coefficients for FVC and FEV1 significantly increased as the SMI_CT quartiles increased after adjusting for other confounding variables (p for trend < 0.05). This study showed that abdominal muscle mass, which was precisely measured by CT, independently affected lung function proportionally after adjusting for confounding factors in relatively healthy adults.

Fonoterapia vocal e fisioterapia respiratória com idosos saudáveis: revisão de literatura

RESUMO Este estudo tem como tema a fonoterapia vocal e a fisioterapia respiratória no idoso saudável. O objetivo do presente estudo foi revisar a literatura sobre fonoterapia vocal e sobre fisioterapia respiratória com idosos saudáveis. Foi realizado um levantamento bibliográfico de artigos publicados entre 2004 e 2014 nas bases de dados Lilacs, Bireme, MedLine, PubMed e Scielo. Descritores utilizados: physical therapy specialty; breathing; speech therapy; aged; therapeutics e voice. A literatura sobre fonoterapia vocal com idosos saudáveis mostrou que as intervenções têm sido feitas por meio de orientação vocal; terapia vocal tradicional para presbifonia, independente do tipo de intervenção; exercícios vocais específicos; e programas terapêuticos padronizados, havendo evidências de melhora de medidas vocais perceptivoauditivas, acústicas, de autoavaliação vocal e de imagem laríngea. Quanto à fisioterapia respiratória, a literatura evidenciou que as técnicas ou procedimentos utilizados com idosos saudáveis foram: uso do aparelho Threshold, técnicas de terapia manual, espirometria de incentivo, exercícios respiratórios associados ao movimento do tronco e membros inferiores e atividade física em geral, apresentando evidências de melhora na força muscular respiratória, função pulmonar e autonomia funcional dos idosos.

Relation between hand grip strength, respiratory muscle strength and spirometric measures in male nursing home residents

Adverse-outcomes related to sarcopenia are mostly mentioned as physical disability. As the other skeletal muscles, respiratory muscles may also be affected by sarcopenia. Respiratory muscle strength is known to affect pulmonary functions. Therefore, we aimed to investigate the relations between extremity muscle strength, respiratory muscle strengths and spirometric measures in a group of male nursing home residents. Among a total of 104 male residents, residents with obstructive measures were excluded and final study population was composed of 62 residents. Mean age was 70.5 ± 6.7 years, body mass index: 27.7 ± 5.3 kg/m2 and dominant hand grip strength: 29.7 ± 6.5 kg. Hand grip strength was positively correlated with maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP) (r = 0.35, p < 0.01 and r = 0.26, p < 0.05, respectively). In regression analysis, the only factor related to MIP was hand grip strength; among spirometric measures only parameter significantly related to grip strength was peak cough flow (PCF). The association of PCF with grip strength disappeared when MIP alone or "MIP and MEP" were included in the regression analysis. In the latter case, PCF was significantly associated only with MIP. We found peripheric muscle strength be associated with MIP and PCF but not with MEP or any other spirometric parameters. The relation between peripheral muscle strength and PCF was mediated by MIP. Our findings suggest that sarcopenia may affect inspiratory muscle strength earlier or more than the expiratory muscle strength. Sarcopenia may cause decrease in PCF in the elderly, which may stand for some common adverse respiratory complications.

Efeitos de exercícios do método Pilates na força muscular respiratória de idosas: um ensaio clínico

INTRODUÇÃO: Dentre os sistemas do organismo, acredita-se que o respiratório seja o que envelhece mais rapidamente, devido à maior exposição a poluentes ambientais ao longo dos anos. O método Pilates surge como forma de condicionamento físico particularmente interessado em proporcionar bem-estar geral ao indivíduo. OBJETIVO: Avaliar os efeitos de exercícios do método Pilates na força muscular respiratória de idosas antes e após 11 semanas de treinamento. Métodos: Trata-se de ensaio clínico, longitudinal e prospectivo. Foram selecionadas sete mulheres com idade igual e superior a 60 anos e com autonomia cognitiva preservada. A Prova de Função Pulmonar (Espirometria) foi realizada por meio do espirômetro marca Vitalograph(r) modelo 8600. A força muscular respiratória foi obtida pelas técnicas de medidas da pressão inspiratória máxima e pressão expiratória máxima, por meio de um manovacuômetro analógico da marca Gerar. O período experimental foi de 11 semanas. Para a análise comparativa dos dados obtidos nas avaliações, foi aplicado o teste t pareado e nível de significância de 5%. RESULTADOS: Os resultados do estudo mostraram aumento significativo (p≤0,01) em relação à pressão expiratória máxima de 46±18 para 75±29 cmH2O. CONCLUSÃO: Os resultados apresentaram aumento significativo na pressão expiratória máxima, sendo o método Pilates uma das práticas recomendadas à população idosa.

Physical activity and respiratory muscle strength in elderly: a systematic review

Introduction The aging will inevitably bring some kind of functional decline in elderly, sarcopenia in this sense stands out because it damages the muscle function and extend also to the respiratory muscles. Objective Systematically review studies that have sought to compare the strength of respiratory muscles between sedentary and physically active elderly in training programs nonspecific respiratory musculature. Materials and methods From the descriptors motor activity, respiratory muscles and elderly, the databases LILACS, MedLine, Cochrane, PEDro, Scirus and Redalyc were consulted. Results Of 1.263 experiments available in said databases, 12 were recovered and 6 were selected due they meet all the inclusion criteria and selection requirements. Conclusion Physical activity programs offered by the selected studies led physically active elderly to have respiratory muscle strength statistically higher than the sedentary. However, this condition did not expressed itself as security to these elderly to present strength levels above of the minimum predictive of normality.

Efeitos da estimulação diafragmática elétrica transcutânea na função pulmonar em idosos

INTRODUÇÃO: O envelhecimento promove mudanças em diversos sistemas orgânicos, inclusive no respiratório, evidenciando alterações nos centros reguladores da ventilação, nos quimiorreceptores, na densidade óssea da caixa torácica, além de diminuição da força dos músculos inspiratórios. OBJETIVO: Avaliar o efeito de um programa de treinamento específico da musculatura respiratória por meio da estimulação diafragmática elétrica transcutânea (EDET) sobre a função pulmonar de idosos. MÉTODO: 21 idosos foram divididos em dois grupos: controle (GC), composto por sete indivíduos com idade de 69,86±3,48 anos, e grupo EDET (EDET), composto por 14 voluntários com idade de 71,36±4,73 anos, submetidos ao treinamento com EDET durante duas semanas. Avaliaram-se os volumes e capacidades pulmonares, como volume corrente (VC), volume minuto (VM), capacidade inspiratória (CI) e capacidade vital (CV) por meio da ventilometria e a força da musculatura respiratória antes da primeira e após a décima sessão, por meio da avaliação das pressões respiratórias máximas. Utilizaram-se os testes de Wilcoxon e Mann-Whitney para as devidas comparações estatísticas, sendo adotado um nível de significância de 5%. RESULTADOS: O grupo EDET apresentou incremento na pressão inspiratória máxima (PImáx), na pressão expiratória máxima (PEmáx) e no volume corrente (VC) após o treinamento. CONCLUSÃO: O treinamento muscular mediante utilização da EDET promoveu melhora da força muscular respiratória e do volume corrente. Registro de ensaio clínico: RBR-5dmpkr.

Aquatic therapy: scientific foundations and clinical rehabilitation applications

The aquatic environment has broad rehabilitative potential, extending from the treatment of acute injuries through health maintenance in the face of chronic diseases, yet it remains an underused modality. There is an extensive research base supporting aquatic therapy, both within the basic science literature and clinical literature. This article describes the many physiologic changes that occur during immersion as applied to a range of common rehabilitative issues and problems. Because of its wide margin of therapeutic safety and clinical adaptability, aquatic therapy is a very useful tool in the rehabilitative toolbox. Through a better understanding of the applied physiology, the practitioner may structure appropriate therapeutic programs for a diverse patient population.

The effects of respiratory-muscle training on exercise in older women

This research examined the effects of respiratory-muscle (RM) training on RM function and exercise performance in older women. Twenty-six women (60-69 yr of age) were assessed for spirometry, RM strength (maximal inspiratory and expiratory pressure), inspiratory-muscle endurance, and walking performance to a perceived exertion rating of "hard." They were randomly allocated to a threshold RM training group (RMT) or a nonexercising control group (CON) for 8 wk.After training, the 22% (inspiratory) and 30% (expiratory) improvements in RM strength in the RMT group were significantly higher than in the CON group (p < .05). The RMT group also displayed several significant performance improvements, including improved within-group treadmill performance time (12%) and reductions in submaximal heart rate (5%), percentage of maximum voluntary ventilation (16%), and perceived exertion for breathing (8%). RM training appears to improve RM function in older women. Furthermore, these improvements appear to be related to improved submaximal exercise performance.

The effects of ageing on respiratory muscle function and performance in older adults

The reduced physiological capacity evident with ageing may affect the ability to perform many tasks, potentially affecting quality of life. Previous research has clearly demonstrated the reduced capacity of the respiratory system with ageing and described the effect that habitual physical activity has upon this decline. This research aimed to examine the influence of age on respiratory muscle (RM) function and the relationship between RM function and physical performance within the Australian population. Seventy-two healthy older adults (50-79 years) were divided into males (n=36) and females (n=36) and examined for pulmonary function, RM strength, inspiratory muscle endurance (IME) and 1.6 km walking performance. There were no significant age by gender effects for any variables; however, ageing was significantly related to reduced RM function and walking capacity within each gender. Furthermore, regression analysis showed that the RM strength could be predicted from age. Partial correlations controlling for age indicated that expiratory muscle strength was significantly related to walking performance in males (p=0.04), whilst IME contributed significantly to walking performance in all participants. These within-gender effects and relationships indicate that RM strength is an important physiological variable to maintain in the older population, as it may be related to functional ability.