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Basha MA, Azab AR, Elnaggar RK, Aboelnour NH, Kamel NM, Aloraini SM, Kamel FH. Inspiratory muscle training impact on respiratory muscle strength, pulmonary function, and quality of life in children with chest burn: A randomized controlled trial. Burns 2024; 50:1916-1924. [PMID: 38782684 DOI: 10.1016/j.burns.2024.05.007] [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: 09/29/2023] [Revised: 03/10/2024] [Accepted: 05/02/2024] [Indexed: 05/25/2024]
Abstract
PURPOSE Respiratory muscle function is compromised in children recovering from chest wall burns, which potentially leads to more impact on exercise capacity and quality of life. This study investigates the effects of an inspiratory muscle training intervention accompanied with a pulmonary rehabilitation program on respiratory muscle strength, lung function, functional capacity, and quality of life in chest burned children. METHODS Forty children with burns, aged from 10 to 18 years old and total body surface area of 30% to 50%, were randomly allocated to the inspiratory muscle training group (IMT- G: n = 20) or control group (CG: n = 20). They received IMT plus pulmonary rehabilitation or pulmonary rehabilitation with sham IMT, respectively for eight weeks. The outcomes were the respiratory muscle strength measured by maximum inspiratory pressure (MIP) and maximum expiratory pressure (MEP); lung functions (FEV1, FVC and FEV1/FVC ratio); functional capacity as well as Pediatric Quality of Life to measure physical and psychosocial functioning. outcome measures were assessed at before and after intervention (after eight weeks). RESULTS Based on the pre-intervention assessments, we found no significant difference between both groups (p > 0.05). Significant post-intervention differences were reported between both groups in MIP (P = .003), MEP (P = .017), FVC (P = .001), FEV1 (P = .007), FEV1/FVC ratio (P = .028), functional capacity (P = .003), physical domain of QoL (P = .006) and psychological domain of QoL (P = .002) in favor of the IMT group. CONCLUSIONS Eight weeks of inspiratory muscle training combined with pulmonary rehabilitation program improved children with chest burns' respiratory muscles strength, lung functions, functional capacity, and quality of life. Inspiratory muscle training may be employed in burn rehabilitation programs. It is a safe and effective therapy in chest burned children.
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Affiliation(s)
- Maged A Basha
- Department of Physical Therapy, College of Applied Medical Sciences, Qassim University, Buraydah 51452, P.O. Box 6666, Saudi Arabia; Department of Physical Therapy, El Sahel Teaching Hospital, General Organization for Teaching Hospitals and Institutes, Cairo, Egypt.
| | - Alshimaa R Azab
- Department of Health and Rehabilitation Sciences, College of Applied Medical Sciences, Prince Sattam Bin Abdulaziz University, Al-Kharj, Saudi Arabia; Department of Physical Therapy for Pediatrics, Faculty of Physical Therapy, Cairo University, Giza, Egypt
| | - Ragab K Elnaggar
- Department of Health and Rehabilitation Sciences, College of Applied Medical Sciences, Prince Sattam Bin Abdulaziz University, Al-Kharj, Saudi Arabia; Department of Physical Therapy for Pediatrics, Faculty of Physical Therapy, Cairo University, Giza, Egypt
| | - Nancy H Aboelnour
- Department of Physical Therapy for Surgery, Faculty of Physical Therapy, Cairo University, Giza, Egypt
| | - Noha M Kamel
- Department of Physical Therapy for Surgery, Faculty of Physical Therapy, Cairo University, Giza, Egypt
| | - Saleh M Aloraini
- Department of Physical Therapy, College of Applied Medical Sciences, Qassim University, Buraydah 51452, P.O. Box 6666, Saudi Arabia
| | - FatmaAlzahraa H Kamel
- Department of Physical Therapy, College of Applied Medical Sciences, Qassim University, Buraydah 51452, P.O. Box 6666, Saudi Arabia; Department of Physical Therapy for Surgery, Faculty of Physical Therapy, Cairo University, Giza, Egypt
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Spiesshoefer J, Regmi B, Senol M, Jörn B, Gorol O, Elfeturi M, Walterspacher S, Giannoni A, Kahles F, Gloeckl R, Dreher M. Potential Diaphragm Muscle Weakness-related Dyspnea Persists 2 Years after COVID-19 and Could Be Improved by Inspiratory Muscle Training: Results of an Observational and an Interventional Clinical Trial. Am J Respir Crit Care Med 2024; 210:618-628. [PMID: 38763165 PMCID: PMC11389583 DOI: 10.1164/rccm.202309-1572oc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 05/19/2024] [Indexed: 05/21/2024] Open
Abstract
Rationale: Diaphragm muscle weakness might underlie persistent exertional dyspnea, despite normal lung and cardiac function in individuals who were previously hospitalized for acute coronavirus disease (COVID-19) illness. Objectives: The authors sought, first, to determine the persistence and pathophysiological nature of diaphragm muscle weakness and its association with exertional dyspnea 2 years after hospitalization for COVID-19 and, second, to investigate the impact of inspiratory muscle training (IMT) on diaphragm and inspiratory muscle weakness and exertional dyspnea in individuals with long COVID. Methods: Approximately 2 years after hospitalization for COVID-19, 30 individuals (11 women, 19 men; median age, 58 years; interquartile range [IQR] = 51-63) underwent comprehensive (invasive) respiratory muscle assessment and evaluation of dyspnea. Eighteen with persistent diaphragm muscle weakness and exertional dyspnea were randomized to 6 weeks of IMT or sham training; assessments were repeated immediately after and 6 weeks after IMT completion. The primary endpoint was change in inspiratory muscle fatiguability immediately after IMT. Measurements and Main Results: At a median of 31 months (IQR = 23-32) after hospitalization, 21 of 30 individuals reported relevant persistent exertional dyspnea. Diaphragm muscle weakness on exertion and reduced diaphragm cortical activation were potentially related to exertional dyspnea. Compared with sham control, IMT improved diaphragm and inspiratory muscle function (sniff transdiaphragmatic pressure, 83 cm H2O [IQR = 75-91] vs. 100 cm H2O [IQR = 81-113], P = 0.02), inspiratory muscle fatiguability (time to task failure, 365 s [IQR = 284-701] vs. 983 s [IQR = 551-1,494], P = 0.05), diaphragm voluntary activation index (79% [IQR = 63-92] vs. 89% [IQR = 75-94], P = 0.03), and dyspnea (Borg score, 7 [IQR = 5.5-8] vs. 6 [IQR = 4-7], P = 0.03). Improvements persisted for 6 weeks after IMT completion. Conclusions: To the best of the authors' knowledge, this study is the first to identify a potential treatment for persisting exertional dyspnea in long COVID and provide a possible pathophysiological explanation for the treatment benefit. Clinical trial registered with www.clinicaltrials.gov (NCT04854863, NCT05582642).
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Affiliation(s)
| | - Binaya Regmi
- Department of Pneumology and Intensive Care Medicine and
| | - Mehdi Senol
- Department of Pneumology and Intensive Care Medicine and
| | - Benedikt Jörn
- Department of Pneumology and Intensive Care Medicine and
| | - Oscar Gorol
- Department of Pneumology and Intensive Care Medicine and
| | | | - Stephan Walterspacher
- Faculty of Health/School of Medicine, Witten/Herdecke University, Witten, Germany
- Medical Clinic II, Department of Pneumology, Cardiology and Intensive Care Medicine, Klinikum Konstanz, Konstanz, Germany
| | - Alberto Giannoni
- Interdisciplinary Health Science Center, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Florian Kahles
- Department of Cardiology, Vascular Medicine and Intensive Care Medicine, University Hospital RWTH Aachen, Aachen, Germany
| | - Rainer Gloeckl
- Philipps-University of Marburg, German Center for Lung Research, Marburg, Germany; and
- Institute for Pulmonary Rehabilitation Research, Schoen Klinik Berchtesgadener Land, Schoenau am Koenigssee, Germany
| | - Michael Dreher
- Department of Pneumology and Intensive Care Medicine and
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Pereira HLA, Mancuzo EV, Ribeiro-Samora GA, Albuquerque Pataro AC, Dos Reis Estrella D, Pereira DAG, Parreira VF. Concurrent validity between field tests and cardiopulmonary exercise testing in patients with idiopathic pulmonary fibrosis. Physiother Theory Pract 2024:1-9. [PMID: 38602319 DOI: 10.1080/09593985.2024.2341245] [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: 10/18/2023] [Accepted: 04/05/2024] [Indexed: 04/12/2024]
Abstract
BACKGROUND Maximal treadmill cardiopulmonary exercise testing is the gold standard for assessing functional capacity in patients with idiopathic pulmonary fibrosis (IPF). PURPOSE Primarily to investigate the concurrent validity between three field tests and cardiopulmonary exercise testing in these patients. METHODS Patients performed the cardiopulmonary exercise testing, a six-minute walk test, an incremental shuttle walk test, and, the Glittre-ADL test. For cardiopulmonary exercise testing, the ten seconds with the higher average of the peak oxygen uptake obtained within the last 30 seconds were considered; for six-minute walk test and incremental shuttle walk test, the longer distance; and for the Glittre-ADL test, the shorter time spent. Concurrent validity was assessed using different regression models based on the best adjustment of the data. RESULTS Twenty-two patients with IPF were assessed, aged: 68 ± 8.1 years, 13 male. Patients presented a peak oxygen uptake of 16.5 ± 3.6 mL.kg-1.min1, achieving a distance of 512.6 ± 102.8 meters in the six-minute walk test and 415.7 ± 125.1 meters in incremental shuttle walk test. The walking distance in the six-minute walk test and the incremental shuttle walk test explained, respectively, 64% and 56% peak oxygen uptake variance observed in the cardiopulmonary exercise testing (R2 = 0.64,p < .001; R2 = 0.56,p < .001). The time spent in the Glittre-ADL test was 233.4 ± 88.7 seconds and explained 47% of the peak oxygen uptake variance observed in cardiopulmonary exercise testing (R2 = 0.47,p = .001). CONCLUSION The six-minute walk test, incremental shuttle walk test, and Glittre-ADL test were considered valid tests to explain the peak oxygen uptake variance obtained by the cardiopulmonary exercise testing in patients with IPF.
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Affiliation(s)
| | - Eliane Viana Mancuzo
- Department of Medical Clinic, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Giane Amorim Ribeiro-Samora
- Visiting Professor at Physiotherapy Program, Universidade Federal do Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | - Anna Clara Albuquerque Pataro
- Department of Physiotherapy - Undergraduate student, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Deborah Dos Reis Estrella
- Sciences Applied to Adult Health Care Program, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | | | - Verônica Franco Parreira
- Department of Physiotherapy, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
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Bianquis C, Leiva Agüero S, Cantero C, Golfe Bonmatí A, González J, Hu X, Lacoste-Palasset T, Livesey A, Guillamat Prats R, Salai G, Sykes DL, Toland S, van Zeller C, Viegas P, Vieira AL, Zaneli S, Karagiannidis C, Fisser C. ERS International Congress 2023: highlights from the Respiratory Intensive Care Assembly. ERJ Open Res 2024; 10:00886-2023. [PMID: 38651090 PMCID: PMC11033729 DOI: 10.1183/23120541.00886-2023] [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: 11/23/2023] [Accepted: 11/28/2023] [Indexed: 04/25/2024] Open
Abstract
Early career members of Assembly 2 (Respiratory Intensive Care) attended the 2023 European Respiratory Society International Congress in Milan, Italy. The conference covered acute and chronic respiratory failure. Sessions of interest to our assembly members and to those interested in respiratory critical care are summarised in this article and include the latest updates in respiratory intensive care, in particular acute respiratory distress syndrome and mechanical ventilation.
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Affiliation(s)
- Clara Bianquis
- Sorbonne Université, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France
| | - Sebastian Leiva Agüero
- Academic unit of the University Institute of Health Science H.A. Barceló Foundation, La Rioja, Argentina
| | - Chloé Cantero
- APHP, Groupe Hospitalier Universitaire APHP-Sorbonne Université, Site Pitié-Salpêtrière, Service de Pneumologie, Paris, France
| | | | - Jessica González
- Translational Research in Respiratory Medicine, University Hospital Arnau de Vilanova and Santa Maria, IRBLleida, Lleida, Spain
- CIBER of Respiratory Diseases (CIBERES), Institute of Health Carlos III, Madrid, Spain
| | - Xinxin Hu
- St Vincent's Health Network Sydney, Sydney, Australia
- University of Sydney, Sydney, Australia
| | - Thomas Lacoste-Palasset
- Assistance Publique Hôpitaux de Paris, Service de Pneumologie et Soins Intensifs Respiratoires, Centre de Référence de l'Hypertension Pulmonaire, Hôpital Bicêtre, Le Kremlin Bicêtre, France
- Université Paris–Saclay, Faculté de Médecine, Le Kremlin Bicêtre, France
| | - Alana Livesey
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | | | - Grgur Salai
- Department of Pulmonology, University Hospital Dubrava, Zagreb, Croatia
| | | | - Sile Toland
- Department of Medicine, Letterkenny University Hospital, Donegal, Ireland
| | - Cristiano van Zeller
- Department of Respiratory Medicine, King's College Hospital NHS Foundation Trust, London, UK
| | - Pedro Viegas
- Departamento de Pneumonologia, Centro Hospitalar de Vila Nova de Gaia/Espinho, Oporto, Portugal
| | | | - Stavroula Zaneli
- 1st Respiratory Department, Medical School, National and Kapodistrian University of Athens, “Sotiria” Chest Hospital, Athens, Greece
| | - Christian Karagiannidis
- Department of Pneumology and Critical Care Medicine, ARDS and ECMO Centre, Cologne-Merheim Hospital, Kliniken der Stadt Köln gGmbH, Witten/Herdecke University Hospital, Cologne, Germany
| | - Christoph Fisser
- Department of Internal Medicine II, University Medical Centre Regensburg, Regensburg, Germany
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de Brito SAF, Scianni AA, Silveira BMF, de Oliveira ERM, Mateus ME, Faria CDCDM. Effects of high-intensity respiratory muscle training on respiratory muscle strength in individuals with Parkinson's disease: Protocol of a randomized clinical trial. PLoS One 2023; 18:e0291051. [PMID: 37682839 PMCID: PMC10490961 DOI: 10.1371/journal.pone.0291051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 08/17/2023] [Indexed: 09/10/2023] Open
Abstract
OBJECTIVE To investigate the efficacy of high-intensity respiratory muscle training (combined inspiratory and expiratory muscle training) in improving inspiratory and expiratory muscle strength, inspiratory muscle endurance, peak cough flow, dyspnea, fatigue, exercise capacity, and quality of life in this population. METHODS A randomized controlled trial, concealed allocation, blinded assessments, and intention-to-treat analysis will be carried out. Altogether, 34 individuals with PD (age ≥ 50 years old, with maximum inspiratory pressure (MIP) <80cmH2O or maximum expiratory pressure (MEP) <90cmH2O) will be recruited. Patients will be randomly assigned to either (1) high-intensity respiratory muscle training (experimental group, 60% of MIP and MEP) or (2) sham training (control group, 0cmH2O). Individuals will perform a home-based intervention, with indirect home supervision, consisting of two daily 20-min sessions (morning and afternoon), seven times a week, during eight weeks. Primary outcomes are MIP and MEP. Secondary outcomes are inspiratory muscle endurance, peak cough flow, dyspnea, fatigue, exercise capacity, and quality of life. The effects of the training will be analyzed from the collected data using intention-to-treat. Between-group differences will be measured using a two-way ANOVA with repeated measures (2*3), considering baseline, post-intervention, and 12-week follow-up. IMPACT The results of this trial will provide valuable new information on the efficacy of high-intensity respiratory muscle training in improving muscle strength, functional outcomes, and quality of life in individuals with PD. Performing combined inspiratory and expiratory muscle training using a single equipment is cheaper and feasible, takes less time and is easy to use. In addition, this intervention will be carried out in the home environment that increases accessibility, reduces time, and costs of transport, which increases the feasibility to reproduce their findings in clinical practice. TRIAL REGISTRATION NCT05608941. Registered on November 8, 2022.
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Affiliation(s)
| | - Aline Alvim Scianni
- Department of Physical Therapy, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Bruna Mara Franco Silveira
- Department of Physical Therapy, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | | | - Maria Eduarda Mateus
- Department of Physical Therapy, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
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Vázquez-Gandullo E, Hidalgo-Molina A, Montoro-Ballesteros F, Morales-González M, Muñoz-Ramírez I, Arnedillo-Muñoz A. Reply to Yigit, S.; Akinci, B. Comment on "Vázquez-Gandullo et al. Inspiratory Muscle Training in Patients with Chronic Obstructive Pulmonary Disease (COPD) as Part of a Respiratory Rehabilitation Program Implementation of Mechanical Devices: A Systematic Review. Int. J. Environ. Res. Public Health 2022, 19, 5564". INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4801. [PMID: 36981710 PMCID: PMC10049418 DOI: 10.3390/ijerph20064801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 03/02/2023] [Indexed: 06/18/2023]
Abstract
We would like to thank you for your interest [...].
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Affiliation(s)
- Eva Vázquez-Gandullo
- Pneumology, Allergology and Thoracic Surgery Department, University Hospital Puerta del Mar, 11009 Cádiz, Spain
| | - Antonio Hidalgo-Molina
- Pneumology, Allergology and Thoracic Surgery Department, University Hospital Puerta del Mar, 11009 Cádiz, Spain
| | | | | | - Isabel Muñoz-Ramírez
- Pneumology, Allergology and Thoracic Surgery Department, University Hospital Puerta del Mar, 11009 Cádiz, Spain
| | - Aurelio Arnedillo-Muñoz
- Pneumology, Allergology and Thoracic Surgery Department, University Hospital Puerta del Mar, 11009 Cádiz, Spain
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Ammous O, Feki W, Lotfi T, Khamis AM, Gosselink R, Rebai A, Kammoun S. Inspiratory muscle training, with or without concomitant pulmonary rehabilitation, for chronic obstructive pulmonary disease (COPD). Cochrane Database Syst Rev 2023; 1:CD013778. [PMID: 36606682 PMCID: PMC9817429 DOI: 10.1002/14651858.cd013778.pub2] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND Inspiratory muscle training (IMT) aims to improve respiratory muscle strength and endurance. Clinical trials used various training protocols, devices and respiratory measurements to check the effectiveness of this intervention. The current guidelines reported a possible advantage of IMT, particularly in people with respiratory muscle weakness. However, it remains unclear to what extent IMT is clinically beneficial, especially when associated with pulmonary rehabilitation (PR). OBJECTIVES: To assess the effect of inspiratory muscle training (IMT) on chronic obstructive pulmonary disease (COPD), as a stand-alone intervention and when combined with pulmonary rehabilitation (PR). SEARCH METHODS We searched the Cochrane Airways trials register, CENTRAL, MEDLINE, Embase, PsycINFO, Cumulative Index to Nursing and Allied Health Literature (CINAHL) EBSCO, Physiotherapy Evidence Database (PEDro) ClinicalTrials.gov, and the World Health Organization International Clinical Trials Registry Platform on 20 October 2021. We also checked reference lists of all primary studies and review articles. SELECTION CRITERIA We included randomized controlled trials (RCTs) that compared IMT in combination with PR versus PR alone and IMT versus control/sham. We included different types of IMT irrespective of the mode of delivery. We excluded trials that used resistive devices without controlling the breathing pattern or a training load of less than 30% of maximal inspiratory pressure (PImax), or both. DATA COLLECTION AND ANALYSIS We used standard methods recommended by Cochrane including assessment of risk of bias with RoB 2. Our primary outcomes were dyspnea, functional exercise capacity and health-related quality of life. MAIN RESULTS: We included 55 RCTs in this review. Both IMT and PR protocols varied significantly across the trials, especially in training duration, loads, devices, number/ frequency of sessions and the PR programs. Only eight trials were at low risk of bias. PR+IMT versus PR We included 22 trials (1446 participants) in this comparison. Based on a minimal clinically important difference (MCID) of -1 unit, we did not find an improvement in dyspnea assessed with the Borg scale at submaximal exercise capacity (mean difference (MD) 0.19, 95% confidence interval (CI) -0.42 to 0.79; 2 RCTs, 202 participants; moderate-certainty evidence). We also found no improvement in dyspnea assessed with themodified Medical Research Council dyspnea scale (mMRC) according to an MCID between -0.5 and -1 unit (MD -0.12, 95% CI -0.39 to 0.14; 2 RCTs, 204 participants; very low-certainty evidence). Pooling evidence for the 6-minute walk distance (6MWD) showed an increase of 5.95 meters (95% CI -5.73 to 17.63; 12 RCTs, 1199 participants; very low-certainty evidence) and failed to reach the MCID of 26 meters. In subgroup analysis, we divided the RCTs according to the training duration and mean baseline PImax. The test for subgroup differences was not significant. Trials at low risk of bias (n = 3) demonstrated a larger effect estimate than the overall. The summary effect of the St George's Respiratory Questionnaire (SGRQ) revealed an overall total score below the MCID of 4 units (MD 0.13, 95% CI -0.93 to 1.20; 7 RCTs, 908 participants; low-certainty evidence). The summary effect of COPD Assessment Test (CAT) did not show an improvement in the HRQoL (MD 0.13, 95% CI -0.80 to 1.06; 2 RCTs, 657 participants; very low-certainty evidence), according to an MCID of -1.6 units. Pooling the RCTs that reported PImax showed an increase of 11.46 cmH2O (95% CI 7.42 to 15.50; 17 RCTs, 1329 participants; moderate-certainty evidence) but failed to reach the MCID of 17.2 cmH2O. In subgroup analysis, we did not find a difference between different training durations and between studies judged with and without respiratory muscle weakness. One abstract reported some adverse effects that were considered "minor and self-limited". IMT versus control/sham Thirty-seven RCTs with 1021 participants contributed to our second comparison. There was a trend towards an improvement when Borg was calculated at submaximal exercise capacity (MD -0.94, 95% CI -1.36 to -0.51; 6 RCTs, 144 participants; very low-certainty evidence). Only one trial was at a low risk of bias. Eight studies (nine arms) used the Baseline Dyspnea Index - Transition Dyspnea Index (BDI-TDI). Based on an MCID of +1 unit, they showed an improvement only with the 'total score' of the TDI (MD 2.98, 95% CI 2.07 to 3.89; 8 RCTs, 238 participants; very low-certainty evidence). We did not find a difference between studies classified as with and without respiratory muscle weakness. Only one trial was at low risk of bias. Four studies reported the mMRC, revealing a possible improvement in dyspnea in the IMT group (MD -0.59, 95% CI -0.76 to -0.43; 4 RCTs, 150 participants; low-certainty evidence). Two trials were at low risk of bias. Compared to control/sham, the MD in the 6MWD following IMT was 35.71 (95% CI 25.68 to 45.74; 16 RCTs, 501 participants; moderate-certainty evidence). Two studies were at low risk of bias. In subgroup analysis, we did not find a difference between different training durations and between studies judged with and without respiratory muscle weakness. Six studies reported theSGRQ total score, showing a larger effect in the IMT group (MD -3.85, 95% CI -8.18 to 0.48; 6 RCTs, 182 participants; very low-certainty evidence). The lower limit of the 95% CI exceeded the MCID of -4 units. Only one study was at low risk of bias. There was an improvement in life quality with CAT (MD -2.97, 95% CI -3.85 to -2.10; 2 RCTs, 86 participants; moderate-certainty evidence). One trial was at low risk of bias. Thirty-two RCTs reported PImax, showing an improvement without reaching the MCID (MD 14.57 cmH2O, 95% CI 9.85 to 19.29; 32 RCTs, 916 participants; low-certainty evidence). In subgroup analysis, we did not find a difference between different training durations and between studies judged with and without respiratory muscle weakness. None of the included RCTs reported adverse events. AUTHORS' CONCLUSIONS IMT may not improve dyspnea, functional exercise capacity and life quality when associated with PR. However, IMT is likely to improve these outcomes when provided alone. For both interventions, a larger effect in participants with respiratory muscle weakness and with longer training durations is still to be confirmed.
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Affiliation(s)
- Omar Ammous
- Faculty of Medicine, University of Sfax, Sfax, Tunisia
| | - Walid Feki
- Department of Respiratory Medicine, Hedi Chaker University Hospital, University of Sfax, Sfax, Tunisia
| | - Tamara Lotfi
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Canada
| | | | - Rik Gosselink
- Department of Rehabilitation Sciences, Faculty of Movement and Rehabilitation Sciences, University Hospitals Leuven, Leuven, Belgium
| | - Ahmed Rebai
- Centre of Biotechnology of Sfax, University of Sfax, Sfax, Tunisia
| | - Samy Kammoun
- Department of Respiratory Medicine, Hedi Chaker University Hospital, University of Sfax, Sfax, Tunisia
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Souto-Miranda S, van ‘t Hul AJ, Vaes AW, Antons JC, Djamin RS, Janssen DJA, Franssen FME, Marques A, Spruit MA. Differences in Pulmonary and Extra-Pulmonary Traits between Women and Men with Chronic Obstructive Pulmonary Disease. J Clin Med 2022; 11:jcm11133680. [PMID: 35806965 PMCID: PMC9267757 DOI: 10.3390/jcm11133680] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 06/11/2022] [Accepted: 06/23/2022] [Indexed: 02/04/2023] Open
Abstract
Background: Evidence suggests sex-related differences in chronic obstructive pulmonary disease (COPD). Whether these differences are reflected in the prevalence of treatable traits remains unknown. Methods: Two samples of patients referred to secondary (n = 530) or tertiary care (n = 2012) were analyzed. Men and women were matched for age, forced expiratory volume in 1 s and body mass index. Sex-related differences were tested using t-tests, Mann-Whitney U, or chi-square tests. Results: Frequent exacerbations (30.5 vs. 19.7%), high cardiovascular risk (88.1 vs. 66.2%) and activity-related severe dyspnea (50.9 vs. 34.8%) were more prevalent in women in secondary care (p < 0.05). Severe hyperinflation (43.0 vs. 25.4%), limited diffusing capacity (79.6 vs. 70.1%), impaired mobility (44.0 vs. 28.7%), frequent exacerbations (66.8 vs. 57.4%), frequent hospitalizations (47.5 vs. 41.6%), severe activity-related dyspnea (89.1 vs. 85.0%), symptoms of anxiety (56.3 vs. 42.0%) and depression (50.3 vs. 44.8%), and poor health status (79.9 vs. 71.0%) were more prevalent in women in tertiary care (p < 0.05). Severe inspiratory muscle weakness (14.6 vs. 8.2%) and impaired exercise capacity (69.1 vs. 59.6%) were more prevalent among men (p < 0.05) in tertiary care. Conclusions: Sex-related differences were found, with most traits more prevalent and severe among women. Care providers should be aware of these differences to adjust treatment.
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Affiliation(s)
- Sara Souto-Miranda
- Department of Research and Development, Ciro, 6085 NM Horn, The Netherlands; (A.W.V.); (D.J.A.J.); (F.M.E.F.); (M.A.S.)
- Respiratory Research and Rehabilitation Laboratory (Lab3R) and Institute of Biomedicine (iBiMED), University of Aveiro, 3810-193 Aveiro, Portugal;
- Department of Respiratory Medicine, Maastricht University Medical Centre, NUTRIM School of Nutrition and Translational Research in Metabolism, Faculty of Health, Medicine and Life Sciences, Maastricht University, 6229 ER Maastricht, The Netherlands
- Correspondence:
| | - Alex J. van ‘t Hul
- Department of Respiratory Diseases, Radboud Institute for Health Sciences, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands; (A.J.v.‘t.H.); (J.C.A.)
| | - Anouk W. Vaes
- Department of Research and Development, Ciro, 6085 NM Horn, The Netherlands; (A.W.V.); (D.J.A.J.); (F.M.E.F.); (M.A.S.)
| | - Jeanine C. Antons
- Department of Respiratory Diseases, Radboud Institute for Health Sciences, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands; (A.J.v.‘t.H.); (J.C.A.)
| | - Remco S. Djamin
- Department of Respiratory Diseases, Amphia Hospital, 4818 CK Breda, The Netherlands;
| | - Daisy J. A. Janssen
- Department of Research and Development, Ciro, 6085 NM Horn, The Netherlands; (A.W.V.); (D.J.A.J.); (F.M.E.F.); (M.A.S.)
- Department of Health Services Research, Care and Public Health Research Institute, Faculty of Health Medicine and Life Sciences, Maastricht University, 6226 NB Maastricht, The Netherlands
| | - Frits M. E. Franssen
- Department of Research and Development, Ciro, 6085 NM Horn, The Netherlands; (A.W.V.); (D.J.A.J.); (F.M.E.F.); (M.A.S.)
- Department of Respiratory Medicine, Maastricht University Medical Centre, NUTRIM School of Nutrition and Translational Research in Metabolism, Faculty of Health, Medicine and Life Sciences, Maastricht University, 6229 ER Maastricht, The Netherlands
| | - Alda Marques
- Respiratory Research and Rehabilitation Laboratory (Lab3R) and Institute of Biomedicine (iBiMED), University of Aveiro, 3810-193 Aveiro, Portugal;
| | - Martijn A. Spruit
- Department of Research and Development, Ciro, 6085 NM Horn, The Netherlands; (A.W.V.); (D.J.A.J.); (F.M.E.F.); (M.A.S.)
- Department of Respiratory Medicine, Maastricht University Medical Centre, NUTRIM School of Nutrition and Translational Research in Metabolism, Faculty of Health, Medicine and Life Sciences, Maastricht University, 6229 ER Maastricht, The Netherlands
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Cabrita B, Dias S, Luisa Fernandes A, Correia S, Teixeira G, Camilo Z, Simão P. The effects of inspiratory muscle training in adults with muscular dystrophy. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2022. [DOI: 10.12968/ijtr.2021.0008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background/Aims Patients with muscular dystrophy usually have impaired lung function and respiratory muscle strength, leading to pneumonia and respiratory failure, which are significant causes of morbidity and mortality. Inspiratory muscle training might be a safe adjunct treatment to increase the strength and endurance of weakened respiratory muscles. The researchers have developed a new protocol for inspiratory muscle training and evaluated its effect on inspiratory muscle strength and coughing capacity. Methods A total of 12 participants diagnosed with muscle dystrophy and decreased maximal inspiratory pressure (<60 cmH2O) participated in this prospective study. Training was individually tailored, starting with low resistance levels and progressing according to tolerance and symptoms. The primary outcome measure was maximal inspiratory pressure. Secondary outcomes were maximal expiratory pressure, peak cough flow and the feasibility of the intervention. Results There were two participants who did not complete the study, and three were lost to follow-up; therefore, only seven patients finished the intervention. In these patients, the authors found a statistically significant improvement in the maximal inspiratory pressure (P=0.018) and peak cough flow (P=0.046) after 3 months of training. There was also an improvement in the maximal expiratory pressure, although this was not statistically significant (P=0.176). Median compliance to training was 99% (94.5–100). Conclusions This intervention led to statistically significant improvements in inspiratory muscles strength and coughing capacity in patients with muscular dystrophy. The results were significantly positive and contribute to the evidence in support of this underused, yet possibly beneficial, treatment, although larger randomised controlled trials are required to verify this.
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Affiliation(s)
- Bruno Cabrita
- Pulmonology Department, Pedro Hispano Hospital, Matosinhos, Portugal
| | - Sara Dias
- Pulmonology Department, Pedro Hispano Hospital, Matosinhos, Portugal
| | | | - Sílvia Correia
- Pulmonology Department, Pedro Hispano Hospital, Matosinhos, Portugal
| | - Graciete Teixeira
- Pulmonology Department, Pedro Hispano Hospital, Matosinhos, Portugal
| | - Zita Camilo
- Pulmonology Department, Pedro Hispano Hospital, Matosinhos, Portugal
| | - Paula Simão
- Pulmonology Department, Pedro Hispano Hospital, Matosinhos, Portugal
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Vázquez-Gandullo E, Hidalgo-Molina A, Montoro-Ballesteros F, Morales-González M, Muñoz-Ramírez I, Arnedillo-Muñoz A. Inspiratory Muscle Training in Patients with Chronic Obstructive Pulmonary Disease (COPD) as Part of a Respiratory Rehabilitation Program Implementation of Mechanical Devices: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:5564. [PMID: 35564959 PMCID: PMC9099727 DOI: 10.3390/ijerph19095564] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 04/29/2022] [Accepted: 04/29/2022] [Indexed: 01/20/2023]
Abstract
Chronic Obstructive Pulmonary Disease (COPD) is a complex and heterogeneous disease, with pulmonary and extrapulmonary manifestations, which leads to the need to personalize the assessment and treatment of these patients. The latest updates of national and international guidelines for the management of COPD reveal the importance of respiratory rehabilitation (RR) and its role in improving symptoms, quality of life, and psychosocial sphere of patients. Within RR, the inspiratory muscle training (IMT) has received special interest, showing benefits in maximum inspiratory pressure, perception of well-being, and health status in patients with chronic heart disease, respiratory diseases, and dyspnea during exercise. The aim of this review is to assess the efficacy of IMT in COPD patients through the use of inspiratory muscle training devices, compared with respiratory rehabilitation programs without inspiratory muscle training. In the last years, many mechanical devices focused on inspiratory muscle training have been developed, some of them, such as the AirOFit PRO™, PowerBreath®, or FeelBreathe®, have shown clear benefits. The active search for candidate patients to undergo the RR program with inspiratory muscle training using this type of device in COPD patients represents an advance in the treatment of this disease, with direct benefits on the quality of life of the patients. In this article, we review the available evidence on IMT in these patients and describe the different devices used for it.
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Affiliation(s)
- Eva Vázquez-Gandullo
- Pneumology, Allergology and Thoracic Surgery Department, University Hospital Puerta del Mar, 11009 Cádiz, Spain; (A.H.-M.); (F.M.-B.); (I.M.-R.)
| | - Antonio Hidalgo-Molina
- Pneumology, Allergology and Thoracic Surgery Department, University Hospital Puerta del Mar, 11009 Cádiz, Spain; (A.H.-M.); (F.M.-B.); (I.M.-R.)
| | - Francisca Montoro-Ballesteros
- Pneumology, Allergology and Thoracic Surgery Department, University Hospital Puerta del Mar, 11009 Cádiz, Spain; (A.H.-M.); (F.M.-B.); (I.M.-R.)
| | | | - Isabel Muñoz-Ramírez
- Pneumology, Allergology and Thoracic Surgery Department, University Hospital Puerta del Mar, 11009 Cádiz, Spain; (A.H.-M.); (F.M.-B.); (I.M.-R.)
| | - Aurelio Arnedillo-Muñoz
- Pneumology, Allergology and Thoracic Surgery Department, University Hospital Puerta del Mar, 11009 Cádiz, Spain; (A.H.-M.); (F.M.-B.); (I.M.-R.)
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Tounsi B, Acheche A, Lelard T, Tabka Z, Trabelsi Y, Ahmaidi S. Effects of specific inspiratory muscle training combined with whole-body endurance training program on balance in COPD patients: Randomized controlled trial. PLoS One 2021; 16:e0257595. [PMID: 34555068 PMCID: PMC8460029 DOI: 10.1371/journal.pone.0257595] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 09/02/2021] [Indexed: 11/18/2022] Open
Abstract
PURPOSE This study aims to assess the effect of inspiratory muscle training (IMT) combined with endurance training (ET) on balance in patients with chronic obstructive pulmonary disease (COPD). METHODS We studied 32 male patients (62 ± 6 years) with moderate to very severe COPD. They were randomly assigned to an experimental group (IMT+ET) n = 16 or a control group (ET) n = 16 with similar characteristics. The evaluations were carried out at inclusion and after eight weeks of the training period. Functional balance was assessed by the Berg Balance Scale (BBS), the Timed-up and Go (TUG), the Single Leg Stance test (SLS), and the Activities-specific Balance Confidence (ABC) scale. The strength of the inspiratory muscles (PImax) was assessed by maximal inspiratory mouth pressure. Functional exercise performance was assessed by the 6 minutes walking test (6MWT). IMT program consists in performing two daily sets of 30 inspirations with 50% of PImax increased by 10% every two weeks. ET program consists in performing 30 min treadmill exercise at 60% to 80% of the average speed achieved during the 6MWT three days per week. RESULTS After the training period, the experimental group demonstrated greater improvements in BBS (IMT+ET vs. ET; p = 0.019), and in ABC (IMT+ET vs. ET; p = 0.014). However, no significant differences between groups were observed for TUG, SLS, and 6MWT. There was a significant difference between groups in PImax (IMT+ET vs. ET; p = 0.030). Significant moderate correlations were obtained between ΔPImax and ΔBBS for both groups (IMT+ET: r = 0.624, p = 0.010; ET r = 0.550, p = 0.027) as well as for ΔABC but only in the experimental group (IMT+ET: r = 0.550, p = 0.027). CONCLUSION Compared to ET alone, the results suggest that IMT combined with ET enhances inspiratory muscle function and functional balance according to BBS and ABC in patients with COPD. We suggest that inspiratory muscle training might be introduced as additional training to pulmonary rehabilitation programs aimed at improving balance in COPD patients. TRIAL REGISTRATION The trial registry name: Clinical Trials; Registration number: NCT04084405; URL: https://clinicaltrials.gov/ct2/show/NCT04084405.
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Affiliation(s)
- Bilel Tounsi
- Laboratory of Exercise Physiology and Rehabilitation (APERE, UR-EA 3300), Sport Sciences Department, Picardie Jules Verne University, Amiens, France
- Research Laboratory of Exercise Physiology and Pathophysiology: From Integral to Molecular Biology, Medicine and Health (LR19ES09), Faculty of Medicine of Sousse, University of Sousse, Sousse, Tunisia
| | - Amal Acheche
- Research Laboratory of Exercise Physiology and Pathophysiology: From Integral to Molecular Biology, Medicine and Health (LR19ES09), Faculty of Medicine of Sousse, University of Sousse, Sousse, Tunisia
| | - Thierry Lelard
- Laboratory of Exercise Physiology and Rehabilitation (APERE, UR-EA 3300), Sport Sciences Department, Picardie Jules Verne University, Amiens, France
| | - Zouhair Tabka
- Research Laboratory of Exercise Physiology and Pathophysiology: From Integral to Molecular Biology, Medicine and Health (LR19ES09), Faculty of Medicine of Sousse, University of Sousse, Sousse, Tunisia
| | - Yassine Trabelsi
- Research Laboratory of Exercise Physiology and Pathophysiology: From Integral to Molecular Biology, Medicine and Health (LR19ES09), Faculty of Medicine of Sousse, University of Sousse, Sousse, Tunisia
| | - Said Ahmaidi
- Laboratory of Exercise Physiology and Rehabilitation (APERE, UR-EA 3300), Sport Sciences Department, Picardie Jules Verne University, Amiens, France
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Cabrita B, Dias S, Fernandes AL, Correia S, Ferreira J, Simão P. Inspiratory muscle training in neuromuscular patients: Assessing the benefits of a novel protocol. J Back Musculoskelet Rehabil 2021; 34:537-543. [PMID: 33523039 DOI: 10.3233/bmr-200141] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Neuromuscular diseases are characterized by the compromise of respiratory muscles, thoracic ventilation, muscle strength and coughing capacity. Patients have low quality of life and increased morbidity and mortality mostly due to respiratory impairment. OBJECTIVE To assess the benefits of adding inspiratory muscle training to neuromuscular patients' treatment and their compliance to the approach. METHODS We conducted a single-center prospective study with neuromuscular patients with decreased maximal inspiratory pressure. We developed an inspiratory muscle training protocol with three-month duration and once-daily training. The protocol had a progressive intensity that was individually tailored based on patients' baseline characteristics and tolerance. We used Powerbreathe Medic Classic devices to perform the training. RESULTS There were 21 patients who met the inclusion criteria and were enrolled in the study. Muscular dystrophy (n= 12, 57.3%) and amyotrophic lateral sclerosis (n= 4, 19%) were the most common diseases. After three months of training, patients increased their maximal inspiratory muscle pressure (p= 0.002) and peak cough flow (p= 0.011). Compliance to the protocol was 99 ± 5.5%. CONCLUSIONS This protocol showed significant improvements on pulmonary muscles function and might be considered as an adjunct treatment to neuromuscular treatment. However, these positive results require larger further studies to validate the clinical benefits long-term.
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Lage SM, Pereira DAG, Corradi Magalhães Nepomuceno AL, Castro ACD, Araújo AG, Hoffman M, Silveira BMF, Parreira VF. Efficacy of inspiratory muscle training on inspiratory muscle function, functional capacity, and quality of life in patients with asthma: A randomized controlled trial. Clin Rehabil 2021; 35:870-881. [PMID: 33406892 DOI: 10.1177/0269215520984047] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To evaluate the efficacy of an inspiratory muscle training protocol on inspiratory muscle function, functional capacity, and quality of life in patients with asthma. DESIGN A single-blind, randomized controlled clinical trial. SETTING Community-based. SUBJECTS Patients with asthma, aged between 20 and 70 years old, non-smokers. INTERVENTIONS Participants were randomized into two groups: inspiratory muscle training group performed inspiratory muscle training 5 days a week for 8 weeks, consisting of six sets of 30 breaths per day with a training load ⩾50% of maximal inspiratory pressure, plus an educational program; the control group only received the educational program. MAIN MEASUREMENTS Maximal inspiratory pressure, inspiratory muscle endurance, and the distance performed on the incremental shuttle walking test were assessed pre-intervention, post-intervention and at follow-up (3 months after the end of the intervention). The asthma quality of life questionnaire was applied pre and post-intervention. RESULTS Data from 39 participants were analyzed. Maximal inspiratory pressure in percentage of predicted and endurance test duration were significantly higher post-intervention in the inspiratory muscle training group (∆ post-pre: 50.8% vs 7.3% of predicted - P < 0.001 and ∆ post-pre: 207.9 seconds vs 2.7 seconds - P < 0.001, respectively). There was no significant difference in the incremental shuttle walking distance between groups (∆ post-pre: 30.9 m vs -8.1 m, P = 0.165). Quality of life was perceived as significantly better, without a difference between groups (P > 0.05). CONCLUSIONS About 8 weeks of inspiratory muscle training in patients with controlled asthma significantly increased inspiratory muscle strength and endurance.
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Affiliation(s)
- Susan Martins Lage
- Rehabilitation Sciences Program, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.,Faculdade Ciências Médicas de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | | | | | | | | | - Mariana Hoffman
- Rehabilitation Sciences Program, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.,Department of Allergy, Immunology and Respiratory Medicine, Monash University, Melbourne, VIC, Australia
| | - Bruna Mara Franco Silveira
- Rehabilitation Sciences Program, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Verônica Franco Parreira
- Department of Physical Therapy, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
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Effectiveness of inspiratory muscle training (IMT) on pulmonary function and functional capacity in chronic smoker's v/s non-smokers patients undergoing open abdominal surgery - A study protocol. Int J Surg Protoc 2020; 24:31-35. [PMID: 33241166 PMCID: PMC7674510 DOI: 10.1016/j.isjp.2020.10.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Revised: 10/29/2020] [Accepted: 10/31/2020] [Indexed: 01/19/2023] Open
Abstract
Background Abdominal surgeries are performed for the treatment and diagnosis of many diseases. Smokers undergoing abdominal surgery, are high risk population, having underlying pathological changes in lung parenchyma due to inflammatory effect of smoking. Site of incision and history of smoking may significantly affect pulmonary function such as FVC and FEV1. Respiratory muscle training pre-operatively has shown significant improvement of pulmonary function compare to only conventional therapy and has led to reduction of PPCs, length of hospital stay and cost. This study aims to find effectiveness of IMT in chronic smokers undergoing abdominal surgery and its significance in reduction of PPC and in pulmonary function and functional capacity as compared to non-smokers. Methodology This study protocol is observational cohort study comparing smoker and non-smoker participants undergoing abdominal surgery. The participants will be assessed for pulmonary function test and functional capacity (6MWD); pre-operatively and post-operatively day 1 till the day of discharge. Both the groups will receive IMT and conventional chest Physiotherapy from POD1 and increment of IMT will be done by assessing MIP each day. Dissemination We plan to publish this review in a peer-reviewed journal. We may also present this review at local and/or national conferences.
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Key Words
- 6MWD, Six Minute Walk Distance
- 6MWT, Six Minute Walk Test
- Abdominal surgeries
- FEV1, Forced Expiratory Volume In 1st Second
- FVC, Forced Vital Capacity
- Functional capacity
- IMT, Inspiratory Muscle Training
- Inspiratory muscle training
- MEP, Maximum Expiratory Pressure
- MIP, Maximum Inspiratory Pressure
- PEF, Peak Expiratory Flow
- PFT, Pulmonary Function Test
- POD, Post-Operative Day
- PPCs, Post-operative Pulmonary Complications
- Pulmonary function
- RMS, Respiratory Muscle Strength
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15
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Inspiratory Muscle Training in Rehabilitation of Low Back Pain: A Randomized Controlled Trial. J Sport Rehabil 2020; 29:1151-1158. [PMID: 31910393 DOI: 10.1123/jsr.2019-0231] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2019] [Revised: 10/20/2019] [Accepted: 11/06/2019] [Indexed: 11/18/2022]
Abstract
CONTEXT People with chronic low back pain (CLBP) suffer from weaknesses in their core muscle activity and dysfunctional breathing. Inspiratory muscle training (IMT) was recently developed to treat this condition. OBJECTIVES The present study was conducted to investigate the effect of IMT on core muscle activity, pulmonary parameters, and pain intensity in athletes with CLBP. DESIGN This study was designed as a single-blind, randomized, controlled trial. SETTING Clinical rehabilitation laboratory. PARTICIPANTS A total of 23 male and 24 female athletes with CLBP were randomly divided into the experimental and control groups. MAIN OUTCOME MEASURES The experimental group performed IMT for 8 weeks, 7 days per week and twice daily, using POWERbreathe KH1, beginning at 50% of maximum inspiratory pressure with a progressively increasing training load. The surface electromyography muscle activity of the erector spinae, multifidus, transverse abdominis and rectus abdominis, respiratory function and Visual Analogue Scale score were also measured before and after the intervention in both groups. The repeated-measures analysis of variance and 1-way analysis of covariance were further used to compare the intragroup and intergroup results following the intervention. RESULTS The findings of the study revealed that multifidus and transverse abdominis activity, as well as respiratory function, increased significantly in the IMT group (P < .05). Moreover, a descending trend was observed in the Visual Analogue Scale score in the experimental group (P < .05). CONCLUSION The results showed that IMT can improve respiratory function, increase core muscle activity, and, consequently, reduce pain intensity in athletes with CLBP.
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Fortes JVS, Borges MGB, Marques MJDS, Oliveira RL, Rocha LRD, Castro ÉMD, Esquivel MS, Borges DL. Effects of Inspiratory Muscle Training Using an Electronic Device on Patients Undergoing Cardiac Surgery: A Randomized Controlled Trial. INTERNATIONAL JOURNAL OF CARDIOVASCULAR SCIENCES 2020. [DOI: 10.36660/ijcs.20190093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Bordin DF, Cardoso DM, Wagner LE, Beckenkamp PR, Silva ALGD, Paiva DN. Sternocleidomastoid muscle activation following inspiratory muscle training in patients with chronic obstructive pulmonary disease: a randomized clinical trial. FISIOTERAPIA E PESQUISA 2020. [DOI: 10.1590/1809-2950/19009727022020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT This study aims to assess the effect of short-time low frequency inspiratory muscle trainer (Threshold IMT) on inspiratory muscle strength and electromyographic activity of the sternocleidomastoid (SCM) muscle in people with chronic obstructive pulmonary disease (COPD). People with COPD participating in a lung rehabilitation program were allocated to a control or inspiratory muscle training (IMT) group. The control group participated in the usual rehabilitation, whereas the other group received IMT (performed with a load of 50% maximal inspiratory pressure (MIP) adjusted weekly). Both interventions lasted for 2 months. Outcomes included electromyographic analysis of the SCM and MIP. In total, ten participants were allocated to each group. The IMT group presented an increase in absolute (p<0.001) and predicted (p<0.001) values of MIP and also in pre- and post-intervention variation between groups (p=0.003 and p=0.008, respectively). Such differences were not found in the control group. The SCM muscle activity decreased in the IMT post intragroup evaluation (p=0.008). IMT provided a reduction of the electromyographic activity of SCM in COPD patients, also increasing inspiratory muscle strength in the study participants.
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18
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Lee SW, Lyu YR, Park SJ, Kwak JY, Yang WK, Kim SH, Kang W, Son JW, Jung IC, Park YC. The effect of lung-conduction exercise in chronic obstructive pulmonary disease: Study protocol for randomized, assessor-blind, multicenter trial. Medicine (Baltimore) 2020; 99:e19826. [PMID: 32358353 PMCID: PMC7440170 DOI: 10.1097/md.0000000000019826] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 03/09/2020] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) is an irreversible disease characterized by cough, sputum production, and dyspnea, and has a high prevalence and mortality. Pulmonary rehabilitation (PR) is a management that improves the quality of life for COPD patients; however, PR is not readily accessible. Therefore, we developed lung-conduction exercises (LCE) that can be performed without any limitations. LCE consists of breathing, stretching, and tapping to relieve dyspnea in COPD patients. METHODS/DESIGN This randomized, assessor-blind, multicenter trial aims to recruit 54 patients with moderate and severe COPD. Subjects will be randomly allocated to a control group (only medication), an LCE group (medication + LCE, 5 times a week), or a PR group (medication + PR, 5 times a week). The 6-minute walk distance, pulmonary function tests (forced expiratory volume at 1 second, forced vital capacity, and forced expiratory volume at 1 second/forced vital capacity), modified Borg scale, modified medical research council dyspnea scale, COPD assessment test, and St. George respiratory questionnaire will be measured before starting the trial and after the 4th and 8th weeks to determine motor performance, lung function, and dyspnea. CONCLUSION We aim to demonstrate that LCE is effective in improving symptoms and psychosomatic stability in COPD patients. Therefore, this trial will play an important role in fortifying the foundation of clinical application.
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Affiliation(s)
- Su Won Lee
- Division of Respiratory Medicine, Department of Internal Medicine, College of Korean Medicine, Daejeon University
| | - Yee Ran Lyu
- Division of Respiratory Medicine, Department of Internal Medicine, College of Korean Medicine, Daejeon University
- Clinical Trial Center, Daejeon Korean Medicine Hospital of Daejeon University
| | - So Jung Park
- Clinical Trial Center, Daejeon Korean Medicine Hospital of Daejeon University
| | - Jin Young Kwak
- Clinical Trial Center, Daejeon Korean Medicine Hospital of Daejeon University
| | - Won Kyung Yang
- Division of Respiratory Medicine, Department of Internal Medicine, College of Korean Medicine, Daejeon University
- Institute of Traditional Medicine and Bioscience
| | | | - Weechang Kang
- Department of Statistics, Hyehwa Liberal Arts College, Daejeon University
| | - Ji Woong Son
- Division of Respiratory and Critical Care Medicine, Department of Internal Medicine, Konyang University Hospital
| | - In Chul Jung
- Clinical Trial Center, Daejeon Korean Medicine Hospital of Daejeon University
- Department of Neuropsychology, College of Korean Medicine, Daejeon University, Daejeon, Republic of Korea
| | - Yang Chun Park
- Division of Respiratory Medicine, Department of Internal Medicine, College of Korean Medicine, Daejeon University
- Clinical Trial Center, Daejeon Korean Medicine Hospital of Daejeon University
- Institute of Traditional Medicine and Bioscience
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Burge AT, Cox NS, Abramson MJ, Holland AE. Interventions for promoting physical activity in people with chronic obstructive pulmonary disease (COPD). Cochrane Database Syst Rev 2020; 4:CD012626. [PMID: 32297320 PMCID: PMC7160071 DOI: 10.1002/14651858.cd012626.pub2] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Escalating awareness of the magnitude of the challenge posed by low levels of physical activity in people with chronic obstructive pulmonary disease (COPD) highlights the need for interventions to increase physical activity participation. The widely-accepted benefits of physical activity, coupled with the increasing availability of wearable monitoring devices to objectively measure participation, has led to a dramatic rise in the number and variety of studies that aimed to improve the physical activity of people with COPD. However, little was known about the relative efficacy of interventions tested so far. OBJECTIVES In people with COPD, which interventions are effective at improving objectively-assessed physical activity? SEARCH METHODS We identified trials from the Cochrane Airways Trials Register Register, which contains records identified from bibliographic databases including the Cochrane Central Register of Controlled Trials, MEDLINE, Embase, CINAHL, AMED, and PsycINFO. We also searched PEDro, ClinicalTrials.gov, the World Health Organization International Clinical Trials Registry Platform portal and the Australian New Zealand Clinical Trials Registry (from inception to June 2019). We checked reference lists of all primary studies and review articles for additional references, as well as respiratory journals and respiratory meeting abstracts, to identify relevant studies. SELECTION CRITERIA We included randomised controlled trials of interventions that used objective measures for the assessment of physical activity in people with COPD. Trials compared an intervention with no intervention or a sham/placebo intervention, an intervention in addition to another standard intervention common to both groups, or two different interventions. DATA COLLECTION AND ANALYSIS We used standard methods recommended by Cochrane. Subgroup analyses were possible for supervised compared to unsupervised pulmonary rehabilitation programmes in clinically-stable COPD for a range of physical activity outcomes. Secondary outcomes were health-related quality of life, exercise capacity, adverse events and adherence. Insufficient data were available to perform prespecified subgroup analyses by duration of intervention or disease severity. We undertook sensitivity analyses by removing studies that were at high or unclear risk of bias for the domains of blinding and incomplete outcome data. MAIN RESULTS We included 76 studies with 8018 participants. Most studies were funded by government bodies, although some were sponsored by equipment or drug manufacturers. Only 38 studies had physical activity as a primary outcome. A diverse range of interventions have been assessed, primarily in single studies, but improvements have not been systematically demonstrated following any particular interventions. Where improvements were demonstrated, results were confined to single studies, or data for maintained improvement were not provided. Step count was the most frequently reported outcome, but it was commonly assessed using devices with documented inaccuracy for this variable. Compared to no intervention, the mean difference (MD) in time in moderate- to vigorous-intensity physical activity (MVPA) following pulmonary rehabilitation was four minutes per day (95% confidence interval (CI) -2 to 9; 3 studies, 190 participants; low-certainty evidence). An improvement was demonstrated following high-intensity interval exercise training (6 minutes per day, 95% CI 4 to 8; 2 studies, 275 participants; moderate-certainty evidence). One study demonstrated an improvement following six months of physical activity counselling (MD 11 minutes per day, 95% CI 7 to 15; 1 study, 280 participants; moderate-certainty evidence), but we found mixed results for the addition of physical activity counselling to pulmonary rehabilitation. There was an improvement following three to four weeks of pharmacological treatment with long-acting muscarinic antagonist and long-acting beta2-agonist (LAMA/LABA) compared to placebo (MD 10 minutes per day, 95% CI 4 to 15; 2 studies, 423 participants; high-certainty evidence). These interventions also demonstrated improvements in other measures of physical activity. Other interventions included self-management strategies, nutritional supplementation, supplemental oxygen, endobronchial valve surgery, non-invasive ventilation, neuromuscular electrical stimulation and inspiratory muscle training. AUTHORS' CONCLUSIONS A diverse range of interventions have been assessed, primarily in single studies. Improvements in physical activity have not been systematically demonstrated following any particular intervention. There was limited evidence for improvement in physical activity with strategies including exercise training, physical activity counselling and pharmacological management. The optimal timing, components, duration and models for interventions are still unclear. Assessment of quality was limited by a lack of methodological detail. There was scant evidence for a continued effect over time following completion of interventions, a likely requirement for meaningful health benefits for people with COPD.
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Affiliation(s)
- Angela T Burge
- La Trobe UniversityDepartment of Physiotherapy, Podiatry and Prosthetics and Orthotics, School of Allied Health, Human Services and SportMelbourneVictoriaAustralia
- Institute for Breathing and SleepMelbourneAustralia
- Alfred HealthPhysiotherapyPO Box 315MelbourneAustraliaPrahran VIC 3181
- Monash UniversityDepartment of Allergy, Clinical Immunology and Respiratory MedicineMelbourneAustralia
| | - Narelle S Cox
- Institute for Breathing and SleepMelbourneAustralia
- Monash UniversityDepartment of Allergy, Clinical Immunology and Respiratory MedicineMelbourneAustralia
- School of Allied Health, Human Services and Sport, La Trobe UniversityDepartment of Physiotherapy, Podiatry and Prosthetics and OrthoticsMelbourneVictoriaAustralia3004
| | - Michael J Abramson
- Monash UniversitySchool of Public Health & Preventive MedicineMelbourneVictoriaAustralia3004
| | - Anne E Holland
- La Trobe UniversityDepartment of Physiotherapy, Podiatry and Prosthetics and Orthotics, School of Allied Health, Human Services and SportMelbourneVictoriaAustralia
- Institute for Breathing and SleepMelbourneAustralia
- Alfred HealthPhysiotherapyPO Box 315MelbourneAustraliaPrahran VIC 3181
- Monash UniversityDepartment of Allergy, Clinical Immunology and Respiratory MedicineMelbourneAustralia
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20
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The Efficacy of Therapeutic Respiratory Muscle Training Interventions in People with Bronchiectasis: A Systematic Review and Meta-Analysis. J Clin Med 2020; 9:jcm9010231. [PMID: 31952338 PMCID: PMC7019679 DOI: 10.3390/jcm9010231] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 01/08/2020] [Accepted: 01/10/2020] [Indexed: 12/11/2022] Open
Abstract
Background: Respiratory muscle dysfunction is an important health problem with high morbidity and mortality and associated costs in patients with bronchiectasis (BC). The aim of this study was to analyse the effects of therapeutic respiratory muscle training (RMT) interventions on improving sputum clearance, ventilator function, muscle strength and functional capacity in BC. Methods: Systematic review and meta-analysis were conducted following PRISMA guidelines. Two independent investigators searched using several electronic databases. The methodological quality of nine studies was assessed using the PEDro scale. Study selection/eligibility criteria: The following were included: randomised controlled trials, randomised crossover trials and pilot studies of patients with BC that used the intervention as RMT (inspiratory/expiratory) and evaluations of respiratory muscle strength (maximal expiratory pressure/maximal inspiratory pressure). This systematic review was registered in PROSPERO (CRD42017075101). Nine studies were included, five of which obtained an A recommendation grade, three with B, and one with C. Study quality was poor to good (mean PEDro Score of 6.375 out of 10). Studies had small sample sizes (8–98). Results show improvements on PImax in favour of therapeutic respiratory muscle training intervention (MD = 6.08; 95% CI = 1.38, 10.77; p < 0.01; I2 = 92%). However, high heterogeneity was identified on meta-analysis.
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Kofod LM, Hage T, Christiansen LH, Skalkam K, Martinez G, Godtfredsen NS, Molsted S. Inspiratory muscle strength and walking capacity in patients with COPD. Eur Clin Respir J 2019; 7:1700086. [PMID: 31853341 PMCID: PMC6913623 DOI: 10.1080/20018525.2019.1700086] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Accepted: 11/28/2019] [Indexed: 12/12/2022] Open
Abstract
Purpose: It has been suggested that patients with inspiratory muscle weakness could benefit from specific inspiratory muscle training (IMT). We aimed to examine the frequency of patients with inspiratory muscle weakness in a Danish hospital-based outpatient pulmonary rehabilitation program, and to evaluate the association between inspiratory muscle strength and peripheral muscle strength and walking capacity. Methods: Maximal Inspiratory Pressure (MIP) was assessed in 97 patients with COPD (39 men, 58 women, mean age years 70 ± 9, forced expiratory volume in 1 s ((FEV1) = 35 ± 10% pred.). The impact of MIP on knee-extension strength, walking distance, and symptom burden was evaluated using multiple linear regression analyses. Results: The MIP of the patients with COPD was 63 (95% CI 59; 67) cmH2O and it was significantly reduced compared to gender and age-matched reference values 76 (95% CI 73; 79) cmH2O (p < 0.001). Seven patients (7.2%) were under the lower limit of normal. MIP was negatively correlated with increasing age, female gender, decreasing knee-extension strength and lower FEV1% pred. Walking distance was associated with knee-extension strength and it was not associated with MIP. Conclusion: Maximal inspiratory pressure was reduced in patients with COPD but only a few patients had a weak MIP. Whilst MIP was associated with leg muscle strength, it was not associated with walking distance or symptoms.
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Affiliation(s)
- Linette Marie Kofod
- Physical Medicine and Rehabilitation Research - Copenhagen (PMR-C), Department of Physio- and Occupational Therapy, Copenhagen University Hospital, Hvidovre, Denmark
| | - Tine Hage
- Department of Physiotherapy, Copenhagen University Hospital, Nordsjælland, Denmark
| | | | - Karin Skalkam
- Department of Physiotherapy, Copenhagen University Hospital, Nordsjælland, Denmark
| | - Gerd Martinez
- Physical Medicine and Rehabilitation Research - Copenhagen (PMR-C), Department of Physio- and Occupational Therapy, Copenhagen University Hospital, Hvidovre, Denmark.,Department of Pulmonology, Copenhagen University Hospital, Hvidovre, Denmark
| | | | - Stig Molsted
- Department of Clinical Research, Copenhagen University Hospital, Nordsjælland, Denmark
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22
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Tran K, Chen Y, Ovechkin A, Roussel T. Design, Development, and Characterization of BreathForce: A Respiratory Training System for Patients with Spinal Cord Injuries. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2019; 2018:1510-1513. [PMID: 30440679 DOI: 10.1109/embc.2018.8512485] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
In this effort, we report the development of a portable inspiratory-expiratory training device for use in rehabilitation of participants with cardiovascular and respiratory motor deficits. The device uses existing airway restriction components to establish a manually adjustable respiratory training apparatus and includes an integrated pressure sensor with custom software to direct and track therapy sessions. The battery-powered system promotes proven rehabilitation methodologies performed at the clinic in a platform to be translated to the home for participants with spinal cord injuries.
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Gholami Borujeni B, Yalfani A. Reduction of postural sway in athletes with chronic low back pain through eight weeks of inspiratory muscle training: A randomized controlled trial. Clin Biomech (Bristol, Avon) 2019; 69:215-220. [PMID: 31614295 DOI: 10.1016/j.clinbiomech.2019.09.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 09/05/2019] [Accepted: 09/08/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Postural control and respiratory function are mechanically and neuromuscularly dependent on each other. The present study was conducted to determine the effects of inspiratory muscle training on postural sway in athletes with chronic low back pain. METHODS Twenty-four patients were randomly selected as the experimental group and 23 patients as the control group. The experimental group underwent the inspiratory muscle training protocol for eight weeks, seven days per week and twice daily. The postural sway variables were recorded using a plantar pressure measurement device. The postural sway variables were recorded when performing overhead and single leg squat. Patient's perceived low back pain was assessed using Visual Analog Scale. Disability was assessed using the Athletes Disability Index questionnaire. Patient depression/anxiety was assessed using the Patient Health Questionnaire-4. FINDINGS The results of the two-way ANOVA in the overhead squat test showed that postural sway indices significantly decreased in the experimental group after 8-weeks intervention compared to the pre-test values. The results of the two-way ANOVA in single leg squat test showed significant differences between the pre- and post-test in the experimental group in the postural sway indices except for the factor of standard deviation Y, also compared to the pre-test value, pain was significantly decreased in the experimental group. INTERPRETATION The 8-weeks inspiratory muscle training decreased postural sway in athletes with chronic low back pain when performing the overhead and single leg squat. In addition, the pain index decreased after 8-weeks of inspiratory muscle training.
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Affiliation(s)
- Behnam Gholami Borujeni
- Department of Corrective Exercises and Sport Injury, Faculty of Physical Education and Sport Sciences, Bu Ali Sina University, Hamedan, Iran.
| | - Ali Yalfani
- Department of Corrective Exercises and Sport Injury, Faculty of Physical Education and Sport Sciences, Bu Ali Sina University, Hamedan, Iran.
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24
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Hoffman M, Augusto VM, Eduardo DS, Silveira BMF, Lemos MD, Parreira VF. Inspiratory muscle training reduces dyspnea during activities of daily living and improves inspiratory muscle function and quality of life in patients with advanced lung disease. Physiother Theory Pract 2019; 37:895-905. [DOI: 10.1080/09593985.2019.1656314] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Mariana Hoffman
- Rehabilitation Sciences Post Graduation Program, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
- Physiotherapy Discipline, La Trobe Clinical School, La Trobe University, Melbourne, Australia
| | - Valéria M. Augusto
- Department of Internal Medicine, UFMG, 271, Centro, Belo Horizonte, Brazil
| | - Daisy S. Eduardo
- Advanced Lung Disease and Pre Lung Transplantation Ambulatory Clinics, UFMG, 271, Centro, Belo Horizonte, Brazil
| | - Bruna M. F. Silveira
- Rehabilitation Sciences Post Graduation Program, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - Marcela D. Lemos
- Laboratory of Cardiorespiratory Assessment and Research, Department of Physical Therapy, UFMG, Belo Horizonte, Brazil
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Kaszuba M, Śliwka A, Piliński R, Nowobilski R, Wloch T. Methodologies of inspiratory muscle training techniques in obstructive lung diseases. REHABILITACJA MEDYCZNA 2019. [DOI: 10.5604/01.3001.0013.1474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Inspiratory muscle training (IMT) is a non-pharmacological, non-invasive therapeutic method that can improve the quality of life in patients with obstructive lung diseases. The effectiveness of IMT may depends on the type of the device used in the training and the parameters of the training programme.
Objectives: The aim of the review was to present different techniques and protocols of IMT used in patients with obstructive lung diseases.
Methods: The MEDLINE and EMBASE were searched to identify the potentially eligible publications from the previous 5 years. The various protocols of IMT used in different studies were analysed and described in detail.
Results: A database search identified 333 records, of which 22 were included into the final analysis. All of the finally analysed studies were conducted in patients with chronic obstructive pulmonary disease (COPD). The protocols of IMT used in the studies differed in the type of the device used, the duration of the training programme, the number and the duration of training sessions, the initial load, and the rate at which the load was changed during the training.
Conclusions: IMT is used mainly in studies on patients with COPD and not with asthma. There is no one approved training programme for IMT. The most predominant type of IMT is a training with threshold loading. The most frequently used devices for IMT are POWERbreath and Threshold IMT. The protocols of IMT used in the studies are very diverse.
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Affiliation(s)
- Marek Kaszuba
- Zakład Rehabilitacji w Chorobach Wewnętrznych, Instytut Fizjoterapii, Wydział Nauk o Zdrowiu, Uniwersytet Jagielloński Collegium Medicum / Faculty of Health Sciences, Jagiellonian University Medical College, Krakow, Poland
| | - Agnieszka Śliwka
- Zakład Rehabilitacji w Chorobach Wewnętrznych, Instytut Fizjoterapii, Wydział Nauk o Zdrowiu, Uniwersytet Jagielloński Collegium Medicum / Faculty of Health Sciences, Jagiellonian University Medical College, Krakow, Poland
| | - Rafał Piliński
- Zakład Rehabilitacji w Chorobach Wewnętrznych, Instytut Fizjoterapii, Wydział Nauk o Zdrowiu, Uniwersytet Jagielloński Collegium Medicum / Faculty of Health Sciences, Jagiellonian University Medical College, Krakow, Poland
| | - Roman Nowobilski
- Zakład Rehabilitacji w Chorobach Wewnętrznych, Instytut Fizjoterapii, Wydział Nauk o Zdrowiu, Uniwersytet Jagielloński Collegium Medicum / Faculty of Health Sciences, Jagiellonian University Medical College, Krakow, Poland
| | - Tomasz Wloch
- Zakład Rehabilitacji w Chorobach Wewnętrznych, Katedra Rehabilitacji Klinicznej, Wydział Rehabilitacji Ruchowej, Akademia Wychowania Fizycznego w Krakowie / Department of Physiotherapy, University School of Physical Education, Krakow, Poland
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Abedi Yekta AH, Poursaeid Esfahani M, Salehi S, Hassabi M, Khosravi S, Kharabian S, Sohrabi MR, Mafi AA, Rezaei S. Assessment of the Effects of Inspiratory Muscle Training (IMT) and Aerobic Training on the Quality of Life of Patients with Chronic Obstructive Pulmonary Disease. TANAFFOS 2019; 18:223-229. [PMID: 32411262 PMCID: PMC7210575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Accepted: 07/09/2019] [Indexed: 11/10/2022]
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) is a major cause of morbidity and mortality worldwide. The aim of this study was to investigate the effects of inspiratory muscle training (IMT) and aerobic exercise on health-related quality of life of patients with COPD. MATERIALS AND METHODS This randomized controlled clinical trial was conducted on 60 patients with moderate to severe COPD, who were referred to Imam Hossein Hospital of Tehran, Iran in 2016. The patients were randomly assigned to four groups and treated for eight weeks. Group 1 (n=16) participated in 16 sessions of IMT (15 minutes per session), group 2 (n=14) performed aerobic exercises twice a week (40 minutes per session), group 3 (n=15) performed IMT and aerobic exercises, and group 4 (n=15) received no intervention, except for routine treatments (control). Quality of life was evaluated based on the Saint George's Respiratory Questionnaire (SGRQ) at baseline, week 4, and week 8 after the intervention. RESULTS After eight weeks, all four groups experienced a significant improvement in their quality of life (P<0.05), and group 3 (IMT and aerobic exercise) showed the greatest improvement. However, quality of life improvement in group 4 (control) was less than the other three groups (P<0.05). CONCLUSION Aerobic exercise and IMT were more effective than routine protocols in improving the quality of life of COPD patients. Furthermore, short-term IMT plus aerobic exercise had the greatest impact on improving the health-related quality of life of COPD patients and could be used in the management of these patients.
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Affiliation(s)
- Amir Hossein Abedi Yekta
- Department of Sports Medicine, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mehrshad Poursaeid Esfahani
- Department of Sports Medicine, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Shahin Salehi
- Department of Sports Medicine, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Hassabi
- Department of Sports Medicine, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Shahrzad Khosravi
- Department of Sports Medicine, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Shahram Kharabian
- Department of Sports Medicine, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Reza Sohrabi
- Department of Sports Medicine, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Amir Ali Mafi
- Clinical Research Development Center of Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Saeed Rezaei
- Department of Sports Medicine, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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McDonald T, Stiller K. Inspiratory muscle training is feasible and safe for patients with acute spinal cord injury. J Spinal Cord Med 2019; 42:220-227. [PMID: 29400990 PMCID: PMC6419641 DOI: 10.1080/10790268.2018.1432307] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
OBJECTIVE To investigate the feasibility and safety and, to a lesser extent efficacy, of inspiratory muscle training (IMT) for patients with acute complete cervical or thoracic spinal cord injury (SCI). DESIGN Prospective, observational pilot study comprising a series of case reports. SETTING Tertiary care, public hospital. PARTICIPANTS Seven adult subjects with an acute complete cervical or thoracic SCI. INTERVENTIONS Participants received IMT as soon as their respiratory condition was stable. A high-resistance, low-repetition program of IMT using a POWERbreathe KH1 device was instituted. Training comprised 3-6 sets of 6 breaths, commenced at 50% maximum inspiratory pressure with the training load progressively increased. OUTCOME MEASURES Feasibility (number of sessions when the criteria to participate in IMT were met/not met), safety (symptoms and physiological stability) before, during and after IMT sessions and efficacy (lung function) were measured. RESULTS There were 50 sessions in total where participants met the criteria to receive IMT, with a mean (range) of 7.1 (3-11) IMT sessions per participant delivered over 10.7 (4-17) days. IMT was feasible, with all 50 planned sessions of IMT able to be delivered, and safe, with stable physiological parameters and no adverse symptoms or events recorded before, during or after IMT. Maximal inspiratory pressure increased for four participants and forced vital capacity increased for three participants over the duration of their IMT sessions. CONCLUSION A high-resistance, low-repetition program of IMT was feasible and safe in adults with an acute complete cervical or thoracic SCI whose respiratory status was stable. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry (ACTRN 12614000975695).
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Affiliation(s)
- Tony McDonald
- Physiotherapy Department, Royal Adelaide Hospital, Adelaide, Australia,Correspondence to: Tony McDonald, 5G-183 Royal Adelaide Hospital, Port Road, Adelaide, South Australia, Australia5000. Ph: 61 8 70740000.
| | - Kathy Stiller
- Allied Health, Central Adelaide Local Health Network, Adelaide, Australia
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Souza RMP, Cardim AB, Maia TO, Rocha LG, Bezerra SD, Marinho PÉM. Inspiratory muscle strength, diaphragmatic mobility, and body composition in chronic obstructive pulmonary disease. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2019; 24:e1766. [PMID: 30628141 DOI: 10.1002/pri.1766] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Revised: 10/12/2018] [Accepted: 12/17/2018] [Indexed: 11/06/2022]
Abstract
BACKGROUND AND PURPOSE Chronic obstructive pulmonary disease (COPD) is a systemic inflammatory disease that can cause repercussions on respiratory muscles and body composition. The aim of the current study was to evaluate inspiratory muscle strength, diaphragmatic mobility, and body composition in COPD subjects and to correlate these variables. METHODS This was a cross-sectional study performed with 21 COPD patients. Inspiratory muscle strength (manovacuometry), pulmonary function test (forced vital capacity [FVC], forced expiratory volume in 1 s [FEV1 ], and FEV1 /FVC ratio), diaphragmatic mobility (ultrasonography), and body composition (bioelectrical impedance analysis) were examined. RESULTS COPD individuals in Stages II (28.9%), III (52%), and IV (19%) according to Global Initiative for Chronic Obstructive Disease were recruited, 61.9% of which were men. Inspiratory muscle weakness was found in 47.6% of subjects, who presented a lower fat-free mass percentage (p = 0.017) and smaller fat-free mass index (p = 0.001) and greater fat mass percentage (p = 0.029) and less diaphragmatic mobility (p = 0.007) compared with the nonrespiratory weakness group. Maximal inspiratory pressure exhibited a moderately positive relationship to the fat-free mass index (r = 0.767, p < 0.001) and a weak positive relationship to diaphragmatic mobility (r = 0.496, p = 0.022). CONCLUSION Our study showed a high prevalence of inspiratory muscle weakness based on the severity of airway obstruction and on the presence of muscular depletion. The evaluation of body composition detected important changes. It also demonstrated that not only muscular weakness was present in these patients but also this had repercussions on the mobility of the diaphragm muscle.
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Affiliation(s)
- Rosália M P Souza
- Cardiopulmonary Physical Therapy Laboratory, Department of Physical Therapy, Universidade Federal de Pernambuco, Recife, Brazil
| | - Adriane B Cardim
- Cardiopulmonary Physical Therapy Laboratory, Department of Physical Therapy, Universidade Federal de Pernambuco, Recife, Brazil
| | - Tuíra O Maia
- Cardiopulmonary Physical Therapy Laboratory, Department of Physical Therapy, Universidade Federal de Pernambuco, Recife, Brazil
| | - Lívia G Rocha
- Cardiopulmonary Physical Therapy Laboratory, Department of Physical Therapy, Universidade Federal de Pernambuco, Recife, Brazil
| | - Shirley D Bezerra
- Cardiopulmonary Physical Therapy Laboratory, Department of Physical Therapy, Universidade Federal de Pernambuco, Recife, Brazil
| | - Patrícia Érika M Marinho
- Cardiopulmonary Physical Therapy Laboratory, Department of Physical Therapy, Universidade Federal de Pernambuco, Recife, Brazil
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Parreiras de Menezes KK, Nascimento LR, Ada L, Avelino PR, Polese JC, Mota Alvarenga MT, Barbosa MH, Teixeira-Salmela LF. High-Intensity Respiratory Muscle Training Improves Strength and Dyspnea Poststroke: A Double-Blind Randomized Trial. Arch Phys Med Rehabil 2018; 100:205-212. [PMID: 30316960 DOI: 10.1016/j.apmr.2018.09.115] [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: 04/26/2018] [Revised: 08/29/2018] [Accepted: 09/14/2018] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To examine whether high-intensity home-based respiratory muscle training, that is, with higher loads, delivered more frequently and for longer duration, than previously applied, would increase the strength and endurance of the respiratory muscles, reduce dyspnea and respiratory complications, and improve walking capacity post-stroke. DESIGN Randomized trial with concealed allocation, blinded participants and assessors, and intention-to-treat analysis. SETTING Community-dwelling patients. PARTICIPANTS Patients with stroke, who had respiratory muscle weakness (N=38). INTERVENTIONS The experimental group received 40-minute high-intensity home-based respiratory muscle training, 7 days per week, for 8 weeks, progressed weekly. The control group received a sham intervention of similar dose. MAIN OUTCOME MEASURES Primary outcome was inspiratory muscle strength (via maximal inspiratory pressure), whereas secondary outcomes were expiratory muscle strength (maximal expiratory pressure), inspiratory muscle endurance, dyspnea (Medical Research Council score), respiratory complications (hospitalizations), and walking capacity (6-minute walk test). Outcomes were measured at baseline, after intervention, and 1 month beyond intervention. RESULTS Compared to the control, the experimental group increased inspiratory (27cmH2O; 95% confidence interval [95% CI], 15 to 40) and expiratory (42cmH2O; 95% CI, 25 to 59) strength, inspiratory endurance (33 breaths; 95% CI, 20 to 47), and reduced dyspnea (-1.3 out of 5.0; 95% CI, -2.1 to -0.6), and the benefits were maintained at 1 month beyond training. There was no significant between-group difference for walking capacity or respiratory complications. CONCLUSION High-intensity home-based respiratory muscle training was effective in increasing strength and endurance of the respiratory muscles and reducing dyspnea for people with respiratory muscle weakness post-stroke, and the magnitude of the effect was higher, than that previously reported in studies, which applied standard protocols.
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Affiliation(s)
| | - Lucas Rodrigues Nascimento
- Department of Physiotherapy, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil; Discipline of Physiotherapy, Universidade Federal do Espírito Santo, Vitória, Espírito Santo, Brazil
| | - Louise Ada
- Discipline of Physiotherapy, University of Sydney, New South Wales, Australia
| | - Patrick Roberto Avelino
- Department of Physiotherapy, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Janaine Cunha Polese
- Department of Physiotherapy, Faculdade Ciências Médicas de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | | | - Mariana Hoffman Barbosa
- Department of Physiotherapy, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
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Sørensen D, Svenningsen H. Adherence to home-based inspiratory muscle training in individuals with chronic obstructive pulmonary disease. Appl Nurs Res 2018; 43:75-79. [DOI: 10.1016/j.apnr.2018.07.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Revised: 06/29/2018] [Accepted: 07/25/2018] [Indexed: 10/28/2022]
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Lima SC, Ribeiro SNS, Oliveira NFD, Miranda CMD, Britto RR, Montemezzo D. Identificação de equipamentos e procedimentos utilizados por fisioterapeutas brasileiros para testes de endurance muscular inspiratória. FISIOTERAPIA E PESQUISA 2018. [DOI: 10.1590/1809-2950/17014925032018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
RESUMO A avaliação da função dos músculos inspiratórios por meio do teste de endurance muscular inspiratória (EMI), definida como a capacidade de sustentação dessa tarefa ao longo do tempo, atualmente apresenta ampla variedade de instrumentos e procedimentos para sua mensuração. Este estudo teve como objetivo identificar os diferentes equipamentos, procedimentos e forma de avaliação dos testes de EMI entre fisioterapeutas brasileiros. É um estudo transversal realizado por meio de questionário enviado por correio eletrônico individualmente a cada participante. Cento e treze fisioterapeutas de diferentes regiões do país, grande parte com atuação conjunta na clínica e na docência (52,1%), responderam realizar poucas vezes a medida de EMI (48,7%). O manovacuômetro aneroide foi o aparelho mais utilizado por 42,5% dos profissionais. O clipe nasal e o bocal tubular de plástico rígido ou papel foram os acessórios mais utilizados durante o teste, correspondendo a 51,8% e 33%, respectivamente. O teste de ventilação voluntária máxima foi o mais utilizado para avaliação da endurance inspiratória, relatado por 23% dos respondentes. O teste de carga constante para avaliação da endurance foi adotado por 51,2% dos fisioterapeutas, sendo que 54,9% associaram comandos verbais à demonstração para explicação do teste. A interpretação dos valores aferidos era feita através de valores de referência por 25,7% dos entrevistados. Identificou-se que os fisioterapeutas brasileiros entrevistados não apresentaram a mesma conduta para os testes de EMI. No entanto os equipamentos, procedimentos e a forma de avaliação são utilizados com base nas diretrizes sobre o tema e de acordo com a disponibilidade de recursos do serviço.
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Charususin N, Gosselink R, Decramer M, Demeyer H, McConnell A, Saey D, Maltais F, Derom E, Vermeersch S, Heijdra YF, van Helvoort H, Garms L, Schneeberger T, Kenn K, Gloeckl R, Langer D. Randomised controlled trial of adjunctive inspiratory muscle training for patients with COPD. Thorax 2018; 73:942-950. [PMID: 29914940 DOI: 10.1136/thoraxjnl-2017-211417] [Citation(s) in RCA: 68] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Revised: 05/16/2018] [Accepted: 05/28/2018] [Indexed: 11/04/2022]
Abstract
BACKGROUND This study aimed to investigate whether adjunctive inspiratory muscle training (IMT) can enhance the well-established benefits of pulmonary rehabilitation (PR) in patients with COPD. METHODS 219 patients with COPD (FEV1: 42%±16% predicted) with inspiratory muscle weakness (PImax: 51±15 cm H2O) were randomised into an intervention group (IMT+PR; n=110) or a control group (Sham-IMT+PR; n=109) in this double-blind, multicentre randomised controlled trial between February 2012 and October 2016 (ClinicalTrials.gov NCT01397396). Improvement in 6 min walking distance (6MWD) was a priori defined as the primary outcome. Prespecified secondary outcomes included respiratory muscle function and endurance cycling time. FINDINGS No significant differences between the intervention group (n=89) and the control group (n=85) in improvements in 6MWD were observed (0.3 m, 95% CI -13 to 14, p=0.967). Patients who completed assessments in the intervention group achieved larger gains in inspiratory muscle strength (effect size: 1.07, p<0.001) and endurance (effect size: 0.79, p<0.001) than patients in the control group. 75 s additional improvement in endurance cycling time (95% CI 1 to 149, p=0.048) and significant reductions in Borg dyspnoea score at isotime during the cycling test (95% CI -1.5 to -0.01, p=0.049) were observed in the intervention group. INTERPRETATION Improvements in respiratory muscle function after adjunctive IMT did not translate into additional improvements in 6MWD (primary outcome). Additional gains in endurance time and reductions in symptoms of dyspnoea were observed during an endurance cycling test (secondary outcome) TRIAL REGISTRATION NUMBER: NCT01397396; Results.
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Affiliation(s)
- Noppawan Charususin
- Respiratory Rehabilitation and Respiratory Division, University Hospital Leuven, Leuven, Belgium.,KU Leuven - University of Leuven, Department of Rehabilitation Sciences, Faculty of Movement and Rehabilitation Sciences, Leuven, Belgium.,Department of Physical Therapy, Faculty of Allied Health Sciences, Thammasat University, Pathumthani, Thailand
| | - Rik Gosselink
- Respiratory Rehabilitation and Respiratory Division, University Hospital Leuven, Leuven, Belgium.,KU Leuven - University of Leuven, Department of Rehabilitation Sciences, Faculty of Movement and Rehabilitation Sciences, Leuven, Belgium
| | - Marc Decramer
- Respiratory Rehabilitation and Respiratory Division, University Hospital Leuven, Leuven, Belgium
| | - Heleen Demeyer
- Respiratory Rehabilitation and Respiratory Division, University Hospital Leuven, Leuven, Belgium.,KU Leuven - University of Leuven, Department of Rehabilitation Sciences, Faculty of Movement and Rehabilitation Sciences, Leuven, Belgium
| | - Alison McConnell
- Department of Human Sciences and Public Health, Faculty of Health and Social Sciences, Bournemouth University, Bournemouth, UK
| | - Didier Saey
- Centre de recherche, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Quebec, Canada
| | - François Maltais
- Centre de recherche, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Quebec, Canada
| | - Eric Derom
- Department of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium
| | - Stefanie Vermeersch
- Department of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium
| | - Yvonne F Heijdra
- Department of Pulmonary Diseases, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Hanneke van Helvoort
- Department of Pulmonary Diseases, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Linda Garms
- Department of Pulmonary Diseases, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Tessa Schneeberger
- Department of Respiratory Medicine and Pulmonary Rehabilitation, Schoen Klinik Berchtesgadener Land, Schoenau am Koenigssee, Germany
| | - Klaus Kenn
- Department of Respiratory Medicine and Pulmonary Rehabilitation, Schoen Klinik Berchtesgadener Land, Schoenau am Koenigssee, Germany.,German Center for Lung Research (DZL), Universities of Giessen and Marburg Lung Center (UGMLC), Giessen, Germany
| | - Rainer Gloeckl
- Department of Respiratory Medicine and Pulmonary Rehabilitation, Schoen Klinik Berchtesgadener Land, Schoenau am Koenigssee, Germany.,Department of Prevention, Rehabilitation and Sports Medicine, Technical University of Munich (TUM), Munich, Germany
| | - Daniel Langer
- Respiratory Rehabilitation and Respiratory Division, University Hospital Leuven, Leuven, Belgium.,KU Leuven - University of Leuven, Department of Rehabilitation Sciences, Faculty of Movement and Rehabilitation Sciences, Leuven, Belgium
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Beaumont M, Forget P, Couturaud F, Reychler G. Effects of inspiratory muscle training in COPD patients: A systematic review and meta-analysis. CLINICAL RESPIRATORY JOURNAL 2018; 12:2178-2188. [DOI: 10.1111/crj.12905] [Citation(s) in RCA: 92] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Revised: 02/13/2018] [Accepted: 04/04/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Marc Beaumont
- Pulmonary Rehabilitation Unit, Morlaix Hospital Centre; European University of Occidental Brittany; Brest France
| | - Patrice Forget
- Department of Anesthesiology and Perioperative Medicine; Universitair Ziekenhuis Brussel; Brussels Belgium
| | - Francis Couturaud
- Department of Internal Medicine and Chest Diseases, EA3878 (G.E.T.B.O.), CIC INSERM 0502; University Hospital of Brest, European University of Occidental Brittany; Brest France
| | - Gregory Reychler
- Institut de Recherche Expérimentale et Clinique (IREC), Pôle de Pneumologie, ORL & Dermatologie; Université Catholique de Louvain; Brussels Belgium
- Service de Pneumologie, Cliniques Universitaires Saint-Luc; Brussels Belgium
- Cliniques Universitaires Saint-Luc, De Médecine Physique Et Réadaptation Service; Brussels Belgium
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An investigation into the use of ultrasound as a surrogate measure of diaphragm function. Heart Lung 2018; 47:418-424. [PMID: 29779705 DOI: 10.1016/j.hrtlng.2018.04.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Accepted: 04/26/2018] [Indexed: 12/25/2022]
Abstract
PURPOSE Sonographic assessment of the diaphragm may be a surrogate for interpretation of diaphragm function in mechanically ventilated patients. This study aimed to determine the correlation between respiratory muscle function and diaphragm thickness in a healthy population. METHODS A descriptive study was conducted. Diaphragm thickness was determined by sonographic measurement. Respiratory muscle strength, fatigue and endurance was determined using a mouth pressure manometer. RESULTS 55 subjects with a mean (SD) age 21.16 ± 1.55 years were studied. Diaphragm thickness was moderately correlated with strength (r = 0.52; r2=0.27; p < 0.001). Respiratory muscle fatigue was not correlated with thickness (r=-0.15; r2=0.02; p = 0.29) or strength (r=-0.19; r2=0.04; p = 0.16). CONCLUSION Diaphragm thickness was moderately correlated to strength but not to fatigue or endurance in healthy individuals. Sonography may be a surrogate measure of volitional respiratory muscle strength and requires confirmation in critically ill patients.
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Magalhães PA, Camillo CA, Langer D, Andrade LB, Duarte MDCM, Gosselink R. Weaning failure and respiratory muscle function: What has been done and what can be improved? Respir Med 2018; 134:54-61. [DOI: 10.1016/j.rmed.2017.11.023] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Revised: 09/18/2017] [Accepted: 11/28/2017] [Indexed: 02/03/2023]
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Nepomuceno BRV, Barreto MDS, Almeida NC, Guerreiro CF, Xavier-Souza E, Neto MG. Safety and efficacy of inspiratory muscle training for preventing adverse outcomes in patients at risk of prolonged hospitalisation. Trials 2017; 18:626. [PMID: 29282152 PMCID: PMC5745884 DOI: 10.1186/s13063-017-2372-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Accepted: 11/30/2017] [Indexed: 11/10/2022] Open
Abstract
Background The early institution of inspiratory muscle training on hospitalised patients with no established respiratory deficits could prevent in-hospital adverse outcomes that are directly or indirectly associated to the loss of respiratory muscle mass inherent to a prolonged hospital stay. The objective of the clinical trial is to assess the impact of inspiratory muscle training on hospital inpatient complications. Methods This is a double-blind randomised controlled trial. Subjects in the intervention group underwent an inspiratory muscle training loaded with 50% maximum inspiratory pressure twice daily for 4 weeks from study enrolment. Patients were randomly assigned to an inspiratory muscle training group or a sham inspiratory muscle training group. All patients received conventional physiotherapy interventions. Baseline and post-intervention respiratory and peripheral muscle strength, functionality (performance of activities of daily living), length of hospital stay, and death were evaluated. Clinical outcomes were assessed until hospital discharge. This study was approved by the Institutional Hospital Ethics Committee (03/2014). Results Thirty-one patients assigned to the inspiratory muscle training group and 34 to the sham inspiratory muscle training group were analysed. Patients in the inspiratory muscle training group had a shorter mean length of hospital stay (35.3 ± 2.7 vs. 41.8 ± 3.5 days, p < 0.01) and a lower risk of endotracheal intubation (relative risk (RR) = 0.36; 95% confidence interval (CI) 0.27–0.97; p = 0.03) as well as muscle weakness (RR = 0.36; 95% CI 0.19–0.98; p = 0.02) and mortality (RR = 0.23; 95% CI 0.2–0.94; p = 0.04). The risk of adverse events did not differ significantly between groups. Conclusion Inspiratory muscle training was a protective factor against endotracheal intubation, muscle weakness, and mortality. Trial registration ClinicalTrials.gov, ID: NCT02459444. Registered on 19 May 2015.
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Affiliation(s)
- Balbino Rivail Ventura Nepomuceno
- Medicine and Health, Federal University of Bahia - UFBA, Av. Tancredo Neves, n 1283, Sala 902 - Edf. Ômega - Caminho das Árvores, Salvador, Bahia, ZIP 41820-021, Brazil. .,Department of Biofunção, Institute of Health Sciences - ICS, UFBA, Av. Tancredo Neves, n 1283, Sala 902 - Edf. Ômega - Caminho das Árvores, Salvador, Bahia, ZIP 41820-021, Brazil. .,Reative Physiotherapy Specialist, Av. Tancredo Neves, n 1283, Sala 902 - Edf. Ômega - Caminho das Árvores, Salvador, Bahia, ZIP 41820-021, Brazil. .,Metropolitan Union for Education and Culture, Av. Tancredo Neves, n 1283, Sala 902 - Edf. Ômega - Caminho das Árvores, Salvador, Bahia, ZIP 41820-021, Brazil.
| | - Mayana de Sá Barreto
- Metropolitan Union for Education and Culture, Av. Tancredo Neves, n 1283, Sala 902 - Edf. Ômega - Caminho das Árvores, Salvador, Bahia, ZIP 41820-021, Brazil
| | - Naniane Cidreira Almeida
- Metropolitan Union for Education and Culture, Av. Tancredo Neves, n 1283, Sala 902 - Edf. Ômega - Caminho das Árvores, Salvador, Bahia, ZIP 41820-021, Brazil
| | | | | | - Mansueto Gomes Neto
- Medicine and Health, Federal University of Bahia - UFBA, Av. Tancredo Neves, n 1283, Sala 902 - Edf. Ômega - Caminho das Árvores, Salvador, Bahia, ZIP 41820-021, Brazil.,Department of Physiotherapy, Institute of Health Sciences-ICS, UFBA, Salvador, BA, Brazil
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The effects of inspiratory muscle training based on the perceptions of patients with advanced lung disease: a qualitative study. Braz J Phys Ther 2017; 22:215-221. [PMID: 29258735 DOI: 10.1016/j.bjpt.2017.12.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Accepted: 08/20/2017] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Advanced lung disease is a chronic non-neoplastic disease that compromises activities of daily living. Treatment includes pulmonary rehabilitation and inspiratory muscle training. Studies have shown the effectiveness of inspiratory muscle training in lung disease patients, but literature is scarce on the patients' perceptions about this topic. OBJECTIVE To explore the perceptions of patients with advanced lung disease about inspiratory muscle training. METHODS Qualitative study. Interviews were conducted using a semi-structured questionnaire regarding topics on the participation of patients in inspiratory muscle training and on daily activities performed before and after training. Interviews were transcribed and analyzed according to thematic content analysis. RESULTS Ten patients (eight women and 2 men, ranging in age from 27 to 89 years) with inspiratory muscle weakness (maximal inspiratory pressure=44±13.9cmH2O) were included. Five patients were diagnosed with Chronic Obstructive Pulmonary Disease, two with bronchiectasis and three with pulmonary fibrosis. All patients completed at least 80% of the total training sessions. The reports were grouped into four thematic categories: (1) impact of inspiratory muscle training on breathlessness (e.g., "I wasn't feeling as tired as I previously felt."); (2) change in daily activities (e.g., "I needed to go to the supermarket, I felt less tired doing it."); (3) improved mobility (e.g., "I could not stand for long periods […] walking, for example […] Now I stand more, I have more capability."); and (4) increased communication (e.g., "More power, right? Even in speaking […] When I could, I felt my voice coming out better."). CONCLUSION There were improvements in breathlessness, daily activities, mobility, and communication, which positively affected the psychological and social aspects of the patients.
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Wolpat A, Lima FV, Silva FM, Tochetto M, de Freitas A, Grandi T, Rodrigues L, Paiva V, Cipriano G, Chiappa AM, Zago J, Chiappa GR. Association between inspiratory muscle weakness and slowed oxygen uptake kinetics in patients with chronic obstructive pulmonary disease. Appl Physiol Nutr Metab 2017; 42:1239-1246. [DOI: 10.1139/apnm-2016-0568] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Patients with chronic obstructive pulmonary disease (COPD) may have poor inspiratory muscle function, which reduces minute and alveolar ventilation, leading to increased hypoxemia and slow pulmonary oxygen uptake kinetics. However, little is known about the effect of inspiratory muscle weakness (IMW) on oxygen uptake kinetics in patients with COPD. Thus, we tested the hypothesis that COPD patients with IMW have slowed oxygen uptake kinetics. An observational study was conducted that included COPD patients with moderate to severe airflow limitation and a history of intolerance to exercise. Participants were divided into 2 groups: (IMW+; n = 22) (IMW–; n = 23) of muscle weakness. The maximal inspiratory, expiratory, and sustained inspiratory strength as well as the maximal endurance of the inspiratory muscles were lower in IMW+ patients (36 ± 9.5 cm H2O; 52 ± 14 cm H2O; 20 ± 6.5 cm H2O; 94 ± 84 s, respectively) than in IMW– patients (88 ± 12 cm H2O; 97 ± 28 cm H2O; 82.5 ± 54 cm H2O; 559 ± 92 s, respectively; p < 0.05). Moreover, the 6-min walk test and peak oxygen uptake were reduced in the IMW+ patients. During the constant work test, oxygen uptake kinetics were slowed in the IMW+ compared with IMW– patients (88 ± 29 vs 61 ± 18 s, p < 0.05). Our findings demonstrate that inspiratory muscle weakness in COPD is associated with slowed oxygen uptake kinetics, and thus, reduced functional capacity.
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Affiliation(s)
- Andiara Wolpat
- Physical Therapy Department, Serra Gaucha University, Caxias do Sul, Brazil
| | - Francisco V. Lima
- Physical Therapy Department, University of Brasilia, Brasilia, Brazil
| | - Fabiola M. Silva
- Physical Therapy Department, University of Brasilia, Brasilia, Brazil
| | - Micheli Tochetto
- Physical Therapy Department, Serra Gaucha University, Caxias do Sul, Brazil
| | | | - Tatiane Grandi
- Physical Therapy Department, Serra Gaucha University, Caxias do Sul, Brazil
| | - Leonardo Rodrigues
- Physical Therapy Department, Serra Gaucha University, Caxias do Sul, Brazil
| | - Verônica Paiva
- Physical Therapy Department, Serra Gaucha University, Caxias do Sul, Brazil
| | - Gerson Cipriano
- Physical Therapy Department, University of Brasilia, Brasilia, Brazil
| | - Adriana M. Chiappa
- Intensive Medicine Service, Hospital de clinicas de Porto Alegre, Porto Alegre, Brazil
| | - Julio Zago
- Physical Therapy Department, University of Brasilia, Brasilia, Brazil
| | - Gaspar R. Chiappa
- Anhanguera Faculty of Porto Alegre, Avenida Cavalhada 4890, 91740-000
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Wang K, Zeng GQ, Li R, Luo YW, Wang M, Hu YH, Xu WH, Zhou LQ, Chen RC, Chen X. Cycle ergometer and inspiratory muscle training offer modest benefit compared with cycle ergometer alone: a comprehensive assessment in stable COPD patients. Int J Chron Obstruct Pulmon Dis 2017; 12:2655-2668. [PMID: 28919733 PMCID: PMC5593419 DOI: 10.2147/copd.s140093] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Cycle ergometer training (CET) has been shown to improve exercise performance of the quadriceps muscles in patients with COPD, and inspiratory muscle training (IMT) may improve the pressure-generating capacity of the inspiratory muscles. However, the effects of combined CET and IMT remain unclear and there is a lack of comprehensive assessment. MATERIALS AND METHODS Eighty-one patients with COPD were randomly allocated to three groups: 28 received 8 weeks of CET + IMT (combined training group), 27 received 8 weeks of CET alone (CET group), and 26 only received 8 weeks of free walking (control group). Comprehensive assessment including respiratory muscle strength, exercise capacity, pulmonary function, dyspnea, quality of life, emotional status, nutritional status, and body mass index, airflow obstruction, and exercise capacity index were measured before and after the pulmonary rehabilitation program. RESULTS Respiratory muscle strength, exercise capacity, inspiratory capacity, dyspnea, quality of life, depression and anxiety, and nutritional status were all improved in the combined training and CET groups when compared with that in the control group (P<0.05) after pulmonary rehabilitation program. Inspiratory muscle strength increased significantly in the combined training group when compared with that in the CET group (ΔPImax [maximal inspiratory pressure] 5.20±0.89 cmH2O vs 1.32±0.91 cmH2O; P<0.05). However, there were no significant differences in the other indices between the two groups (P>0.05). Patients with weakened respiratory muscles in the combined training group derived no greater benefit than those without respiratory muscle weakness (P>0.05). There were no significant differences in these indices between the patients with malnutrition and normal nutrition after pulmonary rehabilitation program (P>0.05). CONCLUSION Combined training is more effective than CET alone for increasing inspiratory muscle strength. IMT may not be useful when combined with CET in patients with weakened inspiratory muscles. Nutritional status had slight impact on the effects of pulmonary rehabilitation. A comprehensive assessment approach can be more objective to evaluate the effects of combined CET and IMT.
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Affiliation(s)
- Kai Wang
- Department of Respiratory Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Guang-Qiao Zeng
- Department of Respiratory Medicine, The State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Disease, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Rui Li
- Department of Respiratory Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Yu-Wen Luo
- Department of Respiratory Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Mei Wang
- Department of Respiratory Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Yu-He Hu
- Department of Respiratory Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Wen-Hui Xu
- Department of Respiratory Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Lu-Qian Zhou
- Department of Respiratory Medicine, The State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Disease, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Rong-Chang Chen
- Department of Respiratory Medicine, The State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Disease, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Xin Chen
- Department of Respiratory Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, China
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Effect of high-intensity home-based respiratory muscle training on strength of respiratory muscles following a stroke: a protocol for a randomized controlled trial. Braz J Phys Ther 2017; 21:372-377. [PMID: 28728960 PMCID: PMC5628364 DOI: 10.1016/j.bjpt.2017.06.017] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Revised: 12/09/2016] [Accepted: 12/12/2016] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Respiratory muscle training has shown to increase strength of the respiratory muscles following a stroke. However, low duration and/or intensity of training may be responsible for the small effect size seen and/or absence of carry-over effects to an activity, e.g., walking. Therefore, an investigation of the effects of long-duration, high-intensity respiratory muscle training is warranted. OBJECTIVE This proposed protocol for a randomized clinical trial will examine the efficacy of high-intensity respiratory muscle training to increase strength and improve activity following a stroke. METHODS This study will be a two-arm, prospectively registered, randomized controlled trial, with blinded assessors. Thirty-eight individuals who have suffered a stroke will participate. The experimental group will undertake a 40-min of respiratory muscle training program, seven days/week, for eight weeks in their homes. Training loads will be increased weekly. The control group will undertake a sham respiratory muscle training program with equivalent duration and scheduling of training. The primary outcome will be the strength of the inspiratory muscles, measured as maximal inspiratory pressure. Secondary outcomes will include expiratory muscle strength, inspiratory muscle endurance, dyspnea, respiratory complications, and walking capacity. Outcomes will be collected by a researcher blinded to group allocation at baseline (Week 0), after intervention (Week 8), and one month beyond intervention (Week 12). CONCLUSION High-intensity respiratory muscle training may have the potential to optimize the strength of the respiratory muscles following a stroke. If benefits are carried over to activity, the findings may have broader implications, since walking capacity has been shown to predict physical activity and community participation on this population.
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de Medeiros AIC, Fuzari HKB, Rattesa C, Brandão DC, de Melo Marinho PÉ. Inspiratory muscle training improves respiratory muscle strength, functional capacity and quality of life in patients with chronic kidney disease: a systematic review. J Physiother 2017; 63:76-83. [PMID: 28433237 DOI: 10.1016/j.jphys.2017.02.016] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Revised: 07/07/2016] [Accepted: 02/22/2017] [Indexed: 01/26/2023] Open
Abstract
QUESTION Does inspiratory muscle training improve respiratory muscle strength, functional capacity, lung function and quality of life of patients with chronic kidney disease? Does inspiratory muscle training improve these outcomes more than breathing exercises? DESIGN Systematic review and meta-analysis of randomised trials. PARTICIPANTS People with chronic kidney disease undergoing dialysis treatment. OUTCOME MEASURES The primary outcomes were: maximal inspiratory pressure, maximal expiratory pressure, and distance covered on the 6-minute walk test. The secondary outcomes were: forced vital capacity, forced expiratory volume in the first second (FEV1), and quality of life. RESULTS The search identified four eligible studies. The sample consisted of 110 participants. The inspiratory muscle training used a Threshold® or PowerBreathe® device, with a load ranging from 30 to 60% of the maximal inspiratory pressure and lasting from 6 weeks to 6 months. The studies showed moderate to high risk of bias, and the quality of the evidence was rated low or very low, due to the studies' methodological limitations. The meta-analysis showed that inspiratory muscle training significantly improved maximal inspiratory pressure (MD 23 cmH2O, 95% CI 16 to 29) and the 6-minute walk test distance (MD 80m, 95% CI 41 to 119) when compared with controls. Significant benefits in lung function and quality of life were also identified. When compared to breathing exercises, significant benefits were identified in maximal expiratory pressure (MD 6 cmH2O, 95% CI 2 to 10) and FEV1 (MD 0.24litres 95% CI 0.14 to 0.34), but not maximal inspiratory pressure or forced vital capacity. CONCLUSION In patients with chronic renal failure on dialysis, inspiratory muscle training with a fixed load significantly improves respiratory muscle strength, functional capacity, lung function and quality of life. The evidence for these benefits may be influenced by some sources of bias. REGISTRATION PROSPERO (CRD 42015029986). [de Medeiros AIC, Fuzari HKB, Rattesa C, Brandão DC, de Melo Marinho PÉ (2017) Inspiratory muscle training improves respiratory muscle strength, functional capacity and quality of life in patients with chronic kidney disease: a systematic review. Journal of Physiotherapy 63: 76-83].
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Affiliation(s)
| | | | - Catarina Rattesa
- Physiotherapy Department, Universidade Federal de Pernambuco, Recife, Brazil
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Nepomuceno Júnior BRV, Gómez TB, Gomes Neto M. Use of Powerbreathe® in inspiratory muscle training for athletes: systematic review. FISIOTERAPIA EM MOVIMENTO 2016. [DOI: 10.1590/1980-5918.029.004.ao19] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Abstract Introduction: Inspiratory muscle training (IMT) has been used as part of athletic training. It is beneficial due to an increase in respiratory capacity, and can be related to the optimization of exercise tolerance. There are a growing number of publications on the subject, however the methodological rigor of these publications is still unknown. Objective: To perform a systematic literature review in order to analyze the effects of Powerbreathe® on inspiratory muscle training by athletes. Methods: Original scientific studies published in English, from 2000 to 2015, were included. Their typology was classified. The literature search was performed in the Lilacs, Medline, Pubmed, and Scielo databases using the following keywords: inspiratory muscle training, athletes, and Sports medicine (in English), treinamento muscular inspiratório, atleta, medicina esportiva (in Portuguese). Results: Inspiratory muscle training with specific linear resistance has been used in some athletic training, and its results are promising. However, its application is still recent and generally supported by experiments with limited population and which do not properly define the confounding factors for the results. Conclusion: The state of the art suggests that IMT is useful as a respiratory therapy supporting the training of athletes for some specific sports. However, there is a scarcity of studies of high methodological quality, thus requiring further experiments on the subject.
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RAMSOOK ANDREWH, KOO RYAN, MOLGAT-SEON YANNICK, DOMINELLI PAOLOB, SYED NAFEEZ, RYERSON CHRISTOPHERJ, SHEEL ANDREWW, GUENETTE JORDANA. Diaphragm Recruitment Increases during a Bout of Targeted Inspiratory Muscle Training. Med Sci Sports Exerc 2016; 48:1179-86. [DOI: 10.1249/mss.0000000000000881] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Gomes-Neto M, Saquetto MB, Silva CM, Carvalho VO, Ribeiro N, Conceição CS. Effects of Respiratory Muscle Training on Respiratory Function, Respiratory Muscle Strength, and Exercise Tolerance in Patients Poststroke: A Systematic Review With Meta-Analysis. Arch Phys Med Rehabil 2016; 97:1994-2001. [PMID: 27216224 DOI: 10.1016/j.apmr.2016.04.018] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Revised: 04/25/2016] [Accepted: 04/27/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To examine the effects of respiratory muscle training on respiratory function, respiratory muscle strength, and exercise tolerance in patients poststroke. DATA SOURCES We searched MEDLINE, Cochrane Library, Embase, SciELO, Physiotherapy Evidence Database (PEDro), and CINAHL (from the earliest date available to November 2015) for trials. STUDY SELECTION Randomized controlled trials (RCTs) that examined the effects of respiratory muscle training versus nonrespiratory muscle training in patients poststroke. Two reviewers selected studies independently. DATA EXTRACTION Extracted data from the published RCTs. Study quality was evaluated using the PEDro Scale. Weighted mean differences (WMDs), standard mean differences (SMDs), and 95% confidence intervals (CIs) were calculated. DATA SYNTHESIS Eight studies met the study criteria. Respiratory muscle training improved maximal inspiratory pressure WMDs (7.5; 95% CI, 2.7-12.4), forced vital capacity SMDs (2.0; 95% CI, 0.6-3.4), forced expiratory volume at 1 second SMDs (1.2; 95% CI, 0.6-1.9), and exercise tolerance SMDs (0.7; 95% CI, 0.2-1.2). No serious adverse events were reported. CONCLUSIONS Respiratory muscle training should be considered an effective method of improving respiratory function, inspiratory muscle strength, and exercise tolerance in patients poststroke. Further research is needed to determine optimum dosages and duration of effect.
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Affiliation(s)
- Mansueto Gomes-Neto
- Department of Physical Therapy, Federal University of Bahia, Salvador, Bahia, Brazil; Postgraduate Program in Medicine and Health - UFBA, Salvador, Bahia, Brazil; The GREAT Group (Study Group on Physical Activity), Aracaju, Sergipe, Brazil.
| | - Micheli Bernardone Saquetto
- Department of Physical Therapy, Federal University of Bahia, Salvador, Bahia, Brazil; Postgraduate Program in Medicine and Health - UFBA, Salvador, Bahia, Brazil
| | | | - Vitor Oliveira Carvalho
- The GREAT Group (Study Group on Physical Activity), Aracaju, Sergipe, Brazil; Department of Physical Therapy, Federal University of Sergipe, Aracaju, Sergipe, Brazil
| | - Nildo Ribeiro
- Department of Physical Therapy, Federal University of Bahia, Salvador, Bahia, Brazil
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Mantoani LC, Rubio N, McKinstry B, MacNee W, Rabinovich RA. Interventions to modify physical activity in patients with COPD: a systematic review. Eur Respir J 2016; 48:69-81. [DOI: 10.1183/13993003.01744-2015] [Citation(s) in RCA: 113] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Accepted: 03/04/2016] [Indexed: 12/28/2022]
Abstract
The broad range of interventions to increase physical activity (PA) in patients with chronic obstructive pulmonary disease (COPD) has not been systematically assessed. We aimed to perform a systematic review of the interventional studies that have assessed PA as an outcome in patients with COPD.A systematic search in five different databases (Medline, Embase, PsycINFO, CINAHL and Web of Science) was performed in March 2015. Two independent reviewers analysed the studies against the inclusion criteria (COPD defined by spirometry; prospective, randomised/nonrandomised studies, cohort and experimental studies with interventions using PA as an outcome), extracted the data and assessed the quality of evidence.60 studies were included. Seven intervention groups were identified. PA counselling increased PA levels in COPD, especially when combined with coaching. 13 studies showed positive effects of pulmonary rehabilitation (PR) on PA, while seven studies showed no changes. All three PR programmes >12 weeks in duration increased PA. Overall, the quality of evidence was graded as very low.Interventions focusing specifically on increasing PA, and longer PR programmes, may have greater impacts on PA in COPD. Well-designed clinical trials with objective assessment of PA in COPD patients are needed.
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Triest FJ, Singh SJ, Vanfleteren LE. Cardiovascular risk, chronic obstructive pulmonary disease and pulmonary rehabilitation: Can we learn from cardiac rehabilitation? Chron Respir Dis 2016; 13:286-94. [PMID: 27081189 DOI: 10.1177/1479972316642367] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Patients with chronic obstructive pulmonary disease (COPD) who participate in pulmonary rehabilitation (PR) often have concomitant cardiovascular disease (CVD), which is a frequently undiagnosed and undertreated comorbidity. CVD contributes to the burden of the disease and is associated with an increased risk for hospitalizations and mortality. Optimizing the diagnosis and management of cardiovascular risk and disease should be considered as part of the holistic approach of PR. In addition, we need to consider similarities and differences in cardiac and PR programs, in order to improve personalized care in patients with both diseases. The current review addresses the burden of CVD in COPD patients who participate in PR, how CVD and its risk factors affect PR and should be managed during PR, and extends on what we can learn of the organization of cardiac rehabilitation programs.
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Affiliation(s)
- Filip Jj Triest
- Department of Research and Education, Centre of Expertise for Chronic Organ Failure (CIRO+), Horn, the Netherlands Department of Respiratory Medicine, Maastricht University Medical Centre (MUMC+), Maastricht, the Netherlands
| | - Sally J Singh
- Centre for Exercise and Rehabilitation Science, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Lowie Egw Vanfleteren
- Department of Research and Education, Centre of Expertise for Chronic Organ Failure (CIRO+), Horn, the Netherlands Department of Respiratory Medicine, Maastricht University Medical Centre (MUMC+), Maastricht, the Netherlands
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Janssens L, McConnell AK, Pijnenburg M, Claeys K, Goossens N, Lysens R, Troosters T, Brumagne S. Inspiratory muscle training affects proprioceptive use and low back pain. Med Sci Sports Exerc 2016; 47:12-9. [PMID: 24870567 DOI: 10.1249/mss.0000000000000385] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
PURPOSE We have shown that individuals with recurrent nonspecific low back pain (LBP) and healthy individuals breathing against an inspiratory load decrease their reliance on back proprioceptive signals in upright standing. Because individuals with LBP show greater susceptibility to diaphragm fatigue, it is reasonable to hypothesize that LBP, diaphragm dysfunction, and proprioceptive use may be interrelated. The purpose of this study was to investigate whether inspiratory muscle training (IMT) affects proprioceptive use during postural control in individuals with LBP. METHODS Twenty-eight individuals with LBP were assigned randomly into a high-intensity IMT group (high IMT) and low-intensity IMT group (low IMT). The use of proprioception in upright standing was evaluated by measuring center of pressure displacement during local muscle vibration (ankle, back, and ankle-back). Secondary outcomes were inspiratory muscle strength, severity of LBP, and disability. RESULTS After high IMT, individuals showed smaller responses to ankle muscle vibration, larger responses to back muscle vibration, higher inspiratory muscle strength, and reduced LBP severity (P < 0.05). These changes were not seen after low IMT (P > 0.05). No changes in disability were observed in either group (P > 0.05). CONCLUSIONS After 8 wk of high IMT, individuals with LBP showed an increased reliance on back proprioceptive signals during postural control and improved inspiratory muscle strength and severity of LBP, not seen after low IMT. Hence, IMT may facilitate the proprioceptive involvement of the trunk in postural control in individuals with LBP and thus might be a useful rehabilitation tool for these patients.
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Affiliation(s)
- Lotte Janssens
- 1KU Leuven Department of Rehabilitation Sciences, University of Leuven, Leuven, BELGIUM; 2Centre for Sports Medicine and Human Performance, Brunel University, Uxbridge, UNITED KINGDOM; 3KU Leuven Department of Rehabilitation Sciences, University of Leuven, Kulab, Bruges, BELGIUM; 4Department of Physical Medicine and Rehabilitation, University Hospitals Leuven, Leuven, BELGIUM; 5Respiratory Rehabilitation and Respiratory Division, University Hospitals Leuven, Leuven, BELGIUM
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Efficacy of a Novel Method for Inspiratory Muscle Training in People With Chronic Obstructive Pulmonary Disease. Phys Ther 2015; 95:1264-73. [PMID: 25858974 DOI: 10.2522/ptj.20140245] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2014] [Accepted: 03/23/2015] [Indexed: 02/09/2023]
Abstract
BACKGROUND Most inspiratory muscle training (IMT) interventions in patients with chronic obstructive pulmonary disease (COPD) have been implemented as fully supervised daily training for 30 minutes with controlled training loads using mechanical threshold loading (MTL) devices. Recently, an electronic tapered flow resistive loading (TFRL) device was introduced that has a different loading profile and stores training data during IMT sessions. OBJECTIVE The aim of this study was to compare the efficacy of a brief, largely unsupervised IMT protocol conducted using either traditional MTL or TFRL on inspiratory muscle function in patients with COPD. DESIGN Twenty patients with inspiratory muscle weakness who were clinically stable and participating in a pulmonary rehabilitation program were randomly allocated to perform 8 weeks of either MTL IMT or TFRL IMT. METHODS Participants performed 2 daily home-based IMT sessions of 30 breaths (3-5 minutes per session) at the highest tolerable intensity, supported by twice-weekly supervised sessions. Adherence, progression of training intensity, increases in maximal inspiratory mouth pressure (Pimax), and endurance capacity of inspiratory muscles (Tlim) were evaluated. RESULTS More than 90% of IMT sessions were completed in both groups. The TFRL group tolerated higher loads during the final 3 weeks of the IMT program, with similar effort scores on the 10-Item Borg Category Ratio (CR-10) Scale, and achieved larger improvements in Pimax and Tlim than the MTL group. LIMITATIONS A limitation of the study was the absence of a study arm involving a sham IMT intervention. CONCLUSIONS The short and largely home-based IMT protocol significantly improved inspiratory muscle function in both groups and is an alternative to traditional IMT protocols in this population. Participants in the TFRL group tolerated higher training loads and achieved larger improvements in inspiratory muscle function than those in the MTL group.
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Wang Y, Zhang J, Feng J, Cao J, Chen BY. A Study of Patients with "Interface Respiratory Failure" Due to Chronic Obstructive Pulmonary Diseases. W INDIAN MED J 2015; 64:81-6. [PMID: 26360678 PMCID: PMC4696623 DOI: 10.7727/wimj.2014.028] [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: 02/04/2014] [Accepted: 04/01/2014] [Indexed: 11/12/2023]
Abstract
OBJECTIVE To explain a definition of "interface respiratory failure" as arterial blood gas assay with arterial oxygen partial pressure in the range of 60-75 mmHg. SUBJECTS AND METHODS We compared arterial blood gases (ABGs), resting respiratory drive and its derivatives, mechanics of respiratory muscles, resistance and compliance of the respiratory tract and some important cytokines (interleukin-4 and interferon-γ) of stable chronic obstructive pulmonary disease (COPD) subgroups (total 50 cases) and control group (25 cases). RESULTS The patients attaining the "interface respiratory failure" stage developed great changes in respiratory mechanics parameters and inflammatory mediator, which might cause the exacerbation of COPD and the inclination to generate "real respiratory failure" and COPD progression. CONCLUSIONS The definition of interface respiratory failure is scientific, direct and its width is appropriate. We should intervene appropriately and positively to avoid progression from "interface respiratory failure" to the "real respiratory failure" stage, and this avoidance means a higher survival rate and a lower medical expense. Interventions should focus on oxygen therapy, bronchodilators, improving respiratory compliance, cytokines and anti-infective agents, respectively.
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Affiliation(s)
- Y Wang
- Respiratory Department of Tianjin Medical University General Hospital, Tianjin 300052, China
| | - J Zhang
- Respiratory Department of Tianjin Medical University General Hospital, Tianjin 300052, China
| | - J Feng
- Respiratory Department of Tianjin Medical University General Hospital, Tianjin 300052, China.
| | - J Cao
- Respiratory Department of Tianjin Medical University General Hospital, Tianjin 300052, China
| | - B-Y Chen
- Respiratory Department of Tianjin Medical University General Hospital, Tianjin 300052, China
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Paiva DN, Assmann LB, Bordin DF, Gass R, Jost RT, Bernardo-Filho M, França RA, Cardoso DM. Inspiratory muscle training with threshold or incentive spirometry: Which is the most effective? REVISTA PORTUGUESA DE PNEUMOLOGIA 2015; 21:76-81. [PMID: 25926370 DOI: 10.1016/j.rppnen.2014.05.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2014] [Accepted: 05/24/2014] [Indexed: 10/24/2022] Open
Abstract
Inspiratory muscular training (IMT) increases the respiratory muscle strength, however, there is no data demonstrating its superiority over the incentive spirometry (IS) in doing so. Values of muscle strength after IMT (Threshold IMT(®)) and by the IS (Voldyne(®)) in healthy females was compared. Subjects (n=40) were randomly divided into control group (CG, n=14), IS group (ISG, n=13) and threshold group (TG, n=13). PImax was measured before (pre-IMT), at 15 and 30 days of IMT. There was an increase in PImax of the TG at 15 days (p<0.001) and 30 days of IMT (p<0.001). The same occurred with the ISG, which increased the PImax at 15 days (p<0.001) and 30 days of training (p<0.001). After 30 days of IMT, the TG presented a PImax which was significantly higher than ISG and the CG (p=0.045 and p<0.001, respectively). It can be concluded that IMT by threshold was more effective in increasing muscle strength than the Voldyne.
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Affiliation(s)
- Dulciane Nunes Paiva
- Pos Graduate Course in Health Promotion, University of Santa Cruz do Sul (UNISC), Santa Cruz do Sul, RS, Brazil; Physical Therapy Course, University of Santa Cruz do Sul (UNISC), Santa Cruz do Sul, RS, Brazil
| | - Laíse Bender Assmann
- Physical Therapy Course, University of Santa Cruz do Sul (UNISC), Santa Cruz do Sul, RS, Brazil
| | - Diogo Fanfa Bordin
- Physical Therapy Course, University of Santa Cruz do Sul (UNISC), Santa Cruz do Sul, RS, Brazil
| | - Ricardo Gass
- Physical Therapy Course, University of Santa Cruz do Sul (UNISC), Santa Cruz do Sul, RS, Brazil
| | - Renan Trevisan Jost
- Faculty of Medicine, Catholic University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Mario Bernardo-Filho
- Department of Biophysics and Biometry, State University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | | | - Dannuey Machado Cardoso
- Physical Therapy Course, University of Santa Cruz do Sul (UNISC), Santa Cruz do Sul, RS, Brazil
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