Effect of Pilates exercises on pulmonary function, respiratory muscle strength, and functional capacity in patients with inhalation injury after flame thermal burn: A prospective randomized controlled trial

BACKGROUND

Inhalation injury is an acute respiratory tract injury that occurrs by inhalation of smoke, toxic gases, or steam. Early management is needed to reduce its mortality and morbidity. The purpose of this study was to ascertain whether Pilates training could help burn patients with inhalation injury after flame thermal burn in increasing pulmonary function, respiratory muscle strength, and functional ability.

METHODS

In this prospective, randomized, controlled trial, sixty participants (26 males and 34 females) with inhalation injury and deep partial-thickness flame burns of 30-40 % total body surface area (TBSA) were randomized in blocks of four, with a 1:1 allocation ratio into two groups: Group A (Pilates Group); received Pilates training plus conventional physical therapy program, and Group B (Control Group); received conventional physical therapy program only. This study was conducted at the Faculty of Physical Therapy's outpatient clinic, Cairo University, 3 sessions/week for 12 weeks. The primary outcome measure was the forced vital capacity (FVC) measured by a spirometer, while the secondary outcome measures were peak expiratory flow rate (PEFR), forced expiratory volume in 1 s (FEV1), FEV1/FVC% assessed by a spirometer, strength of respiratory muscles (maximum inspiratory pressure (MIP) and maximum expiratory pressure (MEP) assessed by the digital manovacuometer, and the functional capacity evaluated by 6-Minute Walk Test (6-MWT).

RESULTS

A two-way mixed-design MANOVA was used to analyze the results within and between groups. There were no significant differences in demographic data between groups (P > 0.05). There were significant differences in all variables after treatment in group A compared with group B; FVC (95 % CI: 0.38, 1.13) (P = 0.001), FEV1 (95 % CI: 0.39, 0.97) (P = 0.001), FEV1/FVC % (95 % CI: 1.90, 17.19) (P = 0.02), PEFR (95 % CI: 0.47, 0.99) (P = 0.001), MIP (95 % CI: 5.12, 11.44) (P = 0.001), MEP (95 % CI: 2.57, 8.24) (P = 0.001), 6-MWT (95 % CI: 27.22, 54.96) (P = 0.001), FVC (% predicted) (95 % CI: 3.58, 12.58) (P = 0.001), FEV1 (% predicted) (95 % CI: 1.21, 11.11) (P = 0.02), PEFR (% predicted) (95 % CI: 1.33, 10.83) (P = 0.01), MIP (% predicted) (95 % CI: 2.26, 11.72) (P = 0.001) and MEP (% predicted) (95 % CI: 1.33, 10.37) (P = 0.01).

CONCLUSION

The current study demonstrated that a Pilates exercise program in addition to a traditional physical therapy program for 12 weeks significantly improved the pulmonary function (FVC, FEV1, PEFR and FEV1/FEV), strength of respiratory muscles (MIP and MEP), and functional capacity (6-MWT) in patients with inhalation injury after flame burns. These results underscore the importance of including Pilates exercises in the rehabilitation plan for burn patients with inhalation injury. Future studies are needed to evaluate the effect of Pilates exercises on other degrees and TBSA of burn, long-term follow up, and to measure cardiopulmonary parameters.

Normative values and prediction equations for the modified incremental step test in healthy adults aged 18-83 years

OBJECTIVE

To establish normative values and reference equations for predicting the number of steps and oxygen consumption (VO2) from the modified incremental step test (MIST) in healthy adults aged 18-83 years.

DESIGN

Prospective observational study.

PARTICIPANTS

One hundred and ninety-four healthy adults aged 18-83 years with normal spirometry.

SETTINGS

Exercise physiology laboratory of a university.

METHODS

Participants underwent two MISTs (30 minutes apart). The MIST was performed on a 20-cm-high step using an externally paced rhythm imposed by audible signals, starting with 10 steps per minute and with constant increments of 1 step every 30 seconds.

MAIN OUTCOMES

Number of steps and VO2 obtained from MIST.

RESULTS

Normative values were provided for males and females for each age group. The following equations were determined: number of steps = 675.113 + (66.165*sex, 0 female and 1 male) - (5.353*age) - (6.593*body mass index) (R² =0.44, P < 0.001); VO2 = 0.106 + (0.216*sex, 0 female and 1 male) - (0.008*age [years]) + (0.021*weight [kilograms]) + (0.001*number of steps) (R² =0.80, P < 0.001).

CONCLUSION

Normative values and prediction equations are proposed for the number of steps and VO2 which can be used to interpret performance on the MIST in individuals with different health conditions. These equations now need validation in other samples.

The effects of Pilates training on respiratory muscle strength in patients with ankylosing spondylitis

BACKGROUND

Reduction in flexibility and mobility are important factors that lead to impairments in quality of life, reduction of exercise tolerance, and a decreased pulmonary capacity with the progression of Ankylosing Spondylitis (AS).

AIM

The purpose of this study was to investigate the effects of Pilates exercises on mobility, quality of life, and respiratory muscle strength in patients with AS.

METHODS

Forty patients with AS were randomly divided into two groups as Pilates group and the control group. The Pilates group performed Pilates exercises in supervised group sessions and the control group performed conventional exercises at home three days a week for eight weeks. The main outcome measure was respiratory muscle strength. Secondary outcome measures were forced vital capacity (FVC), forced expiratory volume in one second (FEV1) FEV1/FVC ratio, chest expansion, Bath indices (BASDAI, BASMI), Ankylosing Spondylitis Quality of Life Questionnaire (ASQoL) and six-minute walk test (6MWT). All participants were assessed by a blind assessor at baseline and the end of eight weeks.

RESULTS

Thirty-six AS patients (n = 19 in the Pilates group, n = 17 in the control group) completed the study. Respiratory muscle strength, FEV1/FVC, chest expansion, BASDAI, BASMI, ASQoL, and 6MWT significantly improved at the 8th week (p < .05) in the Pilates group, while inspiratory muscle strength, FEV1/FVC, chest expansion, and 6MWT showed significant improvements in the control group at 8th week compared to baseline (p < .05). No significant between-group differences were observed when the change over time values were compared (Δ).

CONCLUSION

Both Pilates and home exercises seem to be effective for improving respiratory parameters and functional status in patients with AS. Pilates exercises without using any equipment and additional exercises is found to be useful for improving respiratory functions and disease-related symptoms.

Exercise training for adults undergoing maintenance dialysis

BACKGROUND

Dialysis treatments weigh heavily on patients' physical and psychosocial health. Multiple studies have assessed the potential for exercise training to improve outcomes in adults undergoing dialysis. However, uncertainties exist in its relevance and sustainable benefits for patient-important outcomes. This is an update of a review first published in 2011.

OBJECTIVES

To assess the benefits and safety of regular structured exercise training in adults undergoing dialysis on patient-important outcomes including death, cardiovascular events, fatigue, functional capacity, pain, and depression. We also aimed to define the optimal prescription of exercise in adults undergoing dialysis.

SEARCH METHODS

In this update, we conducted a systematic search of the Cochrane Kidney and Transplant Register of Studies up to 23 December 2020. The Register includes studies identified from CENTRAL, MEDLINE, EMBASE, the International Clinical Trials Register (ICTRP) Search Portal and ClinicalTrials.gov as well as kidney-related journals and the proceedings of major kidney conferences.

SELECTION CRITERIA

Randomised controlled trials (RCTs) and quasi-RCTs of any structured exercise programs of eight weeks or more in adults undergoing maintenance dialysis compared to no exercise or sham exercise.

DATA COLLECTION AND ANALYSIS

Two authors independently assessed the search results for eligibility, extracted the data and assessed the risk of bias using the Cochrane risk of bias tool. Whenever appropriate, we performed random-effects meta-analyses of the mean difference in outcomes. The primary outcomes were death (any cause), cardiovascular events and fatigue. Secondary outcomes were health-related quality of life (HRQoL), depression, pain, functional capacity, blood pressure, adherence to the exercise program, and intervention-related adverse events.

MAIN RESULTS

We identified 89 studies involving 4291 randomised participants, of which 77 studies (3846 participants) contributed to the meta-analyses. Seven studies included adults undergoing peritoneal dialysis. Fifty-six studies reported aerobic exercise interventions, 21 resistance exercise interventions and 19 combined aerobic and resistance training within the same study arm. The interventions lasted from eight weeks to two years and most often took place thrice weekly during dialysis treatments. A single study reported death and no study reported long-term cardiovascular events. Five studies directly assessed fatigue, 46 reported HRQoL and 16 reported fatigue or pain through their assessment of HRQoL. Thirty-five studies assessed functional capacity, and 21 reported resting peripheral blood pressure. Twelve studies reported adherence to exercise sessions, and nine reported exercise-related adverse events. Overall, the quality of the included studies was low and blinding of the participants was generally not feasible due to the nature of the intervention. Exercise had uncertain effects on death, cardiovascular events, and the mental component of HRQoL due to the very low certainty of evidence. Compared with sham or no exercise, exercise training for two to 12 months may improve fatigue in adults undergoing dialysis, however, a meta-analysis could not be conducted. Any exercise training for two to 12 months may improve the physical component of HRQoL (17 studies, 656 participants: MD 4.12, 95% CI 1.88 to 6.37 points on 100 points-scale; I² = 49%; low certainty evidence). Any exercise training for two to 12 months probably improves depressive symptoms (10 studies, 441 participants: SMD -0.65, 95% CI -1.07 to -0.22; I² = 77%; moderate certainty evidence) and the magnitude of the effect may be greater when maintaining the exercise beyond four months (6 studies, 311 participants: SMD -0.30, 95% CI 0.14 to -0.74; I² = 71%). Any exercise training for three to 12 months may improve pain (15 studies, 872 participants: MD 5.28 95% CI -0.12 to 10.69 points on 100 points-scale; I² = 63%: low certainty evidence) however, the 95% CI indicates that exercise training may make little or no difference in the level of pain. Any exercise training for two to six months probably improves functional capacity as it increased the distance reached during six minutes of walking (19 studies, 827 participants: MD 49.91 metres, 95% CI 37.22 to 62.59; I² = 34%; moderate certainty evidence) and the number of sit-to-stand cycles performed in 30 seconds (MD 2.33 cycles, 95% CI 1.71 to 2.96; moderate certainty evidence). There was insufficient evidence to assess the safety of exercise training for adults undergoing maintenance dialysis. The results were similar for aerobic exercise, resistance exercise, and a combination of both aerobic and resistance exercise.

AUTHORS' CONCLUSIONS

It is uncertain whether exercise training improves death, cardiovascular events, or the mental component of HRQoL in adults undergoing maintenance dialysis. Exercise training probably improves depressive symptoms, particularly when the intervention is maintained beyond four months. Exercise training is also likely to improve functional capacity. Low certainty evidence suggested that exercise training may improve fatigue, the physical component of quality of life, and pain. The safety of exercise training for adults undergoing dialysis remains uncertain.

Cardiorespiratory Adaptation to Pilates Training

Several authors report health improvements with training based on the Pilates Method; however, no explicit analysis has been performed on cardiorespiratory effects after Method exclusive training. Purpose: The purpose of this study was to evaluate the effects of 15 weeks of Pilates training on cardiorespiratory fitness in young, sedentary women. Method: A total of 13 sedentary women 21-35 years volunteered and signed an informed consent for the observational study of a single group, performing control-test, pre- and post-exercise measurements. The Pilates program was conducted for 15 weeks, with two 50-min sessions per week. Cardiorespiratory responses were assessed using an open circuit ergospirometry system by gas analyzer (MGC, model CPX/D). Results: During the 15-week program, statistically significant advances were observed in maximum oxygen consumption F (1.25; 13.78) = 18.95; p =.001; ω² =.858 with large effect size (r =.81; p <.001), first ventilatory threshold F (1.19; 13.15) = 20.43; p =.001; ω2 =.034 with large effect size (r =.77; p <.05) and second ventilatory threshold F (1.18; 13.00) = 24.56; p =.001 also presenting a large effect size (r =.85; p <.05). Conclusion: These results indicate that practicing Pilates for 30 × 50 min sessions had a positive influence on cardiorespiratory parameters in healthy sedentary women with low respiratory capacities.

The effects of core stabilization training on dynamic balance and pulmonary parameters in patients with asthma

BACKGROUND

In the literature, novel physiotherapy and rehabilitation approaches are getting significant attention as a way to cope with secondary complications in the management of asthma.

OBJECTIVE

To investigate the effectiveness of core stabilization exercises combined with the Asthma Education Program (AEP) and breathing exercises in patients with asthma.

METHODS

The study sample consists of 40 asthmatic patients (age 52.25 ± 11.51 years) who were randomly divided into a Training Group (TG) (n= 20) and a Control Group (CG) (n= 20). All subjects were included in the AEP, and both groups were trained in breathing retraining exercises (2 times/wk, 6-week duration in the clinic). The core stabilization exercise program was also applied in the TG. Respiratory muscle strength (maximum inspiratory and expiratory pressures), physical activity level (International Physical Activity Questionnaire Short Form (IPAQ)), health-related quality of life (Asthma Quality of Life Questionnaire (AQOL)), functional exercise capacity (six-minute walking test (6MWT)), and dynamic balance (Prokin PK200) were assessed before and after the interventions.

RESULTS

The TG showed more significant improvements in MIP (ΔTG:4.55 cmH2O, ΔCG:0.95 cmH2O), IPAQ (ΔTG:334.15 MET-min/wk., ΔCG:99 MET-min/wk.), 6MWT (ΔTG:24.50 m, ΔCG:11.50 m), and dynamic balance sub-parameters compared to the mean difference between the initial assessment and after a 6-week intervention program, which included twelve exercise sessions (p< 0.01).

CONCLUSIONS

The findings present greater improvements in inspiratory muscle strength, physical activity level, functional exercise capacity, and dynamic balance when core stabilization exercises are included in the pulmonary rehabilitation program for the management of asthma.

Conventional and Virtual Reality Mirror Therapies in Upper Obstetric Brachial Palsy: A Randomized Pilot Study

The abilities of children diagnosed with Obstetric Brachial Palsy (OBP) are limited by brachial plexus injuries. Thus, their participation in the community is hindered, which involves a lower quality of life due to worse performance in activities of daily living as a consequence of the functional limitations of the affected upper limb. Conventional Mirror Therapy (Conventional MT) and Virtual Therapy improve the affected upper limb functionality. Therefore, the aim of this study was to compare the effects of Conventional MT and Virtual Reality MT on the spontaneous use of the affected upper limb and quality of life of children with upper Obstetric Brachial Palsy between 6 and 12 years of age. A randomized pilot study was performed. Twelve children were randomly assigned to perform Conventional Mirror Therapy or Virtual Reality Mirror Therapy for four weeks. Ten children completed the treatment. Two assessments (pre/post-intervention) were carried out to assess the spontaneous use of the affected upper limb and the quality of life using the Children’s Hand-use Experience Questionnaire (CHEQ) and the Pediatric Quality of Life Inventory Generic Core Scales (PedsQL TM 4.0), respectively. There was a statistically significant increment in spontaneous use, observed in independent tasks (p = 0.02) and in the use of the affected hand with grasp (p = 0.04), measured with the CHEQ, for the Virtual Reality MT group. There were no statistically significant changes (p > 0.05) for the Conventional MT group in the spontaneous use of the affected upper limb. Regarding the quality of life, statistically significant changes were obtained in the Physical and Health activity categories of the parents’ questionnaire (p = 0.03) and in the total score of the children’s questionnaire (p = 0.04) in the Virtual Reality MT group, measured using the PedsQL TM 4.0. Statistically significant changes were not obtained for the quality of life in the Conventional MT group. This study suggests that, compared to Conventional MT, Virtual Reality MT would be a home-based therapeutic complement to increase independent bimanual tasks using grasp in the affected upper limb and improve the quality of life of children diagnosed with upper OBP in the age range of 6–12 years.

Pilates Method Improves Cardiorespiratory Fitness: A Systematic Review and Meta-Analysis

Cardiorespiratory fitness has been postulated as an independent predictor of several chronic diseases. We aimed to estimate the effect of Pilates on improving cardiorespiratory fitness and to explore whether this effect could be modified by a participant's health condition or by baseline VO2 max levels. We searched databases from inception to September 2019. Data were pooled using a random effects model. The Cochrane risk of bias (RoB 2.0) tool and the Quality Assessment Tool for Quantitative Studies were performed. The primary outcome was cardiorespiratory fitness measured by VO2 max. The search identified 527 potential studies of which 10 studies were included in the systematic review and 9 in the meta-analysis. The meta-analysis showed that Pilates increased VO2 max, with an effect size (ES) = 0.57 (95% CI: 0.15-1; I2 = 63.5%, p = 0.018) for the Pilates group vs. the control and ES = 0.51 (95% CI: 0.26-0.76; I2 = 67%, p = 0.002) for Pilates pre-post effect. The estimates of the pooled ES were similar in both sensitivity and subgroup analyses; however, random-effects meta-regressions based on baseline VO2 max were significant. Pilates improves cardiorespiratory fitness regardless of the population's health status. Therefore, it may be an efficacious alternative for both the healthy population and patients suffering from specific disorders to achieve evidenced-based results from cardiorespiratory and neuromotor exercises.

Effects of mat Pilates training and habitual physical activity on thoracoabdominal expansion during quiet and vital capacity breathing in healthy women

BACKGROUND

Pilates is a body/mind method that requires different types of exercise (balance, endurance, strength, and flexibility) and attention to muscle control, posture, and breathing. The aim of the present study was to investigate the effects of 12 weeks of mat Pilates training and habitual physical activity on thoracoabdominal motion of healthy and physically active women.

METHODS

Thirty-five women without experience in Pilates exercise, aged between 18 and 35 years, participated in the study (habitual physical activity group: N.=14; and mat Pilates group: N.=21). Three-dimensional kinematic analysis was used to evaluate total and separate thoracoabdominal compartments' expansion (superior and inferior thorax and abdomen), contribution of each compartment to total thoracoabdominal expansion, and coordination between thoracoabdominal compartments.

RESULTS

After 12 weeks of mat Pilates training, thoracoabdominal expansion during quiet breathing was improved by increasing the expansion of abdomen by about 33% (P=0.01). Moreover, expansion of superior (P=0.04) and inferior thorax (P=0.02) and abdomen (P=0.01) was also improved in Pilates (35%, 33%, and 37%, respectively) compared to the habitual physical activity group, after the experimental protocol. Finally, the habitual physical activity group presented a decrease of 13% in the expansion of abdomen (P=0.002).

CONCLUSIONS

The results suggest the capability of Mat Pilates in improving the action of respiratory and abdominal muscles during breathing and, thus, its benefits to breathing mechanics.