1
|
Liu F, Jones AYM, Tsang RCC, Yam TTT, Hao Y, Tsang WWN. Effects of inspiratory muscle training on pulmonary function, diaphragmatic thickness, balance and exercise capacity in people after stroke: a systematic review and meta-analysis. Disabil Rehabil 2024:1-16. [PMID: 39363485 DOI: 10.1080/09638288.2024.2408606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2024] [Revised: 09/14/2024] [Accepted: 09/17/2024] [Indexed: 10/05/2024]
Abstract
PURPOSE To examine the effects of inspiratory muscle training (IMT) on pulmonary and diaphragmatic function, exercise capacity, balance and quality of life (QOL), in post-stroke individuals. METHODS A literature search was conducted using MEDLINE, CINAHL, EMBASE, PubMed, PEDro, Web of Science and China Biological Medicine databases. Randomized controlled trials (RCTs) with a PEDro score ≥6 focusing on the effects of IMT were included. The GRADE system was used to determine the certainty of evidence for each outcome. RESULTS Nine studies (255 participants) were included. IMT significantly increased forced expiratory volume in one second (FEV1) (4 studies, 112 participants, mean difference (MD)=0.18 litre, 95% confidence interval (CI): 0.14-0.23); maximal inspiratory pressure (MIP) (8 studies, 226 participants, MD = 6.37 cm H2O, 95% CI: 1.26-11.49); and diaphragm thickness fraction (DTf) on both sides (MD of affected side vs. unaffected side: 51 vs. 37%). The evidence certainty for diaphragmatic function was moderate. No significant change was observed in forced vital capacity (FVC), balance function, exercise capacity and QOL. CONCLUSION This review reveals moderate evidence certainty in support of IMT improving diaphragmatic function. It appears that a training intensity between 30 and 50% MIP results in a significantly improved MIP.
Collapse
Affiliation(s)
- Fang Liu
- Department of Physiotherapy, School of Nursing and Health Sciences, Hong Kong Metropolitan University, Hong Kong, China
| | - Alice Y M Jones
- School of Health and Rehabilitation Sciences, The University of Queensland, Queensland, Australia
| | - Raymond C C Tsang
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, China
| | - Timothy T T Yam
- Department of Physiotherapy, School of Nursing and Health Sciences, Hong Kong Metropolitan University, Hong Kong, China
| | - Yingzi Hao
- School of Rehabilitation Medicine, The Shandong University of Traditional Chinese Medicine, Shandong, China
| | - William W N Tsang
- Department of Physiotherapy, School of Nursing and Health Sciences, Hong Kong Metropolitan University, Hong Kong, China
| |
Collapse
|
2
|
Lin TK, Chen MY, Cheng HH, Chow J, Chen CM, Chou W. Effectiveness of abdominal sandbag training in enhancing diaphragm muscle function and exercise tolerance in patients with chronic respiratory failure. J Formos Med Assoc 2024; 123:1087-1092. [PMID: 38302365 DOI: 10.1016/j.jfma.2024.01.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Revised: 01/13/2024] [Accepted: 01/20/2024] [Indexed: 02/03/2024] Open
Abstract
BACKGROUND Chronic respiratory failure is a common cause of ventilator dependence in the intensive care unit (ICU). The causes of chronic respiratory failure include primary disease or complications, such as ICU-acquired weakness. Traditional practice requires patients to remain immobile and bedridden; however, recent evidence suggests that early adequate exercise promotes recovery without increasing risks. In this study, we explored the efficacy of planned progressive abdominal sandbag training in promoting the successful withdrawal of patients with chronic respiratory failure from mechanical ventilation. METHODS This study was conducted between April 2019 and November 2020. Patients were recruited and divided into two groups: abdominal sandbag training group and control group (no training). The training group participated in a 3-month daily pulmonary rehabilitation program, which involved a 30-min session of progressive sandbag loading on the upper abdomen as a form of diaphragmatic resistant exercise. The pressure support level of the ventilator was adjusted to maintain a tidal volume of 8 mL/kg. To investigate the effect of abdominal sandbag training on patients with chronic respiratory failure, we compared tidal volume, shallow breathing index, maximum respiratory pressure, and diaphragm characteristics between the training and control groups. RESULTS This study included 31 patients; of them, 17 (54.8 %) received abdominal sandbag training and 14 (45.2 %) did not. No significant between-group difference was found in baseline characteristics. Compared with the control group, the training group exhibited considerable improvements in ventilation-related parameters (p < 0.001): the tidal volume markedly increased (p = 0.012), rapid shallow breathing index declined (p = 0.016), and maximum respiratory pressure increased (p < 0.001) in the training group. The diaphragm motion value (p = 0.048) and diaphragm thickness (p = 0.041) were greater in the training group than in the control group. Nine patients (52.9 %) in the training group were removed from the ventilator compared with 1 (7.1 %) in the control group (p = 0.008). CONCLUSION Abdominal sandbag training may be beneficial for patients dependent on a ventilator. The training improves the function of the diaphragm muscle, thereby increasing tidal volume and reducing the respiratory rate and rapid shallow breathing index, thus facilitating withdrawal from ventilation. This training approach may also improve the thickness and motion of the diaphragm and the rate of ventilator detachment.
Collapse
Affiliation(s)
- Tsung Ko Lin
- Chi Mei Medical Center, Department of Rehabilitation, Taiwan
| | - Miao Yu Chen
- Chi Mei Hospital, Chiali, Department of Respiratory Therapy, Taiwan
| | - Hsin Han Cheng
- Chi Mei Medical Center, Department of Rehabilitation, Taiwan
| | - Julie Chow
- Chi Mei Medical Center, Department of Pediatrics, Taiwan
| | - Chin Ming Chen
- Chi Mei Medical Center, Department of Intensive Care, Taiwan
| | - Willy Chou
- Chi Mei Medical Center, Department of Rehabilitation, Taiwan.
| |
Collapse
|
3
|
Ruelland C, Beaumont M. [Effects of gender on pulmonary rehabilitation outcomes in patients with COPD]. Rev Mal Respir 2024; 41:463-471. [PMID: 38945799 DOI: 10.1016/j.rmr.2024.06.007] [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: 09/21/2023] [Accepted: 06/07/2024] [Indexed: 07/02/2024]
Abstract
INTRODUCTION COPD has become more prevalent among women, revealing a specific feminine phenotype. Women experience greater dyspnea and a more impaired quality of life. The main objective of this study was to assess the effect of gender on dyspnea during a pulmonary rehabilitation program (PRP). METHODS Retrospective study including COPD patients having participated in PRPs. The following data were analyzed according to gender before and after a PRP: dyspnea, quality of life, anxiety and depression, exercise capacity, muscle function (quadriceps and inspiratory muscles). RESULTS More than 500 patients (252 men and 252 women) were included. We did not find a significant effect of gender on the evolution of dyspnea, anxiety or depressive disorders, exercise capacity, inspiratory muscle strength, or overall quality of life score. That said, we found a possible effect on the sub-scores of the quality of life questionnaire, and regarding quadriceps strength. All criteria improved during the program in both groups. CONCLUSIONS During a PRP, gender does not impact the evolution of dyspnea. While women may nonetheless benefit to a greater extent in terms of quality of life sub-scores (impact, activities, symptoms) and quadriceps strength, these results still require confirmation.
Collapse
Affiliation(s)
- C Ruelland
- Service de réadaptation respiratoire, Médipôle Lyon-Villeurbanne, Villeurbanne, France
| | - M Beaumont
- Service de réadaptation respiratoire, CH des Pays de Morlaix, 15, Kersaint Gilly, 29600 Morlaix, France; Inserm, université de Brest, CHRU de Brest, UMR 1304, GETBO, Brest, France.
| |
Collapse
|
4
|
Pehlivan E, Çetinkaya E, Özcan ZB, Karaahmetoğlu FS, Çörtük M, Ataç A, Çınarka H. Investigation of Inspiratory Muscle Training Efficiency Before Bronchoscopic Lung Volume Reduction: A Randomized Controlled Trial. Arch Bronconeumol 2024:S0300-2896(24)00226-6. [PMID: 39025760 DOI: 10.1016/j.arbres.2024.06.007] [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: 03/20/2024] [Revised: 06/03/2024] [Accepted: 06/04/2024] [Indexed: 07/20/2024]
Abstract
INTRODUCTION Pulmonary rehabilitation (PR) is recommended prior to bronchoscopic lung volume reduction (BLVR) procedures to optimize patient outcomes. However, there's a lack of clear guidance on PR content. The aim of our study is to examine the effect of adding inspiratory muscle training (IMT) to standard PR before BLVR on exercise capacity, dyspnea, fatigue level and quality of life. METHODS Sixty-four patients were randomly assigned to either the PR Group (PRGr) or the PR with IMT group (IMTGr). Both groups underwent an 8-week standard PR program, including breathing exercises, muscle strengthening, and walking. Additionally, IMTGr received IMT sessions. Outcome measures comprised six-minute walking distance (6MWD), maximal inspiratory and expiratory pressures (MIP, MEP), peripheral muscle strength, modified Medical Research Council dyspnea score, fatigue symptom scale, spirometric parameters, Saint George Quality of Life Questionnaire (SGRQ), International Physical Activity Questionnaire Short Form (IPAQ-SF), and Hospital Anxiety and Depression Scale. RESULTS Our study found no significant difference in exercise capacity improvement between IMTGr and PRGr. However, IMTGr showed significant improvement in MIP compared to PRGr. Both groups experienced improvements in dyspnea, fatigue, and depression scores, as well as enhancements in 6MWD, MEP, peripheral muscle strength, IPAQ-SF and SGRQ scores. CONCLUSION Adding IMT to PR did not show a significant difference between groups among BLVR-eligible patients. However, improved respiratory muscle strength may have positive clinical implications. Further research is needed to explore short and long-term effects.
Collapse
Affiliation(s)
- Esra Pehlivan
- University of Health Sciences, Faculty of Hamidiye Health Sciences, Department of Physiotherapy and Rehabilitation, Istanbul, Turkey.
| | - Erdoğan Çetinkaya
- University of Health Sciences, Department of Chest Disease, Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey
| | - Zeynep Betül Özcan
- University of Health Sciences, Enstitute of Hamidiye Health Sciences, Department of Physiotherapy and Rehabilitation, Istanbul, Turkey
| | - Fulya Senem Karaahmetoğlu
- University of Health Sciences, Enstitute of Hamidiye Health Sciences, Department of Physiotherapy and Rehabilitation, Istanbul, Turkey
| | - Mustafa Çörtük
- University of Health Sciences, Department of Chest Disease, Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey
| | - Amine Ataç
- Istanbul Gedik University, Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Istanbul, Turkey
| | - Halit Çınarka
- University of Health Sciences, Department of Chest Disease, Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey
| |
Collapse
|
5
|
Aktan R, Özalevli S, Yakut H, Özgen Alpaydin A. The effects of inspiratory muscle warm-up prior to inspiratory muscle training during pulmonary rehabilitation in subjects with chronic obstructive pulmonary disease: a randomized trial. Physiother Theory Pract 2024:1-11. [PMID: 38205730 DOI: 10.1080/09593985.2023.2301439] [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: 09/11/2023] [Accepted: 12/27/2023] [Indexed: 01/12/2024]
Abstract
BACKGROUND While a whole-body warm-up may not adequately prepare the inspiratory muscles for exercise, inspiratory warm-up is an effective approach in preparing the inspiratory muscles for exertion. OBJECTIVES To investigate the effects of inspiratory muscle warm-up performed prior to inspiratory muscle training (IMT) during pulmonary rehabilitation (PR) in patients with moderate-to-severe chronic obstructive pulmonary disease (COPD) and inspiratory muscle weakness. METHODS Pulmonary function tests, maximal inspiratory and expiratory pressures (MIP and MEP), 6-minute walk test distance (6MWD), modified Medical Research Council Dyspnea Scale(mMRC), St. George's respiratory questionnaire and the 36-item short-form health survey were evaluated. Both groups performed IMT during PR for 8 weeks. The warm-up group (n = 15), in addition to the standard IMT group (n = 15), performed an inspiratory muscle warm-up protocol before each IMT session. RESULTS At the end of the 8-week intervention, improvements in dyspnea (mMRC in score, p =0.033, effect size =0.76); exercise capacity (6MWD in meters, p =0.001, effect size =1.30); pulmonary function [forced expiratory volume in 1 second (FEV1) in %predicted, p =0.006, effect size =1.10]; and inspiratory muscle strength (MIP in cmH2O, p =0.001, effect siz e = 1.35) were significantly greater in the warm-up group. Moreover, there were significant improvements in health-related quality of life (HRQoL) sub-scores after the training in both groups (p <0.05). CONCLUSIONS This study demonstrated improvements in both groups, surpassing or closely approaching the established minimal clinically important difference values for the respective outcomes. Performing a warm-up for inspiratory muscles before IMT boosts benefits for pulmonary function, inspiratory muscle strength, exercise capacity, dyspnea, and HRQoL in subjects with moderate-to-severe COPD and inspiratory muscle weakness.
Collapse
Affiliation(s)
- Rıdvan Aktan
- Department of Physiotherapy, Izmir University of Economics, Balcova, Izmir, Turkey
| | - Sevgi Özalevli
- School of Physical Therapy and Rehabilitation, Dokuz Eylül University, Balcova, Izmir, Turkey
| | - Hazal Yakut
- School of Physical Therapy and Rehabilitation, Dokuz Eylül University, Balcova, Izmir, Turkey
- Department of Physiotherapy and Rehabilitation, Izmir Democracy University, Konak, Izmir, Turkey
| | - Aylin Özgen Alpaydin
- Department of Chest Diseases, Faculty of Medicine, Dokuz Eylül University, Balcova, Izmir, Turkey
| |
Collapse
|