Influence of Inspiratory Muscle Training on Changes in Fasting Hyperglycemia in the Older Adult: The Epidoso Project

Inspiratory muscle training as adjuvant therapy in obstructive sleep apnea: a randomized controlled trial

The aim of this randomized controlled trial was to analyze the effects of an inspiratory muscle training (IMT) program on apnea and hypopnea index (AHI), inspiratory muscle strength, sleep quality, and daytime sleepiness in individuals with obstructive sleep apnea (OSA), whether or not they used continuous positive airway pressure (CPAP (+/−) therapy. The intervention group underwent IMT with a progressive resistive load of 40-70% of the maximum inspiratory pressure (PImax) for 30 breaths once a day for 12 weeks. The control group was submitted to a similar protocol, but with at a minimum load of 10 cmH₂O. Changes in the AHI were the primary outcome. PImax was measured with a digital vacuometer, daytime somnolence was measured by the Epworth sleepiness scale (ESS), and the quality of sleep by the Pittsburgh Sleep Quality Index (PSQI). CPAP use was treated as a confounder and controlled by stratification resulting in 4 subgroups: IMT−/CPAP−, IMT−/CPAP+, IMT+/CPAP−, and IMT+/CPAP+. Sixty-five individuals were included in the final analysis. Significant variations were found in the 4 parameters measured throughout the study after the intervention in both CPAP− and CPAP+ participants: PImax was increased and AHI was reduced, whereas improvements were seen in both ESS and PSQI. The twelve-week IMT program increased inspiratory muscle strength, substantially reduced AHI, and had a positive impact on sleep quality and daytime sleepiness, whether or not participants were using CPAP. Our findings reinforce the role of an IMT program as an adjunct resource in OSA treatment.

Effects of respiratory muscle training on parasympathetic activity in diabetes mellitus

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

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

BACKGROUND

Patients with Type 2 diabetes mellitus (T2DM) suffer cardiopulmonary impairment and may present with weakness of the inspiratory muscles.

OBJECTIVE

This study was designed to determine the effects of incentive spirometry (IS) on selected cardiopulmonary parameters, functional capacity and glycemic control in patients with T2DM.

METHODS

Fifty-nine participants (25 males and 34 females) recruited from the out-patient clinic of the Department of Medicine of two hospitals in Lagos State, Nigeria, who were randomly assigned into two groups, completed the study. In addition to the medical management of T2DM, IS group received incentive spirometry while control group continued with the medical management of T2DM alone. Selected cardiovascular parameters, pulmonary parameters, functional capacity (using 6-min walk test) and fasting blood glucose level were assessed at baseline and at the end of eight weeks intervention period. Data were analyzed using the Statistical Package for Social Sciences (SPSS Version 21). Level of significance was set at p < 0 . 05 .

RESULTS

There were statistically significant improvements in all the cardiovascular parameters ( p = 0 . 001 ) of IS group except systolic blood pressure. There were significant changes in all the pulmonary parameters, functional capacity and glycemic control ( p < 0 . 05 ) of IS group while there was none in control group. There were significant differences between the mean changes of various selected outcome measures of the two groups ( p < 0 . 05 ) except for diastolic blood pressure and blood glucose level.

CONCLUSION

IS had positive effects in improving cardiopulmonary function, functional capacity and glycemic control in patients with T2DM.

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

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

Acute inspiratory muscle exercise effect on glucose levels, glucose variability and autonomic control in patients with type 2 diabetes: A crossover randomized trial

Inspiratory muscle exercise (IME) can be an alternative to conventional exercise. We aimed to evaluate the effect of IME on glucose, glucose variability, and autonomic cardiovascular control in type 2 diabetes. Fourteen diabetic subjects were randomly assigned to IME with 2% maximal inspiratory pressure (PImax) or 60% PImax wearing a continuous glucose monitoring system for three days. Glucose variability [glucose variance (VAR), glucose coefficient of variation (CV%), glucose standard deviation (SD), and mean amplitude of glycemic excursions (MAGE)] were evaluated. Glucose reduction was observed in 5 min (60% of PImax 33.2% and 2% of PImax 32.0%), 60 min (60% of PImax 29.6% and 2% of PImax 31.4%) and 120 min (60% of PImax 21.4% and 2% of PImax 24.0%) after IME (vs.1 h before the exercise), with no difference between loads. This reduction in glucose levels was observed in all moments of the IME protocol. Glucose variability was reduced after 12 h and 18 h of the IME (ΔCV: P < 0.001, ΔSD: P < 0.001 and ΔVAR: P < 0.001) for both loads. No difference was found in MAGE (P = 0.594) after IME. Mean arterial pressure and heart rate rose during the exercise session with 60% of PImax. Although sufficiently strong to induce cardiovascular changes, an inspiratory muscle exercise session with 60% of PImax in subjects with type 2 diabetes has failed to induce any significant improvement in glucose, glucose variability and autonomic control, compared to the 2% Plmax exercise session.

Can Inspiratory Muscle Training Improve Exercise Tolerance and Lower Limb Function After Myocardial Infarction?

Background

Respiratory therapy is an integral part of treatment of cardiac patients. The aim of this study was to evaluate the effect of addition of inspiratory muscle training (IMT) to second-stage cardiac rehabilitation on exercise tolerance and function of lower extremities in patients following myocardial infarction (MI).

Material/Methods

This study included 90 patients (mean age 65 years) with MI who took part in the second stage of an 8-week cycle of cardiac rehabilitation (CR). They were divided into 3 groups: group I underwent CR and IMT, group II only underwent CR, and group III only underwent IMT. Groups I and II were allocated randomly according sealed opaque envelopes. The third group consisted of patients who could not participate in standard rehabilitation for various reasons. Before and after the 8-week program, participants were assessed for maximal inspiratory and expiratory pressure (PImax and PEmax) values, exercise tolerance, and knee muscle strength.

Results

In groups I and II, a significant increase in the PImax parameters and exercise tolerance parameters (MET) were observed. Group I had increased PEmax parameters. In group III, the same changes in the parameter values that reflect respiratory muscle function were observed. All of the examined strength parameters of the knee joint muscles demonstrated improvement in all of the investigated groups, but the biggest differences were observed in group I.

Conclusions

Use of IMT in the ambulatory rehabilitation program of MI patients resulted in improved rehabilitation efficacy, leading to a significant improvement in physical condition.