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Zhu T, Jin HP, Liu SS, Zhu HJ, Wang JW. Effects of extracorporeal diaphragm pacing combined with inspiratory muscle training on respiratory function in people with stroke: a randomized controlled trial. Neurol Res 2024; 46:727-734. [PMID: 38661091 DOI: 10.1080/01616412.2024.2347133] [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: 09/17/2023] [Accepted: 04/21/2024] [Indexed: 04/26/2024]
Abstract
OBJECTIVES To evaluate the effect of external diaphragmatic pacing (EDP) combined with inspiratory muscle training on respiratory function in post-stroke patients. METHODS Patients with stroke were enrolled from the First Affiliated Hospital of Soochow University in China between 2021 and 2022. The patients were randomized into an EDP treatment group (control group) or an EDP treatment plus inspiratory muscle training group (experimental group). Each therapy was administered once a day for 6 days per week. The peak inspiratory flow (PIF), maximal inspiratory pressure (MIP), forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC), FEV1/FVC% ratio, and diaphragm thickness and mobility were measured and compared between the two groups after 4 weeks. RESULTS After 4 weeks of intervention, respiratory muscle function indicators including PIF (95% CI: 0.21-1.28, p = 0.008) and MIP (95% CI: 6.92-25.44, p = 0.001) significantly improved in the experimental group. Diaphragmatic thickness also significantly increased in the experimental group (p < 0.05), while diaphragmatic excursion showed no significant difference between the two groups. Additionally, FVC (95% CI: 0.14-1.14, p = 0.013) and FEV1 (95% CI: 0.20-1.06, p = 0.005) demonstrated a significant increase in the experimental group, whereas FEV1/FVC% (95% CI: -0.84 to 9.36, p = 0.099) exhibited no significant group difference. CONCLUSION EDP combined with inspiratory muscle training in individuals with stroke provides greater benefits than EDP alone in terms of respiratory function recovery, except for the parameters of diaphragmatic excursion and FEV1/FVC%.
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Affiliation(s)
- Ting Zhu
- Department of Rehabilitation, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Hua-Ping Jin
- Department of Rehabilitation, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Sha-Sha Liu
- Department of Rehabilitation, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Hong-Jun Zhu
- Department of Rehabilitation, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Jing-Wen Wang
- Department of Rehabilitation, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
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2
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Zhou Q, Zhang Y, Yao W, Liang S, Feng H, Pan H. Effects of proprioceptive neuromuscular facilitation combined with threshold inspiratory muscle training on respiratory function in neurocritical patients with weaning failure: a randomized controlled trial. Int J Rehabil Res 2024:00004356-990000000-00092. [PMID: 38635479 DOI: 10.1097/mrr.0000000000000627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/20/2024]
Abstract
The purpose of this study was to determine the effects of combining proprioceptive neuromuscular facilitation (PNF) with threshold inspiratory muscle training (TIMT), compared with TIMT alone, on respiratory function in neurocritical patients who experienced a weaning failure. Forty-seven participants (mostly after a stroke), were randomly divided into the experimental group (n = 24) and the control group (n = 23). The control group received usual care and TIMT, whereas the experimental group, in addition, underwent four 90-s periods of manual PNF. Both groups performed training in the ICU twice a day for 5 consecutive days. The main outcome measures included maximum inspiratory pressure, diaphragmatic excursions, diaphragm thickening fraction, oxygenation index, and forced expiratory volume in 1 s/forced vital capacity. The results showed a significant group-by-time interaction effect for maximum inspiratory pressure [F (1, 45) = 17.84, η2 = 0.328, P < 0.001] and oxygenation index [F [1, 45) = 5.58, η2 = 0.11, P = 0.023]. When compared with the control group, the experimental group showed overall significantly higher maximum inspiratory pressure [mean difference = 4.37 cm H2O, 95% confidence interval (CI) 0.25-8.50, P = 0.038]. No other significant group differences were found. Combining PNF with TIMT may improve respiratory function in neurocritical patients with weaning failure. This combination approach may increase the likelihood of survival of neurocritical patients in the ICU.
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Affiliation(s)
- Qian Zhou
- Department of Rehabilitation Medicine, The Affiliated Jiangning Hospital of Nanjing Medical University, Nanjing
| | - Yuanyuan Zhang
- Department of Rehabilitation Medicine, The Affiliated Jiangning Hospital of Nanjing Medical University, Nanjing
| | - Wei Yao
- Department of Rehabilitation Medicine, The Affiliated Jiangning Hospital of Nanjing Medical University, Nanjing
| | - Sijie Liang
- Department of Rehabilitation Medicine, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Hui Feng
- Department of Rehabilitation Medicine, The Affiliated Jiangning Hospital of Nanjing Medical University, Nanjing
| | - Huaping Pan
- Department of Rehabilitation Medicine, The Affiliated Jiangning Hospital of Nanjing Medical University, Nanjing
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Progress of Muscle Chain Theory in Shoulder Pain Rehabilitation: Potential Ideas for Pulmonary Rehabilitation. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2022; 2022:2537957. [PMID: 36110187 PMCID: PMC9470317 DOI: 10.1155/2022/2537957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 08/29/2022] [Indexed: 11/17/2022]
Abstract
Pulmonary dysfunction is very common in stroke patients. A study has shown that acute stroke patients often cause a series of pulmonary dysfunction due to primary damage to the respiratory center, which is an important reason for hindering disease treatment and recovery. American Thoracic Society (ATS) and the European Respiratory Society (ERS) pointed out that pulmonary rehabilitation (PR) can be applied to the rehabilitation of stroke patients to improve their lung function. PR can improve the respiratory muscle strength of stroke patients, which is beneficial to improving the respiratory function of patients. At the same time, it can also significantly increase the maximum oxygen intake of patients, effectively improve the cardiopulmonary function of stroke patients, and reduce respiratory complications such as aspiration pneumonia. However, the common dysfunction of joints and muscles such as shoulder pain after stroke will affect the process of pulmonary rehabilitation. This is mainly because the changes in the position of the shoulder girdle, the decrease in the range of motion of the cervical and thoracic spine, and the changes in the cervical spondylolisthesis position caused by the elevation of the upper limbs will directly affect the breathing movement during the pulmonary rehabilitation process. The instability of the spine will weaken the deep abdominal muscles and reduce the function of the diaphragm; moreover, changes in the alignment and stability of the cervical and thoracic spine will also lead to wrong breathing methods. Therefore, it is of practical clinical significance to evaluate the functional rehabilitation of shoulder joint muscles and evaluate the efficacy of stroke patients to improve their respiratory function. This article through an extensive review of domestic and foreign literature in recent years, combined with clinical practice experience, summarizes the practical application of chain structure theory in the fields of rehabilitation training, postural adjustment, pain relief, etc., and further studies the functional exercise method based on muscle chain theory. The research on the muscle chain of shoulder pain rehabilitation as a model illustrates the positive effect of reconstructing neuroarticular muscle function on the respiratory system, hoping to provide new ideas for the treatment of respiratory diseases in stroke patients.
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4
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Reproducibility of Maximum Respiratory Pressure Assessment. Chest 2022; 162:828-850. [DOI: 10.1016/j.chest.2022.04.144] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 04/22/2022] [Accepted: 04/22/2022] [Indexed: 11/20/2022] Open
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Choi KB, Cho SH. Are Physical Therapeutics Important for Stroke Patients to Recover Their Cardiorespiratory Fitness? Medicina (B Aires) 2021; 57:medicina57111182. [PMID: 34833400 PMCID: PMC8619703 DOI: 10.3390/medicina57111182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Revised: 10/21/2021] [Accepted: 10/25/2021] [Indexed: 11/16/2022] Open
Abstract
Background and Objectives: Aspects of improving cardiorespiratory fitness should be factored into therapeutics for recovery of movement in stroke patients. This study aimed to recommend optimized cardiorespiratory fitness therapeutics that can be prescribed to stroke patients based on a literature review and an expert-modified Delphi technique. Materials and Methods: we searched PubMed, Embase, CINAHL, and Cochrane databases and yielded 13,498 articles published from 2010 to 2019 to support the development of drafts. After applying the exclusion criteria, 29 documents were analyzed (drafts, 17 articles; modified Delphi techniques, 12 articles). This literature was reviewed in combination with the results of a modified Delphi technique presented to experts in the physical medicine and rehabilitation field. Analysis of the literature and survey results was conducted at the participating university hospital. Results: the results of this analysis were as follows: first, 12 intervention items derived through a researcher’s literature review and a Delphi technique questionnaire were constructed using the Likert scale; second, we asked the experts to create two modified Delphi techniques by reconstructing the items after statistical analysis for each order comprising five categories, and 15 items were finally confirmed. Conclusions: the recommendations in this study may lead to the development of a standard decision-making process for physiotherapists to improve their patients’ cardiorespiratory fitness. Moreover, the study results can help prescribers document patient care to reduce prescription errors and improve safety. In the future, multidisciplinary studies could potentially provide better therapeutics alternatives for cardiorespiratory fitness.
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Affiliation(s)
- Ki-Bok Choi
- Team of Rehabilitation Treatment, Chosun University Hospital, 365, Pilmun-daero, Dong-gu, Gwangju 61453, Korea;
| | - Sung-Hyoun Cho
- Department of Physical Therapy, Nambu University, 23 Cheomdan Jungang-ro, Gwangsan-gu, Gwangju 62271, Korea
- Correspondence: ; Tel.: +82-10-3060-1330
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6
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da Silva FMF, Cipriano G, Lima ACGB, Andrade JML, Nakano EY, Chiappa GR, Cahalin LP, Cipriano GFB. Maximal Dynamic Inspiratory Pressure Evaluation in Heart Failure: A Comprehensive Reliability and Agreement Study. Phys Ther 2020; 100:2246-2253. [PMID: 32941640 DOI: 10.1093/ptj/pzaa165] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 04/26/2020] [Accepted: 08/11/2020] [Indexed: 12/24/2022]
Abstract
OBJECTIVE The purpose of this study was to analyze the reliability (interrater and intrarater) and agreement (repeatability and reproducibility) properties of tapered flow resistive loading (TFRL) measures in patients with heart failure (HF). METHODS For this cross-sectional study, participants were recruited from the cardiopulmonary rehabilitation program at the University of Brasilia from July 2015 to July 2016. All patients participated in the study, and 10 were randomly chosen for intrarater and interrater reliability testing. The 124 participants with HF (75% men) were 57.6 (SD = 1.81) years old and had a mean left ventricular ejection fraction of 38.9% (SD = 15%) and a peak oxygen consumption of 13.05 (SD = 5.3) mL·kg·min-1. The main outcome measures were the maximal inspiratory pressure (MIP) measured with a standard manovacuometer (SM) and the MIP and maximal dynamic inspiratory pressure (S-Index) obtained with TFRL. The S-Index reliability (interrater and intrarater) was examined by 2 evaluators, the S-Index repeatability was examined with 10 repetitions, and the reproducibility of the MIP and S-Index was measured with SM and TFRL, respectively. RESULTS The reliability analysis revealed high S-Index interrater and intrarater reliability values (intraclass correlation coefficients [ICCs] of 0.89 [95% CI = 0.58-0.98] and 0.97 [95% CI = 0.89-0.99], respectively). Repeatability analyses revealed that 8 maneuvers were required to reach the maximum S-Index in 75.81% (95% CI = 68.27-83.34) of the population. The reproducibility of TFRL measures (S-Index = 68.8 [SD = 32.8] cm H2O; MIP = 66 [SD = 32.3] cm H2O) was slightly lower than that of the SM measurement (MIP = 70.1 [SD = 35.9] cm H2O). CONCLUSIONS The TFRL device provided a reliable intrarater and interrater S-Index measure in patients with HF and had acceptable repeatability, requiring 8 maneuvers to produce a stable S-Index measure. The reproducibilities of the S-Index, MIP obtained with SM, and MIP obtained with TRFL were similar. IMPACT TRFL is a feasible method to assess both MIP and the S-index as measures of inspiratory muscle strength in patients with HF and can be used for inspiratory muscle training, making the combined testing and training capabilities important in both clinical research and the management of patients with HF.
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Affiliation(s)
- Fabiola M F da Silva
- Science and Technology in Health Program, University of Brasília, Brasília, Brazil
| | - Gerson Cipriano
- Science and Technology in Health Program and Physical Therapy Department, Science of Rehabilitation Program, University of Brasília
| | | | | | | | - Gaspar R Chiappa
- Respiratory and Pathology Laboratory, Federal University of Mato Grosso do Sul, Mato Grosso do Sul, Brazil
| | - Lawrence P Cahalin
- Physical Therapy Department and Leonard M. Miller School of Medicine, University of Miami, Coral Gables, Florida
| | - Graziella F B Cipriano
- Science and Technology in Health Program and Physical Therapy Department, Science of Rehabilitation Program, University of Brasília, QNN 14 Área Especial, Ceilândia Sul, CEP 72220-140, Brasília, Brazil
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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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8
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Areias GDS, Santiago LR, Teixeira DS, Reis MS. Concurrent Validity of the Static and Dynamic Measures of Inspiratory Muscle Strength: Comparison between Maximal Inspiratory Pressure and S-Index. Braz J Cardiovasc Surg 2020; 35:459-464. [PMID: 32864924 PMCID: PMC7454635 DOI: 10.21470/1678-9741-2019-0269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Objective To verify the concurrent validity between the inspiratory muscle strength (IMS) values obtained in static (maximal inspiratory pressure [MIP]) and dynamic (S-Index) assessments. Methods Healthy individuals were submitted to two periods of evaluation: i) MIP, static maneuver to obtain IMS, determined by the Mueller’s maneuver from residual volume (RV) until total lung capacity (TLC); ii) and S-Index, inspiration against open airway starting from RV until TLC. Both measures were performed by the same evaluator and the subjects received the same instructions. Isolated maneuvers with differences < 10% were considered as reproducible measures. Results Data from 45 subjects (21 males) were analyzed and that showed statistical difference between MIP and S-Index values (133.5 ± 33.3 and 125.6 ± 32.2 in cmH2O, respectively), with P=0.014. Linear regression showed r2=0.54 and S-Index prediction formula = 39.8+(0.75×MIP). Pearson’s correlation demonstrated a strong and significant association between the measures with r=0.74. The measurements showed good concordance evidenced by the Bland-Altman test. Conclusion S-Index and MIP do not present similar values since they are evaluations of different events of the muscular contraction. However, they have a strong correlation and good agreement, which indicate that both are able to evaluate the IMS of healthy individuals.
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Affiliation(s)
- Guilherme de Souza Areias
- Programa de Pós-Graduação em Educação Física e Desportos, Universidade Federal do Rio de Janeiro - UFRJ, Rio de Janeiro, RJ, Brazil.,Grupo de Pesquisa em Avaliação e Reabilitação Cardiorrespiratória - GECARE, Departamento de Fisioterapia, Universidade Federal do Rio de Janeiro - UFRJ, Rio de Janeiro, RJ, Brazil
| | - Luan Rodrigues Santiago
- Programa de Pós-Graduação em Educação Física e Desportos, Universidade Federal do Rio de Janeiro - UFRJ, Rio de Janeiro, RJ, Brazil.,Grupo de Pesquisa em Avaliação e Reabilitação Cardiorrespiratória - GECARE, Departamento de Fisioterapia, Universidade Federal do Rio de Janeiro - UFRJ, Rio de Janeiro, RJ, Brazil
| | - Daniel Sobral Teixeira
- Programa de Pós-Graduação em Educação Física e Desportos, Universidade Federal do Rio de Janeiro - UFRJ, Rio de Janeiro, RJ, Brazil.,Grupo de Pesquisa em Avaliação e Reabilitação Cardiorrespiratória - GECARE, Departamento de Fisioterapia, Universidade Federal do Rio de Janeiro - UFRJ, Rio de Janeiro, RJ, Brazil
| | - Michel Silva Reis
- Programa de Pós-Graduação em Educação Física e Desportos, Universidade Federal do Rio de Janeiro - UFRJ, Rio de Janeiro, RJ, Brazil.,Grupo de Pesquisa em Avaliação e Reabilitação Cardiorrespiratória - GECARE, Departamento de Fisioterapia, Universidade Federal do Rio de Janeiro - UFRJ, Rio de Janeiro, RJ, Brazil.,Programa de Pós-Graduação em Ciências Cardiovasculares, Universidade Federal do Rio de Janeiro - UFRJ, Rio de Janeiro, RJ, Brazil
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9
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Wang C, Yu L, Yang J, Wang RW, Zheng YN, Zhang Y. Effectiveness of LiuZiJue Qigong versus traditional core stability training for poststroke patients complicated with abnormal trunk postural control: study protocol for a single-center randomized controlled trial. Trials 2020; 21:254. [PMID: 32164792 PMCID: PMC7068967 DOI: 10.1186/s13063-020-4117-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2019] [Accepted: 01/29/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Trunk function in stroke patients with hemiplegia is associated with respiration and core stability and is also found to be associated with balance and postural control and activities of daily living. LiuZiJue Qigong (LQG) is a traditional Chinese method of fitness based on breath pronunciation. The purpose of this study is to compare the clinical efficacy of LQG and traditional core stability training in the treatment of stroke patients with abnormal trunk posture. This protocol is written according to the SPIRIT 2013 statement. METHODS/DESIGN This study is a single-center randomized controlled trial in which 160 stroke patients are randomly divided into a study group and a control group. Patients in the study group will receive LQG combined with conventional rehabilitation therapy, and patients in the control group will receive traditional core stability training combined with conventional rehabilitation therapy. All treatments will be done for 45 min/day, five times per week, for 2 weeks. The primary outcome (Trunk Impairment Scale) and secondary outcomes (Berg Balance Scale, Fugl-Meyer Assessment, Modified Barthel Index, Maximum Phonation Time, Dynamic and Static balance testing, and thickness and the mobile degrees of diaphragm) will be measured at baseline, 2 weeks, and the end of the rehabilitation course. DISCUSSION The aim purpose of this research study is to compare the clinical efficacy of LQG and traditional core stability exercise in the treatment of stroke patients with abnormal trunk posture. TRIAL REGISTRATION Chinese Clinical Trial Register, ChiCTR1800014864. Registered on 24 November 2018.
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Affiliation(s)
- Chen Wang
- Department of Rehabilitation, Shanghai Xuhui Central Hospital, No. 966 Middle Huaihai Road, Xuhui District, Shanghai, 200031, People's Republic of China.,School of Kinesiology, Shanghai University of Sport, No. 200 Hengren Road, Yangpu District, Shanghai, 200438, People's Republic of China
| | - Long Yu
- Department of Rehabilitation, Shanghai Xuhui Central Hospital, No. 966 Middle Huaihai Road, Xuhui District, Shanghai, 200031, People's Republic of China
| | - Jian Yang
- Department of Rehabilitation, Shanghai Xuhui Central Hospital, No. 966 Middle Huaihai Road, Xuhui District, Shanghai, 200031, People's Republic of China
| | - Ren Wei Wang
- School of Kinesiology, Shanghai University of Sport, No. 200 Hengren Road, Yangpu District, Shanghai, 200438, People's Republic of China
| | - Ya Nan Zheng
- Department of Rehabilitation, Shanghai Xuhui Central Hospital, No. 966 Middle Huaihai Road, Xuhui District, Shanghai, 200031, People's Republic of China.,School of Kinesiology, Shanghai University of Sport, No. 200 Hengren Road, Yangpu District, Shanghai, 200438, People's Republic of China
| | - Ying Zhang
- Department of Rehabilitation, Shanghai Xuhui Central Hospital, No. 966 Middle Huaihai Road, Xuhui District, Shanghai, 200031, People's Republic of China.
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Roldán A, Cordellat A, Monteagudo P, García-Lucerga C, Blasco-Lafarga NM, Gomez-Cabrera MC, Blasco-Lafarga C. Beneficial Effects of Inspiratory Muscle Training Combined With Multicomponent Training in Elderly Active Women. RESEARCH QUARTERLY FOR EXERCISE AND SPORT 2019; 90:547-554. [PMID: 31397649 DOI: 10.1080/02701367.2019.1633009] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Accepted: 06/08/2019] [Indexed: 06/10/2023]
Abstract
Purpose: This study aims to analyze changes in Maximum Inspiratory Pressure (MIP), lung function, cardiorespiratory fitness, and blood pressure, in 10 healthy active elderly women, following 7 weeks of inspiratory muscle training (IMT) combined with a multicomponent training program (MCTP). The association among these health parameters, their changes after training (deltas), and the influence of MIP at baseline (MIPpre) are also considered. Methods: IMT involved 30 inspirations at 50% of the MIP, twice daily, 7 days a week, while MCTP was 1 hr, twice a week. MIP, lung function (FVC, FEV1, FEV1/FVC, FEF25-75%, PEF), 6MWT, and blood pressure (SBP, DBP), jointly with body composition, were assessed before and after the intervention. Results: Seven weeks were enough to improved MIP (p = .019; d = 1.397), 6MWT (p = .012; d = .832), SBP (p = .003; d = 1.035) and DBP (p = .024; d = .848). Despite the high physical fitness (VO2 peak: M = 23.38, SD = 3.39 ml·min·Kg-1), MIPpre was low (M = 39.00, SD = 7.63 cmH2O) and displayed a significant negative correlation with ΔMIPpre-post (r = -.821; p < .004), showing that women who started the intervention with lower MIP achieved higher improvements in inspiratory muscle strength after training. Conclusions: No significant changes in spirometric parameters may signal that lung function is independent of early improvements in inspiratory muscles and cardiorespiratory fitness. Absence of correlation between physical fitness and respiratory outcomes suggests that being fit does not ensure cardiorespiratory health in active elderly women, so IMT might be beneficial and should supplement the MCTP in this population.
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11
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Bissett BM, Wang J, Neeman T, Leditschke IA, Boots R, Paratz J. Which ICU patients benefit most from inspiratory muscle training? Retrospective analysis of a randomized trial. Physiother Theory Pract 2019; 36:1316-1321. [PMID: 30739584 DOI: 10.1080/09593985.2019.1571144] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Background: Inspiratory muscle training (IMT) increases inspiratory muscle strength and improves quality of life in intensive care unit (ICU) patients who have been invasively mechanically ventilated for ≥7 days. The purpose of this study was to identify which patients benefit most from IMT following weaning from mechanical ventilation. Methods: Secondary analysis of a randomized trial of supervised daily IMT in 70 patients (mean age 59 years) in a 31-bed ICU was carried out. Changes in inspiratory muscle strength (maximum inspiratory pressure, MIP) between enrolment and 2 weeks (ΔMIP) were analyzed to compare the IMT group (71% male) and the control group (58% male). Linear regression models explored which factors at baseline were associated with ΔMIP. Results: Thirty-four participants were allocated to the IMT group where baseline MIP was associated with an increase in ΔMIP, significantly different from the control group (p = 0.025). The highest ΔMIP was associated with baseline MIP ≥ 28 cmH2O. In the IMT group, higher baseline quality of life (EQ5D) scores were associated with positive ΔMIP, significantly different from the control group (p = 0.029), with largest ΔMIP for those with EQ5D ≥ 40. Conclusions: Physiotherapists should target ICU patients with moderate inspiratory muscle weakness (MIP ≥28 cmH2O) and moderate to high quality of life (EQ5D>40) within 48 h of ventilatory weaning as ideal candidates for IMT following prolonged mechanical ventilation.
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Affiliation(s)
- Bernie M Bissett
- Discipline of Physiotherapy, University of Canberra , Canberra, Australia.,Physiotherapy Department, Canberra Hospital , Canberra, Australia
| | - Jiali Wang
- Statistical Consulting Unit, Australian National University , Canberra, Australia
| | - Teresa Neeman
- Statistical Consulting Unit, Australian National University , Canberra, Australia
| | - I Anne Leditschke
- Intensive Care Unit, Mater Hospital , Brisbane, Australia.,Mater Research Institute, University of Queensland , Brisbane, Australia
| | - Robert Boots
- Intensive Care Unit, Royal Brisbane and Women's Hospital , Brisbane, Australia.,School of Medicine, University of Queensland , Brisbane, Australia
| | - Jennifer Paratz
- Intensive Care Unit, Royal Brisbane and Women's Hospital , Brisbane, Australia.,School of Medicine, University of Queensland , Brisbane, Australia.,School of Health Sciences, Griffith University , Gold Coast, Australia
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12
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Lee K, Park D, Lee G. Progressive Respiratory Muscle Training for Improving Trunk Stability in Chronic Stroke Survivors: A Pilot Randomized Controlled Trial. J Stroke Cerebrovasc Dis 2019; 28:1200-1211. [PMID: 30712955 DOI: 10.1016/j.jstrokecerebrovasdis.2019.01.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 12/27/2018] [Accepted: 01/12/2019] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Stroke weakens the respiratory muscles, which in turn may influence the trunk stability; it is unclear whether the progressive respiratory muscle training (RMT) is effective in improving the trunk stability. The aim of this study was to investigate the effects of progressive RMT with trunk stabilization exercise (TSE) on respiratory muscles thickness, respiratory muscle functions, and trunk stability in chronic stroke survivors. METHODS This is a pilot randomized controlled trial. Chronic stroke survivors (n = 33) who were able to sit independently participated in the tstudy. The participants were allocated into the RMP with TSE group or the TSE group. The respiratory muscle thickness during resting and contraction were measured. Maximal expiratory pressure (MEP), peak expiratory flow (PEF), and forceful expiratory volume at 1 sec (FEV1) for forced expiratory muscle function and maximal inspiratory pressure (MIP), peak inspiratory flow (PIF), and vital capacity (VC) for inspiratory muscle function were examined. Trunk stability was estimated by maximal velocity and path length of the center of pressure (COP) by using a balance board with sitting posture. RESULTS The respiratory muscle thickness was significantly increased on the affected side in the RMT group than in the TSE group. The MEP, PEF, MIP, and PIF were significantly increased in the RMT group than in the TSE group; however, FEV1 and VC showed no significant differences between the 2 groups. Trunk stability for the maximal velocity of COP of extension and affected side bending was significantly increased in the RMT group than in the TSE group. In addition, the maximal path length of COP of flexion, extension, affected/less affected side bending was significantly increased in the RMT group than in the TSE group. CONCLUSIONS RMT combined with TSE can be suggested as an effective method to improve the respiratory muscle thickness, respiratory muscle functions, and trunk stability in chronic stroke survivors as opposed to TSE only.
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Affiliation(s)
- Kyeongbong Lee
- Physical Therapy Part, Physical & Rehabilitation Medicine, Samsung Medical Center, Seoul, Republic of Korea
| | - Daesung Park
- Department of Physical Therapy, Konyang University, Daejeon, Republic of Korea
| | - GyuChang Lee
- Department of Physical Therapy, Kyungnam University, Changwon, Republic of Korea.
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13
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Lee K, Cho JE, Hwang DY, Lee W. Decreased Respiratory Muscle Function Is Associated with Impaired Trunk Balance among Chronic Stroke Patients: A Cross-sectional Study. TOHOKU J EXP MED 2018; 245:79-88. [PMID: 29848898 DOI: 10.1620/tjem.245.79] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The abdominal muscles play a role in trunk balance. Abdominal muscle thickness is asymmetrical in stroke survivors, who also have decreased respiratory muscle function. We compared the thickness of the abdominal muscles between the affected and less affected sides in stroke survivors. In addition, the relationship between respiratory muscle function and trunk balance was evaluated. Chronic stroke patients (18 men, 15 women; mean age, 58.94 ± 12.30 years; Mini-Mental Status Examination score ≥ 24) who could sit without assist were enrolled. Abdominal muscle thickness during rest and contraction was measured with ultrasonography, and the thickening ratio was calculated. Respiratory muscle function assessment included maximum respiratory pressure, peak flow, and air volume. Trunk function was evaluated using the Trunk Impairment Scale, and trunk balance was estimated based on the center of pressure velocity and path length within the limit of stability in sitting posture. Abdominal muscles were significantly thinner on the affected side, and the thickening ratio was lower in the affected side (P < 0.05). In addition, the higher thickening ratio of the affected side showed significant relationship with higher trunk function. Moreover, higher respiratory muscle function was significantly correlated with higher level of trunk function and balance in stroke patients (P < 0.05). Thus, chronic stroke survivors have decreased abdominal muscle thickness on the affected side, and respiratory muscle function has positive correlation with trunk function and balance. We propose that respiratory muscle training should be included as part of trunk balance training in chronic stroke patients.
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Affiliation(s)
- Kyeongbong Lee
- Physical Therapy Part, Department of Physical and Rehabilitation Medicine, Samsung Medical Center
| | - Ji-Eun Cho
- Department of Physical Therapy, Graduate School of Sahmyook University
| | - Dal-Yeon Hwang
- Department of Physical Therapy, Myongji Choonhye Rehabilitation Hospital
| | - WanHee Lee
- Department of Physical Therapy, College of Health Science, Sahmyook University
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14
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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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15
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Formiga MF, Roach KE, Vital I, Urdaneta G, Balestrini K, Calderon-Candelario RA, Campos MA, Cahalin LP. Reliability and validity of the test of incremental respiratory endurance measures of inspiratory muscle performance in COPD. Int J Chron Obstruct Pulmon Dis 2018; 13:1569-1576. [PMID: 29805255 PMCID: PMC5960252 DOI: 10.2147/copd.s160512] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Purpose The Test of Incremental Respiratory Endurance (TIRE) provides a comprehensive assessment of inspiratory muscle performance by measuring maximal inspiratory pressure (MIP) over time. The integration of MIP over inspiratory duration (ID) provides the sustained maximal inspiratory pressure (SMIP). Evidence on the reliability and validity of these measurements in COPD is not currently available. Therefore, we assessed the reliability, responsiveness and construct validity of the TIRE measures of inspiratory muscle performance in subjects with COPD. Patients and methods Test-retest reliability, known-groups and convergent validity assessments were implemented simultaneously in 81 male subjects with mild to very severe COPD. TIRE measures were obtained using the portable PrO2 device, following standard guidelines. Results All TIRE measures were found to be highly reliable, with SMIP demonstrating the strongest test-retest reliability with a nearly perfect intraclass correlation coefficient (ICC) of 0.99, while MIP and ID clustered closely together behind SMIP with ICC values of about 0.97. Our findings also demonstrated known-groups validity of all TIRE measures, with SMIP and ID yielding larger effect sizes when compared to MIP in distinguishing between subjects of different COPD status. Finally, our analyses confirmed convergent validity for both SMIP and ID, but not MIP. Conclusion The TIRE measures of MIP, SMIP and ID have excellent test-retest reliability and demonstrated known-groups validity in subjects with COPD. SMIP and ID also demonstrated evidence of moderate convergent validity and appear to be more stable measures in this patient population than the traditional MIP.
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Affiliation(s)
- Magno F Formiga
- Department of Physical Therapy, University of Miami Miller School of Medicine, Coral Gables, FL, USA.,CAPES Foundation, Ministry of Education of Brazil, Brasilia, Brazil
| | - Kathryn E Roach
- Department of Physical Therapy, University of Miami Miller School of Medicine, Coral Gables, FL, USA
| | - Isabel Vital
- Pulmonary Section, Miami Veterans Administration Medical Center, Miami, FL, USA
| | - Gisel Urdaneta
- Pulmonary Section, Miami Veterans Administration Medical Center, Miami, FL, USA
| | - Kira Balestrini
- Pulmonary Section, Miami Veterans Administration Medical Center, Miami, FL, USA
| | - Rafael A Calderon-Candelario
- Pulmonary Section, Miami Veterans Administration Medical Center, Miami, FL, USA.,Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Michael A Campos
- Pulmonary Section, Miami Veterans Administration Medical Center, Miami, FL, USA.,Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Lawrence P Cahalin
- Department of Physical Therapy, University of Miami Miller School of Medicine, Coral Gables, FL, USA
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16
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Kim M, Lee K, Cho J, Lee W. Diaphragm Thickness and Inspiratory Muscle Functions in Chronic Stroke Patients. Med Sci Monit 2017; 23:1247-1253. [PMID: 28284044 PMCID: PMC5358861 DOI: 10.12659/msm.900529] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Background The aims of this study are to investigate the difference between the diaphragm thickness at end expiration and the thickness at total lung capacity (TLC), and to examine differences in inspiratory muscle function between stroke patients and healthy individuals. Material/Methods Forty-five stroke patients and 49 healthy volunteers were included in this study. Diaphragm thickness was measured at end expiration and at TLC by ultrasonography. The maximal inspiratory pressure (MIP), peak inspiratory flow (PIF), vital capacity (VC), and inspiratory muscle endurance (IME) were assess to evaluate inspiratory muscle function. Results In stroke patients, the diaphragm was significantly thinner on the affected side than the less affected side at end expiration and at TLC. The change between the thickness at end expiration and at TLC were also significant on both sides. Between groups, the difference in diaphragm thickness at end expiration was not significant, but at TLC, the diaphragms were significantly thicker in healthy individuals than on either side in stroke patients, and the change in diaphragm thickness was significantly greater for healthy individuals. Inspiratory muscle functions were also significantly greater in healthy individuals. MIP, PIF, and VC were positively correlated with the change in thickness in healthy individuals, and MIP was positively correlated with the change in thickness and IME in stroke patients. Conclusions Stroke patients showed decreases in the thickening ability of the diaphragm at TLC and in inspiratory muscle function. The change between the diaphragm thickness at end expiration and at TLC was positively correlated with MIP, PIF, and VC.
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Affiliation(s)
- Minkyu Kim
- Department of Physical Therapy, The Graduate School, Sahmyook University, Seoul, South Korea
| | - Kyeongbong Lee
- Department of Physical Therapy, The Graduate School, Sahmyook University, Seoul, South Korea
| | - Jieun Cho
- Department of Physical Therapy, The Graduate School, Sahmyook University, Seoul, South Korea
| | - Wanhee Lee
- Department of Physical Therapy, College of Health and Welfare, Sahmyook University, Seoul, South Korea
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