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Oliveira JM, Clark VL, Furlanetto KC, Gibson PG, McDonald VM. Core Function in Adults With Severe Asthma and Its Relationship With Breathing Symptoms. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2024; 12:1254-1262.e1. [PMID: 38316184 DOI: 10.1016/j.jaip.2024.01.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 01/04/2024] [Accepted: 01/26/2024] [Indexed: 02/07/2024]
Abstract
BACKGROUND People with asthma may have skeletal muscle dysfunction but data describing core function in severe asthma are limited. OBJECTIVE To compare core function between people with severe asthma and healthy controls and to determine the difference between males and females. Furthermore, we aimed to investigate the association between core function and breathing symptoms. METHOD Adults with a diagnosis of severe asthma and healthy controls undertook an assessment that included 3 core function tests: partial sit-up, Biering-Sorensen, and side bridge. Breathing symptoms were assessed by the modified Medical Research Council dyspnea scale, modified Borg scale, and Nijmegen questionnaire. RESULTS People with severe asthma (n = 136) (38% male, age median [Q1-Q3] 59 y [45-68], body mass index 30 kg/m2 [26-37]) were compared with 66 people without respiratory disease (47% male, age 55 y [34-65], body mass index 25 kg/m2 [22-28]). There was no difference between groups in the partial sit-up (P = .09). However, participants with severe asthma performed worse with the Biering-Sorensen (P < .001), and the left and right side bridge test (P < .001 for both) than the healthy comparison group. Similar results were found when comparing males and females separately. Males with severe asthma had increased function compared with their female counterparts in the left side bridge test. Core function tests correlated with the breathing symptom measures, the modified Medical Research Council, modified Borg scale, and Nijmegen questionnaire (-0.51 > r > -0.19; P ≤ .03). CONCLUSIONS Adults with severe asthma have worse core function than their control counterparts, independent of sex. Furthermore, as core function decreases, breathing symptoms increase.
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Affiliation(s)
- Joice M Oliveira
- Graduate Program in Rehabilitation Sciences, Pitágoras-Unopar University, Paraná, Brazil; Laboratory of Research in Respiratory Physiotherapy (LFIP), Department of Physiotherapy, State University of Londrina, Paraná, Brazil; Asthma and Breathing Research Centre, Hunter Medical Research Institute, Newcastle, New South Wales, Australia; School of Nursing and Midwifery, College of Health, Medicine and Wellbeing, The University of Newcastle, Newcastle, New South Wales, Australia
| | - Vanessa L Clark
- Asthma and Breathing Research Centre, Hunter Medical Research Institute, Newcastle, New South Wales, Australia; School of Nursing and Midwifery, College of Health, Medicine and Wellbeing, The University of Newcastle, Newcastle, New South Wales, Australia
| | - Karina C Furlanetto
- Graduate Program in Rehabilitation Sciences, Pitágoras-Unopar University, Paraná, Brazil; Laboratory of Research in Respiratory Physiotherapy (LFIP), Department of Physiotherapy, State University of Londrina, Paraná, Brazil
| | - Peter G Gibson
- Asthma and Breathing Research Centre, Hunter Medical Research Institute, Newcastle, New South Wales, Australia; School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, New South Wales, Australia; Department of Respiratory and Sleep Medicine, John Hunter Hospital, Newcastle, New South Wales, Australia
| | - Vanessa M McDonald
- Asthma and Breathing Research Centre, Hunter Medical Research Institute, Newcastle, New South Wales, Australia; School of Nursing and Midwifery, College of Health, Medicine and Wellbeing, The University of Newcastle, Newcastle, New South Wales, Australia; Department of Respiratory and Sleep Medicine, John Hunter Hospital, Newcastle, New South Wales, Australia.
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Tan M, Liang Y, Lv W, Ren H, Cai Q. The effects of inspiratory muscle training on swimming performance: A study on the cohort of swimming specialization students. Physiol Behav 2023; 271:114347. [PMID: 37699450 DOI: 10.1016/j.physbeh.2023.114347] [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: 06/23/2023] [Revised: 07/29/2023] [Accepted: 09/09/2023] [Indexed: 09/14/2023]
Abstract
PURPOSE Current evidence posits a strong correlation between respiratory muscle function and swimming performance. Despite this, few studies have explored the integration of inspiratory muscle training (IMT) into standard swimming training regimens, which remains an unexplored avenue for improving performance in swimmers. This study aims to evaluate the potential advantages of IMT for enhancing respiratory function and swimming performance and determine whether such training could induce beneficial physiological adaptations. METHODS We designed and conducted a randomized controlled trial involving 43 swimming specialization students aged 18-25 years. Participants were randomly allocated to two groups: a control group, which followed regular swimming training, and an experimental group, which complemented the standard training with IMT. The intervention lasted for six weeks. Key outcomes measured included swimming performance metrics (time of 50 m freestyle, number of breaths in 50 m freestyle, distance before first breath in freestyle, time of 100 m freestyle) and various inspiratory muscle function parameters such as vital capacity (VC), maximum inspiratory pressure (MIP), maximum inspiratory flow (MIF), and maximum inspiratory capacity (MIC). We also assessed certain biochemical parameters, including hemoglobin, creatine kinase (CK), blood urea nitrogen (BUN), testosterone, and cortisol concentrations. RESULTS Following the training period, the experimental group exhibited significant improvements in swimming performance and respiratory function parameters. We also noted an increase in hemoglobin levels and a reduction in testosterone concentrations in this group, suggesting beneficial physiological adaptations in response to the combined IMT and swimming training. CONCLUSION Our findings underline the potential of IMT as a supplementary training modality for enhancing respiratory function and improving swimming performance. The changes in biochemical parameters suggest physiological adaptations that might contribute to these observed improvements. This study opens the door for future research on the benefits of integrating IMT into training regimens for competitive swimmers. Further investigation is warranted to fully elucidate the mechanisms behind the observed benefits and to validate these findings in a larger cohort and other athlete populations.
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Affiliation(s)
| | - Yuxi Liang
- Guangzhou Sport University, Guangzhou, China
| | - Wenting Lv
- Guangzhou Sport University, Guangzhou, China
| | - Hao Ren
- Institute for Healthcare Artificial Intelligence, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Qijun Cai
- Guangzhou Sport University, Guangzhou, China
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Parodi-Feye AS, Cappuccio-Díaz ÁD, Magallanes-Mira CA. Effects of Inspiratory Muscle Training on Physiological Performance Variables in Women's Handball. J Hum Kinet 2023; 89:101-112. [PMID: 38053961 PMCID: PMC10694718 DOI: 10.5114/jhk/169366] [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: 03/06/2023] [Accepted: 06/05/2023] [Indexed: 12/07/2023] Open
Abstract
Inspiratory muscle training (IMT) has been used in different sports, although there is no consensus on its benefits. We investigated the effects of eight weeks of IMT in women's handball. Twenty-four players were randomly distributed into experimental (EXP; n = 13) and control (CON; n = 11) groups. Only the EXP group performed IMT using the POWERBreathe device, following indications of the manufacturers. Before and after the intervention, spirometric variables were evaluated at rest and during a graded test using direct analysis of respiratory gases. Perception of exertion at submaximal intensity was also determined. No significant differences were observed post- vs. pre-intervention (p ≥ 0.05) regarding forced vital capacity (FVC), forced expiratory volume in the 1st second (VEF1), FVC/VEF1, maximal expiratory flow at 50% of FVC or peak inspiratory flow. Post-intervention, only the CON group increased their absolute and relative VO2max (2.1 ± 0.2 L/min pre vs. 2.2 ± 0.3 L/min post; 33.6 ± 3.6 ml/kg∙min pre vs. 34.5 ± 3.2 ml/kg∙min post, respectively). No significant improvements (p ≥ 0.05) were observed in VO2 associated with ventilatory threshold 1 (VT1), nor in the intensity associated with VO2max and VT1. However, there was a tendency for the mentioned variables to decrease in the CON group, while in the EXP group the trend was to maintain or increase previous values. IMT did not determine an improvement in the perception of exertion at submaximal intensity. The use of POWERBreathe, as described in the present study, is feasible in terms of time and effort, although its benefits may not be significant.
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Affiliation(s)
- Andrés Santiago Parodi-Feye
- Department of Physical Education and Sport, Superior Institute of Physical Education, University of the Republic (Udelar), Montevideo, Uruguay
| | - Álvaro Daniel Cappuccio-Díaz
- Department of Physical Education and Sport, Superior Institute of Physical Education, University of the Republic (Udelar), Montevideo, Uruguay
| | - Carlos Alberto Magallanes-Mira
- Department of Physical Education and Sport, Superior Institute of Physical Education, University of the Republic (Udelar), Montevideo, Uruguay
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Yorita A, Tokunaga Y, Kinoshita T, Nakakura A, Oda H, Imaoka H, Matsunaga K, Kakuma T, Hoshino T, Kawayama T. Usefulness of a 4-Grade Novel Mouthpiece Device for Increased Mouth Pressure Reproducing Artificial Difficulty in Breathing. Kurume Med J 2023; 68:229-238. [PMID: 37316289 DOI: 10.2739/kurumemedj.ms6834008] [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] [Indexed: 06/16/2023]
Abstract
OBJECTIVE The use of a novel 4-grade mouthpiece device to reproduce difficulty in breathing was assessed in healthy individuals. METHODS A double-blind, randomized, crossover-controlled trial was conducted to investigate the efficacy and safety of the device with increasing mouth pressure. The modified Borg (mBorg) scale values, respiratory system resistance at 5 Hz (R5), and forced expiratory volume in one second (FEV1) were assessed while using the device. MATERIALS The four grades of breathing difficulty device were tested in 32 healthy participants. RESULTS The 4-grade device linearly worsened the mBorg scale with increasing mouth pressure. The mean R5 (± standard deviation [SD]) with grade I, II, III, and IV devices were 5.6 ± 0.1, 10.3 ± 0.3, 21.5 ± 0.7, and 54.8 ± 2.0 kPa/L/s, respectively. The mean %FEV1 predicted (± SD) were 83.6 ± 15.9% with grade I, 55.3 ± 11.8% with grade II, 32.0 ± 6.1% with grade III, and 15.3 ± 3.2% with the grade IV device. The mBorg scale was positively correlated with R5 (r = 0.79, p < 0.0001) and negatively with %FEV1 predicted (r = -0.81, p < 0.0001). No severe adverse events were reported during the trial. CONCLUSION We demonstrated that the novel device could effectively reproduce the semi-quantitative artificial difficulty in breathing safely and easily in healthy individuals. These devices could be helpful to understand the mechanisms of difficulty in breathing.
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Affiliation(s)
- Akiko Yorita
- Division of Respirology, Neurology, and Rheumatology, Department of Medicine, Kurume University School of Medicine
| | - Yoshihisa Tokunaga
- Division of Respirology, Neurology, and Rheumatology, Department of Medicine, Kurume University School of Medicine
| | - Takashi Kinoshita
- Division of Respirology, Neurology, and Rheumatology, Department of Medicine, Kurume University School of Medicine
| | | | - Hanako Oda
- Division of Respirology, Neurology, and Rheumatology, Department of Medicine, Kurume University School of Medicine
| | - Haruki Imaoka
- Division of Respirology, Neurology, and Rheumatology, Department of Medicine, Kurume University School of Medicine
| | - Kazuko Matsunaga
- Division of Respirology, Neurology, and Rheumatology, Department of Medicine, Kurume University School of Medicine
| | | | - Tomoaki Hoshino
- Division of Respirology, Neurology, and Rheumatology, Department of Medicine, Kurume University School of Medicine
| | - Tomotaka Kawayama
- Division of Respirology, Neurology, and Rheumatology, Department of Medicine, Kurume University School of Medicine
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Illidi CR, Romer LM, Johnson MA, Williams NC, Rossiter HB, Casaburi R, Tiller NB. Distinguishing science from pseudoscience in commercial respiratory interventions: an evidence-based guide for health and exercise professionals. Eur J Appl Physiol 2023; 123:1599-1625. [PMID: 36917254 PMCID: PMC10013266 DOI: 10.1007/s00421-023-05166-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 02/19/2023] [Indexed: 03/16/2023]
Abstract
Respiratory function has become a global health priority. Not only is chronic respiratory disease a leading cause of worldwide morbidity and mortality, but the COVID-19 pandemic has heightened attention on respiratory health and the means of enhancing it. Subsequently, and inevitably, the respiratory system has become a target of the multi-trillion-dollar health and wellness industry. Numerous commercial, respiratory-related interventions are now coupled to therapeutic and/or ergogenic claims that vary in their plausibility: from the reasonable to the absurd. Moreover, legitimate and illegitimate claims are often conflated in a wellness space that lacks regulation. The abundance of interventions, the range of potential therapeutic targets in the respiratory system, and the wealth of research that varies in quality, all confound the ability for health and exercise professionals to make informed risk-to-benefit assessments with their patients and clients. This review focuses on numerous commercial interventions that purport to improve respiratory health, including nasal dilators, nasal breathing, and systematized breathing interventions (such as pursed-lips breathing), respiratory muscle training, canned oxygen, nutritional supplements, and inhaled L-menthol. For each intervention we describe the premise, examine the plausibility, and systematically contrast commercial claims against the published literature. The overarching aim is to assist health and exercise professionals to distinguish science from pseudoscience and make pragmatic and safe risk-to-benefit decisions.
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Affiliation(s)
- Camilla R Illidi
- Clinical Exercise and Respiratory Physiology Laboratory, Department of Kinesiology and Physical Education, Faculty of Education, McGill University, Montréal, QC, Canada
| | - Lee M Romer
- Division of Sport, Health and Exercise Sciences, College of Health, Medicine and Life Sciences, Brunel University London, Uxbridge, UK
| | - Michael A Johnson
- Exercise and Health Research Group, Sport, Health and Performance Enhancement (SHAPE) Research Centre, School of Science and Technology, Nottingham Trent University, Nottingham, Nottinghamshire, UK
| | - Neil C Williams
- Exercise and Health Research Group, Sport, Health and Performance Enhancement (SHAPE) Research Centre, School of Science and Technology, Nottingham Trent University, Nottingham, Nottinghamshire, UK
| | - Harry B Rossiter
- Institute of Respiratory Medicine and Exercise Physiology, Division of Respiratory and Critical Care Physiology and Medicine, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, 1124 W. Carson Street, CDCRC Building, Torrance, CA, 90502, USA
| | - Richard Casaburi
- Institute of Respiratory Medicine and Exercise Physiology, Division of Respiratory and Critical Care Physiology and Medicine, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, 1124 W. Carson Street, CDCRC Building, Torrance, CA, 90502, USA
| | - Nicholas B Tiller
- Institute of Respiratory Medicine and Exercise Physiology, Division of Respiratory and Critical Care Physiology and Medicine, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, 1124 W. Carson Street, CDCRC Building, Torrance, CA, 90502, USA.
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Sakai Y, Yamaga T, Yamamoto S, Matsumori K, Ichiyama T, Hanaoka M, Ikegami S, Horiuchi H. Effects and Usefulness of Inspiratory Muscle Training Load in Patients with Advanced Lung Cancer with Dyspnea. J Clin Med 2023; 12:jcm12103396. [PMID: 37240502 DOI: 10.3390/jcm12103396] [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: 03/15/2023] [Revised: 04/28/2023] [Accepted: 05/09/2023] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND Patients with advanced lung cancer tend to experience dyspnea. Pulmonary rehabilitation has been reported as a method for relieving dyspnea. However, exercise therapy imposes a high burden on patients, and it is difficult to sustain in many cases. Inspiratory muscle training (IMT) imposes a relatively low burden on patients with advanced lung cancer; however, its benefits have not been demonstrated. METHODS We retrospectively analyzed 71 patients who were hospitalized for medical treatment. The participants were divided into an exercise therapy group and an IMT load + exercise therapy group. Changes in maximal inspiratory pressure (MIP) and dyspnea were examined using a two-way repeated measures analysis of variance. RESULTS MIP variations significantly increase in the IMT load group, with significant differences between baseline and week 1, between week 1 and week 2, and between baseline and week 2. The analysis also showed that the variations in dyspnea decreased in the IMT load + exercise therapy group with significant differences between baseline and week 1 and between baseline and week 2. CONCLUSIONS The results show that IMT is useful and has a high persistence rate in patients with advanced lung cancer who present dyspnea and cannot perform high-intensity exercise therapy.
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Affiliation(s)
- Yasunari Sakai
- Department of Rehabilitation, Shinshu University Hospital, Matsumoto 390-8621, Japan
| | - Takayoshi Yamaga
- Department of Occupational Therapy, Faculty of Medical Science, Nagoya Women's University, Nagoya 467-8610, Japan
| | - Shuhei Yamamoto
- Department of Rehabilitation, Shinshu University Hospital, Matsumoto 390-8621, Japan
| | - Keiji Matsumori
- Department of Rehabilitation, Shinshu University Hospital, Matsumoto 390-8621, Japan
| | - Takashi Ichiyama
- Department of Respiratory Center, Shinshu University Hospital, Matsumoto 390-8621, Japan
| | - Masayuki Hanaoka
- Department of Respiratory Center, Shinshu University Hospital, Matsumoto 390-8621, Japan
| | - Shota Ikegami
- Department of Rehabilitation, Shinshu University Hospital, Matsumoto 390-8621, Japan
| | - Hiroshi Horiuchi
- Department of Rehabilitation, Shinshu University Hospital, Matsumoto 390-8621, Japan
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Laohachai K, Ayer J. Impairments in Pulmonary Function in Fontan Patients: Their Causes and Consequences. Front Pediatr 2022; 10:825841. [PMID: 35498782 PMCID: PMC9051243 DOI: 10.3389/fped.2022.825841] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 02/23/2022] [Indexed: 11/26/2022] Open
Abstract
Patients with a Fontan circulation lack a sub-pulmonary ventricle with pulmonary blood flow passively redirected to the lungs. In the Fontan circulation, ventilation has a significant influence on pulmonary blood flow and cardiac output both at rest and with exercise. Children and adults with a Fontan circulation have abnormalities in lung function. In particular, restrictive ventilatory patterns, as measured by spirometry, and impaired gas transfer, as measured by the diffusing capacity of carbon monoxide, have been frequently observed. These abnormalities in lung function are associated with reduced exercise capacity and quality of life. Moderate to severe impairment in lung volumes is independently associated with reduced survival in adults with congenital heart disease. Skeletal and inspiratory muscle weakness has also been reported in patients with a Fontan circulation, with the prospect of improving respiratory muscle function through exercise training programs. In this review, we will present data on cardiopulmonary interactions in the Fontan circulation, the prevalence and severity of impaired lung function, and respiratory muscle function in this population. We will discuss potential causes for and consequence of respiratory impairments, and their impact on exercise capacity and longer-term Fontan outcome. We aim to shed light on possible strategies to reduce morbidity by improving respiratory function in this growing population of patients.
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Affiliation(s)
- Karina Laohachai
- Cardiology Department, Women's and Children's Hospital, Adelaide, SA, Australia.,Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Julian Ayer
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.,The Heart Centre for Children, Children's Hospital at Westmead, Sydney, NSW, Australia
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Relationship between respiratory muscle endurance and dyspnea during high-intensity exercise in trained distance runners. Respir Physiol Neurobiol 2021; 296:103812. [PMID: 34741844 DOI: 10.1016/j.resp.2021.103812] [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: 07/29/2021] [Revised: 10/12/2021] [Accepted: 10/31/2021] [Indexed: 11/23/2022]
Abstract
We hypothesized that the trained distance runners, who have a relatively high respiratory muscle endurance, but not high respiratory muscle strength, have lower dyspneic sensations during submaximal running. Twenty-one male collegiate distance runners participated. Incremental respiratory endurance tests (IRET) and maximal inspiratory mouth pressure (PImax) measurements were performed under resting conditions. A submaximal exercise test was also performed on a treadmill at two different speeds (16 and 18 km/h) for 4 min each, and the subjects reported the rate of dyspnea (range: 0-10). The time to endpoint during the IRET, an index of respiratory muscle endurance, ranged from 9.4 to 18.8 min, and PImax, as an index of inspiratory muscle strength, ranged from 74.1 to 137.0 cmH2O. The dyspnea rating during running at 16 and 18 km/h ranged from 1 to 6 and from 4 to 8, respectively. The relative exercise intensity was approximately 80 % of peak oxygen uptake (VO2peak) at 16 km/h and 90 %VO2peak at 18 km/h. The time to endpoint during the IRET was significantly negatively correlated with dyspnea during running at 18 km/h (r = -0.459, P = 0.040), but not at 16 km/h (r = -0.161, P = 0.470). There was no significant correlation between PImax and dyspnea during running at 16 km/h (r = -0.003, P = 0.989) or 18 km/h (r = 0.070, P = 0.755). These results suggest that dyspneic sensations during high-intensity running are related to respiratory muscle endurance, but not inspiratory muscle strength, in trained distance runners.
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Sirayder U, Inal-Ince D, Acik C, Soyuer F. Impaired exercise capacity in electrostatic polyester powder paint workers. Inhal Toxicol 2021; 33:55-65. [PMID: 33622153 DOI: 10.1080/08958378.2021.1876189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
PURPOSE Limited number of studies investigated the effects of Electrostatic powder paints (EPP) on human health. We investigated the effects of EPP exposure on lung function, exercise capacity, and quality of life, and the factors determining exercise capacity in EPP workers. METHODS Fifty-four male EPP workers and 54 age-matched healthy male individuals (control group) were included. Lung function and respiratory muscle strength were measured. The lower limit of normal (LLN) cut-points for FEV1 and FEV1/FVC were calculated. An EPT was used to evaluate bronchial hyperactivity. The handgrip and quadriceps muscle strength were evaluated using a hand-held dynamometer. An ISWT was used to determine exercise capacity. The physical activity level was questioned using the IPAQ. The SGRQ and NHP were used to assessing respiratory specific and general quality of life, respectively. RESULTS Duration of work, FEV1, MIP, handgrip strength, and ISWT distance were significantly lower, and the change in FEV1 after EPT and %HRmax were significantly higher in the EPP group compared to the control group (p < 0.05). There were no subjects with a < LLN for FEV1 and FEV1/FVC in both groups. In the EPP group, ISWT distance was significantly related to age, height, duration of work, FEV1, change in FEV1 after EPT, MIP, MEP, handgrip strength, IPAQ, SGRQ, and NHP total scores (p < 0.05). The change in FEV1 after EPT, MIP, and duration of work explained % 62 of the variance in the ISWT distance (p < 0.001). CONCLUSIONS Changes in lung function based on LLN for the FEV1 and FEV1/FVC were not clinically relevant in EPP workers. Exercise capacity is impaired in EPP workers. Degree of exercise-induced bronchospasm, inspiratory muscle strength, and duration of work are the determinants of exercise capacity in EPP workers.
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Affiliation(s)
- Ukbe Sirayder
- Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Nuh Naci Yazgan University, Kayseri, Turkey
| | - Deniz Inal-Ince
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Cihangir Acik
- Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Nuh Naci Yazgan University, Kayseri, Turkey
| | - Ferhan Soyuer
- Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Antalya Bilim University, Antalya, Turkey
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Boyle KG, Mitchell RA, Ramsook AH, Schaeffer MR, Koehle MS, Sheel AW, Guenette JA. The effect of diaphragm fatigue on the multidimensional components of dyspnoea and diaphragm electromyography during exercise in healthy males. J Physiol 2020; 598:3223-3237. [DOI: 10.1113/jp279755] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 05/11/2020] [Indexed: 11/08/2022] Open
Affiliation(s)
- Kyle G. Boyle
- Centre for Heart and Lung Innovation St. Paul's Hospital Vancouver Canada
- Department of Physical Therapy Faculty of Medicine University of British Columbia Vancouver Canada
| | - Reid A. Mitchell
- Centre for Heart and Lung Innovation St. Paul's Hospital Vancouver Canada
- Department of Physical Therapy Faculty of Medicine University of British Columbia Vancouver Canada
| | - Andrew H. Ramsook
- Centre for Heart and Lung Innovation St. Paul's Hospital Vancouver Canada
- Department of Physical Therapy Faculty of Medicine University of British Columbia Vancouver Canada
| | - Michele R. Schaeffer
- Centre for Heart and Lung Innovation St. Paul's Hospital Vancouver Canada
- Department of Physical Therapy Faculty of Medicine University of British Columbia Vancouver Canada
| | - Michael S. Koehle
- School of Kinesiology Faculty of Education University of British Columbia Vancouver Canada
- Department of Family Practice Faculty of Medicine University of British Columbia Vancouver Canada
| | - A. William Sheel
- School of Kinesiology Faculty of Education University of British Columbia Vancouver Canada
| | - Jordan A. Guenette
- Centre for Heart and Lung Innovation St. Paul's Hospital Vancouver Canada
- Department of Physical Therapy Faculty of Medicine University of British Columbia Vancouver Canada
- School of Kinesiology Faculty of Education University of British Columbia Vancouver Canada
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Mackała K, Kurzaj M, Okrzymowska P, Stodółka J, Coh M, Rożek-Piechura K. The Effect of Respiratory Muscle Training on the Pulmonary Function, Lung Ventilation, and Endurance Performance of Young Soccer Players. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 17:E234. [PMID: 31905644 PMCID: PMC6981841 DOI: 10.3390/ijerph17010234] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 12/23/2019] [Accepted: 12/24/2019] [Indexed: 12/31/2022]
Abstract
This study investigated whether the addition of eight weeks of inspiratory muscle training (IMT) to a regular preseason soccer training program, including incremental endurance training (IET), would change pulmonary function, lung ventilation, and aerobic performance in young soccer players. Sixteen club-level competitive junior soccer players (mean age 17.63 ± 0.48 years, height 182 ± 0.05 cm, body mass 68.88 ± 4.48 kg) participated in the study. Participants were randomly assigned into two groups: experimental (n = 8) and control (n = 8). Both groups performed regular preseason soccer training, including endurance workouts as IET. In addition to this training, the experimental group performed additional IMT for eigght weeks with a commercially available respiratory muscle trainer (Threshold IMT), with a total of 80 inhalations (twice per day, five days per week). Pre- and post-intervention tests of pulmonary function, maximal inspiratory pressure, and the Cooper test were implemented. Eight weeks of IMT had a positive impact on expiratory muscle strength (p = 0.001); however, there was no significant effect on respiratory function parameters. The results also indicate increased efficiency of the inspiratory muscles, contributing to an improvement in aerobic endurance, measured by VO₂max estimated from running distance in the cardiorespiratory Cooper test (p < 0.005).
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Affiliation(s)
- Krzysztof Mackała
- Department of Track and Field, University School of Physical Education, Wroclaw, Ul. Paderewskiego 35, 51-612 Wrocław, Poland;
| | - Monika Kurzaj
- Faculty of Physiotherapy, University School of Physical Education in Wroclaw, Poland, Ul. Paderewskiego 35, 51-612 Wrocław, Poland; (M.K.); (P.O.); (K.R.-P.)
| | - Paulina Okrzymowska
- Faculty of Physiotherapy, University School of Physical Education in Wroclaw, Poland, Ul. Paderewskiego 35, 51-612 Wrocław, Poland; (M.K.); (P.O.); (K.R.-P.)
| | - Jacek Stodółka
- Department of Track and Field, University School of Physical Education, Wroclaw, Ul. Paderewskiego 35, 51-612 Wrocław, Poland;
| | - Milan Coh
- Faculty of Sport, University of Ljubljana, Gortanova ul. 22, 1000 Ljubljana, Slovenia;
| | - Krystyna Rożek-Piechura
- Faculty of Physiotherapy, University School of Physical Education in Wroclaw, Poland, Ul. Paderewskiego 35, 51-612 Wrocław, Poland; (M.K.); (P.O.); (K.R.-P.)
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Inspiratory Muscle Training After Heart Valve Replacement Surgery Improves Inspiratory Muscle Strength, Lung Function, and Functional Capacity. J Cardiopulm Rehabil Prev 2019; 39:E1-E7. [DOI: 10.1097/hcr.0000000000000409] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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13
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Hartz CS, Sindorf MAG, Lopes CR, Batista J, Moreno MA. Effect of Inspiratory Muscle Training on Performance of Handball Athletes. J Hum Kinet 2018; 63:43-51. [PMID: 30279940 PMCID: PMC6162985 DOI: 10.2478/hukin-2018-0005] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Inspiratory muscle training (IMT) is a strategy that has been used to improve performance in different sports modalities. This study investigated the effects of an IMT program on respiratory muscle strength and resistance as well as aerobic physical performance (PP) of handball athletes. Nineteen 20 ± 3 year-old male athletes were allocated into an experimental (EG, n = 10) or a placebo group (PG, n = 9). Their respiratory muscle strength was evaluated by measuring the maximum inspiratory and expiratory pressures (MIP and MEP), muscular respiratory resistance by maximum voluntary ventilation (MVV) and aerobic PP by the cardiopulmonary exercise test. The study was designed to evaluate the effects of a 12-week IMT program with five sessions a week. A significant difference was observed in the pre and post IMT values of the MIP (170 ± 34 to 262 ± 33 cmH2O) and MEP (177 ± 36 to 218 ± 37 cmH2O) in the EG, and MIP (173 ± 45 to 213 ± 21 cmH2O) in the PG, with a large effect size for the MIP, when the groups were compared. MVV showed a significant increase (162 ± 24 to 173 ± 30 L) in the EG, with a small effect size. There was a significant difference in maximum oxygen uptake (54 ± 8 to 60 ± 7 ml/kg/min) in aerobic PP. Oxygen uptake at the respiratory compensation point (RCP) (46 ± 6 to 50 ± 5 ml/kg/min), with a moderate effect size for both variables, was observed in the EG after IMT. We concluded that IMT provided a significant increase in respiratory muscle strength and resistance, contributing to increased aerobic PP in the EG, which suggests that IMT could be incorporated in handball players' training.
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Affiliation(s)
- Charlini S. Hartz
- Postgraduate Program in Human Movement Sciences - Methodist University of Piracicaba - UNIMEP - Piracicaba, São Paulo, Brazil
| | - Márcio A. G. Sindorf
- Postgraduate Program in Human Movement Sciences - Methodist University of Piracicaba - UNIMEP - Piracicaba, São Paulo, Brazil
| | - Charles R. Lopes
- Postgraduate Program in Human Movement Sciences - Methodist University of Piracicaba - UNIMEP - Piracicaba, São Paulo, Brazil
- Adventist College of Hortolândia, Hortolândia, São Paulo, Brazil
| | - José Batista
- Postgraduate Program in Human Movement Sciences - Methodist University of Piracicaba - UNIMEP - Piracicaba, São Paulo, Brazil
| | - Marlene A. Moreno
- Postgraduate Program in Human Movement Sciences - Methodist University of Piracicaba - UNIMEP - Piracicaba, São Paulo, Brazil
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14
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Ramsook AH, Molgat-Seon Y, Schaeffer MR, Wilkie SS, Camp PG, Reid WD, Romer LM, Guenette JA. Effects of inspiratory muscle training on respiratory muscle electromyography and dyspnea during exercise in healthy men. J Appl Physiol (1985) 2017; 122:1267-1275. [PMID: 28255085 DOI: 10.1152/japplphysiol.00046.2017] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Revised: 02/13/2017] [Accepted: 02/26/2017] [Indexed: 11/22/2022] Open
Abstract
Inspiratory muscle training (IMT) has consistently been shown to reduce exertional dyspnea in health and disease; however, the physiological mechanisms remain poorly understood. A growing body of literature suggests that dyspnea intensity can be explained largely by an awareness of increased neural respiratory drive, as measured indirectly using diaphragmatic electromyography (EMGdi). Accordingly, we sought to determine whether improvements in dyspnea following IMT can be explained by decreases in inspiratory muscle electromyography (EMG) activity. Twenty-five young, healthy, recreationally active men completed a detailed familiarization visit followed by two maximal incremental cycle exercise tests separated by 5 wk of randomly assigned pressure threshold IMT or sham control (SC) training. The IMT group (n = 12) performed 30 inspiratory efforts twice daily against a 30-repetition maximum intensity. The SC group (n = 13) performed a daily bout of 60 inspiratory efforts against 10% maximal inspiratory pressure (MIP), with no weekly adjustments. Dyspnea intensity was measured throughout exercise using the modified 0-10 Borg scale. Sternocleidomastoid and scalene EMG was measured using surface electrodes, whereas EMGdi was measured using a multipair esophageal electrode catheter. IMT significantly improved MIP (pre: -138 ± 45 vs. post: -160 ± 43 cmH2O, P < 0.01), whereas the SC intervention did not. Dyspnea was significantly reduced at the highest equivalent work rate (pre: 7.6 ± 2.5 vs. post: 6.8 ± 2.9 Borg units, P < 0.05), but not in the SC group, with no between-group interaction effects. There were no significant differences in respiratory muscle EMG during exercise in either group. Improvements in dyspnea intensity ratings following IMT in healthy humans cannot be explained by changes in the electrical activity of the inspiratory muscles.NEW & NOTEWORTHY Exertional dyspnea intensity is thought to reflect an increased awareness of neural respiratory drive, which is measured indirectly using diaphragmatic electromyography (EMGdi). We examined the effects of inspiratory muscle training (IMT) on dyspnea, EMGdi, and EMG of accessory inspiratory muscles. IMT significantly reduced submaximal dyspnea intensity ratings but did not change EMG of any inspiratory muscles. Improvements in exertional dyspnea following IMT may be the result of nonphysiological factors or physiological adaptations unrelated to neural respiratory drive.
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Affiliation(s)
- Andrew H Ramsook
- Centre for Heart Lung Innovation, University of British Columbia and St. Paul's Hospital, Vancouver, British Columbia, Canada.,Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
| | - Yannick Molgat-Seon
- Centre for Heart Lung Innovation, University of British Columbia and St. Paul's Hospital, Vancouver, British Columbia, Canada.,School of Kinesiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Michele R Schaeffer
- Centre for Heart Lung Innovation, University of British Columbia and St. Paul's Hospital, Vancouver, British Columbia, Canada.,Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
| | - Sabrina S Wilkie
- Centre for Heart Lung Innovation, University of British Columbia and St. Paul's Hospital, Vancouver, British Columbia, Canada.,Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
| | - Pat G Camp
- Centre for Heart Lung Innovation, University of British Columbia and St. Paul's Hospital, Vancouver, British Columbia, Canada.,Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
| | - W Darlene Reid
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada; and
| | - Lee M Romer
- Centre for Human Performance, Exercise, and Rehabilitation, Brunel University London, Uxbridge, United Kingdom
| | - Jordan A Guenette
- Centre for Heart Lung Innovation, University of British Columbia and St. Paul's Hospital, Vancouver, British Columbia, Canada; .,Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada.,School of Kinesiology, University of British Columbia, Vancouver, British Columbia, Canada
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15
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Rocha FR, Brüggemann AKV, Francisco DDS, de Medeiros CS, Rosal D, Paulin E. Diaphragmatic mobility: relationship with lung function, respiratory muscle strength, dyspnea, and physical activity in daily life in patients with COPD. J Bras Pneumol 2017; 43:32-37. [PMID: 28380186 PMCID: PMC5790674 DOI: 10.1590/s1806-37562016000000097] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Accepted: 10/31/2016] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE: To evaluate diaphragmatic mobility in relation to lung function, respiratory muscle strength, dyspnea, and physical activity in daily life (PADL) in patients with COPD. METHODS: We included 25 patients with COPD, classified according to the Global Initiative for Chronic Obstructive Lung Disease criteria, and 25 healthy individuals. For all of the participants, the following were evaluated: anthropometric variables, spirometric parameters, respiratory muscle strength, diaphragmatic mobility (by X-ray), PADL, and the perception of dyspnea. RESULTS: In the COPD group, diaphragmatic mobility was found to correlate with lung function variables, inspiratory muscle strength, and the perception of dyspnea, whereas it did not correlate with expiratory muscle strength or PADL. CONCLUSIONS: In patients with COPD, diaphragmatic mobility seems to be associated with airway obstruction and lung hyperinflation, as well as with ventilatory capacity and the perception of dyspnea, although not with PADL. OBJETIVO: Avaliar a relação da mobilidade diafragmática com a função pulmonar, força muscular respiratória, dispneia e atividade física de vida diária (AFVD) em pacientes com DPOC. MÉTODOS: Foram avaliados 25 pacientes com diagnóstico de DPOC, classificados de acordo com critérios da Global Initiative for Chronic Obstructive Lung Disease, e 25 indivíduos saudáveis. Todos foram submetidos às seguintes avaliações: mensuração antropométrica, espirometria, força muscular respiratória, mobilidade diafragmática (por radiografia), AFVD e percepção de dispneia. RESULTADOS: No grupo DPOC, houve correlações da mobilidade diafragmática com variáveis de função pulmonar, força muscular inspiratória e percepção de dispneia. Não houve correlações da mobilidade diafragmática com força muscular expiratória e AFVD. CONCLUSÕES: A mobilidade diafragmática parece estar associada tanto com a obstrução das vias aéreas quanto com a hiperinsuflação pulmonar em pacientes com DPOC, assim como com a capacidade ventilatória e percepção de dispneia, mas não com AFVD.
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Affiliation(s)
- Flávia Roberta Rocha
- . Curso de Fisioterapia, Universidade do Estado de Santa Catarina - UDESC - Florianópolis (SC) Brasil
| | | | - Davi de Souza Francisco
- . Curso de Fisioterapia, Universidade do Estado de Santa Catarina - UDESC - Florianópolis (SC) Brasil
| | | | - Danielle Rosal
- . Fundação Universidade Regional de Blumenau - FURB - Blumenau (SC) Brasil
| | - Elaine Paulin
- . Curso de Fisioterapia, Universidade do Estado de Santa Catarina - UDESC - Florianópolis (SC) Brasil
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16
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Hulzebos EHJ, van Meeteren NLU, van den Buijs BJWM, de Bie RA, Brutel de la Rivière A, Helders PJM. Feasibility of preoperative inspiratory muscle training in patients undergoing coronary artery bypass surgery with a high risk of postoperative pulmonary complications: a randomized controlled pilot study. Clin Rehabil 2016; 20:949-59. [PMID: 17065538 DOI: 10.1177/0269215506070691] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: To determine in a pilot study the feasibility and effects of preoperative inspiratory muscle training in patients at high risk of postoperative pulmonary complications who were scheduled for coronary artery bypass graft surgery. Design: Single-blind, randomized controlled pilot study. Setting: University Medical Centre Utrecht, the Netherlands. Subjects: Twenty-six patients at high risk of postoperative pulmonary complications were selected. Intervention: The intervention group ( N = 14) received 2-4 weeks of preoperative inspiratory muscle training on top of the usual care received by the patients in the control group. Main measures: Primary outcome variables of feasibility were the occurrence of adverse events, and patient satisfaction and motivation. Secondary outcome variables were postoperative pulmonary complications and length of hospital stay. Results: The feasibility of inspiratory muscle training was good and no adverse events were observed. Treatment satisfaction and motivation, scored on 10-point scales, were 7.9 (± 0.7) and 8.2 (± 1.0), respectively. Postoperative atelectasis occurred in significantly fewer patients in the intervention group than in the control group (ϰ2DF1 = 3.85; P = 0.05): Length of hospital stay was 7.93 (± 1.94) days in the intervention group and 9.92 (± 5.78) days in the control group ( P = 0.24). Conclusion: Inspiratory muscle training for 2-4 weeks before coronary artery bypass graft surgery was well tolerated by patients at risk of postoperative pulmonary complications and prevented the occurrence of atelectasis in these patients. A larger randomized clinical trial is warranted.
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Affiliation(s)
- Erik H J Hulzebos
- Section Rehabilitation, Department of Neurology and Neurosurgery, Rudolf Magnus Institute of Neuroscience, University Medical Center Utrecht, The Netherlands.
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17
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Montesinos-Magraner L, López-Bueno L, Gómez-Garrido A, Gomis M, González LM, García-Massó X, Serra-Añó P. The influence of regular physical activity on lung function in paraplegic people. Spinal Cord 2016; 54:861-865. [PMID: 26927294 DOI: 10.1038/sc.2016.4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Revised: 11/30/2015] [Accepted: 12/15/2015] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Cross-sectional study. OBJECTIVES The main goal of this study was to examine the influence of regular physical activity (PA) on lung volumes and flows. SETTING The study was conducted in the Vall d'Hebrón Hospital, Barcelona (Spain), and La Fe Hospital, Valencia (Spain). METHODS Spirometric tests were performed to 67 paraplegics, and differences were established between the active group (AG) (n=37) that performed >60 min per week of moderate-to-vigorous PA (MVPA) and 30 non-AG (NAG). Further, we established the relationship between the spirometric and PA variables and between being active and reaching the lower limit of normal (LLN) of the spirometric variables. RESULTS AG had greater values than the NAG: FVC (P<0.01), FEV1 (P<0.01) and PEF (P<0.01). Moderate correlations between the MVPA and FVC (r=0.41, P<0.01) and the MVPA and FEV1 (r=0.39, P<0.01) were obtained. The relationship between being physically active and reaching the LLN was statistically significant for FEV1 (χ2=6.184, P<0.05) but not for FVC (P>0.05). CONCLUSIONS The performance of MVPA for a minimum of 60 min per week can have a beneficial effect, both on lung volumes and on expiratory flow, and led to an achievement of the LLN in FEV1.
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Affiliation(s)
| | - L López-Bueno
- Department of Physiotherapy, University of Valencia, Valencia, Spain
| | - A Gómez-Garrido
- Cardiorespiratory rehabilitation unit, Vall d'Hebron University Hospital, Barcelona, Spain
| | - M Gomis
- School of Health Sciences TecnoCampus, Pompeu Fabra University, Barcelona, Spain
| | - L M González
- Department of Physical Education and Sports, University of Valencia, Valencia, Spain
| | - X García-Massó
- Department for Teaching of Musical, Visual and Corporal Expression, University of Valencia, Valencia, Spain
| | - P Serra-Añó
- Department of Physiotherapy, University of Valencia, Valencia, Spain
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18
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The effect of resistance inspiratory muscle training in the management of breathlessness in patients with thoracic malignancies: a feasibility randomised trial. Support Care Cancer 2014; 23:1637-45. [DOI: 10.1007/s00520-014-2511-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2014] [Accepted: 11/10/2014] [Indexed: 10/24/2022]
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Inspiratory high frequency airway oscillation attenuates resistive loaded dyspnea and modulates respiratory function in young healthy individuals. PLoS One 2014; 9:e91291. [PMID: 24651392 PMCID: PMC3961233 DOI: 10.1371/journal.pone.0091291] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2013] [Accepted: 02/10/2014] [Indexed: 11/27/2022] Open
Abstract
Direct chest-wall percussion can reduce breathlessness in Chronic Obstructive Pulmonary Disease and respiratory function may be improved, in health and disease, by respiratory muscle training (RMT). We tested whether high-frequency airway oscillation (HFAO), a novel form of airflow oscillation generation can modulate induced dyspnoea and respiratory strength and/or patterns following 5 weeks of HFAO training (n = 20) compared to a SHAM-RMT (conventional flow-resistive RMT) device (n = 15) in healthy volunteers (13 males; aged 20–36 yrs). HFAO causes oscillations with peak-to-peak amplitude of 1 cm H2O, whereas the SHAM-RMT device was identical but created no pressure oscillation. Respiratory function, dyspnoea and ventilation during 3 minutes of spontaneous resting ventilation, 1 minute of maximal voluntary hyperventilation and 1 minute breathing against a moderate inspiratory resistance, were compared PRE and POST 5-weeks of training (2×30 breaths at 70% peak flow, 5 days a week). Training significantly reduced NRS dyspnoea scores during resistive loaded ventilation, both in the HFAO (p = 0.003) and SHAM-RMT (p = 0.005) groups. Maximum inspiratory static pressure (cm H2O) was significantly increased by HFAO training (vs. PRE; p<0.001). Maximum inspiratory dynamic pressure was increased by training in both the HFAO (vs. PRE; p<0.001) and SHAM-RMT (vs. PRE; p = 0.021) groups. Peak inspiratory flow rate (L.s−1) achieved during the maximum inspiratory dynamic pressure manoeuvre increased significantly POST (vs. PRE; p = 0.001) in the HFAO group only. HFAO reduced inspiratory resistive loading–induced dyspnoea and augments static and dynamic maximal respiratory manoeuvre performance in excess of flow-resistive IMT (SHAM-RMT) in healthy individuals without the respiratory discomfort associated with RMT.
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20
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CliftonSmith T, Rowley J. Breathing pattern disorders and physiotherapy: inspiration for our profession. PHYSICAL THERAPY REVIEWS 2013. [DOI: 10.1179/1743288x10y.0000000025] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Abstract
During dynamic exercise, the healthy pulmonary system faces several major challenges, including decreases in mixed venous oxygen content and increases in mixed venous carbon dioxide. As such, the ventilatory demand is increased, while the rising cardiac output means that blood will have considerably less time in the pulmonary capillaries to accomplish gas exchange. Blood gas homeostasis must be accomplished by precise regulation of alveolar ventilation via medullary neural networks and sensory reflex mechanisms. It is equally important that cardiovascular and pulmonary system responses to exercise be precisely matched to the increase in metabolic requirements, and that the substantial gas transport needs of both respiratory and locomotor muscles be considered. Our article addresses each of these topics with emphasis on the healthy, young adult exercising in normoxia. We review recent evidence concerning how exercise hyperpnea influences sympathetic vasoconstrictor outflow and the effect this might have on the ability to perform muscular work. We also review sex-based differences in lung mechanics.
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Affiliation(s)
- Andrew William Sheel
- The School of Kinesiology, The University of British Columbia, Vancouver, Canada.
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22
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Brown PI, Venables HK, Liu H, de-Witt JT, Brown MR, Faghy MA. Ventilatory muscle strength, diaphragm thickness and pulmonary function in world-class powerlifters. Eur J Appl Physiol 2013; 113:2849-55. [DOI: 10.1007/s00421-013-2726-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2013] [Accepted: 09/10/2013] [Indexed: 11/24/2022]
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West CR, Taylor BJ, Campbell IG, Romer LM. Effects of inspiratory muscle training on exercise responses in Paralympic athletes with cervical spinal cord injury. Scand J Med Sci Sports 2013; 24:764-72. [DOI: 10.1111/sms.12070] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/20/2013] [Indexed: 11/28/2022]
Affiliation(s)
- C. R. West
- Centre for Sports Medicine and Human Performance; Brunel University; Uxbridge UK
| | - B. J. Taylor
- Centre for Sports Medicine and Human Performance; Brunel University; Uxbridge UK
| | - I. G. Campbell
- Centre for Sports Medicine and Human Performance; Brunel University; Uxbridge UK
| | - L. M. Romer
- Centre for Sports Medicine and Human Performance; Brunel University; Uxbridge UK
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Corwin EJ, Meek P, Cook PF, Lowe NK, Sousa KH. Shape shifters: biobehavioral determinants and phenomena in symptom research. Nurs Outlook 2012; 60:191-7. [PMID: 22789451 DOI: 10.1016/j.outlook.2012.04.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2011] [Revised: 03/12/2012] [Accepted: 04/29/2012] [Indexed: 10/28/2022]
Abstract
Symptom assessment and management are critical to patient-centered care. Traditionally, the determinants of a symptom are viewed as separate from the phenomena associated with that symptom. By separating determinants and phenomena, however, the complexity and dynamism of the patient experience are ignored. Likewise, categorizing symptom determinants and phenomena as solely biological or behavioral minimizes their dimensionality and may hinder interdisciplinary dialogue. Here we propose that determinants and phenomena are not fixed but shift between each other depending on perspective. To illustrate this way of thinking the metaphor of the "shape shifter" from folklore is used. A shape shifter moves between states and may be seen differently by the same person at different times or by multiple individuals at one time. To guide discussion, we present 5 exemplars of increasing complexity, wherein a determinant becomes a phenomenon or vice versa, depending upon context. Suggestions for statistical testing of the model are included with each. We conclude by exploring how shifting between determinants and phenomena may affect symptom cluster assessment and management.
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Affiliation(s)
- Elizabeth J Corwin
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA 30322, USA.
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Turner LA, Mickleborough TD, McConnell AK, Stager JM, Tecklenburg-Lund S, Lindley MR. Effect of inspiratory muscle training on exercise tolerance in asthmatic individuals. Med Sci Sports Exerc 2012; 43:2031-8. [PMID: 21502887 DOI: 10.1249/mss.0b013e31821f4090] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSE The aim of this study was to determine the effects of inspiratory muscle training (IMT) on exercise tolerance, inspiratory muscle fatigue, and the perception of dyspnea in asthmatic individuals. METHODS Using a matched double-blind placebo-controlled design, 15 clinically diagnosed asthmatic individuals underwent either 6 wk of IMT (n = 7) consisting of 30 breaths twice daily at 50% maximum inspiratory pressure (PI max) or sham-IMT (placebo; PLA, n = 8) consisting of 60 breaths daily at 15% PI max. Time to the limit of exercise tolerance (Tlim) was assessed using constant-power output (70% peak power) cycle ergometry. Inspiratory muscle fatigue was determined by comparing the pre- to postexercise reduction in PI max. Dyspnea during the Tlim test was evaluated at 2-min intervals using the Borg CR-10 scale. RESULTS There were no significant changes (P > 0.05) in Tlim, inspiratory muscle fatigue, or perception of dyspnea in the PLA group after the intervention. In contrast, in the IMT group, PI max increased by 28%, and Tlim increased by 16% (P < 0.05). Dyspnea during exercise was also reduced significantly by 16% (P < 0.05). The exercise-induced fall in PI max was reduced from 10% before IMT to 6% after IMT (P < 0.05), despite the longer Tlim. Pulmonary function remained unchanged in both the IMT and PLA groups. CONCLUSIONS These data suggest that IMT attenuates inspiratory muscle fatigue, reduces the perception of dyspnea, and increases exercise tolerance. These findings suggest that IMT may be a helpful adjunct to asthma management that has the potential to improve participation and adherence to exercise training in this group. However, the perception of breathlessness is also an important signal of bronchoconstriction, and thus, caution should be exercised if this symptom is abnormally low.
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Affiliation(s)
- Louise A Turner
- Department of Kinesiology, Indiana University, Bloomington, IN 47401, USA
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Bissett B, Leditschke IA, Paratz JD, Boots RJ. Respiratory Dysfunction in Ventilated Patients: Can Inspiratory Muscle Training Help? Anaesth Intensive Care 2012; 40:236-46. [DOI: 10.1177/0310057x1204000205] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Respiratory muscle dysfunction is associated with prolonged and difficult weaning from mechanical ventilation. This dysfunction in ventilator-dependent patients is multifactorial: there is evidence that inspiratory muscle weakness is partially explained by disuse atrophy secondary to ventilation, and positive end-expiratory pressure can further reduce muscle strength by negatively shifting the length-tension curve of the diaphragm. Polyneuropathy is also likely to contribute to apparent muscle weakness in critically ill patients, and nutritional and pharmaceutical effects may further compound muscle weakness. Moreover, psychological influences, including anxiety, may contribute to difficulty in weaning. There is recent evidence that inspiratory muscle training is safe and feasible in selected ventilator-dependent patients, and that this training can reduce the weaning period and improve overall weaning success rates. Extrapolating from evidence in sports medicine, as well as the known effects of inspiratory muscle training in chronic lung disease, a theoretical model is proposed to describe how inspiratory muscle training enhances weaning and recovery from mechanical ventilation. Possible mechanisms include increased protein synthesis (both Type 1 and Type 2 muscle fibres), enhanced limb perfusion via dampening of a sympathetically-mediated metaboreflex, reduced lactate levels and modulation of the perception of exertion, resulting in less dyspnoea and enhanced exercise capacity.
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Affiliation(s)
- B. Bissett
- Physiotherapy Department and Intensive Care Unit, Canberra Hospital, Canberra, Australian Capital Territory and University of Queensland, Brisbane, Queensland, Australia
- Physiotherapy Department, Canberra Hospital and PhD Candidate, University of Queensland
| | - I. A. Leditschke
- Physiotherapy Department and Intensive Care Unit, Canberra Hospital, Canberra, Australian Capital Territory and University of Queensland, Brisbane, Queensland, Australia
- Intensive Care Unit, Canberra Hospital and Australian National University
| | - J. D. Paratz
- Physiotherapy Department and Intensive Care Unit, Canberra Hospital, Canberra, Australian Capital Territory and University of Queensland, Brisbane, Queensland, Australia
- Department of Intensive Care Medicine, Royal Brisbane and Women's Hospital and University of Queensland
| | - R. J. Boots
- Physiotherapy Department and Intensive Care Unit, Canberra Hospital, Canberra, Australian Capital Territory and University of Queensland, Brisbane, Queensland, Australia
- Deputy Director, Intensive Care Unit, Department of Intensive Care Medicine, Royal Brisbane and Women's Hospital and University of Queensland
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Keramidas ME, Kounalakis SN, Eiken O, Mekjavic IB. Muscle and cerebral oxygenation during exercise performance after short-term respiratory work. Respir Physiol Neurobiol 2011; 175:247-54. [DOI: 10.1016/j.resp.2010.11.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2010] [Revised: 11/19/2010] [Accepted: 11/19/2010] [Indexed: 11/25/2022]
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Villiot-Danger JC, Villiot-Danger E, Borel JC, Pépin JL, Wuyam B, Vergès S. Respiratory muscle endurance training in obese patients. Int J Obes (Lond) 2010; 35:692-9. [PMID: 20805830 DOI: 10.1038/ijo.2010.191] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Increased respiratory muscle work is associated with dyspnea and poor exercise tolerance in obese patients. We evaluated the effect of respiratory muscle endurance training (RMET) on respiratory muscle capacities, symptoms and exercise capacity in obese patients. DESIGN A total of 20 obese patients hospitalized for 26 ± 6 days to follow a low-calorie diet and a physical activity program were included in this case-control study. Of them, 10 patients performed RMET (30-min isocapnic hyperpnea at 60-80% maximum voluntary ventilation, 3-4 times per week during the whole hospitalization period: RMET group), while the other 10 patients performed no respiratory training (control (CON) group). RMET and CON groups were matched for body mass index (BMI) (45 ± 7 kg m(-2)) and age (42 ± 12 years). Lung function, respiratory muscle strength and endurance, 6-min walking distance, dyspnea (Medical Research Council scale) and quality of life (short-form health survey 36 questionnaire) were assessed before and after intervention. RESULTS Similar BMI reduction was observed after hospitalization in the RMET and CON groups (-2 ± 1 kg m(-2), P < 0.001). No significant change in lung function and respiratory muscle strength was observed except for vital capacity, which increased in the RMET group (+0.20 ± 0.26 l, P = 0.039). Respiratory muscle endurance increased in the RMET group only (+52 ± 27%, P < 0.001). Compared with the CON group, the RMET group had greater improvement in 6MWT (+54 ± 35 versus +1 ± 7 m, P = 0.007), dyspnea score (-2 ± 1 versus -1 ± 1 points, P = 0.047) and quality of life (total score: +251 ± 132 versus +84 ± 152 points, P = 0.018) after hospitalization. A significant correlation between the increase in respiratory muscle endurance and improvement in 6MWT distance was observed (r (2) = 0.36, P = 0.005). CONCLUSIONS The present study indicates that RMET is feasible in obese patients and can induce significant improvement in dyspnea and exercise capacity. RMET may be a promising tool to improve functional capacity and adherence to physical activities in this population, but further studies are needed to confirm these results.
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Affiliation(s)
- J-C Villiot-Danger
- HP2 Laboratory, INSERM ERI17, Joseph Fourier University, Grenoble, France
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29
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Becker BE. Aquatic therapy: scientific foundations and clinical rehabilitation applications. PM R 2009; 1:859-72. [PMID: 19769921 DOI: 10.1016/j.pmrj.2009.05.017] [Citation(s) in RCA: 237] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2009] [Revised: 04/28/2009] [Accepted: 05/28/2009] [Indexed: 11/19/2022]
Abstract
The aquatic environment has broad rehabilitative potential, extending from the treatment of acute injuries through health maintenance in the face of chronic diseases, yet it remains an underused modality. There is an extensive research base supporting aquatic therapy, both within the basic science literature and clinical literature. This article describes the many physiologic changes that occur during immersion as applied to a range of common rehabilitative issues and problems. Because of its wide margin of therapeutic safety and clinical adaptability, aquatic therapy is a very useful tool in the rehabilitative toolbox. Through a better understanding of the applied physiology, the practitioner may structure appropriate therapeutic programs for a diverse patient population.
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Affiliation(s)
- Bruce E Becker
- Washington State University, National Aquatics and Sports Medicine Institute, Department of Rehabilitation Medicine, University of Washington School of Medicine, Spokane WA 99224, USA.
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Role of chemoreceptors in mediating dyspnea. Respir Physiol Neurobiol 2008; 167:9-19. [PMID: 19118647 DOI: 10.1016/j.resp.2008.12.002] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2008] [Revised: 11/26/2008] [Accepted: 12/04/2008] [Indexed: 11/22/2022]
Abstract
Dyspnea, or the uncomfortable awareness of respiratory distress, is a common symptom experienced by most people at some point during their lifetime. It is commonly encountered in individuals with pulmonary disease, such as chronic obstructive pulmonary disease (COPD), but can also be seen in healthy individuals after strenuous exercise, at altitude or in response to psychological stress. Dyspnea is a multifactorial sensation involving the brainstem, cortex, and limbic system, as well as mechanoreceptors, irritant receptors and chemoreceptors. Chemoreceptors appear to contribute to the sensation of dyspnea in two ways. They stimulate the respiratory control system in response to hypoxia and/or hypercapnia, and the resultant increase respiratory motor output can be consciously perceived as unpleasant. They also can induce the sensation of dyspnea through an as yet undetermined mechanism-potentially via direct ascending connections to the limbic system and cortex. The goal of this article is to briefly review how changes in blood gases reach conscious awareness and how chemoreceptors are involved in dyspnea.
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Ross E, Middleton N, Shave R, George K, McConnell A. Changes in respiratory muscle and lung function following marathon running in man. J Sports Sci 2008; 26:1295-301. [DOI: 10.1080/02640410802104904] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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32
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Romer LM, Polkey MI. Exercise-induced respiratory muscle fatigue: implications for performance. J Appl Physiol (1985) 2008; 104:879-88. [DOI: 10.1152/japplphysiol.01157.2007] [Citation(s) in RCA: 173] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
It is commonly held that the respiratory system has ample capacity relative to the demand for maximal O2and CO2transport in healthy humans exercising near sea level. However, this situation may not apply during heavy-intensity, sustained exercise where exercise may encroach on the capacity of the respiratory system. Nerve stimulation techniques have provided objective evidence that the diaphragm and abdominal muscles are susceptible to fatigue with heavy, sustained exercise. The fatigue appears to be due to elevated levels of respiratory muscle work combined with an increased competition for blood flow with limb locomotor muscles. When respiratory muscles are prefatigued using voluntary respiratory maneuvers, time to exhaustion during subsequent exercise is decreased. Partially unloading the respiratory muscles during heavy exercise using low-density gas mixtures or mechanical ventilation can prevent exercise-induced diaphragm fatigue and increase exercise time to exhaustion. Collectively, these findings suggest that respiratory muscle fatigue may be involved in limiting exercise tolerance or that other factors, including alterations in the sensation of dyspnea or mechanical load, may be important. The major consequence of respiratory muscle fatigue is an increased sympathetic vasoconstrictor outflow to working skeletal muscle through a respiratory muscle metaboreflex, thereby reducing limb blood flow and increasing the severity of exercise-induced locomotor muscle fatigue. An increase in limb locomotor muscle fatigue may play a pivotal role in determining exercise tolerance through a direct effect on muscle force output and a feedback effect on effort perception, causing reduced motor output to the working limb muscles.
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Paulin E, Yamaguti WPS, Chammas MC, Shibao S, Stelmach R, Cukier A, Carvalho CRF. Influence of diaphragmatic mobility on exercise tolerance and dyspnea in patients with COPD. Respir Med 2007; 101:2113-8. [PMID: 17644365 DOI: 10.1016/j.rmed.2007.05.024] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2006] [Revised: 05/20/2007] [Accepted: 05/24/2007] [Indexed: 12/25/2022]
Abstract
BACKGROUND Patients with chronic obstructive pulmonary disease (COPD) present increased airway resistance, air trapping, pulmonary hyperinflation, and diaphragm muscle alterations, all of which affect pulmonary mechanics. PURPOSE To evaluate the influence diaphragmatic mobility has on exercise tolerance and dyspnea in patients with COPD. MATERIALS AND METHODS Fifty-four COPD patients with lung hyperinflation were evaluated to assess pulmonary function, diaphragm mobility, exercise tolerance, and dyspnea (score). Twenty healthy (age- and body mass index-matched) subjects were evaluated as controls. RESULTS The COPD patients presented lower diaphragmatic mobility than did the controls (36.27+/-10.96 mm vs. 46.33+/-9.46 mm). Diaphragmatic mobility presented a linear correlation with distance covered on the 6-min walk test (6MWT) (r=0.38; p=0.005) and a negative correlation with dyspnea (r=-0.36; p=0.007). Patients were then divided into two subgroups based on the degree of diaphragmatic mobility: G1 (<or=33.99 mm) and G2 (>or=34 mm). Those in G1 presented poorer 6MWT performance and greater dyspnea upon exertion than did those in G2 (distance covered on the 6MWT: 454.76+/-100.67 m vs. 521.63+/-70.82 m; dyspnea score: 5.22+/-3.06 vs. 3.48+/-2.77). The G1 patients also presented greater residual volume (in liters) and lower maximal voluntary ventilation (in % of predicted values) than did the G2 patients (266.20+/-55.30 vs. 209.74+/-48.49 and 39.00+/-14.94 vs. 58.11+/-20.96). CONCLUSION Diaphragmatic mobility influences dyspnea and exercise tolerance in patients with COPD.
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Affiliation(s)
- E Paulin
- Department of Physical Therapy, Paranaense University, Praça Mascarenhas de Moras s/n, 87502-210 Umuarama, PR, Brazil
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Magadle R, McConnell AK, Beckerman M, Weiner P. Inspiratory muscle training in pulmonary rehabilitation program in COPD patients. Respir Med 2007; 101:1500-5. [PMID: 17329091 DOI: 10.1016/j.rmed.2007.01.010] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2006] [Revised: 12/29/2006] [Accepted: 01/09/2007] [Indexed: 11/24/2022]
Abstract
Most pulmonary rehabilitation (PR) programs do not currently incorporate IMT in their PR programs for COPD patients. The aim of the present study was to assess the influence of adding IMT to the patients already involved in a rehabilitation program. Thirty-four patients with significant COPD were recruited for the study. All patients participated in a general exercise reconditioning (GER) program for 12 weeks. The patients were then randomized to receive IMT or sham IMT, in addition to GER for the next 6 months. Following three months of GER training there was a significant increase in the 6-min walk test (6MWT) (from mean+/-SEM 254+/-38 to 322+/-42 m, p<0.01), and small but non-significant decreases in the perception of dyspnea (POD), and in the St. George Respiratory Questionnaire score (SGRQ). Following the addition of IMT to the GER program there was a significant increase in the PI(max) in the GER+IMT group (from 66+/-4.7 to 78+/-4.5 cm H(2)O, p<0.01). This was accompanied by a significant improvement in the POD and a further significant improvement in the SGRQ score. IMT provides additional benefits to patients undergoing PR program and is worthwhile even in patients who have already undergone a GER program.
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Affiliation(s)
- Rasmi Magadle
- Department of Medicine A, Hillel Yaffe Medical Center, Hadera 38100, Israel
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35
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Sasaki M. The Effect of Expiratory Muscle Training on Pulmonary Function in Normal Subjects. J Phys Ther Sci 2007. [DOI: 10.1589/jpts.29.197] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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36
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Sasaki M. The Effect of Expiratory Muscle Training on Pulmonary Function in Normal Subjects. J Phys Ther Sci 2007. [DOI: 10.1589/jpts.19.197] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Makoto Sasaki
- Course of Physical Therapy, School of Health Sciences, Akita University
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von Leupoldt A, Dahme B. Psychological aspects in the perception of dyspnea in obstructive pulmonary diseases. Respir Med 2006; 101:411-22. [PMID: 16899357 DOI: 10.1016/j.rmed.2006.06.011] [Citation(s) in RCA: 82] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2006] [Revised: 06/05/2006] [Accepted: 06/09/2006] [Indexed: 01/12/2023]
Abstract
Dyspnea is an impairing symptom in obstructive pulmonary diseases. Besides multiple physiological pathways contributing to this sensation recent research has demonstrated an important role of psychological factors in the perception of dyspnea. The present review article synthesizes the research literature with regard to psychological aspects of the perception of dyspnea as well as other dyspnea-related issues such as course of disease, neuropsychological correlates and interventions that focus on psychological or behavioural changes. The available data show that inaccurate perception of dyspnea is related to poorer treatment outcome in obstructive pulmonary diseases and is impacted upon by emotional, attentional and learning processes. Neuropsychological deficits might further contribute to this association. Different psychological and behavioural interventions might reduce comorbid psychological disorders and thus improve the perception of dyspnea. However, future research is clearly required to substantiate current findings.
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Affiliation(s)
- Andreas von Leupoldt
- Psychological Institute III, University of Hamburg, Von-Melle-Park 5, 20146 Hamburg, Germany.
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Watsford ML, Murphy AJ, Pine MJ. The effects of ageing on respiratory muscle function and performance in older adults. J Sci Med Sport 2006; 10:36-44. [PMID: 16814604 DOI: 10.1016/j.jsams.2006.05.002] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2005] [Revised: 04/28/2006] [Accepted: 05/01/2006] [Indexed: 12/25/2022]
Abstract
The reduced physiological capacity evident with ageing may affect the ability to perform many tasks, potentially affecting quality of life. Previous research has clearly demonstrated the reduced capacity of the respiratory system with ageing and described the effect that habitual physical activity has upon this decline. This research aimed to examine the influence of age on respiratory muscle (RM) function and the relationship between RM function and physical performance within the Australian population. Seventy-two healthy older adults (50-79 years) were divided into males (n=36) and females (n=36) and examined for pulmonary function, RM strength, inspiratory muscle endurance (IME) and 1.6 km walking performance. There were no significant age by gender effects for any variables; however, ageing was significantly related to reduced RM function and walking capacity within each gender. Furthermore, regression analysis showed that the RM strength could be predicted from age. Partial correlations controlling for age indicated that expiratory muscle strength was significantly related to walking performance in males (p=0.04), whilst IME contributed significantly to walking performance in all participants. These within-gender effects and relationships indicate that RM strength is an important physiological variable to maintain in the older population, as it may be related to functional ability.
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Affiliation(s)
- Mark L Watsford
- Human Performance Laboratory, School of Leisure, Sport and Tourism, University of Technology, Sydney, Kuring-Gai Campus, P.O. Box 222, Lindfield NSW 2070, Australia.
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Silva CS, Torres LAGMM, Rahal A, Terra Filho J, Vianna EO. Comparison of morning and afternoon exercise training for asthmatic children. Braz J Med Biol Res 2005; 39:71-8. [PMID: 16400466 DOI: 10.1590/s0100-879x2006000100008] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Fitness improvement was used to compare morning with afternoon exercise periods for asthmatic children. Children with persistent moderate asthma (according to GINA criteria), 8 to 11 years old, were divided into 3 groups: morning training group (N = 23), afternoon training group (N = 23), and non-training group (N = 23). The program was based on twice a week 90-min sessions for 4 months. We measured the 9-min running distance, resting heart rate and abdominal muscle strength (sit-up number) before and after the training. All children took budesonide, 400 microg/day, and an on demand inhaled ss-agonist. The distance covered in 9 min increased (mean +/- SEM) from 1344 +/- 30 m by 248 +/- 30 m for the morning group, from 1327 +/- 30 m by 162 +/- 20 m for the afternoon group, and from 1310 +/- 20 m by 2 +/- 20 m for the control group (P < 0.05 for the comparison of morning and afternoon groups with the control group by ANOVA and P > 0.05 for morning with afternoon comparison). The reduction of resting heart rate from 83 +/- 1, 85 +/- 2 and 86 +/- 1 bpm was 5.1 +/- 0.8 bpm in the morning group, 4.4 +/- 0.8 bpm in the afternoon group, and -0.2 +/- 0.7 bpm in the control group (P > 0.05 for morning with afternoon comparison and P < 0.05 versus control). The number of sit-ups in the morning, afternoon and control groups increased from 22.0 +/- 1.7, 24.3 +/- 1.4 and 23 +/- 1.1 sit-ups by 9.8 +/- 0.9, 7.7 +/- 1.4, and 1.9 +/- 0.7 sit-ups, respectively (P > 0.05 for morning with afternoon comparison and P < 0.05 versus control). No statistically significant differences were detected between the morning and afternoon groups in terms of physical training of asthmatic children.
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Affiliation(s)
- C S Silva
- Divisão de Pneumologia, Departamento de Clínica Médica, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil
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Pine MJ, Murphy AJ, Watsford ML. Role of respiratory system function in the age-related decline of human functional capacity. Australas J Ageing 2005. [DOI: 10.1111/j.1741-6612.2005.00104.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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41
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Weiner P, McConnell A. Respiratory muscle training in chronic obstructive pulmonary disease: inspiratory, expiratory, or both? Curr Opin Pulm Med 2005; 11:140-4. [PMID: 15699786 DOI: 10.1097/01.mcp.0000152999.18959.8a] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Most patients with significant chronic obstructive pulmonary disease (COPD) have inspiratory and expiratory muscle weakness. In addition, hyperinflation induces functional weakening of the inspiratory muscles, increased elastic load to breathing, and intrinsic positive end expiratory pressure (PEEPi). Therefore, it was rational to expect that patients with COPD would benefit from specific inspiratory or expiratory muscle training (SIMT, SEMT respectively). However, the functional benefits of SIMT have remained equivocal. In recent years, a number of studies have demonstrated that, when training loads are controlled, SIMT results in important functional benefits. The role of SEMT is still unclear. RECENT FINDINGS Well-controlled SIMT in patients with COPD leads to relief of dyspnea, during both daily activities and during physical activity. This yields increased exercise tolerance, and thus the capacity to walk, improving health related quality of life. We argue that there is now evidence that SIMT is an important addition to pulmonary rehabilitation programs for patients with COPD. Although two recent studies have shown that SEMT also provides a beneficial effect in patients with COPD, this does not appear to be supplementary to the effect to SIMT. SUMMARY Inspiratory and expiratory muscles can be specifically trained yielding improvements in both strength and endurance. The improvement in inspiratory muscle performance is associated with an improvement in the sensation of dyspnea, exercise tolerance, and quality of life. When the expiratory muscles are specifically trained, a significant increase in exercise performance has also been shown. However, there is probably no additional benefit in combining SEMT with SIMT.
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Affiliation(s)
- Paltiel Weiner
- Department of Medicine A, Hillel Yaffe Medical Center, Hadera, Israel.
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