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Loughran KJ, Emerson J, Avery L, Suri S, Flynn D, Kaner E, Rapley T, Martin D, McPhee J, Fernandes-James C, Harrison SL. Exercise-based interventions targeting balance and falls in people with COPD: a systematic review and meta-analysis. Eur Respir Rev 2024; 33:240003. [PMID: 38925795 PMCID: PMC11216689 DOI: 10.1183/16000617.0003-2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Accepted: 03/19/2024] [Indexed: 06/28/2024] Open
Abstract
INTRODUCTION This review quantifies the mean treatment effect of exercise-based interventions on balance and falls risk in people with COPD. METHODS A structured search strategy (2000-2023) was applied to eight databases to identify studies evaluating the impact of exercise-based interventions (≥14 days in duration) on balance or falls in people with COPD. Pooled mean treatment effects (95% confidence intervals (CIs), 95% prediction intervals (PIs)) were calculated for outcomes reported in five or more studies. Inter-individual response variance and the promise of behaviour change techniques (BCTs) were explored. RESULTS 34 studies (n=1712) were included. There were greater improvements in balance post intervention compared to controls for the Berg Balance Scale (BBS) (mean 2.51, 95% CI 0.22-4.80, 95% PI -4.60-9.63), Timed Up and Go (TUG) test (mean -1.12 s, 95% CI -1.69- -0.55 s, 95% PI -2.78-0.54 s), Single-Leg Stance (SLS) test (mean 3.25 s, 95% CI 2.72-3.77 s, 95% PI 2.64-3.86 s) and Activities-specific Balance Confidence (ABC) scale (mean 8.50%, 95% CI 2.41-14.58%, 95% PI -8.92-25.92%). Effect on falls remains unknown. Treatment effects were larger in male versus mixed-sex groups for the ABC scale and SLS test, and in balance training versus other exercise-based interventions for the BBS and TUG test. Falls history was not associated with changes in balance. Meta-analysis of individual response variance was not possible and study-level results were inconclusive. Eleven promising BCTs were identified (promise ratio ≥2). CONCLUSION Evidence for the effect of exercise-based interventions eliciting clinically important improvements in balance for people with COPD is weak, but targeted balance training produces the greatest benefits. Future exercise interventions may benefit from inclusion of the identified promising BCTs.
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Affiliation(s)
- Kirsti J Loughran
- School of Health and Life Sciences, Teesside University, Middlesbrough, UK
| | - Jonathan Emerson
- School of Health and Life Sciences, Teesside University, Middlesbrough, UK
| | - Leah Avery
- School of Health and Life Sciences, Teesside University, Middlesbrough, UK
| | - Sophie Suri
- School of Health and Life Sciences, Teesside University, Middlesbrough, UK
- NIHR Applied Research Collaboration, North East and North Cumbria, Middlesbrough, UK
| | - Darren Flynn
- Department of Nursing, Midwifery and Health, Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, UK
| | - Eileen Kaner
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Tim Rapley
- Department of Social Work, Community Wellbeing and Education, Northumbria University, Newcastle upon Tyne, UK
| | - Denis Martin
- School of Health and Life Sciences, Teesside University, Middlesbrough, UK
| | - Jamie McPhee
- Department of Sport and Exercise Sciences, Manchester Metropolitan University Institute of Sport, Manchester, UK
| | - Caroline Fernandes-James
- Respiratory Department, University Hospital of North Tees, North Tees & Hartlepool NHS Foundation Trust, Hardwick, UK
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Williams E, Cooper I, Beer K, Hird K, Cavalheri V, Watson K, Needham M. Does inspiratory muscle training improve lung function and quality of life in people with inclusion body myositis? A pilot study. Neuromuscul Disord 2024; 37:6-12. [PMID: 38489862 DOI: 10.1016/j.nmd.2024.02.002] [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: 11/08/2023] [Revised: 02/19/2024] [Accepted: 02/21/2024] [Indexed: 03/17/2024]
Abstract
Inclusion body myositis is the most common acquired myositis in adults, predominantly weakening forearm flexor and knee extensor muscles. Subclinical respiratory muscle weakness has recently been recognised in people with inclusion body myositis, increasing their risk of respiratory complications. Inspiratory muscle training, a technique which demonstrates efficacy and safety in improving respiratory function in people with neuromuscular disorders, has never been explored in those with inclusion body myositis. In this pilot study, six adults with inclusion body myositis (age range 53 to 81 years) completed eight weeks of inspiratory muscle training. Measures of respiratory function, quality of life, sleep quality and a two-minute walk test were performed pre and post-intervention. All participants improved their respiratory function, with maximal inspiratory pressure, sniff nasal inspiratory pressure and forced vital capacity increasing by an average of 50 % (p = .002), 43 % (p = .018) and 13 % (p = .003) respectively. No significant change was observed in quality of life, sleep quality or two-minute walk test performance. No complications occurred due to inspiratory muscle training This pilot study provides the first evidence that inspiratory muscle training may be safe and effective in people with Inclusion Body Myositis, potentially mitigating the complications of poor respiratory function.
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Affiliation(s)
- Ethan Williams
- School of Medicine, The University of Notre Dame, Fremantle, Western Australia, Australia; St John of God Midland, Public and Private Hospitals, Midland, Western Australia, Australia.
| | - Ian Cooper
- Perron Institute for Neurological and Translational Science, Western Australia, Australia
| | - Kelly Beer
- Perron Institute for Neurological and Translational Science, Western Australia, Australia
| | - Kathryn Hird
- School of Medicine, The University of Notre Dame, Fremantle, Western Australia, Australia
| | - Vinicius Cavalheri
- Curtin School of Allied Health, Faculty of Health Sciences, Curtin University, Western Australia, Australia; Allied Health, South Metropolital Health Service, Western Australia, Australia
| | - Kathryn Watson
- Physiotherapy Department, Fiona Stanley Fremantle Hospitals Group, Western Australia, Australia
| | - Merrilee Needham
- School of Medicine, The University of Notre Dame, Fremantle, Western Australia, Australia; Perron Institute for Neurological and Translational Science, Western Australia, Australia; Department of Neurology, Fiona Stanley Fremantle Hospitals Group, Western Australia, Australia; Centre for Molecular Medicine and innovative Technology (CMMIT) Murdoch University, Western Australia, Australia
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The use of respiratory muscle training in patients with pulmonary dysfunction, internal diseases or central nervous system disorders: a systematic review with meta-analysis. Qual Life Res 2023; 32:1-26. [PMID: 35460472 PMCID: PMC9034447 DOI: 10.1007/s11136-022-03133-y] [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] [Accepted: 03/21/2022] [Indexed: 01/12/2023]
Abstract
OBJECTIVE The aim of this systematic review with meta-analysis was to evaluate the effectiveness of RMT in internal and central nervous system disorders, on pulmonary function, exercise capacity and quality of life. METHODS The inclusion criteria were (1) publications designed as Randomized Controlled Trial (RCT), with (2) participants being adults with pulmonary dysfunction caused by an internal disease or central nervous system disorder, (3) an intervention defined as RMT (either IMT or EMT) and (4) with the assessment of exercise capacity, respiratory function and quality of life. For the methodological quality assessment of risk of bias, likewise statistical analysis and meta-analysis the RevMan version 5.3 software and the Cochrane Risk of Bias Tool were used. Two authors independently analysed the following databases for relevant research articles: PubMed, Scopus, Cochrane Library, Web of Science, and Embase. RESULTS From a total of 2200 records, the systematic review includes 29 RCT with an overall sample size of 1155 patients. Results suggest that patients with internal and central nervous system disorders who underwent RMT had better quality of life and improved significantly their performance in exercise capacity and in respiratory function assessed with FVC and MIP when compared to control conditions (i.e. no intervention, sham training, placebo or conventional treatments). CONCLUSION Respiratory muscle training seems to be more effective than control conditions (i.e. no intervention, sham training, placebo or conventional treatment), in patients with pulmonary dysfunction due to internal and central nervous system disorders, for quality of life, exercise capacity and respiratory function assessed with MIP and FVC, but not with FEV1.
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Severin R, Franz CK, Farr E, Meirelles C, Arena R, Phillips SA, Bond S, Ferraro F, Faghy M. The effects of COVID-19 on respiratory muscle performance: making the case for respiratory muscle testing and training. Eur Respir Rev 2022; 31:31/166/220006. [PMID: 36198415 PMCID: PMC9724806 DOI: 10.1183/16000617.0006-2022] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 07/22/2022] [Indexed: 01/28/2023] Open
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection results in multiorgan damage primarily mediated by viral infiltration via angiotensin-converting enzyme-2 receptors on the surface of cells. A primary symptom for many patients is exertional dyspnoea which may persist even beyond recovery from the viral infection. Respiratory muscle (RM) performance was hypothesised as a contributing factor to the severity of coronavirus disease 2019 (COVID-19) symptoms, such as dyspnoea, and outcomes. This was attributed to similarities between patient populations at elevated risk for severe COVID-19 symptoms and those with a greater likelihood of baseline RM weakness and the effects of prolonged mechanical ventilation. More recent evidence suggests that SARS-CoV-2 infection itself may cause damage to the RM, and many patients who have recovered report persistent dyspnoea despite having mild cases, normal lung function or undamaged lung parenchyma. These more recent findings suggest that the role of RM in the persistent dyspnoea due to COVID-19 may be more substantial than originally hypothesised. Therefore, screening for RM weakness and providing interventions to improve RM performance appears to be important for patients with COVID-19. This article will review the impact of SARS-CoV-2 infection on RM performance and provide clinical recommendations for screening RM performance and treatment interventions.
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Affiliation(s)
- Richard Severin
- Department of Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, USA,Department of Physical Therapy, Robbins College of Health and Human Sciences, Baylor University, Waco, TX, USA,Healthy Living for Pandemic Event Protection (HL-PIVOT) Network, Chicago, IL, USA,Corresponding author: Richard Severin ()
| | - Colin K. Franz
- The Shirley Ryan Ability Lab, Chicago, IL, USA,Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Ellen Farr
- The Shirley Ryan Ability Lab, Chicago, IL, USA,Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Cristiane Meirelles
- Department of Physical Therapy, School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, OH, USA
| | - Ross Arena
- Department of Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, USA,Healthy Living for Pandemic Event Protection (HL-PIVOT) Network, Chicago, IL, USA
| | - Shane A. Phillips
- Department of Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, USA,Healthy Living for Pandemic Event Protection (HL-PIVOT) Network, Chicago, IL, USA
| | - Sam Bond
- Department of Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, USA,Healthy Living for Pandemic Event Protection (HL-PIVOT) Network, Chicago, IL, USA
| | | | - Mark Faghy
- Healthy Living for Pandemic Event Protection (HL-PIVOT) Network, Chicago, IL, USA,Human Sciences Research Centre, University of Derby, Derby, UK
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Pichon R, Van Hove O, Ménard M, Hearing D, Crétual A. Impairment and characteristics of postural control sub-components in people with COPD: a scoping review. Disabil Rehabil 2022:1-16. [PMID: 36000464 DOI: 10.1080/09638288.2022.2107083] [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: 11/03/2022]
Abstract
Purpose: Impairment of postural control is common in people with COPD. However, the precise characteristics of this alteration are not clearly known. The "Systems Framework for Postural Control" which define postural control sub-components, represents an interesting tool to explore this field. The main aim of this review was to identify which postural control sub-components are impaired in people with COPD and to summarise characteristics for each sub-component. A secondary aim was to precise the relation between postural control and activities of daily living (ADL).Materials and methods: A scoping review was conducted, according to the JBI methodology. Medline, Cochrane Library, Scielo, Google Scholar, OpenGrey, and HAL were searched from inception to May 2022. The search was performed in English and French.Results: Eighty-nine articles were included. There was evidence of a potential impairment for most of the postural control sub-components. Characteristics of every sub-component alteration were heterogeneous. Reduced postural control could be associated with difficulties in ADL.Conclusions: People with COPD may have impairment in a wide range of postural control sub-components. Further research is needed to clarify if a common pattern of modification exits for this alteration and to precise the link with ADL.Implications for rehabilitationImpairment of postural control is a common extra-respiratory manifestation in people with COPD and so clinicians must include it in their clinical reasoning.Numerous postural control sub-components could be altered in people with COPD, suggesting that postural control assessment must be holistic.This scoping review shows that characteristics of postural control impairment are varied and that there may be no common pattern at the COPD population level.The relationship between impaired postural control and activities of daily living remains unclear, but clinicians should be alert to potential negative interactions between these two areas.
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Affiliation(s)
- Romain Pichon
- Institut de Formation en Pédicurie-Podologie, Ergothérapie et Kinésithérapie (IFPEK), Rennes, France.,M2S Laboratory - EA 7470, University Rennes 2, Rennes, France
| | | | - Mathieu Ménard
- M2S Laboratory - EA 7470, University Rennes 2, Rennes, France.,Institut d'Ostéopathie de Rennes - Bretagne (IO-RB), Bruz, France
| | - Diane Hearing
- M2S Laboratory - EA 7470, University Rennes 2, Rennes, France
| | - Armel Crétual
- M2S Laboratory - EA 7470, University Rennes 2, Rennes, France
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Association Between Inspiratory Muscle Function and Balance Ability in Older People: A Pooled Data Analysis Before and After Inspiratory Muscle Training. J Aging Phys Act 2021; 30:421-433. [PMID: 34530401 DOI: 10.1123/japa.2020-0507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Revised: 05/10/2021] [Accepted: 07/06/2021] [Indexed: 11/18/2022]
Abstract
Inspiratory muscle training (IMT) improved balance ability and respiratory muscle function in healthy older adults. The current study is a retrospective analysis to explore the relationship between inspiratory muscle function, balance ability, and adaptation to IMT. All participants (total = 129; IMT = 60; age range = 65-85 years) performed inspiratory and balance assessments, including the mini-balance evaluation system test, maximal inspiratory pressure, and peak inspiratory flow tests. Baseline inspiratory muscle function was positively related to balance ability (p < .05), and IMT-induced improvements in inspiratory function (23.3% in maximal inspiratory pressure, 8.0% in peak inspiratory flow rate, 14.9% in maximal peak inspiratory power) were related to improvements in balance (10.6% in mini-balance evaluation system test), with the greatest improvements (17.0%) observed in the oldest participants (76-85 years old, p < .05). In conclusion, with or without IMT, positive associations between inspiratory function and balance ability exist, with greater improvements in inspiratory muscle function related to greater improvements in balance ability.
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