1
|
Hartman M, Mináriková J, Batalik L, Pepera G, Su JJ, Formiga MF, Cahalin L, Dosbaba F. Effects of Home-Based Training with Internet Telehealth Guidance in COPD Patients Entering Pulmonary Rehabilitation: A Systematic Review. Int J Chron Obstruct Pulmon Dis 2023; 18:2305-2319. [PMID: 37876660 PMCID: PMC10591652 DOI: 10.2147/copd.s425218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 09/21/2023] [Indexed: 10/26/2023] Open
Abstract
Objective Chronic obstructive pulmonary disease (COPD) is one of the leading causes of death worldwide. Telehealth rehabilitation may offer new opportunities in patient therapy. This systematic review aimed to evaluate the effects of internet-mediated telerehabilitation and compare them with the outcomes of conventional pulmonary rehabilitation in COPD patients. Methods Electronic databases PubMed, Prospero, Scopus, and Cochrane were searched for randomized controlled trials from January 2005 to December 2021. Two investigators reviewed studies for relevance and extracted study population, methods, and results data. Results Ten studies were eligible for systematic review from the initial selection (n = 1492). There was considerable heterogeneity in telerehabilitation approaches. Functional exercise capacity and quality of life were assessed in all studies. None of the results were inferior to conventional care. High adherence and high levels of safety were observed. Conclusion Telerehabilitation in COPD patients is a safe therapy approach that increases and maintains functional exercise capacity and quality of life, making it an equivalent option to conventional outpatient rehabilitation. However, there is currently a lack of a unified approach to the composition of therapy and the use of technology, which needs to be addressed in the future.
Collapse
Affiliation(s)
- Martin Hartman
- Department of Rehabilitation and Sports Medicine, 2nd Faculty of Medicine, Charles University, University Hospital Motol, Prague, Czech Republic
| | - Jitka Mináriková
- Department of Rehabilitation and Sports Medicine, 2nd Faculty of Medicine, Charles University, University Hospital Motol, Prague, Czech Republic
| | - Ladislav Batalik
- Department of Rehabilitation, University Hospital Brno, Brno, 62500, Czech Republic
- Department of Public Health, Faculty of Medicine, Masaryk University Brno, Brno, 62500, Czech Republic
| | - Garyfallia Pepera
- Clinical Exercise Physiology and Rehabilitation Research Laboratory, Physiotherapy Department, School of Health Sciences, University of Thessaly, Lamia, Greece
| | - Jing Jing Su
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, People’s Republic of China
| | - Magno F Formiga
- Universidade Federal do Ceará, Faculdade de Medicina, Departamento de Fisioterapia, Fortaleza, Ceará, Brazil
| | - Lawrence Cahalin
- Department of Physical Therapy, University of Miami Miller School of Medicine, Coral Gables, FL, USA
| | - Filip Dosbaba
- Department of Rehabilitation and Sports Medicine, 2nd Faculty of Medicine, Charles University, University Hospital Motol, Prague, Czech Republic
- Department of Rehabilitation, University Hospital Brno, Brno, 62500, Czech Republic
| |
Collapse
|
2
|
Formiga MF, Dosbaba F, Hartman M, Batalik L, Senkyr V, Radkovcova I, Richter S, Brat K, Cahalin LP. Role of the Inspiratory Muscles on Functional Performance From Critical Care to Hospital Discharge and Beyond in Patients With COVID-19. Phys Ther 2023; 103:pzad051. [PMID: 37247250 DOI: 10.1093/ptj/pzad051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 01/04/2023] [Accepted: 02/19/2023] [Indexed: 05/31/2023]
Abstract
OBJECTIVE The role of inspiratory muscle performance in functional performance in patients with coronavirus disease 2019 (COVID-19) is poorly understood. The purpose of this study was to perform a longitudinal examination of inspiratory and functional performance from intensive care unit (ICU) discharge (ICUD) to hospital discharge (HD) and symptoms at HD and 1 month after HD in patients with COVID-19. METHODS Thirty patients (19 men, 11 women) with COVID-19 were included. Examination of inspiratory muscle performance at ICUD and HD was performed with an electronic manometer, which provided the maximal inspiratory pressure (MIP) and several other inspiratory measures. Examination of dyspnea and functional performance was performed at ICUD and HD with the Modified Borg Dyspnea Scale and the 1-minute sit-to-stand test (1MSST), respectively. RESULTS The mean age was 71 (SD = 11) years, the mean length of ICU stay was 9 (SD = 6) days, and the mean length of hospital stay was 26 (SD = 16) days. Most of the patients were diagnosed with severe COVID-19 (76.7%) and had a mean Charlson Comorbidity Index of 4.4 (SD = 1.9), reflecting high comorbidity. The mean MIP of the entire cohort increased minimally from ICUD to HD (from 36 [SD = 21] to 40 [SD = 20] cm H2O), reflecting predicted values for men and women at ICUD and HD of 46 (25%) to 51 (23%) and 37 (24%) to 37 (20%), respectively. The 1MSTS score increased significantly from ICUD to HD (9.9 [SD = 7.1] vs 17.7 [SD = 11.1]) for the entire cohort but remained far below population-based reference values (2.5th percentile) for the majority of patients at ICUD and HD. At ICUD, MIP was found to be a significant predictor of a favorable change in 1MSTS performance (β = 0.308; odds ratio = 1.36) at HD. CONCLUSION A significant reduction in inspiratory and functional performance exists in patients with COVID-19 at both ICUD and HD, with a greater MIP at ICUD being a significant predictor of a greater 1MSTS score at HD. IMPACT This study shows that inspiratory muscle training may be an important adjunct after COVID-19.
Collapse
Affiliation(s)
- Magno F Formiga
- Programa Pós-Graduação em Fisioterapia e Funcionalidade, Faculdade de Medicina, Universidade Federal do Ceará, Fortaleza, Ceará, Brazil
| | - Filip Dosbaba
- Department of Rehabilitation, University Hospital Brno, Brno, South Moravia, Czech Republic
| | - Martin Hartman
- Department of Rehabilitation, University Hospital Brno, Brno, South Moravia, Czech Republic
- Department of Rehabilitation and Sports Medicine, 2nd Faculty of Medicine, Charles University, University Hospital Motol, Prague, Czech Republic
| | - Ladislav Batalik
- Department of Rehabilitation, University Hospital Brno, Brno, South Moravia, Czech Republic
- Department of Public Health, Faculty of Medicine, Masaryk University Brno, Brno, South Moravia, Czech Republic
| | - Vojtech Senkyr
- Department of Rehabilitation, University Hospital Brno, Brno, South Moravia, Czech Republic
| | - Ivana Radkovcova
- Department of Rehabilitation, University Hospital Brno, Brno, South Moravia, Czech Republic
| | - Svatopluk Richter
- Department of Radiology and Nuclear Medicine, University Hospital Brno, Brno, South Moravia, Czech Republic
| | - Kristian Brat
- Department of Respiratory Diseases, University Hospital Brno, Brno South Moravia, Czech Republic
| | - Lawrence P Cahalin
- Department of Physical Therapy, University of Miami Miller School of Medicine, Coral Gables, Florida, USA
| |
Collapse
|
3
|
de Araújo Morais L, Cipriano G, Martins WR, Chiappa GR, Formiga MF, Cipriano GFB. Inspiratory muscle training on quality of life in individuals with spinal cord injury: A systematic review and meta-analysis. Spinal Cord 2023; 61:359-367. [PMID: 37393409 DOI: 10.1038/s41393-023-00906-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 06/19/2023] [Accepted: 06/20/2023] [Indexed: 07/03/2023]
Abstract
STUDY DESIGN Systematic review and meta-analysis. OBJECTIVES The objective was to summarize the effectiveness of Inspiratory Muscle Training (IMT) on the quality of life in individuals with Spinal Cord Injury (SCI). METHODS An online systematic literature search was conducted in the following databases: PubMed/MEDLINE, PubMed CENTRAL, EMBASE, ISI Web of Science, SciELO, CINAHL/SPORTDiscus, and PsycINFO. Randomized and non-randomized clinical studies investigating the effectiveness of IMT in quality of life were included in the present study. The results used the mean difference and 95% confidence interval for maximal inspiratory pressure (MIP), forced expiratory volume in 1 s (FEV1), maximal expiratory pressure (MEP), and the standardized mean differences for the quality of life and maximum ventilation volume. RESULTS The search found 232 papers, and after the screening, four studies met the inclusion criteria and were included in the meta-analytical procedures (n = 150 participants). No changes were demonstrated in the quality of life domains (general health, physical function, mental health, vitality, social function, emotional problem, and pain) after IMT. The IMT provided a considerable effect over the MIP but not on FEV1 and MEP. Conversely, it was not able to provide changes in any of the quality of life domains. None of the included studies evaluated the IMT effects on the expiratory muscle maximal expiratory pressure. CONCLUSION Evidence from studies shows that inspiratory muscle training improves the MIP; however, this effect does not seem to translate to any change in the quality of life or respiratory function outcomes in individuals with SCI.
Collapse
Affiliation(s)
| | - Gerson Cipriano
- Science and Technology in Health Program (PPGCTS), University of Brasília, Brasília, Brazil
- Rehabilitation Sciences Graduate Program (PPGCR), University of Brasília, Brasília, Brasil
- Graduate Program in Human Movement and Rehabilitation of Evangelical (PPGMHR), UniEVANGÉLICA, Anápolis, Brazil
| | | | - Gaspar R Chiappa
- Graduate Program in Human Movement and Rehabilitation of Evangelical (PPGMHR), UniEVANGÉLICA, Anápolis, Brazil
| | - Magno F Formiga
- Master's Program in Physical Therapy and Functioning, Department of Physical Therapy, School of Medicine, Federal University of Ceará, Fortaleza, Brazil
| | - Graziella França Bernardelli Cipriano
- Science and Technology in Health Program (PPGCTS), University of Brasília, Brasília, Brazil
- Rehabilitation Sciences Graduate Program (PPGCR), University of Brasília, Brasília, Brasil
| |
Collapse
|
4
|
de Queiros VS, Rolnick N, Sabag A, de França IM, Wilde P, Vieira JG, Reis VM, Formiga MF, Cabral BGDAT, Dantas PMS. Correction: Acute Responses in Blood Flow Restriction Low-intensity Aerobic Training: A Meta-analysis. Int J Sports Med 2023; 44:e2. [PMID: 37413984 DOI: 10.1055/a-2104-4794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/08/2023]
Affiliation(s)
- Victor Sabino de Queiros
- Graduate Program in Health Sciences, Federal University of Rio Grande do Norte (UFRN), Natal-RN, Brazil
| | - Nicholas Rolnick
- The Human Performance Mechanic, CUNY Lehman College, New York, USA
| | - Angelo Sabag
- NICM Health Research Institute, Western Sydney University, Westmead, Australia
| | - Ingrid Martins de França
- Graduate Program in Physiotherapy, Federal University of Rio Grande do Rio Grande Norte (UFRN), Natal-RN, Brazil
| | - Phelipe Wilde
- Graduate Program in Health Sciences, Federal University of Rio Grande do Norte (UFRN), Natal-RN, Brazil
| | - João Guilherme Vieira
- Graduate Program in Physical Education, Federal University of Juiz de Fora (UFJF), Juiz de Fora-MG, Brazil
| | - Victor Machado Reis
- Research Center in Sports Sciences, Health Sciences and Human Development, CIDESD, University of Trás-os-Montes e Alto Douro, Vila Real, Portugal
| | - Magno F Formiga
- Graduate Program in Physiotherapy and Functionality, Faculty of Medicine, Federal University of Ceará, Fortaleza - CE, Brazil
| | - Breno Guilherme de Araújo Tinôco Cabral
- Graduate Program in Health Sciences, Federal University of Rio Grande do Norte (UFRN), Natal-RN, Brazil
- Graduate Program in Physical Education, Federal University of Rio Grande do Norte (UFRN), Natal-RN, Brazil
| | - Paulo Moreira Silva Dantas
- Graduate Program in Health Sciences, Federal University of Rio Grande do Norte (UFRN), Natal-RN, Brazil
- Graduate Program in Physical Education, Federal University of Rio Grande do Norte (UFRN), Natal-RN, Brazil
| |
Collapse
|
5
|
de Queiros VS, Rolnick N, Sabag A, de França IM, Wilde P, Vieira JG, Reis VM, Formiga MF, Cabral BGDAT, Dantas PMS. Acute Responses in Blood Flow Restriction Low-intensity Aerobic Training: A Meta-analysis. Int J Sports Med 2023. [PMID: 37160160 DOI: 10.1055/a-2038-3635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
The purpose was to determine the effect low-intensity training with blood flow restriction (LI-BFR) versus high-intensity aerobic training (HIT) on acute physiological and perceptual responses. The Cumulative Index to Nursing and Allied Health Literature, National Library of Medicine, Scopus, SPORTDiscus and Web of Science databases and the reference list of eligible studies were consulted to identify randomized experimental studies, published until July 4, 2022, that analyzed physiological or perceptual responses between LI-BFR versus HIT in healthy young individuals. Mean difference (MD) and standardized mean difference (SMD) were used as effect estimates and random effects models were applied in all analyses. Twelve studies were included in this review. During exercise sessions, HIT promoted higher values of heart rate (MD=28.9 bpm; p<0.00001; I 2 =79%), oxygen consumption (SMD=4.01; p<0.00001; I 2 =83%), ventilation (MD=48.03 l/min; p=0.0001; I 2 =97%), effort (SMD=1.54; p=0.003; I 2 =90%) and blood lactate (MD=3.85 mmol/L; p=0.002; I 2 =97%). Perception of pain/discomfort was lower in HIT (SMD=-1.71; p=0.04; I 2 =77.5%). In conclusion, LI-BFR promotes less pronounced physiological responses than HIT but with greater perception of pain.
Collapse
Affiliation(s)
| | - Nicholas Rolnick
- The Human Performance Mechanic, Lehman College of CUNY Department of Health Sciences, Bronx, United States
| | - Angelo Sabag
- NICM Health Research Institute, Western Sydney University, Penrith South, Australia
| | | | - Phelipe Wilde
- Graduate Program in Health Sciences, Federal University of Rio Grande do Norte, Natal, Brazil
| | - João Guilherme Vieira
- Graduate Program in Physical Education, Federal University of Juiz de Fora (UFJF), Juiz de Fora-MG, Brazil
| | - Victor Machado Reis
- Research Center in Sports Sciences, Health Sciences and Human Development, CIDESD, University of Trás-os-Montes e Alto Douro, Vila Real, Portugal
- Graduate Program in Physiotherapy and Functionality, Federal University of Ceara, Fortaleza, Brazil
| | - Magno F Formiga
- Graduate Program in Physical Education, Federal University of Rio Grande do Norte (UFRN), Natal-RN, Brazil
| | - Breno Guilherme de Araújo Tinôco Cabral
- Graduate Program in Health Sciences, Federal University of Rio Grande do Norte, Natal, Brazil
- Graduate Program in Physiotherapy and Functionality, Federal University of Ceara, Fortaleza, Brazil
| | - Paulo Moreira Silva Dantas
- Graduate Program in Health Sciences, Federal University of Rio Grande do Norte, Natal, Brazil
- Graduate Program in Physiotherapy and Functionality, Federal University of Ceara, Fortaleza, Brazil
| |
Collapse
|
6
|
Dosbaba F, Hartman M, Batalik L, Senkyr V, Radkovcova I, Richter S, Brat K, Cahalin LP, Formiga MF. A comprehensive examination of inspiratory muscle performance from the intensive care unit to hospital discharge in patients with COVID-19. Heart Lung 2023; 60:95-101. [PMID: 36934476 PMCID: PMC10008810 DOI: 10.1016/j.hrtlng.2023.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 03/06/2023] [Accepted: 03/10/2023] [Indexed: 03/14/2023]
Abstract
BACKGROUND The two most common symptoms associated with COVID-19 are dyspnea and fatigue. One possible cause of such symptoms may be inspiratory muscle weakness. OBJECTIVES The purpose of this study was to examine inspiratory muscle performance (IMP) from intensive care unit discharge (ICUD) to hospital discharge (HD) in patients with COVID-19 hypothesizing that IMP would be markedly depressed at both ICUD and HD. METHODS IMP was examined at ICUD and HD via the PrO2 device (PrO2 Health, Smithfield, RI) which provided the maximal inspiratory pressure (MIP), sustained MIP (SMIP), inspiratory duration (ID), and fatigue index test (FIT). Patient symptoms were assessed at ICUD, HD, and 1-month post-HD. RESULTS 30 patients (19 men, 11 women) with COVID-19 were included. The mean±SD age, BMI, and length of ICU and hospital stay was 71±11 yrs, 27.9 ± 6.3 kg/m, 9 ± 6 days, and 26±16 days, respectively. The mean±SD MIP, SMIP, ID, and FIT of the entire cohort at ICUD vs HD were 36±21 vs 40±20 cm H2O, 231±157 vs 297±182 PTU, 8.8 ± 4.2 vs 9.5 ± 4.6 s, and 9.0 ± 9.4 vs 13.1 ± 12.3, respectively, with only SMIP and FIT significantly greater at HD (p=.006 and 0.03, respectively). SMIP at HD was significantly related to resting dyspnea at HD (r=-0.40; p=.02). The SMIP and FIT of men were found to increase significantly from ICUD to HD, but no measure of IMP in the women increased significantly from ICUD to HD. At least one COVID-19-related symptom was present 1 month after HD with the most persistent symptoms being fatigue, cough, and dyspnea in 47%, 40%, and 37% of the patients, respectively. CONCLUSIONS A significant reduction in IMP exists in patients with COVID-19 at both ICUD and HD and no measure of IMP in women was observed to increase significantly from ICUD to HD. Impaired inspiratory muscle endurance rather than strength was associated with greater dyspnea at HD.
Collapse
Affiliation(s)
- Filip Dosbaba
- Department of Rehabilitation, University Hospital Brno, Brno 62500, Czech Republic.
| | - Martin Hartman
- Department of Rehabilitation, University Hospital Brno, Brno 62500, Czech Republic; Department of Rehabilitation and Sports Medicine, 2nd Faculty of Medicine, Charles University, University Hospital Motol, Prague, Czech Republic
| | - Ladislav Batalik
- Department of Rehabilitation, University Hospital Brno, Brno 62500, Czech Republic; Department of Public Health, Faculty of Medicine, Masaryk University Brno, Brno 62500, Czech Republic
| | - Vojtech Senkyr
- Department of Rehabilitation, University Hospital Brno, Brno 62500, Czech Republic
| | - Ivana Radkovcova
- Department of Rehabilitation, University Hospital Brno, Brno 62500, Czech Republic
| | - Svatopluk Richter
- Department of Radiology and Nuclear Medicine, University Hospital Brno, Brno 62500, Czech Republic
| | - Kristian Brat
- Department of Respiratory Diseases, University Hospital Brno, Brno 62500, Czech Republic
| | - Lawrence P Cahalin
- Department of Physical Therapy, University of Miami Miller School of Medicine, Coral Gables, FL, United States
| | - Magno F Formiga
- Faculdade de Medicina, Departamento de Fisioterapia, Universidade Federal do Ceará, Fortaleza, Ceará, Brazil.
| |
Collapse
|
7
|
Cahalin LP, Formiga MF, Owens J, Osman BM. A Meta-Analysis of Remote Ischemic Preconditioning in Lung Surgery and Its Potential Role in COVID-19. Physiother Can 2023; 75:30-41. [PMID: 37250733 PMCID: PMC10211375 DOI: 10.3138/ptc-2021-0031] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 08/17/2021] [Accepted: 09/06/2021] [Indexed: 08/08/2023]
Abstract
Purpose: To determine the effects of remote ischemic preconditioning (RIPC) on pulmonary gas exchange in people undergoing pulmonary surgery and discuss a potential role of RIPC in COVID-19. Method: A search for studies examining the effects of RIPC after pulmonary surgery was performed. RevMan was used for statistical analyses examining measures of A-ado2, Pao2/Fio2, respiratory index (RI), a/A ratio and Paco2 obtained earlier after surgery (i.e., 6-8 hours) and later after surgery (i.e., 18-24 hours). Results: Four trials were included (N = 369 participants). Significant (p < 0.05) overall effects of RIPC were observed early after surgery on A-ado2 and RI (SMD -0.84 and SMD -1.23, respectively), and later after surgery on RI, Pao2/Fio2, and a/A ratio (SMD -0.39, 0.72, and 1.15, respectively) with the A-ado2 approaching significance (p = 0.05; SMD -0.45). Significant improvements in inflammatory markers and oxidative stress after RIPC were also observed. Conclusions: RIPC has the potential to improve pulmonary gas exchange, inflammatory markers, and oxidative stress in people with lung disease undergoing lung surgery and receiving mechanical ventilation. These potential improvements may be beneficial for people with COVID-19, but further investigation is warranted.
Collapse
Affiliation(s)
- Lawrence P. Cahalin
- University of Miami, Department of Physical Therapy, Coral Gables, Florida, United States
| | - Magno F. Formiga
- Universidade Federal do Ceará, Departamento de Fisioterapia, Fortaleza, Ceará, Brazil
| | - Johnny Owens
- Owens Recovery Science, San Antonio, Texas, United States
| | - Brian M. Osman
- of Miami, Department of Anesthesiology, Perioperative Medicine, and Pain Management, Miami, Florida, United States
| |
Collapse
|
8
|
Fernandes AT, Rodrigues EK, Araújo ER, Formiga MF, Horan PKS, Ferreira ABNDS, Barbosa HA, Barbosa PS. Risk factors and survival in patients with COVID-19 in northeastern Brazil. PLoS One 2022; 17:e0278213. [PMID: 36441799 PMCID: PMC9704671 DOI: 10.1371/journal.pone.0278213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 11/12/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Knowledge about the epidemiology and risk factors surrounding COVID-19 contributes to developing better health strategies to combat the disease. OBJECTIVE This study aimed to establish a survival analysis and identify the risk factors for patients with COVID-19 in an upper middle-income city in Brazil. METHODS A retrospective cohort study was conducted with 280 hospitalized patients with COVID-19. The eCOVID platform provided data to monitor COVID-19 cases and help the communication between professionals. RESULTS Age ≥ 65 years was associated with decreased survival (54.8%), and females had a lower survival rate than males (p = 0.01). Regarding risk factors, urea concentration (p<0.001), hospital length of stay (p = 0.002), oxygen concentration (p = 0.005), and age (p = 0.02) were associated with death. CONCLUSION Age, hospital length of stay, high blood urea concentration, and low oxygen concentration were associated with death by COVID-19 in the studied population. These findings corroborate with studies conducted in research centers worldwide.
Collapse
Affiliation(s)
- Ana Tereza Fernandes
- Department of Physical Therapy, State University of Paraiba, Campina Grande, Brazil
- * E-mail:
| | - Eujessika K. Rodrigues
- Center of Technology Strategies in Health, State University of Paraiba, Campina Grande, Brazil
| | - Eder R. Araújo
- Department of Physical Therapy, State University of Paraiba, Campina Grande, Brazil
| | - Magno F. Formiga
- Department of Physical Therapy, Federal University of Ceara, Fortaleza, Brazil
| | | | | | | | - Paulo S. Barbosa
- Center of Technology Strategies in Health, State University of Paraiba, Campina Grande, Brazil
| |
Collapse
|
9
|
Cahalin LP, Formiga MF, Anderson B, Cipriano G, Hernandez ED, Owens J, Hughes L. A call to action for blood flow restriction training in older adults with or susceptible to sarcopenia: A systematic review and meta-analysis. Front Physiol 2022; 13:924614. [PMID: 36045750 PMCID: PMC9421943 DOI: 10.3389/fphys.2022.924614] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 07/12/2022] [Indexed: 11/13/2022] Open
Abstract
Background: The extent to which exercise training with blood flow restriction (BFR) improves functional performance (FP) in people with sarcopenia remains unclear. We performed a comprehensive search of BFR training in subjects with sarcopenia or susceptible to sarcopenia hoping to perform a systematic review and meta-analysis on the effects of BFR on FP in older adults without medical disorders, but with or susceptible to sarcopenia.Methods: PubMed and the Cochrane library were searched through February 2022. Inclusion criteria were: 1) the study examined older adults (>55 years of age) with or susceptible to sarcopenia and free of overt acute or chronic diseases, 2) there was a random allocation of participants to BFR and active control groups, 3) BFR was the sole intervention difference between the groups, and 4) the study provided post-intervention measures of skeletal muscle and physical function which were either the same or comparable to those included in the revised European Working Group on Sarcopenia in Older People (EWGSOP) diagnostic algorithm.Results: No studies of BFR training in individuals with sarcopenia were found and no study included individuals with FP values below the EWGSOP criteria. However, four studies of BFR training in older adults in which FP was examined were found. BFR training significantly improved the timed up and go (MD = −0.46, z = 2.43, p = 0.02), 30-s chair stand (MD = 2.78, z = 3.72, p < 0.001), and knee extension strength (standardized MD = 0.5, z = 2.3, p = 0.02) in older adults.Conclusion: No studies of BFR exercise appear to have been performed in patients with or suspected sarcopenia based on latest diagnostic criteria. Despite the absence of such studies, BFR training was found to significantly improve the TUG, 30-s chair stand, and knee extension strength in older adults. Studies examining the effects of BFR in subjects below EWGSOP cut-off points are needed.
Collapse
Affiliation(s)
- Lawrence P. Cahalin
- Department of Physical Therapy, Miller School of Medicine, University of Miami, Coral Gables, FL, United States
- *Correspondence: Lawrence P. Cahalin,
| | - Magno F. Formiga
- Departamento de Fisioterapia, Faculdade de Medicina, Universidade Federal do Ceará, Fortaleza, CE, Brazil
| | - Brady Anderson
- Department of Physical Therapy, Miller School of Medicine, University of Miami, Coral Gables, FL, United States
| | - Gerson Cipriano
- Departamento de Fisioterapia, Universidade de Brasília, Brasília, DF, Brazil
| | - Edgar D. Hernandez
- Departamento del Movimiento Corporal Humano y sus desórdenes, Universidad Nacional de Colombia, Bogotá, Colombia
| | - Johnny Owens
- Owens Recovery Science, San Antonio, TX, United States
| | - Luke Hughes
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Northumbria, United Kingdom
| |
Collapse
|
10
|
Cahalin LP, Formiga MF, Owens J, Anderson B, Hughes L. Beneficial Role of Blood Flow Restriction Exercise in Heart Disease and Heart Failure Using the Muscle Hypothesis of Chronic Heart Failure and a Growing Literature. Front Physiol 2022; 13:924557. [PMID: 35874535 PMCID: PMC9296815 DOI: 10.3389/fphys.2022.924557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 06/10/2022] [Indexed: 11/13/2022] Open
Abstract
Background: Blood flow restriction exercise (BFRE) has become a common method to increase skeletal muscle strength and hypertrophy for individuals with a variety of conditions. A substantial literature of BFRE in older adults exists in which significant gains in strength and functional performance have been observed without report of adverse events. Research examining the effects of BFRE in heart disease (HD) and heart failure (HF) appears to be increasing for which reason the Muscle Hypothesis of Chronic Heart Failure (MHCHF) will be used to fully elucidate the effects BFRE may have in patients with HD and HF highlighted in the MHCHF.Methods: A comprehensive literature review was performed in PubMed and the Cochrane library through February 2022. Inclusion criteria were: 1) the study was original research conducted in human subjects older than 18 years of age and diagnosed with either HD or HF, 2) study participants performed BFRE, and 3) post-intervention outcome measures of cardiovascular function, physical performance, skeletal muscle function and structure, and/or systemic biomarkers were provided. Exclusion criteria included review articles and articles on viewpoints and opinions of BFRE, book chapters, theses, dissertations, and case study articles.Results: Seven BFRE studies in HD and two BFRE studies in HF were found of which four of the HD and the two HF studies examined a variety of measures reflected within the MHCHF over a period of 8–24 weeks. No adverse events were reported in any of the studies and significant improvements in skeletal muscle strength, endurance, and work as well as cardiorespiratory performance, mitochondrial function, exercise tolerance, functional performance, immune humoral function, and possibly cardiac performance were observed in one or more of the reviewed studies.Conclusion: In view of the above systematic review, BFRE has been performed safely with no report of adverse event in patients with a variety of different types of HD and in patients with HF. The components of the MHCHF that can be potentially improved with BFRE include left ventricular dysfunction, inflammatory markers, inactivity, a catabolic state, skeletal and possibly respiratory muscle myopathy, dyspnea and fatigue, ANS activity, and peripheral blood flow. Furthermore, investigation of feasibility, acceptability, adherence, adverse effects, and symptoms during and after BFRE is needed since very few studies have examined these important issues comprehensively in patients with HD and HF.
Collapse
Affiliation(s)
- Lawrence P. Cahalin
- Department of Physical Therapy, Miller School of Medicine, University of Miami, Miami, FL, United States
- *Correspondence: Lawrence P. Cahalin,
| | - Magno F. Formiga
- Departamento de Fisioterapia, Faculdade de Medicina, Universidade Federal Do Ceará, Fortaleza, Brazil
| | - Johnny Owens
- Owens Recovery Science, San Antonio, TX, United States
| | - Brady Anderson
- Department of Physical Therapy, Miller School of Medicine, University of Miami, Miami, FL, United States
| | - Luke Hughes
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Northumbria, United Kingdom
| |
Collapse
|
11
|
Dosbaba F, Hartman M, Batalik L, Brat K, Plutinsky M, Hnatiak J, Formiga MF, Cahalin LP. Test of incremental respiratory endurance as home-based, stand-alone therapy in chronic obstructive pulmonary disease: A case report. World J Clin Cases 2022; 10:353-360. [PMID: 35071539 PMCID: PMC8727254 DOI: 10.12998/wjcc.v10.i1.353] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 10/01/2021] [Accepted: 11/28/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The prevalence of chronic obstructive pulmonary disease (COPD) is increasing worldwide, and at the same time it is associated with increased mortality and reduced quality of life. Efforts to build sustainable rehabilitation approaches to COPD treatment and prevention are crucial. The system of long-term pulmonary rehabilitation care is insufficient. The main reasons for the absence of these outpatient programs are the lack of experience, the lack of interest of insurance companies in secondary prevention programs, and the lack of healthcare facilities in large geographical areas. The possibility of at-home pulmonary rehabilitation models (telemonitoring and telecoaching) could solve this problem.
CASE SUMMARY A 71-year-old man with severe COPD, Global Initiative for Obstructive Lung Diseases stage 3 underwent an 8-wk remotely monitored inspiratory muscle training with a device based on the test of incremental respiratory endurance method. Spirometry, body plethysmography, test of incremental respiratory endurance examination, 6-min walking test, body mass index, airflow obstruction, dyspnea, exercise capacity index, and subjective perception of dyspnea were performed as part of the initial and final examination. The patient performed training at home, and the physiotherapist monitored the patient remotely through a web application that allowed the physiotherapist to evaluate all training parameters in real-time and respond to any problems. After 8 wk of home training, there was a significant increase in all monitored values: maximal inspiratory pressure, a novel parameter sustained maximal inspiratory pressure, forced expiratory volume in 1 s, total lung capacity, forced vital capacity, peak expiratory flow, and inspiratory capacity. There was also an improvement in the perception of dyspnea according to the COPD Assessment Test and a modified Medical Research Council Breathlessness Scale, an increase in exercise tolerance according to the 6-min walking test, and a decrease in the exercise capacity index as a predictor of prognosis.
CONCLUSION Respiratory telerehabilitation was greatly beneficial in a cooperative patient with COPD and may represent an alternative therapeutic approach to the increasing incidence of all lung diseases.
Collapse
Affiliation(s)
- Filip Dosbaba
- Department of Rehabilitation, University Hospital Brno, Brno 62500, Czech Republic
| | - Martin Hartman
- Department of Rehabilitation, University Hospital Brno, Brno 62500, Czech Republic
| | - Ladislav Batalik
- Department of Rehabilitation, University Hospital Brno, Brno 62500, Czech Republic
- Department of Public Health, Faculty of Medicine, Masaryk University Brno, Brno 62500, Czech Republic
| | - Kristian Brat
- Department of Respiratory Diseases, University Hospital Brno, Brno 62500, Czech Republic
- International Clinical Research Center, St. Anne’s University Hospital, Brno 65691, Czech Republic
| | - Marek Plutinsky
- Department of Respiratory Diseases, University Hospital Brno, Brno 62500, Czech Republic
| | - Jakub Hnatiak
- Department of Rehabilitation, University Hospital Brno, Brno 62500, Czech Republic
| | - Magno F Formiga
- Departamento de Fisioterapia, Universidade Estadual da Paraíba, Campina Grande 58051, Brazil
| | - Lawrence Patrick Cahalin
- Department of Physical Therapy, University of Miami – Miller School of Medicine, Coral Gables, FL 33101, United States
| |
Collapse
|
12
|
Lima ACGB, Formiga MF, Giollo LT, da Silva ML, da Silva VZM, Otto MEB, Chiappa GR, Cipriano G. Arterial stiffness and pulse wave morphology in Chagas heart failure: insights from noninvasive applanation tonometry. J Cardiovasc Med (Hagerstown) 2022; 23:e36-e38. [PMID: 34839319 DOI: 10.2459/jcm.0000000000001287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
| | | | | | | | - Vinicius Z M da Silva
- University of Brasília, Distrito Federal
- University Center of Anapólis (UniEVANGÉLICA), Goiás, Brazil
| | | | - Gaspar R Chiappa
- University of Brasília, Distrito Federal
- University Center of Anapólis (UniEVANGÉLICA), Goiás, Brazil
| | | |
Collapse
|
13
|
Costa Vital JE, de Morais Nunes A, Souza de Albuquerque Cacique New York B, Araujo de Sousa BD, Nascimento MF, Formiga MF, Fernandes ATNSF. Biofeedback therapeutic effects on blood pressure levels in hypertensive individuals: A systematic review and meta-analysis. Complement Ther Clin Pract 2021; 44:101420. [PMID: 34062320 DOI: 10.1016/j.ctcp.2021.101420] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 05/06/2021] [Accepted: 05/16/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Systemic arterial hypertension (SAH) is considered a multifactorial disease characterized by a persistent increase in blood pressure levels. Currently, the efficient control of blood pressure is achieved by both the use of pharmacological therapy and the control of risk factors. In addition, the use of biofeedback (BFB) as a non-pharmacological strategy represents a promising therapy. OBJECTIVE This study aims to evaluate the effects of BFB on systolic and diastolic blood pressure levels, as well as on environmental and psychosocial factors in patients with essential SAH. METHODS A systematic review (SR) of the literature was carried out in English and Portuguese using the following databases: SCIELO, LILACS, CINAHL, Cochrane, and PubMed. The search strategy included a mix of terms for the key concepts Biofeedback, Heart Rate Variability, Psychophysiological Feedback, and Heart Biofeedback. Studies were analyzed independently. RESULTS The included studies evaluated a total of 462 subjects of both sexes. The meta-analysis revealed that BFB significantly elicited greater blood pressure control, mainly improving DBP levels (Z = 2.15; P = 0.03). DISCUSSION Besides improvement in DBP readings post-intervention, BFB also resulted in better disease-related environmental and psychosocial factors, such as reduced stress levels. The magnitude of effect did not appear to depend on the type of BFB applied. CONCLUSION This SR demonstrated that BFB with visual and/or auditory information is a complementary option to pharmacological treatment in the management of individuals with systolic and diastolic arterial hypertension. Moreover, the use of this adjuvant therapy seems to facilitate better DPB control.
Collapse
Affiliation(s)
| | - Adriele de Morais Nunes
- Physiotherapist, Postgraduate Program Rehabilitation Sciences at the Federal University of Rio Grande do Norte (UFRN), Santa Cruz, Brazil.
| | | | | | - Micaele Farias Nascimento
- Physiotherapist, Postgraduate Program in Health Science and Technology at the State University of Paraíba (UEPB), Campina Grande, Paraíba, Brazil.
| | - Magno F Formiga
- Physiotherapist, PhD, Professor of the Physiotherapy Course at the State University of Paraíba (UEPB), Campina Grande, Paraíba, Brazil.
| | - Ana Tereza N S F Fernandes
- Physiotherapist, PhD, Professor of the Physiotherapy Course at the State University of Paraíba (UEPB), Campina Grande, Paraíba, Brazil.
| |
Collapse
|
14
|
Formiga MF, Fay R, Hutchinson S, Locandro N, Ceballos A, Lesh A, Buscheck J, Meanor J, Owens JG, Cahalin LP. EFFECT OF AEROBIC EXERCISE TRAINING WITH AND WITHOUT BLOOD FLOW RESTRICTION ON AEROBIC CAPACITY IN HEALTHY YOUNG ADULTS: A SYSTEMATIC REVIEW WITH META-ANALYSIS. Int J Sports Phys Ther 2020; 15:175-187. [PMID: 32269850 PMCID: PMC7134358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023] Open
Abstract
BACKGROUND Exercise training (ET) with blood flow restriction (BFR) is becoming increasingly popular, but the majority of BFR ET studies have evaluated skeletal muscle strength and hypertrophy. The favorable effect of BFR ET on skeletal muscle and the vasculature appears to improve aerobic capacity (AC) although conflicting results have been observed.Purpose: The purposes of this systematic review with meta- analysis were to examine the effects of aerobic ET with and without BFR on AC and to compare the effect of low-to-moderate aerobic ET with and without BFR to high-intensity aerobic ET with and without BFR on AC. STUDY DESIGN Systematic Review with Meta-analysis. METHODS A comprehensive search for studies examining the effects of aerobic ET with and without BFR on AC was performed. Inclusion criteria were: (a) the study was conducted in healthy individuals, (b) there was random allocation of study participants to training and control groups, (c) BFR was the sole intervention difference between the groups. RESULTS A total of seven studies (5 low-to-moderate ET and 2 high-intensity ET) were included in the meta-analysis providing data from 121 subjects. There was a significant standardized mean difference (SMD) of 0.38 (95% CI = 0.01, 0.75) in AC between the BFR and non-BFR groups of all seven studies (z = 2.01; p = 0.04). Separate analyses of the five low-to-moderate aerobic ET studies found similar results with aerobic ET with BFR eliciting a significantly greater AC (z = 2.47; p=0.01) than aerobic ET without BFR (SMD of 0.57; 95% CI = 0.12, 1.01). Separate analyses of the two high-intensity aerobic ET studies with and without BFR found no significant difference in AC between the groups (SMD of - 0.01; 95% CI = - 0.67, 0.64). CONCLUSION Aerobic ET with BFR elicits a significantly greater AC than aerobic ET without BFR in healthy young adults. However, low-to-moderate intensity aerobic ET with BFR elicited a greater improvement in AC than aerobic ET without BFR while high-intensity aerobic ET with BFR did not elicit an improvement in AC over high-intensity aerobic ET without BFR. LEVEL OF EVIDENCE 1a.
Collapse
Affiliation(s)
| | - Rebekah Fay
- Department of Physical Therapy, Miller School of Medicine, University of Miami, Coral Gables, FL, USA
| | - Savannah Hutchinson
- Department of Physical Therapy, Miller School of Medicine, University of Miami, Coral Gables, FL, USA
| | - Nicholas Locandro
- Department of Physical Therapy, Miller School of Medicine, University of Miami, Coral Gables, FL, USA
| | - Angel Ceballos
- Department of Physical Therapy, Miller School of Medicine, University of Miami, Coral Gables, FL, USA
| | - Alexandra Lesh
- Department of Physical Therapy, Miller School of Medicine, University of Miami, Coral Gables, FL, USA
| | - Joel Buscheck
- Department of Physical Therapy, Miller School of Medicine, University of Miami, Coral Gables, FL, USA
| | - Jacy Meanor
- Department of Physical Therapy, Miller School of Medicine, University of Miami, Coral Gables, FL, USA
| | | | - Lawrence P. Cahalin
- Department of Physical Therapy, Miller School of Medicine, University of Miami, Coral Gables, FL, USA
| |
Collapse
|
15
|
Formiga MF, Dosbaba F, Hartman M, Batalik L, Plutinsky M, Brat K, Ludka O, Cahalin LP. Novel versus Traditional Inspiratory Muscle Training Regimens as Home-Based, Stand-Alone Therapies in COPD: Protocol for a Randomized Controlled Trial. Int J Chron Obstruct Pulmon Dis 2020; 15:2147-2155. [PMID: 32982207 PMCID: PMC7494397 DOI: 10.2147/copd.s266234] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 08/11/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Subjects with COPD frequently develop considerable weakness and deconditioning of the inspiratory musculature, which can be corrected with inspiratory muscle training (IMT). While rehabilitation centers may be able to provide IMT as part of the rather complex management of COPD, there is currently a lack of rehabilitation services in the Czech Republic. Remote IMT may then benefit subjects with COPD who are unable to attend or do not have access to rehabilitation programs. We aim at evaluating the utility of the test of incremental respiratory endurance (TIRE) as an at-home IMT method in subjects with COPD, while comparing the effectiveness of this novel training approach to the outcomes of traditional, threshold loading IMT protocols. METHODS/DESIGN This prospective, randomized controlled trial will comprise 8 weeks of at-home IMT sessions with remote supervision followed by 4 months of unsupervised, independent IMT. Eligible subjects will be randomly assigned to one of the following three distinct home-based IMT protocols: (1) TIRE, (2) Threshold loading, and (3) Sham training. Subjects allocated to the TIRE group will train once daily using an advanced IMT electronic system (PrO2), while the other two groups will receive threshold devices. Study outcomes will include measures of inspiratory muscle strength and endurance, pulmonary function, COPD-specific symptomatology, functional exercise capacity, surrogate markers of mortality risk, mental health status and health-related quality of life. DISCUSSION While we acknowledge the value of threshold loading IMT protocols, we believe that the TIRE training method has the potential to provide additional clinical benefits in COPD given its sophisticated remote tracking system and ability to modulate all aspects of muscular performance, including not only strength but also endurance, power and work capacity, allowing users to achieve considerably higher inspiratory pressures throughout the full range of inspiration when compared to other more traditionally used IMT methods.
Collapse
Affiliation(s)
- Magno F Formiga
- Departamento de Fisioterapia, Universidade Estadual da Paraíba, Campina Grande, PB, Brazil
| | - Filip Dosbaba
- Department of Rehabilitation, University Hospital Brno, Brno, Czech Republic
- Correspondence: Filip Dosbaba; Ladislav Batalik Department of Rehabilitation, University Hospital Brno, Jihlavska 20, Brno62500, Czech Republic Email ;
| | - Martin Hartman
- Department of Rehabilitation, University Hospital Brno, Brno, Czech Republic
| | - Ladislav Batalik
- Department of Rehabilitation, University Hospital Brno, Brno, Czech Republic
| | - Marek Plutinsky
- Department of Respiratory Diseases, University Hospital Brno, Brno, Czech Republic
- Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Kristian Brat
- Department of Respiratory Diseases, University Hospital Brno, Brno, Czech Republic
- Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Ondrej Ludka
- Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Lawrence P Cahalin
- Department of Physical Therapy, University of Miami – Miller School of Medicine, Coral Gables, FL, USA
| |
Collapse
|
16
|
Formiga MF, Vital I, Urdaneta G, Masters B, Herrera J, Campos MA, Cahalin LP. Higher serum levels of systemic inflammatory markers are linked to greater inspiratory muscle dysfunction in COPD. Clin Respir J 2019; 13:247-255. [PMID: 30773817 DOI: 10.1111/crj.13006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 01/29/2019] [Accepted: 02/12/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) is associated with an inflammatory response that becomes more pronounced in acute exacerbations. Considerable attention has recently focused on the value of several inflammatory mediators in predicting worsening of COPD-related symptoms. Whereas respiratory muscle dysfunction is also widely present in this population, little is known about how systemic inflammation relates to inspiratory muscle dysfunction in COPD. METHODS Fifty-three males with mild-to-very severe airflow obstruction underwent blood sampling for 23 inflammatory markers, including acute-phase proteins, cytokines and adipokines. Inspiratory muscle performance was assessed via the test of incremental respiratory endurance, providing measures of maximal (MIP) and sustained maximal (SMIP) inspiratory pressures. RESULTS The mean ± SD MIP and SMIP were 75.32 ± 19.62 cmH2 O and 406.15 ± 124.55 PTU. MIP negatively correlated with CRP, SAA and cystatin C (r-values from -0.333 to -0.378, P < 0.02), while SMIP was inversely related to SAA and cystatin C (r = -0.534 and r = -0.396, P = 0.00). Significant differences in CRP, SAA, cystatin C and PARC were also found between subjects with and without inspiratory muscle weakness. No additional significant relationships were observed between either MIP or SMIP and other inflammatory markers in the study. CONCLUSIONS MIP and SMIP are markedly reduced with greater degrees of inflammation in COPD as expressed by higher levels of CRP, SAA and cystatin C. Future research is needed to further examine the above findings and determine the impact of systemic inflammation along with its underlying mechanisms on inspiratory muscle function in COPD.
Collapse
Affiliation(s)
- Magno F Formiga
- Department of Physical Therapy, University of Miami Miller School of Medicine, Coral Gables, Florida.,CAPES Foundation, Ministry of Education of Brazil, Brasilia, Brazil.,Pulmonary Section, Miami Veterans Administration Medical Center, Miami, Florida
| | - Isabel Vital
- Pulmonary Section, Miami Veterans Administration Medical Center, Miami, Florida
| | - Gisel Urdaneta
- Pulmonary Section, Miami Veterans Administration Medical Center, Miami, Florida
| | | | | | - Michael A Campos
- Pulmonary Section, Miami Veterans Administration Medical Center, Miami, Florida.,Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, University of Miami Miller School of Medicine, Miami, Florida
| | - Lawrence P Cahalin
- Department of Physical Therapy, University of Miami Miller School of Medicine, Coral Gables, Florida
| |
Collapse
|
17
|
Formiga MF, Vital I, Urdaneta G, Campos MA, Cahalin LP. Beyond inspiratory muscle strength: Clinical utility of single-breath work capacity assessment in veterans with COPD. Respir Med 2019; 147:13-18. [PMID: 30704693 DOI: 10.1016/j.rmed.2018.12.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Revised: 12/29/2018] [Accepted: 12/31/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND Inspiratory muscle function in COPD has been traditionally described in terms of maximal inspiratory pressure (MIP). Arguably, however, is the day-to-day relevance of MIP, given that individuals rarely need maximal inspiratory forces to perform general tasks, but rather repeated breathing muscle contractions which demand endurance. The sustained maximal inspiratory pressure (SMIP) reflects the ability of the respiratory muscles to maintain force over time (i.e. single-breath work capacity). We investigated the relationships between SMIP and COPD-related clinical outcomes, hypothesizing that SMIP would have superior correlational and discriminatory value when compared to MIP. METHODS 61 males with mild-to-very severe airflow obstruction underwent measures of spirometry, whole-body plethysmography, symptomatology, comorbidity, quality of life, exacerbations and mental health. MIP and SMIP were obtained via the Test of Incremental Respiratory Endurance. RESULTS The mean ± SD MIP and SMIP were 77.2 ± 22.9 cmH2O and 407.9 ± 122.8 PTU. Both MIP and SMIP positively correlated with pulmonary function, with SMIP displaying the highest correlations. We found significant differences in spirometry, hyperinflation, symptomatology, exacerbation frequency, comorbidity, quality of life and anxiety in subjects grouped as having reduced or normal single-breath work capacity. Finally, significantly lower SMIP values were found in individuals with an IC/TLC ratio ≤25%. CONCLUSIONS The assessment of SMIP appears to have superior clinical value than MIP in COPD. Our analyses revealed that subjects whose SMIP was reduced experienced more severe airflow obstruction, greater hyperinflation, as well as worse health and mental status with increased symptomatology and impaired quality of life.
Collapse
Affiliation(s)
- Magno F Formiga
- Department of Physical Therapy, University of Miami Miller School of Medicine, Coral Gables, FL, United States; CAPES Foundation, Ministry of Education of Brazil, Brasilia, DF, Brazil.
| | - Isabel Vital
- Pulmonary Section, Miami Veterans Administration Medical Center, Miami, FL, United States
| | - Gisel Urdaneta
- Pulmonary Section, Miami Veterans Administration Medical Center, Miami, FL, United States
| | - Michael A Campos
- Pulmonary Section, Miami Veterans Administration Medical Center, Miami, FL, United States; Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Lawrence P Cahalin
- Department of Physical Therapy, University of Miami Miller School of Medicine, Coral Gables, FL, United States.
| |
Collapse
|
18
|
Formiga MF, Vital I, Urdaneta G, Balestrini K, Cahalin LP, Campos MA. The BODE index and inspiratory muscle performance in COPD: Clinical findings and implications. SAGE Open Med 2018; 6:2050312118819015. [PMID: 30574307 PMCID: PMC6295678 DOI: 10.1177/2050312118819015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Accepted: 11/21/2018] [Indexed: 11/15/2022] Open
Abstract
Objectives The Test of Incremental Respiratory Endurance is a novel testing method that provides a unique examination of one's inspiratory muscle strength, work and endurance. Little is known about the relationship between inspiratory muscle performance and mortality risk in obstructive lung disease. We examined the relationship between the Test of Incremental Respiratory Endurance measures and the Body-mass index, airflow Obstruction, Dyspnea and Exercise index in chronic obstructive pulmonary disease. Methods In all, 70 males with mild-to-very severe chronic obstructive pulmonary disease (mean ± standard deviation of 70.2 ± 5.9 years) underwent measurements of body-mass index, spirometry, dyspnea and a 6-min walk test from which the Body-mass index, airflow Obstruction, Dyspnea and Exercise score was calculated. The Test of Incremental Respiratory Endurance provided measures of maximal inspiratory pressure, sustained maximal inspiratory pressure and inspiratory duration. Results All Test of Incremental Respiratory Endurance parameters inversely correlated with the Body-mass index, airflow Obstruction, Dyspnea and Exercise score: maximal inspiratory pressure (r = -0.355, p = 0.00), sustained maximal inspiratory pressure (r = -0.426, p = 0.00) and ID (r = -0.278, p = 0.02), with sustained maximal inspiratory pressure displaying the highest correlation. Independent significant correlations were also observed between the sustained maximal inspiratory pressure and all Body-mass index, airflow Obstruction, Dyspnea and Exercise score components, except for body-mass index. Finally, sustained maximal inspiratory pressure was significantly different among the Body-mass index, airflow Obstruction, Dyspnea and Exercise index quartiles. Discussion The significant association between the Body-mass index, airflow Obstruction, Dyspnea and Exercise score and inspiratory muscle performance, in particular sustained maximal inspiratory pressure, suggests that these measures may have a potential prognostic value in the evaluation of chronic obstructive pulmonary disease.
Collapse
Affiliation(s)
- Magno F Formiga
- Department of Physical Therapy, Miller School of Medicine, University of Miami, Coral Gables, FL, USA.,CAPES Foundation, Ministry of Education of Brazil, Brasilia, Brazil
| | - Isabel Vital
- Pulmonary Section, Miami Veterans Administration Medical Center, Miami, FL, USA
| | - Gisel Urdaneta
- Pulmonary Section, Miami Veterans Administration Medical Center, Miami, FL, USA
| | - Kira Balestrini
- Pulmonary Section, Miami Veterans Administration Medical Center, Miami, FL, USA
| | - Lawrence P Cahalin
- Department of Physical Therapy, Miller School of Medicine, University of Miami, Coral Gables, FL, USA
| | - Michael A Campos
- Pulmonary Section, Miami Veterans Administration Medical Center, Miami, FL, USA.,Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Miller School of Medicine, University of Miami, Coral Gables, FL, USA
| |
Collapse
|
19
|
Thomaz SR, Teixeira FA, de Lima ACGB, Cipriano Júnior G, Formiga MF, Cahalin LP. Osteopathic manual therapy in heart failure patients: A randomized clinical trial. J Bodyw Mov Ther 2018; 22:293-299. [PMID: 29861222 DOI: 10.1016/j.jbmt.2017.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Heart Failure (HF) patients usually present with increased arterial resistance and reduced blood pressure (BP) leading to an impaired functional capacity. Osteopathic Manual Therapy (OMT) focused on myofascial release techniques (MRT) and in the balancing of diaphragmatic tensions, has been shown to improve blood flow in individuals using the resistive index (RI). However, its effects in HF patients have not been examined. PURPOSE To evaluate the acute response of selected osteopathic techniques on RI, heart rate (HR), and BP in patients with HF. METHODS Randomized-controlled clinical trial of HF patients assigned to MRT (six different techniques with three aimed at the pelvis, two at the thorax, and one at the neck for 15 min) or Control group (subjects in supine position for 15 min without intervention). The RI of the femoral, brachial and carotid arteries was measured via doppler ultrasound while HR and BP were measured via sphygmomanometry before and after a single MRT or control intervention. RESULTS Twenty-two HF patients equally distributed (50% male, mean age 53 years; range 32-69 years) (ejection fraction = 35.6%, VO2peak: 12.9 mL/kg-1 min-1) were evaluated. We found no intra or inter group differences in RI of the carotid (ΔMRT: 0.07% vs Δ Control:11.8%), brachial (ΔMRT:0.17% vs ΔControl: 2.9%), or femoral arteries (ΔMRT:1.65% vs ΔControl: 0.97%) (P > 0.05) and no difference in HR or BP (ΔMRT:0.6% vs ΔControl: 3%), (P > 0.05). CONCLUSION A single MRT session did not significantly change the RI, HR, or BP of HF patients.
Collapse
Affiliation(s)
- Sergio R Thomaz
- Sciences and Technologies in Health's Sciences Program, Department of Physical Therapy, University of Brasilia, Brasília, DF, Brazil.
| | - Felipe A Teixeira
- Sciences and Technologies in Health's Sciences Program, Department of Physical Therapy, University of Brasilia, Brasília, DF, Brazil
| | - Alexandra C G B de Lima
- Sciences and Technologies in Health's Sciences Program, Department of Physical Therapy, University of Brasilia, Brasília, DF, Brazil
| | - Gerson Cipriano Júnior
- Physical Education and Rehabilitation Science PhD Program, University of Brasilia, Brasilia, DF, Brazil
| | - Magno F Formiga
- Department of Physical Therapy, Miller School of Medicine, University of Miami, Coral Gables, FL, United States
| | - Lawrence Patrick Cahalin
- Department of Physical Therapy, Miller School of Medicine, University of Miami, Coral Gables, FL, United States
| |
Collapse
|
20
|
Formiga MF, Roach KE, Vital I, Urdaneta G, Balestrini K, Calderon-Candelario RA, Campos MA, Cahalin LP. Reliability and validity of the test of incremental respiratory endurance measures of inspiratory muscle performance in COPD. Int J Chron Obstruct Pulmon Dis 2018; 13:1569-1576. [PMID: 29805255 PMCID: PMC5960252 DOI: 10.2147/copd.s160512] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Purpose The Test of Incremental Respiratory Endurance (TIRE) provides a comprehensive assessment of inspiratory muscle performance by measuring maximal inspiratory pressure (MIP) over time. The integration of MIP over inspiratory duration (ID) provides the sustained maximal inspiratory pressure (SMIP). Evidence on the reliability and validity of these measurements in COPD is not currently available. Therefore, we assessed the reliability, responsiveness and construct validity of the TIRE measures of inspiratory muscle performance in subjects with COPD. Patients and methods Test-retest reliability, known-groups and convergent validity assessments were implemented simultaneously in 81 male subjects with mild to very severe COPD. TIRE measures were obtained using the portable PrO2 device, following standard guidelines. Results All TIRE measures were found to be highly reliable, with SMIP demonstrating the strongest test-retest reliability with a nearly perfect intraclass correlation coefficient (ICC) of 0.99, while MIP and ID clustered closely together behind SMIP with ICC values of about 0.97. Our findings also demonstrated known-groups validity of all TIRE measures, with SMIP and ID yielding larger effect sizes when compared to MIP in distinguishing between subjects of different COPD status. Finally, our analyses confirmed convergent validity for both SMIP and ID, but not MIP. Conclusion The TIRE measures of MIP, SMIP and ID have excellent test-retest reliability and demonstrated known-groups validity in subjects with COPD. SMIP and ID also demonstrated evidence of moderate convergent validity and appear to be more stable measures in this patient population than the traditional MIP.
Collapse
Affiliation(s)
- Magno F Formiga
- Department of Physical Therapy, University of Miami Miller School of Medicine, Coral Gables, FL, USA.,CAPES Foundation, Ministry of Education of Brazil, Brasilia, Brazil
| | - Kathryn E Roach
- Department of Physical Therapy, University of Miami Miller School of Medicine, Coral Gables, FL, USA
| | - Isabel Vital
- Pulmonary Section, Miami Veterans Administration Medical Center, Miami, FL, USA
| | - Gisel Urdaneta
- Pulmonary Section, Miami Veterans Administration Medical Center, Miami, FL, USA
| | - Kira Balestrini
- Pulmonary Section, Miami Veterans Administration Medical Center, Miami, FL, USA
| | - Rafael A Calderon-Candelario
- Pulmonary Section, Miami Veterans Administration Medical Center, Miami, FL, USA.,Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Michael A Campos
- Pulmonary Section, Miami Veterans Administration Medical Center, Miami, FL, USA.,Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Lawrence P Cahalin
- Department of Physical Therapy, University of Miami Miller School of Medicine, Coral Gables, FL, USA
| |
Collapse
|
21
|
Formiga MF, Campos MA, Cahalin LP. Inspiratory Muscle Performance of Former Smokers and Nonsmokers Using the Test of Incremental Respiratory Endurance. Respir Care 2017; 63:86-91. [PMID: 28951469 DOI: 10.4187/respcare.05716] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Smoking has potential deleterious effects on respiratory muscle function. Smokers may present with reduced inspiratory muscle strength and endurance. We compared inspiratory muscle performance of nonsmokers with that of former smokers without overt respiratory problems via the Test of Incremental Respiratory Endurance. METHODS This study was performed on 42 healthy subjects between the ages of 30 and 79 y (mean ± SD of 56.5 ± 14.4 y). Fourteen male and 7 female former smokers were matched to nonsmokers based on sex, age, height, and weight. Subjects completed a questionnaire about their health and current smoking status. Testing included the best of 3 or more consistent trials. The Test of Incremental Respiratory Endurance measurements included maximal inspiratory pressure measured from residual volume as well as sustained maximal inspiratory pressure and inspiratory duration measured from residual volume to total lung capacity during a maximal sustained inhalation. RESULTS No significant difference in inspiratory performance of the entire group of former smokers compared with nonsmokers was found. However, separate sex analyses found a significant difference in sustained maximal inspiratory pressure between male former smokers and nonsmokers (518.7 ± 205.0 pressure time units vs 676.5 ± 255.2 pressure time units, P = .041). CONCLUSIONS We found similar maximal inspiratory pressure between former smokers and nonsmokers via the Test of Incremental Respiratory Endurance, but the significant difference in sustained maximal inspiratory pressure between male former smokers and nonsmokers suggests that the sustained maximal inspiratory pressure may have greater discriminatory ability in assessing the effects of smoking on inspiratory muscle performance. Further investigation of the effects of smoking on inspiratory performance via the Test of Incremental Respiratory Endurance is warranted.
Collapse
Affiliation(s)
- Magno F Formiga
- Department of Physical Therapy, University of Miami Miller School of Medicine, Coral Gables, Florida.,CAPES Foundation, Ministry of Education of Brazil, Brasilia, Brazil
| | - Michael A Campos
- Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, University of Miami Miller School of Medicine, Miami, Florida
| | - Lawrence P Cahalin
- Department of Physical Therapy, University of Miami Miller School of Medicine, Coral Gables, Florida.
| |
Collapse
|
22
|
Cahalin LP, Dibble NH, Kasa TJ, Poliszuk RO, Jones RM, Dhah J, Scott I, Vertullo L, King LA, Ruiz JT, Formiga MF, Feigenbaum LA, Baraga MG. Inspiratory Performance is Significantly Related to Isokinetic Knee Power in Collegiate Women Soccer Players. Med Sci Sports Exerc 2017. [DOI: 10.1249/01.mss.0000518488.77383.72] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
23
|
Wong ML, Formiga MF, Feigenbaum LA, Raya MA, Rice RP, Galmarini TM, Scrima L, Cahalin LP. Core Strength/Endurance and Inspiratory Muscle Performance - Are They Related? Med Sci Sports Exerc 2017. [DOI: 10.1249/01.mss.0000518630.79384.67] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
24
|
Formiga MF, Wong ML, Feigenbaum LA, Musto AA, Raya MA, Rice RP, Scrima L, Kuik MT, Cahalin LP. Inspiratory Muscle Performance is Significantly Related to Agility and Speed in Collegiate Tennis Players. Med Sci Sports Exerc 2017. [DOI: 10.1249/01.mss.0000519617.11504.b2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
25
|
Milian A, Wong ML, Bolanos J, Glynn T, Kirk-Sanchez N, Formiga MF, Cahalin LP. Sex Differences in Resting Heart Rate and Heart Rate Recovery in Low Back Pain Subjects. Med Sci Sports Exerc 2017. [DOI: 10.1249/01.mss.0000517035.36211.31] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|