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The effect of inspiratory muscle training on fatigue and dyspnea in patients with heart failure: A randomized, controlled trial.
Hossein Pour, AH, Gholami, M, Saki, M, Birjandi, M
Japan journal of nursing science : JJNS. 2020;(2):e12290
Abstract
AIM: Fatigue and dyspnea are debilitating symptoms in patients with heart failure (HF). The purpose of this study was to evaluate the effects of inspiratory muscle training (IMT) on dyspnea, fatigue and the New York Heart Association (NYHA) functional classification in patients with HF. METHODS In this prospective, randomized, controlled trial, 84 patients with HF (NYHA classes II-III/IV) with a mean age of 56.62 ± 9.56 years were randomly assigned to a 6-week IMT (n = 42) or a sham IMT (n = 42) program. The IMT was performed at 40% of the maximal inspiratory pressure (MIP) in the IMT group and at 10% in the sham group. The main outcomes were assessed at baseline and after the intervention and included dyspnea severity scale (Modified Medical Research Council [MMRC], Fatigue Severity Scale [FSS] and the NYHA functional classification (based on the presenting symptoms). RESULTS The between-group analysis showed significant improvements in dyspnea, fatigue and the NYHA functional classification in the IMT group compared to the sham group (P < .05). The within-group analysis showed significant improvements in dyspnea (from 2.63 ± 0.79 to 1.38 ± 0.66, P < .001), fatigue (from 43.36 ± 8.5 to 28.95 ± 9.11, P < .001) and the NYHA functional classification (from 2.73 ± 0.5 to 2.1 ± 0.6, P = .001) in the IMT group, while fatigue and dyspnea increased significantly in the sham group. CONCLUSIONS The 6-week home-based IMT was found to be an effective and safe tool for reducing dyspnea and fatigue and improving the NYHA functional classification.
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Six-week inspiratory resistance training ameliorates endurance performance but does not affect obesity-related metabolic biomarkers in obese adults: A randomized controlled trial.
Kuo, YC, Chang, HL, Cheng, CF, Mündel, T, Liao, YH
Respiratory physiology & neurobiology. 2020;:103285
Abstract
This investigation examined the effects of a six-week inspiratory resistance training (IRT) on metabolic health biomarkers, pulmonary function, and endurance in obese individuals. Twenty-eight obese adults (BMI > 27 kg/m2 Taiwan obesity criteria) were randomly assigned to either IRT (IRT; N = 16) or sham control (PLA; N = 12). The training parameters (twice/day; 3 days/week; 30 breaths/section; IRT: 55% PImax [maximal inspiratory pressure], PLA: 10% PImax) were identical. The endurance, pulmonary function, and blood lipid profiles were measured before/after intervention. After training, the PImax in IRT was greater than in PLA (+49.6%, p < .001), and the 6-minute walking test (6MWT) performance in IRT was greater than in PLA (+12.9%, p = 0.001). However, there were no differences in pulmonary function (FVC, FEV1, or FEV1/FVC) and lipid profiles between groups. Our results demonstrate that a six-week progressively-programmed IRT was effective to improve endurance capacity and inspiratory muscle strength in obese individuals, whereas the IRT had no effects on pulmonary function, body composition, and blood lipid profiles.
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Effects of peripheral and different inspiratory muscle training methods in coronary artery disease patients with metabolic syndrome: A randomized-controlled trial.
Muammer, K, Mutluay, F, Demir, R, Özkan, AA
Respiratory medicine. 2020;:106119
Abstract
UNLABELLED Background OBJECTIVE To investigate the effects of peripheral muscle training (PMT) and different inspiratory muscle training (IMT) methods on respiratory functions, exercise capacity, and biochemistry parameters in coronary artery disease patients with metabolic syndrome. METHODS This prospective, single-blind, randomized-controlled study included 60 patients of stable coronary artery disease with metabolic syndrome (New York Heart Association [NYHA] Class I-II, left ventricular ejection fraction >40%). Patients were randomly divided into three groups: neuromuscular electrical stimulation (NMES) plus PMT group (NMES + PMT group, n = 20), IMT plus PMT group (IMT + PMT group, n = 20) and PMT group (PMT group, n = 20). Treatment continued for six weeks for all groups. The NMES was applied to rectus abdominis, IMT was applied with 30% of maximal inspiratory pressures, and PMT was applied at home. Spirometry, maximal inspiratory and expiratory pressure, dyspnea scores, exercise stress test, and biochemistry parameters were measured before and after training. RESULTS There were significant improvements in spirometric tests, respiratory muscle strength, dyspnea scores, exercise capacity, fasting blood glucose, and antistreptolysin O after treatment in all groups (p < 0.05). Significant improvements in C-reactive protein and erythrocyte sedimentation rate were observed in NMES + PMT and IMT + PMT groups (p < 0.05). Among the groups, there was a significant difference in maximal inspiratory pressure (p = 0.02) and erythrocyte sedimentation rate (p = 0.037) in favor of NMES + PMT group (p < 0.05). CONCLUSION Our study results showed significant improvements in respiratory functions, exercise capacity, and biochemistry markers in all groups. Different IMT methods can be used in cardiopulmonary rehabilitation to improve exercise intolerance in coronary artery disease patients with metabolic syndrome. CLINICAL TRIAL REGISTRATION NUMBER NCT03523026.
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Critical inspiratory pressure - a new methodology for evaluating and training the inspiratory musculature for recreational cyclists: study protocol for a randomized controlled trial.
Rehder-Santos, P, Minatel, V, Milan-Mattos, JC, Signini, ÉF, de Abreu, RM, Dato, CC, Catai, AM
Trials. 2019;(1):258
Abstract
BACKGROUND Inspiratory muscle training (IMT) has brought great benefits in terms of improving physical performance in healthy individuals. However, there is no consensus regarding the best training load, as in most cases the maximal inspiratory pressure (MIP) is used, mainly the intensity of 60% of MIP. Therefore, prescribing an IMT protocol that takes into account inspiratory muscle strength and endurance may bring additional benefits to the commonly used protocols, since respiratory muscles differ from other muscles because of their greater muscular resistance. Thus, IMT using critical inspiratory pressure (PThC) can be an alternative, as the calculation of PThC considers these characteristics. Therefore, the aim of this study is to propose a new IMT protocol to determine the best training load for recreational cyclists. METHODS Thirty recreational cyclists (between 20 and 40 years old) will be randomized into three groups: sham (SG), PThC (CPG) and 60% of MIP, according to age and aerobic functional capacity. All participants will undergo the following evaluations: pulmonary function test (PFT), respiratory muscle strength test (RMS), cardiopulmonary exercise test (CPET), incremental inspiratory muscle endurance test (iIME) (maximal sustained respiratory pressure for 1 min (PThMAX)) and constant load test (CLT) (95%, 100% and 105% of PThMÁX) using a linear load inspiratory resistor (PowerBreathe K5). The PThC will be calculated from the inspiratory muscle endurance time (TLIM) and inspiratory loads of each CLT. The IMT will last 11 weeks (3 times/week and 55 min/session). The session will consist of 5-min warm-up (50% of the training load) and three sets of 15-min breaths (100% of the training load), with a 1-min interval between them. RMS, iIME, CLT and CPET will be performed beforehand, at week 5 and 9 (to adjust the training load) and after training. PFT will be performed before and after training. The data will be analyzed using specific statistical tests (parametric or non-parametric) according to the data distribution and their respective variances. A p value <0.05 will be considered statistically significant. DISCUSSIONS It is expected that the results of this study will enable the training performed with PThC to be used by health professionals as a new tool to evaluate and prescribe IMT. TRIAL REGISTRATION ClinicalTrials.gov, NCT02984189 . Registered on 6 December 2016.
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Effectiveness of water-based Liuzijue exercise on respiratory muscle strength and peripheral skeletal muscle function in patients with COPD.
Wu, W, Liu, X, Liu, J, Li, P, Wang, Z
International journal of chronic obstructive pulmonary disease. 2018;:1713-1726
Abstract
OBJECTS The purpose of this study was to quantitatively assess the effects of water-based Liuzijue exercise on patients with COPD and compare it with land-based Liuzijue exercise. MATERIALS AND METHODS Participants were randomly allocated to one of three groups: the water-based Liuzijue exercise group (WG), the land-based Liuzijue exercise group (LG), and the control group (CG). CG participants accepted no exercise intervention, while training groups performed Liuzijue exercise according to Health Qigong Liuzijue (People's Republic of China) in different environments for 60-min sessions twice a week for 3 months. RESULTS Of the 50 patients enrolled, 45 (90%) completed the 3-month intervention. The CG showed decreased expiratory muscle strength, extensor and flexor endurance ratio (ER) of the elbow joints and flexor peak torque (PT), total work (TW), and ER of the knee joints (p<0.05). Both training groups showed improved respiratory muscle strength, which differed from the CG (p<0.001). In addition, extensor and flexor TW of the elbow joints in the training groups were increased (p<0.01), and the WG differed from the CG in extensor TW and ER and flexor TW (p<0.01), while the LG differed from the CG in flexor TW and extensor ER (p<0.05). PT, PT/body weight (BW), and TW in the knee joint extensor in the training groups were increased as well (PT and PT/BW: p<0.05, TW: p<0.01), and the WG differed from the CG in terms of knee joints outcomes, while the LG differed from the CG in flexor TW only (p<0.05). CONCLUSION Water-based Liuzijue exercise has beneficial effects on COPD patients' respiratory muscle strength and peripheral skeletal muscle function, and additional benefits may exist in endurance of upper limbs and strength and endurance of lower limbs when compared with land-based Liuzijue exercise.
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Skeletal Muscle Dysfunction in Chronic Obstructive Pulmonary Disease. What We Know and Can Do for Our Patients.
Jaitovich, A, Barreiro, E
American journal of respiratory and critical care medicine. 2018;(2):175-186
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Abstract
Skeletal muscle dysfunction occurs in patients with chronic obstructive pulmonary disease (COPD) and affects both ventilatory and nonventilatory muscle groups. It represents a very important comorbidity that is associated with poor quality of life and reduced survival. It results from a complex combination of functional, metabolic, and anatomical alterations leading to suboptimal muscle work. Muscle atrophy, altered fiber type and metabolism, and chest wall remodeling, in the case of the respiratory muscles, are relevant etiological contributors to this process. Muscle dysfunction worsens during COPD exacerbations, rendering patients progressively less able to perform activities of daily living, and it is also associated with poor outcomes. Muscle recovery measures consisting of a combination of pulmonary rehabilitation, optimized nutrition, and other strategies are associated with better prognosis when administered in stable patients as well as after exacerbations. A deeper understanding of this process' pathophysiology and clinical relevance will facilitate the use of measures to alleviate its effects and potentially improve patients' outcomes. In this review, a general overview of skeletal muscle dysfunction in COPD is offered to highlight its relevance and magnitude to expert practitioners and scientists as well as to the average clinician dealing with patients with chronic respiratory diseases.
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Best mode of inspiratory muscle training in heart failure patients: a systematic review and meta-analysis.
Sadek, Z, Salami, A, Joumaa, WH, Awada, C, Ahmaidi, S, Ramadan, W
European journal of preventive cardiology. 2018;(16):1691-1701
Abstract
Objectives The objective of this study was to evaluate the effects of inspiratory muscle training on inspiratory muscle strength, functional capacity and dyspnoea for patients with chronic heart failure, by summarising the published research on the effects of inspiratory muscle training. To identify the best mode of intervention in terms of: the load of maximal inspiratory pressure; the frequency of sessions; and the total duration of intervention. Methods A relevant literature research using the PubMed database, Cochrane and references of published studies, from 1998 to 2016, was conducted. Out of 65 randomised controlled trials, seven were considered as potentially relevant and were retrieved for detailed analysis. The methodological quality of each randomised controlled trial was rated using the physiotherapy evidence database scale. Results The included seven studies contained data on 203 patients. Typical training protocols involved training three, six or seven times per week with intensity ranging from 30% to 60% and for a duration ranging from 6 to 12 weeks. Maximal inspiratory pressure, walking distance and dyspnoea were improved in all studies and especially in those who set a load of 60% in their maximal inspiratory pressure, and have trained patients six times per week for 12 weeks. Conclusion In chronic heart failure patients, inspiratory muscle training results in a marked improvement in inspiratory muscle strength, walking distance and dyspnoea, notably when training patients at 60% of maximal inspiratory pressure, six times per week and for 12 weeks. A small number of studies and heterogeneity among studies may limit the findings of the present study.
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The influence of inspiratory muscle training combined with the Pilates method on lung function in elderly women: A randomized controlled trial.
Alvarenga, GM, Charkovski, SA, Santos, LKD, Silva, MABD, Tomaz, GO, Gamba, HR
Clinics (Sao Paulo, Brazil). 2018;:e356
Abstract
OBJECTIVE Aging is progressive, and its effects on the respiratory system include changes in the composition of the connective tissues of the lung that influence thoracic and lung compliance. The Powerbreathe® K5 is a device used for inspiratory muscle training with resistance adapted to the level of the inspiratory muscles to be trained. The Pilates method promotes muscle rebalancing exercises that emphasize the powerhouse. The aim of this study was to evaluate the influence of inspiratory muscle training combined with the Pilates method on lung function in elderly women. METHODS The participants were aged sixty years or older, were active women with no recent fractures, and were not gait device users. They were randomly divided into a Pilates with inspiratory training group (n=11), a Pilates group (n=11) and a control group (n=9). Spirometry, manovacuometry, a six-minute walk test, an abdominal curl-up test, and pulmonary variables were assessed before and after twenty intervention sessions. RESULTS The intervention led to an increase in maximal inspiratory muscle strength and pressure and power pulmonary variables (p<0.0001), maximal expiratory muscle strength (p<0.0014), six-minute walk test performance (p<0.01), and abdominal curl-up test performance (p<0.00001). The control group showed no differences in the analyzed variables (p>0.05). CONCLUSION The results of this study suggest inspiratory muscle training associated with the Pilates method provides an improvement in the lung function and physical conditioning of elderly patients.
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Reference Values for Inspiratory Muscle Endurance in Healthy Children and Adolescents.
Woszezenki, CT, Heinzmann-Filho, JP, Vendrusculo, FM, Piva, TC, Levices, I, Donadio, MV
PloS one. 2017;(1):e0170696
Abstract
AIMS: To generate reference values for two inspiratory muscle endurance (IME) protocols in healthy children and adolescents. MATERIALS AND METHODS This is an observational, cross-sectional study, in healthy children and adolescents from 4 to 18 years of age. Weight, height, maximal inspiratory pressure (MIP) and IME were measured using two protocols. A fixed load of 30% of MIP with a 10% increment every 2 minutes was used in the incremental threshold loading protocol. As for the maximal loading protocol, a fixed load of 70% of MIP was used and the time limit (Tlim) achieved until fatigue was measured. RESULTS A total of 462 participants were included, 281 corresponding to the incremental loading protocol and 181 to maximal loading. There were moderate and positive correlations between IME and age, MIP, weight and height in the incremental threshold loading. However, the regression model demonstrated that MIP and age were the best variables to predict the IME. Otherwise, weak and positive correlations with age, weight and height were found in the maximal loading. Only age and height influenced endurance in the regression model. The predictive power (r2) of the incremental threshold loading protocol was 0.65, while the maximal loading was 0.15. The reproducibility measured by the intraclass correlation coefficient (ICC) was higher in the incremental loading (0.96) compared to the maximal loading test (0.69). CONCLUSION IME in healthy children and adolescents can be explained by age, height and MIP. The incremental threshold loading protocol showed more reliable results and should be the model of choice to evaluate IME in the pediatric age group.
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Cycle ergometer and inspiratory muscle training offer modest benefit compared with cycle ergometer alone: a comprehensive assessment in stable COPD patients.
Wang, K, Zeng, GQ, Li, R, Luo, YW, Wang, M, Hu, YH, Xu, WH, Zhou, LQ, Chen, RC, Chen, X
International journal of chronic obstructive pulmonary disease. 2017;:2655-2668
Abstract
BACKGROUND Cycle ergometer training (CET) has been shown to improve exercise performance of the quadriceps muscles in patients with COPD, and inspiratory muscle training (IMT) may improve the pressure-generating capacity of the inspiratory muscles. However, the effects of combined CET and IMT remain unclear and there is a lack of comprehensive assessment. MATERIALS AND METHODS Eighty-one patients with COPD were randomly allocated to three groups: 28 received 8 weeks of CET + IMT (combined training group), 27 received 8 weeks of CET alone (CET group), and 26 only received 8 weeks of free walking (control group). Comprehensive assessment including respiratory muscle strength, exercise capacity, pulmonary function, dyspnea, quality of life, emotional status, nutritional status, and body mass index, airflow obstruction, and exercise capacity index were measured before and after the pulmonary rehabilitation program. RESULTS Respiratory muscle strength, exercise capacity, inspiratory capacity, dyspnea, quality of life, depression and anxiety, and nutritional status were all improved in the combined training and CET groups when compared with that in the control group (P<0.05) after pulmonary rehabilitation program. Inspiratory muscle strength increased significantly in the combined training group when compared with that in the CET group (ΔPImax [maximal inspiratory pressure] 5.20±0.89 cmH2O vs 1.32±0.91 cmH2O; P<0.05). However, there were no significant differences in the other indices between the two groups (P>0.05). Patients with weakened respiratory muscles in the combined training group derived no greater benefit than those without respiratory muscle weakness (P>0.05). There were no significant differences in these indices between the patients with malnutrition and normal nutrition after pulmonary rehabilitation program (P>0.05). CONCLUSION Combined training is more effective than CET alone for increasing inspiratory muscle strength. IMT may not be useful when combined with CET in patients with weakened inspiratory muscles. Nutritional status had slight impact on the effects of pulmonary rehabilitation. A comprehensive assessment approach can be more objective to evaluate the effects of combined CET and IMT.