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Huang Z, Li Z, Yan M, Zheng J, Huang W, Hong L, Lu Q, Liu L, Huang X, Fan H, Su W, Huang X, Wu X, Guo Z, Qiu C, Zhao Z, Hong Y. Effect of respiratory muscle training in patients with stable chronic obstructive pulmonary disease: A systematic review and meta-analysis. Heliyon 2024; 10:e28733. [PMID: 38576558 PMCID: PMC10990946 DOI: 10.1016/j.heliyon.2024.e28733] [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] [Received: 11/13/2023] [Revised: 03/22/2024] [Accepted: 03/22/2024] [Indexed: 04/06/2024] Open
Abstract
Objectives Chronic obstructive pulmonary disease (COPD) is a prevalent respiratory disorder characterized by progressive airflow limitation. This meta-analysis aims to evaluate the effectiveness of respiratory muscle training (RMT) on key pulmonary function parameters, inspiratory muscle strength and quality of life in patients with stable COPD. Methods A comprehensive search was conducted in the databases including PubMed, Cochrane, Web of Science, Embase, and ClinicalTrials.gov, from their inception to June 12, 2023. Randomized controlled trials (RCTs) evaluating the impact of RMT on stable COPD were included for meta-analysis. Results In total, 12 RCTs involving 453 participants were included in the meta-analysis. RMT demonstrated a significant increase in maximal inspiratory pressure (PImax, MD, 95% CI: 14.34, 8.17 to 20.51, P < 0.001) but not on maximal expiratory pressure (PEmax). No significant improvement was observed in 6-Min walk test (6MWT), dyspnea, forced expiratory volume in 1 s (FEV1), forced vital capacity ratio (FVC) and quality of life between RMT and control groups. However, subgroup analysis revealed a significant negative effect of RMT alone on FEV1/FVC (MD, 95% CI: 2.59, -5.11 to -0.06, P = 0.04). When RMT was combined with other interventions, improvements in FEV1/FVC and FEV1 were found, although not statistically significant. Conclusion RMT can effectively improve maximal inspiratory pressure in stable COPD patients, but the effect is slight in improving lung function, dyspnea and quality of life. It is recommended to combine with other treatment strategies to comprehensively improve the prognosis of COPD patients.
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Affiliation(s)
- Zhongjie Huang
- Department of Respiratory Medicine, The 910th Hospital of the Joint Service Support Force of the Chinese People's Liberation Army, Quanzhou Strait Hospital, Quanzhou, 362000, China
| | - Zhibin Li
- Department of Emergency Medicine, The 910th Hospital of the Joint Service Support Force of the Chinese People's Liberation Army, Quanzhou Strait Hospital, Quanzhou, 362000, China
| | - Meihao Yan
- Department of Respiratory Medicine, Jinjiang Hospital, Fujian Hospital Affiliated to Shanghai Sixth People's Hospital, Jinjiang, 362299, China
| | - Jianming Zheng
- Department of Infection, The 910th Hospital of the Joint Service Support Force of the Chinese People's Liberation Army, Quanzhou Strait Hospital, Quanzhou, 362000, China
| | - Wencheng Huang
- Department of Respiratory Medicine, The 910th Hospital of the Joint Service Support Force of the Chinese People's Liberation Army, Quanzhou Strait Hospital, Quanzhou, 362000, China
| | - Liyue Hong
- Department of Respiratory Medicine, The 910th Hospital of the Joint Service Support Force of the Chinese People's Liberation Army, Quanzhou Strait Hospital, Quanzhou, 362000, China
| | - Qiuxiang Lu
- Department of Respiratory Medicine, The 910th Hospital of the Joint Service Support Force of the Chinese People's Liberation Army, Quanzhou Strait Hospital, Quanzhou, 362000, China
| | - Limin Liu
- Department of Respiratory Medicine, The 910th Hospital of the Joint Service Support Force of the Chinese People's Liberation Army, Quanzhou Strait Hospital, Quanzhou, 362000, China
| | - Xincheng Huang
- Department of Respiratory Medicine, The 910th Hospital of the Joint Service Support Force of the Chinese People's Liberation Army, Quanzhou Strait Hospital, Quanzhou, 362000, China
| | - Hongtao Fan
- Department of Respiratory Medicine, The 910th Hospital of the Joint Service Support Force of the Chinese People's Liberation Army, Quanzhou Strait Hospital, Quanzhou, 362000, China
| | - Weiping Su
- Department of Respiratory Medicine, The 910th Hospital of the Joint Service Support Force of the Chinese People's Liberation Army, Quanzhou Strait Hospital, Quanzhou, 362000, China
| | - Xiaoping Huang
- Department of Respiratory Medicine, The 910th Hospital of the Joint Service Support Force of the Chinese People's Liberation Army, Quanzhou Strait Hospital, Quanzhou, 362000, China
| | - Xiaoyan Wu
- Department of Respiratory Medicine, The 910th Hospital of the Joint Service Support Force of the Chinese People's Liberation Army, Quanzhou Strait Hospital, Quanzhou, 362000, China
| | - Zhixiong Guo
- Department of Respiratory Medicine, The 910th Hospital of the Joint Service Support Force of the Chinese People's Liberation Army, Quanzhou Strait Hospital, Quanzhou, 362000, China
| | - Caiting Qiu
- Department of Respiratory Medicine, The 910th Hospital of the Joint Service Support Force of the Chinese People's Liberation Army, Quanzhou Strait Hospital, Quanzhou, 362000, China
| | - Zhaodi Zhao
- Department of Respiratory Medicine, The 910th Hospital of the Joint Service Support Force of the Chinese People's Liberation Army, Quanzhou Strait Hospital, Quanzhou, 362000, China
| | - Yuancheng Hong
- Department of Respiratory Medicine, The 910th Hospital of the Joint Service Support Force of the Chinese People's Liberation Army, Quanzhou Strait Hospital, Quanzhou, 362000, China
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Cai Y, Ren X, Wang J, Ma B, Chen O. Effects of Breathing Exercises in Patients With Chronic Obstructive Pulmonary Disease: A Network Meta-analysis. Arch Phys Med Rehabil 2024; 105:558-570. [PMID: 37150427 DOI: 10.1016/j.apmr.2023.04.014] [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: 12/18/2022] [Revised: 03/28/2023] [Accepted: 04/10/2023] [Indexed: 05/09/2023]
Abstract
OBJECTIVE A network meta-analysis of randomized controlled trials (RCTs) was conducted to compare and rank the effectiveness of various breathing exercises for patients with chronic obstructive pulmonary disease (COPD). DATA SOURCES We searched PubMed, Web of Science, Embase, and the Cochrane Library databases to determine the articles. STUDY SELECTION Publications investigating the effect of breathing exercises on exercise capacity (six-minute walk test [6MWT]), pulmonary function (the ratio of the first second forced expiratory volume of forced vital capacity [FEV1/FVC]), quality of life (St George's Respiratory Questionnaire [SGRQ]), inspiratory muscle pressure (maximum inspiratory pressure [PImax]), and dyspnea (Borg scale) were searched. DATA EXTRACTION Data extracted by 2 researchers were entered into predesigned tables for data extraction. The quality of the literature was assessed using the Cochrane Collaboration's tool. DATA SYNTHESIS A total of 43 RCTs involving 1977 participants were analyzed. To boost exercise capacity, the top 2 exercises were inspiratory muscle training (75%), Chinese traditional fitness exercises (13%); To improve pulmonary function, the top 2 exercises were Chinese traditional fitness exercises (32%), diaphragm breathing (30%); To raise patients' quality of life, the top 2 exercises were yoga (52%), diaphragm breathing (28%); To increase inspiratory muscle pressure, the top 2 exercises were pursed-lip breathing (47%), Chinese traditional fitness exercises (25%); To improve dyspnea, the top 2 exercises were yoga (44%), inspiratory muscle training (22%). CONCLUSIONS Various breathing exercises for COPD patients confer benefits that manifest in diverse ways. Pulmonary rehabilitation specialists could administer personalized breathing exercises tailored to each patient's condition to attain optimal therapeutic outcomes.
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Affiliation(s)
- Yingying Cai
- School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Xiaohe Ren
- School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Jingyi Wang
- School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Bin Ma
- School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Ou Chen
- School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Jinan, China.
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Cai S, Yao J, Han M, Luo X, Yu Y, Lu X, Xiang X, Huang L. The effect of cognition in combination with an ACBT on dyspnea-related kinesiophobia in patients with moderate to severe COPD: Quasirandomized controlled trial study. Geriatr Nurs 2024; 56:138-147. [PMID: 38342002 DOI: 10.1016/j.gerinurse.2024.01.002] [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: 10/19/2023] [Revised: 01/04/2024] [Accepted: 01/11/2024] [Indexed: 02/13/2024]
Abstract
Patients with moderate to severe COPD frequently experience dyspnea, which causes these patients to acquire a fear of dyspnea and a fear of activity. This study developed a cognitive intervention combined with active cycle of breathing technique (ACBT) intervention program based on the fear-avoidance model, with the goal of evaluating the program's effectiveness in improving dyspnea-related kinesiophobia in patients with moderate to severe COPD. This study had a total of 106 participants. For 8 weeks, the intervention group (N=53) received cognitive combined with ACBT, while the control group (N=53) received standard care. The findings of the four times the dyspnea belief questionnaire were collected indicated that the combined intervention had a better impact on reducing dyspnea-related kinesiophobia than did routine nursing (P<0.05), and the impact persisted even after the intervention. Additionally, it may enhance dyspnea and quality of life, increase exercise capacity, and lower the BODE index.
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Affiliation(s)
- Shasha Cai
- Department of Nursing, The First Affiliated Hospital, Zhejiang University School of Medicine, China
| | - Jinlan Yao
- School of Medicine, Huzhou University, Huzhou Central Hospital, Huzhou, Zhejiang Province, China
| | - Maomao Han
- Department of Nursing, Haining People's Hospital, Haining, Zhejiang Province, China
| | - Xiaolin Luo
- Zhejiang Evaluation Center for Medical Service and Administration, Hangzhou, Zhejiang Province, China
| | - Yudi Yu
- Department of Nursing, The First Affiliated Hospital, Zhejiang University School of Medicine, China
| | - Xiaorong Lu
- Department of Nursing, Haining People's Hospital, Haining, Zhejiang Province, China
| | - Xinyue Xiang
- Department of Nursing, The First Affiliated Hospital, Zhejiang University School of Medicine, China
| | - Lihua Huang
- Department of Nursing, The First Affiliated Hospital, Zhejiang University School of Medicine, China.
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Troosters T, Janssens W, Demeyer H, Rabinovich RA. Pulmonary rehabilitation and physical interventions. Eur Respir Rev 2023; 32:32/168/220222. [PMID: 37286219 DOI: 10.1183/16000617.0222-2022] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 03/23/2023] [Indexed: 06/09/2023] Open
Abstract
Pulmonary rehabilitation has established a status of evidence-based therapy for patients with symptomatic COPD in the stable phase and after acute exacerbations. Rehabilitation should have the possibility of including different disciplines and be offered in several formats and lines of healthcare. This review focusses on the cornerstone intervention, exercise training, and how training interventions can be adapted to the limitations of patients. These adaptations may lead to altered cardiovascular or muscular training effects and/or may improve movement efficiency. Optimising pharmacotherapy (not the focus of this review) and oxygen supplements, whole-body low- and high-intensity training or interval training, and resistance (or neuromuscular electrical stimulation) training are important training modalities for these patients in order to accommodate cardiovascular and ventilatory impairments. Inspiratory muscle training and whole-body vibration may also be worthwhile interventions in selected patients. Patients with stable but symptomatic COPD, those who have suffered exacerbations and patients waiting for or who have received lung volume reduction or lung transplantation are good candidates. The future surely holds promise to further personalise exercise training interventions and to tailor the format of rehabilitation to the individual patient's needs and preferences.
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Affiliation(s)
- Thierry Troosters
- KU Leuven, Department of Rehabilitation Sciences, Leuven, Belgium
- Respiratory Division, University Hospitals Leuven, Leuven, Belgium
| | - Wim Janssens
- Respiratory Division, University Hospitals Leuven, Leuven, Belgium
- KU Leuven, Department of Chronic Disease and Metabolism, Leuven, Belgium
| | - Heleen Demeyer
- KU Leuven, Department of Rehabilitation Sciences, Leuven, Belgium
- Respiratory Division, University Hospitals Leuven, Leuven, Belgium
- Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium
| | - Roberto A Rabinovich
- University of Edinburgh, MRC Centre for Information Research, Edinburgh, UK
- Respiratory Department, Royal Infirmary of Edinburgh, Edinburgh, UK
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Rodrigues GD, Nobrega ACLD, Soares PPDS. Respiratory training in older women: Unravelling central and peripheral hemodynamic slow oscillatory patterns. Exp Gerontol 2023; 172:112058. [PMID: 36529363 DOI: 10.1016/j.exger.2022.112058] [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: 06/02/2022] [Revised: 11/28/2022] [Accepted: 12/09/2022] [Indexed: 12/16/2022]
Abstract
We hypothesized that inspiratory muscle training (IMT) increases the respiratory-induced low-frequency oscillations of mean blood pressure (MBP) and middle cerebral artery blood velocity (MCAv), upregulating cerebrovascular function in older women. Firstly, participants were recorded with free-breathing (FB) and then breathed at a slow-paced frequency (0.1 Hz; DB test) supported by sonorous metronome feedback. Blood pressure was recorded using finger photoplethysmography method, ECG, and respiration using a thoracic belt. To obtain the MCAv a transcranial ultrasound Doppler device was used. Spectral analysis of MBP, R-R intervals, and mean MCAv time series was obtained by an autoregressive model. The transfer function analysis (TFA) was employed to calculate the coherence, gain, and phase. After that, older women were enrolled in a randomized controlled protocol, the IMT-group (n = 8; 64 ± 3 years-old) performed IMT at 50 % of maximal inspiratory pressure (MIP), and Sham-group, a placebo training at 5 % MIP (Sham-group; n = 6; 66 ± 3 years-old). Participants breathed against an inspiratory resistance twice a day for 4-weeks. DB test is repeated post IMT and Sham interventions. IMT-group, compared to Sham-group, augmented tidal volume responses to DB (Sham-group 1.03 ± 0.41 vs. IMT-group 1.61 ± 0.56 L; p = 0.04), increased respiratory-induced MBP (Sham-group 26.37 ± 4.46 vs. IMT-group 48.21 ± 3.15 mmHg2; p = 0.04) and MCAv (Sham-group 14.16 ± 31.26 vs. IMT-group 79.90 ± 21.76 cm2s-2; p = 0.03) slow oscillations, and reduced TFA gain (Sham-group 2.46 ± 1.32 vs. IMT-group 1.78 ± 1.30 cm·s-1.mmHg-1; p = 0.01). Our findings suggest that IMT increases the respiratory-induced oscillations in MBP and MCAv signals and reduces TFA gain. It seems compatible with an improved dynamic cerebrovascular regulation following IMT in older women.
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Affiliation(s)
- Gabriel Dias Rodrigues
- Department of Physiology and Pharmacology, Fluminense Federal University, Niterói, RJ, Brazil; INCT (In)Activity and Exercise, CNPq, National Institute for Science and Technology, Niterói, RJ, Brazil; Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.
| | - Antonio Claudio Lucas da Nobrega
- Department of Physiology and Pharmacology, Fluminense Federal University, Niterói, RJ, Brazil; INCT (In)Activity and Exercise, CNPq, National Institute for Science and Technology, Niterói, RJ, Brazil
| | - Pedro Paulo da Silva Soares
- Department of Physiology and Pharmacology, Fluminense Federal University, Niterói, RJ, Brazil; INCT (In)Activity and Exercise, CNPq, National Institute for Science and Technology, Niterói, RJ, Brazil
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Ammous O, Feki W, Lotfi T, Khamis AM, Gosselink R, Rebai A, Kammoun S. Inspiratory muscle training, with or without concomitant pulmonary rehabilitation, for chronic obstructive pulmonary disease (COPD). Cochrane Database Syst Rev 2023; 1:CD013778. [PMID: 36606682 PMCID: PMC9817429 DOI: 10.1002/14651858.cd013778.pub2] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND Inspiratory muscle training (IMT) aims to improve respiratory muscle strength and endurance. Clinical trials used various training protocols, devices and respiratory measurements to check the effectiveness of this intervention. The current guidelines reported a possible advantage of IMT, particularly in people with respiratory muscle weakness. However, it remains unclear to what extent IMT is clinically beneficial, especially when associated with pulmonary rehabilitation (PR). OBJECTIVES: To assess the effect of inspiratory muscle training (IMT) on chronic obstructive pulmonary disease (COPD), as a stand-alone intervention and when combined with pulmonary rehabilitation (PR). SEARCH METHODS We searched the Cochrane Airways trials register, CENTRAL, MEDLINE, Embase, PsycINFO, Cumulative Index to Nursing and Allied Health Literature (CINAHL) EBSCO, Physiotherapy Evidence Database (PEDro) ClinicalTrials.gov, and the World Health Organization International Clinical Trials Registry Platform on 20 October 2021. We also checked reference lists of all primary studies and review articles. SELECTION CRITERIA We included randomized controlled trials (RCTs) that compared IMT in combination with PR versus PR alone and IMT versus control/sham. We included different types of IMT irrespective of the mode of delivery. We excluded trials that used resistive devices without controlling the breathing pattern or a training load of less than 30% of maximal inspiratory pressure (PImax), or both. DATA COLLECTION AND ANALYSIS We used standard methods recommended by Cochrane including assessment of risk of bias with RoB 2. Our primary outcomes were dyspnea, functional exercise capacity and health-related quality of life. MAIN RESULTS: We included 55 RCTs in this review. Both IMT and PR protocols varied significantly across the trials, especially in training duration, loads, devices, number/ frequency of sessions and the PR programs. Only eight trials were at low risk of bias. PR+IMT versus PR We included 22 trials (1446 participants) in this comparison. Based on a minimal clinically important difference (MCID) of -1 unit, we did not find an improvement in dyspnea assessed with the Borg scale at submaximal exercise capacity (mean difference (MD) 0.19, 95% confidence interval (CI) -0.42 to 0.79; 2 RCTs, 202 participants; moderate-certainty evidence). We also found no improvement in dyspnea assessed with themodified Medical Research Council dyspnea scale (mMRC) according to an MCID between -0.5 and -1 unit (MD -0.12, 95% CI -0.39 to 0.14; 2 RCTs, 204 participants; very low-certainty evidence). Pooling evidence for the 6-minute walk distance (6MWD) showed an increase of 5.95 meters (95% CI -5.73 to 17.63; 12 RCTs, 1199 participants; very low-certainty evidence) and failed to reach the MCID of 26 meters. In subgroup analysis, we divided the RCTs according to the training duration and mean baseline PImax. The test for subgroup differences was not significant. Trials at low risk of bias (n = 3) demonstrated a larger effect estimate than the overall. The summary effect of the St George's Respiratory Questionnaire (SGRQ) revealed an overall total score below the MCID of 4 units (MD 0.13, 95% CI -0.93 to 1.20; 7 RCTs, 908 participants; low-certainty evidence). The summary effect of COPD Assessment Test (CAT) did not show an improvement in the HRQoL (MD 0.13, 95% CI -0.80 to 1.06; 2 RCTs, 657 participants; very low-certainty evidence), according to an MCID of -1.6 units. Pooling the RCTs that reported PImax showed an increase of 11.46 cmH2O (95% CI 7.42 to 15.50; 17 RCTs, 1329 participants; moderate-certainty evidence) but failed to reach the MCID of 17.2 cmH2O. In subgroup analysis, we did not find a difference between different training durations and between studies judged with and without respiratory muscle weakness. One abstract reported some adverse effects that were considered "minor and self-limited". IMT versus control/sham Thirty-seven RCTs with 1021 participants contributed to our second comparison. There was a trend towards an improvement when Borg was calculated at submaximal exercise capacity (MD -0.94, 95% CI -1.36 to -0.51; 6 RCTs, 144 participants; very low-certainty evidence). Only one trial was at a low risk of bias. Eight studies (nine arms) used the Baseline Dyspnea Index - Transition Dyspnea Index (BDI-TDI). Based on an MCID of +1 unit, they showed an improvement only with the 'total score' of the TDI (MD 2.98, 95% CI 2.07 to 3.89; 8 RCTs, 238 participants; very low-certainty evidence). We did not find a difference between studies classified as with and without respiratory muscle weakness. Only one trial was at low risk of bias. Four studies reported the mMRC, revealing a possible improvement in dyspnea in the IMT group (MD -0.59, 95% CI -0.76 to -0.43; 4 RCTs, 150 participants; low-certainty evidence). Two trials were at low risk of bias. Compared to control/sham, the MD in the 6MWD following IMT was 35.71 (95% CI 25.68 to 45.74; 16 RCTs, 501 participants; moderate-certainty evidence). Two studies were at low risk of bias. In subgroup analysis, we did not find a difference between different training durations and between studies judged with and without respiratory muscle weakness. Six studies reported theSGRQ total score, showing a larger effect in the IMT group (MD -3.85, 95% CI -8.18 to 0.48; 6 RCTs, 182 participants; very low-certainty evidence). The lower limit of the 95% CI exceeded the MCID of -4 units. Only one study was at low risk of bias. There was an improvement in life quality with CAT (MD -2.97, 95% CI -3.85 to -2.10; 2 RCTs, 86 participants; moderate-certainty evidence). One trial was at low risk of bias. Thirty-two RCTs reported PImax, showing an improvement without reaching the MCID (MD 14.57 cmH2O, 95% CI 9.85 to 19.29; 32 RCTs, 916 participants; low-certainty evidence). In subgroup analysis, we did not find a difference between different training durations and between studies judged with and without respiratory muscle weakness. None of the included RCTs reported adverse events. AUTHORS' CONCLUSIONS IMT may not improve dyspnea, functional exercise capacity and life quality when associated with PR. However, IMT is likely to improve these outcomes when provided alone. For both interventions, a larger effect in participants with respiratory muscle weakness and with longer training durations is still to be confirmed.
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Affiliation(s)
- Omar Ammous
- Faculty of Medicine, University of Sfax, Sfax, Tunisia
| | - Walid Feki
- Department of Respiratory Medicine, Hedi Chaker University Hospital, University of Sfax, Sfax, Tunisia
| | - Tamara Lotfi
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Canada
| | | | - Rik Gosselink
- Department of Rehabilitation Sciences, Faculty of Movement and Rehabilitation Sciences, University Hospitals Leuven, Leuven, Belgium
| | - Ahmed Rebai
- Centre of Biotechnology of Sfax, University of Sfax, Sfax, Tunisia
| | - Samy Kammoun
- Department of Respiratory Medicine, Hedi Chaker University Hospital, University of Sfax, Sfax, Tunisia
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Bohmke NJ, Billingsley HE, Kirkman DL, Carbone S. Nonpharmacological Strategies in Heart Failure with Preserved Ejection Fraction. Cardiol Clin 2022; 40:491-506. [PMID: 36210133 PMCID: PMC10280381 DOI: 10.1016/j.ccl.2022.06.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Patients with heart failure with preserved ejection fraction (HFpEF) suffer from a high rate of cardiometabolic comorbidities with limited pharmaceutical therapies proven to improve clinical outcomes and cardiorespiratory fitness (CRF). Nonpharmacologic therapies, such as exercise training and dietary interventions, are promising strategies for this population. The aim of this narrative review is to present a summary of the literature published to date and future directions related to the efficacy of nonpharmacologic, lifestyle-related therapies in HFpEF, with a focus on exercise training and dietary interventions.
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Affiliation(s)
- Natalie J Bohmke
- Department of Kinesiology & Health Sciences, College of Humanities & Sciences, Virginia Commonwealth University, 500 Academic Centre, Room 113C 1020 W Grace Street, Richmond, VA 23220, USA; Division of Cardiology, Department of Internal Medicine, VCU Pauley Heart Center, Virginia Commonwealth University, West Hospital 6th Floor, North Wing Box, 980036 Richmond, VA 23298, USA
| | - Hayley E Billingsley
- Department of Kinesiology & Health Sciences, College of Humanities & Sciences, Virginia Commonwealth University, 500 Academic Centre, Room 113C 1020 W Grace Street, Richmond, VA 23220, USA; Division of Cardiology, Department of Internal Medicine, VCU Pauley Heart Center, Virginia Commonwealth University, West Hospital 6th Floor, North Wing Box, 980036 Richmond, VA 23298, USA
| | - Danielle L Kirkman
- Department of Kinesiology & Health Sciences, College of Humanities & Sciences, Virginia Commonwealth University, 500 Academic Centre, Room 113C 1020 W Grace Street, Richmond, VA 23220, USA; Division of Cardiology, Department of Internal Medicine, VCU Pauley Heart Center, Virginia Commonwealth University, West Hospital 6th Floor, North Wing Box, 980036 Richmond, VA 23298, USA.
| | - Salvatore Carbone
- Department of Kinesiology & Health Sciences, College of Humanities & Sciences, Virginia Commonwealth University, 500 Academic Centre, Room 113C 1020 W Grace Street, Richmond, VA 23220, USA; Division of Cardiology, Department of Internal Medicine, VCU Pauley Heart Center, Virginia Commonwealth University, West Hospital 6th Floor, North Wing Box, 980036 Richmond, VA 23298, USA.
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Mortari BR, Manzano RM. Efetividade de diferentes protocolos e cargas utilizadas no treinamento muscular inspiratório de indivíduos com DPOC: uma revisão sistemática. FISIOTERAPIA E PESQUISA 2022. [DOI: 10.1590/1809-2950/22004529032022pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
RESUMO A doença pulmonar obstrutiva crônica (DPOC) provoca alterações no sistema musculoesquelético, afetando inclusive os músculos respiratórios e levando ao aumento da dispneia e à redução da capacidade funcional. Nesse sentido, o treinamento muscular inspiratório (TMI) deve fazer parte do programa de reabilitação pulmonar. Diversos estudos já demonstraram sua eficácia, contudo, ainda é necessário investigar qual a melhor forma de realizá-lo. Assim, o objetivo deste estudo foi investigar por meio de uma revisão sistemática a efetividade de diferentes protocolos e cargas de TMI sobre os desfechos de força e resistência dos músculos inspiratórios, bem como de capacidade funcional e redução da dispneia. Trata-se de uma revisão sistemática realizada de acordo com o protocolo PRISMA. A busca foi realizada em fevereiro de 2021, nas seguintes bases de dados: PubMed, SciELO, PEDro. Para a busca dos artigos, os seguintes descritores foram empregados: “COPD”; e “breathing exercises, resistive training, respiratory muscle training”. Um total de 398 pacientes foram incluídos nos 10 estudos selecionados, todos previamente diagnosticados com DPOC. Foram utilizados diferentes dispositivos para o TMI, e os protocolos variaram em relação às cargas e progressão. O dispositivo mais utilizado entre os artigos foi o Threshold, com carga estabelecida de acordo com a porcentagem da pressão inspiratória máxima (30-80%), reajustada de acordo com novas medições a cada uma ou duas semanas. Houve semelhança de resultados positivos encontrados tanto em treinamentos com cargas baixas quanto com cargas altas, havendo uma melhora na força muscular inspiratória, capacidade funcional e dispneia. No entanto, mais estudos são necessários para definir o melhor protocolo de TMI para DPOC.
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Mortari BR, Manzano RM. Effectiveness of different protocols and loads used in inspiratory muscle training of individuals with COPD: a systematic review. FISIOTERAPIA E PESQUISA 2022. [DOI: 10.1590/1809-2950/22004529032022en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
ABSTRACT Chronic obstructive pulmonary disease (COPD) changes the musculoskeletal system, including the respiratory muscles, which are responsible for increasing dyspnea and reducing functional capacity. Several studies have already showed the effectiveness of inspiratory muscle training (IMT); therefore, it should be part of the pulmonary rehabilitation program. However, assessing the best way to do it is still necessary. Thus, this study aimed to evaluate, by a systematic review, the effectiveness of different IMT protocols and loads on the outcomes of inspiratory muscle strength and endurance, functional capacity, and dyspnea reduction. This systematic review was performed in accordance with the PRISMA protocol. Studies were searched in February 2021 in the PubMed, SciELO, PEDro. For the search, the following keywords were used: “COPD” and “breathing exercises, resistive training, respiratory muscle training.” A total of 398 individuals previously diagnosed with COPD were included in the 10 selected studies. Different IMT devices were used and protocols varied in relation to loads and progression. Threshold was the most used IMT device. Its load was established according to the percentage of maximal inspiratory pressure (MIP) (30-80%) and readjusted according to new measurements taken every one or two weeks. Respiratory muscle training with both low loads and high loads presented positive results, however, establishing which is the best IMT protocol for individuals with COPD is not possible yet. Inspiratory muscle strength, functional capacity, and dyspnea get better with IMT.
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Ruberti OM, Telles GD, Rodrigues B. Stress and Physical Inactivity: Two Explosive Ingredients for the Heart in COVID-19 Pandemic Times. Curr Cardiol Rev 2021; 17:e051121190711. [PMID: 33573570 PMCID: PMC8950502 DOI: 10.2174/1573403x17666210126103204] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 11/24/2020] [Accepted: 12/17/2020] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Coronavirus disease 2019 (Covid-19) pandemic is a global health crisis that has culminated in thousands of deaths. In order to reduce the spread of the Sars-CoV-2 virus, governments of several countries have adopted social isolation as a strategy. However, social isolation has culminated in deleterious effects on the population's health, including increased physical inactivity, stress and, consequently, adverse changes in body composition, cardiorespiratory capacity, muscle strength, physical functionality, and vascular events, which are increasingly pointed out as the main determinants of cardiovascular health. Staying physically active during lockdown is a challenge, especially for the population with a higher risk of mortality from COVID-19, who are still encouraged to maintain social distance until there is a vaccine available. Strategies to avoid physical inactivity and reduce stress levels can promote cardiovascular protection and must be considered during COVID-19 time. OBJECTIVE The aim of this paper is to discuss the risks of physical inactivity and stress for the cardiovascular system during the COVID-19 pandemic and propose strategies to protect cardiovascular health. CONCLUSION A home-based training protocol could be an interesting and effective strategy for the population who need to remain physically active and safe at home.
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Affiliation(s)
- Olívia Moraes Ruberti
- Department of Structural and Functional Biology, Institute of Biology, University of Campinas (UNICAMP), R. Monteiro Lobato, 255, Campinas, São Paulo, Brazil;
| | - Guilherme Defante Telles
- Departament of Biodynamics of the Human Body Movement, School of Physical Education and Sport, University of São Paulo, Av. Professor Mello Moraes, 65, São Paulo, São Paulo, Brazil;
| | - Bruno Rodrigues
- Department of Structural and Functional Biology, Institute of Biology, University of Campinas (UNICAMP), R. Monteiro Lobato, 255, Campinas, São Paulo, Brazil; ,Adapted Physical Activity Studies Department, School of Physical Education, University of Campinas, Avendia Érico Veríssimo, 701 Campinas, São Paulo, Brazil,Address correspondence to this author at the School of Physical Education, University of Campinas, Avenida Érico Veríssimo, 701 - Barão Geraldo, Campinas - SP, Brazil, 13083-851. Tel/Fax: +55 19 3521-6816, E-mail:
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Macêdo SRD, Silva-Filho AC, Vieira ASM, Soares Junior NDJ, Dias CJ, Dias Filho CAA, Maciel AW, Rabelo LGD, Pires FO, Ribeiro RM, Rodrigues B, Mostarda CT. Cardiac Autonomic Modulation is a Key Factor for High Blood Pressure in Adolescentes. Arq Bras Cardiol 2021; 117:648-654. [PMID: 34709291 PMCID: PMC8528363 DOI: 10.36660/abc.20200093] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 11/04/2020] [Indexed: 01/16/2023] Open
Abstract
Fundamento O interesse pela hipertensão em crianças e adolescentes aumentou desde a atualização do sistema de classificação da pressão arterial para comparar com o sistema de classificação dos adultos, alterando a terminologia de “normal alta” para “pré-hipertensão”. Objetivo O objetivo deste estudo foi analisar a associação da modulação autonômica cardíaca com os níveis pressóricos dos adolescentes. Métodos 203 adolescentes foram agrupados de acordo com a pressão arterial sistólica (PAS) e a pressão arterial diastólica (PAD). Um grupo foi caracterizado como pré-hipertensão, e o outro como normotenso. Foram coletadas características antropométricas, cardiovasculares e de qualidade do sono. Inicialmente, os dados foram submetidos ao teste de normalidade Kolmogorov-Smirnov . As variáveis quantitativas contínuas foram analisadas por meio do teste T de Student não pareado. Para análise das variáveis categóricas, foi utilizado o teste qui-quadrado. Um modelo de regressão logística foi realizado. O nível de significância estabelecido foi p<0,05. Os dados foram expressos como média ± desvio padrão e intervalo de confiança. O software R foi utilizado para análise dos dados. O tamanho do efeito foi calculado com a fórmula de Cohen. Resultados O grupo pré-hipertensão apresentou aumento da entropia de Shannon e diminuição da variância total. Além disso, no modelo de regressão logística, os adolescentes deste grupo tiveram 1,03 mais chances de ter a entropia de Shannon afetada quando a PAS foi ajustada ao gênero, maturação sexual, tempo escolar, idade, circunferência da cintura e qualidade do sono. Conclusão Nossos dados mostram que a modulação autonômica pode desempenhar um papel importante no desenvolvimento da pressão arterial elevada em adolescentes ao controlar fatores como tempo escolar e qualidade do sono.
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Yu B, Tong S, Wu Y, Abdelrahim MEA, Cao M. Effects of resistance training on exercise ability in chronic obstructive pulmonary disease subjects: A systematic review and meta-analysis. Int J Clin Pract 2021; 75:e14373. [PMID: 34003587 DOI: 10.1111/ijcp.14373] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 05/09/2021] [Indexed: 02/02/2023] Open
Abstract
INTRODUCTION The resistance exercise effect on the exercise ability in chronic obstructive pulmonary disease (COPD) subjects has drawn considerable attention. However, the relationship between resistance exercise and the exercise ability of COPD subjects is conflicting. This meta-analysis was performed to evaluate this relationship. METHODS A systematic-literature search up to July 2020 was performed in OVID, Embase, Cochrane Library, PubMed, Google scholar for randomised control trials reported relationships between resistance exercise and the exercise ability of COPD subjects, and 13 studies were detected with 1286 subjects at the baseline. Mean differences (MD) with 95% confidence intervals (CIs) were calculated comparing the resistance exercise and the exercise ability of COPD subjects using the continuous method with a random or fixed-effect model. RESULTS A significantly higher 6-minutes walk test was observed in subjects performing resistance training (MD, 60.41; 95% CI, 39.97-80.85, P < .001) compared with non-resistance training subjects. However, no significant difference was observed between COPD subjects performing resistance exercise compared with non-resistance training COPD subjects in constant work rate cycle endurance test (MD, 1.59; 95% CI, 0.03-3.15, P = .05), unsupported upper extremity exercise test (MD, 48.77; 95% CI, -1.20 to 98.75, P < .06) and quality of life questionnaires (MD, -0.62; 95% CI, -2.49 to 1.245, P < .51). CONCLUSIONS The resistance exercise significantly increases the 6-minutes walk test in COPD subjects. However, resistance exercise did not significantly affect the constant work rate cycle endurance test, unsupported upper extremity exercise test and quality of life questionnaires. This relationship forces us to recommend the resistance exercise to improve the 6-minutes walk test as a simple and easy evaluation of functional exercise ability in COPD subjects.
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Affiliation(s)
- Bo Yu
- Department of Geriatrics, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shuping Tong
- Department of Respiratory and Critical Care Medicine, The Affiliated Hospital of Inner Mongolia University for Nationalities, Tongliao, China
| | - Yan Wu
- Department of Internal Medicine, Maternity and Child Health Care of Zaozhuang, Zaozhuang, China
| | - Mohamed E A Abdelrahim
- Clinical Pharmacy Department, Faculty of Pharmacy, Beni-Suef University, Beni-Suef, Egypt
| | - Min Cao
- Department of Pulmonary and Critical Care Medicine, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing, China
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Time-efficient, high-resistance inspiratory muscle strength training for cardiovascular aging. Exp Gerontol 2021; 154:111515. [PMID: 34389471 DOI: 10.1016/j.exger.2021.111515] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 07/29/2021] [Accepted: 08/09/2021] [Indexed: 01/14/2023]
Abstract
Cardiovascular diseases (CVD) remain the leading cause of death in developed and developing societies and aging is the primary risk factor for CVD. Much of the increased risk of CVD in midlife/older adults (i.e., adults aged 50 years and older) is due to increases in blood pressure, vascular endothelial dysfunction and stiffening of the large elastic arteries. Aerobic exercise training is an effective lifestyle intervention to improve CV function and decrease CVD risk with aging. However, <40% of midlife/older adults meet guidelines for aerobic exercise, due to time availability-related barriers and other obstacles to adherence. Therefore, there is a need for new lifestyle interventions that not only improve CV function with aging but also promote adherence. High-resistance inspiratory muscle strength training (IMST) is an emerging, time-efficient (5 min/day) lifestyle intervention. Early research suggests high-resistance IMST may promote adherence, lower blood pressure and potentially improve vascular endothelial function. However, additional investigation will be required to more definitively establish high-resistance IMST as a healthy lifestyle intervention for CV aging. This review will summarize the current evidence on high-resistance IMST for improving CV function with aging and will identify key research gaps and future directions.
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Saka S, Gurses HN, Bayram M. Effect of inspiratory muscle training on dyspnea-related kinesiophobia in chronic obstructive pulmonary disease: A randomized controlled trial. Complement Ther Clin Pract 2021; 44:101418. [PMID: 34034036 DOI: 10.1016/j.ctcp.2021.101418] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 05/02/2021] [Accepted: 05/11/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND The major symptom of chronic obstructive pulmonary disease (COPD) is dyspnea, which causes dyspnea-related kinesiophobia resulting in avoidance of activities associated with dyspnea or compensation by reducing the rate of activity. The aim of this study was to assess dyspnea-related kinesiophobia and determine the effect of inspiratory muscle training (IMT) on dyspnea-related kinesiophobia in COPD. METHODS Forty COPD subjects were randomly allocated to either the IMT or sham group. Both groups' maximal inspiratory pressure (MIP) was assessed weekly. All patients were instructed to perform the training exercises for 15 min twice a day, 5 days a week for a total of 8 weeks. In the IMT group, intensity was set at 30% of MIP and adjusted according to weekly MIP value. In the sham group, intensity remained constant at 15% of initial MIP. Pulmonary function test (PFT), respiratory muscle strength, 6-min walk test (6 MWT), Breathlessness Beliefs Questionnaire (BBQ), Modified Medical Research Council scale (MMRC), modified Borg scale, Hospital Anxiety and Depression Scale (HADS), Saint George's Respiratory Questionnaire (SGRQ), and COPD Assessment Test (CAT) were assessed before and after the intervention. RESULTS BBQ scores ranged from 18 to 51, with mean values in the IMT and sham groups of 39.80 ± 7.62 and 43.00 ± 6.58, respectively. When between-group differences of all outcome scores were compared, there was a statistically significant improvement in the IMT group than in the sham group (p < 0.05). After IMT, statistically significant decreases in BBQ and modified Borg scores were observed in within groups (p ≤ 0.001). These decreases were significantly greater in the IMT group (p ≤ 0.001). MMRC decreased significantly only in the IMT group (p < 0.001). There was a statistically significant increase in PFT values in the IMT group (p = 0.007-0.045), but no difference in the sham group (p = 0.129-0.886). Both groups showed statistically significant improvement in respiratory muscle strength, 6 MWT distance, and CAT score after 8 weeks (p < 0.05). All HADS and SGRQ scores decreased significantly in the IMT group (p < 0.001), whereas only the SGRQ activity score decreased significantly in the sham group (p = 0.017). CONCLUSIONS Our study provides data on the presence and level of dyspnea-related kinesiophobia in COPD patients. All patients had BBQ scores higher than 11, indicating dyspnea-related kinesiophobia. IMT reduced BBQ score and improved respiratory function, and exercise capacity. Our results also support the other known benefits of IMT such as reduced dyspnea and symptom perception, decreased anxiety and depression, and improved quality of life.
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Affiliation(s)
- Seda Saka
- Cardiopulmonary Physiotherapy Rehabilitation Department, Institute of Health Sciences, Bezmialem Vakif University, Istanbul, Turkey; Division of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Halic University, Istanbul, Turkey.
| | - Hulya Nilgun Gurses
- Department of Cardiopulmonary Physiotherapy and Rehabilitation, Division of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Bezmialem Vakif University, Istanbul, Turkey.
| | - Mehmet Bayram
- Department of Chest Medicine, Faculty of Medicine, Medipol University, Istanbul, Turkey.
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Inspiratory muscle training improves breathing pattern and sympatho-vagal balance but not spontaneous baroreflex sensitivity in older women. Respir Physiol Neurobiol 2021; 290:103672. [PMID: 33866039 DOI: 10.1016/j.resp.2021.103672] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 03/23/2021] [Accepted: 04/13/2021] [Indexed: 02/02/2023]
Abstract
Even though recent studies reported a positive inspiratory muscle training (IMT) effect on cardiovascular autonomic modulation, its underlying mechanisms as the breathing pattern remain unclear. The study aimed to investigate the IMT effects on resting heart rate variability (HRV), spontaneous baroreflex sensitivity (BRS), and spontaneous breathing pattern in older women. Fourteen healthy older women participated in this study, allocated in IMT (50 % MIP; n = 8) or Sham (5% MIP; n = 6) protocols for four weeks. Blood pressure, heart rate, and ventilatory data were continuously recorded before and after interventions. After four weeks, IMT-group increased maximal inspiratory pressure and vagal-mediated HRV, following by the reduction of sympatho-mediated HRV and the inspiratory time during the spontaneous breathing cycle compared to Sham-group, but did not change BRS. Therefore, the shorter inspiratory time suggests a putative mechanism behind improved vagal-mediated HRV post-IMT in older women.
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Rodrigues GD, Dal Lago P, da Silva Soares PP. Time-dependent effects of inspiratory muscle training and detraining on cardiac autonomic control in older women. Exp Gerontol 2021; 150:111357. [PMID: 33864832 DOI: 10.1016/j.exger.2021.111357] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 04/06/2021] [Accepted: 04/08/2021] [Indexed: 11/26/2022]
Abstract
Inspiratory muscle training improved maximal inspiratory pressure (MIP) and vagal-mediated heart rate variability (HRV) in older women. However, it is unknown what occurs if the training is discontinued (detraining protocol). The aim of this study was to investigate the IMT and detraining effects on resting HRV in older women. Twelve healthy older women (60-72 yrs) enrolled in home-based IMT at 50% MIP (IMT-group) or placebo at 5% MIP (Sham-group) protocol for 4 weeks using a mechanical pressure threshold loading device. The participants were not engaged in any other exercise protocol at that time. During IMT and Sham interventions, the inspiratory load was adjusted weekly by the actual MIP and resting heart rate variability (HRV) evaluated. After training cessation (4 weeks of detraining), participants returned to the lab for HRV and MIP recordings. Adherence to IMT was superior to 95%. IMT increased MIP (23 ± 8 cmH2O) and vagal-mediated HRV (normalized HF; 37 ± 8%), following by the reduction of sympatho-vagal balance (LF/HF), from the second week to the end of the protocol compared to sham-group. After detraining, IMT-group reduced MIP (-23 ± 8 cmH2O) and vagal-mediated HRV (normalized HF; -38 ± 14%) returning to baseline values. In conclusion, MIP and vagal-HRV improvements induced by IMT were reversed by four weeks of detraining.
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Affiliation(s)
- Gabriel Dias Rodrigues
- Department of Physiology and Pharmacology, Fluminense Federal University, Niterói, Brazil
| | - Pedro Dal Lago
- Department of Physical Therapy, Universidade Federal de Ciências da Saúde de Porto Alegre, Brazil
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Mostarda C, Barboza CDA, Cutrim AL, Silva-Filho AC, Dias CJ, Brito-Monzani JDO, Rodrigues B. Obesity as an additional factor for autonomic imbalance and poor sleep behavior in chronic obstructive pulmonary disease: a case-control study. Clinics (Sao Paulo) 2021; 76:e1826. [PMID: 33503172 PMCID: PMC7798128 DOI: 10.6061/clinics/2021/e1826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 09/02/2020] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES We compared the autonomic modulation and sleep behavior of eutrophic and overweight patients with chronic obstructive pulmonary disease (COPD). METHODS COPD participants were divided into the overweight and eutrophic groups. Pulmonary function, blood pressure, body composition, autonomic modulation, and the Pittsburgh Sleep Quality Index score were assessed. Participants performed the six-minute walk test for functional assessment. RESULTS Spirometric variables obtained in eutrophic and overweight individuals with COPD showed no statistically different results. We observed that the SDNN index indicated lower overall variability (p=0.003), and root mean square of successive differences between normal heart beats (RMSSD) (p=0.04) indicated lower parasympathetic modulation in the overweight group than observed in the eutrophic group. The indexes of the frequency domain presented lower values of total variability (p<0.01), low frequency bands (p<0.01), and high frequency (p=0.02), suggesting a higher sympathetic modulation and reduced parasympathetic modulation of the overweight group compared to eutrophic group. The overweight group also showed reduced sleep quality than the eutrophic group. CONCLUSION Overweight COPD patients showed lower autonomic modulation and impaired sleep quality, latency, and efficiency as compared eutrophic subjects. These results reinforce the importance of weight control and the acquisition of healthy habits in this population.
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Affiliation(s)
- Cristiano Mostarda
- Laboratorio de Adaptacoes Cardiovasculares ao Exercicio (LACORE), Universidade Federal do Maranhao, Sao Luis, MA, BR
- Programa de Pos-Graduacao em Educacao Fisica, Universidade Federal do Maranhao, Sao Luis, MA, BR
- Centro de Reabilitacao Cardiopulmonar, Hospital Universitario “Presidente Dutra”, Universidade Federal do Maranhao, Sao Luis, MA, BR
| | | | - Ana Lídia Cutrim
- Laboratorio de Adaptacoes Cardiovasculares ao Exercicio (LACORE), Universidade Federal do Maranhao, Sao Luis, MA, BR
- Programa de Pos-Graduacao em Educacao Fisica, Universidade Federal do Maranhao, Sao Luis, MA, BR
| | - Antonio Carlos Silva-Filho
- Laboratorio de Adaptacoes Cardiovasculares ao Exercicio (LACORE), Universidade Federal do Maranhao, Sao Luis, MA, BR
- Programa de Pos-Graduacao em Educacao Fisica, Universidade Federal do Maranhao, Sao Luis, MA, BR
| | - Carlos José Dias
- Laboratorio de Adaptacoes Cardiovasculares ao Exercicio (LACORE), Universidade Federal do Maranhao, Sao Luis, MA, BR
- Centro de Reabilitacao Cardiopulmonar, Hospital Universitario “Presidente Dutra”, Universidade Federal do Maranhao, Sao Luis, MA, BR
| | - Janaina De Oliveira Brito-Monzani
- Laboratorio de Adaptacoes Cardiovasculares ao Exercicio (LACORE), Universidade Federal do Maranhao, Sao Luis, MA, BR
- Programa de Pos-Graduacao em Educacao Fisica, Universidade Federal do Maranhao, Sao Luis, MA, BR
| | - Bruno Rodrigues
- Faculdade de Educacao Fisica, Universidade Estadual de Campinas (UNICAMP), Campinas, SP, BR
- *Corresponding author. E-mail:
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Li J, Liu W, Ding X, Wang W, Li K. Breathing exercises in people with COPD: A realist review. J Adv Nurs 2020; 77:1698-1715. [PMID: 33615544 DOI: 10.1111/jan.14703] [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: 06/07/2020] [Revised: 10/16/2020] [Accepted: 11/16/2020] [Indexed: 10/22/2022]
Abstract
AIMS To determine the theoretical framework that explains the mechanisms of the success of breathing exercise interventions in people with chronic obstructive pulmonary disease. DESIGN A realist review. DATA SOURCES Seven bibliographic databases and the grey literature were searched from 2015-January 2020 to identify the studies of breathing exercises. REVIEW METHODS The evaluation criteria of realist review and the mixed method appraisal tool were both used to evaluate the included studies. We extracted and integrated the context-mechanism-outcome strings of each study to form the theoretical framework. RESULTS Six theoretical mechanisms that affected the success of the intervention were articulated: Wide acceptance of training methods, Integration of the intervention with life, Self-management of the participants, Confidence in controlling symptoms, Participation and support of practitioners, Motivation for intervention. Conversely, the other two mechanisms including the gap between implementation and training and the duration of the intervention, had negative impacts on the implementation of breathing exercises. CONCLUSION This review updates and expands the previous literature review on the impact of breathing exercises in people and provides researchers and clinical practitioners with theoretical mechanisms to ensure that the interventions achieve expected effects. IMPACT When formulating or selecting breathing exercise interventions, our theoretical framework will guide researchers and clinical practitioners to ensure that the intervention will have practical effects.
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Affiliation(s)
- Jing Li
- School of Nursing, Jilin University, Changchun, China
| | - Wei Liu
- Operation Room Department, The First Hospital of Jilin University, Changchun, China
| | - Xinxin Ding
- School of Nursing, Jilin University, Changchun, China
| | - Wenjing Wang
- School of Nursing, Jilin University, Changchun, China
| | - Kun Li
- School of Nursing, Jilin University, Changchun, China
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Effects of home-based inspiratory muscle training on sickle cell disease (SCD) patients. Hematol Transfus Cell Ther 2020; 43:443-452. [PMID: 32967805 PMCID: PMC8573026 DOI: 10.1016/j.htct.2020.08.005] [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] [Received: 04/28/2020] [Revised: 07/09/2020] [Accepted: 08/23/2020] [Indexed: 11/22/2022] Open
Abstract
Introduction Inspiratory muscle training (IMT) has been shown to be an efficient method of improving exercise tolerance and inspiratory and expiratory muscle strength in several diseases. The effects of IMT on patients with sickle cell anemia (SCD) are relatively unknown. Our study aimed to evaluate the effects of IMT on adult SCD patients, regarding respiratory muscle strength (RMS) variables, lung function, exercise tolerance, blood lactation concentration, limitation imposed by dyspnea during daily activities and impact of fatigue on the quality of life. Methods This was a randomized single-blind study, with an IMT design comprising true load (TG) and sham load (SG) groups. Initial assessment included spirometry, volumetric capnography (VCap) and measurement of RMS by maximal inspiratory and expiratory pressure (PImax and PEmax). The Medical Research Council dyspnea scale and modified fatigue impact scale were also applied and blood lactate concentration was measured before and after the 6-minute walk test. After this initial assessment, the patient used the IMT device at home daily, returning every 6 weeks for RMS reassessment. Both groups used the same device and were unaware of which group they were in. After a period totaling 18 weeks, patients underwent the final evaluation, as initially performed. Results Twenty-five patients in total participated until the end of the study (median age 42 years). There were no significant differences between TG and SG based on age, sex, body mass index or severity of genotype. At the end of the training, both groups showed a significant increase in PEmax and PImax, improvement in Vcap and in exercise tolerance and dyspnea reduction while performing daily life activities. The same was observed in patients grouped according to disease severity (HbSS and HbSβ0vs HbSC and HbSβ+), without differences between groups. Conclusion Home-based inspiratory muscle training benefits outpatients with SCD, including the sham load group. Trial registration http://www.ensaiosclinicos.gov.br; registration number: RBR-6g8n92.
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Yilmaz C, Bostancı Ö, Bulut S. Effect of Respiratory Muscle Training on Pitch Range and Sound Duration in Brass Instrument Players and Singers. J Voice 2020; 36:76-82. [PMID: 32451252 DOI: 10.1016/j.jvoice.2020.04.012] [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: 11/25/2019] [Revised: 04/09/2020] [Accepted: 04/13/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE Effective use of respiratory organs is important for musicians. Therefore, the impact of Respiratory Muscle Training (RMT) on phonation is open to research. The aim of this study was to investigate the measurable effects of RMT on blowing in brass instrumental and on voice performance in singers. METHODS Thirty musicians were recruited and separated into a four groups. The brass instrumental and singers groups were further subdivided into control and RMT groups for a 4 week RMT intervention giving a total four groups: singers experimental (SE; n:10), singers control (SC; n:10), brass instrument players experimental (BIPE; n:5), and BIPC (n:5). The groups selected from the musicians of Samsun State Opera and Ballet Directorate and Samsun Metropolitan Municipality Band Team participated in the study. RESULTS After 4 weeks of RMT application in the study groups, significant increase in all parameters except Forced vital capacity/Forced expiratory volume in 1 second was observed in the values of pulmonary function tests and respiratory muscle strength in subjects with SE and BIPE (P < 0.05). The most significant results of this study are that in addition to changes in the duration of phonation (SE 36%), high-pitch (SE 79%, BIPE 27%) and low-pitch sounds (BIPE 61% and SE 42%), the SE (15%) and BIPE (3%) groups reached higher pitches in the high-pitch notes. CONCLUSIONS It was determined that performance of the highest and lowest pitch sounds within a vocal register in a single breath and phonation times can be improved by RMT.
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Affiliation(s)
- Coşkun Yilmaz
- Ondokuz Mayıs University, Graduate School of Health Sciences, Samsun, Turkey.
| | - Özgür Bostancı
- Ondokuz Mayıs University, Yasar Dogu Sport Science Faculty, Department of Physical Education and Sports, Samsun, Turkey
| | - Seyhan Bulut
- Ondokuz Mayıs University, State Conservatory, Department of Music, Samsun, Turkey
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Hossein Pour AH, Gholami M, Saki M, Birjandi M. The effect of inspiratory muscle training on fatigue and dyspnea in patients with heart failure: A randomized, controlled trial. Jpn J Nurs Sci 2019; 17:e12290. [PMID: 31429207 DOI: 10.1111/jjns.12290] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Revised: 04/18/2019] [Accepted: 06/27/2019] [Indexed: 12/30/2022]
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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Affiliation(s)
| | - Mohammad Gholami
- School of Nursing and Midwifery, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Mandana Saki
- Social Determinants of Health Research Center, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Mehdi Birjandi
- Department of Biostatistics and Epidemiology, School of Health and Nutrition, Lorestan University of Medical Sciences, Khorramabad, Iran
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