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Invitto S, Moselli P. Exploring Embodied and Bioenergetic Approaches in Trauma Therapy: Observing Somatic Experience and Olfactory Memory. Brain Sci 2024; 14:385. [PMID: 38672034 PMCID: PMC11048503 DOI: 10.3390/brainsci14040385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Revised: 04/09/2024] [Accepted: 04/15/2024] [Indexed: 04/28/2024] Open
Abstract
Recent studies highlight how body psychotherapy is becoming highly cited, especially in connection with studies on trauma-related disorders. This review highlights the theoretical assumptions and recent points in common with embodied simulation and new sensory theories by integrating bioenergetic analysis, embodiment, and olfactory memory in trauma and post-traumatic stress disorder (PTSD) therapy. Embodied memory, rooted in sensorimotor experiences, shapes cognitive functions and emotional responses. Trauma, embodied in somatic experiences, disrupts these processes, leading to symptoms such as chronic pain and dissociation. The literature discussed highlights the impact of burning odors on individuals with PTSD and those who have experienced childhood maltreatment. Burning odors can increase stress and heart rate in war veterans, with sensitivity to these odors intensifying over time since the trauma. Additionally, adults who experienced childhood maltreatment exhibit faster processing of unpleasant odors and increased symptom severity. Grounding techniques, such as adopting a balanced posture, enhance breathing and sensory capabilities, potentially aiding in managing symptoms associated with trauma-related disorders such as PTSD.
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Affiliation(s)
- Sara Invitto
- Laboratory on Psychophysiological and Cognitive Olfactory Processes, Department of Biological and Environmental Sciences and Technologies, University of Salento, 73100 Lecce, Italy
- SIAB—Società Italiana Analisi Bioenergetica, 00183 Roma, Italy;
- IIBA International Institute for Bioenergetic Analysis, 08670 Navàs, Barcelona, Spain
| | - Patrizia Moselli
- SIAB—Società Italiana Analisi Bioenergetica, 00183 Roma, Italy;
- IIBA International Institute for Bioenergetic Analysis, 08670 Navàs, Barcelona, Spain
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2
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Cai W, Li M, Xu Y, Li M, Wang J, Zuo Y, Cao J. The effect of respiratory muscle training on children and adolescents with cystic fibrosis: a systematic review and meta-analysis. BMC Pediatr 2024; 24:252. [PMID: 38622583 PMCID: PMC11017573 DOI: 10.1186/s12887-024-04726-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Accepted: 03/27/2024] [Indexed: 04/17/2024] Open
Abstract
BACKGROUND Cystic fibrosis is a chronic genetic disease that can affect the function of the respiratory system. Previous reviews of the effects of respiratory muscle training in people with cystic fibrosis are uncertain and do not consider the effect of age on disease progression. This systematic review aims to determine the effectiveness of respiratory muscle training in the clinical outcomes of children and adolescents with cystic fibrosis. METHODS Up to July 2023, electronic databases and clinical trial registries were searched. Controlled clinical trials comparing respiratory muscle training with sham intervention or no intervention in children and adolescents with cystic fibrosis. The primary outcomes were respiratory muscle strength, respiratory muscle endurance, lung function, and cough. Secondary outcomes included exercise capacity, quality of life and adverse events. Two review authors independently extracted data and assessed study quality using the Cochrane Risk of Bias Tool 2. The certainty of the evidence was assessed according to the GRADE approach. Meta-analyses where possible; otherwise, take a qualitative approach. RESULTS Six studies with a total of 151 participants met the inclusion criteria for this review. Two of the six included studies were published in abstract form only, limiting the available information. Four studies were parallel studies and two were cross-over designs. There were significant differences in the methods and quality of the methodology included in the studies. The pooled data showed no difference in respiratory muscle strength, lung function, and exercise capacity between the treatment and control groups. However, subgroup analyses suggest that inspiratory muscle training is beneficial in increasing maximal inspiratory pressure, and qualitative analyses suggest that respiratory muscle training may benefit respiratory muscle endurance without any adverse effects. CONCLUSIONS This systematic review and meta-analysis indicate that although the level of evidence indicating the benefits of respiratory muscle training is low, its clinical significance suggests that we further study the methodological quality to determine the effectiveness of training. TRIAL REGISTRATION The protocol for this review was recorded in the International Prospective Register of Systematic Reviews (PROSPERO) under registration number CRD42023441829.
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Affiliation(s)
- WenQian Cai
- School of Pediatrics, Nanjing Medical University, Jiangsu Province, China
- Department of Nursing, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Meng Li
- Department of Rehabilitation Medicine, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Yi Xu
- Department of Rehabilitation Medicine, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Mei Li
- Department of Nursing, Children's Hospital of Nanjing Medical University, Nanjing, China.
| | - JiaNan Wang
- School of Pediatrics, Nanjing Medical University, Jiangsu Province, China
- Department of Nursing, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - YaHui Zuo
- School of Pediatrics, Nanjing Medical University, Jiangsu Province, China
- Department of Nursing, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - JinJin Cao
- Department of Gastroenterology, Children's Hospital of Nanjing Medical University, Nanjing, China
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Florian CA, Corina PC, Adelina M, Vlad C, Cristian O, Emanuela V. Respiratory Muscle Training and Its Impact on Balance and Gait in Patients with Severe COPD. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:257. [PMID: 38399544 PMCID: PMC10890123 DOI: 10.3390/medicina60020257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 01/27/2024] [Accepted: 01/29/2024] [Indexed: 02/25/2024]
Abstract
Background and Objectives: Improving extrapulmonary symptoms in COPD through respiratory muscle training can help alleviate the burden of respiratory symptoms, reduce fatigue, and improve exercise capacity in patients with COPD. This, in turn, can enhance physical activity, balance, and gait, ultimately improving the overall quality of life for individuals with COPD. This study aimed to investigate the effects of respiratory muscle training on balance and gait in patients with moderate to severe COPD. Materials and Methods: We included 65 patients with moderate to severe COPD randomly assigned to either the pulmonary rehabilitation protocol group (PR) or the pulmonary rehabilitation and inspiratory muscle training group (PR + IMT) for three weeks. Patients performed a spirometry, maximal inspiratory and expiratory pressure (MIP/MEP), 6 min walking test (6MWT), activities-specific balance confidence (ABC) scale questionnaire, Berg Balance Scale (BBS), timed up and go test (TUG), and single-leg stance test (SLS). Results: Rehabilitation had a notable impact on MIP in Group 2 (PR + IMT), with a highly significant difference between pre- and post-rehabilitation distributions (p < 0.0001). At the same time, Group 1 (PR-only) showed no significant changes (p = 0.27). In Group 1 (Control), pre- and post-rehabilitation comparisons reveal slight non-significant changes for SLS EO (p = 0.16), ABC (p = 0.07), TUG (p = 0.06), and BBS (p = 0.13). In contrast, in Group 2 (Cases), there are significant improvements in all variables after rehabilitation compared to the pre-rehabilitation values: SLS EO (p < 0.0001), ABC (p < 0.0001), TUG (p < 0.0001), and BBS (p < 0.0001). Conclusions: Our research demonstrated that respiratory muscle training significantly positively impacts balance and gait performance among patients with moderate to severe COPD compared to a control group.
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Affiliation(s)
- Crisan Alexandru Florian
- Research Center for the Assessment of Human Motion, Functionality and Disability (CEMFD), “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania;
- Pulmonary Rehabilitation Center, Clinical Hospital of Infectious Diseases and Pulmonology, “Victor Babes”, Gheorghe Adam Street 13, 300310 Timisoara, Romania;
| | - Pescaru Camelia Corina
- Pulmonary Rehabilitation Center, Clinical Hospital of Infectious Diseases and Pulmonology, “Victor Babes”, Gheorghe Adam Street 13, 300310 Timisoara, Romania;
- Center for Research and Innovation in Personalized Medicine of Respiratory Diseases (CRIPMRD), “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania; (O.C.); (V.E.)
| | - Maritescu Adelina
- Pulmonary Rehabilitation Center, Clinical Hospital of Infectious Diseases and Pulmonology, “Victor Babes”, Gheorghe Adam Street 13, 300310 Timisoara, Romania;
- Doctoral School, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania
| | - Carunta Vlad
- Faculty of Physical Education and Sports, West University of Timisoara, Vasile Parvan Street 4, 300223 Timisoara, Romania;
| | - Oancea Cristian
- Center for Research and Innovation in Personalized Medicine of Respiratory Diseases (CRIPMRD), “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania; (O.C.); (V.E.)
- Pulmonology Clinic, Clinical Hospital of Infectious Diseases and Pulmonology, “Victor Babes”, Gheorghe Adam Street 13, 300310 Timisoara, Romania
| | - Vastag Emanuela
- Center for Research and Innovation in Personalized Medicine of Respiratory Diseases (CRIPMRD), “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania; (O.C.); (V.E.)
- Pulmonology Clinic, Clinical Hospital of Infectious Diseases and Pulmonology, “Victor Babes”, Gheorghe Adam Street 13, 300310 Timisoara, Romania
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Gur M, Manor E, Hanna M, Simaan N, Gut G, Toukan Y, Hakim F, Bar-Yoseph R, Bentur L. The effect of inspiratory muscle training in PCD and CF patients: A pilot study. Pediatr Pulmonol 2023; 58:3264-3270. [PMID: 37646121 DOI: 10.1002/ppul.26655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Revised: 08/01/2023] [Accepted: 08/22/2023] [Indexed: 09/01/2023]
Abstract
BACKGROUND Effective work of breathing and bronchial hygiene requires synergy of inspiratory and expiratory muscles. Inspiratory muscle training (IMT) is a part of pulmonary rehabilitation in chronic obstructive pulmonary disease (COPD). There is some evidence of its efficacy in cystic fibrosis (CF) and, recently, in long COVID-19. We are not aware of studies on IMT in primary ciliary dyskinesia (PCD). Our aim was to assess the effect of IMT on respiratory muscle strength and pulmonary function in PCD and CF patients. METHODS A single center pilot study. Spirometry, lung clearance index (LCI), maximal inspiratory pressure (MIP), and maximal expiratory pressure (MEP) were measured at baseline (visit 1), after a month of IMT with ®POWERbreathe (visit 2), and at follow-up (visit 3). RESULTS The cohort included 27 patients (19 PCD, 8 CF); mean age 18.4 ± 9.8 years. After a month of IMT, there was a significant increase in MIP and MIP% (6.19-7.44, p = .015; and 81.85%-100.41%, p = .046, respectively), which was sustained at visit 3. Compliance ≥90% led to higher improvement in MIP. In sub-group analysis, improvement in MIP and MIP% remained significant for PCD patients (p = .026 and p = .049, respectively). No significant changes were found in spirometry, MEP or LCI. CONCLUSIONS IMT was well-tolerated and led to improved inspiratory muscle strength in PCD patients. The clinical implication of improved MIP should be further investigated. Larger, long-term studies are needed to evaluate long-term effects of IMT on pulmonary function, respiratory muscle strength, pulmonary exacerbations, and quality of life.
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Affiliation(s)
- Michal Gur
- Pediatric Pulmonary Institute and CF Center, Rappaport Children's Hospital, Rambam Health Care Campus, Haifa, Israel
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Eynav Manor
- Pediatric Pulmonary Institute and CF Center, Rappaport Children's Hospital, Rambam Health Care Campus, Haifa, Israel
| | - Moneera Hanna
- Pediatric Pulmonary Institute and CF Center, Rappaport Children's Hospital, Rambam Health Care Campus, Haifa, Israel
| | - Nadeen Simaan
- Pediatric Pulmonary Institute and CF Center, Rappaport Children's Hospital, Rambam Health Care Campus, Haifa, Israel
| | - Guy Gut
- Pediatric Pulmonary Institute and CF Center, Rappaport Children's Hospital, Rambam Health Care Campus, Haifa, Israel
| | - Yazeed Toukan
- Pediatric Pulmonary Institute and CF Center, Rappaport Children's Hospital, Rambam Health Care Campus, Haifa, Israel
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Fahed Hakim
- Pediatric Pulmonary Institute and CF Center, Rappaport Children's Hospital, Rambam Health Care Campus, Haifa, Israel
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Ronen Bar-Yoseph
- Pediatric Pulmonary Institute and CF Center, Rappaport Children's Hospital, Rambam Health Care Campus, Haifa, Israel
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Lea Bentur
- Pediatric Pulmonary Institute and CF Center, Rappaport Children's Hospital, Rambam Health Care Campus, Haifa, Israel
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
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Sreenivasulu H, Muppalla SK, Vuppalapati S, Shokrolahi M, Reddy Pulliahgaru A. Hope in Every Breath: Navigating the Therapeutic Landscape of Cystic Fibrosis. Cureus 2023; 15:e43603. [PMID: 37719614 PMCID: PMC10504422 DOI: 10.7759/cureus.43603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/16/2023] [Indexed: 09/19/2023] Open
Abstract
Cystic fibrosis (CF) has long posed a complex challenge to medical science. Still, the tides are turning with remarkable progress in prognosis and demographics, thanks to cutting-edge medical management and treatment breakthroughs. It affects multiple systems, necessitating a comprehensive approach to its management. This article thoroughly reviews the latest advancements in CF treatment across three key areas: respiratory care, infection prevention, and pharmacological management. In respiratory care, emphasis is placed on airway clearance therapies and nebulized saline, while infection prevention strategies encompass hand hygiene, respiratory etiquette, and environmental cleaning and disinfection. Pharmacological management explores pancreatic enzyme replacement therapy (PERT), antimicrobial treatments, cystic fibrosis transmembrane regulator (CFTR) modulators, and promising gene therapies. Patient education and support are highlighted as crucial components of effective CF management, while mental health assessments are emphasized due to CF patients' susceptibility to anxiety and depression. This review highlights the tremendous progress made in the management of CF. Integrating early detection, infection prevention, pharmacological interventions, gene therapy, and patient support is revolutionizing the care and quality of life for individuals with CF.
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Affiliation(s)
- Himabindu Sreenivasulu
- General Medicine, People's Education Society (PES) Institute of Medical Sciences and Research, Kuppam, IND
| | - Sudheer Kumar Muppalla
- Pediatrics, People's Education Society (PES) Institute of Medical Sciences and Research, Kuppam, IND
| | - Sravya Vuppalapati
- General Medicine, People's Education Society (PES) Institute of Medical Sciences and Research, Kuppam, IND
| | | | - Apeksha Reddy Pulliahgaru
- Pediatrics, People's Education Society (PES) Institute of Medical Sciences and Research, Kuppam, IND
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Basbug G, Gurses HN, Zeren M, Elmadag NM. Effects of inspiratory muscle training on respiratory muscle strength, respiratory function and functional capacity in adolescents with idiopathic scoliosis : A randomized, controlled trial. Wien Klin Wochenschr 2023:10.1007/s00508-023-02197-1. [PMID: 37071202 DOI: 10.1007/s00508-023-02197-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 03/13/2023] [Indexed: 04/19/2023]
Abstract
BACKGROUND Adolescent Idiopathic Scoliosis (AIS) may impair respiratory dynamics and affect the performance of inspiratory and expiratory muscles. The benefit of inspiratory muscle training (IMT) is not well investigated in AIS. We aimed to investigate the effects of IMT on respiratory muscle strength, respiratory function and functional capacity in adolescents with mild to moderate AIS. METHODS Thirty-six adolescents were randomized into control or IMT groups. Forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1) and peak expiratory flow (PEF) were measured by spirometry; respiratory muscle strength by maximum inspiratory pressure (MIP) and maximum expiratory pressure (MEP); and functional capacity by 6-min walk test (6MWT) before and after the 8-week-long home-based exercise program. Both groups received conventional exercise program including diaphragmatic breathing exercises, resistive local expansion exercise on the collapsed areas in concave sides of scoliosis, spinal stabilization, strengthening of interscapular muscles and stretching exercises. IMT group also trained with Threshold IMT device for 15 minutes, twice a day for 8 weeks at the intensity of 30% of initial MIP value in addition to conventional exercise program. RESULTS FEV1, PEF, MIP, MEP and 6MWT distance significantly improved in both groups. IMT group also showed significant improvement in FVC. The increases in FVC, MIP, MEP and 6MWT distance of IMT group were significantly higher compared to control group. CONCLUSION IMT is found to be beneficial for patients with AIS for achieving further improvements in respiratory function, respiratory muscle strength and functional capacity compared to conventional exercise program alone.
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Affiliation(s)
- Gozde Basbug
- Department of Cardiopulmonary Physiotherapy and Rehabilitation, Institute of Health Sciences, Bezmialem Vakif University, Istanbul, Turkey
- Division of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Istanbul Kent University, Istanbul, Turkey
| | - Hulya Nilgun Gurses
- Department of Cardiopulmonary Physiotherapy and Rehabilitation, Institute of Health Sciences, Bezmialem Vakif University, Istanbul, Turkey.
- Faculty of Health Sciences, Division of Physiotherapy and Rehabilitation, Bezmialem Vakif University, Silahtaraga Cd. No: 186 Eyup, Istanbul, Turkey.
| | - Melih Zeren
- Division of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Izmir Bakircay University, Izmir, Turkey
| | - Nuh Mehmet Elmadag
- Department of Orthopedics and Traumatology, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
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Junior MGDN, Xavier DM, Abreu RAL, da Silva LF, de Miranda JP, Aquino MJDV, Dos Santos MA, Filho VJDS. Home Based Rehabilitation in Children and Adolescents with Cystic Fibrosis: A Systematic Review with Meta-Analysis and Grade Recommendations. Phys Occup Ther Pediatr 2023; 43:528-547. [PMID: 36655279 DOI: 10.1080/01942638.2023.2169093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Revised: 11/13/2022] [Accepted: 01/08/2023] [Indexed: 01/20/2023]
Abstract
OBJECTIVE The objective of this study is to elucidate the effectiveness of home based rehabilitation (HBR) and compare its results with those obtained in conventional rehabilitation (CR) programs, carried out in clinics and/or outpatient clinics. METHODS Searches were conducted in five databases of randomized clinical trials. Study selection, data extraction, and assessment of the methodological quality of included studies were conducted independently by two reviewers, with discrepancies resolved by a third reviewer. RESULTS The results demonstrate post-intervention values favorable to the use of HBR when compared to control group in the outcomes of forced expiratory volume in 1 second (FEV1) (MD = 14% CI: 5.42 to 22.58, p = 0.001), forced vital capacity (FVC) (MD = 8.00% CI: 0.83 to 15.17, p = 0.03) and quality of life by the Cystic Fibrosis Questionnaire - revised in the categories (Child version score" (MD= 0.71%CI: 0.15 to 1.27, p = 0.01) and "Parent version score" (MD= 0.67%CI: 0.11 to 1.23, p = 0.02). Furthermore, we noticed an increase in the distance covered in the 6-minute walk test (MD= 34.75%CI: -8.00 to 77.50, p = 0.14), in favor of HBR. CONCLUSIONS We found that supervised or partially supervised HBR promotes improvements in FEV1, FVC and related quality of life in children and/or adolescents with cystic fibrosis.
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Affiliation(s)
| | - Diêgo Mendes Xavier
- Postgraduate Program in Rehabilitation and Functional Performance, Universidade Federal dos Vales do Jequitinhonha e Mucuri (UFVJM), Diamantina, Brazil
| | | | | | - Júlio Pascoal de Miranda
- Postgraduate Program in Rehabilitation and Functional Performance, Universidade Federal dos Vales do Jequitinhonha e Mucuri (UFVJM), Diamantina, Brazil
| | | | - Mario Adriano Dos Santos
- Doctor in Medicine, Concentration in Pathology, University of São Paulo (USP), São Paulo, Brazil
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García-Pérez-de-Sevilla G, Yvert T, Blanco Á, Sosa Pedreschi AI, Thuissard IJ, Pérez-Ruiz M. Effectiveness of Physical Exercise Interventions on Pulmonary Function and Physical Fitness in Children and Adults with Cystic Fibrosis: A Systematic Review with Meta-Analysis. Healthcare (Basel) 2022; 10:2205. [PMID: 36360546 PMCID: PMC9690212 DOI: 10.3390/healthcare10112205] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Revised: 10/24/2022] [Accepted: 10/28/2022] [Indexed: 10/15/2023] Open
Abstract
Objective: Physical exercise is associated with several benefits in the treatment of cystic fibrosis (CF), associated with a reduction in patient mortality. The aim of this systematic review was to determine the effectiveness of exercise interventions on physical condition and lung function in children and adults with CF to establish the most appropriate type and dose of physical exercise used so far. Methods: The studies included were randomized controlled trials with physical exercise interventions performed with children or adults with CF, analyzing the effects on pulmonary function, cardiorespiratory capacity, and muscle strength. The variables analyzed in at least four studies in the same population (children or adults) with the same measuring test were included in the meta-analysis. Results:Pulmonary function: There were no changes in the forced expiratory volume 1 s, but mouth expiratory/inspiratory pressures were improved in some studies. Physical fitness: In children, the interventions did not manage to improve the VO2peak (SMD = 0.22; 95%CI: -0.25 to 0.68; p = 0.73) but improved muscle strength. In adults, physical exercise interventions based on high-intensity aerobic training showed positive results in the VO2peak, and in some muscle strength outcomes. Conclusions: Exercise interventions in children and adults with CF are effective in improving muscle strength, cardiovascular capacity, and respiratory muscle function. However, they do not achieve improvements in lung function. The most effective programs are those using strength training or cardiovascular high-intensity interval training, although to date there have been few such interventions.
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Affiliation(s)
| | - Thomas Yvert
- Departamento de Salud y Rendimiento, Facultad de Ciencias de la Actividad Física y del Deporte–Instituto Nacional de Educación Física (INEF), Universidad Politécnica de Madrid, 28040 Madrid, Spain
| | - Ángela Blanco
- Departamento de Salud y Rendimiento, Facultad de Ciencias de la Actividad Física y del Deporte–Instituto Nacional de Educación Física (INEF), Universidad Politécnica de Madrid, 28040 Madrid, Spain
| | | | - Israel J. Thuissard
- Faculty of Biomedical Sciences, Universidad Europea de Madrid, 28670 Madrid, Spain
| | - Margarita Pérez-Ruiz
- Departamento de Salud y Rendimiento, Facultad de Ciencias de la Actividad Física y del Deporte–Instituto Nacional de Educación Física (INEF), Universidad Politécnica de Madrid, 28040 Madrid, Spain
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9
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Ucgun H, Gurses HN, Kaya M, Cakır E. Video game-based exercise in children and adolescents with non-cystic fibrosis bronchiectasis: A randomized comparative study of aerobic and breathing exercises. Pediatr Pulmonol 2022; 57:2207-2217. [PMID: 35669989 DOI: 10.1002/ppul.26026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 05/25/2022] [Accepted: 05/26/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND Video game-based systems have been proposed to improve effectiveness and compliance with exercise training in children and adolescents with noncystic fibrosis bronchiectasis (NCFB). This study aimed to investigate the effects of aerobic and breathing video game-based exercises (VGE) on pulmonary function, respiratory and peripheral muscle strength, functional capacity, and balance in children and adolescents with NCFB. METHOD Thirty-nine children and adolescents aged between 8 and 18 years with NCFB were randomly allocated into three groups as "home-based chest physiotherapy group" (CP), "aerobic VGE given in addition to home-based chest physiotherapy group" (CP + aerobic VGE), and "breathing VGE given in addition to home-based chest physiotherapy group" (CP + breathing VGE). All three groups performed chest physiotherapy program twice a day for 7 days per week for 8 weeks. Pulmonary function, respiratory and peripheral muscle strength, functional capacity, and balance were assessed at baseline and after 8 weeks of training. RESULTS The improvement in maximum expiratory pressure and balance scores were significantly higher in both CP + aerobic and CP + breathing VGE groups. The significant improvement in maximum inspiratory pressure was greater in the CP + breathing VGE group. The changes in peripheral muscle strength and functional capacity were significantly higher in the CP + aerobic VGE group. CONCLUSIONS The present study showed that aerobic VGE provides additional benefits in improving peripheral muscle strength and functional capacity, while breathing VGE provides further increase in improving respiratory muscle strength. In addition, both aerobic and breathing VGE were effective in improving balance, but they were not superior to each other.
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Affiliation(s)
- Hikmet Ucgun
- Department of Cardiopulmonary Physiotherapy and Rehabilitation, Institute of Health Sciences, Bezmialem Vakif University, Istanbul, Turkey.,Division of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Biruni University, Istanbul, Turkey
| | - Hulya Nilgun Gurses
- Division of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Bezmialem Vakıf University, Istanbul, Turkey.,Department of Cardiopulmonary Physiotherapy and Rehabilitation, Division of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Bezmialem Vakıf University, Istanbul, Turkey
| | - Meltem Kaya
- Department of Cardiopulmonary Physiotherapy and Rehabilitation, Institute of Health Sciences, Bezmialem Vakif University, Istanbul, Turkey.,Division of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Bezmialem Vakıf University, Istanbul, Turkey
| | - Erkan Cakır
- Department of Pediatric Pulmonology, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
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10
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Radtke T, Smith S, Nevitt SJ, Hebestreit H, Kriemler S. Physical activity and exercise training in cystic fibrosis. Cochrane Database Syst Rev 2022; 8:CD002768. [PMID: 35943025 PMCID: PMC9361297 DOI: 10.1002/14651858.cd002768.pub5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Physical activity (including exercise) may form an important part of regular care for people with cystic fibrosis (CF). This is an update of a previously published review. OBJECTIVES To assess the effects of physical activity interventions on exercise capacity by peak oxygen uptake, lung function by forced expiratory volume in one second (FEV1), health-related quality of life (HRQoL) and further important patient-relevant outcomes in people with cystic fibrosis (CF). SEARCH METHODS We searched the Cochrane Cystic Fibrosis and Genetic Disorders Group Trials Register which comprises references identified from comprehensive electronic database searches and handsearches of relevant journals and abstract books of conference proceedings. The most recent search was on 3 March 2022. We also searched two ongoing trials registers: clinicaltrials.gov, most recently on 4 March 2022; and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP), most recently on 16 March 2022. SELECTION CRITERIA: We included all randomised controlled trials (RCTs) and quasi-RCTs comparing physical activity interventions of any type and a minimum intervention duration of two weeks with conventional care (no physical activity intervention) in people with CF. DATA COLLECTION AND ANALYSIS Two review authors independently selected RCTs for inclusion, assessed methodological quality and extracted data. We assessed the certainty of the evidence using GRADE. MAIN RESULTS: We included 24 parallel RCTs (875 participants). The number of participants in the studies ranged from nine to 117, with a wide range of disease severity. The studies' age demographics varied: in two studies, all participants were adults; in 13 studies, participants were 18 years and younger; in one study, participants were 15 years and older; in one study, participants were 12 years and older; and seven studies included all age ranges. The active training programme lasted up to and including six months in 14 studies, and longer than six months in the remaining 10 studies. Of the 24 included studies, seven implemented a follow-up period (when supervision was withdrawn, but participants were still allowed to exercise) ranging from one to 12 months. Studies employed differing levels of supervision: in 12 studies, training was supervised; in 11 studies, it was partially supervised; and in one study, training was unsupervised. The quality of the included studies varied widely. This Cochrane Review shows that, in studies with an active training programme lasting over six months in people with CF, physical activity probably has a positive effect on exercise capacity when compared to no physical activity (usual care) (mean difference (MD) 1.60, 95% confidence interval (CI) 0.16 to 3.05; 6 RCTs, 348 participants; moderate-certainty evidence). The magnitude of improvement in exercise capacity is interpreted as small, although study results were heterogeneous. Physical activity interventions may have no effect on lung function (forced expiratory volume in one second (FEV1) % predicted) (MD 2.41, 95% CI ‒0.49 to 5.31; 6 RCTs, 367 participants), HRQoL physical functioning (MD 2.19, 95% CI ‒3.42 to 7.80; 4 RCTs, 247 participants) and HRQoL respiratory domain (MD ‒0.05, 95% CI ‒3.61 to 3.51; 4 RCTs, 251 participants) at six months and longer (low-certainty evidence). One study (117 participants) reported no differences between the physical activity and control groups in the number of participants experiencing a pulmonary exacerbation by six months (incidence rate ratio 1.28, 95% CI 0.85 to 1.94) or in the time to first exacerbation over 12 months (hazard ratio 1.34, 95% CI 0.65 to 2.80) (both high-certainty evidence); and no effects of physical activity on diabetic control (after 1 hour: MD ‒0.04 mmol/L, 95% CI ‒1.11 to 1.03; 67 participants; after 2 hours: MD ‒0.44 mmol/L, 95% CI ‒1.43 to 0.55; 81 participants; moderate-certainty evidence). We found no difference between groups in the number of adverse events over six months (odds ratio 6.22, 95% CI 0.72 to 53.40; 2 RCTs, 156 participants; low-certainty evidence). For other time points (up to and including six months and during a follow-up period with no active intervention), the effects of physical activity versus control were similar to those reported for the outcomes above. However, only three out of seven studies adding a follow-up period with no active intervention (ranging between one and 12 months) reported on the primary outcomes of changes in exercise capacity and lung function, and one on HRQoL. These data must be interpreted with caution. Altogether, given the heterogeneity of effects across studies, the wide variation in study quality and lack of information on clinically meaningful changes for several outcome measures, we consider the overall certainty of evidence on the effects of physical activity interventions on exercise capacity, lung function and HRQoL to be low to moderate. AUTHORS' CONCLUSIONS Physical activity interventions for six months and longer likely improve exercise capacity when compared to no training (moderate-certainty evidence). Current evidence shows little or no effect on lung function and HRQoL (low-certainty evidence). Over recent decades, physical activity has gained increasing interest and is already part of multidisciplinary care offered to most people with CF. Adverse effects of physical activity appear rare and there is no reason to actively discourage regular physical activity and exercise. The benefits of including physical activity in an individual's regular care may be influenced by the type and duration of the activity programme as well as individual preferences for and barriers to physical activity. Further high-quality and sufficiently-sized studies are needed to comprehensively assess the benefits of physical activity and exercise in people with CF, particularly in the new era of CF medicine.
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Affiliation(s)
- Thomas Radtke
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Sherie Smith
- Division of Child Health, Obstetrics & Gynaecology (COG), School of Medicine, University of Nottingham, Nottingham, UK
| | - Sarah J Nevitt
- Department of Health Data Science, University of Liverpool, Liverpool, UK
| | - Helge Hebestreit
- Paediatric Department, Julius-Maximilians University, Würzburg, Germany
| | - Susi Kriemler
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
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Gurses HN, Ucgun H, Zeren M, Denizoglu Kulli H, Cakır E. Does the effect of comprehensive respiratory physiotherapy home-program differ in children with cystic fibrosis and non-cystic fibrosis bronchiectasis? Eur J Pediatr 2022; 181:2961-2970. [PMID: 35595860 DOI: 10.1007/s00431-022-04509-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 05/12/2022] [Accepted: 05/14/2022] [Indexed: 11/24/2022]
Abstract
UNLABELLED Bronchiectasis is a form of airway damage as a consequence of endobronchial infection and inflammation and may be present in different diseases. The underlying aetiologies include both cystic fibrosis (CF) and a group of non-cystic fibrosis diseases (NCFB) such as immunodeficiency, primary ciliary dyskinesia, or severe pulmonary infection. Although children with CF and non-cystic fibrosis bronchiectasis (NCFB) have many similar clinical features, their responses to exercise may be different. The aim of this study was to compare the efficacy of a comprehensive respiratory physiotherapy (CRP) home-program in children with CF and NCFB. Thirty children with CF and thirty children with NCFB were included in the study. Both groups performed the CRP home-program twice daily for 8 weeks. Pulmonary function, exercise capacity, and respiratory and peripheral muscle strength were assessed at baseline and after 8 weeks of training. Both groups experienced significant improvements in pulmonary function, exercise capacity, and respiratory and peripheral muscle strength (p < 0.001). Maximum expiratory pressure, exercise capacity, and peripheral muscle strength were further improved in NCFB group compared to CF (p < 0.05); however, there was a great variability in the improvements for each variable. CONCLUSION CRP is beneficial both for children with CF and NCFB and adherence to the program was high in both groups. WHAT IS KNOWN • Different physiotherapy approaches in the management of non-cystic fibrosis bronchiectasis have been based on the experience gained from the research studies performed in cystic fibrosis. • Although having similar pathophysiology, these two diseases show variation in some pulmonary and extrapulmonary features. WHAT IS NEW • The respiratory muscle strength and the efficacy of comprehensive respiratory physiotherapy have been compared for the first time in children with cystic fibrosis and non-cystic fibrosis bronchiectasis. • Comprehensive respiratory physiotherapy provides higher increases in children with non-cystic fibrosis bronchiectasis in exercise capacity and expiratory and peripheral muscle strength; however, there was a great variability in these improvements. Nevertheless, it can be concluded that both groups significantly benefited from the CRP program.
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Affiliation(s)
- Hulya Nilgun Gurses
- Division of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Bezmialem Vakıf University, Silahtaraga St. No:189, 34060, Istanbul, Turkey. .,Department of Cardiopulmonary Physiotherapy and Rehabilitation, Division of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Bezmialem Vakıf University, Istanbul, Turkey.
| | - Hikmet Ucgun
- Division of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Biruni University, Istanbul, Turkey
| | - Melih Zeren
- Division of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Izmir Bakircay University, Izmir, Turkey
| | - Hilal Denizoglu Kulli
- Division of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Istanbul Atlas University, Istanbul, Turkey
| | - Erkan Cakır
- Department of Pediatric Pulmonology, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
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12
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Heinz KD, Walsh A, Southern KW, Johnstone Z, Regan KH. Exercise versus airway clearance techniques for people with cystic fibrosis. Cochrane Database Syst Rev 2022; 6:CD013285. [PMID: 35731672 PMCID: PMC9216233 DOI: 10.1002/14651858.cd013285.pub2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND There are many accepted airway clearance techniques (ACTs) for managing the respiratory health of people with cystic fibrosis (CF); none of which demonstrate superiority. Other Cochrane Reviews have reported short-term effects related to mucus transport, but no evidence supporting long-term benefits. Exercise is an alternative ACT thought to produce shearing forces within the lung parenchyma, which enhances mucociliary clearance and the removal of viscous secretions. Recent evidence suggests that some people with CF are using exercise as a substitute for traditional ACTs, yet there is no agreed recommendation for this. Additionally, one of the top 10 research questions identified by people with CF is whether exercise can replace other ACTs. Systematically reviewing the evidence for exercise as a safe and effective ACT will help people with CF decide whether to incorporate this strategy into their treatment plans and potentially reduce their treatment burden. The timing of this review is especially pertinent given the shifting landscape of CF management with the advent of highly-effective small molecule therapies, which are changing the way people with CF are cared for. OBJECTIVES To compare the effect of exercise to other ACTs for improving respiratory function and other clinical outcomes in people with CF and to assess the potential adverse effects associated with this ACT. SEARCH METHODS On 28 February 2022, we searched the Cochrane Cystic Fibrosis Trials Register, compiled from electronic database searches and handsearching of journals and conference abstract books. We also searched the reference lists of relevant articles and reviews. We searched online clinical trial registries on 15 February 2022. We emailed authors of studies awaiting classification or potentially eligible abstracts for additional information on 1 February 2021. SELECTION CRITERIA We selected randomised controlled studies (RCTs) and quasi-RCTs comparing exercise to another ACT in people with CF for at least two treatment sessions. DATA COLLECTION AND ANALYSIS Two review authors independently extracted data and assessed risk of bias for the included studies. They assessed the certainty of the evidence using GRADE. Review authors contacted investigators for further relevant information regarding their publications. MAIN RESULTS We included four RCTs. The 86 participants had a wide range of disease severity (forced expiratory volume in one second (FEV1) ranged from 54% to 95%) and were 7 to 41 years old. Two RCTs were cross-over and two were parallel in design. Participants in one RCT were hospitalised with an acute respiratory exacerbation, whilst the participants in three RCTs were clinically stable. All four RCTs compared exercise either alone or in combination with another ACT, but these were too diverse to allow us to combine results. The certainty of the evidence was very low; we downgraded it due to low participant numbers and high or unclear risks of bias across all domains. Exercise versus active cycle of breathing technique (ACBT) One cross-over trial (18 participants) compared exercise alone to ACBT. There was no change from baseline in our primary outcome FEV1, although it increased in the exercise group before returning to baseline after 30 minutes; we are unsure if exercise affected FEV1 as the evidence is very low-certainty. Similar results were seen for other measures of lung function. No adverse events occurred during the exercise sessions (very low-certainty evidence). We are unsure if ACBT was perceived to be more effective or was the preferred ACT (very low-certainty evidence). 24-hour sputum volume was less in the exercise group than with ACBT (secondary outcome). Exercise capacity, quality of life, adherence, hospitalisations and need for additional antibiotics were not reported. Exercise plus postural drainage and percussion (PD&P) versus PD&P only Two trials (55 participants) compared exercise and PD&P to PD&P alone. At two weeks, one trial narratively reported a greater increase in FEV1 % predicted with PD&P alone. At six months, the other trial reported a greater increase with exercise combined with PD&P, but did not provide data for the PD&P group. We are uncertain whether exercise with PD&P improves FEV1 as the certainty of evidence is very low. Other measures of lung function did not show clear evidence of effect. One trial reported no difference in exercise capacity (maximal work rate) after two weeks. No adverse events were reported (1 trial, 17 participants; very low-certainty evidence). Adherence was high, with all PD&P sessions and 96% of exercise sessions completed (1 trial, 17 participants; very low-certainty evidence). There was no difference between groups in 24-hour sputum volume or in the mean duration of hospitalisation, although the six-month trial reported fewer hospitalisations due to exacerbations in the exercise and PD&P group. Quality of life, ACT preference and need for antibiotics were not reported. Exercise versus underwater positive expiratory pressure (uPEP) One trial (13 participants) compared exercise to uPEP (also known as bubble PEP). No adverse events were recorded in either group (very low-certainty evidence). Trial investigators reported that participants perceived exercise as more fatiguing but also more enjoyable than bubble PEP (very low-certainty evidence). There were no differences found in the total weight of sputum collected during treatment sessions. The trial did not report the primary outcomes (FEV1, quality of life, exercise capacity) or the secondary outcomes (other measures of lung function, adherence, need for antibiotics or hospitalisations). AUTHORS' CONCLUSIONS As one of the top 10 research questions identified by clinicians and people with CF, it is important to systematically review the literature regarding whether or not exercise is an acceptable and effective ACT, and whether it can replace traditional methods. We identified an insufficient number of trials to conclude whether or not exercise is a suitable alternative ACT, and the diverse design of included trials did not allow for meta-analysis of results. The evidence is very low-certainty, so we are uncertain about the effectiveness of exercise as an ACT. Longer studies examining outcomes that are important to people with CF are required to answer this question.
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Affiliation(s)
- Katie D Heinz
- Department of Medicine, Glasgow Royal Infirmary, Glasgow, UK
| | - Adam Walsh
- Physiotherapy Department, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Kevin W Southern
- Department of Women's and Children's Health, University of Liverpool, Liverpool, UK
| | - Zoe Johnstone
- Paediatric Cystic Fibrosis Unit, Royal Hospital for Sick Children, Edinburgh, UK
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Pistol Shooting Performance Correlates with Respiratory Muscle Strength and Pulmonary Function in Police Cadets. SUSTAINABILITY 2022. [DOI: 10.3390/su14127515] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Breathing patterns play a crucial role in shooting performance; however, little is known about the respiratory muscle strength and pulmonary capacities that control these patterns. The present study aimed to examine the relationship between shooting performance, respiratory muscle strength, and pulmonary function and to determine differences in respiratory capacities according to the shooting performance categories in police cadets. One hundred sixty-seven police cadets were recruited to assess respiratory muscle strength, pulmonary function, and shooting performance in a well-controlled environment. Measurements included maximal inspiratory pressure (MIP), maximal expiratory pressure (MEP), forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC), slow vital capacity (SVC), maximal voluntary ventilation (MVV), and pistol shooting scores. The shooting score had a moderate positive correlation with MIP (ρ = 0.33) and MEP (ρ = 0.45). FVC (ρ = 0.25), FEV1 (ρ = 0.26), SVC (ρ = 0.26) (p < 0.001) and MVV (ρ = 0.21) (p < 0.05) were slightly correlated with shooting score. There were differences between shooting performance categories in MIP, MEP, FVC, FEV1, SVC, and MVV (p < 0.001, p < 0.05). The results imply that both strong respiratory muscles and optimal pulmonary function may be one of the necessary prerequisites for superior shooting performance in police.
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14
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Zhang Y, Wang C, Yang J, Qiao L, Xu Y, Yu L, Wang J, Ni W, Wang Y, Yao Y, Yong Z, Ding S. Comparing the Effects of Short-Term Liuzijue Exercise and Core Stability Training on Balance Function in Patients Recovering From Stroke: A Pilot Randomized Controlled Trial. Front Neurol 2022; 13:748754. [PMID: 35242094 PMCID: PMC8886894 DOI: 10.3389/fneur.2022.748754] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Accepted: 01/10/2022] [Indexed: 11/13/2022] Open
Abstract
AimsLiuzijue Qigong (LQG) exercise is a traditional Chinese exercise method in which breathing and pronunciation are combined with movement guidance. Breathing is closely related to balance, and LQG, as a special breathing exercise, can be applied to balance dysfunction after stroke. The purpose of this study was to observe the clinical effects of short-term LQG exercise on balance function in patients recovering from stroke.MethodsStroke patients were randomly divided into an Intervention Group (IG) (n = 80) and a Control Group (CG) (n = 80). The IG received conventional rehabilitation training plus LQG and the CG received conventional rehabilitation training plus Core Stability Training (CST). All patients received treatment once a day, 5 times a week for 2 weeks. The primary outcome was Berg Balance Scale (BBS). Secondary outcome measures were static standing and sitting balance with eyes open and closed, Fugl-Meyer Assessment (FMA), Maximum Phonation Time (MPT), Modified Barthel Index (MBI) and diaphragm thickness and mobility during quiet breath (QB) and deep breath (DB).ResultsCompared with the CG, the IG showed significant improvement in the BBS (10.55 ± 3.78 vs. 9.06 ± 4.50, P = 0.039), MPT (5.41 ± 4.70 vs. 5.89 ± 5.24, P = 0.001), MBI (12.88 ± 6.45 vs. 10.00 ± 4.84, P = 0.003), diaphragmatic mobility during QB (0.54 ± 0.73 vs. 0.33 ± 0.40, P = 0.01) and diaphragmatic mobility during DB (0.99 ± 1.32 vs. 0.52 ± 0.77, P = 0.003), Cop trajectory in the standing position with eyes open (−108.34 ± 108.60 vs. −89.00 ± 140.11, P = 0.034) and Cop area in the standing positions with eyes open (−143.79 ± 431.55 vs. −93.29 ± 223.15, P = 0.015), Cop trajectory in the seating position with eyes open (−19.95 ± 23.35 vs. −12.83 ± 26.64, P = 0.001) and Cop area in the seating position with eyes open (−15.83 ± 9.61 vs. −11.29 ± 9.17, P = 0.002).ConclusionsThe short-term LQG combined with conventional rehabilitation training significantly improved the balance functions of stroke patients. It also improved static standing and sitting balance with the eyes open, diaphragm functions, maximum phonation time and the quality of daily life for stroke patients.Clinical Trial Registrationhttp://www.chictr.org.cn/edit.aspx?pid=25313&htm=4, Identifier: ChiCTR1800014864.
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Affiliation(s)
- Ying Zhang
- Department of Rehabilitation, Shanghai Xuhui Central Hospital, Zhongshan-Xuhui Hospital, Fudan University, Shanghai, China
| | - Chen Wang
- Department of Rehabilitation, Shanghai Xuhui Central Hospital, Zhongshan-Xuhui Hospital, Fudan University, Shanghai, China
| | - JianZhong Yang
- Department of Rehabilitation, Shanghai Xuhui Central Hospital, Zhongshan-Xuhui Hospital, Fudan University, Shanghai, China
| | - Lei Qiao
- Department of Rehabilitation, Shanghai Xuhui Central Hospital, Zhongshan-Xuhui Hospital, Fudan University, Shanghai, China
| | - Ying Xu
- Department of Rehabilitation, Shanghai Xuhui Central Hospital, Zhongshan-Xuhui Hospital, Fudan University, Shanghai, China
| | - Long Yu
- Department of Rehabilitation, Shanghai Xuhui Central Hospital, Zhongshan-Xuhui Hospital, Fudan University, Shanghai, China
| | - Jie Wang
- Department of Rehabilitation, Shanghai Xuhui Central Hospital, Zhongshan-Xuhui Hospital, Fudan University, Shanghai, China
| | - Weidong Ni
- Department of Rehabilitation, Shanghai Xuhui Central Hospital, Zhongshan-Xuhui Hospital, Fudan University, Shanghai, China
| | - Yan Wang
- Department of Rehabilitation, Shanghai Xuhui Central Hospital, Zhongshan-Xuhui Hospital, Fudan University, Shanghai, China
| | - Yue Yao
- Department of Rehabilitation, Shanghai Xuhui Central Hospital, Zhongshan-Xuhui Hospital, Fudan University, Shanghai, China
| | - ZhiJie Yong
- Department of Rehabilitation, Shanghai Xuhui Central Hospital, Zhongshan-Xuhui Hospital, Fudan University, Shanghai, China
| | - ShanShan Ding
- Department of Rehabilitation, Shanghai Xuhui Central Hospital, Zhongshan-Xuhui Hospital, Fudan University, Shanghai, China
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15
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Kaeotawee P, Udomittipong K, Nimmannit A, Tovichien P, Palamit A, Charoensitisup P, Mahoran K. Effect of Threshold Inspiratory Muscle Training on Functional Fitness and Respiratory Muscle Strength Compared to Incentive Spirometry in Children and Adolescents With Obesity: A Randomized Controlled Trial. Front Pediatr 2022; 10:942076. [PMID: 35874588 PMCID: PMC9302609 DOI: 10.3389/fped.2022.942076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 06/21/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND To determine the effect of threshold inspiratory muscle training (IMT) on functional fitness and respiratory muscle strength (RMS) compared to incentive spirometry (IS) in children/adolescents with obesity. METHODS A total of 60 obese children/adolescents aged 8-15 years were randomized into the threshold IMT group (n = 20), the IS group (n = 20), or the control group (n = 20). The IMT group performed 30 inspiratory breaths with the intensity set at 40% of baseline maximal inspiratory pressure (MIP) twice daily for 8 weeks; the IS group performed 30 breaths with sustained maximum inspiration twice daily for 8 weeks; and, the control group was assigned no training device for 8 weeks. Six-min walk test (6-MWT), RMS, and spirometry were compared between baseline and 8 weeks. RESULTS Six-MWT distance (528.5 ± 36.2 vs. 561.5 ± 35.2 m, p = 0.002) and MIP (121.2 ± 26.8 vs. 135.3 ± 32.1%Predicted, p = 0.03) were significantly improved after 8 weeks of IMT training. There was no significant difference in any evaluated pulmonary function parameters between baseline and 8 weeks in the IS or control groups; however, 6-MWT distance demonstrated a trend toward significant improvement in the IS group (526.9 ± 59.1 vs.549.0 ± 50.6 m, p = 0.10). No significant difference among groups was found for any variable relative to change from baseline to post-training. CONCLUSION Eight weeks of threshold IMT training significantly improved both inspiratory muscle strength (MIP) and functional fitness (6-MWT) in children/adolescents with obesity. Eight weeks of IS training yielded a trend toward significantly improved functional fitness.
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Affiliation(s)
- Phatthareeda Kaeotawee
- Division of Pulmonology, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Kanokporn Udomittipong
- Division of Pulmonology, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Akarin Nimmannit
- Research Department, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Prakarn Tovichien
- Division of Pulmonology, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Apinya Palamit
- Division of Pulmonology, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Pawinee Charoensitisup
- Division of Pulmonology, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Khunphon Mahoran
- Division of Pulmonology, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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16
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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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17
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Minsky RC, Scalco JC, Rebelo Silva Meira R, Bobbio TG, Schivinski CIS. Which factors can influence the number of forced expiratory manoeuvres on spirometry in schoolchildren? Int J Clin Pract 2021; 75:e14028. [PMID: 33462884 DOI: 10.1111/ijcp.14028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 01/13/2021] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Spirometry is of great value for understanding respiratory function and management of lung diseases. Adaptations in the exam were made to meet paediatric population since the forced expiratory manoeuvres (FEM) present in the exam require effort and cooperation; therefore, its use should be reconsidered. OBJECTIVE To analyse factors that may influence the number of FEM required for successful spirometry in schoolchildren. METHOD Healthy children aged between 6 and 12 years were tested. FEM were conducted according to the American Thoracic Society/European Respiratory Society guideline. The children were divided into three groups according to the number of attempts: G3M if child completed the test in three FEM; G4M if child completed in four attempts FEM; and G5/8M if child completed the test in five to eight FEM. Factors that potentially influenced the number of FEM included: age; impulse oscillometry parameters; slow vital capacity; respiratory muscle strength; orofacial motor function, school performance, physical activity level and quality of life. The Kolmogorov-Smirnov test was performed, followed by the Chi-Square, repeated measures ANOVA and Kruskal-Wallis tests; thereafter, a multinomial logistic regression was applied. RESULTS One hundred and forty-nine schoolchildren (80 girls) with mean age of 9.13 years (±1.98) were included, age was related to the required number of FEM (F = 3.38(2), P = .03) and children with poor school performance had a 2.84-fold greater chance of completing the exam in more than five attempts. CONCLUSION Age and school performance influenced the number of FEM required for a successful spirometry in schoolchildren.
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Affiliation(s)
- Rafaela Coelho Minsky
- Universidade do Estado de Santa Catarina Centro de Ciencias da Saude e do Esporte, CEFID, Florianópolis, Brazil
| | - Janaina Cristina Scalco
- Universidade do Estado de Santa Catarina Centro de Ciencias da Saude e do Esporte, CEFID, Florianópolis, Brazil
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Emirza C, Aslan GK, Kilinc AA, Cokugras H. Effect of expiratory muscle training on peak cough flow in children and adolescents with cystic fibrosis: A randomized controlled trial. Pediatr Pulmonol 2021; 56:939-947. [PMID: 33421333 DOI: 10.1002/ppul.25259] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 12/29/2020] [Accepted: 12/30/2020] [Indexed: 11/06/2022]
Abstract
BACKGROUND Cough is an important defense and airway clearance mechanism for removing thick and viscous secretions in cystic fibrosis (CF). The primary aim of this study was to investigate the effect of expiratory muscle training (EMT) on peak cough flow (PCF) and secondly on respiratory muscle functions, functional exercise capacity, and quality of life (QoL) in CF. METHODS Thirty patients were randomized as training and sham groups. Both groups were trained with the EMT protocol, which involved twice per day for at least 5 days per week for 6 weeks. The training intensity in the training group was 30% of the maximal expiratory pressure (MEP). In the sham group, it remained at the lowest pressure (5 cmH2 O). The primary outcome was PCF. The secondary outcomes were MEP, maximal inspiratory pressure (MIP), spirometric measures, six-minute walking distance (6MWD), and QoL (Cystic Fibrosis Questionnaire-Revised). RESULTS Twenty-eight patients completed the study. Changes in PCF (p = .041) and MEP (p = .003) were higher in the training group than the sham group. Also, treatment burden (p = .008), digestive symptoms (p = .019), and vitality (p = .042) in QoL were more improved in the training group. MIP (p = .028) and 6MWD (p = .035) changed significantly only in the training group. Spirometric measurements did not change (p > .05). CONCLUSIONS The results of the study show that EMT could improve PCF, MEP, treatment burden, digestive symptoms, and vitality domains of QoL in patients with CF. Moreover, MIP and functional exercise capacity improved in the training group with EMT.
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Affiliation(s)
- Cigdem Emirza
- Division of Physiotherapy and Rehabilitation, Institute of Graduate Studies, Istanbul University-Cerrahpaşa, Istanbul, Turkey.,Division of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Istanbul Bilgi University, Istanbul, Turkey
| | - Goksen Kuran Aslan
- Division of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Ayse Ayzit Kilinc
- Department of Pediatric Pulmonology, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Haluk Cokugras
- Department of Pediatric Pulmonology, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
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Abstract
BACKGROUND Cystic fibrosis is the most common autosomal recessive disease in white populations, and causes respiratory dysfunction in the majority of individuals. Numerous types of respiratory muscle training to improve respiratory function and health-related quality of life in people with cystic fibrosis have been reported in the literature. Hence a systematic review of the literature is needed to establish the effectiveness of respiratory muscle training (either inspiratory or expiratory muscle training) on clinical outcomes in cystic fibrosis. This is an update of a previously published review. OBJECTIVES To determine the effectiveness of respiratory muscle training on clinical outcomes in people with cystic fibrosis. SEARCH METHODS We searched the Cochrane Cystic Fibrosis and Genetic Disorders Group Trials register comprising of references identified from comprehensive electronic database searches and handsearches of relevant journals and abstract books of conference proceedings. Date of most recent search: 11 June 2020. A hand search of the Journal of Cystic Fibrosis and Pediatric Pulmonology was performed, along with an electronic search of online trial databases. Date of most recent search: 05 October 2020. SELECTION CRITERIA Randomised controlled studies comparing respiratory muscle training with a control group in people with cystic fibrosis. DATA COLLECTION AND ANALYSIS Review authors independently selected articles for inclusion, evaluated the methodological quality of the studies, and extracted data. Additional information was sought from trial authors where necessary. The quality of the evidence was assessed using the GRADE system. MAIN RESULTS Authors identified 20 studies, of which 10 studies with 238 participants met the review's inclusion criteria. There was wide variation in the methodological and written quality of the included studies. Four of the 10 included studies were published as abstracts only and lacked concise details, thus limiting the information available. Eight studies were parallel studies and two of a cross-over design. Respiratory muscle training interventions varied dramatically, with frequency, intensity and duration ranging from thrice weekly to twice daily, 20% to 80% of maximal effort, and 10 to 30 minutes, respectively. Participant numbers ranged from 11 to 39 participants in the included studies; five studies were in adults only, one in children only and four in a combination of children and adults. No differences between treatment and control were reported in the primary outcome of pulmonary function (forced expiratory volume in one second and forced vital capacity) or postural stability (very low-quality evidence). Although no change was reported in exercise capacity as assessed by the maximum rate of oxygen use and distance completed in a six minute walk test, a 10% improvement in exercise duration was found when working at 60% of maximal effort in one study (n = 20) (very low-quality evidence). In a further study (n = 18), when working at 80% of maximal effort, health-related quality of life improved in the mastery and emotion domains (very low-quality evidence). With regards to the review's secondary outcomes, one study (n = 11) found a change in intramural pressure, functional residual capacity and maximal inspiratory pressure following training (very low-quality evidence). Another study (n=36) reported improvements in maximal inspiratory pressure following training (P < 0.001) (very low-quality evidence). A further study (n = 22) reported that respiratory muscle endurance was longer in the training group (P < 0.01). No studies reported significant differences on any other secondary outcomes. Meta-analyses could not be performed due to a lack of consistency and insufficient detail in reported outcome measures. AUTHORS' CONCLUSIONS There is insufficient evidence to suggest whether this intervention is beneficial or not. Healthcare practitioners should consider the use of respiratory muscle training on a case-by-case basis. Further research of reputable methodological quality is needed to determine the effectiveness of respiratory muscle training in people with cystic fibrosis. Researchers should consider the following clinical outcomes in future studies; respiratory muscle function, pulmonary function, exercise capacity, hospital admissions, and health-related quality of life. Sensory-perceptual changes, such as respiratory effort sensation (e.g. rating of perceived breathlessness) and peripheral effort sensation (e.g. rating of perceived exertion) may also help to elucidate mechanisms underpinning the effectiveness of respiratory muscle training.
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Affiliation(s)
- Gemma Stanford
- Department of Cystic Fibrosis, Royal Brompton & Harefield NHS Foundation Trust, London, UK
- National Heart and Lung Insititute, Imperial College London, London, UK
| | | | - Arturo Solis-Moya
- Servicio de Neumología, Hospital Nacional de Niños, San José, Costa Rica
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Huguet-Rodríguez M, Arias-Buría JL, Huguet-Rodríguez B, Blanco-Barrero R, Braña-Sirgo D, Güeita-Rodríguez J. Impact of Aquatic Exercise on Respiratory Outcomes and Functional Activities in Children with Neuromuscular Disorders: Findings from an Open-Label and Prospective Preliminary Pilot Study. Brain Sci 2020; 10:brainsci10070458. [PMID: 32708972 PMCID: PMC7407397 DOI: 10.3390/brainsci10070458] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 07/15/2020] [Accepted: 07/15/2020] [Indexed: 01/08/2023] Open
Abstract
Neuromuscular disorders (NMD) lead to the progressive loss of motor and respiratory functions and a decline in daily activities and participation. We aimed to evaluate respiratory changes and functional outcomes in children attending an aquatic therapy program. Eleven patients diagnosed with NMD (4-18 years, Vignos scale 1-9) were involved in a 10-week aquatic exercise program. The ventilation variables were: peak cough flow, volumes (forced expiratory volume in one second-FEV1 and inspiratory volume) and respiratory pressures to evaluate strength and oxygen saturation (O2 sat). Functional skills were measured in the aquatic environment (Water Orientation Test Alyn 1) and on dry land, (Pediatric Evaluation of Disability Inventory), together with quality of life (Pediatric Quality of Life Inventory). Our evaluation included several 2 × 6 mixed-model repeated measures analysis of covariance (ANCOVA) with time (baseline, post 1 session, pre-post at five weeks and pre-post at 10 weeks). Important improvements in functional skills were observed in and out of the water and children under the age of 11 displayed a significant difference for inspirational volume (p = 0.002) and O2 sat (p = 0.029). Clinical, statistically insignificant changes were found for peak cough flow and expiratory pressures values after aquatic exercise. These results may support a relationship between aquatic exercise in NMD, respiratory outcomes and functional activities in water and on land.
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Affiliation(s)
- Marta Huguet-Rodríguez
- San José Institute Foundation, aquatic therapy unit, 28054 Madrid, Spain; (M.H.-R.); (R.B.-B.); (D.B.-S.)
| | - José Luis Arias-Buría
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Alcorcón, 28922 Madrid, Spain;
| | | | - Rocío Blanco-Barrero
- San José Institute Foundation, aquatic therapy unit, 28054 Madrid, Spain; (M.H.-R.); (R.B.-B.); (D.B.-S.)
| | - Daniel Braña-Sirgo
- San José Institute Foundation, aquatic therapy unit, 28054 Madrid, Spain; (M.H.-R.); (R.B.-B.); (D.B.-S.)
| | - Javier Güeita-Rodríguez
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Alcorcón, 28922 Madrid, Spain;
- Research Group of Humanities and Qualitative Research in Health Science of Universidad Rey Juan Carlos (Hum & QRinHS), Universidad Rey Juan Carlos, Alcorcón, 28922 Madrid, Spain
- Correspondence: ; Tel.: +34-91-488-86-00
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