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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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López-Pérez ME, Romero-Arenas S, Giráldez-García MA, Colomer-Poveda D, Márquez G. Acute psychophysiological responses during exercise while using resistive respiratory devices: A systematic review. Physiol Behav 2022; 256:113968. [PMID: 36155205 DOI: 10.1016/j.physbeh.2022.113968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 09/08/2022] [Accepted: 09/09/2022] [Indexed: 10/31/2022]
Abstract
Different studies have observed that respiratory muscle training (RMT) improve the endurance and strength of the respiratory muscles, having a positive impact on performance of endurance sports. Nevertheless, it remains to be clarified how to improve the efficiency of such training. The objective of this systematic review was to evaluate the acute physiological responses produced by training the respiratory muscles during exercise with flow resistive devices because such information may support us improve the efficiency of this type of training. A search in the Medline, Science Direct, Web of Science and Scopus databases was conducted, following the PRISMA guidelines. The methodological quality of the articles was assessed using the PEDro scale. Nineteen studies met the inclusion criteria and a total of 212 subjects were included in the studies. The RMT method used in all studies was flow resistive loading, whereas the constant load exercise was the most common type of exercise among the studies. The results obtained seem to indicate that the use of this type of training during exercise reduces the performance, the lactate (La-) values and the ventilation, whereas the end - tidal partial pressure of carbon dioxide (PCO2) is increased.
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Affiliation(s)
- María E López-Pérez
- Department of Physical Education, IES El Palmeral, Hermano Lázaro s/n, Vera, Almería 04620, Spain.
| | | | - Manuel A Giráldez-García
- Department of Physical Education and Sport, Faculty of Sports Sciences and Physical Education, University of A Coruña, A Coruña, Spain
| | - David Colomer-Poveda
- Department of Physical Education and Sport, Faculty of Sports Sciences and Physical Education, University of A Coruña, A Coruña, Spain
| | - Gonzalo Márquez
- Department of Physical Education and Sport, Faculty of Sports Sciences and Physical Education, University of A Coruña, A Coruña, Spain
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Ammous O, Feki W, Lotfi T, Khamis AM, Rebai A, Kammoun S. Inspiratory muscle training, with or without concomitant pulmonary rehabilitation, for chronic obstructive pulmonary disease (COPD). Hippokratia 2020. [DOI: 10.1002/14651858.cd013778] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Omar Ammous
- Faculty of Medicine; University of Sfax; Sfax Tunisia
| | - Walid Feki
- Department of Respiratory Medicine; University of Sfax; Sfax Tunisia
| | - Tamara Lotfi
- Department of Health Research Methods, Evidence and Impact; McMaster University; Hamilton Canada
| | | | - Ahmed Rebai
- Center of Biotechnology; University of Sfax; Sfax Tunisia
| | - Samy Kammoun
- Department of Respiratory Medicine; University of Sfax; Sfax Tunisia
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Templeman L, Roberts F. Effectiveness of expiratory muscle strength training on expiratory strength, pulmonary function and cough in the adult population: a systematic review. Physiotherapy 2019; 106:43-51. [PMID: 32026845 DOI: 10.1016/j.physio.2019.06.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Indexed: 01/18/2023]
Abstract
BACKGROUND Respiratory muscle strength declines in certain disease states, leading to impaired cough, reduced airway clearance and an increased risk of aspiration pneumonia. Respiratory muscle training may therefore reduce this risk. OBJECTIVES To assess current evidence of expiratory muscle strength training (EMST) on maximum expiratory pressure, cough flow and spirometry. DATA SOURCES Databases including CINAHL, Medline, Science Direct and PEDRo were searched. ELIGIBILITY CRITERIA Randomised controlled trials investigating expiratory muscle strength training on maximum expiratory pressure, pulmonary function or cough in any adult population, published before December 2017. STUDY APPRAISAL Data were extracted to a trial description form and study quality evaluated by two reviewers. Meta-analysis was performed with calculation of mean differences and 95% confidence intervals. RESULTS Nine studies met inclusion criteria and ranged in size from 12 to 42 participants. Trials investigated EMST in healthy adults (2), multiple sclerosis (3), COPD (2), acute stroke (1) and spinal cord injury (1). Overall, EMST improved maximum expiratory pressure (15.95cmH2O; 95% CI: 7.77 to 24.12; P<0.01) with no significant impact on cough flow (4.63L/minute; 95%CI -27.48 to 36.74; P=0.78), forced vital capacity (-0.16L; 95%CI -0.35 to 0.02; P=0.09) or forced expiratory volume in 1second (-0.09L; 95%CI -0.10 to -0.08; P<0.001) vs control or sham training. CONCLUSIONS Meta-analysis indicated a small significant increase in maximum expiratory pressure following EMST. Improvements in maximum expiratory pressure did not lead to improvements in cough or pulmonary function. LIMITATIONS Variations in protocol design and population limited the overall effect size. Systematic Review Registration PROSPERO CRD42018104190.
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Affiliation(s)
- Lucy Templeman
- School of Health Sciences, Robert Gordon University, Garthdee Road, Aberdeen AB10 7QG, United Kingdom; NHS Grampian, Physiotherapy Outpatient Department, Woodend Hospital, Eday Road, Aberdeen AB15 6XS, United Kingdom.
| | - Fiona Roberts
- School of Health Sciences, Robert Gordon University, Garthdee Road, Aberdeen AB10 7QG, United Kingdom
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Karsten M, Ribeiro GS, Esquivel MS, Matte DL. The effects of inspiratory muscle training with linear workload devices on the sports performance and cardiopulmonary function of athletes: A systematic review and meta-analysis. Phys Ther Sport 2018; 34:92-104. [DOI: 10.1016/j.ptsp.2018.09.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Revised: 08/31/2018] [Accepted: 09/10/2018] [Indexed: 01/09/2023]
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Gosselink R. Breathing techniques in patients with chronic obstructive pulmonary disease (COPD). Chron Respir Dis 2016; 1:163-72. [PMID: 16281658 DOI: 10.1191/1479972304cd020rs] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background:Breathing techniques are included in the rehabilitation program of patients with chronic obstructive pulmonary disease (COPD). The efficacy of breathing techniques aiming at improving symptoms of dyspnea and eliciting physiological effects is discussed in this paper. In patients with COPD, breathing techniques aim to relieve symptoms and ameliorate adverse physiological effects by: 1) increasing strength and endurance of the respiratory muscles; 2) optimizing the pattern of thoracoabdominal motion; and 3) reducing dynamic hyperinflation of the rib cage and improving gas exchange. Evidence exists to support the effectiveness of pursed lips breathing, forward leaning position, active expiration and inspiratory muscle training, but not for diaphragmatic breathing. Careful patient selection, proper and repeated instruction and control of the techniques, and assessment of the effects are necessary. Despite the evidence that breathing techniques are effective, several problems need to be resolved. The limited evidence for the transfer of the effects of breathing techniques during resting conditions to exercise conditions raises several questions. Do breathing techniques have to be practiced during activities of daily living?
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Affiliation(s)
- R Gosselink
- Respiratory Rehabilitation and Respiratory Division, Muscle Research Unit, Faculty of Physical Education and Physiotherapy, Katholieke Universiteit Leuven, Leuven, Belgium.
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Elmorsi AS, Eldesoky ME, Mohsen MAA, Shalaby NM, Abdalla DA. Effect of inspiratory muscle training on exercise performance and quality of life in patients with chronic obstructive pulmonary disease. EGYPTIAN JOURNAL OF CHEST DISEASES AND TUBERCULOSIS 2016. [DOI: 10.1016/j.ejcdt.2015.10.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Amalakuhan B, Adams SG. Improving outcomes in chronic obstructive pulmonary disease: the role of the interprofessional approach. Int J Chron Obstruct Pulmon Dis 2015; 10:1225-32. [PMID: 26170651 PMCID: PMC4492629 DOI: 10.2147/copd.s71450] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is associated with significant morbidity, places substantial time and cost burden on the health care system, and is now the third leading cause of death in the US. Many interventions are available to appropriately manage patients with COPD; however, fully implementing these strategies to help improve outcomes may be difficult. Collaboration between an interprofessional team of health care professionals (which includes physicians, nurses, respiratory therapists, physical therapists, dietitians, pharmacists, and many others) and COPD patients and caregivers is necessary to optimally manage these patients and to truly impact outcomes in this devastating disease. Prescribing evidence-based non-pharmacological and pharmacological therapies is an important start, but a true team-based approach is critical to successfully implement comprehensive care in patients with COPD. The goal of this review is to employ a case-based approach to provide practical information regarding the roles of the interprofessional team in implementing strategies to optimally manage COPD patients.
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Affiliation(s)
- Bravein Amalakuhan
- Department of Medicine, Division of Pulmonary Diseases/Critical Care Medicine, The University of Texas Health Science Center at San Antonio, TX, USA ; South Texas Veterans Health Care System, Audie L. Murphy Division, San Antonio, TX, USA
| | - Sandra G Adams
- Department of Medicine, Division of Pulmonary Diseases/Critical Care Medicine, The University of Texas Health Science Center at San Antonio, TX, USA ; South Texas Veterans Health Care System, Audie L. Murphy Division, San Antonio, TX, USA
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Cheng ST, Wu YK, Yang MC, Huang CY, Huang HC, Chu WH, Lan CC. Pulmonary rehabilitation improves heart rate variability at peak exercise, exercise capacity and health-related quality of life in chronic obstructive pulmonary disease. Heart Lung 2014; 43:249-55. [DOI: 10.1016/j.hrtlng.2014.03.002] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2013] [Revised: 02/24/2014] [Accepted: 03/01/2014] [Indexed: 10/25/2022]
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Verges S, Renggli AS, Notter DA, Spengler CM. Effects of different respiratory muscle training regimes on fatigue-related variables during volitional hyperpnoea. Respir Physiol Neurobiol 2009; 169:282-90. [DOI: 10.1016/j.resp.2009.09.005] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2009] [Revised: 09/04/2009] [Accepted: 09/07/2009] [Indexed: 10/20/2022]
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Bustamante Madariaga V, Gáldiz Iturri JB, Gorostiza Manterola A, Camino Buey J, Talayero Sebastián N, Sobradillo Peña V. Comparación de 2 métodos de entrenamiento muscular inspiratorio en pacientes con EPOC. Arch Bronconeumol 2007. [DOI: 10.1157/13108782] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Madariaga VB, Iturri JBG, Manterola AG, Buey JC, Sebastián NT, Peña VS. Comparison of 2 Methods for Inspiratory Muscle Training in Patients With Chronic Obstructive Pulmonary Disease. ACTA ACUST UNITED AC 2007; 43:431-8. [PMID: 17692243 DOI: 10.1016/s1579-2129(07)60099-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The aim of this study was to compare the use of threshold and resistive load devices for inspiratory muscle training in patients with chronic obstructive pulmonary disease (COPD). A randomized prospective trial was designed to compare use of the 2 devices under training or control conditions. PATIENTS AND METHODS Thirty-three patients with moderate or severe COPD were randomly assigned to home treatment with a threshold device, a resistive load device, or a control situation in which either of those devices was maintained at a minimum load throughout the study. Training was performed daily in 2 sessions of 15 minutes each for 6 weeks. In the patients who underwent training with threshold (n=12) and resistive load (n=11) devices, the loads used were adjusted weekly until the maximum tolerated load was reached to ensure that the interventions were as equivalent as possible. Respiratory function, respiratory muscle function, and quality of life were assessed before and after training and the different inspiratory pressure profiles were compared between training groups. RESULTS Both peak inspiratory pressure and scores on the Chronic Respiratory Questionnaire (CRQ) improved in the groups that received inspiratory muscle training compared with control subjects: maximal static inspiratory pressure increased from 86 cmH2O to 104.25 cmH2O (P< .01) in the threshold device group and from 91.36 cm H2O to 105.7 cmH2O (P< .01) in the resistive load device group. The resistive load group showed the largest increase in CRQ quality-of-life scores. Differences between the dyspnea score on the CRQ at the beginning and end of the training period were as follows: 3 points in the resistive load group, 2.58 in the threshold group, and 2.5 in the control group. Significant differences in duty cycle measured during training sessions were observed between groups at the end of training (0.31 in the threshold group and 0.557 in the resistive load group), but the mean pressure-time index was similar (0.11) in both groups because of the greater peak and mean inspiratory pressures in the threshold device group. CONCLUSIONS Load readjustment allowed equivalent training intensities to be achieved with different inspiratory pressure profiles. Our study demonstrated the effectiveness of inspiratory muscle training without control of breathing pattern but showed no superiority of one training method over another.
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Weiner P, Magadle R, Beckerman M, Weiner M, Berar-Yanay N. Specific expiratory muscle training in COPD. Chest 2003; 124:468-73. [PMID: 12907530 DOI: 10.1378/chest.124.2.468] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND There are several reports showing that expiratory muscle strength and endurance can be impaired in patients with COPD. This muscle weakness may have clinically relevant implications. Expiratory muscle training tended to improve cough and to reduce the sensation of respiratory effort during exercise in patients other than those with COPD. METHODS Twenty-six patients with COPD (FEV(1) 38% predicted) were recruited for the study. The patients were randomized into two groups: group 1, 13 patients were assigned to receive specific expiratory muscle training (SEMT) daily, six times a week, each session consisting of 1/2 h of training, for 3 months; and group 2, 13 patients were assigned to be a control group and received training with very low load. Spirometry, respiratory muscle strength and endurance, 6-min walk test, Mahler baseline dyspnea index (before), and the transitional dyspnea index (after) were measured before and after training. RESULTS The training-induced changes were significantly greater in the SEMT group than in the control group for the following variables: expiratory muscle strength (from 86 +/- 4.1 to 104 +/- 4.9 cm H(2)O, p < 0.005; mean difference from the control group, 24%; 95% confidence interval, 18 to 32%), expiratory muscle endurance (from 57 +/- 2.9% to 76 +/- 4.0%, p < 0.001; mean difference from the control group, 29%; 95% confidence interval, 21 to 39%), and in the distance walked in 6 min (from 262 +/- 38 to 312 +/- 47 m, p < 0.05; mean difference from the control group, 14%; 95% confidence interval, 9 to 20%). There was also a small but not significant increase (from 5.1 +/- 0.9 to 5.6 +/- 0.7, p = 0.14) in the dyspnea index. CONCLUSIONS The expiratory muscles can be specifically trained with improvement of both strength and endurance in patients with COPD. This improvement is associated with increase in exercise performance and no significant change in the sensation of dyspnea in daily activities.
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Affiliation(s)
- Paltiel Weiner
- Department of Medicine A, Hillel Yaffe Medical Center, Hadera, Israel.
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Topin N, Matecki S, Le Bris S, Rivier F, Echenne B, Prefaut C, Ramonatxo M. Dose-dependent effect of individualized respiratory muscle training in children with Duchenne muscular dystrophy. Neuromuscul Disord 2002; 12:576-83. [PMID: 12117483 DOI: 10.1016/s0960-8966(02)00005-6] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The aim of this study was to evaluate the effects of low intensity, home inspiratory muscle training on respiratory muscle endurance in children with Duchenne muscular dystrophy, using a double-blind protocol. The originality aspect of this study is the use of a reproducible method of endurance and of the same method for evaluation and training. We studied eight trained children (mean age 14.7+/-4.5 years) and eight control children (mean age, 12.6+/-1.8 years). For 6 weeks, children breathed twice a day for 10 min through a valve with either 30% (training group) or less than 5% (control group) of their maximum inspiratory pressure (P(imax)). The results showed (1) a 46% improvement in the time limit after training in the training group and no change in the control group and (2) a significant correlation between the total time of respiratory muscle training and the percentage of endurance improvement in the training group. We conclude that specific training improves respiratory muscle endurance in Duchenne muscular dystrophy and the effectiveness of training appears to be dependent on the quantity of training.
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Affiliation(s)
- Nathalie Topin
- Laboratoire de Physiologie des Interactions, Service Central de Physiologie Clinique, Hôpital Arnaud de Villeneuve, 34295 Cedex 5, Montpellier, France.
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Scherer TA, Spengler CM, Owassapian D, Imhof E, Boutellier U. Respiratory muscle endurance training in chronic obstructive pulmonary disease: impact on exercise capacity, dyspnea, and quality of life. Am J Respir Crit Care Med 2000; 162:1709-14. [PMID: 11069801 DOI: 10.1164/ajrccm.162.5.9912026] [Citation(s) in RCA: 111] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Inspiratory muscle training may have beneficial effects in certain patients with chronic obstructive pulmonary disease (COPD). Because of the lack of a home training device, normocapnic hyperpnea has rarely been used as a training mode for patients with COPD, and is generally considered unsuitable to large-scale application. To study the effects of hyperpnea training, we randomized 30 patients with COPD and ventilatory limitation to respiratory muscle training (RMT; n = 15) with a new portable device or to breathing exercises with an incentive spirometer (controls; n = 15). Both groups trained twice daily for 15 min for 5 d per week for 8 wk. Training-induced changes were significantly greater in the RMT than in the control group for the following variables: respiratory muscle endurance measured through sustained ventilation (+825 +/- 170 s [mean +/- SEM] versus -27 +/- 61 s, p < 0.001), inspiratory muscle endurance measured through incremental inspiratory threshold loading (+58 +/- 10 g versus +21.7 +/- 9.5 g, p = 0.016), maximal expiratory pressure (+20 +/- 7 cm H(2)O versus -6 +/- 6 cm H(2)O, p = 0.009), 6-min walking distance (+58 +/- 11 m versus +11 +/- 11 m, p = 0.002), V O(2peak) (+2.5 +/- 0.6 ml/kg/min versus -0.3 +/- 0.9 ml/kg/min, p = 0.015), and the SF-12 physical component score (+9.9 +/- 2.7 versus +1.8 +/- 2.4, p = 0.03). Changes in dyspnea, maximal inspiratory pressure, treadmill endurance, and the SF-12 mental component score did not differ significantly between the RMT and control groups. In conclusion, home-based respiratory muscle endurance training with the new device used in this study is feasible and has beneficial effects in subjects with COPD and ventilatory limitation.
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Affiliation(s)
- T A Scherer
- Department of Internal Medicine, Triemli Hospital, Zurich, Switzerland.
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Gosker HR, Wouters EF, van der Vusse GJ, Schols AM. Skeletal muscle dysfunction in chronic obstructive pulmonary disease and chronic heart failure: underlying mechanisms and therapy perspectives. Am J Clin Nutr 2000; 71:1033-47. [PMID: 10799364 DOI: 10.1093/ajcn/71.5.1033] [Citation(s) in RCA: 247] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Low exercise tolerance has a large influence on health status in chronic obstructive pulmonary disease and chronic heart failure. In addition to primary organ dysfunction, impaired skeletal muscle performance is a strong predictor of low exercise capacity. There are striking similarities between both disorders with respect to the muscular alterations underlying the impairment. However, different alterations occur in different muscle types. Histologic and metabolic data show that peripheral muscles undergo a shift from oxidative to glycolytic energy metabolism, whereas the opposite is observed in the diaphragm. These findings are in line with the notion that peripheral and diaphragm muscle are limited mainly by endurance and strength capacity, respectively. In both diseases, muscular impairment is multifactorially determined; hypoxia, oxidative stress, disuse, medication, nutritional depletion, and systemic inflammation may contribute to the observed muscle abnormalities and each factor has its own potential for innovative treatment approaches.
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Affiliation(s)
- H R Gosker
- Departments of Pulmonology and Physiology, Maastricht University, Maastricht, Netherlands.
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The effect of fixed load incremental inspiratory muscle training in the elite athlete: a pilot study. Phys Ther Sport 2000. [DOI: 10.1054/ptsp.1999.0002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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O'Donnell DE, McGuire M, Samis L, Webb KA. General exercise training improves ventilatory and peripheral muscle strength and endurance in chronic airflow limitation. Am J Respir Crit Care Med 1998; 157:1489-97. [PMID: 9603128 DOI: 10.1164/ajrccm.157.5.9708010] [Citation(s) in RCA: 139] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
We studied the impact of a 6-wk supervised, multimodality endurance exercise training program (EXT) on strength and endurance of ventilatory and peripheral muscles in patients with chronic airflow limitation (CAL), and determined whether potential improvements contributed to relief of exertional breathlessness (B) and perceived leg effort/discomfort (LE), respectively. Twenty breathless patients with stable CAL (FEV1 = 41 +/- 3% predicted; mean +/- SEM) were tested at 6-wk intervals at baseline, after a nonintervention control period (pre-EXT), and post-EXT. Measurements included: pulmonary function tests (PFTs), maximal inspiratory/expiratory pressures (MIP, MEP), inspiratory muscle endurance (V(LIM)), quadriceps strength and endurance, exercise endurance, and submaximal cycle exercise with cardioventilatory and symptom responses. Measurements at baseline and pre-EXT were identical. Post-EXT, PFTs did not change; exercise endurance measured on the treadmill, cycle ergometer, arm ergometer, and by 6-min walk distance increased 40 +/- 8%, 43 +/- 10%, 12 +/- 5%, and 34 +/- 9%, respectively (p < 0.05); quadriceps strength increased 21 +/- 5% (p < 0.01); MIP and MEP increased 29 +/- 11% and 27 +/- 11%, respectively (p < 0.05); V(LIM) increased almost threefold (p < 0.05). At isotime near end-exercise, B, LE, carbon dioxide production (VCO2), oxygen consumption (VO2), ventilation, and breathing frequency (F) all fell after EXT (p < 0.05): deltaB correlated with deltaF (r = 0.58, p < 0.01). Increased MIP and V(LIM) did not correlate with improved breathlessness or exercise endurance. Similarly, changes in quadriceps strength and endurance did not correlate with changes in LE or exercise endurance. In conclusion, general nonspecific EXT improved ventilatory and peripheral muscle function in severe CAL, but such improvements did not appear to contribute significantly to reduced exertional symptoms and enhanced exercise performance.
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Affiliation(s)
- D E O'Donnell
- Department of Medicine, Queen's University, and St. Mary's of the Lake Hospital, Kingston, Ontario, Canada
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Ries AL, Carlin BW, Carrieri-Kohlman V, Casaburi R, Celli BR, Emery CF, Hodgkin JE, Mahler DA, Make B, Skolnick J. Pulmonary Rehabilitation. Chest 1997. [DOI: 10.1378/chest.112.5.1363] [Citation(s) in RCA: 315] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Gosselink R, Wagenaar RC, Decramer M. Reliability of a commercially available threshold loading device in healthy subjects and in patients with chronic obstructive pulmonary disease. Thorax 1996; 51:601-5. [PMID: 8693441 PMCID: PMC1090490 DOI: 10.1136/thx.51.6.601] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Threshold loading with the Nickerson and Keens' device is frequently applied in the training and assessment of inspiratory muscles. However, this equipment is not easily applied in clinical practice and training. A study was therefore designed to investigate the accuracy and reliability of the Threshold, a commercially available threshold loading device. METHODS The resolution (accuracy) of the system was determined by measuring variation of pressure and flow during one minute in an experimental setup. The reproducibility and flow independence were then determined during threshold loading at six different inspiratory loads between 25% and 50% maximal inspiratory pressure (PImax) in 10 patients with chronic obstructive pulmonary disease (COPD) and eight healthy subjects. RESULTS In the first experiment the mean variation of the sustained pressure for all loads was 1.7%. The mean coefficients of variation for pressure and flow measurements were 0.2% and 3%, respectively. In the second experiment the healthy subjects showed mean coefficients of variation for pressure and flow of 0.8% and 20.5%, respectively, and the patients showed mean coefficients of variation of 0.6% and 14.5%, respectively. CONCLUSIONS During the in vitro experiment as well as during the experiments in patients with COPD and in healthy subjects only small variations in pressure were observed despite large variations in flow. The Threshold is a reliable and reproducible device for loading inspiratory muscles in patients with COPD as well as in healthy subjects.
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Affiliation(s)
- R Gosselink
- Respiratory Rehabilitation and Respiratory Division, University Hospital Gasthuisberg, Leuven, Belgium
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Montemayor T, Alfajeme I, Escudero C, Morera J, Sánchez Agudo L. [Guidelines on the diagnosis and treatment of chronic obstructive lung disease. The SEPAR Working Group. The Spanish Society of Pneumology and Thoracic Surgery]. Arch Bronconeumol 1996; 32:285-301. [PMID: 8814823 DOI: 10.1016/s0300-2896(15)30754-7] [Citation(s) in RCA: 59] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- T Montemayor
- Hospital Universitario Virgen del Rocío, Sevilla
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