12-Week Inspiratory Muscle Training Improves Respiratory Muscle Strength in Adult Patients with Stable Asthma: A Randomized Controlled Trial

Unraveling Ventilator-Induced Diaphragmatic Dysfunction: A Comprehensive Narrative Review on Pathogenesis, Diagnosis and Management of Ventilator-Induced Diaphragmatic Dysfunction

INTRODUCTION

Mechanical ventilation (MV) is a crucial intervention for patients with respiratory failure to ensure optimal gas exchange. However, there is strong evidence that MV exerts significant structural and functional alterations on the diaphragm, leading to a notable decline in its contractile force and the consequent atrophy of its muscle fibers. This condition, referred to as ventilator-induced diaphragmatic dysfunction (VIDD), is an integral factor contributing to challenges in weaning patients off MV, a reduction in their quality of life, and escalated Mortality Risks.

OBJECTIVES

This review highlights the complications of MV, with a focus on VIDD and its clinical implications. It explores bedside diagnostic tools for VIDD and examines exercise-based interventions aimed at preventing or reversing daiphragmatic weakness.

DISCUSSION

Rehabilitation programs, including early mobilization and inspiratory muscle training (IMT) for critically ill patients, have the potential to prevent or mitigate the adverse effects of prolonged Mechanical ventilator and improve clinical outcomes. Numerous studies have demonstrated that these interventions are both safe and feasible, offering benefits such as enhanced physical functioning, reduced duration of mechanical ventilation, and shorter stays in intensive care and hospital settings. However, despite these demonstrated advantages, the implementation of rehabilitation programs remains infrequent in routine clinical practice, often hindered by various perceived barriers.

CONCLUSION

Recognizing and addressing respiratory muscle weakness is crucial, as it represents a reversible and treatable factor that can significantly improve patient outcomes.

Evaluation of online videos and websites on inspiratory muscle training for individuals with chronic lung disease

BACKGROUND

Inspiratory muscle training (IMT) is an effective rehabilitation modality for individuals with chronic lung disease. IMT can improve dyspnea, exercise capacity, and health-related quality of life. Online resources are common sources of health information for individuals. This study is the first to: 1) evaluate the content, reliability, quality, and comprehensibility of IMT-related videos and websites for individuals with chronic lung disease, and 2) determine the characteristics of these online resources.

METHODS

The search term "(respiratory muscle training) OR (inspiratory muscle training)" was used to evaluate the first 200 consecutive YouTube videos and 200 Google websites on IMT for chronic lung disease management. Online resources were evaluated using validated scoring metrics: modified DISCERN tool, Global Quality Scale (GQS), and Patient Education Materials Assessment Tools (PEMAT) understandability and actionability. Content comprising key IMT components was also scored.

RESULTS

Forty videos and fourteen websites were included, with majority uploaded by for-profit organizations. Content scores (out of 25) were low (videos 7.7 ± 4.4; websites 11.4 ± 5.3, p = 0.01). Benefits of IMT were often highlighted, but safety considerations were infrequently mentioned. Resources scored poorly on modified DISCERN (videos 2/5 IQR[1.0-3.0]; websites 3.5/5 IQR[2.0-4.0], p = 0.001), and GQS scores (videos 2/5 IQR[2.0-3.0]; websites 3/5 IQR[2.8-3.3], p = 0.003). Online resources met the PEMAT threshold (>70 %) for understandability, but not actionability.

CONCLUSIONS

Online IMT resources have mainly focused on the benefits of IMT and majority were developed by for-profit organizations. There is a need for high-quality, evidence-based online resources, as IMT is an important rehabilitation modality for chronic lung disease management.

Explore the application effect of acupoint massage combined with ear point pressing beans in the remission stage of asthma

OBJECTIVE

To explore the application effect of acupoint massage combined with ear point pressing beans in the remission stage of bronchial asthma.

METHODS

A total of 120 children with asthma in remission who were treated in the paediatric outpatient department between January 2016 and October 2022 were randomly divided into the experimental and control groups, with 60 patients in each group. The patients in both groups were treated with salmeterol and fluticasone inhalation powder, 1 puff each time, twice a day. The patients in the control group received acupoint massage in addition to this treatment, with acupoint massage performed once a day, Monday to Friday, lasting 30 min each time. The patients in the experimental group received ear point pressing beans in addition to the treatment in the control group. Ear point press bean paste bean once a week,press 3-5 times a day,press each point for i minute. Changes in pulmonary function and asthma control were observed before and after treatment in both groups, with forced expiratory volume in 1 second (FEV1), forced expiratory vital capacity (FVC), FEV1/FVC ratio and the Asthma Control Test (ACT) score compared.

RESULTS

After 8 weeks of treatment, FEV1, FVC, FEV1/FVC ratio and the ACT scores of both groups improved to different degrees (P<0.05). In terms of the effective control rate, the total clinical effective control rate (95 %) of patients in the experimental group was significantly higher than that in the control group (81.67 %) (P < 0.05).

CONCLUSION

Acupoint massage combined with ear point pressing beans has a good effect on the treatment of asthma remission and can effectively improve the quality of life, making it worthy of further promotion in clinical practice.

Effectiveness of Rehabilitation Interventions in Adults With Asthma: A Systematic Review and Meta-analysis

OBJECTIVE

The aim of the study is to evaluate the effectiveness of pulmonary rehabilitation programs and other rehabilitation interventions in adults with asthma.

DESIGN

This is a systematic review and meta-analysis.

RESULTS

MEDLINE (PubMed), Embase, Cumulative Index to Nursing & Allied Health Literature, and CENTRAL were searched from inception to 31 May 2023. PROSPERO registration number: CRD42022331440. Thirty-six randomized controlled trials were analyzed, and only 26 were pooled in the meta-analysis because of the heterogeneity of comparisons and outcomes across the studies. Pulmonary rehabilitation, compared with education associated with breathing exercises, may result in little to no difference in the Asthma Quality of Life Questionnaire (mean difference 0.01 score, 95% confidence interval = -0.48 to 0.50, 163 participants, three studies, low certainty).

CONCLUSIONS

Our findings show that pulmonary rehabilitation, compared with education associated with breathing exercises, may result in little to no difference in the impact of asthma on health-related quality of life. Overall, the certainty of evidence was low or very low preventing any firm conclusion on the effects of single or combined rehabilitation interventions.

Incorporating RC-Cornet PLUS and POWERbreathe Medic Plus Device Along With Pulmonary Rehabilitation on Functional Capacity and Quality of Life in Bronchiectasis: A Case Report

This case report discusses the physiotherapy management of an adult patient with chief complaints of breathlessness and difficulty expelling out mucus for the past month, with a history of multiple hospitalizations due to recurrent respiratory infections, who was diagnosed as bronchiectasis. In this study, the patient was treated with a combination of the RC-Cornet PLUS (CEGLA Medizintechnik, Montabaur, Germany), an oscillatory positive expiratory pressure (OPEP) device used for airway clearance, and the POWERbreathe Medic Plus (POWERbreathe, England, UK), an inspiratory muscle training (IMT) device, along with tailored pulmonary rehabilitation. Pulmonary rehabilitation focused on patient education, breathing exercises, airway clearance techniques (ACTs), endurance training, strengthening, and energy conservation techniques. The RC-Cornet PLUS device further complemented these interventions and facilitated effective mucus clearance, while the POWERbreathe Medic Plus device aided in improving respiratory muscle strength and endurance. Through this comprehensive approach, significant improvement in dyspnea was observed from grade 3 to grade 1 on the Modified Medical Research Council (MMRC) scale, improvement in inspiratory muscle strength was observed from 9 cmH2O to 12 cmH2O, there was an increase in functional capacity using a six-minute walk test distance from 60 meters to 190 meters, and improvement in the quality of life was observed on the WHO Quality of Life scale from 50% to 52.5% just after two weeks. The study concludes that adding the RC-Cornet PLUS device and POWERbreathe Medic Plus device to the standard pulmonary rehabilitation protocol improves functional capacity and quality of life in bronchiectasis patients.

Effectiveness of Threshold-Pressure Inspiratory Muscle Training on Pulmonary Rehabilitation in Children and Adolescents with Asthma

Objective

The objective of this systematic review and meta-analysis was to assess the effectiveness of TIMT on pulmonary function in children and adolescents with asthma.

Method

We searched for randomized controlled clinical trials in the MEDLINE, Embase, the Cochrane Library, Web of Science, CINAHL, Sino Med, Wan fang, CNKI, and VIP until March 2024. In addition, the references included in the literature and the relevant systematic evaluation were manually traced in order to avoid the omission of any relevant literature. These trials compared TIMT against blank TIMT and conventional care. Eligible studies were assessed in terms of risk of bias and quality of evidence using RoB II tool. Where feasible, data were pooled and subjected to meta-analysis. The mean difference (MD) and 95% confidence interval (CI) were estimated by fixed effect models or random effect models.

Result

Six studies were included in the present meta-analysis involving 337 children and adolescents ranged from 4 to 18 years. The meta-analysis showed that TIMT could significantly improve lung function. Compared to the control group, TIMT can significantly improve FEV1 (MD 4.63 mL, 95% CI 2.64 to 6.62 mL, I2 = 4%), FVC (to the control group (MD 7.46 mL, 95% CI 5.09 to 9.82 mL, I2 = 0%), FEV1/FVC (MD 7.33%, 95% CI: 5.01 to 9.65%) and ACT (MD 1.86, 95% CI 0.96 to 2.75 mL, I2 = 12%) of patients at the end of intervention. There was no significant heterogeneity in these meta-analyses.

Conclusion

In conclusion, the results of this systematic review and meta-analysis support the effectiveness of TIMT training in restoring lung function and relieving asthma symptoms of asthmatic children. More high-quality and RCTs with large sample size are urgently required to verify the conclusion.

Effect of Inspiratory Muscle Training on Outcomes After Cardiac Surgery: A Comprehensive Meta-Analysis of Randomized Controlled Trials

PURPOSE

Inspiratory muscle training (IMT) has emerged as a potential intervention to improve respiratory outcomes for patients undergoing cardiac surgery. However, the extent of the IMT effects on preoperative and postoperative respiratory metrics remains uncertain. Hence, we designed this study to determine the effects of IMT on various outcomes of patients undergoing cardiac surgery.

METHODS

We conducted a comprehensive meta-analysis of studies evaluating the impact of preoperative and postoperative IMT on various respiratory variables and postsurgical outcomes. We synthesized data from multiple studies, encompassing diverse patient populations and IMT protocols. The key outcomes included the maximal inspiratory pressure (MIP), forced expiratory volume in 1 sec (FEV1), forced vital capacity (FVC), and others.

RESULTS

Our meta-analysis results showed that preoperative IMT significantly improved the MIP values with a pooled standard mean difference (SMD) of 0.62. The hospital stay length was also reduced with a SMD of - 0.4. Other variables such as FEV1 and FVC also improved significantly. Postoperative IMT improved the MIP and peak flow rate values, but the evidence was less robust than with preoperative interventions. We observed high heterogeneity across studies for several outcomes and found evidence of publication bias for some postoperative measures.

CONCLUSION

Both preoperative and postoperative IMT offer benefits for patients undergoing operations, especially by enhancing respiratory muscle strength and potentially reducing hospital stays. However, the presence of heterogeneity and publication bias underscores the need for further standardized research to consolidate these findings and standardize IMT protocols for optimal patient outcomes.

The Effects of a Pulmonary Rehabilitation Programme on Functional Capacity and Strength of Respiratory Muscles in Patients with Post-COVID Syndrome

AIM

The aim of this study was to estimate the effects of a pulmonary rehabilitation programme (PR) on the functional capacity and respiratory muscle strength of patients with post-COVID syndrome.

METHODS

A cross-sectional study was conducted using hospital data on patients who participated in a pulmonary rehabilitation programme at the Clinic for Lung Diseases, University Hospital Centre Zagreb, Croatia, between January 2021 and December 2022. Data on the spirometry, respiratory muscle strength, and functional exercise capacity of patients were collected at baseline and three weeks after the start of rehabilitation. The study included 80 patients (43 females, 37 males) with a mean age of 51±10 years.

RESULTS

A significant increase in respiratory muscle strength (P<0.001) was observed after pulmonary rehabilitation, with effect sizes ranging from small to large (Cohen's d from 0.39 to 1.07), whereas the effect for PImax expressed as a percentage was large (Cohen's d=0.99). In addition, the pulmonary rehabilitation programme significantly improved the parameters of the six-minute walk test in patients, and the parameters of lung function, FVC, FEV1, and DLCO also improved significantly after PR (P<0.05).

CONCLUSION

The results showed that the pulmonary rehabilitation programme has clinically significant effects on functional capacity and respiratory muscle strength in patients with post-COVID syndrome.

Effects of respiratory muscular training in post-covid-19 patients: a systematic review and meta-analysis of randomized controlled trials

BACKGROUND

Post-Covid-19 syndrome is defined as non-self-sustaining signs and/or symptoms lasting more than 12 weeks, occurring during or after a Covid-19 infection. The primary outcome was the analysis of the respiratory muscle training (RMT) result in respiratory muscle strength, (maximum inspiratory pressure (MIP) e maximum expiratory pressure (MEP)); and the secondary results were the analysis of lung function, dyspnea, quality of life (QoL), fatigue and functional performance.

METHODS

The PICO description for this research was: P: patients diagnosed with post-Covid-19; I: RMT; C: Sham or simulated inspiratory or expiratory muscle training and usual care; O: MIP, MEP, Lung Function, level of dyspnea, QoL and functional performance. On January 15, 2024, the following databases were consulted: PubMed, Lilacs, Cochrane Library, PEDro and EMBASE. Randomized clinical trials were included without restrictions on year of publication or language. The data selection and extraction steps were carried out by two independent reviewers.

RESULTS

The search in the databases resulted in a total of 14,216 studies, and after the eligibility process, 7 studies were included with a sample of 527 patients. The MIP results suffered a statistically significant increase, that is, the RMT was favorable to improve the MIP (MD = 29.55cmH2O IC 95%: 7.56cmH2O to 51.54cmH2O, p = 0,00001). For the MEP outcome, the results were statistically significant in favor of RMT (MD = 10.93cmH2O CI 95%: 3.65cmH2O to 18.21cmH2O, p = 0.00001). We also noticed a significant improvement for the group that received the RMT in the distance covered in the 6-Minute Walk Test (6MWT) MD = 40.70 m CI 95%: 18.23 m to 65.17 m%, p = 0.01).

CONCLUSION

We noticed that RMT is being used in patients with respiratory diseases, including post-Covid-19. Our systematic review observed that this training provides an increase in inspiratory and expiratory muscle strength, a reduction in dyspnea levels, and an increase in the distance covered in the 6MWT and improved QoL in post-covid patients after intervention.

A preliminary study on the respiratory benefits of adaptive video gaming in individuals with cervical spinal cord injuries

PURPOSE

The purpose of this study was to collect preliminary data to assess whether participation in adaptive video gaming using a pneumatic sip-and-puff video game controller may provide respiratory or health benefits for individuals with cervical-level spinal cord injuries.

METHODS

A survey was anonymously distributed to potential participants and consisted of four sections: (1) General Information, (2) Gaming Habits, (3) Respiratory Quality of Life, and (4) Impact of Adaptive Video Gaming on Respiratory Health.

RESULTS

The study included 124 individuals with cervical-level spinal cord injuries. Participants had primarily positive self-rated health and good respiratory quality of life. Nearly half of the participants (47.6%) Agreed or Strongly Agreed that their breathing control has improved after using their sip-and-puff gaming controller and 45.2% Agreed or Strongly Agreed that their respiratory health has improved. Individuals who Agreed or Strongly Agreed that adaptive video gaming has improved their breathing control also reported a significantly higher level of exertion while gaming compared to those who did not Agree or Strongly Agree (p = 0.00029).

CONCLUSIONS

It is possible that there are respiratory benefits of using sip-and-puff video game controllers for individuals with cervical spinal cord injuries. The benefits reported by users were found to be dependent on their level of exertion while playing video games. Further exploration in this area is needed due to the positive benefits reported by participants.

Effects of Hypopressive Abdominal Training on Ventilatory Capacity and Quality of Life: A Randomized Controlled Trial

Pelvic floor dysfunctions, associated with alterations in respiratory mechanics and, consequently, quality of life, are the cause of the most frequent gynecological problems. Pelvic floor muscle training emerges as a first-line treatment, with new approaches such as hypopressive exercises. The aim of this study was to analyze the efficacy of an 8-week supervised training program of hypopressive exercises on the pelvic floor and its impact on improving the ventilatory mechanics and quality of life in women. Analysis of the spirometric parameters showed a significant main Group × Time effect for three parameters: the ratio of FEV1/FVC (p = 0.030), the forced expiratory flow at 75% of the expired vital capacity (p < 0.001), and the forced expiratory flow over the middle half of the forced vital capacity (p = 0.005). No statistical significance was found regarding the SF-12 questionnaire components; only differences were found over time in the physical role (p = 0.023), bodily pain (p = 0.001), and vitality (p < 0.010) domains and in the physical component summary score (p = 0.010). After an 8-week intervention of hypopressive exercises, an improvement in the ventilatory and pulmonary capacities can be observed.

Effects of low workload respiratory training with steam inhalation on lung function in stable asthma: A controlled clinical study

To investigate effects of low workload respiratory muscle training (RMT) on respiratory muscle power and lung function in asthmatics, we recruited asthmatic persons who performed a 4-week training programme. The training included 20 daily ex- and inhalations with counter pressure 30% from the individual maximal expiratory pressure (MEP). Lung function was measured before and after the training programme and a follow-up period. The study also included several subjective endpoints for respiratory symptoms. A significant increase in a training group (n = 27) compared with a control group (n = 20) was seen in MEP (+12.4%, vs. +3.5%, p = 0.086), maximal inspiratory pressure (MIP) (+21.1% vs. +0.82%, p = 0.023), slow vital capacity (VC) (+3.7% vs. +1.5%, p = 0.023) and in forced expiratory time (FET, +15.5%, vs. -5.0%, p = 0.022). After being a control for group A, also group B performed similar RMT as group A. In the combined group (A and B, n = 47) MEP (11.3%, p = 0.003), MIP (19.73%, p < 0.001), VC (4.1%, p < 0.001) and FET (14.7%, p < 0.001) increased significantly from the baseline. Changes in other lung function variables were not indicative. On a scale of 1-5, the subjects perceived improvement in reduction of mucus secretion in the airways (median 3, p < 0.001), alleviation of coughing (median 3, p < 0.001) and reduction in dyspnoea (median 3, p < 0.001). As a conclusion, low workload respiratory training of 4 weeks improved respiratory muscle power and increased VC in patients with stable asthma.

The therapeutic role of inspiratory muscle training in the management of asthma: a narrative review

Asthma is a disorder of the airways characterized by chronic airway inflammation, hyperresponsiveness, and variable recurring airway obstruction. Treatment options for asthma include pharmacological strategies, whereas nonpharmacological strategies are limited. Established pharmacological approaches to treating asthma may cause unwanted side effects and do not always afford adequate protection against asthma, possibly because of an individual's variable response to medications. A potential nonpharmacological intervention that is most available and cost effective is inspiratory muscle training (IMT), which is a technique targeted at increasing the strength and endurance of the diaphragm and accessory muscles of inspiration. Studies examining the impact of IMT on asthma have reported increases in inspiratory muscle strength and a reduction in the perception of dyspnea and medication use. However, because of the limited number of studies and discordant methods between studies more evidence is required to elucidate in individuals with asthma the efficacy of IMT on inspiratory muscle endurance, exercise capacity, asthma control, symptoms, and quality of life as well as in adolescents with differing severities of asthma. Large randomized controlled trials would be a significant step forward in clarifying the effectiveness of IMT in individuals with asthma. Although IMT may have favorable effects on inspiratory muscle strength, dyspnea, and medication use, the current evidence that IMT is an effective treatment for asthma is inconclusive.

The effect of inspiratory muscle training in PCD and CF patients: A pilot study

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.

Basis of preventive and non-pharmacological interventions in asthma

Asthma is one of the most common atopic disorders in all stages of life. Its etiology is likely due to a complex interaction between genetic, environmental, and lifestyle factors. Due to this, different non-pharmacological interventions can be implemented to reduce or alleviate the symptoms caused by this disease. Thus, the present narrative review aimed to analyze the preventive and non-pharmacological interventions such as physical exercise, physiotherapy, nutritional, ergonutritional, and psychological strategies in asthma treatment. To reach these aims, an extensive narrative review was conducted. The databases used were MedLine (PubMed), Cochrane (Wiley), Embase, PsychINFO, and CinAhl. Asthma is an immune-mediated inflammatory condition characterized by increased responsiveness to bronchoconstrictor stimuli. Different factors have been shown to play an important role in the pathogenesis of asthma, however, the treatments used to reduce its incidence are more controversial. Physical activity is focused on the benefits that aerobic training can provide, while physiotherapy interventions recommend breathing exercises to improve the quality of life of patients. Nutritional interventions are targeted on implement diets that prioritize the consumption of fruits and vegetables and supplementation with antioxidants. Psychological interventions have been proposed as an essential non-pharmacological tool to reduce the emotional problems associated with asthma.

Respiratory Muscle Function in Older Adults with Chronic Respiratory Diseases after Pulmonary Rehabilitation in Subterranean Salt Chambers

Training the respiratory muscles is a crucial aspect of pulmonary rehabilitation. The purpose of this study was to assess the function of respiratory muscles in older adults both before and after a period of pulmonary rehabilitation and treatment stay within the underground chambers of a salt mine. A total of 50 patients aged 65 years and older with chronic respiratory conditions was enrolled in the study. These participants underwent a 3-week subterranean pulmonary rehabilitation (PR) program in the "Wieliczka" Salt Mine. Levels of sniff nasal inspiratory pressure (SNIP), maximum inspiratory pressure (MIP), and maximum expiratory pressure (MEP) were measured using the MicroRPM both before and after the outpatient PR program conducted 135 m underground. A total of 44 patients with a mean age of 68.8 ± 2.9 years who completed the PR program and tests were included in the analysis. The average changes in the parameters of pulmonary function before and after the PR were: MIP 8.8 cmH2O, MEP 7.1 cmH2O, and SNIP 11.2 cmH2O (for p < 0.05). For patients older than 70 years, beneficial changes were only observed for MEP, which increased by 9.3 cmH2O (for p < 0.05). Speleotherapy combined with pulmonary rehabilitation improves respiratory muscle function in older adults with chronic respiratory diseases, mainly in terms of MEP. Therefore, a greater emphasis on inspiratory muscle training in the rehabilitation program should be considered.

The Effectiveness of Nursing Rehabilitation Interventions on Self-Care for Older Adults with Respiratory Disorders: A Systematic Review with Meta-Analysis

Background: This research work aimed to summarize the rehabilitation nursing interventions published in the scientific literature that most contribute to effective adherence to self-care in older adults with respiratory diseases. Methods: A systematic literature review with meta-analysis was conducted by searching the EBSCOhost platform (CINAHL Complete, MEDLINE Complete, Cochrane, and MedicLatina) using the PRISMA methodology. Five articles were selected for final analysis. Meta-analysis was carried out using Comprehensive Meta-Analysis (CMA) software, and the results were presented in a forest plot. Results: Thirty-one self-promoting rehabilitation nursing interventions were identified, with the most effective being those related to the assessment of progress in physical capacity/activity tolerance (functional status category/domain) and the assessment of the increase in health-related quality of life (health-related quality of life category/domain). Conclusions: Rehabilitation nursing interventions such as self-management programs led by nurses, community-based and home-based rehabilitation programs, and inspiratory muscle training can effectively reduce and enable the effective control of symptoms associated with respiratory disorders, boosting older adults' empowerment to engage in self-care.

Exercise Rehabilitation and Chronic Respiratory Diseases: Effects, Mechanisms, and Therapeutic Benefits

Chronic respiratory diseases (CRD), is a group of disorders, primarily chronic obstructive pulmonary disease and asthma, which are characterized by high prevalence and disability, recurrent acute exacerbations, and multiple comorbidities, resulting in exercise limitations and reduced health-related quality of life. Exercise training, an important tool in pulmonary rehabilitation, reduces adverse symptoms in patients by relieving respiratory limitations, increasing gas exchange, increasing central and peripheral hemodynamic forces, and enhancing skeletal muscle function. Aerobic, resistance, and high-intensity intermittent exercises, and other emerging forms such as aquatic exercise and Tai Chi effectively improve exercise capacity, physical fitness, and pulmonary function in patients with CRD. The underlying mechanisms include enhancement of the body's immune response, better control of the inflammatory response, and acceleration of the interaction between the vagus and sympathetic nerves to improve gas exchange. Here, we reviewed the new evidence of benefits and mechanisms of exercise intervention in the pulmonary rehabilitation of patients with chronic obstructive pulmonary disease, bronchial asthma, bronchiectasis, interstitial lung disease, and lung cancer.

Effect of lower torso training on asthma patients

Purpose: the researchers see that this project is significant for asthma patients to help them improve. Therefore, this study hypothesizes that lower torso muscle endurance may affect 6MWT in asthma patients. To test this hypothesis, we examined the effect of decreased thoracic muscular endurance on asthma patients' 6-minute walk test (6MWT). Material & Methods: this study included two groups (experimental and control), and they used a quantitative descriptive technique and achieved Pre – Post tests research design. The researcher began by administering a pre-test to the two groups. Researchers then carried out the therapy to experiment group, whereas the control group used the hospital protocol. Following the conclusion of the treatment, the researcher conducted a post-test for both groups. The program of the treatment's impact may be determined precisely by comparing the pre-and post-test findings. The trial lasted 24 meetings, with training occurring three times a week. On many occasions, twenty asthmatic patients from Imam Sadiq Hospital who had been hospitalized at a pulmonary rehabilitation center were assessed. Patients were included if they met the global effort for asthma recommendations for asthma diagnosis. The current study employed an experimental design. This study evaluated the maximal inspiratory pressure (PI, max), the pulmonary function test, the baseline dyspnea index (BDI), and the six-minute walk test (6MWT). Each exercise (leg extension and leg press) on gymnasium equipment was assigned a one-minute repetition. Additionally, the St. George Respiratory Questionnaire (SGRQ) was used to determine a person's quality of life. The researchers discovered that a training program had statistically significant favorable impacts on the 6MWT and body weight. Conclusion: this study's findings demonstrated the critical role of lower torso training in achieving submaximal exercise tolerance. Additionally, they may pave the way for new avenues for training programs aimed at increasing functional activity in asthma patients.

The Effect of Threshold Loading Training and an Innovative Respiratory Training Devices with Lower Torso Sports Training in Asthma Patients: A Randomized Trial

This study investigated the influence of two different devices with lower torso sports training in patients with asthma. Patients with asthma (n = 300) aged 55-60 years with FEV1/FVC ratio < 65%, who were repeatedly admitted to a pulmonary rehabilitation centre, participated. Patients were evaluated and randomized into two groups (experimental group 1; EXP-1, n = 150, who applied a conventional threshold loading device, and experimental group 2; EXP-2, n = 150, who used an innovative respiratory training device). Patients were included only if they met the global criteria for asthma. The experimental intervention period lasted 10 weeks with 3 weekly training sessions lasting 30-40 min. The maximal inspiratory pressure (PI, max), pulmonary function test, baseline dyspnoea index (BDI), oxygen saturation, and 6 min walking test (6MWT) performance were all measured at baseline and postintervention. Also, an assessment of the 1 min repeated exercise performance (leg extension and leg press) was performed. Moreover, St. George Respiratory Questionnaire was used to quantify the quality of life (SGRQ). Statistical analysis displayed significant favourable effects on 6MWT, leg press, and FRV1, for patients using both devices (EXP-1 and EXP-2, respectively) with lower torso athletic training. The other variables, weight SPO2 and SGRO, also showed no significant change in neither EXP-1 nor EXP-2. Thus, the new respiratory training device (EXP-2) appeared to be as effective as the conventional threshold loading device (EXP-1). In conclusion, our findings demonstrated beneficial effects of combining respiratory training with athletic training in asthma patients. Additionally, the validity of a unique respiratory training device for asthma patients was confirmed.

Therapeutic effect of modified Xiaoqinglong Decoction on cough-variant asthma and immunological functioning in children

OBJECTIVE

To investigate the effect of modified Xiaoqinglong Decoction on cough variant asthma (CVA) and immunological functioning in children.

METHODS

In this is retrospective analysis, 122 children with CAV admitted to our hospital from Mar. 2021 to Mar. 2022 were divided into an observation group (n=61) and a control group (n=61) according to treatment methods. The control group received fluticasone propionate inhalation aerosol, and the observation group additionally received Xiaoqinglong Decoction. The therapeutic efficacy in the two groups was compared after 8 weeks of treatment. The comparison indictors included scores of daytime and nighttime cough, pulmonary function, fractional exhaled nitric oxide (FeNO), eosinophil count, inflammatory response (interleukin-4 (IL-4), tumor necrosis factor-α (TNF-α) and macrophage inflammatory protein ((MIP)-1α), immunoglobulin (Ig)) level and adverse reactions.

RESULTS

The overall response rate of children with CVA in the observation group was higher than that in the control group (P<0.05). After treatment, the scores of daytime and nighttime cough in the observation group were lower than those in the control group (P<0.05). The Forced Vital Capacity (FVC), peak expiratory flow (PEF) and FEV1 (Forced Expiratory Volume)/FVC of the observation group were higher than those in the control group (P<0.05). The FeNO and eosinophil count in the observation group were lower than those in the control group (P<0.05). The serum IL-4 was higher, while TNF-α and MIP-1α levels were lower in the observation group in the control group (P<0.05). The serum IgA, IgG and IgM levels in the observation group were higher than those in the control group (P<0.05).

CONCLUSION

The modified Xiaoqinglong Decoction has a conspicuous effect on children with CVA. It helps to reduce cough symptoms, improve pulmonary function, reduce inflammatory response and improve immunological functioning of children.

Effects on Respiratory Pressures, Spirometry Biomarkers, and Sports Performance after Inspiratory Muscle Training in a Physically Active Population by Powerbreath®: A Systematic Review and Meta-Analysis

Sports performance in athletes can be limited by respiratory factors, so it is understandable to propose that inspiratory muscle training (IMT) can improve respiratory function and exercise performance. Power-Breathe^® (PwB) is a sectorized respiratory muscle training tool that uses a resistive load to train IMT. There is currently a growing interest in respiratory muscle training, so we set out to systematically assess the effects of IMT with PwB on respiratory parameters and athletic performance in physically active, healthy adults. Based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline, the Cochrane and PEDro scales to assess methodological quality, effect size using the Rosenthal formula, and the Cochrane tool for estimation of risk of bias, studies searchable in Medline, Web of Science, and Cochrane. In addition, for the performance of the meta-analysis, the documentation and quantification of the heterogeneity in each meta-analysis were directed through the Cochran's Q test and the I2 statistic; in addition, a publication bias analysis was performed using funnel plots. Of the total of 241 studies identified in the search, 11 studies for the systematic review and nine for the meta-analysis met the exclusion and/or inclusion criteria. IMT, with PwB, showed significant improvements in maximal inspiratory pressure (MIP) and substantial improvements in forced vital capacity (FVC) in the meta-analysis results. Also, sports performance was significantly increased by IMT with PwB. In conclusion, the use of PwB is an IMT tool that improves respiratory and sports performance.

[Efficacy of the different therapeutic exercise modalities in cardiac rehabilitation after myocardial infarction. A review of the literature]

We aimed to assess the efficacy of different therapeutic exercise modalities in cardiac rehabilitation after acute myocardial infarction. A search of randomized controlled studies published between 2016 and 2021 in Scopus, PubMed, CINAHL, Web of Science and Cochrane Library was carried out using the MeSH terms "exercise therapy" and "myocardial infarction". Ten articles met the inclusion criteria; in these studies, the used exercises were combined or traditional programs that included relaxation training, and were performed either at home or at the hospital. We examined exercise tolerance, cardiovascular parameters, anthropometric measurements, and quality of life. Significant improvements in the assessed variables were observed in most studies. We conclude that all studied therapeutic exercise modalities are useful in cardiac rehabilitation after myocardial infarction, although the best outcomes are seen for combined therapeutic exercise programs.

Effects of Inspiratory Muscle Training and High-Intensity Interval Training on Lung Function and Respiratory Muscle Function in Asthma

BACKGROUND

Asthma is a heterogeneous disease, usually characterized by chronic airway inflammation. Although inspiratory muscle training (IMT) and high-intensity interval training (HIIT) are beneficial for patients with asthma, controversies persist. Therefore, we aimed to investigate the effects of IMT and HIIT on lung function and respiratory muscle function of subjects with asthma.

METHODS

We searched PubMed, Embase, Web of Science, and the Cochrane Library databases up to May 2021. Inclusion criteria were randomized controlled trials (RCTs) of subjects with asthma who received either IMT or HIIT. The outcome measures were changes in lung function and respiratory muscle function.

RESULTS

A total of 13 RCTs (10 in IMT and 3 in HIIT) were included, with a total of 598 subjects. The meta-analysis showed a significantly improved FEV1 of the expected value (FEV1%pred) (mean difference [MD] 4.49% [95% CI 2.31-6.67], P < .001; I2 = 13%), FVC of the expected value (FVC % pred) (MD 5.72% [95% CI 3.56-7.88], P < .001; I2 = 0%), FEV1/FVC % (MD 5.01% [95% CI 2.45-7.58], P < .001; I2 = 25%), FVC (L) (MD 0.21 L [95% CI 0.03-0.40], P = .02; I2 = 0%), maximum inspiratory pressure (PImax) (MD 27.62 cm H2O [95% CI 6.50-48.74], P = .01; I2 = 96%), and PImax (%pred) (MD 27.35% [95% CI 6.94-47.76], P = .009; I2 = 83.5%) in the IMT group. There was no statistical significance in maximum expiratory pressure.

CONCLUSIONS

IMT improved pulmonary function (FEV1%pred, FVC) and inspiratory muscle strength in subjects with stable asthma. Due to the small number of RCT studies included and the limited outcome measures involving HIIT, we were unable to draw conclusions about whether HIIT was beneficial in this meta-analysis. Moreover, clinical heterogeneity exists in different areas such as population and training programs; the above conclusions still need to be confirmed in future studies.

Kinesiotherapy and physical activity in COPD and Asthma Patients – A Review

Background: Obstructive chronic diseases are a continuous challenge for healthcare perfusionists all over the world. Asthma and Chronic Obstructive Pulmonary Disease (COPD) are the most frequent of these diseases. Respiratory or pulmonary rehabilitation started to gain momentum and it is more frequently used to improve muscle strength, cardiac and respiratory endurance and joint flexibility. The objective of this paper is to establish the current programs of physical activity or kinesiotherapy used in the past year and to reveal if there are any gaps or mismatches in the development of the program or in the instruments used to quantify the results of the rehabilitation programs. Materials and methods: We reviewed a total number of 12 articles, randomized control trials using the search words kinesiotherapy, physical therapy, COPD and asthma from the last year on PubMed.gov, from 11 different countries in order to establish which have similar types of exercises, parameters used in order to compare results and which were the outcomes. Results: The final results are positive, although it is hard to determine a unity because there were so many different parameters used to monitor the patients. The most frequent parameter was the 6MWT used to compare the effectiveness of the physical program in 6 studies. Discussion and conclusions: This review had its limitation in comparing the 12 articles researched because of the different number of patients, the various physical activity and rehabilitation exercises used, but especially because of the many varieties of scales and scores used to monitor the effectiveness of the treatment. In order to successfully compare such papers, an international guideline is necessary to relay specific rehabilitation programs for every type of respiratory pathology and also which are the most recommended scales or scores or parameters in general to asses such rehabilitation programs. Keywords: kinesiotherapy; physical activity; physical therapy; COPD, asthma

Time to Move Beyond a "One-Size Fits All" Approach to Inspiratory Muscle Training

Inspiratory muscle training (IMT) has been studied as a rehabilitation tool and ergogenic aid in clinical, athletic, and healthy populations. This technique aims to improve respiratory muscle strength and endurance, which has been seen to enhance respiratory pressure generation, respiratory muscle weakness, exercise capacity, and quality of life. However, the effects of IMT have been discrepant between populations, with some studies showing improvements with IMT and others not. This may be due to the use of standardized IMT protocols which are uniformly applied to all study participants without considering individual characteristics and training needs. As such, we suggest that research on IMT veer away from a standardized, one-size-fits-all intervention, and instead utilize specific IMT training protocols. In particular, a more personalized approach to an individual's training prescription based upon goals, needs, and desired outcomes of the patient or athlete. In order for the coach or practitioner to adjust and personalize a given IMT prescription for an individual, factors, such as frequency, duration, and modality will be influenced, thus inevitably affecting overall training load and adaptations for a projected outcome. Therefore, by integrating specific methods based on optimization, periodization, and personalization, further studies may overcome previous discrepancies within IMT research.