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@#In the past two decades, adult cardiac surgery has developed by leaps and bounds in both anesthetic techniques and surgical methods, whereas the incidence of postoperative pulmonary complications (PPCs) has not changed. Until now PPCs are still the most common complications after cardiac surgery, resulting in poor prognosis, significantly prolonged hospital stays and increased medical costs. With the promotion of the concept of enhanced recovery after surgery (ERAS), pre-rehabilitation has been becoming a basic therapy to prevent postoperative complications. Among them, preoperative inspiratory muscle training as a very potential intervention method has been widely and deeply studied. However, there is still no consensus about the definition and diagnostic criteria of PPCs around the world; and there is significant heterogeneity in preoperative inspiratory muscle training in the prevention of pulmonary complications after cardiac surgery in adults, which impedes its clinical application. This paper reviewed the definition, mechanism, and evaluation tools of PPCs, as well as the role, implementation plan and challenges of preoperative inspiratory muscle training in the prevention of PPCs in patients undergoing cardiac surgery, to provide reference for clinical application.
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Objective:To observe any effect of threshold pressure loaded inspiratory muscle training on the balance of persons with Parkinson′s disease (PD).Methods:Forty-eight persons with PD were randomly divided into an observation group and a control group, each of 24. Both groups were given conventional neurological drug treatment and conventional rehabilitation training. The observation group additionally completed inspiratory muscle training using a threshold pressure load trainer, 5 days per week for 8 weeks. Before and after the treatment, both groups′ inspiratory muscle functioning was quantified using ultrasound to assess diaphragm mobility and thickness, and maximum inspiratory pressure (MIP). Balance was quantified using Trunk Injury Scale (TIS) scoring, the Berg Balance Scale (BBS), limits of stability (LOS), and the timed up and go test (TUGT). Walking was evaluated using the 10-metre walk test (10MWT) and the Dynamic Gait Index (DGI).Results:After the treatment all of the indicators had improved significantly in both groups, on average, but those of the observation group were then significantly better. Correlation analysis showed that the difference in MIP of the observation group before and after treatment was significantly negatively correlated with the TUGT and 10MWT times.Conclusion:Threshold pressure loaded inspiratory muscle training combined with conventional rehabilitation therapy significantly improves the inspiratory muscle strength, balance and walking of persons with PD.
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El asma bronquial es una enfermedad respiratoria crónica que genera elevados índices de discapacidad, sobre todo en la población infantil. La aplicación de fisioterapia respiratoria constituye un coadyuvante en los esquemas terapéuticos de la enfermedad; en este sentido el entrenamiento muscular inspiratorio y el método Buteyko constituyen técnicas respiratorias que han sido reportadas como útiles en el tratamiento del asma bronquial. La presente investigación tuvo como objetivo describir las ventajas que ofrecen ambos métodos como esquemas terapéuticos de niños con asma bronquial. Como principales resultados se describen una serie de estudios que muestran las ventajas de la implementación de estos métodos para mejorar distintos componentes de la patogenia y manifestaciones clínicas del asma bronquial. Estos estudios muestran que la aplicación indistinta de uno o ambos métodos mejora diversos aspectos entre los que sobresalen mejorar volúmenes y capacidades pulmonares, función pulmonar, fuerza muscular ventilatoria y la mecánica respiratoria. Adicionalmente, mejoran algunos elementos relacionados con la mecánica respiratoria como es el uso de la respiración bucal. Se concluye que la realización de la fisioterapia respiratoria en niños con asma bronquial constituye una alternativa viable y eficaz en el mejoramiento de varios parámetros relacionados con esta enfermedad. Diversos estudios demuestran que la aplicación de estas técnicas respiratorias mejora la capacidad respiratoria, el tono y trofismo de músculos respiratorios y la mecánica respiratoria. Los resultados positivos evidencian la necesidad de aumentar la implementación del entrenamiento muscular inspiratorio y el método Buteyko como esquema terapéutico en niños con asma bronquial en unidades de atención pública y privada(AU)
Bronchial asthma is a chronic respiratory disease that generates high rates of disability, especially in children. The application of respiratory physiotherapy constitutes an adjunct in the therapeutic schemes of the disease; in this sense, inspiratory muscle training and the Buteyko method constitute respiratory techniques that have been reported as useful in the treatment of bronchial asthma. The present investigation aimed to describe the advantages offered by both methods as therapeutic regimens for children with bronchial asthma. The main results are a series of studies that show the advantages of the implementation of these methods to improve different components of the etiopathogenesis and clinical manifestations of bronchial asthma. These studies show that the indistinct application of one or both methods improves different aspects, among which the improvement of lung volumes and capacities, lung function, ventilatory muscle strength and respiratory mechanics stand out. Additionally, they improve some elements related to respiratory mechanics such as the use of mouth breathing. It is concluded that the performance of respiratory physiotherapy in children with bronchial asthma constitutes a viable and effective alternative in the improvement of various parameters related to this disease. Several studies show that the use of these respiratory techniques improves respiratory capacity, tone and trophism of respiratory muscles, and respiratory mechanics. The positive results demonstrate the need to increase the implementation of inspiratory muscle training and the Buteyko method as a therapeutic scheme in children with bronchial asthma in public and private care units(AU)
Subject(s)
Humans , Male , Female , Child, Preschool , Child , Asthma/therapy , Physical Therapy Modalities/education , Respiratory Mechanics/ethicsABSTRACT
Objective:To explore the effect of inspiratory muscle training (IMT) on the pulmonary functioning, respiratory muscle strength and endurance of morbidly obesity persons after bariatric surgery.Methods:Thirty-six morbidly obese patients undergoing bariatric surgery were randomly divided into an experimental group and a control group. A 20-minute daily IMT intervention was administered on the 2nd through the 30th day after the operation. The intensities were 40% and 5% of the maximum inspiratory pressure (MIP). Forced vital capacity, forced expiratory volume in 1 second, maximum peak expiratory flow, maximum inspiratory pressure (MIP) and maximum expiratory pressure, as well as endurance were measured before the operation and on the 2nd, 7th, 14th and 30th day afterward.Results:By the 7th day the pulmonary function of the experimental group had recovered to the level before the operation. For the control group that took until the 14th day. On the 30th day after the operation the average MIP and inspiratory muscle endurance of the experimental group had increased significantly compared with before the operation, while the average MIP of the control group had decreased significantly.Conclusions:Inspiratory muscle training can improve inspiratory muscle strength and endurance and accelerate the recovery of lung function of morbidly obese persons after bariatric surgery.
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Objective:To evaluate the effectiveness of inspiratory muscle training in middle-aged and elderly patients with obstructive sleep apnea(OSA).Methods:The randomized controlled trials (RCT) on the effect of inspiratory muscle training in middle-aged and elderly patients with OSA were collected using the databases of PubMed, Embase, Cochrane Library, Web of Science, Chinese National Knowledge Infrastructure, Chinese Biomedical Literature Database and Wanfang database, the time was from the construction of the database to December 2020. The literature quality was evaluated and data were extracted from the included literature. RevMan5.3 software was used to analyze the collected data.Results:A total of 8 RCTs were included. Meta-analysis showed that inspiratory muscle training could reduce apnea hypopnea index(AHI)( P<0.05), Epworth Sleepiness Scale(ESS)( P<0.01) and Pittsburgh Sleep Quality Index(PQSI)( P<0.01), but had no effect on lowest oxygen saturation ( P>0.05). Conclusions:Inspiratory muscle training is a safe and feasible training method that can decrease AHI, ESS and PSQI in middle-aged and elderly patients with OSA.
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ABSTRACT Introduction: Inspiratory muscle training (IMT) has been shown to be an efficient method of improving exercise tolerance and inspiratory and expiratory muscle strength in several diseases. The effects of IMT on patients with sickle cell anemia (SCD) are relatively unknown. Our study aimed to evaluate the effects of IMT on adult SCD patients, regarding respiratory muscle strength (RMS) variables, lung function, exercise tolerance, blood lactation concentration, limitation imposed by dyspnea during daily activities and impact of fatigue on the quality of life. Methods: This was a randomized single-blind study, with an IMT design comprising true load (TG) and sham load (SG) groups. Initial assessment included spirometry, volumetric capnography (VCap) and measurement of RMS by maximal inspiratory and expiratory pressure (PImax and PEmax). The Medical Research Council dyspnea scale and modified fatigue impact scale were also applied and blood lactate concentration was measured before and after the 6-minute walk test. After this initial assessment, the patient used the IMT device at home daily, returning every 6 weeks for RMS reassessment. Both groups used the same device and were unaware of which group they were in. After a period totaling 18 weeks, patients underwent the final evaluation, as initially performed. Results: Twenty-five patients in total participated until the end of the study (median age 42 years). There were no significant differences between TG and SG based on age, sex, body mass index or severity of genotype. At the end of the training, both groups showed a significant increase in PEmax and PImax, improvement in Vcap and in exercise tolerance and dyspnea reduction while performing daily life activities. The same was observed in patients grouped according to disease severity (HbSS and HbSβ0 vs HbSC and HbSβ+), without differences between groups. Conclusion: Home-based inspiratory muscle training benefits outpatients with SCD, including the sham load group. Trial registration:http://www.ensaiosclinicos.gov.br; registration number: RBR-6g8n92.
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Breathing Exercises , Anemia, Sickle Cell , Inspiratory Capacity , Exercise Tolerance , Capnography , Maximal Respiratory PressuresABSTRACT
Objective:To explore the effect of inspiratory muscle training (IMT) on cardiac autonomic nerve function and the life quality of elderly women.Methods:Fifty-six healthy women aged 60 to 70 were randomly divided into an IMT group and a placebo control group (PLA), each of 28. The IMT group was given IMT training 5 times a week for 5 weeks with the inspiratory resistance set at 50% of their maximum inspiratory pressure (MIP). The PLA group was treated similarly, but the inspiratory resistance was set at the 5% of the MIP. Before and after the intervention, both groups were evaluated in terms of heart rate variability (HRV) at rest, and heart rate during the inspiratory phase (HR-in) and expiratory phase (HR-ex) of deep breathing. Their quality of like was quantified using the World Health Organization′s quality of life scale (WHOQOL-100).Results:After the intervention, the average MIP and high frequency power in the HRV spectrum had increased significantly, but the ratio of low frequency to high frequency power had decreased significantly in the IMT group. In deep breathing the average HR-in and HR-ex both had decreased significantly. The average scores on all dimensions of the WHOQOL-100 were significantly higher than before the intervention and higher than those of the control group. Indeed, there were no significant differences in the PLA group′s results before and after the intervention.Conclusions:Five weeks of IMT training can significantly improve the cardiac autonomic nerve function and life quality of elderly women. This provides a reference for prescribing rehabilitation exercise for such women.
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Respiratory training can prevent and treat nonspecific low back pain, mainly by activating the deep stabilizing muscles of trunk, establishing appropriate intra-abdominal pressure and optimizing the proprioceptive input of lumbar back, so as to maintain the stability and control of the spine. At present, the commonly used breathing training methods in clinic mainly include diaphragmatic breathing, inspiratory muscle training and abdominal breathing. However, the formulation of respiratory training prescriptions and the comparative study of therapeutic effects among different respiratory training methods still need to be further explored.
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Background: Surgical care has a role in treating a broad spectrum of diseases in the alleviation of human suffering. Upper abdominal surgery included gastrectomy, pancreatectomy, hepatic resection, cholecystectomy and splenectomy. Maximal inspiratory pressure (Pimax) is an important indicator for assessing the strength of inspiratory muscles. Respiratory muscle training devices enhance respiratory muscle strength, endurance and exercise capacity. Pressure Threshold IMT devices are usually handheld devices with a spring load that is impeded with different intensities. Incentive Spirometer is a form of ventilatory training that emphasis sustained maximum inspiration. Therefore, the present study aims to assess the effect of Threshold Inspiratory Muscle Training versus Incentive spirometry in participants with upper abdominal surgeries. Materials and Methods: A prospective cross-sectional comparative study was done with 30 participants with upper abdominal surgeries in the age group of 20 to 65. On Day 1 and after 2 weeks the maximal inspiratory pressure was measured using Hand Held Pressure Manometer Device (Pimax). Group A participants received Threshold Inspiratory Muscle Training (IMT) and Group B participants received Incentive spirometry. The intervention was given for 5 days in a week for 2 weeks. The duration for each session was of 15-30 minutes which also includes rest periods. Data was analyzed using student Paired ‘t’ test and Unpaired ‘t’ test. Result: There was extremely significant difference (p<0.0001) in Maximal Inspiratory Pressure (Pimax) in both the groups but Group A showed slightly more improvement were Threshold Inspiratory Muscle Training (IMT) was given as an intervention after 2 weeks. Conclusion: The study shows extremely significant improvement in Maximal Inspiratory Pressure (PImax) in both the groups. This study concluded that Threshold IMT has more effect than Incentive Spirometry in participants with upper abdominal surgeries.
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Objective@#To summarize the experience of respiratory tract management in a case of spinal muscular atrophy with neuromuscular scoliosis.@*Methods@#Respiratory tract nursing included prevention of pulmonary infection, inspiratory muscle training, rebuilding respiratory form before surgery, and assessment of sputum expectoration capacity, pain management, airway management after surgery.@*Results@#The patient was discharged without pulmonary complications.@*Conclusions@#For patient with breathing problem, respiratory tract management can prevent pulmonary complications during perioperative period.
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Objective:To evaluate the effect of threshold inspiratory muscle training (TIMT) on respiratory muscle strength and clinical outcomes for machinery ventilates patients. Methods:The Cochrane Library, PubMed, Embase, Web of Science, CBM, Wanfang Database, CNKI and VIP were searched for the randomized controlled trials (RCT) about the effect of TIMT on respiratory muscle strength and clinical outcomes from establishment to July 1st, 2018. Two researchers strictly evaluated literature quality and extracted information, and then a Meta-analysis was carried out. Results:A total of 14 literatures were included with 650 patients, 323 cases in the experimental group and 327 cases in the control group. Compared with the control group, the massive inspiratory pressure (MIP) increased (MD = -6.65, 95%CI -8.27~-5.03, P < 0.001), the respiratory muscle strength increased (MD = -5.04, 95%CI -7.68~-2.04, P = 0.0002), the weaning time reduced (MD = -1.01, 95%CI -1.65~-0.37, P = 0.002), the mechanical ventilation time shortened (MD= -2.24, 95%CI -4.33~-0.15, P = 0.04), as well as the intensive care unit (ICU) length of stay (MD= -3.41, 95%CI -6.06~-0.76, P= 0.01). There was no significant difference in maximum expiratory pressure (MEP) (MD= 1.22, 95%CI -6.55~9.00, P = 0.76), the rate of reintubation/tracheotomy (RR = 0.99, 95%CI 0.56~1.73, P = 0.96) and mortality (RR= 1.05, 95%CI 0.53~2.06, P = 0.89) between two groups. Conclusion:TIMP could improve MIP and respiratory muscle strength of patients with mechanical ventilation, shorten the weaning time, the mechanical ventilation time and the ICU length of stay, and then reduce the incidence of weaning failure.
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Objective To summarize the experience of respiratory tract management in a case of spinal muscular atrophy with neuromuscular scoliosis. Methods Respiratory tract nursing included prevention of pulmonary infection, inspiratory muscle training, rebuilding respiratory form before surgery, and assessment of sputum expectoration capacity ,pain management, airway management after surgery. Results The patient was discharged without pulmonary complications. Conclusions For patient with breathing problem, respiratory tract management can prevent pulmonary complications during perioperative period.
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OBJECTIVE: Aging is progressive, and its effects on the respiratory system include changes in the composition of the connective tissues of the lung that influence thoracic and lung compliance. The Powerbreathe® K5 is a device used for inspiratory muscle training with resistance adapted to the level of the inspiratory muscles to be trained. The Pilates method promotes muscle rebalancing exercises that emphasize the powerhouse. The aim of this study was to evaluate the influence of inspiratory muscle training combined with the Pilates method on lung function in elderly women. METHODS: The participants were aged sixty years or older, were active women with no recent fractures, and were not gait device users. They were randomly divided into a Pilates with inspiratory training group (n=11), a Pilates group (n=11) and a control group (n=9). Spirometry, manovacuometry, a six-minute walk test, an abdominal curl-up test, and pulmonary variables were assessed before and after twenty intervention sessions. RESULTS: The intervention led to an increase in maximal inspiratory muscle strength and pressure and power pulmonary variables (p<0.0001), maximal expiratory muscle strength (p<0.0014), six-minute walk test performance (p<0.01), and abdominal curl-up test performance (p<0.00001). The control group showed no differences in the analyzed variables (p>0.05). CONCLUSION: The results of this study suggest inspiratory muscle training associated with the Pilates method provides an improvement in the lung function and physical conditioning of elderly patients.
Subject(s)
Humans , Female , Middle Aged , Aged , Respiratory Muscles/physiology , Breathing Exercises/methods , Exercise Movement Techniques/methods , Lung/physiology , Exercise/physiology , Vital Capacity/physiology , Forced Expiratory Volume/physiology , Walk Test , Maximal Respiratory Pressures , Healthy Aging/physiologyABSTRACT
Objective: To explore the effect of adopting inspiratory muscle training of heavy load of deep breathing trainer for exercise tolerance and breathing difficulty level of patient with chronic obstructive pulmonary disease COPD in stable stage.Methods: 108 patients with COPD in stable stage were divided into observation group(54 cases)and control group(54 cases).Patients of control group received resistance training of inspiratory muscle of low load(9 cm H2O)of deep breathing trainer.And that of observation group received inspiratory muscle training of heavy load(the maximum inspiratory pressure was 60％)of deep breathing trainer,and this training was arranged at morning and evening(the time of each training was 15 min)of every day,and the training included 6 times in each week,and the total training time was 6 months.And then the exercise tolerance(6 min walk distance,6MWD),the step number of pedometer,the score of breathing scale of modified medical British research council(mMRC)and lung function were compared.Results: The 6MWD and step number of pedometer of observation group of 1 month,3 months and 6 months post training were significantly higher than that of control group(t=12.365,t=13.254,t=12.845,P＜0.05),respectively.And the score of dyspnea of mMRC of observation group of 1 month,3 months and 6 months post training were significantly better than that of control group(t=4.365,t=4.021,t=4.325,P＜0.05),respectively.And the forced expiratory volume in one second(FEV1),FEV1％and the ratio of FEV1 and FVC％of lung function of 1 month,3 months and 6 months post training were significantly better than that pre training(F=3.265,F=2.985,F=2.963,P＜0.05).And the differences of the three indicators between observation group and control group were significant(F=3.474,F=3.146,F=3.271,P＜0.05).Conclusion: For patients with COPD in stable stage,the inspiratory muscle training of heavy load of deep breathing trainer can enhance exercise tolerance of patient,and relieve their symptom of dyspnea and improve lung function of patients.
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A síndrome pós-pólio (SPP) é a recidiva dos sintomas da poliomielite anterior aguda (PAA), e o quadro é caracterizado por fraqueza muscular flácida assimétrica, com frequente comprometimento respiratório e de deglutição, além dos distúrbios de sono. O presente estudo relata o caso de uma paciente idosa, em ventilação mecânica domiciliar. Investiu-se no treinamento muscular inspiratório (TMI) com Powerbreathe® por 30 repetições por 2 vezes ao dia, durante 4 semanas, associado a um programa de exercícios físicos. Tal estratégia apresentou como desfecho o desmame da ventilação mecânica (VM), assim como melhora concomitante na Pimax e Mensuração de Independência Funcional (MIF), retornando ao final deste curto programa de reabilitação a realizar atividades laborais em domicílio. O presente relato de caso conclui que o emprego da TMI em pacientes com SPP pode ser uma estratégia promissora para o desmame ventilatório. (AU)
The post-polio syndrome (PPS) is the recurrence of the symptoms of acute anterior poliomyelitis (AAP), and characterized by asymmetrical flaccid muscle weakness, with respiratory and swallowing impairment, in addition to sleep disorders. The present study reports the case of an elderly patient in home mechanical ventilation. We invested in inspiratory muscle training (IMT) ® with Powerbreathe for 30 repetitions, twice daily, during 4 weeks, associated with a program of physical exercise. This strategy showed weaning from mechanical ventilation (MV), as well as a concomitant improvement in Pimax and Functional Independence Measure (FIM), returning at the end of this short rehabilitation program to perform work activities at home. This case study concludes that the use of IMT in patients with PPS may be a promising strategy for weaning. (AU)
Subject(s)
Humans , Aged , Postpoliomyelitis Syndrome , Ventilator Weaning , Muscle Weakness , Respiration, ArtificialABSTRACT
Dyspnea is an important issue for the patients with chronic heart failure. Breathing training, especially the inspiratory muscle training can help to improve the patients′ cardiopulmonary function, endurance and quality of life. In this paper, the foreign research about the method, effect evaluation and appropriate case of inspiratory muscle training in patients with chronic heart failure were reviewed so as to explore a specific strategy of inspiratory muscle training for China′s patients with chronic heart failure.
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Objective To investigate the effect of preoperative and postoperative inspiratory muscle training(IMT) on cardiopulmonary function and quality of life for patients undergoing esophagectomy.Methods Sixty patients who had received esophagectomy for esophageal cancer were randomly divided into an observation group (n =30) and a control group (n =30).All of the subjects were given conventional treatment (including preoperative health education,abdominal respiration training,pursed lip respiration training and expectoration training).On this basis,the patients in the treatment group were advised to do deep respiratory training using a breathing training device,four times a day,lasting 20 minutes each time,for 10 days (including five days before and five days after the operation).Respiratory muscle strength,blood gases,six minute walk test (6MWT) distances and Borg dyspnea scores were measured on admission,on the day prior to the operation and on the 1st,3rd and 5th day after the operation.And also on admission and on the 5th day after the operation their pulmonary function was tested,and their psychological status and quality of life were evaluated using the hospital anxiety and depression scale (HADS) and the Nottingham health profile (NHP) respectively.Results There was no significant difference in any index between the two groups on admission(P ＞ 0.05).Everyone's respiratory function and exercise capacity were sharply decreased,and Borg dyspnea score increased on the first postoperative day,and then gradually and significantly improved in both groups compared to that on admission(P ＜ 0.05).On the fifth postoperative day,the maximal inspiratory pressure of 67.41 ± 14.53 mmH2O,maximal ventilatory volume of 79.83 ± 5.37 L,6MWT of 427.19 ± 46.52 m,Borg score of 1.45 ± 0.48 points,postoperative anxiety score of 8.14 ±2.80 points,NHP total (128.91 ± 25.12 points),NHP pain score (24.66 ± 10.12 points),NHP sleeping score (25.18 ± 9.75 points),and NHP physical activity scores (22.81 ± 10.72 points) were significantly more improved in the observation group than those in the control group(P ＜ 0.05).Conclusion Preoperative and postoperative inspiratory muscle training can significantly reduce postoperative anxiety symptoms,improve postoperative cardiopulmonary function and the quality of life during perioperative period.Such therapy deserves further clinical research.
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BACKGROUND: Heart failure induces histological, metabolic and functional adaptations in the inspiratory muscles. This inspiratory muscle weakness, which occurs in 30% to 50% of the heart failure patients, is associated with reduction in the functional capacity, reduction in the quality of life and with a poor prognosis in these individuals. OBJECTIVES: The objective of this review was to discuss the pathophysiological mechanisms that may explain the role of the inspiratory muscles in the exercise limitation with focus in the reflexes that control the ventilation and the circulation during the exercise. METHOD: We performed searches in the PUBMED database using the terms "inspiratory muscles", "inspiratory muscle training", "metaboreflex" and chemoreflex" and including studies published since 1980. RESULTS: Inspiratory muscle weakness is associated with exercise intolerance and with an exaggerated inspiratory chemoreflex and metaboreflex in heart failure. The inspiratory metaboreflex may be attenuated by the inspiratory muscle training or by the aerobic exercise training improving the exercise performance. CONCLUSIONS: Patients with heart failure may present changes in the inspiratory muscle function associated with inspiratory chemoreflex and metaboreflex hyperactivity, which exacerbate the exercise intolerance.
CONTEXTUALIZAÇÃO: A insuficiência cardíaca (IC) acarreta alterações histológicas, metabólicas e funcionais dos músculos inspiratórios. A fraqueza dos músculos inspiratórios, que ocorre em 30% a 50% dos pacientes com IC, associa-se com a redução da capacidade funcional, prejuízos para a qualidade de vida e piora no prognóstico desses indivíduos. OBJETIVOS: Discutir os mecanismos fisiopatológicos que potencialmente explicam o papel da musculatura inspiratória na limitação ao exercício, abordando-se os reflexos que controlam a ventilação e a circulação durante o exercício. MÉTODO: Foram realizadas pesquisas na base de dados PUBMED, utilizando os termos inspiratory muscles, inspiratory muscle training, metaborreflex e chemoreflex e incluindo estudos publicados desde 1980. RESULTADOS: A fraqueza muscular inspiratória está relacionada com intolerância ao exercício e com exacerbação do quimiorreflexo e do metaborreflexo inspiratório na IC. O metaborreflexo inspiratório pode ser atenuado pelo treinamento muscular inspiratório ou pelo treinamento aeróbico, melhorando o desempenho ao exercício. CONCLUSÕES: Os pacientes com IC podem apresentar alterações da função muscular inspiratória associadas com hiperatividade quimiorreflexa e metaborreflexa inspiratória, as quais podem agravar a intolerância ao exercício.
Subject(s)
Humans , Exercise , Heart Failure/physiopathology , Respiratory Muscles/physiopathology , Reflex , Respiratory Muscles/metabolismABSTRACT
Respiratory muscle weakness is observed in chronic obstructive pulmonary disease (COPD) patients and contributes to hypoxemia, hypercapnia, dyspnoea, nocturnal oxygen desaturation and reduced exercise performance. During exercise it has been shown that diaphragm work is increased in COPD and COPD patients use a larger proportion of the maximal inspiratory pressure (PImax) than healthy subjects. This pattern of breathing is closely related to the dyspnoea sensation during exercise and might potentially induce respiratory muscle fatigue. However, diaphragmatic fatigue was not demonstrated after exhaustive exercise. Studies in patients with COPD have shown natural adaptations of the diaphragm to greater oxidative capacity and resistance to fatigue. The above mentioned considerations gave conflicting arguments to the rationale of inspiratory muscle training (IMT) in COPD. Both IMT alone and IMT as adjunct to general exercise reconditioning significantly increased inspiratory muscle strength and endurance. A significant effect was found for dyspnoea at rest and during exercise. Improvedfunctional exercise capacity tended to be an additional effect of IMT alone and as an adjunct to general exercise reconditioning, but this trend did not reach statistical significance. No significant correlations were found for training effects with patient characteristics. However, subgroup analysis in IMTplus exercise training revealed that patients with inspiratory muscle weakness improved significantly more compared to patients without inspiratory muscle weakness. From this review it is concluded that inspiratory muscle training is an important addition to a pulmonary rehabilitation programme directed at chronic obstructive pulmonary disease patients with inspiratory muscle weakness. The effect on exercise performance is still to be determined. In summary, IMT improves inspiratory muscle strength and endurance, functional exercise capacity, dyspnoea and quality of life. Inspirat...
Los pacientes con enfermedad pulmonar obstructiva crónica (EPOC) tienen debilidad de los músculos respiratorios, lo cual contribuye a la disnea, hipoxemia, hipercapnia, desaturación nocturna y limitación de la actividad física. Durante el ejercicio se ha demostrado que aumenta el trabajo del diafragma en pacientes con EPOC y utilizan una mayor proporción de la presión inspiratoria máxima (PImax) comparado con los sujetos sanos. Elpatrón respiratorio anormal de los pacientes con EPOC está relacionado con la sensación de disnea durante el ejercicio y, potencialmente, podría inducir a la fatiga muscular respiratoria. Sin embargo, la fatiga del diafragma no se ha demostrado después de un ejercicio intenso. Los estudios en pacientes con EPOC han demostrado cambios adaptativos en las fibras musculares del diafragma que tienen mayor capacidad oxidativa y resistencia a la fatiga. De este modo, existen argumentos contradictorios en relación al beneficio clínico obtenido con el entrenamiento de los músculos inspiratorios (EMI) en pacientes con EPOC. El EMI aislado o como complemento de ejercicios de reacondicionamiento general aumenta significativamente la fuerza muscular inspiratoria y la resistencia a la fatiga, disminuyendo significativamente la disnea en reposo y durante el ejercicio. Además, los estudios sugieren que el EMI tiende a mejorar la capacidad funcional para realizar ejercicio, efecto favorable que no alcanzó significación estadística. El análisis de subgrupos ha demostrado mayor beneficio clínico del EMI en los pacientes con debilidad muscular inspiratoria. De esta revisión se concluye que el entrenamiento muscular inspiratorio puede ser útil en pacientes seleccionados con enfermedad pulmonar obstructiva crónica, que tienen disfunción muscular inspiratoria comprobada, insertado en un programa de rehabilitación integral. El efecto sobre la capacidad de realizar ejercicio aún no ha sido determinado. En resumen, el EMI aumenta la fuerza muscular inspirator...