ABSTRACT
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
Background: The maximum static respiratory pressures, namely the maximum inspiratory pressure (MIP) and maximum expiratory pressure (MEP), reflect the strength of the respiratory muscles. These measures are simple, non-invasive, and have established diagnostic and prognostic value. This study is the first to examine the maximum respiratory pressures within the Brazilian population according to the recommendations proposed by the American Thoracic Society and European Respiratory Society (ATS/ERS) and the Brazilian Thoracic Association (SBPT). Objective: To establish reference equations, mean values, and lower limits of normality for MIP and MEP for each age group and sex, as recommended by the ATS/ERS and SBPT. Method: We recruited 134 Brazilians living in Belo Horizonte, MG, Brazil, aged 20-89 years, with a normal pulmonary function test and a body mass index within the normal range. We used a digital manometer that operationalized the variable maximum average pressure (MIP/MEP). At least five tests were performed for both MIP and MEP to take into account a possible learning effect. Results: We evaluated 74 women and 60 men. The equations were as follows: MIP=63.27-0.55 (age)+17.96 (gender)+0.58 (weight), r2 of 34% and MEP= - 61.41+2.29 (age) - 0.03(age2)+33.72 (gender)+1.40 (waist), r2 of 49%. Conclusion: In clinical practice, these equations could be used to calculate the predicted values of MIP and MEP for the Brazilian population. .
Contextualização: A medida das pressões respiratórias estáticas máximas (pressão inspiratória (PImáx) e pressão expiratória máxima (PEmáx)) refletem a força dos músculos respiratórios. Essas medidas são simples, não invasivas e têm valores diagnóstico e prognóstico estabelecidos. Este é o primeiro estudo que avaliou pressões respiratórias máximas com a população brasileira realizado de acordo com as recomendações propostas pela American Thoracic Society e European Respiratory Society (ATS/ERS) e pela Sociedade Brasileira de Pneumologia e Tisiologia (SBPT). Objetivo: Estabelecer equações de referência, valores médios e limites inferiores de normalidade para a PImáx e a PEmáx para cada faixa etária e gênero, conforme as recomendações da ATS/ERS e da SBPT. Método: Foram recrutados 134 brasileiros residentes em Belo Horizonte, MG, Brazil, com idade entre 20-89 anos, com prova de função pulmonar e índice de massa corporal dentro da normalidade. Foi utilizado um manovacuômetro digital que operacionalizou a variável pressão média máxima. Para a PImáx e a PEmáx, foram realizadas, pelo menos, cinco manobras, considerando o efeito aprendizado. Resultados: Foram avaliados 74 mulheres e 60 homens. As equações propostas foram: PImáx=63,27-0,55 (idade)+17,96 (sexo)+0,58 (peso), r2=34% e PEmáx=-61,41+2,29 (idade)-0,03 (idade2)+33,72 (sexo)+1,40 (cintura), r2=49%. Conclusão: As equações resultantes deste estudo poderão ser utilizadas na prática clínica para cálculo de valores preditos para PImáx e PEmáx na população brasileira. .