Comparison of Effects of Liuzijue Exercise and Conventional Respiratory Training on Patients after Cardiac Surgery: A Randomized Controlled Trial / 中国结合医学杂志

OBJECTIVE@#To evaluate the feasibility and safety of Liuzijue exercise (LE) for the clinical effect in patients after cardiac surgery.@*METHODS@#Totally 120 patients who underwent cardiac surgery and were admitted to the Cardiothoracic Intensive Care Unit of Nanjing Drum Tower Hospital between July and Oclober, 2022 were allocated to the LE group, the conventional respiratory training (CRT) group, and the control group by a random number table at a ratio of 1:1:1; 40 patients in each group. All patients received routine treatment and cardiac rehabilitation. LE group and CRT group respectively performed LE and CRT once a day for 30 min for 7 days. Control group did not receive specialized respiratory training. The forced vital capacity, forced expiratory volume in 1 s, peak inspiratory flow rate, peak expiratory flow rate, maximum inspiratory pressure, maximum expiratory pressure, modified Barthel index (MBI), and Hamilton Rating Scale for Anxiety (HAM-A) were evaluated before, after 3 and 7 days of intervention. In addition, the postoperative length of hospital stay (LOS) and the adverse events that occurred during the intervention period were compared.@*RESULTS@#A total of 107 patients completed the study, 120 patients were included in the analysis. After 3 days of intervention, the pulmonary function, respiratory muscle strength, MBI and HAM-A of all 3 groups improved compared with that before the intervention (P<0.05 or P<0.01). Compared with the control group, pulmonary function and respiratory muscle strength were significantly improved in the CRT and LE groups (P<0.05 or P<0.01). MBI and HAM-A were significantly improved in the LE group compared with the control and CRT groups (P<0.05 or P<0.01). On the 7th day after intervention, the difference was still statistically significant (P<0.01), and was significantly different from that on the 3rd day (P<0.05 or P<0.01). In addition, on the 7th day of intervention, the pulmonary function and respiratory muscle strength in the LE group were significantly improved compared with those in the CRT group (P<0.01). MBI and HAM-A were significantly improved in the CRT group compared with the control group (P<0.01). There were no significant differences in postoperative LOS among the 3 groups (P>0.05). No training-related adverse events occurred during the intervention period.@*CONCLUSIONS@#LE is safe and feasible for improving pulmonary function, respiratory muscle strength, the ability to complete activities of daily living and for relieving anxiety of patients after cardiac surgery (Registration No. ChiCTR2200062964).

Inspiratory muscle training can improve the pulmonary functioning, respiratory muscle strength and endurance of morbidly obese persons after bariatric surgery / 中华物理医学与康复杂志

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.

High-intensity inspiratory muscle resistance training can improve the exercise capacity and life quality of persons with bronchiectasis / 中华物理医学与康复杂志

Objective:To explore any effect of high-intensity inspiratory muscle resistance training on exercise capacity and life quality for persons with bronchiectasis.Methods:Sixty patients with bronchiectasis were randomly divided into an observation group and a control group, each of 30. The observation group received two 30-minute sessions of inspiratory muscle resistance training daily using the PowerBreak inspiratory muscle trainer 3 days/week for 8 weeks. The intensity was 70% of the maximum inspiratory pressure (MIP). The control group underwent the same training with the intensity at 10% of the MIP. The severity of illness, pulmonary function, respiratory muscle strength and endurance, exercise capacity and life quality of the two groups were evaluated before and after the intervention.Results:Compared with before the intervention, the average MIP in the observation group and the average distance they walked in the 6min walk test (6MWT) improved significantly. Their average social factor score on the Leicester cough questionnaire had increased significantly, while their average heart rate and self-perceived exertion during the 6MWT had decreased significantly. There were no significant differences in any of these indicators for the control group.Conclusions:High-intensity inspiratory muscle resistance training can significantly improve the exercise capacity and life quality of patients with bronchiectasis. The treatment is worthy of further research and application in the clinic.

Combining respiratory muscle training with feedback electrical stimulation can improve the pulmonary functioning and respiratory muscle strength of stroke survivors / 中华物理医学与康复杂志

Objective:To observe any short-term effect of combining respiratory muscle training with feedback respiratory electrical stimulation on the pulmonary function and respiratory muscle strength of stroke survivors.Methods:Sixty stroke survivors were randomly divided into an observation group ( n=30) and a control group ( n=30). Both groups were given conventional rehabilitation 6 days a week for 3 weeks, but the observation group also received respiratory muscle training with feedback electrical stimulation. Before and after the treatment, both groups′ pulmonary functioning and respiratory muscle strength were measured, and also their trunk control, skill in the activities of daily living and fatigue level. The trunk impairment scale (TIS), modified Barthel index (MBI) and fatigue severity scale (FSS) were used. The incidence of stroke-associated pneumonia (SAP) was also compared between the two groups. Results:After the treatment, average forced vital capacity, forced expiratory volume in 1 second, maximum voluntary ventilation, peak expiratory flow, maximum inspiratory pressure, maximum expiratory pressure, as well as the average TIS and MBI scores of both groups had improved significantly, and there was a significant decrease in the average FSS scores. After the intervention, all of the average measurements of the experimental group were significantly better than the control group′s averages except their MBI scores. There was no significant difference in the incidence of SAP.Conclusions:Three weeks of respiratory muscle training combined with electrical stimulation feedback can effectively improve the pulmonary function, respiratory muscle strength and inspiratory muscle endurance of stroke survivors, resulting in better coughing ability, trunk control and reduced fatigue.

Effects of respiratory muscle endurance training on lung function, respiratory muscle strength and the motor capacity of hypertense patients / 中华物理医学与康复杂志

Objective:To explore the effect of respiratory muscle endurance training on the blood pressure, lung function, respiratory muscle strength and motor capacity of persons with hypertension.Methods:Sixty persons with essential hypertension were randomly divided into an experimental group and a control group, each of 30. The experimental group received 8 weeks of inspiratory resistance training with an intensity of 55% of their maximum inspiratory air pressure (MIP) while the control group had an intensity of 10% MIP with the other training conditions the same as those of the experimental group. Both groups practiced 30 times as a set, two sets a day, 4 days a week. Blood pressure, lung function and respiratory muscle strength were measured before and after the intervention, and motor capacity was measured using the 6-minute walk test (6MWT).Results:After the intervention, the average MIP of the experimental group had increased significantly (to 123.6±13.9 from 83.5±9.8cmH 2O). The average 6MWT time of the experimental group had also improved significantly, but there were no significant differences in any of the control group observations. Conclusion:Eight weeks of respiratory muscle endurance training can improve the inspiratory muscle strength and motor capacity of patients with essential hypertension, but it has no effect on blood pressure or lung functioning.

Pre- and postoperative respiratory muscle strength, body mass index and fasting glucose profile of patients with type 2 diabetes mellitus submitted to metabolic surgery / Perfil de pacientes com diabetes mellitus tipo 2 quanto a força muscular respiratória, o índice de massa corpórea e a glicemia em jejum avaliados no pré e no pós-operatório de cirurgia metabólica

Abstract Introduction: The lung is considered a target organ in diabetes mellitus as a consequence of alterations secondary to chronic hyperglycemia that compromise respiratory muscle strength. Metabolic surgery for improving diabetes mellitus has beneficial effects on weight loss and glucose metabolism. Objective: The objective of this study was to evaluate the respiratory muscle strength, assessed by MIP and MEP, body mass index (BMI) and fasting glucose profile of patients with type 2 diabetes mellitus before and after metabolic surgery without gastric resection. Method: Seventeen patients with type 2 diabetes mellitus participated in the study. The participants had a mean age of 44.8 ± 11.81 years. Results: The results showed a significant decrease of MEP values ​​in the immediate postoperative period when compared to the preoperative period (p=0.001), while no significant results were obtained for MIP. Regarding BMI and fasting glucose, significant weight loss and a significant reduction in fasting glucose levels were observed in the late postoperative period (p=0.006 and p=0.007, respectively). Conclusion: The MIP and MEP were reestablished and satisfactory results were obtained for BMI and fasting glucose in the late postoperative period. Further studies are needed to monitor patients in the pre- and postoperative period of metabolic surgery, identifying complications and acting on the care and recovery of these patients.

Resumo Introdução: O pulmão é considerado um dos órgãos-alvo do diabetes mellitus, como consequência das alterações secundárias à hiperglicemia crônica, comprometendo a força muscular respiratória. A cirurgia metabólica para a melhora do diabetes mellitus exerce efeitos benéficos na perda de peso e no metabolismo da glicose. Objetivo: O objetivo deste estudo foi avaliar o perfil da força muscular respiratória, avaliada por PImáx e PEmáx, o índice de massa corporal (IMC) e a glicemia em jejum de pacientes com diabetes mellitus tipo 2 antes e após a cirurgia metabólica sem ressecção gástrica. Método: Dezessete pacientes com diabetes mellitus tipo 2 participaram do estudo. Os participantes tinham idade média de 44,8±11,81 anos. Resultados: Os resultados mostraram uma diminuição significativa dos valores da PEmáx no pós-operatório imediato, quando comparado ao pré-operatório (p = 0,001), enquanto não foram obtidos resultados significativos para a PImáx. Em relação ao IMC e à glicemia em jejum, observou-se perda significativa de peso e redução significativa dos níveis de glicemia de jejum no pós-operatório tardio (p = 0,006; p= 0,007, respectivamente). Conclusão: A PImáx e a PEmáx foram restabelecidas e resultados satisfatórios foram obtidos para IMC e glicemia de jejum no pós-operatório tardio. Mais estudos são necessários para monitorar pacientes no pré e pós-operatório de cirurgia metabólica, identificando complicações e atuando no cuidado e recuperação desses pacientes.

Effect of Threshold Inspiratory Muscle Training on Respiratory Muscle Function: A Meta-analysis / 中国康复理论与实践

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.

Effect of Inspiratory Muscle Trainer on Running Performance and Respiratory Muscle Strength in Athletes

Background: Athletes are trained for specific games and for specific muscle groups. In all the games respiratory muscles with proper strength are needed so as to provide better outcome. But as the peripheral muscles are trained the Respiratory muscles are not trained specifically in any of the athlete. The less trained Respiratory muscles can directly affect the output of the Athlete by activating Metaboreflex. This reflex is activated when the Respiratory muscles gets fatigued; in which the blood is pulled towards the fatigued Respiratory muscles; due to which the peripheral muscle gets less blood and oxygen to work longer; which results in reduced output. So as to improve overall output, along with specific muscles, the Respiratory muscles should also be trained. Aim: This study was designed to evaluate the effect of Inspiratory Muscle Trainer on Running Performance and Respiratory Muscle strength in Athletes. Materials and methods: An Interventional study was conducted on Athletes studying in a Physical Education college Gujarat. The subjects were selected according to inclusion criteria. The Pre-training outcome of PImax (Inspiratory Mouth Pressure); PEmax (Expiratory Mouth Pressure) and time taken for 30m sprint was taken. And then subjects were divided into two groups’ one training and other control. Group A: Training for Respiratory muscles by Inspiratory Muscle Training Device along with other regular physical activity. Group B: Not getting any additional training for Respiratory muscle other than regular physical activity. The training was given at 50% PImax for 15 min a day for 6 weeks. At the end of 6 weeks postdata of PImax PEmax and speed were collected. Agnihotri DS, Bhise AR, Patel SM. Effect of Inspiratory Muscle Trainer on Running Performance and Respiratory Muscle Strength in Athletes. IAIM, 2016; 3(8): 159-163. Page 160 Results: Data analysis was done using SPSS20 version. In Experimental group Inspiratory Mouth Pressure, Expiratory Mouth Pressure improved significantly (p<0.05) also time taken for completion of 30msprint reduced significantly. (p<0.05) Conclusion: The Inspiratory Muscle Trainer can be used to improve Inspiratory Mouth Pressure, Expiratory Mouth Pressure and Running Performance in Athletes.

Valores de referência para força muscular respiratória em crianças brasileiras / Reference values for respiratory muscle strength in brazilian children: a review

INTRODUCTION: Reference values and equations show strong variability and regional differences, despite a well-established role of the assessment of respiratory muscle strength (RMS) in children, with the objective to follow up on diseases that affect the function of respiratory muscles and enable adequate growth and development. OBJECTIVE: To describe reference values and prediction equations of maximal respiratory pressures for Brazilian children METHODS: Literature review was conducted using databases LILACS, MEDLINE and Science Direct, and descriptors established by DeCS of the Virtual Health Library: reference values, child, respiratory muscle strength, predictive equations and their respective synonyms in English RESULTS: Six clinical trials were carried out, which determined reference values for children in various Brazilian regions. There was a relationship among RMS values and other factors, such as age, height and body mass. However, there was a significant difference among the data in the Brazilian states and divergence among the predicted values CONCLUSION: There is a consensus on the relationship among RMS, anthropometric factors and regional influences. The articles studied reported diverging predicted values and reference equations

INTRODUÇÃO: Apesar da reconhecida importância da análise das pressões respiratórias máximas (PRM) em pediatria, tanto no seguimento de enfermidades que afetam a função dos músculos respiratórios, quanto da adequação do crescimento e desenvolvimento infantil, existe ampla variabilidade e regionalização quantos aos valores e equações de referência OBJETIVO: Descrever os valores de referência e equações preditivas das pressões respiratórias máximas para crianças brasileiras MÉTODO: Revisão de literatura realizada nas bases de dados LILACS, MEDLINE e Science Direct, utilizando os descritores estabelecidos pelo DeCS da Biblioteca Virtual em Saúde: valores de referência, criança, força muscular respiratória, equações preditivas, e seus sinônimos em inglês RESULTADOS: Encontrou-se seis ensaios clínicos, com valores de referência para a população pediátrica, realizados em diferentes regiões brasileiras. Observou-se relação entre os valores das PRM e fatores como idade, estatura e massa corporal. Porém, houve relevante diferença entre os dados nos estados brasileiros e divergência entre os valores preditos CONCLUSÕES: Há consenso ao relacionar as pressões respiratórias máximas e fatores antropométricos, bem como uma influência regional. Os valores preditos e as equações de referência foram divergentes entre os trabalhos encontrados PALAVRAS-CHAVE: valores de referência, criança, força muscular respiratória, equações preditivas

Hippotherapy and respiratory muscle strength in children and adolescents with Down syndrome / Equoterapia e força muscular respiratória em crianças e adolescentes com síndrome de Down

Introduction Individuals with Down syndrome may have decreased respiratory muscle strength due to hypotonia, a common characteristic in this population. Objective To analyze the effects of a hippotherapy program on respiratory muscle strength in individuals with Down syndrome. Materials and methods The study included 41 subjects, 20 of which were in the hippotherapy practicing group (PG) and 21 of which were in the non-practicing group (NPG). Study subjects were of both sexes, aged 7-13 years, and all diagnosed with Down syndrome. A manovacuometer was used to measure respiratory muscle strength, following the protocol proposed by Black and Hyatt (23). Statistical analysis was performed by means of descriptive distribution. After verifying normality and homoscedasticity of the variables, the Mann-Whitney test was used to determine differences between the means of the two groups (PG and NPG), and the Spearman’s rank correlation coefficient test was used to view possible relationships with age and time practicing hippotherapy. Significance was set at p < 0.05. Results and discussion Individuals who practiced hippotherapy showed improvements in both inspiratory and expiratory respiratory muscle strength, although no significant difference was demonstrated. Conclusion This study demonstrates that hippotherapy benefits respiratory muscle strength in individuals with Down syndrome, and that the youngest subjects had the best results. .

Introdução Os indivíduos portadores de síndrome de Down (SD) podem apresentar uma redução da força muscular respiratória, principalmente em função da hipotonia, característica comum nessa população. Objetivo Analisar o efeito de um programa de equoterapia sobre a força muscular respiratória em indivíduos com SD. Materiais e métodos Participaram do estudo 41 indivíduos, sendo 20 pertencentes ao grupo praticantes (GP) e 21 ao grupo não praticante (GNP), de ambos os sexos, com idades compreendidas entre 7 e 13 anos, todos diagnosticadas com síndrome de Down (SD). Utilizou-se a manovacuometria para aferição da força muscular respiratória, seguindo o protocolo proposto por Black e Hyatt (23). A análise estatística deu-se a partir de uma distribuição descritiva. Após verificado a normalidade e homocedasticidade das variáveis utilizou-se o teste de Mann Whitney para verificar as diferenças entre as médias dos grupos (GNP e GP), como a utilização do teste de correlação de Spearman para visualizar possíveis relações com a idade e o tempo de prática de equoterapia. Adotou uma significância de p < 0,05. Resultados e discussão Os indivíduos que realizavam a equoterapia apresentaram melhoras em relação à força muscular respiratória, tanto inspiratória (MIP) quando expiratória (MEP), embora não apresentando diferença significativa em relação ao grupo não praticante. Conclusão Este estudo demonstra que o programa de equoterapia apresenta benefícios na força muscular respiratória em indivíduos com SD e que principalmente os mais jovens obtiveram melhores resultados. .

Sniff Nasal Inspiratory Pressure in 299 Healthy Boys / 中国康复理论与实践

@#Objective To investigate the sniff nasal inspiratory pressure (SNIP) of Chinese boys. Methods 299 healthy boys aged 5-12 years were measured with SNIP. Their height, weight, and age were recorded. Results The SNIP averaged (76.9±22.6) cmH2O, and was (59.1±14.2) cmH2O, (76.9±19.5) cmH2O, (85.3±23.5) cmH2O and (83.0±22.6) cmH2O in the boys of 5-6 years old, 7-8 years old, 9-10 years old and 11-12 years old, respectively. It was significantly different among boys of 5-6 years old, 7-8 years old and 9-10 years old (P<0.05), but no significant difference between 9-10 years old and 11-12 years old (P=0.55). Regression analysis indicated significant relations of SNIP with age, height, weight and Body Mass Index (P<0.01). Conclusion The SNIP of Chinese healthy boys are different from abroad. It is necessary to establish the Chinese children SNIP reference range.

Sniff Nasal Inspiratory Pressure in 299 Healthy Boys / 中国康复理论与实践

Objective To investigate the sniff nasal inspiratory pressure (SNIP) of Chinese boys. Methods 299 healthy boys aged 5-12 years were measured with SNIP. Their height, weight, and age were recorded. Results The SNIP averaged (76.9 ± 22.6) cmH2O, and was (59.1±14.2) cmH2O, (76.9±19.5) cmH2O, (85.3±23.5) cmH2O and (83.0±22.6) cmH2O in the boys of 5-6 years old, 7-8 years old, 9-10 years old and 11-12 years old, respectively. It was significantly different among boys of 5-6 years old, 7-8 years old and 9-10 years old (P<0.05), but no significant difference between 9-10 years old and 11-12 years old (P=0.55). Regression analysis indicated significant relations of SNIP with age, height, weight and Body Mass Index (P<0.01). Conclusion The SNIP of Chinese healthy boys are different from abroad. It is necessary to establish the Chinese children SNIP reference range.

Evaluación de los músculos respiratorios en la parálisis diafragmática bilateral / Assessment of respiratory muscle strength in bilateral diaphragmatic paralysis

Measurement of respiratory muscle strength is useful in order to detect respiratory muscle weakness and to quantify its severity. Apropos of a patient with bilateral diaphragmatic paralysis, we review the clinical manifestations and methods for assessing the strength of the respiratory muscles. In patients with severe respiratory muscle weakness, vital capacity and total lung capacity are reduced but are a non-specific and relatively insensitive measure. Conventionally, inspiratory and expiratory muscle strength has been assessed by maximal inspiratory and expiratory mouth pressures sustained for one second (PIMax and PEMax). The sniffmanoeuvre is natural and probably easier to perform. Sniff pressures are more reproducible and useful measure of diaphragmatic strength. However, the PIMax-PEMax and sniff manoeuvres are volition dependent, and submaximal efforts are most likely to occur in patients who are ill or breathless. Non-volitional tests include measurements of twitch esophageal, gastric and transdiaphragmatic pressure during bilateral electrical and magnetic phrenic nerve stimulation. Electrical phrenic nerve stimulation is technically difficult and is also uncomfortable and painful. Magnetic phrenic nerve stimulation is less painful and transdiaphragmatic pressure is reproducible in normal subjects. Systematic clinical evaluation and additional laboratory tests allow the diagnosis in most patients with respiratory muscle weakness.

La evaluación de la fuerza de los músculos respiratorios permite diagnosticar y cuantificar la gravedad de la debilidad muscular en diferentes enfermedades. A propósito de un paciente con parálisis diafragmática bilateral, hemos revisado el cuadro clínico y los procedimientos diagnósticos para evaluar la fuerza de los músculos respiratorios. En los pacientes con debilidad muscular respiratoria severa, disminuye la capacidad vital y la capacidad pulmonar total, pero es una medida inespecífica y relativamente insensible. Tradicionalmente, la fuerza muscular respiratoria es evaluada midiendo la presión inspiratoria y espiratoria máximas en la boca sostenidas durante un segundo (PIMax y PEMax). La medición de la presión inspiratoria máxima en la nariz (SNIP) es una maniobra natural, más simple de medir y más reproducible, siendo útil en la evaluación de la fuerza diafragmática. Sin embargo, estas técnicas no invasivas son operador dependiente, por lo tanto, esfuerzos submáximos es más probable que ocurran en pacientes graves o con disnea. Las mediciones de las presiones esofágica, gástrica y transdiafragmática mediante estimulación eléctrica o magnética del nervio frénico no son dependientes de la voluntad y son más confiables. Sin embargo, la estimulación eléctrica del nervio frénico es técnicamente difícil y puede ser incómoda y dolorosa. La estimulación magnética del nervio frénico es menos dolorosa y la medición de la presión transdiafragmática es reproducible en sujetos normales. La evaluación clínica sistemática y los exámenes de laboratorio complementarios permiten establecer el diagnóstico en la mayoría de los pacientes con debilidad de los músculos respiratorios.

Sniff Nasal Inspiratory Pressure in 299 Healthy Boys / 中国康复理论与实践

@#Objective To investigate the sniff nasal inspiratory pressure (SNIP) of Chinese boys. Methods 299 healthy boys aged 5-12 years were measured with SNIP. Their height, weight, and age were recorded. Results The SNIP averaged (76.9±22.6) cmH2O, and was (59.1±14.2) cmH2O, (76.9±19.5) cmH2O, (85.3±23.5) cmH2O and (83.0±22.6) cmH2O in the boys of 5-6 years old, 7-8 years old, 9-10 years old and 11-12 years old, respectively. It was significantly different among boys of 5-6 years old, 7-8 years old and 9-10 years old (P<0.05), but no significant difference between 9-10 years old and 11-12 years old (P=0.55). Regression analysis indicated significant relations of SNIP with age, height, weight and Body Mass Index (P<0.01). Conclusion The SNIP of Chinese healthy boys are different from abroad. It is necessary to establish the Chinese children SNIP reference range.

Acute effects of different inspiratory resistive loading on heart rate variability in healthy elderly patients

BACKGROUND: The cardiovascular system is noticeably affected by respiration. However, whether different inspiratory resistive loading intensities can influence autonomic heart rate (HR) modulation remains unclear. OBJECTIVE: The objective was to investigate HR modulation at three different inspiratory resistive loading intensities in healthy elderly men. METHOD: This was a prospective, randomized, double-blind study that evaluated 25 healthy elderly men. Cardiac autonomic modulation was assessed using heart rate variability (HRV) indices. All of the volunteers underwent maximal inspiratory pressure (MIP) measurements according to standardized pulmonary function measurements. Three randomly-applied inspiratory resistive loading (30, 60 and 80% of MIP) intensities were then applied using an inspiratory resistance device (POWERbreathe, Southam, UK), during which the volunteers were asked to inhale for 2 seconds and exhale for 3 seconds and complete 12 breaths per minute. Each effort level was performed for 4 minutes, and HR and the distance between 2 subsequent R waves of electrocardiogram (R-R intervals) were collected at rest and at each intensity for further HRV analysis. RESULTS : The parasympathetic HRV (rMSSD, SD1 and HF) indices demonstrated lower values at 80% (rMSSD: 19±2 ms, SD1: 13±2 ms and HF: 228±61 ms2) than at 30% MIP (rMSSD: 25±3 ms, SD1: 18±2 ms and HF: 447±95 ms2; p<0.05). CONCLUSIONS: Lower inspiratory resistive loading intensities promoted a marked and positive improvement of parasympathetic sinus node modulation. .

Efeitos da técnica expansiva e incentivador respiratório na força da musculatura respiratória em idosos institucionalizados / Effects of expansive technical and incentive spirometry in respiratory muscle strength in institutionalized elderly

INTRODUÇÃO: O envelhecimento é um processo fisiológico que traz consigo várias alterações nos sistemas corporais, inclusive a diminuição de força da musculatura respiratória. OBJETIVO: Avaliar PImáx (pressão inspiratória máxima), PEmáx (pressão expiratória máxima) e pico de fluxo expiratório de idosos institucionalizados antes e após a aplicação de técnicas manuais expansivas e incentivador respiratório orientado a fluxo (Respiron®) e comparar os resultados obtidos. MATERIAIS E MÉTODOS: Estudo longitudinal, caso controle realizado em uma instituição da cidade de Curitiba (PR), com 16 indivíduos (70 a 80 anos) do sexo masculino. Os sujeitos foram selecionados e submetidos à avaliação da força da musculatura respiratória por meio do manovacuômetro da marca Indumed® e fluxo expiratório através do peak flow da marca Mini Wright®. Após a avaliação, a amostra foi dividida aleatoriamente em grupos: grupo 1 (G1, n = 7) - idosos submetidos ao uso incentivador inspiratório (Respiron®) e técnicas expansivas (exercícios diafragmáticos e compressão/descompressão); grupo 2 (G2, n = 7) - técnicas manuais expansivas; grupo 3 (G3, n = 7), incentivador inspiratório; grupo 4 (G4, n = 7) - grupo controle. RESULTADOS: Ocorreu melhora para todas as variáveis pré e pós-tratamento para os grupos experimentais, porém o destaque é dado para o grupo II. CONCLUSÃO: Este estudo apresentou resultados satisfatórios com a aplicação de técnicas de expansão pulmonar e Respiron® na força da musculatura respiratória e pico de fluxo expiratório de idosos institucionalizados.

INTRODUCTION: Aging is a physiological process that brings with it several changes in the body system, including the decrease in respiratory muscle strength. OBJECTIVE: To evaluate MIP (maximal inspiration pressure), MEP (maximal expiratory pressure) and expiratory flow peak of institutionalized elderly before and after application of manual techniques and expansive flow-oriented incentive spirometry (Respiron®), and compare the results obtained. MATERIALS AND METHODS: A longitudinal study, case control study in an institution in Curitiba (PR), with 16 male individuals (70-80 years old). The subjects were selected and evaluated for their respiratory muscle strength through the manometer Indumed® and expiratory peak flow through the flow of Mini Wright® brand. The treatment program was conducted for 15 minutes, interspersed with one minute rest every four minutes of technique, three times a week for six consecutive weeks. After evaluation, the sample was randomly divided into groups: group 1 (G1, n = 7) - elderly submitted to the use the encouraged inspiratory (Respiron®) and to expansive techniques (diaphragmatic breathing exercises and compression/decompression); group 2 (G2, n = 7) - manual expansive techniques; group 3 (G3, n = 7) - inspiratory incentive; group 4 (G4, n = 7) - control group. RESULTS: There was an improvement for all variables before and after treatment for the experimental groups, but the emphasis is given to group II. CONCLUSION: This study showed satisfactory results with the application of techniques for lung expansion and Respiron® in respiratory muscle strength and expiratory flow peak of institutionalized elderly.

Posicionamento corporal alterando a força muscular respiratória e o grau de obstrução em crianças asmáticas / Changes in postural position altering the respiratory muscle strength and level of obstruction in asthmatic children

INTRODUÇÃO: A asma é uma desordem inflamatória crônica que, em casos graves, altera o fluxo aéreo, mesmo no período intercrise. OBJETIVO: Verificar, em crianças asmáticas, a influência das posturas sentada ereta e sentada inclinada para frente sobre o efeito da nebulização medicamentosa, avaliando as forças inspiratória e expiratória máximas (PI máx e PE máx) e o pico de fluxo expiratório (PFE). MÉTODO: 57 crianças, na faixa etária de 6 a 12 anos, foram distribuídas em três grupos: Grupo I, com crianças na postura sentada ereta e sentada inclinada para frente; Grupo II, com crianças na postura sentada ereta antes e após a nebulização; e Grupo III, com crianças na postura sentada inclinada para frente antes e após a nebulização. As crianças foram avaliadas três vezes nas medidas analisadas. Para comparação, foi utilizado o teste t de student (pareado) RESULTADOS: A PI máx, a PE máx e o PFE foram maiores na posição sentada inclinada para frente, com p = 0,003, p = 0,006 e p = 0,000, respectivamente. Após a nebulização, o Grupo II apresentou aumentos de 44,16% na PI máx, 36,02% no PEF e 34,88% na PE máx. Após a nebulização, o Grupo III apresentou elevação de 69,46% na PI máx, 60,87% na PE máx e 52,05% no PFE. Comparados os grupos II e III, os ganhos são maiores no Grupo III, com (p < 0,05) para as medidas do PFE e da PE máx. CONCLUSÃO: A postura sentada inclinada para frente oferece maior vantagem mecânica para a musculatura expiratória, favorecendo a redução da obstrução, por evidenciar aumentos na PE máx e no PFE.

INTRODUCTION: Asthma is a chronic inflammatory disorder which in severe cases changes the air flow, even in the period between episodes. OBJECTIVE: To evaluate, in asthmatic children under the effect of nebulized drug, the influence of upright sitting and leaning forward sitting postures, by assessing the intensity of the inspiratory and expiratory pressures (MIP and MEP) and peak expiratory flow (PEF). METHODS: 57 children aged 6-12 years were divided in three groups: In Group I, both postures, upright sitting and leaning forward sitting, were assessed without using nebulized drug; in Group II, only the upright sitting posture was assessed before and after nebulization; in Group III, only the leaning forward sitting posture was assessed before and after nebulization. The measures were repeated by assessing these children three times in a single session. A student t-test (pared) was used for comparisons. RESULTS: MIP, MEP and PEF were higher in the leaning forward position indicating respective p values of p = 0.003, p = 0.006 and p = 0.000. After nebulization, the Group II demonstrated an increase of 44.16% in MIP, 36.02% in PEF and 34.88% in MEP. After nebulization, the Group III showed a gain of 69.46% in MIP, 60.87 in MEP and 52.05% in PEF. The difference between groups II and III were significant (p < 0.05) for levels of PEF and MEP, indicating that the Group III showed better performance during these tests. CONCLUSION: It can be suggested that the leaning forward sitting posture provided an increased mechanical advantage for expiratory muscles, favoring the airflow during expiration and reducing the obstruction as evidenced by MEP and PEF increase.

Evolution of respiratory muscle strength in post-operative gastroplasty / Evolução da força muscular respiratória no período pós-operatório de gastroplastia redutora

BACKGROUND: Obesity is a worldwide health problem that may also induce respiratory dysfunction. Literature linking weight loss and maximum respiratory pressures is inconclusive. OBJECTIVE: To evaluate longitudinally the maximum inspiratory pressure (MIP) and maximum expiratory pressure (MEP) of morbidly obese individuals before and after gastric bypass surgery, and to compare them to a control group matched by sex and age. METHODS: A vacuum manometer (GeRar®, SP, Brazil) was used to assess the MIP and MEP of 30 morbidly obese participants (24 women), aged 32±8 years and with body mass index (BMI) of 43±4 kg/m², both before and then one and six months after gastric bypass surgery. After an average of 36 months, 17 patients were reevaluated. A control group of 30 individuals with normal lung function (aged 30±8 with a BMI of 22±2 kg/m²) was also studied. An unpaired t-test and ANOVA for repeated measures were used for statistical analysis, with p<0.05 considered as significant. RESULTS: No significant differences were observed in the baseline evaluation between the two groups. A significant increase was found in MIP after approximately 36 months of surgery in the obese group. A significant decrease in MEP was observed after one month, as well as a significant increase after 36 months compared with one and six months post-surgery. CONCLUSION: The data showed a significant long-term increase in MIP, as well as a significant decrease in MEP after one month followed by a return to pre-operative values, which indicates that gastric bypass surgery has a positive influence on the strength of inspiratory muscles.

CONTEXTUALIZAÇÃO: A obesidade é um problema de saúde em todo o mundo e pode causar disfunção respiratória. A literatura que associa a perda de peso corporal às pressões respiratórias máximas (PRM) é inconclusiva. OBJETIVO: Avaliar, longitudinalmente, a pressão inspiratória máxima (PImáx) e a pressão expiratória máxima (PEmáx) de pacientes com obesidade mórbida antes e após gastroplastia redutora e compará-los a um grupo controle pareado por sexo e idade. MÉTODO: Um manovacuômetro (GeRar®, SP, Brasil) foi utilizado para avaliar PImáx e PEmáx de 30 participantes obesos (24 mulheres e seis homens, 32±8 anos), com índice de massa corporal (IMC) de 43±4 kg/m², antes da gastroplastia redutora e após um e seis meses. Após 36 meses, em média, foram reavaliados 17 obesos. Como grupo controle, foram avaliados 30 indivíduos com função pulmonar normal, 30±8 anos, e IMC de 22±2 kg/m². Para análise estatística, utilizou-se teste t de Student para grupos independentes e ANOVA para medidas repetidas. Um p<0,05 foi considerado significativo. Resultados: Não foram observadas diferenças significativas na avaliação inicial entre os dois grupos. Houve aumento significativo após 36 meses de cirurgia no grupo com obesidade em relação à PImáx. Em relação à PEmáx, houve diminuição significativa após um mês e aumento significativo após 36 meses, quando comparada com um e seis meses de cirurgia. CONCLUSÕES: Os dados demonstraram aumento significativo da PImáx em longo prazo, bem como redução significativa da PEmáx após um mês, seguido de um retorno aos valores de pré-operatório, indicando influência positiva da gastroplastia redutora sobre a força dos músculos inspiratórios.

Comparação da força muscular respiratória entre idosos sedentários e ativos: estudo transversal / Comparison between respiratory muscle strength in sedentary and active elderly. A Transversal Study

O envelhecimento gera diminuição da força muscular respiratória e a atividade física pode minimizar esse efeito. O objetivo deste estudo foi analisar se a força da musculatura respiratória de idosos sedentários difere daquela dos ativos. A amostra foi composta por 16 idosos, divididos em grupo ativo e inativo. Foram verificadas a pressão inspiratória máxima (PImáx) e a pressão expiratória máxima (PEmáx). O grupo ativo apresentou valores maiores. Concluímos que a atividade física reduziu as perdas de força muscular respiratória no grupo estudado.

Aging results in decreased respiratory muscle strength and physical activity can minimize this effect. The aim of this study was to analyze if the strength of respiratory muscles differs between sedentary and active elderly. The sample consisted of 16 subjects divided in active and inactive groups. It was measured the maximal inspiratory pressure (PImáx) and the maximal expiratory pressure (PEmáx). The active group had higher values. We conclude that physical activity reduced the loss of respiratory muscle strength in the study group.