Efficacy of Respiratory Muscle Training in the Immediate Postoperative Period of Cardiac Surgery: A Systematic Review and Meta-Analysis

ABSTRACT Introduction: This study aimed to evaluate the efficacy of respiratory muscle training during the immediate postoperative period of cardiac surgery on respiratory muscle strength, pulmonary function, functional capacity, and length of hospital stay. Methods: This is a systematic review and meta-analysis. A comprehensive search on PubMed®, Excerpta Medica Database (or Embase), Cumulative Index of Nursing and Allied Health Literature (or CINAHL), Latin American and Caribbean Health Sciences Literature (or LILACS), Scientific Electronic Library Online (or SciELO), Physiotherapy Evidence Database (or PEDro), and Cochrane Central Register of Controlled Trials databases was performed. A combination of free-text words and indexed terms referring to cardiac surgery, coronary artery bypass grafting, respiratory muscle training, and clinical trials was used. A total of 792 studies were identified; after careful selection, six studies were evaluated. Results: The studies found significant improvement after inspiratory muscle training (IMT) (n = 165, 95% confidence interval [CI] 9.68, 21.99) and expiratory muscle training (EMT) (n = 135, 95% CI 8.59, 27.07) of maximal inspiratory pressure and maximal expiratory pressure, respectively. Also, IMT increased significantly (95% CI 19.59, 349.82, n = 85) the tidal volume. However, no differences were found in the peak expiratory flow, functional capacity, and length of hospital stay after EMT and IMT. Conclusion: IMT and EMT demonstrated efficacy in improving respiratory muscle strength during the immediate postoperative period of cardiac surgery. There was no evidence indicating the efficacy of IMT for pulmonary function and length of hospital stay and the efficacy of EMT for functional capacity.

Impacto del Entrenamiento Respiratorio de Hiperpnea Isocápnica Voluntaria sobre el Costo Energético asociado a la Respiración inducido por Ejercicio Físico / Impact of Voluntary Isocapnic Hyperpnea training on the cost of breathing

Introducción. Determinar el efecto de ocho semanas de entrenamiento por hiperpnea isocápnica voluntaria (HIV) sobre el costo energético asociado a la respiración (COB) reflejado en los cambios en la oxigenación de los músculos intercostales (∆SmO2-m. intercostales) inducida por ejercicio físico de intensidad incremental. Métodos. Doce participantes físicamente activos fueron entrenados durante ocho semanas de HIV 3 días x semana, 12 minutos, al 60% de ventilación voluntaria máxima (VVM). En la semana previa y posterior al entrenamiento HIV se realizó un test cardiopulmonar (CPET) de intensidad incremental en cicloergómetro, durante esta prueba se registró la ∆SmO2-m. intercostales mediante el dispositivo MOXY®. El efecto de HIV sobre la ∆SmO2-m. intercostales se analizó mediante la prueba two-way mixed ANOVA considerando los factores (fase × tarea). Resultados. ∆SmO2-m.intercostales fue significativamente menor a partir del 30% (­5,0±4,7%; p<0.01) hasta el 100% (­10,6±12,8%; p<0.01) de la tarea luego de ocho semanas de HIV. Además, se reportó un aumento de la presión inspiratoria máxima (PIM)=16,5±11,4 cmH2O (p<0.01); y de la resistencia muscular respiratoria=106,6±149,0 s (p<0.01). El tiempo total de ejercicio aumentó en 106,6±149,0 s (p=0.04), así como la carga total en 10,50± 10,12 vatios (p<0.01). Conclusión. El HIV disminuye el COB inducido por ejercicio incremental asociado a un incremento en la performance física y de los músculos respiratorios. En futuros estudios se sugiere estudiar esta estrategia de entrenamiento analítico de los músculos respiratorios en usuarios con limitación física relacionada al aumento prematuro del COB.

Background. Objetive. To determine the effect of eight weeks of voluntary isocapnic hyperpnea (VIH) training on cost of breathing (COB) as reflected by intercostales muscles deoxygenation (∆SmO2-m. intercostales) induced by incremental-intensity physical exercise. Methods. Twelve physically active participants underwent eight weeks of VIH training, three days a week, for 12 minutes each session, at 60% of maximal voluntary ventilation (MVV). In the week before and after VIH training, a cardiopulmonary test (CPET) of incremental intensity was performed on a cycloergometer. During this test, intercostal ∆SmO2-m.intercostales was recorded using the MOXY® device. The effect of VIH on ∆SmO2-m.intercostales were analyzed using a two-way mixed ANOVA test considering the factors (phase × task). Results. ∆SmO2-m.intercostales significantly decreased from 30% (­5.0±4.7%; p<0.01) to 100% (­10.6±12.8%; p<0.01) of the task after eight weeks of VIH. Additionally, an increase in maximal inspiratory pressure (MIP) of 16.5±11.4 cmH2O (p<0.01) and respiratory muscle endurance of 106.6±149.0 s (p<0.01) was reported. Total exercise time increased by 106.6±149.0 s (p=0.04), as well as total workload by 10.50±10.12 watts (p<0.01). Conclusion. VIH reduces COB induced by incremental exercise and is associated with increased physical and respiratory muscle performance. Future studies should explore this respiratory muscle training strategy for individuals with physical limitations related to a premature increase in COB.

Effects of Inspiratory Muscle Training in Type 2 Diabetes: A Systematic Review

ABSTRACT Introduction: People with type 2 diabetes mellitus present multiple complications and comorbidities, such as peripheral autonomic neuropathies and reduced peripheral force and functional capacity. Inspiratory muscle training is a widely used intervention with numerous benefits for various disorders. The present study aimed to conduct a systematic review to identify inspiratory muscle training effects on functional capacity, autonomic function, and glycemic indexes in patients with type 2 diabetes mellitus. Methods: A search was carried out by two independent reviewers. It was performed in PubMed®, Cochrane Library, Latin American and Caribbean Literature in Health Sciences (or LILACS), Physiotherapy Evidence Database (PEDro), Embase, Scopus, and Web of Science databases. There were no restrictions of language or time. Randomized clinical trials of type 2 diabetes mellitus with inspiratory muscle training intervention were selected. Studies' methodological quality was assessed using PEDro scale. Results: We found 5,319 studies, and six were selected for qualitative analysis, which was also conducted by the two reviewers. Methodological quality varied - two studies were classified as high quality, two as moderate quality, and two as low quality. Conclusion: It was found that after inspiratory muscle training protocols, there was a reduction in the sympathetic modulation and an increase in functional capacity. The results should be carefully interpreted, as there were divergences in the methodologies adopted, populations, and conclusions between the studies evaluated in this review.

Inspiratory muscle training as adjuvant therapy in obstructive sleep apnea: a randomized controlled trial

The aim of this randomized controlled trial was to analyze the effects of an inspiratory muscle training (IMT) program on apnea and hypopnea index (AHI), inspiratory muscle strength, sleep quality, and daytime sleepiness in individuals with obstructive sleep apnea (OSA), whether or not they used continuous positive airway pressure (CPAP (+/−) therapy. The intervention group underwent IMT with a progressive resistive load of 40-70% of the maximum inspiratory pressure (PImax) for 30 breaths once a day for 12 weeks. The control group was submitted to a similar protocol, but with at a minimum load of 10 cmH2O. Changes in the AHI were the primary outcome. PImax was measured with a digital vacuometer, daytime somnolence was measured by the Epworth sleepiness scale (ESS), and the quality of sleep by the Pittsburgh Sleep Quality Index (PSQI). CPAP use was treated as a confounder and controlled by stratification resulting in 4 subgroups: IMT−/CPAP−, IMT−/CPAP+, IMT+/CPAP−, and IMT+/CPAP+. Sixty-five individuals were included in the final analysis. Significant variations were found in the 4 parameters measured throughout the study after the intervention in both CPAP− and CPAP+ participants: PImax was increased and AHI was reduced, whereas improvements were seen in both ESS and PSQI. The twelve-week IMT program increased inspiratory muscle strength, substantially reduced AHI, and had a positive impact on sleep quality and daytime sleepiness, whether or not participants were using CPAP. Our findings reinforce the role of an IMT program as an adjunct resource in OSA treatment.

The effect of respiratory muscle training combined with occupational therapy on the upper limb function of stroke survivors / 中华物理医学与康复杂志

Objective:To observe the effect of combining respiratory muscle training with occupational therapy in rehabilitating the upper limb function of stroke survivors.Methods:Fifty stroke survivors with upper limb dysfunction were randomly divided into an observation group and a control group, each of 25. Both groups were given routine rehabilitation treatment including proper positioning of the affected limb, physical therapy and motor function training. The observation group also received progressive resistance training of the inspiratory muscles and respiration control training combined with occupational therapy twice daily for 4 weeks. The trunk control test (TCT), Berg balance scale (BBS), Fugl-Meyer Upper Extremity Assessment (FMA-UE), Action Research Arm Test (ARAT), Modified Ashworth Scale (MAS) for the Hemiplegic Upper Limb and the Modified Barthel Index (MBI) were used to assess the core stability, balance, upper limb functioning, upper limb muscle tension and ability in the activities of daily living of all of the subjects.Results:Before the treatment there were no significant differences in any of the indexes between the two groups. Afterward the average TCT, BBS, FMA-UE, ARAT, MAS and MBI scores of both groups had improved significantly, but the improvements were all significantly greater in the observation group.Conclusions:Combining respiratory muscle training with occupational therapy can further improve the function of the upper limbs and daily living ability beyond what is observed with traditional rehabilitation therapy after a stroke.

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.

Pulmonary rehabilitation for COVID-19: a living systematic review protocol

Objective This living systematic review aims to provide a timely, rigorous and continuously updated summary of the evidence available on the role of pulmonary rehabilitation in the treatment of patients with COVID-19. Design This is the protocol of a living systematic review. Data sources We will conduct searches in the L·OVE (Living OVerview of Evidence) platform for COVID-19, a system that maps PICO questions to a repository maintained through regular searches in electronic databases, preprint servers, trial registries and other resources relevant to COVID-19. No date or language restrictions will be applied. Eligibility criteria for selecting studies and methods We adapted an already published common protocol for multiple parallel systematic reviews to the specificities of this question. We will include randomized trials evaluating the effect of pulmonary rehabilitation as monotherapy or in combination with other interventions-versus sham or no treatment in patients with COVID-19. Two reviewers will independently screen each study for eligibility, extract data, and assess the risk of bias. We will pool the results using meta-analysis and will apply the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system to assess the certainty of the evidence for each outcome. Ethics and dissemination No ethics approval is considered necessary. The results of this review will be widely disseminated via peer-reviewed publications, social networks and traditional media.

Programa Condicionamento Vocal e Respiratório (CVR): proposta de intervenção para profissionais da voz / Vocal and Respiratory Conditioning (VRC) Program: intervention proposal for voice professional / Programa de Condicionamiento Vocal y Respiratorio (CVR): propuesta de intervención para profesionales de la voz

Programas de intervenção para profissionais da voz podem englobar estratégias de treinamento muscular vocal e respiratório. Neste tipo de abordagem, a integração de ações fonoaudiológicas e fisioterapêuticas tem produzido resultados positivos. A presente comunicação tem como objetivo apresentar uma proposta de intervenção fonoaudiológica e fisioterapêutica denominada Condicionamento Vocal e Respiratório (CVR), desenvolvida com profissionais da voz. Composta por oito encontros semanais, ela teve como objetivo aumentar a resistência vocal e respiratória dos participantes, promovendo melhor desempenho profissional. Para a fonação, foram indicados exercícios de trato vocal semiocluído com a utilização de canudos comerciais e de silicone; para a respiração, foram realizados exercícios com um incentivador a fluxo (Respiron Classic®).

Intervention program for voice professionals may cover strategies for vocal and respiratory muscle training. The integration of speech-language pathology and physiotherapeutic interventions in these approaches has resulted in positive outcomes. This communication aims to introduce a proposal for speech-language pathology and physiotherapy intervention called Vocal and Respiratory Conditioning (VRC). Developed with voice professionals and consisting of eight weekly meetings, this proposal aimed to increase the vocal and respiratory endurance of the participants, promoting better professional performance. On the one hand, semi-occluded vocal tract exercises using commercial and silicone straws were indicated for phonation; on the other hand, exercises with a flow stimulator (Respiron®) were performed for breathing.

Los programas de intervención para profesionales de la voz pueden incluir estrategias de entrenamiento de los músculos vocales y respiratorios. En este tipo de abordaje, la integración de las acciones de fonoaudiología y fisioterapia ha producido resultados positivos. Esta comunicación tiene como objetivo presentar una propuesta de intervención fonoaudiológica y fisioterapeutica denominada Condicionamiento Vocal y Respiratorio (CVR), desarrollada con profesionales de la voz. Compuesto por ocho reuniones semanales, tuvo como objetivo aumentar la resistencia vocal y respiratoria de los participantes, promoviendo un mejor desempeño profesional. Para la fonación, se indicaron ejercicios de vías vocales semicerrados utilizando canutos comerciales y de silicona; para la respiración, los ejercicios se realizaron con un estimulador de flujo (Respiron Classic®).

Effects of respiratory muscle training on parasympathetic activity in diabetes mellitus

This study verified the effects of respiratory muscle training (RMT) on hemodynamics, heart rate (HR) variability, and muscle morphology in rats with streptozotocin-induced diabetes mellitus (DM). Thirty-six male Wistar rats were randomized into 4 groups and 34 completed the study: i) sham-sedentary (Sham-ST; n=9); ii) sham-RMT (Sham-RMT; n=9); iii) DM-sedentary (DM-ST; n=8); and iv) DM-RMT (DM-RMT; n=8). Hemodynamics were assessed by central cannulation, and R-R intervals were measured by electrocardiogram. In addition, the effects of RMT on the cross-sectional area of the diaphragm, anterior tibial, and soleus muscles were analyzed. The induction of DM by streptozotocin resulted in weight loss, hyperglycemia, reduced blood pressure, and attenuated left ventricular contraction and relaxation (P<0.05). We also observed a decrease in root mean square of successive differences between adjacent RR intervals (RMSSD) index and in the cross-sectional area of the muscles assessed, specifically the diaphragm, soleus, and anterior tibial muscles in diabetic rats (P<0.05). Interestingly, RMT led to an increase in RMSSD in rats with DM (P<0.05). The induction of DM produced profound deleterious changes in the diaphragmatic and peripheral muscles, as well as impairments in cardiovascular hemodynamics and autonomic control. Nevertheless, RMT may beneficially attenuate autonomic changes and improve parasympathetic modulation.

Efecto del entrenamiento de la musculatura inspiratoria con válvula umbral sobre la capacidad funcional en mujeres físicamente activas mayores de 60 años / Effect of inspiratory muscle training with threshold valve on functional capacity of physically active women who are older than 60 years of age

Resumen Introducción: Los cambios fisiológicos asociados al envejecimiento generan una serie de modificaciones funcionales, destacando una disminución en la capacidad respiratoria. En este sentido, una estrategia alternativa para mejorar tal condición podría ser el entrenamiento de la musculatura inspiratoria (EMI). Objetivo: Analizar el efecto del EMI con válvula umbral, sobre la capacidad funcional en mujeres físicamente activas mayores de 60 años. Materiales y métodos: Se realizó un EMI con válvula umbral durante 4 semanas, sobre un grupo experimental (GE; n:10), contrastado con un grupo control (GC; n:5). Se valoraron las siguientes variables hemodinámicas y antropométricas: peso, talla, índice de masa corporal (IMC), lactato, doble producto y capacidad funcional, analizando los cambios pre y post entrenamiento. Resultados: en el grupo GE disminuye post intervención la concentración de lactato y la escala de percepción del esfuerzo; 3,16±0,51 a 2,5±0,39 y 5,56 ± 1,81 a 4±2, respectivamente. En el mismo grupo se incrementan los valores de presión inspiratoria máxima (Pimáx) post intervención; 42,11±14,57 a 60,44±14,47. El GC no presentó cambios en sus valores. Conclusión: No se evidencian cambios favorables en los metros recorridos post intervención, sin embargo, el EMI mostró una disminución sobre la concentración de lactato post ejercicio, lo que podría identificar un retraso en la aparición de la fatiga.

Abstract Introduction: Physiological changes associated with aging generate a series of functional modifications, mainly a decrease in respiratory capacity. In this regard, an alternative strategy to improve such a condition could be inspiratory muscle training (IMT). Objective: To analyze the effect of IMT with threshold valve on the functional capacity of physically active women who are older than 60 years of age. Materials and methods: IMT with threshold valve was carried out over a period of 4 weeks, comparing data from the experimental group (GE; n:10) to the control group (GC; n:5). The following hemodynamic and anthropometric variables were assessed: weight, height, body mass index (BMI), lactate, double product (DP) and functional capacity. Pre and post training changes were evaluated. Results: The GE group showed a decrease in both post-intervention lactate concentration (from 3.16±0.51 to 2.5±0.39) and effort perception scale (from 5.56 ± 1.81 to 4±2). On the other hand, this group experienced a post-intervention increase in maximal inspiratory pressure (MIP) from 42.11±14.57 to 60.44±14.47. The GC group did not present changes in its values. Conclusion: Although no evidence was found regarding favorable changes in the walked distance post-intervention, IMT induced a reduction in post-exercise lactate concentration, which could indicate a delay of onset of fatigue.

The effect of inspiratory muscle training on the quality of life, immune response, inspiratory and lower limb muscle strength of older adults: a randomized controlled trial / O efeito do treinamento muscular inspiratório em idosos sobre a qualidade de vida, resposta imune, força muscular inspiratória e de membros inferiores: um ensaio clínico randomizado

Abstract Objective: To evaluate the impact of inspiratory muscle training (IMT) on the quality of life, immune response, inspiratory and lower limb muscle strength of older adults. Method: A randomized clinical trial was conducted with 30 institutionalized older adults. They were allocated into two groups: the IMT group (n=15), which underwent IMT with PowerBreathe Classic, using a load of 60% of maximal inspiratory pressure (MIP). This was performed using a 30 repetition protocol, three times a week, for six weeks. The second group was the control group (n=15) which did not perform any type of therapeutic intervention. In both groups, MIP, lower limb strength by sit-up test, quality of life by the SF-36 questionnaire and C-reactive protein (CRP) were evaluated. Results: The results demonstrated the homogeneity between the groups regarding the demographic and clinical variables. The IMT group showed an increase in the variation of MIP (9.20±7.36 cmH2O) compared to the control (0.93±8.79 cmH2O). Improvement was also observed in the sitting and standing test (p<0.05) (Tukey Test) in the difference between the values ​​before and after the IMT. In terms of quality of life, two of the eight SF-36 domains were influenced by the IMT, namely: functional capacity and limitations due to physical factors. There were no changes in CRP in either group. Conclusion: IMT improved the inspiratory muscle strength, lower limb strength and quality of life of institutionalized older adults. These findings reinforce the contribution of this therapy to reducing the deleterious effects of aging.

Resumo Objetivo: Avaliar o impacto do treinamento muscular inspiratório (TMI) sobre a qualidade de vida, resposta imune, força muscular inspiratória e de membros inferiores de idosos. Método: Trata-se de um ensaio clínico randomizado, realizado com 30 idosos institucionalizados. Eles foram alocados em dois grupos, Grupo TMI (n=15): TMI com o PowerBreathe Classic, usando carga de 60% da pressão inspiratória máxima (PIM). O TMI foi realizado através de um protocolo de 30 repetições, três vezes por semana, durante seis semanas; e Grupo controle (n=15): não realizavam nenhum tipo de intervenção terapêutica. Em ambos os grupos foram avaliadas a PIM, a força de membros inferiores pelo teste de sentar-levantar, a qualidade de vida pelo questionário SF-36 e a proteína C reativa (PCR). Resultados: Os resultados demonstraram a homogeneidade entre os grupos em relação às variáveis demográficas e clínicas. O grupo TMI apresentou um aumento da variação da PIM (9,20±7,36cmH2O) comparado ao controle (0,93±8,79 cmH2O). Foi observada ainda melhora no teste de sentar e levantar (p<0,05) (teste de Tukey) na diferença entre os valores antes e após o TMI. Em relação à qualidade de vida, dois dos oito domínios do SF-36 sofreram influência do TMI, são eles: capacidade funcional e limitações por aspectos físicos. Não ocorreram mudanças na PCR em nenhum dos grupos. Conclusão: o TMI foi capaz de melhorar a força muscular inspiratória, a força de membros inferiores, e a qualidade de vida de idosos institucionalizados. Estes achados reforçam a contribuição desta terapêutica em reduzir os efeitos deletérios do envelhecimento.

Effects of Respiratory Muscle Training on the Respiratory Function, Balance, and Activities of Daily Living in Patients with Stroke

PURPOSE: This study evaluated the effects of respiratory muscle training on respiratory function, balance, and activities of daily living (ADL) in patients with stroke. METHODS: The study included 21 patients with stroke, divided into the experimental group and control group. Both groups underwent traditional physical therapy once a day for 30 minutes, five times weekly for 6 weeks. The experimental group underwent additional respiratory muscle training once a day, five times a week during the study period. Maximal inspiratory pressure (MIP), maximal expiratory pressure (MEP), Berg balance scale (BBS), and Korean-modified Barthel index (K-MBI) were measured before and after the study period. For statistical analysis, paired t-test was used to compare the difference between the pre and post values. Independent t-test was used compare the differences between groups. RESULTS: Both groups had significantly improved MIP, MEP, BBS, and K-MBI scores after the study period. The experimental group had significantly improved MIP, MEP, BBS, and K-MBI scores. CONCLUSION: These results suggest that respiratory muscle training improves respiratory function, balance, and ADL in patients with stroke.

Respiratory muscle training on the rehabilitation of patients undergoing cardiothoracic and abdominal surgery: a Meta-analysis / 中国实用护理杂志

Objective To systematically evaluate the effects of respiratory muscle training by using respiratory muscle training device on rehabilitation of people undergoing cardiothoracic and abdominal surgery. Methods The relevant randomized controlled trials were searched in the databases of the CINAHL, Medline, PubMed, EBSCO, China National Knowledge Infrastructure (CNKI), Wanfang Data, VIP. The quality of studies was critically appraised and data were extracted by two reviewers independently, a meta-analysis was conducted for the included studies. Results Finally 12 randomized controlled trial involving 1060 patients were included. Meta-analysis showed that respiratory muscle training device could improve respiratory muscle strength [SMD =0.70, 95%CI (0.15-1.24)]; improved lung function [forced vital capacity:SMD=0.48, 95%CI (0.10-0.87);inspiratory capacity:SMD=0.55, 95%CI (0.07-1.04)]; improve; effectively reduced postoperative pulmonary complications [OR=0.21, 95%CI:(0.15-0.31)]; shorten the length of hospital stays [SMD=-0.52, 95%CI (-0.87--0.16)], all P< 0.05. Conclusions The application of respiratory muscle training with respiratory muscle device could promote the rehabilitation of patients undergoing cardiothoracic and abdominal surgery.

Does respiratory muscle training improve respiratory functions and sport performance? : Review of the concept and directions for future research / 体力科学

<p>As the intensity of exercise becomes higher, increases in the oxygen uptake (VO₂) and cardiac output (Q) start to level off, and they will enter a steady state. However, the pulmonary ventilation (V_E) continues to increase in an exponential manner even after the VO₂ and Q level-off. After exercising to extreme fatigue, the oxygen used by the respiratory muscles (VO₂) increases to 10 to 16% of the VO₂max. In this situation, the respiratory muscles use the oxygen that would have been allocated to the active muscles because the oxygen used for the entire body is already in a steady state. Therefore, overexercising must be discontinued due to a shortage of oxygen for the active muscles (in the legs); amount of O₂ debt has reached its limit. Since the total amount of oxygen that can be taken into the body remains constant, the enhancement of the respiratory muscles and their functions (including the respiratory efficiency (V_E/VO₂)) in advance is expected to improve their endurance. Several previous studies suggested that respiratory muscle training (RMT) enhances the endurance of subjects. Furthermore, recent studies suggested that RMT not only enhances endurance, but also improves the physical elements of significantly intense exercise (including speed, muscle strength, and power) performed for a short period of time. It is necessary to conduct further research to clarify the mechanism of RMT in the improvement of physical performance. RMT is not expected to improve the VO₂max, and the following are possible causes of the improvement of performance: improvements in the respiratory muscles and efficiency (V_E/VO₂), a subsequent decrease in the blood lactate concentration, and subjective respiratory distress and sense of fatigue in the active muscles.</p>

Efecto del entrenamiento de músculos abdominales sobre la fuerza muscular respiratoria y flujos espiratorios forzados en adolescentes sanos sedentarios / Effect of abdominal muscle training on respiratory muscle strength and forced expiratory flows in sedentary, healthy adolescents

Introducción. El entrenamiento muscular respiratorio es el método más utilizado para revertir la debilidad muscular respiratoria; no obstante, el efecto de protocolos basados en maniobras no respiratorias no ha sido suficientemente estudiado en población pediátrica. El objetivo de este estudio fue determinar el efecto del entrenamiento de la musculatura abdominal sobre la fuerza de los músculos respiratorios y los flujos espiratorios forzados en adolescentes sanos. Métodos. Estudio cuasiexperimental. La muestra estuvo integrada por adolescentes sanos divididos en dos grupos: un grupo experimental, quienes realizaron 8 semanas de entrenamiento de la musculatura abdominal activo, y un grupo control equivalente. Se midió la fuerza de los músculos abdominales, la presión inspiratoria máxima, la presión espiratoria máxima (PeMax), el flujo espiratorio máximo y el flujo máximo de tos antes y después del protocolo. Se consideró significativo un valor de p < 0,05. Resultados. Todas las variables estudiadas aumentaron significativamente en el grupo experimental; sin embargo, solo la PeMax se incrementó en el grupo control. Adicionalmente, el grupo experimental presentó una mayor PeMax que el grupo control al final del protocolo, así como también una mayor ganancia en la PeMax y flujo espiratorio máximo. Finalmente, el incremento en la PeMax se asoció con el aumento en el flujo máximo de tos en el grupo experimental, lo que no fue observado en el grupo control. Conclusión. En 8 semanas de entrenamiento de la musculatura abdominal, se logró incrementar la PeMax y el flujo espiratorio máximo en adolescentes sanos (sedentarios). Estos efectos se asociaron a incrementos en el flujo máximo de tos inducidos por la intervención.

Introduction. Respiratory muscle training is the most commonly used method to revert respiratory muscle weakness; however, the effect of protocols based on non-respiratory maneuvers has not been adequately studied in the pediatric population. The objective of this study was to establish the effect of abdominal muscle training on respiratory muscle strength and forced expiratory flows in healthy adolescents. Methods. This was a quasi-experiment. The sample was made up of healthy adolescents divided into two groups: an experimental group who completed eight weeks of active abdominal muscle training, and an equivalent control group. The following indicators were measured: abdominal muscle strength, maximal inspiratory pressure, maximal expiratory pressure (MEP), peak expiratory flow, and peak cough flow, before and after protocol completion. A value of p < 0.05 was considered significant. Results. All studied outcome measures increased significantly in the experimental group but only MEP increased in the control group. In addition, a higher MEP was observed in the experimental group compared to the control group at the end of the protocol, together with a greater increase in MEP and peak expiratory flow. Finally, the increase in MEP was associated with an increase in cough peak flow in the experimental group but not in the control group. Conclusion. After eight weeks of abdominal muscle training, MEP and peak expiratory flow increased in healthy (sedentary) adolescents. Such effects were associated with intervention-induced increases in cough peak flow.

Threshold Training of Respiratory Muscles after Stroke:A Meta-analysis / 中国康复理论与实践

Objective To study the effects of threshold training of respiratory muscles on respiratory muscle function and pulmonary in-fection after stroke with meta-analysis. Methods The randomized controlled trials about threshold training of respiratory muscles in stroke patients in Cochrane Library, PubMed, Medline, Embase, OVID, Chinese Biomedical Database, WanFang database and CNKI full-text data-base from January, 2005 to June, 2015 were systematically searched. Literatures were evaluated and extracted by two researchers. Results Four studies were included, with a total of 167 cases, 84 cases in the intervention group (threshold training of respiratory muscles) and 83 cases in the control group. Compared with the control group, the intervention might improve the respiratory muscle strength (for maximum inspired pressure, MD=9.46, 95%CI=4.61~14.32, P<0.001;for maximum expired pressure, MD=9.44, 95%CI=2.68~16.20, P=0.006), and decreased pulmonary infection (OR=0.35, 95%CI=0.13~0.97, P=0.04). Conclusion Threshold training of respiratory muscles can improve respiratory muscle function and reduce the incidence of pulmonary infection.

Treinamento Muscular Respiratório na Doença do Refluxo Gastresofágico de sujeitos com DPOC: Revisão De Literatura / Respiratory Muscle Training In Gastroesophageal Reflux Disease of Subjectswith COPD: Literature Review / Entrenamiento Muscular Respiratorio En El Enfermedad Del Reflujo Gastroesofágico En Sujetos Con EPOC: Revisión de Literatura

O objetivo foi realizar uma revisão de literatura sobre os efeitos do treinamento muscular respiratório na Doença do Refluxo Gastroesofágico (DRGE) de sujeitos com Doença Pulmonar Obstrutiva Crônica (DPOC). Para a seleção dos estudos foram utilizados os descritores: Gastroesophageal Reflux?, ?Respiratoryaspiration? e ?COPD? nas bases de dados PubMed, LILACS, ScIELO e TripDataBase, entre os meses de janeiro e fevereiro de 2015. Como critérios de seleção foram adotados: artigos publicados em Português, Inglês ou Espanhol, sem limitação de ano. Os títulos e resumos foram lidos, e, caso houvesse dúvidas quanto ao objetivo da pesquisa de cada artigo, o mesmo era lido na íntegra. Após a leitura dos títulos, resumos e, se necessário, a íntegra do texto para melhor compreensão do trabalho, foram elencados os artigos que tivessem maior relação com o objetivo da pesquisa. A pesquisa realizada com os descritores propostos gerou um total de 324 artigos. Após a primeira análise foram selecionados68, destes 32 foram excluídos por repetição. Os 36 artigos restantes foram avaliados conforme o objetivo do estudo, finalizando em 12. No entanto, nenhum teve como objetivo verificar os efeitos do treinamento muscular respiratório na DRGE de sujeitos com DPOC. Dessa forma, os autores realizaram uma revisão de literatura a fim de fornecer bases teóricas para futuras pesquisas sobre a temática. Conclui-se comeste estudo que, até o momento, não há pesquisas que avaliaram os efeitos do treinamento muscular respiratório sobre a DRGE de sujeitos com DPOC, o que sugere a necessidade de realizar pesquisas abordando a temática.

The purpose was to perform a systematic review about the effects of respiratory muscle training in Gastroesophageal Reflux Disease (GERD) of subjects with Chronic Obstructive Pulmonary Disease (COPD). For the selection of studies, the following descriptors were used: ?Gastroesophageal Reflux?, ?Respiratory aspiration? and ?COPD? in the databases PubMed, LILACS, SciELO and TripDataBase, from January to February 2015. As selection criteria were used:articles published in Portuguese, English, and Spanish, regardless of the year of publication. The titles and abstracts were read and if there were doubts as to the purpose of the study of each article, the same was read in its entirety. After reading the titles, abstracts and, if necessary, in full, were listed items that were more closely related to the research purpose. The research with the proposed descriptors generated a total of 324 articles. After the first analysis were selected 68, of these 32 were excluded by repetition. The remaining 36 articles were evaluated according to the purpose of the study, ending in 12. However, none aimed to determine theeffects of respiratory muscle training in COPD subjects with GERD. Thus, the authors conducted a literature review to provide theoretical basis for future research about the theme. It was concluded from this study that there aren?t studies that evaluated the effects of respiratory muscle training on COPD subjects with GERD, which suggests the necessity to conduct research addressing the theme.

El objetivo fue hacer una revisión de la literatura sobre los efectos del entrenamiento de los músculos respiratorios en la enfermedad por reflujo gastroesofágico (ERGE) en sujetos con EPOC. Para selección de losestudios se utilizaron losdescriptores: Gastroesophageal Reflux?,?Respiratoryaspiration? y ?EPOC? en las bases de datos PubMed, LILACS,SciELOyTripBataBase, entre los meses de enero y febrero 2015. Como criterios de selección fueron adaptados: artículos publicados en Portugués, Inglés o Español, sin limitación año. Los títulos y resúmenes seleyeron y si había dudas sobre la finalidad del estudio de cada artículo, el mismo fue leído en su totalidad. Después de leer los títulos, los resúmenes y, si necesario, el texto completo para una mejor comprensión delartículo, fueron listadas los artículos que tuvieron mayor relación con objetivo de la investigación. La investigación realizada con los descriptores propuestos generó un total 324 artículos. Después del primer análisis fueron seleccionados 68, de estos 32 fueron excluidos por repetición. Los 36 artículos restantes fueron evaluados de acuerdo con propósitodel estudio, terminando en 12. Sin embargo, ninguno tuvo como objetivo determinar los efectos del entrenamiento muscular respiratorio en la ERGE en sujetos con EPOC. Por lo tanto, los autores realizaron una revisión bibliográfica con fin de proporcionar base teórica para futuras investigaciones sobre el tema. Se concluye de este estudio que hasta la fecha no hay estudios que evaluaron los efectos del entrenamiento muscular respiratorio sobre la ERGE en sujetoscon EPOC, lo que sugiere la necesidad de realizar investigaciones que abordan el tema.

Efecto del entrenamiento de músculos abdominales sobre la función respiratoria en adolescentes sanos: Estudio piloto / Effect of abdominal muscle training on respiratory function in healthy adolescents: A preliminar study

The respiratory muscle training has been used to improve muscle strength and optimize the mechanism of cough. The aim of this study is to evaluate the effect of abdominal muscle training on respiratory muscle strength (MIP, MEP), peak expiratory flow (PEF) and peak cough flow (PCF) in healthy adolescents. The study design was quasi-experimental, variables of respiratory function were assessed before and after the muscle training protocol in a sample of sedentary healthy adolescents without gender restriction. The sample size calculated was 15 subjects. The training protocol consisted in 8 weeks of training divided into two stages (basic and advanced training plan) twice a week. Descriptive statistics were performed, tests for normality (Shapiro Wilk), U Mann Whitney test, Pearson coefficient and t-student test were used. Results are expressed as mean and its standard deviation. It was considered significant a p value < 0,05. Seventeen subjects (8 males and 9 females) entered to the study, all subjects performed the protocol and completed it without incidents. After completing the training protocol the sit-up test performance increased 21.7% (p = 0.0001), the MIP increase 16,5 cm H2O (17.1%) (p = 0.006), MEP increased 34.9 cm H2O (50,2 %) (p = 0.0001). Moreover, PEF increased 35.3 L/min (8.3%) (p = 0.003) and PCF increased 36.6 L/min (9,1%). There was no correlation between sit-up test performance and lung function variables. PEF showed only a moderate correlation with PCF (r = 0.6; p = 0.007) and MEP (r = 0.59; p = 0.01). We conclude that, in this sample, increases in respiratory muscle strength, PEF and PCF were observed after abdominal muscle training. No association between abdominal muscle strength and respiratory function variables was found before initiating the training protocol.

El entrenamiento muscular respiratorio ha sido utilizado para mejorar la fuerza de los músculos y optimizar el mecanismo de la tos. El objetivo de este estudio es evaluar el efecto del entrenamiento de músculos abdominales sobre la fuerza de los músculos respiratorios (Pimax, Pemax), flujo espiratorio máximo (FEM) y flujo máximo de tos (FMT) en adolescentes sanos. Este estudio es cuasi experimental, donde se evaluaron las variables de función respiratoria antes y después del protocolo de entrenamiento. La muestra estuvo integrada por adolescentes sanos sedentarios sin restricción de sexo. La muestra mínima estimada fue de 15 sujetos. El protocolo de entrenamiento consistió en 8 semanas de entrenamiento dividido en 2 etapas (plan básico y avanzado de ejercicios) dos veces por semana. Se realizó estadística descriptiva, pruebas de normalidad (Shapiro Wilk); se utilizó test U de Mann Whitney, coeficiente de correlación de Pearson y test t-student para muestras pareadas. Los resultados se expresan en promedios y desviación estándar. Se consideró significativo un valor de p < 0,05. Ingresaron al estudio 17 sujetos (8 hombres y 9 mujeres), todos los sujetos realizaron el protocolo completo. Posterior al protocolo los sujetos incrementaron en 21,7% el rendimiento del sit-up test (p=0,0001); la Pimax aumentó 16,5 cm H2O (+17,1%) (p=0.006), la Pemax aumentó 34,9 cm H2O (+50,2%) (p=0,0001). Por otra parte, el FEM aumentó 35,3 L/min (+8,3%) (p=0,003) y el FMT aumentó 36,6 L/min (+9,1%). La fuerza de músculos abdominales no muestra correlación con las variables de función respiratoria. Sólo FEM muestra correlación moderada con el FMT (r = 0,6; p = 0,007) y Pemax (r = 0,59; p = 0,01). Se concluye que, en la muestra estudiada, se observan incrementos en la fuerza muscular respiratoria, FEM y FMT luego de un protocolo de entrenamiento de músculos abdominales. No se observó asociación entre la fuerza muscular abdominal y las variables de función respiratoria antes de iniciado el protocolo.

Rehabilitación respiratoria en el paciente neuromuscular: efectos sobre la tolerancia al ejercicio y musculatura respiratoria: resultado de una serie de casos / Respiratory rehabilitation in neuromuscular patients: effects on exercise tolerance and respiratory muscles

Background: The pulmonary rehabilitation (PR) has acquired an important role in neuromuscular patient treatment. The aim was to investigate the effects of PR program on 6-minute walking test variables (6MWT) and respiratory muscle function (RMF) in patients with neuromuscular disease. Patients and Methods: In the study were included 13 patients, age 12.5 +/- 2.8 years old. Seven of them were able to walk (2 Facioscapulohumeral Muscular Dystrophy (FSHD), 1 Becker Muscular Dystrophy, 1 Congenital Myopathy, 1 Bethlem Syndrome, 2 Duchenne Muscular Dystrophy); and 6 were unable to walk (4 Duchenne Muscular Dystrophy, 1 Spinal Muscular Atrophy (SMA) type III and 1 SMAII). The results of RMF and 6MWT before and after 13 weeks of respiratory muscle training (RMT) (40-50 percent Pimax and 60-70 percent Pemax) and aerobic training (AT) (50 percent heart rate reserve) were analyzed. Wilcoxon test with 95 percent confidence interval was used to assess statistical significance. Results: Significant changes (p < 0.05) were observed in the averages of dyspnea score that decreased in 1.8 points (from 4.4 to 2.6; -40.9 percent) and in sustained inspiratory pressure (Pims) that increased in 14.3 cm H2O (from 16 to 30.3; +89.4 percent). Other variables that assessed aerobic capacity (6 MWT, heart rate and leg fatigue) and RMF (Pimax and Pemax) showed a trend towards improvement, but did not reach statistical significance. Conclusion: In patients with neuromuscular diseases significant changes in dyspnea after cardiopulmonary training protocol were observed. Moreover, the moderate intensity respiratory muscle training was well tolerated and an effective method to generate significant increases in Pims, constituting an alternative to previously established protocols.

Introducción: La rehabilitación respiratoria (RR) ha adquirido un papel importante en el manejo del paciente con enfermedad neuromuscular. El objetivo de este estudio fue investigar los efectos de un programa de rehabilitación respiratoria (RR) sobre variables del test de caminata de 6 min (C6M) y función muscular respiratoria (FMR) en pacientes con patología neuromuscular. Pacientes y Métodos: En el estudio se incluyeron 13 pacientes, edad: 12,5 +/- 2,8 años, de los cuales 7 son ambulantes (2 distrofia muscular (DM) fascio-escápulo-humeral, 1 DM de Becker, 1 miopatía congénita, 1 síndrome de Bethlem, 2 DM de Duchenne); y 6 no son ambulantes (4 DM de Duchenne, 1 atrofia espinal (AT) tipo 3 y 1AT 2). Se analizaron los registros de FMR y C6M al inicio y posterior a 13 semanas de entrenamiento muscular respiratorio (40-50 por ciento Pimax y 60-70 por ciento Pemax) y cardiopulmonar (50 por ciento de FCR). Se utilizó el test no paramétrico de Wilcoxon con un intervalo de confianza de 95 por ciento. Resultados: Se observaron cambios significativos (p < 0,05) en el puntaje de disnea que disminuyó 1,8 puntos (de 4,4 a 2,6; -40,9 por ciento) y en la presión inspiratoria máxima sostenida (Pims) que aumentó 14,3 cm de H2O (de 16 a 30,3 cm H(2)0; +89,4 por ciento). Las otras variables que evaluaron capacidad aeróbica (C6M, frecuencia cardíaca y fatiga de las piernas) y función de los músculos respiratorios (Pimax y Pemax) mostraron una tendencia a la mejoría, sin embargo, no alcanzaron significación estadística. Conclusiones: En pacientes con enfermedades neuromusculares se observan cambios significativos en la disnea posterior a un protocolo de entrenamiento cardiopulmonar. Por otra parte, el entrenamiento muscular respiratorio de moderada intensidad fue un método bien tolerado y efectivo para generar incrementos significativos en la Pims, constituyendo una alternativa a los protocolos previamente establecidos.

Efectos del entrenamiento muscular inspiratorio/espiratorio sobre función respiratoria de pacientes tetrapléjicos / Effects of inspiratory/expiratory muscular training on respiratory function in quadriplegic patients

Introduction: Functional impairment in patients with high spinal cord injuries is associated to ventilatory dysfunction due to paretic respiratory muscles, which causes alterations in the ventilatory and in the cough mechanisms. Respiratory muscle training has been studied as a therapeutic alternative for this group of patients with no conclusive results, whereas a mixed protocol, which stimulates both inspiratory and expiratory muscles, had not been previously investigated. Objective: To evaluate the effects of systematic respiratory muscle training during four months, on pulmonary function, respiratory muscles strength and effort tolerance, cough efficacy and dyspnea perception, in a group of quadriplegic patients with at least one year of evolution post injury. Method: A quasi-experimental design was used. Six adults with cervical spinal cord injuries were enlisted and incorporated in a mixed respiratory muscles training for four months. Pulmonary function, respiratory muscles strength and resistance, cough efficacy and dyspnea perception were assessed pre and post training. Results: The application of the mixed training protocol significantly improved inspiratory muscle strength (p = 0,028),respiratory muscles effort tolerance (p = 0,028) and cough efficacy (p = 0,034).The other measures did not reach statistical significance. Conclusion: Mixed(inspiratory/expiratory) muscular training, shows partially favorable results in the improvement of pulmonary function. Studies using greater numbers of patients are necessary to achieve more categorical results.

Introducción: El compromiso funcional en pacientes con lesiones medulares altas se asocia a disfunción ventilatoria por paresia de musculatura respiratoria y provoca alteraciones ventilatorias y en el mecanismo de la tos. El entrenamiento de la musculatura respiratoria ha sido analizado como alternativa terapéutica para neumo este grupo de pacientes sin resultados concluyentes, mientras que un protocolo mixto, que estimule músculos inspiratorios y espiratorios no ha sido estudiado con anterioridad. Objetivo: Evaluar la respuesta del sistema respiratorio al entrenamiento sistemático de la musculatura respiratoria durante cuatro meses, sobre la función pulmonar, fuerza y tolerancia al esfuerzo de la musculatura respiratoria, eficacia de la tos y percepción de disnea de un grupo de pacientes tetrapléjicos. Materiales y Métodos: Se aplicó un diseño cuasi-experimental. Seis pacientes con lesiones medulares cervicales de al menos un año de evolución fueron reclutados e incluidos en un programa de entrenamiento mixto de la musculatura respiratoria durante 4 meses. Se evaluó la función pulmonar, fuerza y resistencia de la musculatura respiratoria, eficacia de la tos y percepción de disnea antes y después del período de entrenamiento. Resultados: El protocolo de entrenamiento mixto aplicado incrementó significativamente la fuerza muscular inspiratoria (p= 0,028), la tolerancia al esfuerzo de los músculos respiratorios (p = 0,028) y la eficacia de la tos (p = 0,034). El incremento en todas las otras variables medidas no alcanzó significancia estadística. Conclusión: El entrenamiento muscular mixto(inspiratorio/espiratorio) muestra resultados parcialmente favorables en la mejoría de indicadores de función pulmonar. Estudios de mayor número de pacientes son necesarios para acceder a resultados más categóricos.