ABSTRACT
AIMS: To generate reference values for two inspiratory muscle endurance (IME) protocols in healthy children and adolescents. MATERIALS AND METHODS: This is an observational, cross-sectional study, in healthy children and adolescents from 4 to 18 years of age. Weight, height, maximal inspiratory pressure (MIP) and IME were measured using two protocols. A fixed load of 30% of MIP with a 10% increment every 2 minutes was used in the incremental threshold loading protocol. As for the maximal loading protocol, a fixed load of 70% of MIP was used and the time limit (Tlim) achieved until fatigue was measured. RESULTS: A total of 462 participants were included, 281 corresponding to the incremental loading protocol and 181 to maximal loading. There were moderate and positive correlations between IME and age, MIP, weight and height in the incremental threshold loading. However, the regression model demonstrated that MIP and age were the best variables to predict the IME. Otherwise, weak and positive correlations with age, weight and height were found in the maximal loading. Only age and height influenced endurance in the regression model. The predictive power (r2) of the incremental threshold loading protocol was 0.65, while the maximal loading was 0.15. The reproducibility measured by the intraclass correlation coefficient (ICC) was higher in the incremental loading (0.96) compared to the maximal loading test (0.69). CONCLUSION: IME in healthy children and adolescents can be explained by age, height and MIP. The incremental threshold loading protocol showed more reliable results and should be the model of choice to evaluate IME in the pediatric age group.
Subject(s)
Physical Endurance/physiology , Respiratory Muscles/physiology , Adolescent , Child , Child, Preschool , Cross-Sectional Studies , Female , Humans , Male , Reference Values , Reproducibility of Results , Respiratory Function TestsABSTRACT
Abstract Introduction: Inspiratory muscle training (IMT) is a resource widely used in pediatrics. However, there is great variability in relation to the characteristics of the protocols used. Objective: To identify the main clinical conditions and IMT protocols used in the pediatric age group. Methods: Integrative review of the literature by searching on Pubmed, Scielo, PEDro and EMBASE databases using the following strategy: threshold OR inspiratory muscle training OR muscle endurance OR muscle resistance OR endurance training OR maximal inspiratory pressure AND respiratory muscle. We have selected clinical trials that performed IMT in children and adolescents (0 to 18 years old), with a clinical diagnosis, and published in English, Portuguese and Spanish. Results: 17 studies were included. From these, 11 underwent IMT in patients with some neuromuscular disorder, being Duchenne Muscular Dystrophy the most common. The selected articles included a total sample of 327 participants. As for the characteristics of the protocols, 7 performed strength training, 5 endurance and 5 strength and endurance. The training load ranged from 30 to 80% of maximal inspiratory pressure. Moreover, 8 studies performed IMT twice daily and the session duration and the training period varied between 10 and 30 minutes, and from 3 weeks to 24 months, respectively. Conclusion: The IMT was used more frequently in patients with some neuromuscular disorder. Although there is no consensus as to the characteristics of the protocols, the choice of the load should take into account the purpose of IMT and the disease severity.
Resumo Introdução: O treinamento muscular inspiratório (TMI) é um recurso bastante utilizado na pediatria. No entanto, há uma grande variabilidade em relação às características dos protocolos utilizados. Objetivo: Identificar as principais condições clínicas e os protocolos de TMI utilizado na faixa etária pediátrica. Métodos: Revisão integrativa da literatura com buscas nas bases de dados Pubmed, Scielo, PEDro e Embase, utilizando a seguinte estratégia: threshold OR inspiratory muscle training OR muscle endurance OR muscle resistance OR endurance training OR maximal inspiratory pressure AND respiratory muscle. Foram selecionados ensaios clínicos que realizaram TMI em crianças e adolescentes (0 a 18 anos), com algum diagnóstico clínico, nos idiomas inglês, português e espanhol. Resultados: Foram incluídos 17 estudos. Destes, 11 realizaram TMI em pacientes com alguma desordem neuromuscular, sendo a distrofia muscular de duchenne a mais comum. Os artigos selecionados totalizaram uma amostra de 327 participantes. Em relação às características dos protocolos, 7 realizaram treinamento de força, 5 de endurance e 5 de força e endurance. A carga de treinamento variou de 30 a 80% da pressão inspiratória máxima. Além disso, 8 estudos realizaram TMI 2 vezes ao dia e o tempo de duração da sessão e do período de treinamento variou entre 10 e 30 minutos e de 3 semanas a 24 meses, respectivamente. Conclusão: O TMI foi mais utilizado em pacientes com desordens neuromusculares. Embora não exista um consenso quanto às características dos protocolos, a escolha da carga deve levar em conta o propósito do TMI e a gravidade da doença.
Subject(s)
Humans , Child , Respiratory Muscles , Clinical Diagnosis , Muscle Strength , Pediatrics , Clinical Protocols , Muscular Dystrophy, Duchenne , Resistance TrainingABSTRACT
Abstract Objective: To assess the effects of obesity on lung volume and capacity in children and adolescents. Data source: This is a systematic review, carried out in Pubmed, Lilacs, Scielo and PEDro databases, using the following Keywords: Plethysmography; Whole Body OR Lung Volume Measurements OR Total Lung Capacity OR Functional Residual Capacity OR Residual Volume AND Obesity. Observational studies or clinical trials that assessed the effects of obesity on lung volume and capacity in children and adolescents (0-18 years) without any other associated disease; in English; Portuguese and Spanish languages were selected. Methodological quality was assessed by the Agency for Healthcare Research and Quality. Data synthesis: Of the 1,030 articles, only four were included in the review. The studies amounted to 548 participants, predominantly males, with sample size ranging from 45 to 327 individuals. 100% of the studies evaluated nutritional status through BMI (z-score) and 50.0% reported the data on abdominal circumference. All demonstrated that obesity causes negative effects on lung volume and capacity, causing a reduction mainly in functional residual capacity in 75.0% of the studies; in the expiratory reserve volume in 50.0% and in the residual volume in 25.0%. The methodological quality ranged from moderate to high, with 75.0% of the studies classified as having high methodological quality. Conclusions: Obesity causes deleterious effects on lung volume and capacity in children and adolescents, mainly by reducing functional residual capacity, expiratory reserve volume and residual volume.
Resumo Objetivo: Avaliar os efeitos da obesidade sobre os volumes e as capacidades pulmonares em crianças e adolescentes. Fontes de dados: Trata-se de uma revisão sistemática, através das bases de dados Pubmed, Lilacs, SciELO e PEDro, por meio das seguintes palavras-chave: Plethysmography, Whole Body OR Lung Volume Measurements OR Total Lung Capacity OR Functional Residual Capacity OR Residual Volume AND Obesity. Foram selecionados estudos observacionais ou ensaios clínicos que avaliaram os efeitos da obesidade sobre os volumes e as capacidades pulmonares em crianças e adolescentes (0 a 18 anos), sem qualquer outra doença associada, nos idiomas inglês, português e espanhol. A qualidade metodológica foi avaliada através da Agency for Healthcare Research and Quality. Síntese dos dados: Dos 1.030 artigos, apenas quatro foram incluídos nesta revisão. Os estudos totalizaram 548 participantes, com predomínio do sexo masculino e tamanho amostral entre 45 e 327 indivíduos; 100% dos estudos avaliaram o estado nutricional através do IMC (escore-z) e 50% informaram os dados da circunferência abdominal. Todos demonstraram que a obesidade causa efeitos negativos sobre os volumes e as capacidades pulmonares, causa redução, principalmente, da capacidade residual funcional em 75% dos estudos, do volume de reserva expiratório em 50% e do volume residual em 25%. A qualidade metodológica variou entre moderada e alta, com 75% dos estudos classificados com alta qualidade metodológica. Conclusões: A obesidade causa efeitos deletérios sobre os volumes e as capacidades pulmonares em crianças e adolescentes, com redução principalmente da capacidade residual funcional, volume de reserva expiratório e volume residual.
Subject(s)
Humans , Male , Child , Pediatric Obesity/physiopathology , Lung/physiopathology , Lung Volume MeasurementsABSTRACT
OBJECTIVE: To assess the effects of obesity on lung volume and capacity in children and adolescents. DATA SOURCE: This is a systematic review, carried out in Pubmed, Lilacs, Scielo and PEDro databases, using the following Keywords: Plethysmography; Whole Body OR Lung Volume Measurements OR Total Lung Capacity OR Functional Residual Capacity OR Residual Volume AND Obesity. Observational studies or clinical trials that assessed the effects of obesity on lung volume and capacity in children and adolescents (0-18 years) without any other associated disease; in English; Portuguese and Spanish languages were selected. Methodological quality was assessed by the Agency for Healthcare Research and Quality. DATA SYNTHESIS: Of the 1,030 articles, only four were included in the review. The studies amounted to 548 participants, predominantly males, with sample size ranging from 45 to 327 individuals. 100% of the studies evaluated nutritional status through BMI (z-score) and 50.0% reported the data on abdominal circumference. All demonstrated that obesity causes negative effects on lung volume and capacity, causing a reduction mainly in functional residual capacity in 75.0% of the studies; in the expiratory reserve volume in 50.0% and in the residual volume in 25.0%. The methodological quality ranged from moderate to high, with 75.0% of the studies classified as having high methodological quality. CONCLUSIONS: Obesity causes deleterious effects on lung volume and capacity in children and adolescents, mainly by reducing functional residual capacity, expiratory reserve volume and residual volume.
Subject(s)
Lung/physiopathology , Pediatric Obesity/physiopathology , Adolescent , Child , Humans , Lung Volume MeasurementsABSTRACT
OBJECTIVE: To compare inspiratory muscle function (strength and endurance) between asthmatics and healthy controls, and the influence of age, nutritional status and physical activity on them. METHODS: This is a cross-sectional study. Asthmatic and healthy subjects, aged 6 to 18 years old, recruited from two public schools in Southern Brazil were included in the study. Asthmatic subjects were selected using the criteria presented by the International Study on Asthma and Allergies in Children and control subjects based on the absence of respiratory symptoms. Anthropometric data was measured, body mass index calculated and subjects classified as normal weight, overweight or obese. Physical activity levels, maximum inspiratory pressure (MIP) and inspiratory muscle endurance (IME) were also evaluated. RESULTS: A total of 314 participants were included, separated into control group (181) and asthmatics (133), with a total mean age of 11 years. When both groups were compared, there were no significant differences in both MIP and IME. However, when groups were analyzed subdivided in children and adolescents, IME was significantly reduced (p = 0.003) in asthmatic adolescents. Indeed, when groups were also stratified considering the nutritional status, IME showed a reduction in asthmatic adolescents with overweight (p = 0.042) and obesity (p = 0.041) when compared to healthy controls. No effects of physical activity levels between groups were found. CONCLUSIONS: Results demonstrate a reduction in the IME in asthmatic adolescents with overweight and obesity, indicating an association between asthma, nutritional status and respiratory muscle function.
