Inspiratory muscle training improves maximal inspiratory pressure and may assist weaning in older intubated patients: a randomised trial.

QUESTIONS: Does inspiratory muscle training improve maximal inspiratory pressure in intubated older people? Does it improve breathing pattern and time to wean from mechanical ventilation? DESIGN: Randomised trial with concealed allocation and intention-to-treat analysis. PARTICIPANTS: 41 elderly, intubated adults who had been mechanically ventilated for at least 48 hr in an intensive care unit. INTERVENTION: The experimental group received usual care plus inspiratory muscle training using a threshold device, with an initial load of 30% of their maximal inspiratory pressure, increased by 10% (absolute) daily. Training was administered for 5 min, twice a day, 7 days a week from the commencement of weaning until extubation. The control group received usual care only. OUTCOME MEASURES: The primary outcome was the change in maximal inspiratory pressure during the weaning period. Secondary outcomes were the weaning time (ie, from commencement of pressure support ventilation to successful extubation), and the index of Tobin (ie, respiratory rate divided by tidal volume during a 1-min spontaneous breathing trial). RESULTS: Maximal inspiratory pressure increased significantly more in the experimental group than in the control group (MD 7.6 cmH(2)0, 95% CI 5.8 to 9.4). The index of Tobin decreased significantly more in the experimental group than in the control group (MD 8.3 br/min/L, 95% CI 2.9 to 13.7). In those who did not die or receive a tracheostomy, time to weaning was significantly shorter in the experimental group than in the control group (MD 1.7 days, 95% CI 0.4 to 3.0). CONCLUSIONS: In intubated older people, inspiratory muscle training improves maximal inspiratory pressure and the index of Tobin, with a reduced weaning time in some patients. TRIAL REGISTRATION: NCT00922493.

Níveis de qualidade de vida em idosas ativas praticantes de dança, musculação e meditação / The levels of quality of life among active elderly women practitioners of dance, strengthining and meditation

Resumo O objetivo deste estudo foi comparar os níveis de qualidade de vida entre idosas sedentárias e ativas, praticantes de dança, musculação e meditação, avaliando ainda os efeitos destes sobre aqueles. Para tal, neste estudo ex post facto, a amostra foi dividida em quatro grupos: grupo de dança (GD, n=20, idade=67±4 anos), grupo de musculação (GF, n=15, idade=67±5 anos), grupo de meditação (GM, n=15, idade=68±4 anos) e grupo controle (GC, n=20, idade=68±6 anos). O protocolo utilizado na avaliação da qualidade de vida foi o questionário World Health Organization Quality of Life Group-old - WHOQOL-OLD. Nas comparações múltiplas (Post Hoc de Sheffe ou intervalo de confiança) foram encontrados resultados satisfatórios nas variáveis dom1 (Habilidades sensoriais; GDxGC, p=0,006), dom2 (Autonomia; GDxGF, p=0,026; GDxGC, p<0,001; GFxGC, p=0,001; GMxGC, p<0,001), dom3 (Atividades passadas presentes e futuras; GDxGC, p=0,004; GFxGC, p=0,033; GMxGC, p<0,001), dom4 (Participação social; GDxGC, IC=+0,421,+41,479; GMxGC, IC=+4,456,+48,804) e QVG (GDxGC, p<0,001; GFxGC, p=0,033; GMxGC, p<0,001). Após a exposição dos dados, inferiu-se que os dois programas de atividade física (dança e musculação) e a prática da meditação apresentaram, na amostra analisada, resultados satisfatórios, contribuindo para um melhor nível de qualidade de vida quando comparados com aqueles apresentados pelo GC.

Abstract This study aimed to compare the levels of quality of life between active and sedentary elderly, practitioners of dance, meditation and strengthening. So in this study ex post facto, the sample was divided into four groups: dance group (DG, n = 20, age = 67 ± 4 years), strength group (SG, n = 15, age = 67 ± 5 years), meditation group (MG, n = 15, age = 68 ± 4 years) and the control group (CG, n = 20, age = 68 ± 6 years). The protocol used to assess the quality of life was the questionnaire World Health Organization Quality of Life Group-old - WHOQOL-OLD. In multiple comparisons (Post Hoc Sheffe, or confidence interval) we found satisfactory results in the variables dom1 (Sensory abilities; DGxGC, p = 0006), dom2 (Autonomy; DGxSG, p = 0026; DGxGC, p <0001; SGxGC, p = 0001; MGxGC, p <0001), dom3 (past present and future activities; DGxGC, p = 0004; SGxGC, p = 0033; MGxGC, p <0001), dom4 (Social Participation; DGxGC , CI = +0421, +41479; MGxGC, CI = +4456, 48804), and QVG (DGxGC, p <0001; SGxGC, p = 0033; MGxGC, p <0001). After data exposure, we inferred that the two programs of physical activity (dance and strenghtining) and the practice of meditation had satisfactory results in the trial, contributing to a better quality of life when compared with those presented by the GC.