Changes in training posture induce changes in the chest wall movement and respiratory muscle activation during respiratory muscle training.

Postural changes induce changes in chest wall kinematics and eventually pulmonary function, and affect chest wall shape and chest motion. This study aimed to examine the effects of postural change on changes in the chest wall during respiratory muscle training. Using a repeated measures design, this study followed 13 healthy adults (13 men; mean age, 23.73 years). All participants performed four postures (neutral, full trunk rotation, half-range trunk rotation, and lateral ribcage shift postures) during respiratory muscle training. The chest wall movement during the four postures was measured using a three-dimensional motion-analysis system during respiratory muscle training. Surface electromyography data were collected from the diaphragm and sternocleidomastoid muscles, and the asymmetric ratio of muscle activation was calculated based on the collected data. The chest wall movements of the upper costal and middle costal region were greater in the neutral posture than in the full rotation, half rotation, and lateral ribcage shift postures (P<0.05). The respiratory muscle activation on diaphragm of left was greater in the full rotation posture than in the neutral posture, half rotation, and lateral ribcage shift postures (P<0.05). The asymmetric ratio of muscle activation was greater in the full rotation posture than in the neutral posture, half rotation, and lateral ribcage shift postures (P<0.05). This study verified that postural change during respiratory muscle training may affect chest wall movement and muscle activation. Thus, this study recommends respiratory muscle training to be performed in neutral posture.

Correlation between grip strength and pulmonary function and respiratory muscle strength in stroke patients over 50 years of age.

Age-related skeletal muscle changes may impact respiratory muscle function, and low muscle mass is associated with low pulmonary function in older adults. Stroke not only causes weakness in the muscles of the upper and lower limbs, but it can also affect the respiratory system. This study aimed to investigate the relationships between grip strength and pulmonary function and respiratory muscle strength in stroke patients over 50 years of age. Fifty-one patients (68.69±10.40 years) who had been clinically diagnosed with ischemic or hemorrhagic stroke were included in this study. We measured these patients' forced vital capacity (FVC), forced expiratory volume in 1 sec (FEV1), peak expiratory flow (PEF), maximal inspiratory pressure (MIP), maximal expiratory pressure (MEP), and hand grip strength. The data were analyzed using descriptive statistics and Pearson correlation analysis. Grip strength showed significant correlations with FVC (r=0.686, P=0.000), FEV1 (r=0.607, P=0.000), PEF (r=0.494, P=0.000), MIP (r=0.239, P=0.091), and MEP (r=0.348, P=0.012). This study demonstrated that grip strength is associated with pulmonary function and MEP in stroke patients over 50 years of age.

Combined respiratory muscle training facilitates expiratory muscle activity in stroke patients.

[Purpose] The aim of this study was to investigate the effect of combined respiratory muscle training on expiratory muscle activity in stroke patients. [Subjects and Methods] Twenty-five stroke patients were assigned to either the intervention group (n=12) or the control group (n=13). Both groups participated in a conventional stroke rehabilitation program, while the intervention group also received respiratory muscle training for 20 to 30 minutes a day, 3 times a week, for 8 weeks. Surface electromyographic data were collected from the rectus abdominis, internal oblique, and external oblique on the paretic side. Pulmonary function (forced vital capacity) and cough capacity (peak expiratory flow) also were measured. [Results] Both groups showed a significant increase in muscle activity after the intervention. However, the intervention group also showed significant increases in forced vital capacity and peak expiratory flow. Comparison of the 2 groups revealed that the intervention group had greater improvements in pulmonary function, cough capacity, and muscle activity. [Conclusion] The results of this study suggest that combined respiratory muscle training has positive effects on both respiratory function and expiratory muscle activity in stroke patients.

Upper extremity resistance exercise with elastic bands for respiratory function in children with cerebral palsy.

[Purpose] We investigated the effects of upper extremity resistance exercise with elastic bands on respiratory function in children with cerebral palsy. [Subjects and Methods] Fifteen children were divided into two groups: the experimental (n=8) and control (n=7) groups. Both groups performed general exercises for 30 minutes per session, two times a week during the intervention period. The experimental group performed an additional upper extremity resistance exercise with elastic bands for 20-30 minutes per session, twice weekly for 8 weeks. Pulmonary function, and respiratory muscle and grip strength were measured before and after the exercise. [Results] There was no significant difference in forced vital capacity, forced expiratory volume in one second, the ratio of forced expiratory volume in one second to forced vital capacity, and peak expiratory flow before and after the intervention in either group. The increment of maximal expiratory pressure was significantly greater in the experimental group, compared with the control group. In addition, grip strength was significantly increased in the experimental group after the intervention than before. [Conclusion] We found that upper extremity resistance exercise with elastic bands has a positive effect on expiration and improves grip strength in children with cerebral palsy.

The correlation between diaphragm thickness, diaphragmatic excursion, and pulmonary function in patients with chronic stroke.

[Purpose] This study aimed to investigate the correlation between the diaphragm thickness and diaphragm excursion, and pulmonary function in individuals with stroke. [Subjects and Methods] One hundred fourteen patients who were clinically diagnosed with ischemic or hemorrhagic stroke were included. The diaphragm thickness and excursion were assessed using ultrasonography, and the diaphragm thickening ratio was standardized using a formula. To analyze pulmonary function, we measured the forced vital capacity, forced expiratory volume in one second, and peak expiratory flow. [Results] A statistically significant correlation was found between the diaphragm thickness, thickness ratio, and diaphragm excursion; and the forced vital capacity, forced expiratory volume in one second, and peak expiratory flow. [Conclusion] This study demonstrated that there is a relationship between respiratory function and diaphragm thickness and diaphragm excursion, especially in the paretic side of the diaphragm. Therefore, the role of the respiratory muscles of the paretic side is important in rehabilitation programs to improve the respiratory function of stroke patients.

The correlation of respiratory muscle strength and cough capacity in stroke patients.

[Purpose] The purpose of this study was to investigate the correlation between respiratory muscle strength and cough capacity in stroke patients. [Subjects and Methods] Forty-two stroke patients were assigned to 2 different groups (intervention group=21, control group=21). Both groups participated in a conventional stroke rehabilitation program, with the intervention group also receiving respiratory muscle training for 20 to 30 minutes a day, 3 times a week for 8 weeks. Respiratory muscle strength (maximal inspiratory pressure, maximal expiratory pressure), forced vital capacity, and cough capacity were measured. [Results] The intervention group showed significant increases in maximal inspiratory pressure, maximal expiratory pressure, forced vital capacity, and cough capacity. The change in maximal inspiratory pressure, maximal expiratory pressure, and forced vital capacity showed a significant correlation with cough capacity, with maximal expiratory pressure showing the highest correlation. [Conclusion] The present study showed that the increase in maximal expiratory pressure plays an important role in improving the cough capacity of stroke patients.

Relative activity of respiratory muscles during prescribed inspiratory muscle training in healthy people.

[Purpose] This study aimed to determine the effects of different intensities of inspiratory muscle training on the relative respiratory muscle activity in healthy adults. [Subjects and Methods] Thirteen healthy male volunteers were instructed to perform inspiratory muscle training (0%, 40%, 60%, and 80% maximal inspiratory pressure) on the basis of their individual intensities. The inspiratory muscle training was performed in random order of intensities. Surface electromyography data were collected from the right-side diaphragm, external intercostal, and sternocleidomastoid, and pulmonary functions (forced expiratory volume in 1 s, forced vital capacity, and their ratio; peak expiratory flow; and maximal inspiratory pressure) were measured. [Results] Comparison of the relative activity of the diaphragm showed significant differences between the 60% and 80% maximal inspiratory pressure intensities and baseline during inspiratory muscle training. Furthermore, significant differences were found in sternocleidomastoid relative activity between the 60% and 80% maximal inspiratory pressure intensities and baseline during inspiratory muscle training. [Conclusion] During inspiratory muscle training in the clinic, the patients were assisted (verbally or through feedback) by therapists to avoid overactivation of their accessory muscles (sternocleidomastoid). This study recommends that inspiratory muscle training be performed at an accurate and appropriate intensity through the practice of proper deep breathing.

The effect of progressive high-intensity inspiratory muscle training and fixed high-intensity inspiratory muscle training on the asymmetry of diaphragm thickness in stroke patients.

[Purpose] This study investigated the effects of progressive load and fixed load high-intensity inspiratory muscle training on the asymmetry of diaphragm thickness in stroke patients. [Subjects] Twenty-one stroke patients were assigned to one of three groups: progressive load high-intensity inspiratory muscle training (n = 8), fixed load high-intensity inspiratory muscle training (n = 6), and controls (n = 7). [Methods] The progressive load and fixed load high-intensity inspiratory muscle training participants undertook an exercise program for 20 minutes, three times weekly, for 6 weeks. After each session, diaphragm thickness was measured using ultrasonography. The diaphragm asymmetry ratio and diaphragm thickening ratio were standardized using a formula. [Results] After intervention, the diaphragm asymmetry ratio significantly differed among the three groups, and the diaphragm asymmetry ratio significantly increased in the control group. A significant increase was identified in the diaphragm thickening ratio within the progressive load and fixed load high-intensity inspiratory muscle training groups. [Conclusion] Progressive load and fixed load high-intensity inspiratory muscle training decreased the asymmetry of diaphragm thickness in stroke patients; this effect, in turn, increased the diaphragm thickening ratio in stroke patients. The two interventions examined here should be selectively applied to individuals in the clinical field.

Effects of cervical sustained natural apophyseal glide on forward head posture and respiratory function.

[Purpose] To determine the effects of cervical sustained natural apophyseal glide on forward head posture and respiratory function. [Subjects and Methods] Thirty male and female adults in their 20s with forward head posture were included in the study. The subjects were divided randomly into experimental and control groups (n=15 each). Subjects in the experimental group performed cervical sustained natural apophyseal glide three times/week for four weeks while subjects in the control group did not perform the intervention. The craniovertebral angle, forced vital capacity and forced expiratory volume in the first second, as well as the % predicted value of each measurement were assessed to determine the changes in respiration functions before and after the exercise. [Results] The craniovertebral angle four weeks after the experiment was increased in the experimental group, whereas the control group showed no significant difference compared to baseline. The forced vital capacity, forced expiratory volume in the first second, and the % predicted values thereof were significantly increased in the experimental group four weeks after the experiment, but not in the control group. [Conclusion] Cervical sustained natural apophyseal glide was determined to be effective in improving neck posture and respiratory functions for patients with forward head posture.

Difference in lateral abdominal muscle thickness during forceful exhalation in healthy smokers and non-smokers.

BACKGROUND AND OBJECTIVES: The present study aims to determine whether the internal oblique (IO) and transversus abdominis (TrA) muscles, which are major lumbar stabilisers and also expiratory muscles, are affected by smoking. METHODS: A total of 31 healthy individuals in their 20s (smokers: 15; non-smokers: 16) voluntarily participated in the study. They were made to maintain an upright standing posture with their scapulars on the wall. Then measurement was taken on the thickness of their right IO and TrA while they were at rest and in a state of forced expiration using a 7.5 MHz linear probe, an ultrasonic imaging system. The thickness of the muscles was converted into the percentage of change in muscle thickness (PCMT) and relative contribution ratio (RCR) using a calculation formula, and then the data were analysed. RESULTS: Significant differences were found between the two groups in the PCMT of the TrA and in the RCR of both TrA and IO. CONCLUSION: Smokers have a relatively higher degree of dependence on IO than TrA during forceful expiratory conditions compared with non-smokers. This relative overreaction of the IO is considered to likely cause problems in efficiently diffusing loads of the spine.