Effects of inspiratory muscle training on resting breathing pattern in patients with advanced lung disease.

AIM: The aim of this study was to evaluate the effects of interval high intensity inspiratory muscle training (IMT) on resting breathing pattern in patients with advanced lung disease. METHODS: IMT was performed daily and training load set at 50 % of the maximal inspiratory pressure. Participants were evaluated at pre-IMT, post 8 weeks of IMT and follow-up (3 months after the end of IMT). Breathing pattern (volume and time variables as well as percentages of contribution to tidal volume) was evaluated by Optoelectronic Plethysmography at rest. Friedman test was used to verify the differences between the three time-points (p < 0.05). RESULTS: Nineteen patients (54 ± 16 years old; 5 males) were evaluated at pre-IMT and post-IMT and fourteen were assessed at follow-up. There was no significant difference (p > 0.05) in any comparison for all evaluated breathing pattern variables at the three time-points. CONCLUSION: Resting breathing pattern was not significantly changed after 8 weeks of IMT in patients with advanced lung disease.

Inspiratory muscle training reduces dyspnea during activities of daily living and improves inspiratory muscle function and quality of life in patients with advanced lung disease.

Aim: To evaluate the effects of an inspiratory muscle training (IMT) program on dyspnea during activities of daily living, inspiratory muscle function, functional capacity, and quality of life in patients with advanced lung disease (ALD).Methods: Pre-post interventional study in which patients with ALD from the Advanced Lung Disease and Pre Lung Transplantation Ambulatory Clinic were included. Patients performed home-based high-intensity interval IMT for 8 weeks (two sessions per day, daily). In each session, patients performed two sets of 30 breaths, with a 2-min rest between sets. Dyspnea during activities of daily life, primary outcome - assessed by the London Chest Activity of Daily Living scale-LCADL, inspiratory muscle function (MIP and endurance test), distance on the 6-min walking test [6MWD], and quality of life (St George Respiratory Questionnaire [SGRQ]) were measured pre-IMT, post-IMT, and 3 months after the intervention (follow-up).Results: Dyspnea during activities of daily living significantly decreased after 8 weeks of IMT (LCADLpre = 31.5 [IQR = 23-37.25], LCADLpost = 26 [IQR = 20.75-32], LCADLfollow-up = 30.5 [IQR = 20-35]; p < .03). After IMT, there was an improvement in inspiratory muscle strength (p < .001) and endurance (p < .001). Functional capacity evaluated using the 6MWD increased but did not reach significance (p = .79) There was also a significant improvement in quality of life, as demonstrated by the SGRQ (p < .004).Conclusions: Our results suggest that IMT was able to reduce dyspnea during activities of daily living, as well as improve inspiratory muscle function, and quality of life in patients with ADL, and these benefits were sustained for 3 months.

Sustained maximal inspiration has similar effects compared to incentive spirometers.

PURPOSE: To compare the effects of flow incentive spirometer (FIS), volume incentive spirometer (VIS), and sustained maximal inspiration exercise (SMI) on breathing pattern, chest wall motion, and thoracoabdominal asynchrony. METHODS: Sixteen healthy adults aged 27.63 ± 5.26 years were evaluated by optoelectronic plethysmography in the supine position with trunk inclination of 45° during quiet breathing and during exercise performance. RESULTS: In the comparisons among exercises, VIS promoted a significantly higher inspiratory time and lower mean inspiratory flow compared with FIS. The rating of perceived exertion according to the Borg Scale was significantly higher after the performance of FIS compared with VIS. Regarding asynchrony, none of the exercises caused changes in thoracoabdominal synchrony between the rib cage and abdomen. However, both devices significantly reduced the asynchrony between the pulmonary and abdominal rib cage compared with quiet breathing. CONCLUSION: SMI exercise was equivalent to incentive spirometers and may be an interesting alternative for clinical use in cases in which it is not possible to acquire the devices.

Effects of Diaphragmatic Breathing With and Without Pursed-Lips Breathing in Subjects With COPD.

BACKGROUND: Breathing exercises, such as diaphragmatic breathing and pursed-lips breathing, play a role in some individuals with COPD and might be considered for those patients who are unable to exercise. However, in the literature are reports of some adverse effects of diaphragmatic breathing in patients with COPD. Thus, the purpose of this study was to assess the effects of diaphragmatic breathing and diaphragmatic breathing combined with pursed-lips on chest wall kinematics, breathlessness, and chest wall asynchrony in subjects with COPD, and also to assess whether the combination of both exercises reduces the adverse effects of diaphragmatic breathing while maintaining its benefits. METHODS: Seventeen subjects with COPD, mean ± SD, 65 ± 7 y of age, with a history of smoking and clinical stability without hospitalization or symptoms of exacerbation in the past 4 wk, were evaluated. On day 1, participants' characteristics were collected, and they learned diaphragmatic breathing and its combination with pursed-lips breathing. On day 2, the participants were evaluated by optoelectronic plethysmography with the participants in the seated position while performing breathing exercises. RESULTS: Diaphragmatic breathing and diaphragmatic breathing plus pursed-lips breathing promoted a significant increase in chest wall tidal volume and its compartments as well as a reduction in breathing frequency compared with quiet breathing. No significant changes were observed in dyspnea or end-expiratory volume of the chest wall. A significant increase in asynchrony (inspiratory-expiratory phase ratio) was observed during diaphragmatic breathing and diaphragmatic breathing plus pursed-lips breathing compared with quiet breathing, with no differences observed between the exercises. CONCLUSIONS: Despite the increase in asynchrony, both breathing exercises were able to improve chest wall volumes without affecting dyspnea. The combination of exercises maintained the benefits but did not reduce the adverse effects of diaphragmatic breathing.

Breathing exercises: influence on breathing patterns and thoracoabdominal motion in healthy subjects.

BACKGROUND: The mechanisms underlying breathing exercises have not been fully elucidated. OBJECTIVES: To evaluate the impact of four on breathing exercises (diaphragmatic breathing, inspiratory sighs, sustained maximal inspiration and intercostal exercise) the on breathing pattern and thoracoabdominal motion in healthy subjects. METHOD: Fifteen subjects of both sexes, aged 23 ± 1.5 years old and with normal pulmonary function tests, participated in the study. The subjects were evaluated using the optoelectronic plethysmography system in a supine position with a trunk inclination of 45° during quiet breathing and the breathing exercises. The order of the breathing exercises was randomized. Statistical analysis was performed by the Friedman test and an ANOVA for repeated measures with one factor (breathing exercises), followed by preplanned contrasts and Bonferroni correction. A p<0.005 value was considered significant. RESULTS: All breathing exercises significantly increased the tidal volume of the chest wall (V(cw)) and reduced the respiratory rate (RR) in comparison to quiet breathing. The diaphragmatic breathing exercise was responsible for the lowest V(cw), the lowest contribution of the rib cage, and the highest contribution of the abdomen. The sustained maximal inspiration exercise promoted greater reduction in RR compared to the diaphragmatic and intercostal exercises. Inspiratory sighs and intercostal exercises were responsible for the highest values of minute ventilation. Thoracoabdominal asynchrony variables increased significantly during diaphragmatic breathing. CONCLUSIONS: The results showed that the breathing exercises investigated in this study produced modifications in the breathing pattern (e.g., increase in tidal volume and decrease in RR) as well as in thoracoabdominal motion (e.g., increase in abdominal contribution during diaphragmatic breathing), among others.

Estudo de seguimento da função motora de indivíduos pós-acidente vascular encefálico / Follow-up analysis of the motor function of post-stroke individuals / Estudio de seguimiento de la función motora de individuos post accidente cerebro vascular

Objetivou-se caracterizar e analisar mudanças nas variáveis relacionadas à função motora de hemiparéticos crônicos após um período médio de sete anos. Coletaram-se via telefone dados demográficos e clínicos de hemiparéticos avaliados em 2003. Todos foram convidados a participar da reavaliação, em que se coletaram medidas de força da musculatura respiratória, desempenho funcional, capacidade física e nível de atividade física. Estatísticas descritivas, testes t pareado ou Wilcoxon foram utilizados para análise dos dados. Dos 101 hemiparéticos avaliados presencialmente em 2003, contataram-se por telefone 65 deles ou seus familiares, sendo que 35 (64,6±10,6 anos) responderam às questões por telefone, 22 (56,8±13,3 anos) foram avaliados presencialmente e 8 faleceram. Após uma média de sete anos de seguimento, em relação às medidas realizadas presencialmente, nenhuma variável apresentou diferença significativa entre as avaliações (0,08

The aim of this study was to characterize and analyze changes in the variables related to the motor function of chronic hemiparetic patients after a period of seven years. The demographic and clinical data of the participants, who were initially assessed in 2003, were collected by telephone. All individuals were invited to participate in the reassessments, which included data related to respiratory strength, functional performance, physical ability, and physical activity levels. Descriptive statistics, Wilcoxon or paired t-tests were used for analyses. Out of the 101 hemiparetic partcipants, who were initially assessed in 2003, 65 subjects or their relatives were contacted by telephone; 35 (64.5±10.6 years) answered the questions by telephone, 8 passed away, and 22 (56.8±13.3 years) were physically assessed. After a mean follow up of seven years, none of the physically assessed variables showed significant differences between the two assessments (0.08

Se buscó caracterizar y analizar cambios en las variables relacionadas a la función motora de hemiparéticos crónicos después de un período medio de siete años. Se colectaron por teléfono datos demográficos y clínicos de hemiparéticos evaluados en 2003. Todos fueron invitados a participar de reevaluación, donde se colectaron medidas de fuerza de la musculatura respiratoria, desempeño funcional, capacidad física y nivel de actividad física. Estadísticas descriptivas, tests t pareados o Wilcoxon fueron utilizados para análisis de los datos. De los 101 hemiparéticos evaluados presencialmente en 2003, se contactaron por teléfono 65 de ellos o sus familiares, siendo que 35 (64,6±10,6 años) respondieron las preguntas por teléfono, 22 (56,8±13,3 años) fueron evaluados presencialmente y 8 fallecieron. Después de una media de siete años de seguimiento, en relación a las medidas realizadas presencialmente, ninguna variable presentó diferencia significativa entre las evaluaciones (0,08

Inspiratory muscular training in chronic stroke survivors: a randomized controlled trial.

OBJECTIVE: To assess the effectiveness of inspiratory muscular training (IMT) on measures of strength, resistance, functional performance, and quality of life (QOL) for chronic stroke survivors. DESIGN: Double-blinded randomized controlled trial. SETTING: Research laboratory. PARTICIPANTS: Subjects (N=21) with stroke (11 men, 10 women; maximal inspiratory pressure [MIP] <90% of predicted values) were randomly assigned to the experimental (n=11) and control groups (n=10); 18 participants completed all testing and training. INTERVENTIONS: Interventions were based on home-based training, with resistance adjusted biweekly to 30% of MIP for the experimental group. The control group underwent the same protocol without the threshold resistance valve. Both groups received home training 30 minutes a day 5 times a week for 8 weeks. MAIN OUTCOME MEASURES: MIP, inspiratory muscular endurance (IME), functional performance, and QOL. RESULTS: There were significant between-group differences for the MIP and IME measures. Significant changes were observed for only the experimental group for MIP (67.8±14.6 at baseline to 102.2±26.0cmH(2)O at posttraining) and IME (31.8±19.3 to 49.2±21.1cmH(2)O). No statistically significant differences were observed for measures of functional performance and QOL. CONCLUSIONS: Significant short-term effects of the IMT program for inspiratory strength and endurance were observed in chronic stroke survivors. These findings gave some indications that IMT may benefit people with stroke, and it is feasible to be included in rehabilitation interventions with this population.