Differences in Respiratory Muscle Responses to Hyperpnea or Loaded Breathing in COPD.

INTRODUCTION: We aimed to compare acute mechanical and metabolic responses of the diaphragm and rib cage inspiratory muscles during two different types of respiratory loading in patients with chronic obstructive pulmonary disease. METHODS: In 16 patients (age, 65 ± 13 yr; 56% male; forced expiratory volume in the first second, 60 ± 6%pred; maximum inspiratory pressure, 82 ± 5%pred), assessments of respiratory muscle EMG, esophageal pressure (Pes) and gastric pressures, breathing pattern, and noninvasive assessments of systemic (V˙O2, cardiac output, oxygen delivery and extraction) and respiratory muscle hemodynamic and oxygenation responses (blood flow index, oxygen delivery index, deoxyhemoglobin concentration, and tissues oxygen saturation [StiO2]), were performed during hyperpnea and loaded breathing. RESULTS: During hyperpnea, breathing frequency, minute ventilation, esophageal and diaphragm pressure-time product per minute, cardiac output, and V˙O2 were higher than during loaded breathing (P < 0.05). Average inspiratory Pes and transdiaphragmatic pressure per breath, scalene (SCA), sternocleidomastoid, and intercostal muscle activation were higher during loading breathing compared with hyperpnea (P < 0.05). Higher transdiaphragmatic pressure during loaded breathing compared with hyperpnea was mostly due to higher inspiratory Pes (P < 0.05). Diaphragm activation, inspiratory and expiratory gastric pressures, and rectus abdominis muscle activation did not differ between the two conditions (P > 0.05). SCA-blood flow index and oxygen delivery index were lower, and SCA-deoxyhemoglobin concentration was higher during loaded breathing compared with hyperpnea. Furthermore, SCA and intercostal muscle StiO2 were lower during loaded breathing compared with hyperpnea (P < 0.05). CONCLUSION: Greater inspiratory muscle effort during loaded breathing evoked larger rib cage and neck muscle activation compared with hyperpnea. In addition, lower SCA and intercostal muscle StiO2 during loaded breathing compared with hyperpnea indicates a mismatch between inspiratory muscle oxygen delivery and utilization induced by the former condition.

Pulmonary rehabilitation, physical activity, respiratory failure and palliative respiratory care.

The CIRO Academy in Horn (the Netherlands) organised a 2-day meeting to present and discuss the studies published in 2017 pertaining to key priority areas of respiratory and critical care medicine. This review summarises studies focussing on pulmonary rehabilitation and exercise training, physical activity, chronic respiratory failure and palliative respiratory care published in 2017.

Effects of 2 exercise training programs on physical activity in daily life in patients with COPD.

BACKGROUND: The effects of different exercise training programs on the level of physical activity in daily life in patients with COPD remain to be investigated. OBJECTIVE: In patients with COPD we compared the effects of 2 exercise/training regimens (a high-intensity whole-body endurance-and-strength program, and a low-intensity calisthenics-and-breathing-exercises program) on physical activity in daily life, exercise capacity, muscle force, health-related quality of life, and functional status. METHODS: We randomized 40 patients with COPD to perform either endurance-and-strength training (no. = 20, mean ± SD FEV(1) 40 ± 13% of predicted) at 60-75% of maximum capacity, or calisthenics-and-breathing-exercises training (no. = 20, mean ± SD FEV(1) 39 ± 14% of predicted). Both groups underwent 3 sessions per week for 12 weeks. Before and after the training programs the patients underwent activity monitoring with motion sensors, incremental cycle-ergometry, 6-min walk test, and peripheral-muscle-force test, and responded to questionnaires on health-related quality of life and functional status (activities of daily living, pulmonary functional status, and dyspnea). RESULTS: Time spent active and energy expenditure in daily life were not significantly altered in either group. Exercise capacity and muscle force significantly improved only in the endurance-and-strength group. Health-related quality of life and functional status improved significantly in both groups. CONCLUSIONS: Neither training program significantly improved time spent active or energy expenditure in daily life. The training regimens similarly improved quality of life and functional status. Exercise capacity and muscle force significantly improved only in the high-intensity endurance-and-strength group.

Influência do posicionamento de membros superiores sobre os efeitos do treinamento / Influence of arm positioning on the effects of a short-term high intensity inspiratory muscle training protocol in health young subjects

O objetivo do estudo foi analisar os efeitos de um treinamento muscular inspiratório (TMI) de curta duração e alta intensidade, com e sem o apoio de membros superiores, sobre as pressões respiratórias máximas em jovens saudáveis. Trinta jovens do sexo feminino foram aleatoriamente distribuídas em três grupos: o grupo controle (GC) fez treinamento placebo na posição sentada...

The purpose of this study was to analyse the effects of a short-term, high-intensity inspiratory muscle training (IMT) on health youth maximal respiratory pressures, with and without arm bracing postures. Thirty young women were randomly assigned to three groups: control group (CG); group training with the arm bracing (AB)...