Effects of Inspiratory Muscle Training in Patients With Pulmonary Hypertension.

The study aimed to examine the effects of inspiratory muscle training (IMT) in patients with pulmonary hypertension (PH). A total of 24 patients with PH were included in the randomized controlled evaluator-blind study. IMT was performed at 40% to 60% of the maximal inspiratory pressure for 30 min/d, 7 d/wk (1 day supervised) for 8 weeks. Respiratory muscle strength, dyspnea, diaphragm thickness (DT), pulmonary functions, 24-hour ambulatory blood pressure (BP), arterial stiffness, exercise capacity, upper extremity functional exercise capacity, physical activity levels, fatigue, anxiety-depression levels, activities of daily living (ADL), and quality of life were evaluated. A total of 24 patients (treatment = 12, control = 12) completed the 8-week follow-up. There was no significant difference between the patient groups in terms of demographic and clinical characteristics (p >0.05). Considering the change between the groups in the treatment and control groups, brachial and central BP, dyspnea, respiratory muscle strength, DT in total lung capacity, knee extension muscle strength, functional exercise capacity, upper extremity functional exercise capacity, physical activity, ADL, fatigue, anxiety, and quality of life improved in favor of the IMT group (p <0.05). In conclusion, IMT has improved brachial and central BP, dyspnea, respiratory muscle strength, DT in total lung capacity, knee extension muscle strength, functional exercise capacity, upper extremity functional exercise capacity, physical activity, ADL, fatigue, anxiety, and quality of life compared with the control group. IMT is an effective method in cardiopulmonary rehabilitation for patients with PH.

Effects of high intensity interval-based inspiratory muscle training in patients with heart failure: A single-blind randomized controlled trial.

BACKGROUND: Given the promising effects of inspiratory muscle training (IMT), determining the most appropriate IMT protocol will optimize the training benefits. OBJECTIVES: The objective of this study was to determine the effects of high intensity interval-based inspiratory muscle training (H-IMT) on cardiovascular, pulmonary, physical, and psychosocial functions in patients with heart failure and reduced ejection fraction (HFrEF). METHODS: Thirty-four patients with HFrEF were randomly assigned to the H-IMT or control group for 3 days/week, 8 weeks training period. The H-IMT group performed IMT at least 70% of the maximal inspiratory pressure, whereas the control group performed unloaded IMT. Each session occurred 7 sets with a total of 21 min consisting of 2-min training and 1-min interval. Heart rate variability (HRV), arterial stiffness, respiratory muscle strength and endurance, diaphragm thickness, quadriceps strength, functional capacity, frailty, dyspnea, fatigue, disease-specific health-related quality of life (HRQoL), and generic HRQoL were evaluated at baseline and after 8 weeks training period by blinded assessors. RESULTS: Statistically significant between-group differences were observed in the time domain parameters of HRV, arterial stiffness, inspiratory and quadriceps muscle strength, respiratory muscle endurance, diaphragm thickness, functional capacity, frailty, dyspnea, fatigue, and disease-specific HRQoL in favor of the H-IMT group (p<0.05). CONCLUSIONS: H-IMT is an effective protocol for improving cardiac autonomic function, arterial stiffness, inspiratory and quadriceps muscle strength, respiratory muscle endurance, diaphragm thickness, functional capacity, frailty, dyspnea, fatigue, and disease-specific quality of life in patients with HFrEF. CLINICAL TRIAL REGISTRATION: NCT04839211.

Acute effects of inspiratory muscle training at different intensities in healthy young people.

BACKGROUND: Understanding the acute effects of inspiratory muscle training (IMT) at different intensities on the autonomic nervous system, arterial stiffness, and blood pressure in healthy young people will be important in the constitution of appropriate IMT prescriptions. AIMS: To investigate the acute effects of IMT at different intensities on autonomic function, arterial stiffness, and blood pressure in healthy young people METHODS: Thirty-six healthy participants were enrolled in this crossover study. All participants randomly performed IMT sessions, which consisted of diaphragmatic breathing exercise (DBE), 10%, 30%, and 60% of maximal inspiratory pressure (MIP) on consecutive days. Autonomic function and arterial stiffness were assessed by measuring heart rate variability (HRV) and aortic pulse wave velocity (AoPWV), respectively. HRV, AoPWV, and blood pressure were recorded before and immediately after each IMT session. RESULTS: There was no significant difference in the baseline measurements between IMT sessions (p > 0.05). Heart rate (HR) significantly decreased after DBE and IMT at 10% of MIP (p < 0.05). All time domain parameters of HRV significantly improved after DBE compared with the baseline (p < 0.05). There was no difference in the frequency domain of HRV after the IMT sessions (p > 0.05). AoPWV significantly increased after IMT at 60% of MIP (p < 0.05). Mean arterial pressure significantly changed after DBE and IMT at 60% of MIP (p < 0.05). CONCLUSIONS: A single session of DBE positively affects autonomic function and blood pressure, while IMT at 60% of MIP increases arterial stiffness. The different intensities of IMT have various impacts on autonomic function, arterial stiffness, and blood pressure. TRIAL REGISTRATION: NCT03788356.

Effects of neuromuscular electrical stimulation in patients with pulmonary arterial hypertension: a randomized controlled pilot study.

BACKGROUND: Patients with pulmonary arterial hypertension (PAH) present impairments in muscle strength and exercise capacity. There is growing evidence about the benefits of neuromuscular electrical stimulation (NMES) in patients with respiratory diseases, except in patients with PAH. The aim of this study was to investigate the effects of NMES on muscle strength, and other physical and psychosocial variables in patients with PAH. METHODS: Patients with PAH were randomly divided into two groups as NMES and control. The NMES was applied to the bilateral deltoid and quadriceps femoris muscles with 50 Hz for 3 days/week, 8 weeks for the NMES group. Muscle strength, muscle cross-sectional area and thickness, arterial stiffness, exercise capacity, functional mobility and balance, balance confidence, fatigue, physical activity, and quality of life were assessed at baseline and after 8 weeks by blinded assessors. RESULTS: There was no significant difference in the demographic and clinical characteristics between the patient groups (p > 0.05). The improvements in muscle strength, muscle cross-sectional area and thickness, pulse wave velocity, exercise capacity, functional mobility and balance, balance confidence, fatigue, physical activity, and quality of life were significantly higher in the NMES group compared to the control group (p < 0.05). CONCLUSIONS: This study suggests that NMES intervention is safe and effective for patients with PAH.

High-intensity inspiratory muscle training in bronchiectasis: A randomized controlled trial.

BACKGROUND AND OBJECTIVE: Inspiratory muscle training (IMT) enhances velocity of inspiratory muscle contraction and modifies inspiratory and expiratory time. This study aimed to examine the impact of high-intensity IMT (H-IMT) on exercise capacity in bronchiectasis. METHODS: Forty-five patients were included. Lung function, respiratory muscle strength and endurance, exercise capacity, dyspnoea, fatigue and quality of life (QOL) were evaluated. Patients were randomized into two groups: H-IMT and control groups. Twenty-three patients underwent H-IMT for 8 weeks, using threshold loading with a target workload of maximal inspiratory pressure (MIP) of at least 70%, with 3-min cycles (as 2-min training: 1-min rest intervals) for 21 min. There was a total period of 14 min of loaded breathing and 7 min of recovery. The control group (n = 22) underwent low-intensity IMT at 10% of the initial MIP and was maintained at the same intensity until the end of the training. RESULTS: After training, both MIP and maximal expiratory pressure (MEP) and the incremental shuttle walk distance were increased in the H-IMT group compared with the control group (P < 0.05). There was a significant difference in constant threshold load, time and pressure-time units in the H-IMT group (P < 0.05) but not in the control group (P > 0.05). A significant decrease was found in fatigue in both groups (P < 0.05). The Leicester Cough Questionnaire social score for the H-IMT group decreased significantly after the treatment (P < 0.05). CONCLUSION: The H-IMT increased exercise capacity in patients with non-cystic fibrosis bronchiectasis. It has also positive effects on respiratory muscle strength and endurance, and social aspects of QOL.

Arm strength training improves activities of daily living and occupational performance in patients with COPD.

OBJECTIVES: Arm strength training may improve functional performance for patients with chronic obstructive pulmonary disease (COPD). This trial investigated the effects of arm strength training on arm exercise capacity, activities of daily living (ADL) and occupational performance in patients with COPD. METHODS: These was a randomized controlled trial in an outpatient clinic. Forty-two stable patients with COPD were randomly assigned into treatment and control groups. The treatment group underwent an 8-week (23 sessions) arm strength training programme. Both groups completed daily breathing exercises at home. Tests included hand grip strength, arm ergometer test, the Glittre-ADL and ADL Simulation tests and measures included the Milliken ADL Scale (MAS) and the Canadian Occupational Performance Measure (COPM). RESULTS: Statistically significant increases were detected in hand grip strength and %hand grip strength values, peak arm ergometer workload and the number of ADL simulation test cycles for the treatment group (P < 0.05). Significant decreases were also found in dyspnea and arm fatigue perception during arm ergometer test, and heart rate and dyspnea perception during Glittre-ADL test in the treatment group (P < 0.05). The treatment group also showed significant increases in MAS-house cleaning and laundry and MAS-other activities integrated scores and COPM-performance and satisfaction scores (P < 0.05). CONCLUSIONS: Arm strength training increases peripheral muscle strength, arm exercise capacity, ADL performance and patients' ADL performance satisfaction. Training decreases dyspnea and arm fatigue perception during supported arm exercises, and dyspnea perception during ADL. Arm strength training is a reliable and feasible treatment for COPD patients.

Inspiratory muscle training in pulmonary arterial hypertension.

PURPOSE: The purpose of this study was to investigate the effects of inspiratory muscle training (IMT) on functional capacity, respiratory muscle strength, pulmonary function, quality of life, and fatigue and dyspnea perception in patients with pulmonary arterial hypertension (PAH). METHODS: Twenty-nine clinically stable PAH patients were included in this study. These patients were randomly assigned to a 6-week IMT program (14 patients) or to a sham IMT protocol (15 patients). Before and after the treatment, pulmonary function, respiratory muscle strength, functional capacity, dyspnea and fatigue perception, and quality of life were evaluated. RESULTS: There were significant increases in maximal inspiratory and expiratory pressure, forced expiratory volume in 1 second (% predicted) and 6-minute walk distance in the IMT group compared with the control group (P < .05). There were significant decreases in the Fatigue Severity Scale score, Modified Medical Research Council dyspnea scores, and Nottingham Health Profile emotional reactions subscale in the IMT group compared with the control group (P < .05). CONCLUSIONS: Inspiratory muscle training promotes significant improvements in respiratory muscle strength and functional capacity, thus resulting in a reduction of dyspnea during activities of daily living and less fatigue in PAH patients. Inspiratory muscle training is a clinically practical treatment for PAH without any complications.

Do yoga and aerobic exercise training have impact on functional capacity, fatigue, peripheral muscle strength, and quality of life in breast cancer survivors?

AIM: The aim of the study was to compare the effects of aerobic exercise training and yoga on the functional capacity, peripheral muscle strength, quality of life (QOL), and fatigue in breast cancer survivors. MATERIAL AND METHODS: A total of 52 patients with a diagnosis of breast cancer were included in the study. The patients were randomly assigned to 2 groups: aerobic exercise (n = 28) and yoga added to aerobic exercise (n = 24). Both groups participated in submaximal exercise 30 minutes/d, 3 d/wk for 6 weeks. The second group participated in a 1-hour yoga program in addition to aerobic exercise training. Functional capacity was assessed by the 6-Minute Walk Test (6MWT). Peripheral muscle strength was evaluated with a hand-held dynamometer. The fatigue severity level was assessed with the Fatigue Severity Scale (FSS). The QOL was determined by the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire. RESULTS: There were statistically significant increases in peripheral muscle strength, the 6MWT distance, and the perception of QOL in both groups (P < .05). Additionally, the group with aerobic exercise and yoga showed marked improvement compared with the aerobic exercise group in fatigue perception (P < .05). CONCLUSION: According to the data from this study, aerobic exercise training and yoga improved the functional capacity and QOL of breast cancer patients. Aerobic exercise programs can be supported by body mind techniques, such as yoga, in the rehabilitation of cancer patients for improving functional recovery and psychosocial wellness.

Short-term effects of inspiratory muscle training in coronary artery bypass graft surgery: a randomized controlled trial.

OBJECTIVE: To investigate the efficiency of inspiratory muscle training (IMT) on postoperative respiratory muscle strength, functional capacity, quality of life, and psychosocial status in patients with coronary artery bypass graft (CABG) surgery. DESIGN: Forty-three patients undergoing CABG surgery were randomly assigned to the one of two groups. All subjects received usual care. In addition, subjects in the intervention group received IMT training pre- and postoperatively. Pulmonary function testing, six minute walk test (6MWT), quality of life and psychosocial parameters were assessed preoperatively and the fifth day after the surgery. RESULTS: The mean inspiratory muscle strength increased from 82.64 cmH(2)O at baseline to 95.45 cmH(2)O five days postoperatively in the intervention group. The intervention group (319.55 ± 72.17 m before and 387.91 ± 65.69 m after surgery) covered further distance during the 6MWT than usual care (355.43 ± 56.08 m before and 357.69 ± 43.42 m after surgery). The improvement in quality of life was greater in the intervention group for the dimension of sleep. The anxiety scores were significantly lower in the intervention group than the usual care group. The length of intensive care unit stay was significantly shorter in the intervention group than the usual care group (p < 0.05). CONCLUSION: IMT results in faster recovery of inspiratory muscle strength, functional capacity, intensive care unit stay, quality of life and psychosocial status after CABG.

Active cycle of breathing techniques in non-invasive ventilation for acute hypercapnic respiratory failure.

We hypothesised that applying the active cycle of breathing techniques (ACBT) in patients with acute hypercapnic respiratory failure undergoing non-invasive ventilation would improve patient outcome. Thirty-four patients were randomised so that 17 patients with acute hypercapnic respiratory failure received the ACBT and non-invasive ventilation (ACBT group), and 17 patients received non-invasive ventilation alone (control group). The primary outcome measure was length of time requiring non-invasive ventilation, and secondary outcome measures were change in acute physiology score, change in arterial blood gas values, total duration of non-invasive ventilation, and length of stay in the intensive care unit. Although not significant, there was a greater decrease in arterial carbon dioxide pressure in the ACBT group compared to the control group (-21.41 mmHg vs -17.45 mmHg, p = 0.27). Total duration of ventilation tended to be shorter in the ACBT group than in the control group (64.9 hours vs 84.1 hours, p = 0.15). Length of time in need of non-invasive ventilation was significantly lower in the ACBT group than in the control group (5.0 days vs 6.7 days, p = 0.03). There was no significant difference in length of stay in the intensive care unit between the two groups (8.0 vs 9.4 days, p = 0.31). The use of ACBT may have positive effects in the treatment of patients with acute hypercapnic respiratory failure, resulting in a shorter length of time requiring non-invasive ventilation.