Effects of Inspiratory Muscle Training on Stress Urinary Incontinence in North African Women: A Randomized Controlled Trial.

INTRODUCTION AND HYPOTHESIS: Pelvic floor muscles (PFMs) are involved in respiratory mechanisms. Additionally, stress urinary incontinence (SUI) can affect physical function. This randomized controlled trial was aimed at investigating the effects of inspiratory muscle training (IMT) on SUI severity, PFM function, and physical function in Tunisian women with SUI. METHODS: Twenty-seven incontinent women were randomly assigned to either the experimental group or the control group. The following parameters were assessed: respiratory muscle strength (RMS; maximal inspiratory and expiratory pressures), SUI severity (Urogenital Distress Inventory-6; Incontinence Impact Questionnaire-7; pad test), PFM function (Modified Oxford Scale, electromyography, and endurance), and physical function (Timed Up & Go test; 6-min walk test; incremental shuttle walking test). IMT was conducted using threshold IMT. RESULTS: The IMT program significantly reduced the severity of SUI (p < 0.01), improved PFM function (p < 0.001), enhanced physical function (p < 0.01), and increased RMS (p < 0.001). CONCLUSION: Inspiratory muscle training could be an effective method for improving pelvic floor disorders and physical function in women with SUI.

Impact of Urinary Incontinence on Physical Function and Respiratory Muscle Strength in Incontinent Women: A Comparative Study between Urinary Incontinent and Apparently Healthy Women.

Patients with stress urinary incontinence (SUI) may be afraid to increase intra-abdominal pressure to avoid incontinence. This could lead to weak expiratory muscles. The aim of this study was to investigate the association between respiratory muscle strength, physical function, and SUI in patients with SUI. A cross-sectional study was conducted in the Physical Medicine and Functional Rehabilitation Department. Thirty-one incontinent women (IG) and twenty-nine women in a control group (CG) were enrolled in this study. Anthropometric data, respiratory muscle strength (maximal inspiratory pressure; maximal expiratory pressure), SUI (Urogenital Distress Inventory-6; Incontinence Impact Questionnaire-7; Pad test), and physical function (waist circumference; timed-up-and-go test; abdominal muscle strength) were assessed. Body fat, body mass index, body weight, and waist circumference were higher in IG than CG (p < 0.01), while postural gait and abdominal muscles were lower (p < 0.001). Respiratory muscle strength displayed moderate correlations with SUI severity, especially for maximal expiratory pressure (p < 0.01). Maximal expiratory pressure was moderately associated with physical function. Deterioration in respiratory muscle strength is a characteristic of women with SUI. In this population, pelvic floor muscle training may be prescribed to improve continence. By feeling more confident about increasing intra-abdominal pressure, women with SUI would strengthen their expiratory muscles and eventually improve their physical function.

Effects of Walking Football During Ramadan Fasting on Heart Rate Variability and Physical Fitness in Healthy Middle-Aged Males.

This study aimed to investigate the effect of a walking football (WF) program during Ramadan fasting (RF) on heart rate variability (HRV) indices, body composition, and physical fitness in middle-aged males. Thirty-one healthy sedentary men were randomized to WF (n = 18) and control (n = 13) groups. Both groups participated in RF. The WF group were involved in a training program (small-sided games) of three sessions a week during RF. The time and frequency domains of HRV, body composition, handgrip, lumbar strength, Modified Agility Test (MAT), and 6-minute walk test (6MWT) were measured before Ramadan (BR), during Ramadan (DR), and after Ramadan (AR). We reported that RF has significantly altered some parameters of HRV DR; the mean HR decreased while the mean RR, LF, and HF increased. WF had a significant effect on HRV and mean HR DR compared with BR and AR decreased while mean RR, HF and LF increased. DR, body mass decreased in both groups, while body mass index (BMI) decreased and lean mass increased only in WF group. Lower body mass and BMI levels were reported AR only in WF group. Physical capacity improved AR, compared with BR, only in the WF group with longer distance in 6MWT, shorter time(s) in MAT, and higher lumbar strength levels. We conclude that RF increases parasympathetic system activity. WF practice during RF is safe and might improve body composition, physical fitness, autonomic cardiac function, and physical fitness in middle-aged males.

Effect of Six-Minute Walk Test and Incremental Exercise on Inspiratory Capacity, Ventilatory Constraints, Breathlessness and Exercise Performance in Sedentary Male Smokers without Airway Obstruction.

We investigated physiological responses and exercise capacity in sedentary young smokers during sub-maximal and maximal test and its impact on dyspnea and exercise intolerance. Fifty sedentary male smokers and non-smokers (age: 24 ± 1 years., weight: 71 ± 9 kg, height: 177.3 ± 4.8 cm, body mass index: 22.6 ± 2.5 kg/m2) underwent two visits with pulmonary function tests, breathing pattern, and inspiratory capacity measurement at rest and during sub-maximal and maximal exercise. Smokers show reduced exercise capacity during six minutes walk test (6-MWT) with decreased walked distance (p < 0.001) and inspiratory capacity (p < 0.05). During cardiopulmonary exercise test (CPET), smokers had higher minute ventilation VE for a given submaximal intensity (p < 0.05) and lower minute ventilation at maximal exercise (p < 0.001). End expiratory lung volume was significantly lower in sedentary smokers at rest (p < 0.05), at ventilatory threshold during exercise (p < 0.05), but not during peak exercise. End inspiratory lung volume was significantly lower in smokers at rest (p < 0.05) and ventilatory threshold (p < 0.05). Cigarette smoking alters lung function during submaximal and maximal exercise. This alteration is manifested by the development of dynamic hyperinflation contributing to exercise capacity limitation.

Mechanism of Dyspnea during Exercise in Children with Corrected Congenital Heart Disease.

This study will evaluate cardiorespiratory and peripheral muscle function and their relationship with subjective dyspnea threshold after the surgical correction of congenital heart disease in children. Thirteen children with surgically repaired congenital heart disease were recruited. Each participant performed an incremental exercise test on a cycle ergometer until exhaustion. Gas exchanges were continuously sampled to measure the maximal aerobic parameters and ventilatory thresholds. The functional capacity of the subjects was assessed with a 6 min walk test. At the end of the exercise test, isokinetic Cybex Norm was used to evaluate the strength and endurance of the knee extensor muscle in the leg. Dyspnea was subjectively scored with a visual analog scale during the last 15 s of each exercise step. Oxygen consumption measured at the dyspnea score/VO2 relationship located at the dyspnea threshold, at which dyspnea suddenly increased. Results: The maximal and submaximal values of the parameters describing the exercise and the peripheral muscular performances were: VO2 Peak: 33.8 ± 8.9 mL·min-1·kg-1; HR: 174 ± 9 b·min-1; VEmax: 65.68 ± 15.9 L·min-1; P max: 117 ± 27 W; maximal voluntary isometric force MVIF: 120.8 ± 41.9 N/m; and time to exhaustion Tlim: 53 ± 21 s. Oxygen consumption measured at the dyspnea threshold was related to VO2 Peak (R2 = 0.74; p < 0.01), Tlim (R2 = 0.78; p < 0.01), and the distance achieved during the 6MWT (R2 = 0.57; p < 0.05). Compared to the theoretical maximal values for the power output, VO2, and HR, the surgical correction did not repair the exercise performance. After the surgical correction of congenital heart disease, exercise performance was impeded by alterations of the cardiorespiratory function and peripheral local factors. A subjective evaluation of the dyspnea threshold is a reliable criterion that allows the prediction of exercise capacity in subjects suffering from congenital heart disease.

Relationship Between Electromyogram Spectrum Parameters and the Tension-Time Index During Incremental Exercise in Trained Subjects.

The inspiratory muscle tension-time index TT0.1 (given by P0.1/PImax x TI/TTOT) could be used to reliably assess inspiratory muscle activity during exercise. So far, the correlation between the TT0.1 and diaphragmatic activity has not been measured and the TT0.1 has not been compared with other measurements of the inspiratory muscle load such as the transdiaphragmatic pressure index or TTdi. In this study we hypothesize that the TT0.1 measuring the mouth is a noninvasive reflection of the electromyographic activity of the diaphragm. We simultaneously measured TT0.1 and surface EMG (SEMG) of 8 trained subjects at rest and during incremental exercise. The curvature of TT0.1 and the root mean square (RMS) follow the same trend during the incremental exercise with a significant correlation between TT0.1 and surface EMG parameters (RMS; r = 0.81 p < 0.001 and MPF; r = 0.80 p < 0.001 respectively). We conclude that TT0.1 measured as s an adequate noninvasive method reflects the diaphragmatic activity during incremental exercise in healthy subjects.

Effect of Aerobic Exercise Training on Ventilatory Efficiency and Respiratory Drive in Obese Subjects.

BACKGROUND: Obese patients show a decline in exercise capacity and diverse degrees of dyspnea in association with mechanical abnormalities, increased ventilatory requirements secondary to the increased metabolic load, and a greater work of breathing. Consequently, obese patients may be particularly predisposed to the development of respiratory muscle fatigue during exercise. The aim of this study was to assess inspiratory muscle performance during incremental exercise in 19 obese male subjects (body mass index 41 ± 6 kg/m2) after aerobic exercise training using the noninvasive, inspiratory muscle tension-time index (TT0.1). METHODS: Measurements performed included anthropometric parameters, lung function assessed by spirometry, rate of perceived breathlessness with the modified Borg dyspnea scale (0-10), breathing pattern, maximal exercise capacity, and inspiratory muscle performance with a breath-by-breath automated exercise metabolic system during an incremental exercise test. TT0.1 was calculated using the equation, TT0.1 = P0.1/PImax × TI/Ttot (where P0.1 represents mouth occlusion pressure, PImax is maximal inspiratory pressure, and TI/Ttot is the duty cycle). RESULTS: At rest, there was no statistically significant difference for spirometric parameters and cardiorespiratory parameters between pre- and post-training. At maximal exercise, the minute ventilation, the rate of exchange ratio, the rate of perceived breathlessness, and the respiratory muscle performance parameters were not significantly different pre- and post-training; in contrast, tidal volume (P = .037, effect size = 1.51), breathing frequency (P = .049, effect size = 0.97), power output (P = .048, effect size = 0.79), peak oxygen uptake (P = .02, effect size = 0.92) were significantly higher after training. At comparable work load, training induces lower minute ventilation, mouth occlusion pressure, ratio of occlusion pressure to maximal inspiratory pressure, TT0.1, and rate of perceived breathlessness. CONCLUSIONS: Aerobic exercise at ventilatory threshold can induce significant improvement in respiratory muscle strength, maximal exercise capacity, and inspiratory muscle performance and decreased dyspnea perception in obese subjects.

Inspiratory muscle performance in endurance-trained elderly males during incremental exercise.

The aim of this study was to compare the inspiratory muscle performance during an incremental exercise of twelve fit old endurance-trained athletes (OT) with that of fit young athletes (YT) and healthy age-matched controls (OC). The tension-time index (TT0.1) was determined according to the equation TT0.1=P0.1/PImax×ti/ttot, where P0.1 is the mouth occlusion pressure, PImax the maximal inspiratory pressure and ti/ttot the duty cycle. For a given VCO2, OT group displayed P0.1, P0.1/PImax ratio, TT0.1 and effective impedance of the respiratory muscle values which were lower than OC group and higher than YT group. At maximal exercise, P0.1/PImax ratio and TT0.1 was still lower in the OT group than OC group and higher than YT group. This study showed lower inspiratory muscle performance attested by a higher (TT0.1) during exercise in the OT group than YT group, but appeared to be less marked in elderly men having performed lifelong endurance training compared with sedentary elderly subjects.

Advanced Mechanical Ventilatory Constraints During Incremental Exercise in Class III Obese Male Subjects.

BACKGROUND: We investigated the role of mechanical ventilatory constraints in obese class III subjects during incremental exercise. METHODS: We examined 14 control subjects (body mass index [BMI], 23.6 ± 3.2 kg/m(2)), 15 obese class II subjects (BMI, 37.2 ± 4.5 kg/m(2)), and 17 obese class III subjects (BMI, 53.4 ± 6.8 kg/m(2)). All subjects performed pulmonary function tests and maximal inspiratory pressure at rest, ventilatory parameters, flow-volume loops, and rated perceived exertion and breathlessness during exercise. RESULTS: All subjects had normal pulmonary function. Obesity resulted in increased minute ventilation for a given submaximal work rate, although minute ventilation during peak exercise was lowest in the obese class III subjects. End-expiratory lung volume was significantly lower in the obese subjects at rest and during exercise at the ventilatory threshold but not during peak exercise. During heavy-to-peak exercise, the obese subjects increased their end-expiratory lung volume, whereas the control group continued to decrease this parameter. Compared with controls, end-inspiratory lung volume was significantly lower in obese class II subjects and obese class III subjects at rest and at the ventilatory threshold but not during peak exercise. At maximal exercise, obese class III subjects had a greater end-inspiratory lung volume than obese class II subjects and controls. Obese class III subjects displayed a greater expiratory air flow limitation at rest, at the ventilatory threshold, and during peak exercise than both controls and obese class II subjects. CONCLUSIONS: Mechanical ventilatory constraints increase progressively with degrees of obesity, contributing to exercise limitation in obese subjects.

Is there a beneficial effect difference between age, gender, and different cardiac pathology groups of exercise training at ventilatory threshold in cardiac patients?

BACKGROUND: Research on cardiac rehabilitation has raised interesting methods and effects without however establishing the share of the profits according to age, sex and cardiac pathology. Yet today, this disease with various pathologies strikes people of all ages and both sexes, and the recommended rehabilitation exercise intensity is often the ventilatory threshold. The aim of this study was to compare benefits of a training program at ventilatory threshold according to age, gender and cardiac pathology. METHODS: One hundred and eighty eight cardiac patients, of whom 62 had coronary artery bypass surgery, 22 artery angioplasty, 54 myocardial infarction and 50 valve replacements, aged 31-82 years, performed spirometric and cardiopulmonary exercise tests before and after a training program. This program consisted of exercise on a cycloergometer for three sessions of 45 min per week for eight weeks at heart rates attenuated at ventilatory threshold (V(Th)) obtained during a cardiopulmonary exercise test conducted before the training period. RESULTS: Peak heart rate, peak aerobic power, and peak oxygen uptake determined at V(Th) increased during the training period in all groups of subjects. Men and adult groups had higher absolute values compared to women and elderly groups. No difference was observed in cardiac pathology groups. Similar improvements of aerobic capacities were observed in age, gender and cardiac pathology groups. CONCLUSIONS: A training program conducted at personalised V(Th) significantly improves the aerobic physical capacities of all cardiac patients, and inducessimilar benefits whatever the age, gender or cardiac pathology.

Feasibility and reliability of a repeated sprint test in children age 6 to 8 years.

This study investigated the feasibility and reliability of a 12 × 25-m repeated sprint test with sprints starting every 25-s in children aged 6-8 years (36 boys, 41 girls). In all subjects, total sprint time (TST) demonstrated high test-retest reliability (ICC: r = .98; CV: 0.7% (95% CI: 0.6-0.9)). While sprint time varied over the 12 sprints in all subjects (p < .001) with a significant increase in time for the third effort onwards compared with the first sprint (p < .001), there was no difference in performance between genders. In all subjects, TST decreased with age (p < .001) and was accompanied by an increase in estimated anaerobic power (p < .001) but also in sprint time decrement percentage (p < .001). Gender did not effect these changes. The present study demonstrates the practicability and reliability of a repeated sprint test with respect to age and gender in young children.

Effects of obesity on breathing pattern, ventilatory neural drive and mechanics.

The purpose of this study was to assess whether obesity induces changes in breathing pattern and ventilatory neural drive and mechanics. Measurements performed in 34 male obese subjects (BMI, 39+/-6 kg/m(2)) and 18 controls (BMI, 23+/-3 kg/m(2)) included anthropometric parameters, spirometry, breathing patterns, mouth occlusion pressure, maximal inspiratory pressure and work of breathing. The results show that spirometric flow (FEV(1)% pred, FVC% pred) and maximal inspiratory pressure (P(Imax)) were significantly lowers (p<0.001) in obese subjects compared to controls. The (fR/VT) ratio was higher in obese subjects than in controls (p<0.001). The increase in (fR/VT) was associated with an increase in the ratio of mean inspiratory pressure to maximal inspiratory pressure (P(I)/P(Imax)) and the duty cycle (T(I)/T(TOT)) (p<0.001). The energy cost of breathing (W(rest)/W(crit)), which reflects the oxygen consumed by the respiratory muscle was greater in obese subject than in controls (p<0.001) inducing an increase in the effective inspiratory impedance on the respiratory muscles. It is concluded that obese subjects show impairment in breathing pattern and respiratory mechanics as assessed by rapid shallow breathing leading to ventilatory failure.

Breathing pattern adopted by children with cystic fibrosis with mild to moderate pulmonary impairment during exercise.

BACKGROUND: It is well known that severe lung impairment in cystic fibrosis (CF) may compromise respiratory muscle function at rest. Even though patients with CF and severe obstructive lung disease exhibit an abnormal breathing pattern during exercise (due to expiratory flow limitation), patients with CF and normal lung function reportedly have a normal breathing pattern. OBJECTIVES: The aim of the study was to assess the precise characteristics of the ventilatory pattern adopted during exercise by children with CF and mild to moderate lung disease. METHODS: Nine children diagnosed as having mild to moderate CF and 9 healthy children with a similar age distribution participated in this study. Both groups performed a continuous incremental cycling protocol. Breathing and timing components were assessed during exercise. RESULTS: Differences in the breathing pattern between children with CF and controls during exercise are illustrated in Hey plot which described a rapid shallow breathing pattern in children with CF. During exercise, children with CF showed a significantly lower mean inspiratory flow than healthy children (p < 0.001), whereas the mean expiratory flow was higher (p < 0.001). Children with CF also showed a significant increase in the end-tidal carbon dioxide pressure, which may indicate the emergence of hypercapnia. CONCLUSIONS: During exercise, children with CF (even those not suffering from advanced disease) showed signs of rapid, shallow breathing and an increase in the ventilatory response. This was essentially due to an increase in the mean inspiratory flow, which in turn suggests an expiratory flow limitation. The children were also predisposed to hypercapnia.