Maximal Respiratory Pressure Reference Equations in Healthy Adults and Cut-off Points for Defining Respiratory Muscle Weakness

Introduction: Maximal inspiratory and expiratory pressures (PImax/PEmax) reference equations obtained in healthy people are needed to correctly interpret respiratory muscle strength. Currently, no clear cut-off points defining respiratory muscle weakness are available. We aimed to establish sex-specific reference equations for PImax/PEmax in a large sample of healthy adults and to objectively determine cut-off points for respiratory muscle weakness. Methods: A multicentre cross-sectional study was conducted across 14 Spanish centres. Healthy non-smoking volunteers aged 18–80 years stratified by sex and age were recruited. PImax/PEmax were assessed using uniform methodology according to international standards. Multiple linear regressions were used to obtain reference equations. Cut-off points for respiratory muscle weakness were established by using T-scores. Results: The final sample consisted of 610 subjects (314 females; 48 [standard deviation, SD: 17] years). Reference equations for PImax/PEmax included body mass index and a squared term of the age as independent variables for both sexes (p<0.01). Cut-off points for respiratory muscle weakness based on T-scores ≥2.5 SD below the peak mean value achieved at a young age were: 62 and 83cmH2O for PImax and 81 and 109cmH2O for PEmax in females and males, respectively. Conclusion: These reference values, based on the largest dataset collected in a European population to date using uniform methodology, help identify cut-off points for respiratory muscle weakness in females and males. These data will help to better identify the presence of respiratory muscle weakness and to determine indications for interventions to improve respiratory muscle function. (AU)

Maximal Respiratory Pressure Reference Equations in Healthy Adults and Cut-off Points for Defining Respiratory Muscle Weakness.

INTRODUCTION: Maximal inspiratory and expiratory pressures (PImax/PEmax) reference equations obtained in healthy people are needed to correctly interpret respiratory muscle strength. Currently, no clear cut-off points defining respiratory muscle weakness are available. We aimed to establish sex-specific reference equations for PImax/PEmax in a large sample of healthy adults and to objectively determine cut-off points for respiratory muscle weakness. METHODS: A multicentre cross-sectional study was conducted across 14 Spanish centres. Healthy non-smoking volunteers aged 18-80 years stratified by sex and age were recruited. PImax/PEmax were assessed using uniform methodology according to international standards. Multiple linear regressions were used to obtain reference equations. Cut-off points for respiratory muscle weakness were established by using T-scores. RESULTS: The final sample consisted of 610 subjects (314 females; 48 [standard deviation, SD: 17] years). Reference equations for PImax/PEmax included body mass index and a squared term of the age as independent variables for both sexes (p<0.01). Cut-off points for respiratory muscle weakness based on T-scores ≥2.5 SD below the peak mean value achieved at a young age were: 62 and 83cmH2O for PImax and 81 and 109cmH2O for PEmax in females and males, respectively. CONCLUSION: These reference values, based on the largest dataset collected in a European population to date using uniform methodology, help identify cut-off points for respiratory muscle weakness in females and males. These data will help to better identify the presence of respiratory muscle weakness and to determine indications for interventions to improve respiratory muscle function.

Effectiveness of nordic walking in patients with asthma: A study protocol of a randomized controlled trial.

BACKGROUND: Patients with asthma often consider their symptomatology a barrier to exercise, leading to a reduced physical activity level. This study aims to determine whether the effect of a Nordic walking (NW) training program plus education and usual care is superior to educational and usual care only, in terms of exercise tolerance and other health-related outcomes in patients with asthma. The second aim is to explore the patients' experience with the NW program. METHODS: A randomized controlled trial will be conducted with 114 adults with asthma recruited in sanitary area of A Coruña, Spain. Participants will be randomized to NW or control groups in blocks of six and in the same proportion in each group. Participants in the NW group will enrol in supervised sessions during eight weeks, three times/week. All participants will receive three educational sessions on asthma self-management plus usual care (S1 Appendix). Outcomes such as exercise tolerance (primary outcome), physical activity level, asthma-related symptoms and asthma control, dyspnea, lung function, handgrip strength, health related quality of life, quality of sleep, treatment adherence and healthcare resources use will be measured pre and postintervention, and at three and six months of follow-up. Participants in the NW group will additionally participate in focus groups. DISCUSSION: This is the first study analysing the effect of NW in patients with asthma. NW combined with education and usual care is expected to improve exercise tolerance, but also asthma-related outcomes. If this hypothesis is confirmed, a new community-based therapeutic approach will be available for patients with asthma. TRIAL REGISTRATION: Study registered in ClinicalTrials.gov with number of register NCT05482620.

Effect of respiratory muscle training in asthma: A systematic review and meta-analysis.

BACKGROUND: The last systematic review about respiratory muscle training (RMT) in people with asthma was published almost 10 years ago. Since then, several works have been published. OBJECTIVE: To review the effect of RMT in people with asthma. METHODS: We conducted a systematic review of research included up to September 2021 in PubMed/MEDLINE, PEDro, Scopus, Web of Science, CINAHL, LILACS, Cochrane Central Register of Controlled Trials and ClinicalTrials.gov. We included randomized controlled trials and quasi-experimental studies assessing the effect of RMT on respiratory muscle function, rescue medication, asthma-related symptoms, lung function, exercise capacity, healthcare use, health-related quality of life (HRQoL) and adverse effects in people with asthma. Risk of bias and methodological quality were assessed with the Cochrane Risk of Bias assessment tool and the PEDro scale. Meta-analysis was performed whenever possible; otherwise a qualitative approach was followed. RESULTS: Eleven studies (270 participants) were included, 10 with only adults and were included in the meta-analysis. Inspiratory muscle training (IMT) had beneficial effects on maximal inspiratory pressure (PImax: mean difference [MD] 21.95 cmH2O [95% confidence interval [CI] 15.05; 28.85]), with no changes in maximal expiratory pressure (MD 14.97 cmH2O [95%CI -5.65; 35.59]), lung function (forced expiratory volume in 1 sec: MD 0.06 [95%CI -0.14; 0.26] L; force vital capacity: MD 0.39 [95%CI -0.24; 1.02] L) and exercise capacity (standard mean difference [SMD] 1.73 [95%CI -0.61; 4.08]). Subgroup analysis revealed that IMT load >50% PImax and duration >6 weeks were beneficial for exercise capacity. The qualitative analysis suggested that IMT may have benefits on respiratory muscle endurance, rescue medication and exertional dyspnoea, with no adverse effects. CONCLUSIONS: This systematic review and meta-analysis showed a significant increase in PImax after IMT in adults with asthma and reinforced the relevance of the dose-response principle of training. More evidence is needed to clarify the effect of IMT in respiratory muscle endurance, rescue medication, exercise capacity, healthcare use and HRQoL. TRIAL REGISTRATION: PROSPERO International Prospective Register of Systematic Reviews CRD42020221939; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=221939.

Pulmonary function in patients with chronic stroke compared with a control group of healthy people matched by age and sex.

BACKGROUND: Effects of chronic stroke on pulmonary function are largely unknown. AIM: To compare lung volumes in people with chronic stroke with a control group of healthy people matched by age and sex, as well as to investigate the relationship between the lung volumes and functional capacity. METHODS: A cross-sectional study involving people with chronic stroke. Cases were matched to a control group of healthy people. Lung function and the distance walked during the Six-Minute Walk Test (6MWD) were the main outcomes. Independent t-tests were used to compare pulmonary function between groups and the Pearson correlation coefficient was used to assess any relationship between lung volumes and the 6MWD in the stroke group. RESULTS: Sixty-six participants (24 males in each group; 56.5 ± 15.5 years) were included. People with stroke presented significantly lower lung volumes when compared to the control group. The median of forced vital capacity (FVC) was 79% and peak expiratory flow was 64% of the reference value. The 6MWD was found to be weakly correlated with inspiratory reserve volume (r = 0.39, p = .03) and peak inspiratory flow (r = 0.35, p = .05). CONCLUSIONS: People with chronic stroke show decreased lung volumes when compared with healthy people and this likely impacts on their functional capacity.

[Respiratory physiotherapy in post-COVID-19: a decision-making algorithm for clinical practice]. / Fisioterapia respiratoria post-COVID-19: algoritmo de decisión terapéutica.

The outbreak of COVID-19 has posed a great challenge for the healthcare system which has been later aggravated by the need of managing clinical manifestations and potential sequelae in COVID-19 survivors. In this context, respiratory Physiotherapy emerges as a cornerstone in the interdisciplinary management warranted in this population. Given that the implementation and resources available for the interdisciplinary therapeutic interventions in Spain is scarce, it is essential to perform a comprehensive, exhaustive and personalised assessment. This will allow us to establish more accurate selection criteria in order to optimise the use of existing human and material resources. To this end, we propose here a decision-making algorithm for clinical practice to assess the clinical manifestations in people recovered from COVID-19 based on well-established, validated tests and assessment tools. This algorithm can be used at any clinical practice environment (primary care/community or hospital-based), combined with a patient-centered model and the use of community and e-Health resources and its application to improve the Physiotherapy care of these patients in the COVID-19 era.

Comparison of Two Protocols for the Assessment of Maximal Respiratory Pressures: Spanish Society of Pulmonology and Thoracic Surgery Versus American Thoracic Society/European Respiratory Society.

Background The measurement of maximal respiratory pressures (MRPs) is commonly used to assess respiratory muscle strength. However, in Spain, there is no consensus on which is the most adequate measurement protocol, as theSpanish Society of Pneumology and Thoracic Surgery (SEPAR) protocol differs from the one endorsed by the American Thoracic Society/European Respiratory Society(ATS/ERS). This study compared the absolute and predictive values of maximal expiratory and inspiratory pressures (MEP and MIP) in healthy adults obtained with the two protocols. Methods A cross-sectional study with a sample of healthy adults was conducted. Lung function and MRPs were assessed. MEP and MIP were measured using a digital manometer according to the SEPAR and ATS/ERS. Protocols were applied in random order by the same trained physiotherapist. The comfort experienced with each protocol was assessed through a short questionnaire. Paired t-tests were used to compare the results from both protocols. Results A total of 31 subjects (mean age 35.7±12.4 years; 14 females; FEV1=108.3±10.5%; FVC=103.7±10%) were included. There was a significant difference between MRPs favouring the SEPAR protocol, with the mean difference being 34.9±28.1 cmH2O (p˂0.001) for MEP and 8±11.6 cmH2O (p=0.001) for MIP. ATS/ERS protocol was, however, considered more comfortable than SEPAR (p<0.005). Conclusions This study shows that, in healthy adults, higher MRPs are obtained using the SEPAR protocol. Yet, the ATS/ERS protocol is experienced as more comfortable. Future studies are needed to analyse the application of both protocols in other populations and their associated comfort.

Does COVID-19 Affect the Exercise Capacity of Non-hospitalized Patients?

Objective To determine whether non-hospitalized adults post COVID-19 have impaired exercise capacity. Design Retrospective analysis. Setting Cardiovascular outpatients unit in Instituto Cardiovascular de Rosario, Argentina. Patients Eighty non-hospitalized patients post-infection by COVID-19. Interventions Participants completed an ergometry pre and post COVID-19 infection. Main outcome measures The study's main variables were the metabolic equivalents of task (METs) and the indirect peak oxygen consumption (VO2 peak). Results The median of METs was 11.7 (9.4-14.8) and 11.7 (11-11.7) in pre and post ergometry, respectively, (p = 0.022). The median VO2 (mL/Kg/min) was 21857 (16938-32761) and 21699 (17004-26467) in pre and post ergometry, respectively, without significant differences. Conclusions We found slight differences in maximal physical capacity evaluated through exercise testing in non-hospitalized patients by COVID-19.

Reliability of SNIP test and optimal number of maneuvers in 6-11 years healthy children.

BACKGROUND AND PURPOSE: Sniff nasal inspiratory pressure (SNIP) is a voluntary inspiratory maneuver measured through a plug occluding one nostril. The investigation of the number of maneuvers necessary to reach the highest peak of SNIP in pediatric populations has been inconsistent. Thus, this study aimed to assess the reliability of SNIP in healthy children aged 6 to 11 years according to sex and age group, and to determine the optimal number of SNIP maneuvers for this age group. METHODS: This cross-sectional study included healthy children with normal pulmonary function. We performed 12 to 20 SNIP maneuvers, with a 30 s rest between each maneuver. The reliability was tested using the intraclass correlation coefficient (ICC), standard error of measurement (SEM), minimal detectable change (MDC), and Bland-Altman analysis for agreement. RESULTS: A total of 121 healthy children (62 girls [51%]) were included in this study. The ICC and corresponding confidence interval (CI) between the highest measure and the first reproducible maneuver were 0.752 (0.656-0.824), SEM = 10.37 cmH2O, and MDC = 28.74 cmH2O. For children aged 6 to 7 years, the ICC was 0.669 (0.427-0.822), SEM = 10.76 cmH2O and MDC = 29.82 cmH2O; for children aged 8 to 11 years, the ICC was 0.774 (0.662-0.852), SEM = 9.74 cmH2O, and MDC = 26.05 cmH2O. For girls, the ICC was 0.817 (0.706-0.889), SEM = 9.40 cmH2O and MDC = 26.05 cmH2O; for boys, the ICC was 0.671 (0.487-0.798), SEM = 11.51 cmH2O, and MDC = 31.90 cmH2O. Approximately 80% of the total sample reached the highest SNIP before the 10th maneuver. CONCLUSIONS: SNIP demonstrated moderate reliability between the maneuvers in children aged 6 to 11 years; older children and girls reached the SNIP peak faster. Finally, results indicated that 12 maneuvers were sufficient for healthy children aged 6 to 11 years to achieve the highest SNIP peak.

A COVID-19 Rehabilitation Prospective Surveillance Model for Use by Physiotherapists.

The long-term sequelae of coronavirus disease 2019 (COVID-19) are only now beginning to be defined, but it is already known that the disease can have direct and indirect impacts mainly on the cardiorespiratory and neuromuscular systems and may affect mental health. A role for rehabilitation professionals from all disciplines in addressing COVID-19 sequelae is recognised, but it is essential that patient assessment be systematic if health complications are to be identified and treated and, if possible, prevented. The aim is to present a COVID-19 prospective surveillance model based on sensitive and easily used assessment tools, which is urgently required. Following the Oxford Centre for Evidence-Based Medicine Level of Evidence Tool, an expert team in cardiorespiratory, neuromuscular and mental health worked via telemeetings to establish a model that provides guidelines to rehabilitation professionals working with patients who require rehabilitation after suffering from COVID-19. A COVID-19 prospective surveillance model is proposed for use by rehabilitation professionals and includes both face-to-face and telematic monitoring components. This model should facilitate the early identification and management of long-term COVID-19 sequelae, thus responding to an arising need.

¿Qué papel desempeña la Fisioterapia en la pandemia mundial por COVID-19? / What is the role of Physiotherapy in the global COVID-19 pandemic?

No disponible

Preoperative exercise training prevents functional decline after lung resection surgery: a randomized, single-blind controlled trial.

OBJECTIVES: To investigate the effects of a preoperative pulmonary rehabilitation programme in patients with lung cancer undergoing video-assisted thoracic surgery. DESIGN: Randomized, single-blind controlled trial. SETTING: Teaching hospital. SUBJECTS: Patients with suspected or confirmed lung cancer undergoing video-assisted thoracic surgery. INTERVENTION: Participants were randomized to either a prehabilitation group or a control group. Participants in the prehabilitation group underwent a combination of moderate endurance and resistance training plus breathing exercises three to five times per week. MAIN MEASURES: The primary outcome of the study was exercise capacity. Secondary outcomes were muscle strength (Senior Fitness Test), health-related quality of life (Short-Form 36) and the postoperative outcomes. Patients were evaluated at baseline (before randomization), presurgery (only the prehabilitation group), after surgery and three months post-operatively. RESULTS: A total of 40 patients were randomized and 22 finished the study (10 in the prehabilitation group and 12 in the control group). Three patients were lost to follow-up at three months. After the training, there was a statistically significant improvement in exercise tolerance (+397 seconds, p = 0.0001), the physical summary component of the SF-36 (+4.4 points, p = 0.008) and muscle strength ( p < 0.01). There were no significant differences between groups after surgery. However, three months postoperatively, significant differences were found in the mean change of exercise capacity ( p = 0.005), physical summary component ( p = 0.001) and upper and lower body strength ( p = 0.045 and p = 0.002). CONCLUSIONS: A pulmonary rehabilitation programme before video-assisted thoracic surgery seems to improve patients' preoperative condition and may prevent functional decline after surgery. Clinical Registration Number: NCT01963923 (Registration date 10/10/2013).

Respiratory Muscle Strength in Chronic Stroke Survivors and Its Relation With the 6-Minute Walk Test.

OBJECTIVES: To compare respiratory muscle strength in stroke survivors (SS) with that in a control group (CG) of healthy people matched by age and sex, as well as to investigate any relation between respiratory muscle strength and the distance walked during the 6-minute walk test (6MWT). DESIGN: Cross-sectional study. SETTING: This study comprised patients from a private neurological rehabilitation center and a public association for patients with acquired brain injury. PARTICIPANTS: Chronic SS with a diagnosis of hemiplegia/hemiparesis who were able to walk (n=30) and healthy individuals matched by sex and age (n=30) (N=60). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Respiratory muscle strength was assessed using maximal expiratory pressure (MEP) and maximal inspiratory pressure (MIP) with a pressure transducer and a diver nozzle. The distance walked during the 6MWT was also registered for both groups. The motricity index and the Scale Impact of Stroke version 16.0 were also measured in SS. RESULTS: The Student t test revealed significantly lower values of MIP and MEP in SS than in the CG (MEP, 95.93±43.12cmH2O in SS vs 158.43±41.6cmH2O in the CG; MIP, 58.7±24.67cmH2O in SS vs 105.7±23.14cmH2O in the CG; P<.001). Moreover, these findings were clinically relevant because both MIP and MEP in SS were <60% of the predicted values. A positive correlation between the 6MWT and MIP was found using the Pearson coefficient (r=.43; P<.018). CONCLUSIONS: Respiratory muscle weakness should be considered in a holistic approach to stroke rehabilitation.