Inspiratory muscle training in patients with obesity: a systematic review and meta-analysis.

Introduction: Obesity is a chronic medical condition that affects, among others, the cardiovascular and respiratory systems. Interventions for its treatment focus on sustained weight reduction and general health improvement, leaving respiratory management aside. Our objective was to determine the effects of inspiratory muscle training (IMT) in patients with obesity. Methods: A systematic review was performed in Embase, Cochrane Library (CENTRAL), CINAHL, Web of Science, and PubMed/MEDLINE on June 26, 2023. Randomized clinical trials (RCTs), and quasi-randomized clinical trials investigating the effects of IMT in people with obesity were included. Selected studies were screened by two independent reviewers who extracted data and assessed the quality of the evidence. Results: The initial search returned 705 potential studies were included. Ultimately, eight studies met the criteria for eligibility and were included in the review. IMT improves physical capacity [6-minute walk test (6MWT): 44.5 m, 95% CI: 30.5 to 58.5; p < 0.0001] and the strength of the inspiratory muscles [maximal inspiratory pressure (MIP): -28.4 cm H2O, 95% CI: -41.9 to -14.8; p < 0.0001] compared to the controls, without differences in the pulmonary function, body mass index (BMI) and metabolic parameters. Conclusion: Inspiratory muscle training improves physical capacity and inspiratory muscle strength without significant changes in lung function, BMI, and metabolic parameters.Systematic review registration: PROSPERO, identifier CRD42023439625, https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023439625.

Neuromuscular and acute symptoms responses to progressive elastic resistance exercise in patients with chronic obstructive pulmonary disease: Cross-sectional study.

Background: Quadriceps muscle training is a key part in the rehabilitation of chronic obstructive pulmonary disease (COPD) patients. However, exercise intensity prescription and progression with the typically used elastic bands is challenging. We aimed to evaluate neuromuscular, acute symptoms and cardiorespiratory responses (heart rate and dyspnea) during progressive elastic resistance exercise in patients with COPD. Methods: Fourteen patients diagnosed with moderate-very severe COPD performed knee extensions at different elastic resistance levels (i.e., colors). The neuromuscular activity was recorded using surface electromyography for the rectus femoris, vastus lateralis and vastus medialis, together with rate of perceived exertion, perceived quadriceps fatigue, dyspnea, oxygen saturation and heart rate. Results: For the vastus lateralis and rectus femoris, increase of muscle activity was evident from a two-level increment when using the red color. For the vastus medialis, there were no muscle activity progressions. Dyspnea, quadriceps fatigue and especially rate of perceived exertion increased in a dose-response fashion and were correlated with the resistance level and muscle activity at the three muscles. Conclusion: Heavy elastic resistance exercise is feasible in COPD patients without excessive dyspnea and a stable cardiorespiratory response. In general, at least two elastic resistance increments are needed to enhance muscle activity for the vastus lateralis and rectus femoris, while there is no increase for the vastus medialis. These results may help to individualize exercise dosing during elastic resistance training in patients with COPD.

Effects of respiratory physiotherapy in patients with amyotrophic lateral sclerosis: protocol for a systematic review of randomised controlled trials.

INTRODUCTION: Respiratory muscle weakness and ventilatory failure are common complications in patients with amyotrophic lateral sclerosis (ALS) and may lead to death. Respiratory physiotherapy may improve lung function in this population. This study aims to investigate the effects of respiratory physiotherapy on lung function, cough efficacy and functional status of patients with ALS. METHODS AND ANALYSIS: A protocol was published on the International prospective register of systematic reviews (PROSPERO). The research will cover randomised controlled trials, with no language or publication date restriction, available in the following databases: MEDLINE/PubMed, EMBASE, Cochrane Library, Web of Science and Physiotherapy Evidence Database. The research question will be answered using a search strategy adapted for each database. Searches in databases will be conducted from January 2021 to December 2022. Two authors using the Cochrane risk of bias tool for randomised trials V.2 and Grading of Recommendations, Assessment, Development and Evaluations, respectively, will assess risk of bias and quality of evidence independently. According to the results obtained, data will be reported as a meta-analysis or a narrative report. ETHICS AND DISSEMINATION: No previous ethical approval is required for this publication since data used are already published. Results of this review will be disclosed via peer-reviewed publications and conference presentations. PROSPERO REGISTRATION NUMBER: CRD42021251842.

Respiratory Muscle Training in Patients with Obstructive Sleep Apnoea: A Systematic Review and Meta-Analysis.

Background: Effective treatments for obstructive sleep apnoea (OSA) include positive pressure, weight loss, oral appliances, surgery, and exercise. Although the involvement of the respiratory muscles in OSA is evident, the effect of training them to improve clinical outcomes is not clear. We aimed to determine the effects of respiratory muscle training in patients with OSA. Methods: A systematic review was conducted in seven databases. Studies that applied respiratory muscle training in OSA patients were reviewed. Two independent reviewers analysed the studies, extracted the data and assessed the quality of evidence. Results: Of the 405 reports returned by the initial search, eight articles reporting on 210 patients were included in the data synthesis. Seven included inspiratory muscle training (IMT), and one included expiratory muscle training (EMT). Regarding IMT, we found significant improvement in Epworth sleepiness scale in −4.45 points (95%CI −7.64 to −1.27 points, p = 0.006), in Pittsburgh sleep quality index of −2.79 points (95%CI −4.19 to −1.39 points, p < 0.0001), and maximum inspiratory pressure of −29.56 cmH2O (95%CI −53.14 to −5.98 cmH2O, p = 0.01). However, the apnoea/hypopnea index and physical capacity did not show changes. We did not perform a meta-analysis of EMT due to insufficient studies. Conclusion: IMT improves sleepiness, sleep quality and inspiratory strength in patients with OSA.

Assessment of activities of daily living in patients post COVID-19: a systematic review.

BACKGROUND: Coronavirus disease has provoked much discussion since its first appearance. Despite it being widely studied all over the world, little is known about the impact of the disease on functional ability related to performing activities of daily living (ADL) in patients post COVID-19 infection. OBJECTIVES: To understand the impact of COVID-19 on ADL performance of adult patients and to describe the common scales used to assess performance of ADL on patients post-COVID-19. METHODS: A systematic review was conducted. We included studies that applied a physical capacity test in COVID-19 patients, post-infection. Two independent reviewers analyzed the studies, extracted the data, and assessed the quality of the evidence. RESULTS: A total of 1,228 studies were included, after removing duplicates, 1,005 abstracts were screened and of those 983 were excluded. A final number of nine studies which met the eligibility criteria were included. The findings revealed worsening of physical function and ADL performance in all patients post COVID-19 infection. CONCLUSION: All included studies found a reduction of ADL beyond the test or scale used, revealing a vital worsening of functional ability in ADL performance and consequently loss of independence in COVID-19 patients after the acute phase of infection. Functional ability status previous to COVID-19 is crucial for predicting the severity of the disease and mortality. Barthel Index and ADL score were the most used assessment tools across subjects with different intrinsic capacity and context levels.

Prevalence of potential respiratory symptoms in survivors of hospital admission after coronavirus disease 2019 (COVID-19): A systematic review and meta-analysis.

Knowledge on the sequelae of Coronavirus Disease 2019 (COVID-19) remains limited due to the relatively recent onset of this pathology. However, the literature on other types of coronavirus infections prior to COVID-19 reports that patients may experience persistent symptoms after discharge. To determine the prevalence of respiratory symptoms in survivors of hospital admission after COVID-19 infection. A living systematic review of five databases was performed in order to identify studies which reported the persistence of respiratory symptoms in COVID-19 patients after discharge. Two independent researchers reviewed and analysed the available literature, and then extracted and assessed the quality of those articles. Of the 1,154 reports returned by the initial search nine articles were found, in which 1,816 patients were included in the data synthesis. In the pooled analysis, we found a prevalence of 0.52 (CI 0.38-0.66, p < 0.01, I2 = 97%), 0.37 (CI 0.28-0.48, p < 0.01, I2 = 93%), 0.16 (CI 0.10-0.23, p < 0.01, I2 = 90%) and 0.14 (CI 0.06-0.24, p < 0.01, I2 = 96%) for fatigue, dyspnoea, chest pain, and cough, respectively. Fatigue, dyspnoea, chest pain, and cough were the most prevalent respiratory symptoms found in 52%, 37%, 16% and 14% of patients between 3 weeks and 3 months, after discharge in survivors of hospital admission by COVID-19, respectively.

Physical Activity in Children and Adolescents With Chronic Respiratory Diseases: A Systematic Review and Meta-Analysis.

BACKGROUND: The literature is unclear as to whether children and adolescents with chronic respiratory diseases (CRDs) differ from their healthy peers in physical activity (PA). OBJECTIVE: To determine the PA levels measured through accelerometers in children and adolescents with CRDs. METHODS: The authors conducted a systematic review using five databases. The authors included studies that assessed the PA measured by accelerometers in children and adolescents with CRDs. Two independent reviewers analyzed the studies, extracted the data, and assessed the quality of evidence. RESULTS: From 11,497 reports returned by the initial search, 29 articles reporting on 4381 patients were included. In the sensitivity analysis, the authors found that children and adolescents with CRDs had a moderate-to-vigorous PA (MVPA) of -0.08 hours per day (95% confidence interval [CI], -0.12 to -0.03 h/d; P = .001), which was lower than the healthy controls; the values for sedentary time (mean difference -0.47 h/d; 95% CI, -1.29 to 0.36 h/d; P = .27) and steps/d (mean difference 361 steps/d; 95% CI -385 to 1707 steps/d; P = .45) were similar for both. CONCLUSION: Children and adolescents with CRDs have a slight reduction in MVPA in comparison with healthy controls, but sedentary time and steps/d were similar for both.

Producción Científica e Investigación en Kinesiología en Chile. Una Revisión de los últimos 20 años / Scientific production and research in Kinesiology in Chile. A Review of the Last 20 Years

Introducción: La Kinesiología en Chile ha alcanzado un importante desarrollo, impulsado por el modelo biopsicosocial. La investigación ha mostrado un incipiente pero exponencial desarrollo vinculado a las universidades. El propósito de este estudio es describir y caracterizar el estado de la producción científica realizada por Kinesiólogas y Kinesiólogos de Chile en los últimos 20 años. Método: Se realizó una revisión exploratoria con búsqueda sistemática de la literatura producida entre los años 2000-2020, en diferentes bases de datos: MEDLINE, EMBASE, CINAHL, PEDro y SciELO. Los términos de búsqueda utilizados fueron: Kinesiología, Physiotherapy, Kinesiology, Physical Therapy y Chile. Resultados: Se identificaron 644 artículos con los criterios de inclusión. El idioma predominante fue el inglés (n=451). El 8,9% presentó participación exclusiva de mujeres y el 69,7% de hombres. Las áreas con mayor producción fueron musculoesquelético, cardiometabólico y fisiología del ejercicio, mientras que las más y las más emergentes ergonomía y el área de educación. Geográficamente, la Región Metropolitana concentró más de la mitad de las publicaciones, seguida por la región del Maule, que fue la segunda en cuatro de las seis áreas con mayor producción. Entre 2000- 2005 no se identificaron artículos publicados según los criterios definidos para esta investigación, mientras que entre 2017­2019 se concentró el 56,8%. Conclusiones: En los últimos tres años (2017, 2018 y 2019) ha existido un notorio crecimiento de publicaciones nacionales, concentrándose mayormente en la Región Metropolitana. Las áreas de mayor producción científica son las históricamente incluidas como parte de la formación en kinesiología. Existe una importante brecha de género en relación con la menor participación de mujeres como coautoras y autoras principales.

Introduction: Kinesiology in Chile has reached an important development, driven by the biopsychosocial model. Research has shown an incipient but exponential development with a strong relation with universities. The aim of this study is to describe and characterize scientific production carried out by Kinesiologist/Physical Therapist in Chile in the last twenty years. Methods: An exploratory review with systematic review of literature produced between 2000-2020 in different databases: MEDLINE, EMBASE, CINAHL, PEDro, SciELO.The search terms used were: Kinesiología, Physiotherapy, Kinesiology, Physical Therapy and Chile. Results: 644 articles with inclusion criteria were identified. Predominant language was english (n=451). 8,9% have exclusive participation of women and 69,7% of men. Areas with the highest production were musculoskeletal, cardiometabolic and exercise physiology, and the most emerging ergonomics and education. Geographically, Metropolitan Region concentrated more than half of publications, followed by Maule region, which was the second position in four of the six areas with highest production. Between 2000-2005 no published articles were identified according to the criteria defined for this research, while between 2017-2019, 56,8% were concentrated. Conclusions: In the last three years (2017, 2018 and 2019) there has been a noticeable growth of national publications, concentrating mainly in Metropolitan Region. Areas with greatest scientific production are those historically included as part of academic teaching/training in kinesiology. There is a significant gender gap in relation to the lower participation of women as co-authors and as main authors.

Recomendaciones de protección para kinesiólogas y kinesiólogos que realizan técnicas y procedimientos respiratorios en personas con COVID-19 / Protection recommendations for kinesiologists and kinesiologists who perform respiratory techniques and procedures in people with COVID-19

La Organización Mundial de la Salud (OMS) ha definido la infección por coronavirus (SARS-CoV-2) como una pandemia. Su infección puede causar potencialmente una enfermedad respiratoria muy severa1,2. Por otro lado, la tasa de transmisión ha sido muy alta, especialmente entre profesionales de la salud. Los kinesiólogos están en un alto riesgo de contraer la infección, particularmente cuando aplican técnicas respiratorias, el uso de oxígeno o la ventilación no invasiva. El objetivo de estas recomendaciones es proveer información práctica para que los profesionales tomen las precauciones necesarias para evitar contraer la infección. Además describir los riesgos de transmisión, dispersión de partícula según intervención y las recomendaciones basadas en la literatura actual revisada.

Recently the World Health Organization (WHO) has defined coronavirus infection (SARS-CoV-2) as a pandemic. Its infection can potentially cause a very severe respiratory illness1,2. Furthermore, the transmission rate has been very high, especially among health professionals. Physiotherapists are at high risk of contracting the infection, particularly when applying respiratory techniques, the use of oxygen, or non-invasive ventilation1. The objective of these recommendations is to provide practical information for professionals to take the necessary precautions to avoid contracting the infection. Also, to describe the risks of transmission, particle dispersion according to intervention and the recommendations based on the current literature reviewed.

Agreement between clinical and non-clinical digital manometer for assessing maximal respiratory pressures in healthy subjects.

Measurement of respiratory muscles strength such as maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP) are used to detect, diagnose and treat respiratory weakness. However, devices used for these measurements are not widely available and are costly. Currently, the use of a digital manometer is recommended. In industry, several inexpensive devices are available, but these have not been validated for clinical use. Our objective was to determine the agreement between maximal respiratory pressures obtained with a clinical digital manometer and that with a non-clinical digital manometer in healthy volunteers. We assessed the height, weight, lung function, MIP, and MEP of healthy volunteers. To compare pressures obtained by each type of digital manometer, a parallel approach configuration was used. The agreement was measured with the Intraclass Coefficient Correlation (ICC) and the Bland-Altman plot. Twenty-seven participants (14 men) were recruited with a median age of 22 (range: 21-23) years. Each participant underwent three measurements to give a total of 81 measurements. The mean MIPs were 90.8 ± 26.4 (SEM 2.9) and 91.1 ± 26.4 (SEM 2.9) cmH2O for the clinical and non-clinical digital manometers, respectively. The mean MEPs were 113.8 ± 40.4 (SEM 4.5) and 114.5 ± 40.5 (SEM 4.5) cmH2O for the clinical and non-clinical digital manometers, respectively. We obtained an ICC of 0.998 (IC 0.997-0.999) for MIP and 0.999 (IC 0.998-0.999) for MEP. There is a high agreement in the values obtained for MIP and MEP between clinical and non-clinical digital manometers in healthy volunteers. Further validation at lower pressures and safety profiling among human subjects is needed.

Consenso chileno de técnicas de kinesiología respiratoria en pediatría / Chilean consensus about pediatric chest physioterapy

Chest physiotherapy is currently an outstanding therapeutic tool for the management of pediatric respiratory patients. Many and varied techniques, manual and assisted, have been developed, some requiring patient collaboration. The development of knowledge and the pathophysiological understanding of respiratory diseases in recent years has generated the need to agree on the terminology, the fundamentals and the application of each of the kinesthetic techniques of respiratory treatment in the pediatric field. The objective of this document was to compile the available literature related to the physiological mechanisms, indications, procedural aspects and most frequently used techniques in our country, with the purpose of being a guideline for the clinical practice of professionals and students. The following techniques were included: prolonged slow expiration, slow expiration with glottis opened, autogenic drainage, assisted autogenic drainage, active cycle, compression/decompression, airway clearance, forced expiration techniques, cough and respiratory exercises.

La kinesiología respiratoria es actualmente una herramienta terapéutica destacada para el manejo de los pacientes respiratorios pediátricos. Se han desarrollado muchas y variadas técnicas, manuales y asistidas, algunas requiriendo colaboración del paciente. El desarrollo del conocimiento y la comprensión fisiopatológica de las enfermedades respiratorias en los últimos años ha generado la necesidad de consensuar la terminología, los fundamentos y la aplicación de cada una de las técnicas kinésicas de tratamiento respiratorio en el ámbito pediátrico. El objetivo de este documento fue recopilar la literatura disponible relacionada con los mecanismos fisiológicos, indicaciones, aspectos procedimentales y técnicas más utilizadas en nuestro país, con el propósito de ser una directriz que oriente la práctica clínica de profesionales y estudiantes en formación. Se incluyeron así las siguientes técnicas: espiración lenta prolongada, espiración lenta con glotis abierta, drenaje autógeno, drenaje autógeno asistido, ciclo activo, presión/descompresión, bloqueos torácicos, técnicas de espiración forzada, tos y ejercicios respiratorios.

Evaluación de la actividad física en pacientes con enfermedad pulmonar obstructiva crónica / Tools for physical activity assessment in chronic obstructive pulmonary disease

The prevalence and mortality of chronic obstructive pulmonary disease (COPD) is increasing in Chile, constituting a public health problem. Pulmonary and systemic consequences of COPD affect physical activity, as the disease progresses. There are multiple means for physical activity assessment, from low cost and easily applicable questionnaires to sophisticated laboratory tests. Physical inactivity is a modifiable risk factor for morbidity and mortality in patients with COPD. Physical activity interventions not only contribute to decrease the likelihood of mortality, but also protect from comorbidities, especially cardiovascular ones. It also plays a major role avoiding functional limitations of these subjects. Dyspnea and fatigue render exercise as an unpleasant activity for most patients with COPD. If psychological alterations such as anxiety and depression are summed, these patients drift towards an inactive lifestyle. This article analyzes several tools available to assess physical activity is patients with COPD, useful in clinical practice.

[Tools for physical activity assessment in chronic obstructive pulmonary disease]. / Evaluación de la actividad física en pacientes con enfermedad pulmonar obstructiva crónica.

The prevalence and mortality of chronic obstructive pulmonary disease (COPD) is increasing in Chile, constituting a public health problem. Pulmonary and systemic consequences of COPD affect physical activity, as the disease progresses. There are multiple means for physical activity assessment, from low cost and easily applicable questionnaires to sophisticated laboratory tests. Physical inactivity is a modifiable risk factor for morbidity and mortality in patients with COPD. Physical activity interventions not only contribute to decrease the likelihood of mortality, but also protect from comorbidities, especially cardiovascular ones. It also plays a major role avoiding functional limitations of these subjects. Dyspnea and fatigue render exercise as an unpleasant activity for most patients with COPD. If psychological alterations such as anxiety and depression are summed, these patients drift towards an inactive lifestyle. This article analyzes several tools available to assess physical activity is patients with COPD, useful in clinical practice.

Incidence of Guillain-Barré syndrome in Chile: a population-based study.

The Guillain-Barré syndrome (GBS) incidence rate (IR) varies between 0.16 and 3.00 cases per 100,000 inhabitants. Little data exist on the epidemiology of GBS in Latin American countries. Our objective was to describe GBS epidemiology based on a national database in a Latin American country and to contribute to the global map of GBS epidemiology. This was a retrospective study that included all reported GBS cases in Chile between 2001 and 2012. Gender, age, seasonal occurrence, and geographical distribution were analyzed. A total of 4,158 GBS cases were identified from 19,513,655 registries. The mean age was 37 ± 24 years, and 59% of patients were male (male to female ratio of 1.5 : 1). Gender IR was 2.53/100,000 for males and 1.68/100,000 for females. The overall standardized IR was 2.1/100,000, although this varied between 1.61/100,000 (2001) and 2.35/100,000 (2010). The seasonal distribution was as follows: autumn 22%; winter 25%; spring 27%; and summer 26%. The geographical IR were as follows: far North 1.49/100,000; North 1.94/100,000; Central 1.97/100,000; South 3.18/100,000; and far South 2.78/100,000. The reported IR of GBS in Chile was similar to other studies based on national databases. In Chile, IR was greater in men and in the south.

Guí­as de rehabilitación respiratoria en niños con enfermedades respiratorias crónicas: actualización 2016 / Pulmonary rehabilitation guidelines in children with chronic respiratory diseases: 2016 update

Pulmonary rehabilitation (PR) is an essential tool in the management of chronic respiratory diseases in childhood. PR improve symptoms, physical performance, quality of life and social integration in children who have limitations in their daily activities. Health professionals have a key role in identifying those children who are candidates for pulmonary rehabilitation programs, in the initial evaluation and in the implementation of therapeutic strategies for training and education. This document is intended as a reference guide for all those professionals who are dedicated to the care of children with chronic respiratory diseases.

La rehabilitación respiratoria (RR) es un componente esencial en el manejo de las enfermedades respiratorias crónicas en la infancia. La RR ha demostrado mejorar los síntomas, el rendimiento físico, la calidad de vida y su participación social en aquellos niños que tienen limitaciones en el desarrollo de sus actividades de la vida diaria. Los profesionales de la salud tienen un rol fundamental en identificar aquellos niños que son candidatos para los programas de rehabilitación respiratoria, en la evaluación inicial y en la implementación de estrategias terapéuticas de entrenamiento y de educación. Este documento pretende ser una guía de consulta para todos aquellos profesionales que se dedican a la atención de niños con enfermedades respiratorias crónicas.

Evaluación respiratoria en personas con lesión medular / Respiratory assesment in people with spinal cord injury

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