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1.
Cochrane Database Syst Rev ; 12: CD006112, 2020 12 17.
Artigo em Inglês | MEDLINE | ID: mdl-33331663

RESUMO

BACKGROUND: Cystic fibrosis is the most common autosomal recessive disease in white populations, and causes respiratory dysfunction in the majority of individuals. Numerous types of respiratory muscle training to improve respiratory function and health-related quality of life in people with cystic fibrosis have been reported in the literature. Hence a systematic review of the literature is needed to establish the effectiveness of respiratory muscle training (either inspiratory or expiratory muscle training) on clinical outcomes in cystic fibrosis. This is an update of a previously published review. OBJECTIVES: To determine the effectiveness of respiratory muscle training on clinical outcomes in people with cystic fibrosis. SEARCH METHODS: We searched the Cochrane Cystic Fibrosis and Genetic Disorders Group Trials register comprising of references identified from comprehensive electronic database searches and handsearches of relevant journals and abstract books of conference proceedings. Date of most recent search: 11 June 2020. A hand search of the Journal of Cystic Fibrosis and Pediatric Pulmonology was performed, along with an electronic search of online trial databases. Date of most recent search: 05 October 2020. SELECTION CRITERIA: Randomised controlled studies comparing respiratory muscle training with a control group in people with cystic fibrosis. DATA COLLECTION AND ANALYSIS: Review authors independently selected articles for inclusion, evaluated the methodological quality of the studies, and extracted data. Additional information was sought from trial authors where necessary. The quality of the evidence was assessed using the GRADE system. MAIN RESULTS: Authors identified 20 studies, of which 10 studies with 238 participants met the review's inclusion criteria. There was wide variation in the methodological and written quality of the included studies. Four of the 10 included studies were published as abstracts only and lacked concise details, thus limiting the information available. Eight studies were parallel studies and two of a cross-over design. Respiratory muscle training interventions varied dramatically, with frequency, intensity and duration ranging from thrice weekly to twice daily, 20% to 80% of maximal effort, and 10 to 30 minutes, respectively. Participant numbers ranged from 11 to 39 participants in the included studies; five studies were in adults only, one in children only and four in a combination of children and adults. No differences between treatment and control were reported in the primary outcome of pulmonary function (forced expiratory volume in one second and forced vital capacity) or postural stability (very low-quality evidence). Although no change was reported in exercise capacity as assessed by the maximum rate of oxygen use and distance completed in a six minute walk test, a 10% improvement in exercise duration was found when working at 60% of maximal effort in one study (n = 20) (very low-quality evidence). In a further study (n = 18), when working at 80% of maximal effort, health-related quality of life improved in the mastery and emotion domains (very low-quality evidence). With regards to the review's secondary outcomes, one study (n = 11) found a change in intramural pressure, functional residual capacity and maximal inspiratory pressure following training (very low-quality evidence). Another study (n=36) reported improvements in maximal inspiratory pressure following training (P < 0.001) (very low-quality evidence). A further study (n = 22) reported that respiratory muscle endurance was longer in the training group (P < 0.01). No studies reported significant differences on any other secondary outcomes. Meta-analyses could not be performed due to a lack of consistency and insufficient detail in reported outcome measures. AUTHORS' CONCLUSIONS: There is insufficient evidence to suggest whether this intervention is beneficial or not. Healthcare practitioners should consider the use of respiratory muscle training on a case-by-case basis. Further research of reputable methodological quality is needed to determine the effectiveness of respiratory muscle training in people with cystic fibrosis. Researchers should consider the following clinical outcomes in future studies; respiratory muscle function, pulmonary function, exercise capacity, hospital admissions, and health-related quality of life. Sensory-perceptual changes, such as respiratory effort sensation (e.g. rating of perceived breathlessness) and peripheral effort sensation (e.g. rating of perceived exertion) may also help to elucidate mechanisms underpinning the effectiveness of respiratory muscle training.


Assuntos
Exercícios Respiratórios/métodos , Fibrose Cística/terapia , Inalação/fisiologia , Músculos Respiratórios/fisiologia , Adulto , Criança , Fluxo Expiratório Forçado , Humanos , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto , Capacidade Vital
2.
Fisioterapia (Madr., Ed. impr.) ; 42(6): 286-294, nov.-dic. 2020. tab
Artigo em Espanhol | IBECS | ID: ibc-ET2-7533

RESUMO

INTRODUCCIÓN: La medición de la fuerza muscular respiratoria y la movilidad torácica tienen importancia en la evaluación clínica del sistema respiratorio en población pediátrica, sin embargo, sus valores pueden cambiar por las características de la población de cada país. El objetivo del estudio fue describir la fuerza muscular respiratoria y movilidad torácica en niños sanos de Cali, Colombia y analizar la correlación con medidas antropométricas. MATERIALES Y MÉTODOS: Estudio transversal. Se incluyeron niños sanos entre 8 y 11 años de un colegio de Cali, Colombia a quienes se les midió la fuerza muscular respiratoria con la Presión Inspiratoria Máxima (PIM) y Presión Espiratoria Máxima (PEM) y la movilidad torácica con la cirtometría axilar y xifoidea. También se tomaron las medidas antropométricas peso, talla e IMC para la edad. RESULTADOS: Se admitieron 89 niños, un 50,6% de sexo femenino y con IMC en normopeso para la edad del 62,9%. Mediana de PIM -60,0 cmH2O (Rango Intercuartílico [RIQ] 44,0) y PEM 49,0 cmH2O (RIQ 19,0). Mediana de cirtometría axilar 4,5 cm (RIQ 1,6) y xifoidea 4,7 cm (RIQ 1,7). La PIM tuvo correlación con el índice de masa corporal (IMC) para la edad (rs = 0,23 p = 0,030), la cirtometría axilar con el peso (rs = 0,35; p = 0,001) y el IMC para la edad (rs = 0,31; p = 0,003), la cirtometría xifoidea con el peso (rs = 0,24; p = 0,027) y la talla (rs = 0,22; p = 0,037). No hubo correlación entre la PIM-PEM y cirtometría. DISCUSIÓN: La fuerza muscular respiratoria y la movilidad torácica dependen de los cambios experimentados en el crecimiento del infante y de características diferenciales entre niños y niñas durante la pubertad


INTRODUCTION: The measurement of respiratory muscle strength and thoracic mobility are important in clinical assessment of the respiratory system in the paediatric population, however, their values can change according to the characteristics of the population of each country. The objective of the study was to describe respiratory muscle strength and thoracic mobility in healthy children from Cali, Colombia, and analyse their correlation with anthropometric measurements. MATERIALS AND METHODS: A cross-sectional study. We included healthy children between 8 and 11 years old, from a school in Cali, Colombia, whose respiratory muscle strength was measured with Maximum Inspiratory Pressure (MIP) and Maximum Expiratory Pressure (MEP) and thoracic mobility with axillary and xiphoid cirtometry. Anthropometric measurements were taken, such as weight, height and BMI-for-age. RESULTS: 89 children were admitted, most were female (50.6%) and with normal BMI-for-age (62.9%). Median MIP -60.0 cmH2O (IQR 44.0) and MEP 49.0 cmH2O (IQR 19.0). Median axillary cirtometry 4.5 cm (IQR 1.6) and xiphoid cirtometry 4.7 cm (IQR 1.7). MIP correlated with BMI-for-age (rs = 0.23 p = 0.030), axillary cirtometry with weight (rs = 0.35 p = 0.001) and BMI-for-age (rs = 0.31 p = 0.003), xiphoid cirtometry with weight (rs = 0.24 p = 0.027) and height (rs = 0.22 p = 0.037). There was no correlation between MIP-MEP and cirtometry. DISCUSSION: Respiratory muscle strength and thoracic mobility depend on changes in the growth of the infant and differential characteristics between boys and girls during puberty


Assuntos
Humanos , Masculino , Feminino , Criança , Força Muscular/fisiologia , Músculos Respiratórios/fisiologia , Parede Torácica/fisiologia , Voluntários Saudáveis , Antropometria , Modalidades de Fisioterapia , Estudos Transversais , Peso-Estatura/fisiologia , Índice de Massa Corporal , Processo Xifoide/fisiologia , Inquéritos e Questionários , Análise de Variância
3.
Artigo em Inglês | MEDLINE | ID: mdl-32899902

RESUMO

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is a major cause of morbidity and mortality worldwide. Hyperinflation of the lungs leads to a remodeling of the inspiratory muscles that causes postural deformities and more labored breathing. Postural changes include elevated, protracted, or abducted scapulae with medially rotated humerus, and kyphosis that leads to further tightening of respiratory muscles. As the severity of the disease progresses, use of the upper limbs for functional tasks becomes difficult due to muscle stiffness. There are various studies that suggest different rehabilitation programs for COPD patients; however, to the best of our knowledge none recommends passive stretching techniques. The aim of this study was to assess the effect of respiratory muscle passive stretching on chest expansion and 6-min walk distance (6MWD) in patients with moderate to severe COPD. METHODS: Thirty patients were divided into two groups, experimental (n = 15) and control (n = 15). The experimental group received a hot pack followed by stretching of the respiratory muscles and relaxed passive movements of the shoulder joints. The control group received a hot pack followed by relaxed passive movements of the shoulder joints. RESULTS: In the control group, there was no difference in chest expansion at the levels of both the axilla and the xiphisternum or in 6MWD between baseline and post treatment (p > 0.05). In the experimental group, chest expansion at the level of the axilla (p < 0.05) and 6MWD (p < 0.001) were significantly higher post treatment, while there was no difference in chest expansion at the level of the xiphisternum (p > 0.05). A comparison between control and experimental groups showed that chest expansion at the level of the axilla (p < 0.05) and 6MWD (p < 0.01) were significantly higher in the experimental group, while there was no difference in chest expansion at the level of the xiphisternum (p > 0.05). CONCLUSIONS: Although COPD is an irreversible disease, results of this study indicate that passive stretching of respiratory muscles can clinically improve the condition of such patients, especially in terms of chest expansion and 6MWD. Given the good effects of muscle stretching and the fact that such an exercise is harmless, clinicians and physiotherapists should consider including passive stretching of respiratory muscles in the rehabilitation plan of COPD patients.


Assuntos
Pulmão/fisiopatologia , Exercícios de Alongamento Muscular , Doença Pulmonar Obstrutiva Crônica/terapia , Músculos Respiratórios/fisiopatologia , Adulto , Tolerância ao Exercício , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Músculos Respiratórios/fisiologia , Resultado do Tratamento
4.
J Sports Med Phys Fitness ; 60(8): 1101-1109, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32955836

RESUMO

BACKGROUND: Minimizing the energy required for breathing muscles is based on the adaptation of the respiratory muscles which is reflected in the reduction of breathing frequency (BF) and tidal volume (VT) increase. This may be influenced through a targeted BE and the quality of breathing may be linked to endurance performance. Aim of this study was assess dynamic ventilation parameters at different load intensities and their changes due to the systematic breathing exercise (BE). METHODS: Study recruit 36 runners of both sexes with a mean age 16.8±1.6 years. A random distribution was performed. The intervention program consisted of a set of BE aimed at the activation of the diaphragm. We monitored the dynamics of ventilation parameters at intensities 2, 3, 4 W/kg during a stepped test on a bicycle ergometer. RESULTS: The BE was focused on the activation of the diaphragm for a 12.2±3.6 minutes per day, sixteen weeks. After eight weeks, there were significant changes in VT and BF (P<0.05). After sixteen weeks there was a significant increase in VT of 5.7-18.3% (P<0.01), depending on the load level, BF values decreased significantly by 5.4-14.4% (P<0.01). VE and VO2 values were without changes. There were no significant changes in the control group. CONCLUSIONS: It was confirmed that the two-month BE intervention focused on the activation of the diaphragm is sufficient and resulted in a significant change in the values of dynamic ventilation parameters. After four months of intervention, the changes are significantly greater compared with values found after a two-month intervention period.


Assuntos
Exercícios Respiratórios/métodos , Resistência Física/fisiologia , Respiração , Músculos Respiratórios/fisiologia , Adolescente , Diafragma/fisiologia , Teste de Esforço , Feminino , Humanos , Masculino , Corrida/fisiologia , Volume de Ventilação Pulmonar
5.
Artigo em Inglês | MEDLINE | ID: mdl-32679675

RESUMO

A supervised combined training program was applied to a sedentary 56-year-old man with idiopathic pulmonary fibrosis (IPF) along three years, until lung transplantation. It included: (a) aerobic continuous (CT) and interval training (IT), (b) high load resistance training (RT) and (c) inspiratory muscle training (IMT). IT and IMT were applied for two years, while CT and RT could be maintained until transplantation using supplemental oxygen. Maximal inspiratory pressure (MIP) kept above 180 cm H2O and forced vital capacity (FVC) remained stable until lung transplantation. Peak oxygen uptake VO2 increased during 1.5 years before its decline, staying above the poor prognosis level two years. Finally, the patient maintained his walking capacity and independence for 2 years, before the decline due to the disease. After receiving a two-lung transplant, the patient remained intubated for 12 h, left the intensive care unit after 3.5 days and was discharged after 18 days (average values: 48 h, 7-10 days and 25-35 days, respectively). These results show that systematic and supervised combined training can be safety applied in an IPF patient to maintain functionality and quality of life. In addition, we show that RT can be maintained for as long as necessary without complications.


Assuntos
Fibrose Pulmonar Idiopática , Músculos Respiratórios , Exercícios Respiratórios , Humanos , Fibrose Pulmonar Idiopática/terapia , Inalação , Masculino , Pessoa de Meia-Idade , Qualidade de Vida , Músculos Respiratórios/fisiologia , Capacidade Vital
6.
Artigo em Inglês | MEDLINE | ID: mdl-32560441

RESUMO

Critical surgical and medical advances have shifted the focus of congenital heart disease (CHD) patients from survival to achievement of a greater health-related quality of life (HRQoL). HRQoL is influenced, amongst other factors, by aerobic capacity and respiratory muscle strength, both of which are reduced in CHD patients. This study evaluates the influence of a cardiopulmonary rehabilitation program (CPRP) on respiratory muscle strength and functional capacity. Fifteen CHD patients, ages 12 to 16, with reduced aerobic capacity in cardiopulmonary exercise testing (CPET) were enrolled in a CPRP involving strength and aerobic training for three months. Measurements for comparison were obtained at the start, end, and six months after the CPRP. A significant improvement of inspiratory muscle strength was evidenced (maximum inspiratory pressure 21 cm H2O, 23%, p < 0.01). The six-minute walking test showed a statistically and clinically significant rise in walked distance (48 m, p < 0.01) and a reduction in muscle fatigue (1.7 out of 10 points, p = 0.017). These results suggest CPRP could potentially improve respiratory muscle function and functional capacity, with lasting results, in children with congenital heart disease, but additional clinical trials must be conducted to confirm this finding.


Assuntos
Reabilitação Cardíaca , Cardiopatias Congênitas , Qualidade de Vida , Músculos Respiratórios , Adolescente , Criança , Tolerância ao Exercício , Feminino , Cardiopatias Congênitas/reabilitação , Humanos , Masculino , Força Muscular , Estudos Prospectivos , Músculos Respiratórios/fisiologia
7.
Br J Anaesth ; 125(1): e148-e157, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32386831

RESUMO

BACKGROUND: Bedside measures of patient effort are essential to properly titrate the level of pressure support ventilation. We investigated whether the tidal swing in oesophageal (ΔPes) and transdiaphragmatic pressure (ΔPdi), and ultrasonographic changes in diaphragm (TFdi) and parasternal intercostal (TFic) thickening are reliable estimates of respiratory effort. The effect of diaphragm dysfunction was also considered. METHODS: Twenty-one critically ill patients were enrolled: age 73 (14) yr, BMI 27 (7) kg m-2, and Pao2/Fio2 33.3 (9.2) kPa. A three-level pressure support trial was performed: baseline, 25% (PS-medium), and 50% reduction (PS-low). We recorded the oesophageal and transdiaphragmatic pressure-time products (PTPs), work of breathing (WOB), and diaphragm and intercostal ultrasonography. Diaphragm dysfunction was defined by the Gilbert index. RESULTS: Pressure support was 9.0 (1.6) cm H2O at baseline, 6.7 (1.3) (PS-medium), and 4.4 (1.0) (PS-low). ΔPes was significantly associated with the oesophageal PTP (R2=0.868; P<0.001) and the WOB (R2=0.683; P<0.001). ΔPdi was significantly associated with the transdiaphragmatic PTP (R2=0.820; P<0.001). TFdi was only weakly correlated with the oesophageal PTP (R2=0.326; P<0.001), and the correlation improved after excluding patients with diaphragm dysfunction (R2=0.887; P<0.001). TFdi was higher and TFic lower in patients without diaphragm dysfunction: 33.6 (18.2)% vs 13.2 (9.2)% and 2.1 (1.7)% vs 12.7 (9.1)%; P<0.0001. CONCLUSIONS: ΔPes and ΔPdi are adequate estimates of inspiratory effort. Diaphragm ultrasonography is a reliable indicator of inspiratory effort in the absence of diaphragm dysfunction. Additional measurement of parasternal intercostal thickening may discriminate a low inspiratory effort or a high effort in the presence of a dysfunctional diaphragm.


Assuntos
Esôfago/fisiologia , Respiração com Pressão Positiva/métodos , Músculos Respiratórios/fisiologia , Ultrassonografia/métodos , Trabalho Respiratório/fisiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Cuidados Críticos/métodos , Estado Terminal , Diafragma/fisiologia , Esôfago/diagnóstico por imagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Músculos Respiratórios/diagnóstico por imagem
8.
Pediatr Pulmonol ; 55(6): 1512-1520, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32297707

RESUMO

OBJECTIVES: To estimate normal range of values for the contractility and relaxation parameters of inspiratory muscles and compare them by sex, age, nutritional status and level of physical activity in healthy children. WORKING HYPOTHESIS: We hypothesized that healthy children present similar range of values for the contractility and relaxation parameters of inspiratory muscles. STUDY DESIGN: Exploratory study conducted between 2017 and 2018. PATIENT-SUBJECT SELECTION: Healthy children aged 6 to 11 years without history of respiratory, cardiac, cerebrovascular or neuromuscular disease as well as no nasal congestion, influenza or known septum deviation were included. METHODOLOGY: Anthropometric, spirometry and respiratory muscle strength data were assessed. Maximum rate of pressure development (MRPD), maximum relaxation rate (MRR), time constant of decay curve (τ), contraction time (CT) and half-relaxation time (½ RT) were calculated from the nasal inspiratory pressure curve. RESULTS: The sample was composed of 110 children (55 boys) with 1.045 as mean z-BMI-score. MRPD range of values was 8.09% to 10.86% rise/10 ms, MRR range of values was 8.09% to 10.86% fall/10 ms, τ range of values was 36.41 to 49.88 ms, CT range of values was 200 to 276 ms, ½ RT range of values was 117.5 to 148 ms and MRPD/MRR range of values was 0.71 to 1.04. The contractility and relaxation parameters did not present significant differences among children when compared by sex, age, nutritional status, or level of physical activity groups (P > .05). CONCLUSIONS: The contractility and relaxation parameters present similar values among children and they are not influenced by age, sex, nutritional status or physical activity level.


Assuntos
Contração Muscular/fisiologia , Músculos Respiratórios/fisiologia , Envelhecimento/fisiologia , Criança , Feminino , Humanos , Masculino , Força Muscular , Estado Nutricional , Valores de Referência , Espirometria
9.
PLoS One ; 15(4): e0225559, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32275657

RESUMO

Although inspiratory muscle training (IMT) is reported to improve inspiratory muscle strength in humans little has been reported for horses. We tested the hypothesis that IMT would maintain and/or improve inspiratory muscle strength variables measured in Thoroughbreds during detraining. Thoroughbreds from one training yard were placed into a control (Con, n = 3 males n = 7 females; median age 2.2±0.4 years) or treatment group (Tr, n = 5 males, n = 5 females; median age 2.1±0.3 years) as they entered a detraining period at the end of the racing/training season. The Tr group underwent eight weeks of IMT twice a day, five days per week using custom-made training masks with resistance valves and an incremental threshold of breath-loading protocol. An inspiratory muscle strength test to fatigue using an incremental threshold of breath-loading was performed in duplicate before (T0) and after four (T1) and eight weeks (T2) of IMT/no IMT using a custom-made testing mask and a commercial testing device. Inspiratory measurements included the total number of breaths achieved during the test, average load, peak power, peak volume, peak flow, energy and the mean peak inspiratory muscle strength index (IMSi). Data were analysed using a linear mixed effects model, P≤0.05 significant. There were no differences for inspiratory measurements between groups at T0. Compared to T0, the total number of breaths achieved (P = 0.02), load (P = 0.003) and IMSi (P = 0.01) at T2 had decreased for the Con group while the total number of breaths achieved (P<0.001), load (P = 0.03), volume (P = 0.004), flow (P = 0.006), energy (P = 0.01) and IMSi (P = 0.002) had increased for the Tr group. At T2 the total number of breaths achieved (P<0.0001), load (P<0.0001), volume (P = 0.02), energy (P = 0.03) and IMSi (P<0.0001) were greater for the Tr than Con group. In conclusion, our results support that IMT can maintain and/or increase aspects of inspiratory muscle strength for horses in a detraining programme.


Assuntos
Cavalos/fisiologia , Músculos Respiratórios/fisiologia , Animais , Exercícios Respiratórios , Feminino , Inalação , Masculino , Força Muscular , Condicionamento Físico Animal
10.
Acta otorrinolaringol. esp ; 71(2): 65-69, mar.-abr. 2020. tab
Artigo em Inglês | IBECS | ID: ibc-192441

RESUMO

BACKGROUND: Gastro-oesophageal reflux disease (GERD) is one of the most common diseases, but is still a challenge to cure. Different medical treatments are used, first of all Proton pump inhibitors (PPIs), however these are sometimes ineffective and long-term intake can lead to underestimated complications. Recently, some studies investigated the role of inspiratory muscle training (IMT) in the medical treatment of GERD. It seems that IMT is able to increase the pressure generated by the lower oesophageal sphincter (LES), reduce spontaneous releases of LES, acid exposure, use of PPIs, and improve symptoms and quality of life for GERD patients. OBJECTIVE: The aim of this study was to evaluate the effectiveness of IMT in association with myofunctional therapy exercises of swallowing set by Daniel Garliner (m-IMT) on the symptoms of patients with non-erosive gastro-oesophageal reflux disease (NERD). METHODS: Twenty-one adult patients with NERD were enrolled from May to December 2017 and performed m-IMT over a period of 4 weeks. Before and after treatment, all the patients completed the following questionnaires: GERD oesophageal symptomatology (GERDQ), extra-oesophageal GERD symptomatology (RSI), quality of life (GERD-Health Related Quality of Life Questionnaire (GERD-HRQL), and underwent laryngeal endoscopy. RESULTS: Nineteen patients completed m-IMT. GERDQ (from 8.36 ± 3.94 to 1.7 ± 3.41; p < .05), RSI (from to 21.68 ± 10.26 to 6.93 ± 8.37; p < .05) and GERDHRQL (from 25.68 ± 16.03 to 8.4 ± 11.06; p<.05) the questionnaire scores significantly reduced after treatment. In addition, the laryngeal endoscopy score greatly improved (from 14.24 ± 4.15 to 7.4 ± 1.77; p < .05). CONCLUSIONS: m-IMT is a low cost therapy without side effects. It could be useful in association with PPI or alone for selected GERD cases and for mild NERD forms, in association with diet. Further studies are required to prove the effects of m-IMT on GERD symptoms and decide the best treatment Schedule


INTRODUCCIÓN: La enfermedad por reflujo gastroesofágico (ERGE) es una de las enfermedades más comunes, pero sigue siendo un desafío para curar. Se utilizan diferentes tratamientos médicos, en primer lugar los inhibidores de la bomba de protones (IBP), sin embargo, en ocasiones son ineficaces y una ingesta a largo plazo puede llevar a complicaciones subestimadas. Recientemente, algunos estudios investigaron el papel del entrenamiento muscular inspiratorio (IMT) en el tratamiento médico de la ERGE. Parece que el IMT es capaz de aumentar la presión generada por el esfínter esofágico inferior (LES), reducir las liberaciones espontáneas del LES, la exposición al ácido, el uso de IBP, y mejorar los síntomas y la calidad de vida en pacientes con ERGE. OBJETIVO: El objetivo de este estudio es evaluar la efectividad de la IMT en asociación con los ejercicios de terapia miofuncional de tragar de Daniel Garliner (m-IMT) en los síntomas de los pacientes con ERGE no erosivo (NERGE). MÉTODOS: Veintiún pacientes adultos con ERGE se inscribieron de mayo a diciembre de 2017 y realizaron un período de 4 semanas de m-IMT. Antes y después del tratamiento todos los pacientes completaron los siguientes cuestionarios: sintomatología esofágica de ERGE, sintomatología de ERGE extraesofágica (RSI), calidad de vida (cuestionario de calidad de vida relacionada con la salud [ERGE-HRQL]) y endoscopia laríngea. RESULTADOS: Diecinueve pacientes completaron m-IMT. GERDQ (desde 8,36 ± 3,94 a 1,7 ± 3,41; p < 0,05), RSI (desde hasta 21,68 ± 10,26 hasta 6,93 ± 8,37; p < 0,05) y ERGE-HRQL (desde 25,68±16,03 hasta 8,4 ± 11,06; p < 0,05), las puntuaciones se redujeron significativamente después del tratamiento. Además, la puntuación de la endoscopia laríngea mejoró enormemente (de 14,24 ± 4,15 a 7,4 ± 1,77; p< 0,05). CONCLUSIONES: m-IMT es una terapia de bajo costo sin efectos secundarios. Podría ser útil en asociación con IBP o solo en casos seleccionados de ERGE y en formas NERGE leves, en asociación con la dieta. Se requieren estudios adicionales para probar los efectos de m-IMT en los síntomas de ERGE y establecer el mejor programa de tratamiento


Assuntos
Humanos , Pessoa de Meia-Idade , Idoso , Refluxo Gastroesofágico/terapia , Músculos Respiratórios/fisiologia , Exercícios Respiratórios/métodos , Resultado do Tratamento , Terapia Miofuncional/métodos , Capacidade Inspiratória , Inquéritos e Questionários , Qualidade de Vida , Endoscopia/métodos , Refluxo Gastroesofágico/reabilitação
11.
Enferm. clín. (Ed. impr.) ; 30(supl.3): 136-142, mar. 2020. graf, tab
Artigo em Inglês | IBECS | ID: ibc-196129

RESUMO

OBJECTIVE: This study aimed to synthesize protocol of yoga pranayama's practice through combining yoga pranayama's steps into the new integrated formations of yoga pranayama's steps for adult asthmatic patients as a protocol. METHOD: Literature review from the last 20 years publication of original trial articles on adult asthmatic subjects from 4 databases: PubMed, Science Direct, EBSCO, and Scopus was conducted. Review and non-trial articles were excluded. Articles were appraised using Joanna Bridge Institute (JBI) critical appraisal tools. RESULTS: There were 4 out of 252 articles which met the criteria and being included in this study. The synthesized protocol resulting 11 pranayama steps in the new synthesized protocol. CONCLUSIONS: The regular 13 yoga pranayama steps within 11 pranayama steps based on synthesized protocol takes 30-45min for each session and can be conducted 2-5 times a week for 2-6 months to be able to reveal pulmonary function outcomes


No disponible


Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Asma/terapia , Protocolos Clínicos , Ioga , Asma/prevenção & controle , Pulmão/fisiologia , Grupos Controle , Músculos Respiratórios/fisiologia
12.
Med Sci Sports Exerc ; 52(7): 1610-1616, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-31977643

RESUMO

PURPOSE: This study aimed to compare muscle activation of the diaphragm (DIA), scalenes (SA), parasternal intercostals (PS), and sternomastoid (SM) during submaximal intermittent neck flexion (INF) versus submaximal inspiratory threshold loading (ITL) until task failure in healthy adults. METHODS: Twelve healthy adults performed submaximal ITL or INF tests in random order for 2 d. Surface electromyography was monitored to acquire root mean square (RMS) and median power frequency (MPF) from the SA, PS, SM, and DIA. Maximal inspiratory pressures and maximal voluntary contraction for neck flexion were determined. Next, participants performed the first submaximal test-ITL or INF-targeting 50% ± 5% of the maximal inspiratory pressure or maximal voluntary contraction, respectively, until task failure. After a rest, they performed the other test until task failure. Two days later, they performed ITL and INF but in the opposite order. The Borg scale assessed breathlessness and perceived exertion. RESULTS: Endurance times for ITL and INF were 38.1 and 26.3 min, respectively. INF activated three of four inspiratory muscles at higher average RMS (PS, SM, and SA) and at different MPF (PS, SM, and DIA but not SA) compared with ITL. During ITL, RMS did not change in the four inspiratory muscles over time, but MPF decreased in PS, SM, and SA (P < 0.04). In contrast, RMS increased in three of four inspiratory muscles (SM, PS, and SA) during INF, but MPF did not change throughout its duration. Borg rating was 3.9-fold greater than ITL compared with INF. CONCLUSION: At a similar percentage of maximal load, INF evokes greater activation of primary muscles of inspiration (PS and SA) and a major accessory muscle of inspiration (SM) compared with ITL during a prolonged submaximal protocol.


Assuntos
Inalação , Músculos do Pescoço/fisiologia , Pescoço/fisiologia , Postura/fisiologia , Músculos Respiratórios/fisiologia , Adulto , Estudos Cross-Over , Eletromiografia , Teste de Esforço , Feminino , Humanos , Masculino , Fadiga Muscular , Força Muscular , Adulto Jovem
13.
PLoS One ; 15(1): e0227379, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31978126

RESUMO

The inspiratory muscles contribute to balance via diaphragmatic contraction and by increasing intra-abdominal pressure. We have shown inspiratory muscle training (IMT) improves dynamic balance significantly with healthy community-dwellers. However, it is not known how the magnitude of balance improvements following IMT compares to that of an established balance program. This study compared the effects of 8-week of IMT for community-dwellers, to 8-week of the Otago exercise program (OEP) for care-residents, on balance and physical performance outcomes. Nineteen healthy community-dwellers (74 ± 4 years) were assigned to self-administered IMT. Eighteen, healthy care-residents (82 ± 4 years) were assigned to instructor-led OEP. The IMT involved 30 breaths twice-daily at ~50% of maximal inspiratory pressure (MIP). The OEP group undertook resistance and mobility exercises for ~60 minutes, twice-weekly. Balance and physical performance were assessed using the mini Balance Evaluation System Test (mini-BEST) and time up and go (TUG). After 8-week, both groups improved balance ability significantly (mini-BEST: IMT by 24 ± 34%; OEP by 34 ± 28%), with no between-group difference. Dynamic balance sub-tasks improved significantly more for the IMT group (P < 0.01), than the OEP group and vice versa for static balance sub-tasks (P = 0.01). The IMT group also improved MIP (by 66 ± 97%), peak inspiratory power (by 31 ± 12%) and TUG (by -11 ± 27%); whereas the OEP did not. IMT and OEP improved balance ability similarly, with IMT eliciting greater improvement in dynamic balance, whilst OEP improved static balance more than IMT. Unlike IMT, the OEP did not provide additional benefits in inspiratory muscle function and TUG performance. Our findings suggest that IMT offers a novel method of improving dynamic balance in older adults, which may be more relevant to function than static balance and potentially a useful adjunct to the OEP in frailty prevention.


Assuntos
Envelhecimento/fisiologia , Exercícios Respiratórios/métodos , Pressões Respiratórias Máximas/métodos , Equilíbrio Postural , Músculos Respiratórios/fisiologia , Terapia Respiratória/métodos , Idoso , Idoso de 80 Anos ou mais , Exercício Físico , Terapia por Exercício , Feminino , Humanos , Masculino , Força Muscular , Resistência Física
14.
Braz J Phys Ther ; 24(3): 280-286, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31122717

RESUMO

BACKGROUND: Chronic kidney disease is a complex disease that impacts multiple organs and systems (including musculoskeletal and cardiorespiratory) leading to reduction of functional capacity. OBJECTIVE: The aim of this study was to investigate the effect of a short period of high intensity inspiratory muscle training on maximum inspiratory pressure, functional capacity and endothelial function of chronic kidney disease patients on hemodialysis. METHODS: This randomized controlled trial enrolled 25 patients who were allocated into two groups: intervention (IMTG=14) and control (CG=11) groups. Intervention patients received the exercise protocol over a period of 5 weeks, 6 times per week, with each session consisting of 5 sets of 10 repetitions with an initial load of 50% progressing to 70% of maximum inspiratory pressure , measured weekly. The primary outcome was inspiratory muscle strength and the secondary outcomes were functional capacity and endothelial function evaluated before and after the training protocol. RESULTS: The inspiratory muscle training induced a marked improvement in maximum inspiratory pressure which was evident after the training period (mean difference 19.0cmH2O - 95%CI 0.4-37.5; IMTG: 102±25.7cmH2O vs CG: 83±19.2; p=0.046). The magnitude of maximum inspiratory pressure improvement was 33.5% at the end of the protocol for the IMTG. Functional capacity and endothelial function did not vary between or within groups. CONCLUSION: A short period of high-intensity inspiratory muscle training for five weeks was able to improve inspiratory muscle strength of chronic kidney disease patients on hemodialysis (ClinicalTrials.gov registration NCT03082404).


Assuntos
Força Muscular/fisiologia , Diálise Renal/métodos , Insuficiência Renal Crônica/fisiopatologia , Músculos Respiratórios/fisiologia , Exercício Físico , Humanos , Pressões Respiratórias Máximas , Modalidades de Fisioterapia , Músculos Respiratórios/fisiopatologia , Terapia Respiratória
15.
Jpn J Nurs Sci ; 17(2): e12290, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31429207

RESUMO

AIM: Fatigue and dyspnea are debilitating symptoms in patients with heart failure (HF). The purpose of this study was to evaluate the effects of inspiratory muscle training (IMT) on dyspnea, fatigue and the New York Heart Association (NYHA) functional classification in patients with HF. METHODS: In this prospective, randomized, controlled trial, 84 patients with HF (NYHA classes II-III/IV) with a mean age of 56.62 ± 9.56 years were randomly assigned to a 6-week IMT (n = 42) or a sham IMT (n = 42) program. The IMT was performed at 40% of the maximal inspiratory pressure (MIP) in the IMT group and at 10% in the sham group. The main outcomes were assessed at baseline and after the intervention and included dyspnea severity scale (Modified Medical Research Council [MMRC], Fatigue Severity Scale [FSS] and the NYHA functional classification (based on the presenting symptoms). RESULTS: The between-group analysis showed significant improvements in dyspnea, fatigue and the NYHA functional classification in the IMT group compared to the sham group (P < .05). The within-group analysis showed significant improvements in dyspnea (from 2.63 ± 0.79 to 1.38 ± 0.66, P < .001), fatigue (from 43.36 ± 8.5 to 28.95 ± 9.11, P < .001) and the NYHA functional classification (from 2.73 ± 0.5 to 2.1 ± 0.6, P = .001) in the IMT group, while fatigue and dyspnea increased significantly in the sham group. CONCLUSIONS: The 6-week home-based IMT was found to be an effective and safe tool for reducing dyspnea and fatigue and improving the NYHA functional classification.


Assuntos
Exercícios Respiratórios , Dispneia/fisiopatologia , Fadiga/fisiopatologia , Insuficiência Cardíaca/fisiopatologia , Músculos Respiratórios/fisiologia , Idoso , Dispneia/complicações , Tolerância ao Exercício , Fadiga/complicações , Feminino , Insuficiência Cardíaca/complicações , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Qualidade de Vida
16.
Respir Care ; 65(1): 45-52, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31551283

RESUMO

BACKGROUND: To investigate patient-ventilator interaction during different levels of noninvasive proportional assist ventilation (PAV) compared with noninvasive pressure support ventilation (PSV). METHODS: Fifteen subjects with severe COPD and hypercapnia were consecutively recruited. After the baseline assessment of unassisted spontaneous breathing, 3 levels of ventilatory support were applied. The proportional assist (PA) and pressure support (PS) levels were set by subject comfort. PA-, PS- or PA+, PS+ were set at 25% more or less of PA or PS (PA- = 75% PA, PA+ = 125% PA, PS- = 75% PS, PS+ = 125% PS). Each level lasted at least 20 min. To demonstrate the patient-ventilator interaction, the neural respiratory drive, respiratory muscle effort, flow signal, and airway pressure were simultaneously monitored. RESULTS: The expiratory cycle delay (time between the termination of the diaphragm electromyogram [EMGdi] signal and the end of the inspiratory flow) progressively increased with increasing assist level in both modes. However, compared with PSV, the expiratory cycle delay was significantly longer in each assist level during noninvasive PAV. The runaway phenomenon was observed in PA+. The time between the peak EMGdi signal and the maximum value of the flow signal and the time difference between the peak EMGdi signal and the maximum value of inspiratory pressure were significantly increased with the increasing assist level of PAV. CONCLUSIONS: The expiratory cycle delay of noninvasive PAV was significantly longer than that of noninvasive PSV in the subjects with COPD with respiratory failure. During the levels of PAV, the lag time between neural respiratory drive and airway pressurization was significantly increased and the "runaway" phenomenon may be observed. (ClinicalTrials.gov registration NCT01782768.).


Assuntos
Suporte Ventilatório Interativo , Ventilação não Invasiva , Respiração com Pressão Positiva , Doença Pulmonar Obstrutiva Crônica/terapia , Idoso , Humanos , Hipercapnia/terapia , Pessoa de Meia-Idade , Mecânica Respiratória/fisiologia , Músculos Respiratórios/fisiologia , Volume de Ventilação Pulmonar/fisiologia , Trabalho Respiratório
17.
Anesth Analg ; 130(2): 341-351, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-30855340

RESUMO

BACKGROUND: Skeletal muscle failure in critical illness (intensive care unit-acquired weakness) is a well-known complication developing early during intensive care unit stay. However, muscle weakness during the perioperative setting has not yet been investigated. METHODS: We performed a subgroup investigation of a prospective observational trial to investigate perioperative muscle weakness. Eighty-nine patients aged 65 years or older were assessed for handgrip strength preoperatively, on the first postoperative day, at intensive care unit discharge, at hospital discharge, and at 3-month follow-up. Functional status was evaluated perioperatively via Barthel index, instrumental activities of daily living, Timed Up and Go test, and functional independence measure. After exclusion of patients with intensive care unit-acquired weakness or intensive care unit stay of ≥72 hours, 59 patients were included into our analyses. Of these, 14 patients had additional pulmonary function tests preoperatively and on postoperative day 1. Blood glucose was measured intraoperatively every 20 minutes. RESULTS: Handgrip strength significantly decreased after surgery on postoperative day 1 by 16.4% (P < .001). Postoperative pulmonary function significantly decreased by 13.1% for vital capacity (P = .022) and 12.6% for forced expiratory volume in 1 second (P = .001) on postoperative day 1. Handgrip strength remained significantly reduced at hospital discharge (P = .016) and at the 3-month follow-up (P = .012). Perioperative glucose levels showed no statistically significant impact on muscle weakness. Instrumental activities of daily living (P < .001) and functional independence measure (P < .001) were decreased at hospital discharge, while instrumental activities of daily living remained decreased at the 3-month follow-up (P = .026) compared to preoperative assessments. CONCLUSIONS: Perioperatively acquired weakness occurred, indicated by a postoperatively decreased handgrip strength, decreased respiratory muscle function, and impaired functional status, which partly remained up to 3 months.


Assuntos
Força da Mão/fisiologia , Debilidade Muscular/diagnóstico , Complicações Pós-Operatórias/diagnóstico , Músculos Respiratórios/fisiologia , Idoso , Feminino , Humanos , Unidades de Terapia Intensiva/tendências , Masculino , Debilidade Muscular/etiologia , Debilidade Muscular/fisiopatologia , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/fisiopatologia , Estudos Prospectivos
18.
Int J Sports Physiol Perform ; 15(2): 238-242, 2020 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-31172823

RESUMO

PURPOSE: To evaluate the effects of inspiratory muscle training associated with interval training on respiratory muscle strength and fatigue and aerobic physical performance (PP) in high-performance wheelchair basketball athletes. METHODS: Blinded, randomized clinical trial with 17 male wheelchair basketball players, randomized into control group (CG; n = 8) and training group (TG; n = 9). Respiratory muscle strength was evaluated by measuring maximal inspiratory and expiratory pressures (MIP and MEP), aerobic PP by the Yo-Yo test for wheelchair, and recovery of inspiratory muscle fatigue was assessed at 1, 5, 10, and 15 minutes after exercise test. TG performed inspiratory muscle training protocol with incremental loading for 12 weeks with 50%, 60%, and 70% of MIP, while CG performed with load 15% of MIP. RESULTS: After training period, CG presented a significant increase in MIP and MEP (P ≤ .05), with no change in aerobic PP (P ≥ .05). TG showed a significant increase for all variables (≤.05). MIP showed a large effect size for CG (1.00) and TG (1.35), while MEP showed a moderate effect for CG (0.61) and TG (0.73); distance covered had a moderate effect size for TG (0.70). For recovery of inspiratory muscle strength, CG did not present differences, while TG recovered in 10 minutes (≤.05), representing 87% of the pretest value. Positive and significant correlation between MIP and distance (.54; P ≤ .05) was observed. CONCLUSION: Inspiratory muscle training protocol with progressive loading was more effective for increasing aerobic PP and maximal inspiratory strength recovery.


Assuntos
Desempenho Atlético/fisiologia , Basquetebol/fisiologia , Exercícios Respiratórios , Condicionamento Físico Humano/métodos , Músculos Respiratórios/fisiologia , Esportes para Pessoas com Deficiência/fisiologia , Adulto , Método Duplo-Cego , Humanos , Fadiga Muscular , Força Muscular , Cadeiras de Rodas , Adulto Jovem
19.
Mult Scler Relat Disord ; 37: 101492, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31707233

RESUMO

BACKGROUND: Respiratory training using Threshold Inspiratory Muscle Trainer (IMT) has not been examined adequately in multiple sclerosis (MS). The primary objective in this study of persons with advanced MS was to investigate the training effect of IMT. The secondary objective was to evaluate the retention of IMT benefits. METHODS: This study was a repeated measures within-subject design (before-after trial).. Participants were recruited from a long-term care facility specialized in progressive neurologic conditions. Thirty-six non-ambulatory persons with advanced MS volunteered. Inspiratory muscle exercise using the threshold IMT were performed daily for 10 weeks at 3 sets of 15 repetitions per day. Resistance was progressed weekly based on perceived rate of exertion and symptoms. Primary outcome measures were maximum inspiratory pressure (MIP) and maximum expiratory pressure (MEP) that were measured at baseline, after 5 and 10 weeks of IMT exercises (training period), and at 4 and 8 weeks after the IMT training ended (retention). Linear mixed-effect regression models with time (i.e. weeks from baseline) as the fixed factor and participants as the random effect factor were applied separately to test each hypothesis. Effect size was calculated using partial eta square (η2p). Two-tailed significance level was p < 0.05. RESULTS: Participants were 60.5 ±â€¯8.6 years old. Expanded Disability Status Scale was 8.5 ±â€¯0.4. Baseline MIP were 25.9 ±â€¯16.4 cmH2O (33.2% %± 19.8% of predicted values) and MEP were 23.5 ±â€¯15.7 cmH2O (25.8% %± 14.4% of predicted values). Compared to the baseline, MIP increased significantly to 30.1 ±â€¯17.9 cmH2O (38.9% %± 22.4% of predicted values) and 30.6 ±â€¯17.6 cmH2O (39.6% %± 22.3% of predicted values) after 5 (p < 0.05) and 10 weeks (p < 0.05) of IMT exercises. MIP improvements were retained in an 8-week washout period. MEP did not differ significantly by time. CONCLUSION: In persons with advanced MS, 10-week IMT training increased inspiratory muscle strength. This study is the first to demonstrate the retention of benefits following daily IMT exercises at 8 weeks after training ended.


Assuntos
Exercícios Respiratórios , Inalação/fisiologia , Força Muscular/fisiologia , Avaliação de Resultados em Cuidados de Saúde , Músculos Respiratórios/fisiologia , Idoso , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Testes de Função Respiratória , Índice de Gravidade de Doença
20.
Support Care Cancer ; 28(8): 3627-3635, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31807987

RESUMO

PURPOSE: Patients undergoing hematopoietic stem cell transplantation (HSCT) usually experienced respiratory muscle weakness. Inspiratory muscle training (IMT) at HSCT has not been studied yet. Thus, it is important to evaluate the safety, feasibility, and preliminary effectiveness of IMT for hospitalized patients undergoing HSCT with an unstable and acute clinical condition. METHODS: This is a randomized controlled feasibility study. Thirty-one hospitalized patients undergoing HSCT were randomized to the conventional physical rehabilitation (CON) or to the IMT group (conventional physical rehabilitation + IMT). IMT was carried out at 40% of maximal inspiratory pressure (MIP), 5 sessions weekly, 10-20 min/session. Primary outcomes were safety and feasibility (recruitment, adherence, and attrition rates) of IMT. Secondary outcomes were respiratory strength, respiratory rate, oxygen saturation, and frequency of patients with oxygen desaturation, bleeding, dyspnea, and acute pulmonary edema. RESULTS: Patients were allocated to the IMT (N = 15; 43.6 years) or to the CON group (N = 16; 46.6 years). The recruitment rate was 100%, the adherence rate was 91%, and attrition was 13% to IMT. Two events were observed in 126 IMT sessions (1.5%). MIP increased in the IMT group (P < 0.01). No differences were observed in respiratory rate and oxygen saturation between groups. Trends to negative outcomes were observed in the CON in comparison to IMT group for a need of oxygen therapy (18% vs. 6%), bleeding (12% vs. 6%), dyspnea (25% vs. 13%), and acute pulmonary edema (6% vs. 0%). CONCLUSIONS: IMT is safe, feasible, and improves the inspiratory muscle strength in hospitalized patients undergoing HSCT. TRIAL REGISTRATION: Clinical trial registration: NCT03373526.


Assuntos
Exercícios Respiratórios/métodos , Transplante de Células-Tronco Hematopoéticas/métodos , Músculos Respiratórios/fisiologia , Adulto , Dispneia/terapia , Estudos de Viabilidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Força Muscular , Debilidade Muscular , Modalidades de Fisioterapia , Estudos Prospectivos , Mecânica Respiratória/fisiologia
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