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1.
Medicine (Baltimore) ; 100(9): e24930, 2021 Mar 05.
Artigo em Inglês | MEDLINE | ID: mdl-33655957

RESUMO

BACKGROUND: Rehabilitation training is beneficial for patients with chronic obstructive pulmonary disease (COPD). This study was aimed at evaluating the efficacy of muscle training on dyspnea. METHODS: We used 5 common databases for conducting a meta-analysis included PubMed, the Cochrane Library, Science Direct, Web of Science and Clinical Trials.gov, and eligible randomized controlled trials (RCTs) were included. The main results of include studies were dyspnea of patients who had a clinical diagnosis of COPD measured using Borg score and Medical Research Council (MRC) or modified Medical Research Council (mMRC) scale as the criteria before and after intervention. The intervention measures included respiratory or expiratory muscles or upper limb (UL) or lower limb (LL) training. The mean differences (MD) with the 95% confidence interval (CI) were considered for summary statistics. We also assessed risk of bias using the Cochrane collaboration's tool, and the value of I2 was applied to evaluate the heterogeneity of the trials. RESULTS: Fourteen RCTs with 18 interventions (n = 860 participants) were included. Muscle training significantly improved dyspnea during exercise and in the daily life of patients with COPD (MD, 95% CI: -0.58, -0.84 to -0.32, P  < .0001 and -0.44, -0.65 to -0.24, P  < .0001, respectively). In the subgroup analyses, the trials that used respiratory muscle and UL trainings significantly improved dyspnea during exercise (MD, 95% CI: -0.72, -1.13 to -0.31, P = .0005 and -0.53, -0.91 to -0.15, P = .007, respectively). The studies also showed that the participants in the rehabilitation group, who received respiratory muscle and UL trainings, had a significant improvement of dyspnea in daily life (MD, 95% CI: -0.38, -0.67 to -0.09, P = .01 and -0.51, -0.80 to -0.22, P = .0007, respectively). CONCLUSION: There were some limitations that most of the subjects in this study were patients with moderate to severe COPD and were male, and the training period and duration were different. The analyses revealed that respiratory muscle and UL trainings can improve dyspnea in patients with COPD during exercise and in daily life.


Assuntos
Dispneia/reabilitação , Tolerância ao Exercício/fisiologia , Expiração/fisiologia , Modalidades de Fisioterapia , Doença Pulmonar Obstrutiva Crônica/reabilitação , Ensaios Clínicos Controlados Aleatórios como Assunto , Músculos Respiratórios/fisiopatologia , Dispneia/etiologia , Dispneia/fisiopatologia , Humanos , Doença Pulmonar Obstrutiva Crônica/complicações , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Qualidade de Vida
2.
J Nutr Health Aging ; 25(4): 507-515, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33786569

RESUMO

The condition of muscle fiber atrophy and weakness that occurs in respiratory muscles along with systemic skeletal muscle with age is known as respiratory sarcopenia. The Japanese Working Group of Respiratory Sarcopenia of the Japanese Association of Rehabilitation Nutrition narratively reviews these areas, and proposes the concept and diagnostic criteria. We have defined respiratory sarcopenia as "whole-body sarcopenia and low respiratory muscle mass followed by low respiratory muscle strength and/or low respiratory function." Respiratory sarcopenia can be caused by various factors such as aging, decreased activity, undernutrition, disease, cachexia, and iatrogenic causes. We have also created an algorithm for diagnosing respiratory sarcopenia. Respiratory function decreases with age in healthy older people, along with low respiratory muscle mass and strength. We have created a new term, "Presbypnea," meaning a decline in respiratory function with aging. Minor functional respiratory disability due to aging, such as that indicated by a modified Medical Research Council level 1 (troubled by shortness of breath when hurrying or walking straight up hill), is an indicator of presbypnea. We also define sarcopenic respiratory disability as "a disability with deteriorated respiratory function that results from respiratory sarcopenia." Sarcopenic respiratory disability is diagnosed if respiratory sarcopenia is present with functional disability. Cases of respiratory sarcopenia without functional disability are diagnosed as "at risk of sarcopenic respiratory disability." Functional disability is defined as a modified Medical Research Council grade of 2 or more. Rehabilitation nutrition, treatment that combines rehabilitation and nutritional management, may be adequate to prevent and treat respiratory sarcopenia and sarcopenic respiratory disability.


Assuntos
Músculos Respiratórios/fisiopatologia , Sarcopenia , Envelhecimento/fisiologia , Feminino , Fragilidade , Humanos , Masculino , Força Muscular/fisiologia , Sarcopenia/complicações , Sarcopenia/diagnóstico , Sarcopenia/patologia , Sarcopenia/terapia
3.
Medicine (Baltimore) ; 100(13): e25339, 2021 Apr 02.
Artigo em Inglês | MEDLINE | ID: mdl-33787632

RESUMO

BACKGROUND: To the best of our knowledge, no studies have evaluated the effects of inspiratory muscle training (IMT) on recovered COVID-19 patients after weaning from mechanical ventilation. Therefore, this study assessed the efficacy of IMT on recovered COVID-19 patients following mechanical ventilation. METHODS: Forty-two recovered COVID-19 patients (33 men and 9 women) weaned from mechanical ventilation with a mean age of 48.05 ±â€Š8.85 years were enrolled in this pilot control clinical study. Twenty-one patients were equipped to 2-week IMT (IMT group) and 21 matched peers were recruited as a control (control group). Forced vital capacity (FVC%), forced expiratory volume in 1 second (FEV1%), dyspnea severity index (DSI), quality of life (QOL), and six-minute walk test (6-MWT) were assessed initially before starting the study intervention and immediately after intervention. RESULTS: Significant interaction effects were observed in the IMT when compared to control group, FVC% (F = 5.31, P = .041, ηP2 = 0.13), FEV1% (F = 4.91, P = .043, ηP2 = 0.12), DSI (F = 4.56, P = .032, ηP2 = 0.15), QOL (F = 6.14, P = .021, ηP2 = 0.17), and 6-MWT (F = 9.34, P = .028, ηP2 = 0.16). Within-group analysis showed a significant improvement in the IMT group (FVC%, P = .047, FEV1%, P = .039, DSI, P = .001, QOL, P < .001, and 6-MWT, P < .001), whereas the control group displayed nonsignificant changes (P > .05). CONCLUSIONS: A 2-week IMT improves pulmonary functions, dyspnea, functional performance, and QOL in recovered intensive care unit (ICU) COVID-19 patients after consecutive weaning from mechanical ventilation. IMT program should be encouraged in the COVID-19 management protocol, specifically with ICU patients.


Assuntos
Exercícios Respiratórios/métodos , Músculos Respiratórios/fisiopatologia , Desmame do Respirador/métodos , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Estudos Prospectivos , Qualidade de Vida
4.
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
5.
Rev. bras. neurol ; 56(3): 5-10, jul.-set. 2020. tab, graf
Artigo em Inglês | LILACS | ID: biblio-1120371

RESUMO

Total traumatic injury often requires surgical intervention such as neurotization using the phrenic nerve with the aim to recover the elbow function. However, its repercussions on the respiratory kinematics are unknown. Objective: To evaluate the ribcage volume in tricompartments division, kinematics of Duty Cycle, and shortening velocity of the respiratory muscles after nerve phrenic transfer. Methods: Five participants (4 male), aged 18 to 40 years old (32±2), diagnosed with total brachial plexus injury and with nerve phrenic transfer. The optoelectronic plethysmography (OEP) was the instrument to evaluate volume in quiet breathing (QB), inspiratory capacity (IC) and vital capacity (VC) of the rib cage in its tricompartments division (pulmonary rib cage, abdominal rib cage and abdomen rib cage) and in each hemithorax, as well as the shortening velocity of the respiratory muscles, and respiratory rate. Assessments occurred 30 days prior and 30 days after surgery. Results: There was a decrease in the total compartmental distribution in QB with statistical difference only in the abdominal compartment (p <0.05). Four patients showed a reduction in the shortening speed of the left diaphragm muscle. It was not possible to perform a group analysis of respiratory kinematics and volumes in CV, IC due to the variation found in each patient analyzed. Conclusion: There was a reduction in volume in the rib cage as well as a change in the speed of shortening of the respiratory muscles after the transfer of the phrenic nerve one month after surgery.


A lesão traumática total freqüentemente requer intervenção cirúrgica, como neurotização usando o nervo frênico, com o objetivo de recuperar a função do cotovelo. No entanto, suas repercussões na cinemática respiratória são desconhecidas. Objetivo: Avaliar o volume da caixa torácica na divisão dos tricompartimentos, a cinemática do Duty Cycle e a velocidade de encurtamento dos músculos respiratórios após a transferência do nervo frênico. Métodos: Cinco participantes (4 do sexo masculino), com idade entre 18 e 40 anos (32 ± 2), com diagnóstico de lesão total do plexo braquial e transferência do nervo frênico. A pletismografia optoeletrônica (OEP) foi o instrumento para avaliar o volume na respiração silenciosa (QB), a capacidade inspiratória (IC) e a capacidade vital (VC) da caixa torácica em sua divisão tricompartimental (caixa torácica pulmonar, caixa torácica abdominal e caixa torácica do abdômen ) e em cada hemitórax, bem como a velocidade de encurtamento dos músculos respiratórios e a frequência respiratória. As avaliações ocorreram 30 dias antes e 30 dias após a cirurgia. Resultados: Houve diminuição da distribuição compartimental total no QB com diferença estatística apenas no compartimento abdominal (p <0,05). Quatro pacientes apresentaram redução da velocidade de encurtamento do músculo diafragma esquerdo. Não foi possível realizar uma análise de grupo da cinemática respiratória e dos volumes em CV, IC devido à variação encontrada em cada paciente analisado. Conclusão: Houve redução do volume da caixa torácica e também alteração da velocidade de encurtamento dos músculos respiratórios após a transferência do nervo frênico um mês após a cirurgia.


Assuntos
Humanos , Masculino , Adulto , Adulto Jovem , Nervo Frênico/cirurgia , Músculos Respiratórios/fisiopatologia , Plexo Braquial/lesões , Transferência de Nervo/métodos , Pletismografia/instrumentação , Testes de Função Respiratória/métodos
7.
Medicine (Baltimore) ; 99(34): e21794, 2020 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-32846812

RESUMO

Patients with cardiovascular diseases frequently experience exertional dyspnea. However, the relationship between respiratory muscle strength including its fatigue and cardiovascular dysfunctions remains to be clarified.The maximal inspiratory pressure/maximal expiratory pressure (MIP/MEP) before and after cardiopulmonary exercise testing (CPX) in 44 patients with heart failure and ischemic heart disease were measured. Respiratory muscle fatigue was evaluated by calculating MIP (MIPpost/MIPpre) and MEP (MEPpost/MEPpre) changes.The mean MIPpre and MEPpre values were 67.5 ±â€Š29.0 and 61.6 ±â€Š23.8 cm H2O, respectively. After CPX, MIP decreased in 25 patients, and MEP decreased in 22 patients. We evaluated the correlation relationship between respiratory muscle function including respiratory muscle fatigue and exercise capacity evaluated by CPX such as peak VO2 and VE/VCO2 slope. Among MIP, MEP, change in MIP, and change in MEP, only the value of change in MIP had an association with the value of VE/VCO2 slope (R = -0.36, P = .017). In addition, multivariate analysis for determining factor of change in MIP revealed that the association between the change in MIP and eGFR was independent from other confounding parameters (beta, 0.40, P = .017). The patients were divided into 2 groups, with (MIP change < 0.9) and without respiratory muscle fatigue (MIP change > 0.9), and a significant difference in peak VO2 (14.2 ±â€Š3.4 [with fatigue] vs 17.4 ±â€Š4.7 [without fatigue] mL/kg/min; P = .020) was observed between the groups.Respiratory muscle fatigue demonstrated by the change of MIP before and after CPX significantly correlated with exercise capacity and renal function in patients with cardiovascular disease.


Assuntos
Insuficiência Cardíaca/fisiopatologia , Fadiga Muscular , Isquemia Miocárdica/fisiopatologia , Músculos Respiratórios/fisiopatologia , Idoso , Exercício Físico/fisiologia , Teste de Esforço , Tolerância ao Exercício , Feminino , Taxa de Filtração Glomerular , Humanos , Rim/fisiopatologia , Masculino , Pressões Respiratórias Máximas , Pessoa de Meia-Idade
8.
Respir Res ; 21(1): 163, 2020 Jun 29.
Artigo em Inglês | MEDLINE | ID: mdl-32600344

RESUMO

OBJECTIVE: This study investigated the influence of Coronavirus Disease 2019 (COVID-19) on lung function in early convalescence phase. METHODS: A retrospective study of COVID-19 patients at the Fifth Affiliated Hospital of Sun Yat-sen University were conducted, with serial assessments including lung volumes (TLC), spirometry (FVC, FEV1), lung diffusing capacity for carbon monoxide (DLCO),respiratory muscle strength, 6-min walking distance (6MWD) and high resolution CT being collected at 30 days after discharged. RESULTS: Fifty-seven patients completed the serial assessments. There were 40 non-severe cases and 17 severe cases. Thirty-one patients (54.3%) had abnormal CT findings. Abnormalities were detected in the pulmonary function tests in 43 (75.4%) of the patients. Six (10.5%), 5(8.7%), 25(43.8%) 7(12.3%), and 30 (52.6%) patients had FVC, FEV1, FEV1/FVC ratio, TLC, and DLCO values less than 80% of predicted values, respectively. 28 (49.1%) and 13 (22.8%) patients had PImax and PEmax values less than 80% of the corresponding predicted values. Compared with non-severe cases, severe patients showed higher incidence of DLCO impairment (75.6%vs42.5%, p = 0.019), higher lung total severity score (TSS) and R20, and significantly lower percentage of predicted TLC and 6MWD. No significant correlation between TSS and pulmonary function parameters was found during follow-up visit. CONCLUSION: Impaired diffusing-capacity, lower respiratory muscle strength, and lung imaging abnormalities were detected in more than half of the COVID-19 patients in early convalescence phase. Compared with non-severe cases, severe patients had a higher incidence of DLCO impairment and encountered more TLC decrease and 6MWD decline.


Assuntos
Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/epidemiologia , Pneumonia Viral/diagnóstico , Pneumonia Viral/epidemiologia , Músculos Respiratórios/fisiopatologia , Síndrome Respiratória Aguda Grave/diagnóstico , Adulto , Idoso , Distribuição de Qui-Quadrado , China/epidemiologia , Estudos de Coortes , Convalescença , Teste de Esforço , Feminino , Seguimentos , Volume Expiratório Forçado , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Força Muscular , Pandemias , Alta do Paciente , Radiografia Torácica/métodos , Testes de Função Respiratória , Estudos Retrospectivos , Medição de Risco , Síndrome Respiratória Aguda Grave/epidemiologia , Espirometria/métodos , Centros de Atenção Terciária , Tomografia Computadorizada por Raios X/métodos , Capacidade Vital/fisiologia
9.
Transplant Proc ; 52(5): 1279-1283, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32307144

RESUMO

Renal transplantation is the best long-term treatment option compared with maintenance dialysis in patients with chronic kidney disease. This treatment should be combined with immunosuppressive drugs to obtain positive effects; however, the adverse effects of these medications in the respiratory and peripheral muscle strength, functional capacity, and quality of life of patients remain unknown. OBJECTIVE: The objective of this study is to evaluate the respiratory and peripheral muscle strength, functional capacity, and quality of life of patients undergoing renal transplantation in the preoperative period and during the first 6 months of postoperative period. METHODS: The respiratory and peripheral muscle strength, quality of life, and functional capacity of 40 patients were evaluated from the pretransplant period to 6 months post-renal transplantation. RESULTS: Compared with the preoperative period, the patients experienced improvement of the respiratory and peripheral strength 6 months after transplant (maximal inspiratory pressure 44% and maximal expiratory pressure 28.96%, handgrip 13.81%, and lower limbs 26.95%) and also in the quality of life. CONCLUSION: We conclude that 6 months after transplant, patients showed improvement in respiratory and peripheral muscle strength and quality of life, but even with the improvement, patients presented an unsatisfactory quality of life and muscle strength, regardless of immunosuppressive therapy.


Assuntos
Imunossupressão/efeitos adversos , Transplante de Rim/efeitos adversos , Força Muscular/fisiologia , Qualidade de Vida , Insuficiência Renal Crônica/fisiopatologia , Adulto , Feminino , Força da Mão , Humanos , Estudos Longitudinais , Masculino , Pressões Respiratórias Máximas , Pessoa de Meia-Idade , Período Pós-Operatório , Insuficiência Renal Crônica/cirurgia , Músculos Respiratórios/fisiopatologia
10.
Am J Med ; 133(9): 1025-1032, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32343947

RESUMO

The 2019-2020 coronavirus pandemic elucidated how a single highly infectious virus can overburden health care systems of even highly economically developed nations. A leading contributor to these concerning outcomes is a lack of available intensive care unit (ICU) beds and mechanical ventilation support. Poorer health is associated with a higher risk for severe respiratory complications from the coronavirus. We hypothesize that impaired respiratory muscle performance is an underappreciated factor contributing to poor outcomes unfolding during the coronavirus pandemic. Although impaired respiratory muscle performance is considered to be rare, it is more frequently encountered in patients with poorer health, in particular obesity. However, measures of respiratory muscle performance are not routinely performed in clinical practice, including those with symptoms such as dyspnea. The purpose of this article is to discuss the potential role of respiratory muscle performance from the perspective of the coronavirus pandemic. We also provide a theoretical patient management model to screen for impaired respiratory muscle performance and intervention, if identified, with the goal of unburdening health care systems during future pandemic crises.


Assuntos
Infecções por Coronavirus , Fenômenos Fisiológicos Musculoesqueléticos , Pandemias , Pneumonia Viral , Músculos Respiratórios/fisiopatologia , Betacoronavirus , Infecções por Coronavirus/fisiopatologia , Infecções por Coronavirus/reabilitação , Infecções por Coronavirus/terapia , Humanos , Desempenho Físico Funcional , Pneumonia Viral/fisiopatologia , Pneumonia Viral/reabilitação , Pneumonia Viral/terapia , Respiração Artificial/métodos
11.
PLoS One ; 15(4): e0232225, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32348374

RESUMO

INTRODUCTION AND OBJECTIVES: Dyspnea is the most common symptom among hospitalized patients with heart failure (HF) but besides dyspnea questionnaires (which reflect the subjective patient sensation and are not fully validated in HF) there are no measurable physiological variables providing objective assessment of dyspnea in a setting of acute HF patients. Studies performed in respiratory patients suggest that the measurement of electromyographic (EMG) activity of the respiratory muscles with surface electrodes correlates well with dyspnea. Our aim was to test the hypothesis that respiratory muscles EMG activity is a potential marker of dyspnea severity in acute HF patients. METHODS: Prospective and descriptive pilot study carried out in 25 adult patients admitted for acute HF. Measurements were carried out with a cardio-respiratory portable polygraph including EMG surface electrodes for measuring the activity of main (diaphragm) and accessory (scalene and pectoralis minor) respiratory muscles. Dyspnea sensation was assessed by means of the Likert 5 questionnaire. Data were recorded during 3 min of spontaneous breathing and after breathing at maximum effort for several cycles for normalizing data. An index to quantify the activity of each respiratory muscle was computed. This assessment was carried out within the first 24 h of admission, and at day 2 and 5. RESULTS: Dyspnea score decreased along the three measured days. Diaphragm and scalene EMG index showed a positive and significant direct relationship with dyspnea score (p<0.001 and p = 0.003 respectively) whereas pectoralis minor muscle did not. CONCLUSION: In our pilot study, diaphragm and scalene EMG activity was associated with increasing severity of dyspnea. Surface respiratory EMG could be a useful objective tool to improve assessment of dyspnea in acute HF patients.


Assuntos
Dispneia/fisiopatologia , Eletromiografia/métodos , Insuficiência Cardíaca/fisiopatologia , Músculos Respiratórios/fisiopatologia , Doença Aguda , Idoso , Idoso de 80 Anos ou mais , Diafragma/fisiopatologia , Feminino , Humanos , Masculino , Músculos Peitorais/fisiopatologia , Projetos Piloto , Estudos Prospectivos
12.
Biomed Res Int ; 2020: 7530498, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32185217

RESUMO

Objective: To investigate the pulmonary function responses to respiratory muscle training (RMT) in individuals with tetraplegia and provide a systematic review of the included studies. Methods: Computerized retrieval of randomized controlled trials (RCT) in PubMed, Embase, and the Cochrane Library on the improvement of respiratory function in patients with spinal cord injury by RMT was conducted until May 2019. Two researchers independently screened the literature, extracted the data, and evaluated the risk of bias in the included studies. Articles were scored for their methodological quality using the Cochrane Collaboration risk of bias assessment tool. Results: Sixteen studies were identified. A significant benefit of RMT was revealed for five outcomes: force vital capacity (FVC, WMD: -0.43, 95% CI -0.84 to -0.03, P = 0.037), vital capacity (VC, WMD: -0.40, 95% CI -0.69 to -0.12, P = 0.037), vital capacity (VC, WMD: -0.40, 95% CI -0.69 to -0.12, P = 0.037), vital capacity (VC, WMD: -0.40, 95% CI -0.69 to -0.12, P = 0.037), vital capacity (VC, WMD: -0.40, 95% CI -0.69 to -0.12, P = 0.037), vital capacity (VC, WMD: -0.40, 95% CI -0.69 to -0.12. Conclusion: Our findings demonstrate that RMT can effectively improve spinal cord injury pulmonary function of the patient, which is marked by increasing respiratory strength, function, and endurance. Limited by the quantity and quality of the included studies, the above conclusion needs to be verified by more high-quality studies.


Assuntos
Exercícios Respiratórios , Músculos Respiratórios/fisiopatologia , Traumatismos da Medula Espinal/fisiopatologia , Expiração/fisiologia , Humanos , Inalação/fisiologia , Pulmão/fisiopatologia , Força Muscular/fisiologia , Capacidade Vital/fisiologia
13.
Nurs Res ; 69(4): E27-E36, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32132378

RESUMO

BACKGROUND: Chronic obstructive pulmonary disease (COPD) could lead to poor cardiopulmonary endurance, which affects quality of life and increases the risk of rehospitalization or mortality. However, studies investigating associated factors of cardiopulmonary endurance for COPD inpatients are scant. OBJECTIVE: The aim of the study was to investigate whether and how age, gender, COPD severity, body composition, dyspnea, respiratory muscle strength, and lower limb muscle strength and endurance were related to cardiopulmonary endurance in elderly inpatients with COPD. METHODS: This was a cross-sectional study using a systematic sampling of older inpatients. Data of demographic characteristics such as age, gender, and disease severity were collected, and body mass index was calculated. Degrees of dyspnea were assessed by the modified Medical Research Council Dyspnea Scale. Respiratory muscle strength was reflected by the maximal inspiratory pressure and the maximal expiratory pressure. Lower limb muscle strength and endurance were assessed by a handheld dynamometer and a 30-second sit-to-stand test, respectively. Finally, cardiopulmonary endurance was assessed by a 6-minute walk test. RESULTS: A total of 83 older COPD inpatients participated. The mean age was 74.01 ± 6.93 years. Cardiopulmonary endurance was associated with age, COPD severity, dyspnea, respiratory muscle strength, lower limb muscle strength, and endurance. Predictors of cardiopulmonary endurance were disease severity, dyspnea, and lower limb muscle endurance. These predictors explained 53% of the variance in cardiopulmonary endurance in older inpatients with COPD. DISCUSSION: Cardiopulmonary endurance of hospitalized older adults with COPD should be strengthened by improving conditions of disease severity, dyspnea, and lower limb muscle endurance.


Assuntos
Doença Pulmonar Obstrutiva Crônica/complicações , Músculos Respiratórios/fisiopatologia , Índice de Gravidade de Doença , Teste de Caminhada , Idoso , Estudos Transversais , Dispneia , Feminino , Humanos , Extremidade Inferior , Masculino , Força Muscular/fisiologia , Doença Pulmonar Obstrutiva Crônica/mortalidade , Qualidade de Vida
14.
Med Sci Monit ; 26: e921295, 2020 Mar 17.
Artigo em Inglês | MEDLINE | ID: mdl-32182226

RESUMO

BACKGROUND This study examined the effects of abdominal draw-in lumbar stabilization exercises (ADIM) with respiratory resistance on women ages 40-49 years with low back pain. MATERIAL AND METHODS Forty-four women ages 40-49 years were screened for participation and were randomly assigned to either a respiratory with resistance exercise group (n=22) or a control group (n=22). Abdominal draw-in lumbar stabilization exercises were administered to both groups, but only the respiratory with resistance exercise group received the respiratory resistance training. The exercise training lasted 50 min per session, 3 sessions per week for 4 weeks. The assessment methods used were the quadruple visual analogue scale (QVAS), Oswestry disability index-Korean version (ODI-K), diaphragm thickness and contraction rate, and lung capacity test. RESULTS Both groups showed significant differences in the QVAS, ODI-K, maximum voluntary ventilation (MVV), and diaphragm thickness and contraction rate before and after the intervention (p<0.05). In the respiratory resistance exercise group, the ODI-K, forced vital capacity (FVC), forced expiratory volume in one second (FEV1), MVV, and diaphragm thickness and contraction rate showed significantly better improvement than the control group (p<0.05). CONCLUSIONS A lumbar stabilization exercise program consisting of ADIM and respiratory resistance resulted in decreased pain, reduced dysfunctions, and increased muscle thickness in contraction, contraction rate, and pulmonary function. Strong contraction of the diaphragm and deep abdominal muscles through breathing resistance increased the pressure in the abdominal cavity. Therefore, this may be an effective clinical exercise method for patients with lumbar instability.


Assuntos
Exercícios Respiratórios/métodos , Terapia por Exercício/métodos , Dor Lombar/terapia , Músculos Abdominais/fisiopatologia , Adulto , Feminino , Humanos , Dor Lombar/fisiopatologia , Pessoa de Meia-Idade , Músculos Respiratórios/fisiopatologia , Resultado do Tratamento
15.
Crit Care ; 24(1): 103, 2020 Mar 24.
Artigo em Inglês | MEDLINE | ID: mdl-32204719

RESUMO

This article is one of ten reviews selected from the Annual Update in Intensive Care and Emergency Medicine 2020. Other selected articles can be found online at https://www.biomedcentral.com/collections/annualupdate2020. Further information about the Annual Update in Intensive Care and Emergency Medicine is available from http://www.springer.com/series/8901.


Assuntos
Exercícios Respiratórios/métodos , Respiração Artificial/efeitos adversos , Músculos Respiratórios/fisiopatologia , Exercícios Respiratórios/tendências , Humanos , Unidades de Terapia Intensiva/organização & administração , Unidades de Terapia Intensiva/estatística & dados numéricos , Respiração Artificial/métodos
16.
Medicine (Baltimore) ; 99(10): e19337, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32150072

RESUMO

OBJECTIVE: To examine the efficacy of combined inspiratory and expiratory respiratory muscle training (RMT) with respect to the swallowing function, pulmonary function, functional performance, and dysarthria in patients with stroke. DESIGN: Prospective, randomized controlled trial. SETTING: Tertiary hospital. PARTICIPANTS: The trial included 21 subjects (12 men, 9 women) aged 35 to 80 years presenting with 6 months history of unilateral stroke, respiratory muscle weakness (≥70% predicted maximal inspiratory pressure (MIP) and/or ≤70% maximal expiratory pressure (MEP)), dysphagia, or dysarthria. These subjects were randomly assigned to the control (n = 10, rehabilitation) and experimental (n = 11, rehabilitation with RMT) groups. INTERVENTION: Inspiratory RMT starting from 30% to 60% of MIP and expiratory RMT starting from 15% to 75% of MEP for 5 days/week for 6 weeks. MAIN OUTCOME MEASURES: MIP, MEP, pulmonary function, peak cough flow, perception of dyspnea, Fatigue Assessment Scale, Modified Rankin Scale, Brunnstrom stage, Barthel index, Functional Oral Intake Scale (FOIS), and parameters of voice analysis. RESULTS: Significant differences were observed between both groups in terms of MIP, forced vital capacity (FVC), and forced expiratory volume per second (FEV1) of the percentage predicted. Significant difference was found with respect to the change in fatigue, shimmer percent, amplitude perturbation quotient, and voice turbulence index (VTI) according to the acoustic analysis in the RMT group. The FEV1/FVC ratio was negatively correlated with jitter percent, relative average perturbation, pitch perturbation quotient, and VTI; the maximum mid-expiratory flow (MMEF) and MMEF% were also negatively correlated with VTI. Significant differences among participants of the same group were observed while comparing the Brunnstrom stage before and after training of the affected limbs and the Barthel scale and FOIS scores in both the groups. CONCLUSIONS: Altogether, 6-week combined inspiratory and expiratory RMT is feasible as adjuvant therapy for stroke patients to improve fatigue level, respiratory muscle strength, lung volume, respiratory flow, and dysarthria.Clinical trial registration number (Clinical Trial Identifier): NCT03491111.


Assuntos
Exercícios Respiratórios/métodos , Transtornos de Deglutição/terapia , Disartria/terapia , Debilidade Muscular/terapia , Acidente Vascular Cerebral/complicações , Adulto , Idoso , Idoso de 80 Anos ou mais , Exercícios Respiratórios/normas , Transtornos de Deglutição/etiologia , Transtornos de Deglutição/fisiopatologia , Disartria/etiologia , Disartria/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Debilidade Muscular/etiologia , Debilidade Muscular/fisiopatologia , Estudos Prospectivos , Músculos Respiratórios/fisiopatologia , Estatísticas não Paramétricas , Acidente Vascular Cerebral/fisiopatologia , Acidente Vascular Cerebral/terapia
17.
Int J Rehabil Res ; 43(2): 135-140, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32073462

RESUMO

The objective of the present study was to investigate if different levels of inspiratory muscle strength would be associated with dyspnea, walking capacity, and quality of life after stroke. For this exploratory study, the dependent outcome was strength of the inspiratory muscles, measured by maximal inspiratory pressure. Individuals with maximal inspiratory pressure ≥80 cmH2O were classified as non-weak, those with maximal inspiratory pressure between 45 and 80 cmH2O were classified as weak, and those with maximal inspiratory pressure ≤45 cmH2O were classified as very weak. Related outcomes included dyspnea, measured by the modified Medical Research Council scale; walking capacity, measured by the 6-minute walk test; and quality of life, measured by the Stroke-Specific Quality of Life scale. Fifty-three participants, who had a mean age of 62 years (SD 12) and a mean time since the onset of the stroke of 20 (SD 17) months were included. Significant differences were found only between the weak/very weak and non-weak groups. The mean differences between the non-weak and weak/very weak participants were -1.8 points (95% confidence interval -2.7 to -0.9) for dyspnea and 55 points (95% confidence interval 22-88) for quality of life. Significant correlations were found between measures of inspiratory strength and dyspnea (r = -0.54; P < 0.01) and quality of life (r = 0.56; P < 0.01). There were not found any significant differences or correlations regarding walking capacity. The findings demonstrated that individuals with stroke, who had weakness of the inspiratory muscles, reported greater dyspnea and worse quality of life, compared with those, who did not have weakness. The results regarding walking capacity remain unclear.


Assuntos
Dispneia/fisiopatologia , Debilidade Muscular/fisiopatologia , Qualidade de Vida , Músculos Respiratórios/fisiopatologia , Acidente Vascular Cerebral/fisiopatologia , Idoso , Exercícios Respiratórios , Feminino , Humanos , Vida Independente , Masculino , Pessoa de Meia-Idade
19.
Artigo em Inglês | MEDLINE | ID: mdl-32050421

RESUMO

The purpose of this study was to evaluate the inspiratory and expiratory muscle strength of individuals affected by stroke and to compare it with the predicted values in the literature considering their corresponding age. Respiratory muscle strength was evaluated in 22 elderly people who had sequels of stroke, four with right hemiparesis, 16 with left hemiparesis and two with bilateral, of ages ranging from 34 to 82 years. The collected data were submitted to statistical analysis using a Mann-Whitney test to evaluate if there was a significant difference in the average data collected when compared with a mean of the predicted data in the literature. Fourteen men and eight women were evaluated, who obtained mean values of 71.85 cmH2O and 57.75 cmH2O, respectively, for a maximal inspiratory pressure (MIP), and when compared to the predicted values for men and women, 105.41 cmH2O (p-value 0.0019) and 80.57 cmH2O (p-value 0.00464) were significantly lower. For a maximal expiratory pressure (MEP), the mean value obtained for men was 62.28 cmH2O and 49.5 cmH2O for women, whereas the predicted values in the literature were 114.79 cmH2O (p-value < 0.0001) and 78, 46 cmH2O (p-value 0.0059), respectively. In the statistical analysis, it was possible to notice that the studied population did not reach the predicted age indexes and that there was a significant difference between the median columns. In conclusion, there is a weakness in the respiratory muscles of hemiparetic men and women due to stroke.


Assuntos
Força Muscular/fisiologia , Músculos Respiratórios/fisiopatologia , Acidente Vascular Cerebral/fisiopatologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Expiração/fisiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Acidente Vascular Cerebral/complicações
20.
Physiotherapy ; 106: 43-51, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32026845

RESUMO

BACKGROUND: Respiratory muscle strength declines in certain disease states, leading to impaired cough, reduced airway clearance and an increased risk of aspiration pneumonia. Respiratory muscle training may therefore reduce this risk. OBJECTIVES: To assess current evidence of expiratory muscle strength training (EMST) on maximum expiratory pressure, cough flow and spirometry. DATA SOURCES: Databases including CINAHL, Medline, Science Direct and PEDRo were searched. ELIGIBILITY CRITERIA: Randomised controlled trials investigating expiratory muscle strength training on maximum expiratory pressure, pulmonary function or cough in any adult population, published before December 2017. STUDY APPRAISAL: Data were extracted to a trial description form and study quality evaluated by two reviewers. Meta-analysis was performed with calculation of mean differences and 95% confidence intervals. RESULTS: Nine studies met inclusion criteria and ranged in size from 12 to 42 participants. Trials investigated EMST in healthy adults (2), multiple sclerosis (3), COPD (2), acute stroke (1) and spinal cord injury (1). Overall, EMST improved maximum expiratory pressure (15.95cmH2O; 95% CI: 7.77 to 24.12; P<0.01) with no significant impact on cough flow (4.63L/minute; 95%CI -27.48 to 36.74; P=0.78), forced vital capacity (-0.16L; 95%CI -0.35 to 0.02; P=0.09) or forced expiratory volume in 1second (-0.09L; 95%CI -0.10 to -0.08; P<0.001) vs control or sham training. CONCLUSIONS: Meta-analysis indicated a small significant increase in maximum expiratory pressure following EMST. Improvements in maximum expiratory pressure did not lead to improvements in cough or pulmonary function. LIMITATIONS: Variations in protocol design and population limited the overall effect size. Systematic Review Registration PROSPERO CRD42018104190.


Assuntos
Exercícios Respiratórios/métodos , Tosse/fisiopatologia , Pessoas com Deficiência/reabilitação , Músculos Respiratórios/fisiopatologia , Adulto , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto , Testes de Função Respiratória
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