Exercise Training in Patients with Heart Failure: From Pathophysiology to Exercise Prescription.

Heart failure (HF) is a chronic, progressive, and inexorable syndrome affecting worldwide billion of patients (equally distributed among men and women), with prevalence estimate of 1-3% in developed countries. HF leads to enormous direct and indirect costs, and because of ageing population, the total number of HF patients keep rising, approximately 10% in patients > 65 years old. Exercise training (ET) is widely recognized as an evidence-based adjunct treatment modality for patients with HF, and growing evidence is emerging among elderly patients with HF. We used relevant data from literature search (PubMed, Medline, EMBASE) highlighting the epidemiology of HF; focusing on central and peripheral mechanisms underlying the beneficial effect of ET in HF patients; and on frail HF elderly patients undergoing ET. Since many Countries ordered a lockdown in early stages pandemic trying to limit infections, COVID-19 pandemic, and its limitation to exercise-based cardiac rehabilitation operativity was also discussed. ET exerts both central and peripheral adaptations that clinically translate into anti-remodeling effects, increased functional capacity and reduced morbidity and mortality. Ideally, ET programs should be prescribed in a patient-tailored approach, particularly in frail elderly patients with HF. In conclusion, given the complexity of HF syndrome, combining, and tailoring different ET modalities is mandatory. A procedural algorithm according to patient's baseline clinical characteristics [i.e., functional capacity, comorbidity, frailty status (muscle strength, balance, usual daily activities, hearing and vision impairment, sarcopenia, and inability to actively exercise), logistics, individual preferences and goals] has been proposed. Increasing long-term adherence and reaching the frailest patients are challenging goals for future initiatives in the field.

Respiratory Training Late After Fontan Intervention: Impact on Cardiorespiratory Performance.

Fontan palliation allows patients with "single ventricle" circulation to reach adulthood with an acceptable quality of life, although exercise tolerance is significantly reduced. To assess whether controlled respiratory training (CRT) increases cardiorespiratory performance. 16 Adolescent Fontan patients (age 17. 5 ± 3.8 years) were enrolled. Patients were divided into CRT group (n = 10) and control group (C group, n = 6). Maximal cardiopulmonary test (CPT) was repeated at the end of CRT in the CRT group and after an average time of 3 months in the C group. In the CRT group a CPT endurance was also performed before and after CRT. In the CRT group there was a significant improvement in cardiovascular and respiratory response to exercise after CRT. Actually, after accounting for baseline values, the CRT group had decreased breathing respiratory reserve (- 15, 95% CI -22.3 to - 8.0, p = 0.001) and increased RR peak (+ 4.8, 95% CI 0.7-8.9, p = 0.03), VE peak (+ 13.7, 95% CI 5.6-21.7, p = 0.004), VO2 of predicted (+ 8.5, 95% CI 0.1-17.0, p = 0.05), VO2 peak (+ 4.3, 95% CI 0.3 to 8.2, p = 0.04), and VO2 workslope (+ 1.7, 95% CI 0.3-3.1, p = 0.02) as compared to the control group. Moreover, exercise endurance time increased from 8.45 to 17.7 min (p = 0.01). CRT improves cardiorespiratory performance in post-Fontan patients leading to a better aerobic capacity.

Design and Evaluation of a MEMS Magnetic Field Sensor-Based Respiratory Monitoring and Training System for Radiotherapy.

The patient's respiratory pattern and reproducibility are important factors affecting the accuracy of radiotherapy for lung cancer or liver cancer cases. Therefore, respiration training is required to induce respiration regularity before radiotherapy. However, the need for specialized personnel, space, and time-consuming training represent limitations. To solve these problems, we have developed a respiratory monitoring and training system based on a micro-electro-mechanical-system (MEMS) magnetic sensor. This system consists of a small attaching magnet, a sensor, and a breathing pattern output device. In this study, we evaluated the performance of the signal measurement in the developed system based on the various respiratory cycles, the amplitudes, and the position angles of the magnet and the sensor. The system can provide a more accurate breathing signal graph with lower measurement error and higher spatial resolution than conventional sensor methods by using additional magnet. In addition, it is possible the patient to monitor and train breathing himself by making it easy to carry and use without restriction of time and space.

Effect of respiratory rehabilitation techniques on the autonomic function in patients with chronic obstructive pulmonary disease: A systematic review.

Patients with chronic obstructive pulmonary disease (COPD) show several extrapulmonary abnormalities such as impairment in the autonomic function (AF). Similarly, the use of respiratory training techniques such as controlled breathing techniques, noninvasive mechanical ventilation (NIMV), and oxygen supplementation for AF modulation in patients with COPD is popular in existing literature. However, the evidence to support their use is nonexistent. A systematic search of studies reporting on the effect of controlled breathing techniques, NIMV, and/or oxygen supplementation techniques on AF outcome parameters was conducted in three online databases: PubMed, Embase, and Web of Science. Following the Preferred Reporting Items for Systematic reviews and Meta-Analyses statement, relevant studies were retained and qualitatively analyzed for evidence synthesis. The methodological quality in these studies was evaluated using the evidence based guideline development (EBRO) checklists per designs provided by the Dutch Cochrane Centre. Eighteen studies met the inclusion criteria of the review and were included and discussed. The evidence synthesis revealed that a strong and moderate level evidence supported oxygen supplementation and slow breathing techniques, respectively, in significantly enhancing the baroreceptor sensitivity (BRS) values in patients with COPD. The effect of the examined techniques on the heart rate variability and muscle sympathetic nerve activity was of a limited or inconsistent evidence. The findings from this review suggest that oxygen supplementation and controlled breathing techniques have profound positive influence on the BRS in patients with COPD. However, it is not fully clear whether these influence translates to any therapeutic benefit on the general AF of patients with COPD in the long term.

Impact of expiratory strength training in amyotrophic lateral sclerosis.

INTRODUCTION: We evaluated the feasibility and impact of expiratory muscle strength training (EMST) on respiratory and bulbar function in persons with amyotrophic lateral sclerosis (ALS). METHODS: Twenty-five ALS patients participated in this delayed intervention open-label clinical trial. Following a lead-in period, patients completed a 5-week EMST protocol. Outcome measures included: maximum expiratory pressure (MEP); physiologic measures of swallow and cough; and penetration-aspiration scale (PAS) scores. RESULTS: Of participants who entered the active phase of the study (n = 15), EMST was well tolerated and led to significant increases in MEPs and maximum hyoid displacement during swallowing post-EMST (P < 0.05). No significant differences were observed for PAS scores or cough spirometry measures. CONCLUSIONS: EMST was feasible and well tolerated in this small cohort of ALS patients and led to improvements in expiratory force-generating pressures and swallow kinematics. Further investigation is warranted to confirm these preliminary findings. Muscle Nerve 54: 48-53, 2016.

Pulmonary arterial hypertension-related myopathy: an overview of current data and future perspectives.

BACKGROUND AND AIM: Exercise intolerance is one of the key features of pulmonary arterial hypertension (PAH). The main determinants of exercise impairment include hypoxemia, reduced right ventricular output, perfusion/ventilation mismatch, and weakness of skeletal and breathing muscles. The aim of the current review is to describe the findings in the existing literature about respiratory and muscle dysfunction in PAH. Animal and clinical studies regarding both respiratory and peripheral skeletal muscles and the effect of exercise training on muscle function in PAH patients are analyzed. DATA SYNTHESIS: PAH myopathy is characterized by reduced skeletal muscle mass, reduced volitional and non-volitional contractility, reduced generated force, a fiber switch from type I to type II, increased protein degradation through ubiquitin-proteasome system (UPS) activation, reduced mitochondrial functioning, and impaired activation-contractility coupling. Increased inflammatory response, impaired anabolic signaling, hypoxemia, and abnormalities of mitochondrial function are involved in the pathophysiology of this process. Exercise training has been shown to improve exercise capacity, peak oxygen uptake, quality of life, and possibly clinical outcomes of PAH patients. CONCLUSIONS: The skeletal muscles of PAH patients show a wide spectrum of cellular abnormalities that finally culminate in muscle atrophy and reduced contractility. Exercise training improves muscle function and bears a positive impact on the clinical outcomes of PAH patients.

Feasibility of a portable respiratory training system with a gyroscope sensor.

OBJECTIVES: A portable respiratory training system with a gyroscope sensor (gyroscope respiratory training system [GRTS]) was developed and the feasibility of respiratory training was evaluated. METHODS: Simulated respiratory waveforms from a respiratory motion phantom and actual respirator waveforms from volunteers were acquired using the GRTS and Respiratory Gating for Scanners system (RGSC). Respiratory training was evaluated by comparing the stability and reproducibility of respiratory waveforms from patients undergoing expiratory breath-hold radiation therapy, with and without the GRTS. The stability and reproducibility of respiratory waveforms were assessed by root mean square error and gold marker placement-based success rate of expiratory breath-hold, respectively. RESULTS: The absolute mean difference for sinusoidal waveforms between the GRTS and RGSC was 2.0%. Among volunteers, the mean percentages of errors within ±15% of the respiratory waveforms acquired by the GRTS and RGSC were 96.1% for free breathing and 88.2% for expiratory breath-hold. The mean root mean square error and success rate of expiratory breath-hold (standard deviation) with and without the GRTS were 0.65 (0.24) and 0.88 (0.89) cm and 91.0% (6.9) and 89.1% (11.6), respectively. CONCLUSIONS: Respiratory waveforms acquired by the GRTS exhibit good agreement with waveforms acquired by the RGSC. Respiratory training with the GRTS reduces inter-patient variability in respiratory waveforms, thereby improving the success of expiratory breath-hold radiation therapy. ADVANCES IN KNOWLEDGE: A respiratory training system with a gyroscope sensor is inexpensive and portable, making it ideal for respiratory training. This is the first report concerning clinical implementation of a respiratory training system.

Effects of pulmonary function improvement devices in the pediatric population with cerebral palsy: Systematic review and meta-analysis of randomized clinical trials.

INTRODUCTION: Enhancing lung function can significantly improve daily life functionality for children with cerebral palsy, leading to increased interest in respiratory physiotherapy training devices in clinical practice. This study aims to evaluate the efficacy of devices (inspiratory muscle training and feedback devices) for improving pulmonary function through various respiratory parameters. METHODS: A systematic review with meta-analysis of randomized clinical trials was conducted in seven databases up until May 2023. The included studies focused on training inspiratory muscle function using specific devices (inspiratory muscle training and feedback devices) in children with cerebral palsy. The main outcomes were maximum expiratory pressure and maximum inspiratory pressure. Secondary outcomes included forced vital capacity, forced expiratory volume in 1 s, peak expiratory flow, and the Tiffenau index. The effects of respiratory treatment were calculated through the estimation of the effect size and its 95% confidence intervals. The risk of bias in the included studies was assessed using the Cochrane Collaboration's tool for assessing the risk of bias (RoB2). RESULTS: Nine studies were included in the systematic review with meta-analysis, involving a total of 321 children aged between 6 and 18 years after secondary analyses were conducted. Feedback devices were found to be more effective in improving maximum expiratory pressure (effect size -0.604; confidence interval -1.368 to 0.161), peak expiratory flow, forced expiratory volume in 1 s, and forced vital capacity. Inspiratory muscle training devices yielded better effectiveness in improving maximum inspiratory pressure (effect size -0.500; confidence interval -1.259 to 0.259), the Tiffeneau index, and quality of life. CONCLUSION: Both devices showed potential in improving pulmonary function in children with cerebral palsy. Further high-quality clinical trials are needed to determine the optimal dosage and the most beneficial device type for each pulmonary function parameter.

Effect of Breath Training on Image Quality of Chest Magnetic Resonance Free-breathing Sequence.

BACKGROUND: Magnetic Resonance Imaging (MRI) plays a role in demonstrating substantial utility in lung lesion imaging, detection, diagnosis, and evaluation. Previous studies have found that free-breathing star VIBE sequences not only have high image quality but also have a high ability to detect and display nodules. However, in our routine clinical practice, we have encountered suboptimal image quality in the free-breathing sequences of certain patients. OBJECTIVE: This study aims to assess the impact of breath training on the quality of chest magnetic resonance imaging obtained during free-breathing sequences. METHODS: A total of 68 patients with lung lesions, such as nodules or masses detected via Computed Tomography (CT) examination, were prospectively gathered. They were then randomly divided into two groups: an observation group and a control group. Standard preparation was performed for all patients in both groups before the examination. The observation group underwent 30 minutes of breath training prior to the MRI examination additionally, followed by the acquisition of MRI free-breathing sequence images. The signal intensity (SI) and standard deviation (SD) of the lesion and adjacent normal lung tissue were measured, and the image signal-to-noise ratio (SNR) and contrast signal-to-noise ratio (CNR) of the lesion were calculated for objective image quality evaluation. The subjective image quality of the two groups of images was also evaluated using a 5-point method. RESULTS: MRI examinations were completed in both groups. Significantly better subjective image quality (edge and internal structure clarity, vascular clarity, breathing and cardiac artifacts, and overall image quality) was achieved in the observation group compared to the control group (P<0.05). In addition, higher SNR and CNR values for disease lesions were observed in the observation group compared to the control group (t=4.35, P<0.05; t=5.35, P<0.05). CONCLUSION: It is concluded that the image quality of free-breathing sequences MRI can be improved through breath training before examination.

Inspiratory Muscle Training in Patients Living With Chronic Kidney Disease and Receiving Hemodialysis: Meta-Analysis of Randomized Controlled Trials.

OBJECTIVE: People living with chronic kidney disease (CKD) and receiving hemodialysis (HD) have impaired respiratory muscle strength and endurance. The objective of this study was to systematically review the effects of inspiratory muscle training (IMT) on respiratory muscle strength, functional capacity, lung function, quality of life, endothelial function, and oxidative stress in people living with CKD and receiving HD. METHODS: An electronic search was conducted from inception to June 2023. Randomized controlled trials that evaluated the effects of IMT on respiratory muscle strength, functional capacity, lung function, endothelial function, quality of life, or oxidative stress in adults living with CKD and receiving HD, compared with control, placebo IMT, or conventional physical therapy, were included. RESULTS: Eight studies were included, totaling 246 people. The meta-analysis showed that IMT increased the maximum inspiratory pressure (MIP) by 22.53 cm H2O, the maximum expiratory pressure (MEP) by 19.54 cm H2O, and the distance covered in the 6-minute walk test by 77.63 m. Changes in lung function and quality of life were not observed. It was not possible to quantitatively analyze data on endothelial function and oxidative stress. CONCLUSION: IMT improves MIP, MEP, and functional capacity in people living with CKD and receiving HD. IMT did not demonstrate significant results for lung function and quality of life. Effects on endothelial function and oxidative capacity remain uncertain. IMPACT: Inspiratory muscle training improves MIP, MEP, and functional capacity in people living with CKD and receiving HD, compared with conventional physical therapy or controls or placebo intervention. Increases in functional capacity in this population are extremely important because of the relationship with the survival of these people.

Comparative Study of Different Respiratory Muscle Training Methods: Effects on Cardiopulmonary Indices and Athletic Performance in Elite Short-Track Speedskaters.

Respiratory muscle training (RMT) improves endurance performance, balance, and ability to repeat high-intensity exercise bouts, providing a rationale to be applied in short-track speedskating. To establish a preferable RMT method for short-track speedskating, the influence of inspiratory pressure threshold loading (IPTL) and voluntary isocapnic hyperpnoea (VIH) on cardiopulmonary indices and athletic performance was investigated. Sixteen elite short-track speedskaters completed 6 weeks of RMT based on IPTL or VIH. Wingate Anaerobic Tests (WAnTs), cardiopulmonary exercise tests (CPETs), spirometry assessments, and on-ice time trials were performed before and after RMT intervention. Repeated measures ANOVA was used to assess the differences between each method's influence. No statistically significant (p > 0.05) differences between RMT methods were found in performance during the WAnT, CPET, or specific on-ice time trials. Spirometry measures were similar between both methods. Significant effects were found for the interaction between maximum breathing frequency during CPET (BFmax) and method (p = 0.009), as well as for the interaction between BFMax, method, and sex (p = 0.040). BFmax decreased for IPTL and increased for VIH. The interaction between method and sex revealed that BFmax increased only in males performing VIH. Our findings suggest that IPTL and VIH lead to analogous effects in the study participants, highlighting a negligible practical disparity in the impact of different RMT methods in elite short-track speedskaters.

Combined effects of a Mediterranean diet and respiratory muscle training on higher education woodwind musicians: A randomized controlled trial.

A two-factor within subjects and randomized controlled was conducted with three groups (two experimental and one control) to explore the effects of the Mediterranean diet and respiratory muscle training on ventilatory fatigue, stress, and emotional performance of woodwind musicians. 70 students from the Valencia Conservatory of Music were recruited and randomized into three groups: respiratory training group + nutrition program (RTG; n = 17), control group (CG; n = 35) and nutrition program group (NPG; n = 18). The nutritional program was based on Mediterranean a diet. Body composition, emotional intelligence, physiological stress and ventilatory response were assessed for all groups before and after intervention. Mixed ANOVA showed main effects of diet and training interventions on emotional attention (F = 8.042; p = 0.006), clarity (F = 9.306; p = 0.003), repair (F = 5.527; p = 0.022), Forced-Expiratory-Volume (F = 30.196; p < 0.000) and Forced-Vital-Capacity (F = 21.052; p < 0.000), with both interventions improving emotional intelligence and ventilatory variables. Bonferroni post-hoc analysis revealed significant differences of RTG and CG for emotional attention (MD = 4.60; p = 0.023), comprehension (MD = 5.734; p = 0.005), repair (MD = 8.576; p < 0.000), FEV1 (MD = 0.862; p = 0.005), and FCV (MD = 1.608; p < 0.001); with similar results when comparing NTG and CG: emotional attention (MD = 4.156; p = 0.041), comprehension (MD = 4.473; p = 0.033), repair (MD = 6.511; p = 0.001), Forced-Expiratory-Volume (MD = 1.608; p < 0.001), and Forced-Vital-Capacity (MD = 1.183; p < 0.001). No significant effects of experimental groups were observed for physiological stress variables (p > 0.05). This results suggests that respiratory training enhances emotional intelligence and lessens respiratory fatigue in musicians, and a combination of a Mediterranean diet and respiratory muscle training further boosts emotional intelligence, albeit with limited impact on physiological stress. This study represents a novel investigation into the approach by dietary interventions and respiratory muscle training in wind musicians since there are no studies that analyze it.

Respiratory training effects in Long COVID-19 patients: a systematic review and meta-analysis.

INTRODUCTION: To date, it is unknown whether respiratory training interventions can benefit Long COVID-19 patients. The main objective was to analyze the effects of respiratory training on patients with Long COVID-19, concretely on respiratory muscle strength, lung function, dyspnea, and functional capacity. METHODS: We performed a systematic review following PRISMA statement using PubMed, Scopus, and PEDro (last search November 2023). The risk of bias was assessed using the Cochrane tool. We included randomized controlled trials testing the effect of respiratory training interventions in Long COVID-19 patients versus no intervention, control, or placebo intervention. The data was pooled, and a meta-analysis was complete. RESULTS: We selected 7 studies, which included 572 patients. Meta-analysis results show significant differences in favor of respiratory training in respiratory muscle strength (MD = 13.71; 95% CI = 5.41; 22; p = 0.001), dyspnea (SDM = 1.39; 95% CI = 0.33; 2.46; p = 0.01) and functional capacity (SDM = 0.90; 95% CI = 0.37; 1.43; p = 0.0009), but not in lung function (MD = 0.28; 95%CI = -0.27; 0.83; p = 0.32). CONCLUSION: The results of this systematic review with meta-analysis suggest that respiratory training improves respiratory muscle strength and functional capacity in Long COVID-19 patients, as well as dyspnea if combined with therapeutic exercise. However, respiratory training does not improve lung function in these patients. REVIEW REGISTRATION PROSPERO IDENTIFIER: CRD42022371820.

Qualitative assessment of expectations on the content, form and way of delivery of a prehabilitation programme in patients with lung resection surgery - A Swiss tertiary centre experience.

Objective: To assess the interest in a prehabilitation programme of patients awaiting lung resection and to identify expectations from such a programme. Introduction: At present, in Switzerland, there are no multimodal clinical prehabilitation programmes for lung resection patients awaiting surgery. Methods: Semi-structured face-to-face interviews were conducted with patients who have had or were awaiting lung resection at a Swiss tertiary centre. Thematic analysis was performed to identify common prespecified themes. Results: Twenty-two patients (45.5% female, age 70.6 ± 16.6 years) were interviewed. Seventy-seven percent were interested in a prehabilitation programme. Sixty-two percent, 67% and 90% were interested in endurance, strength and respiratory training, respectively. Six patients (27%) were active smokers, of whom two (one-third) were interested in a smoking cessation programme. Seventy-six percent were interested in nutrition counselling and 90% in receiving education on risk factor management. Forty percent preferred centre-based training/counselling sessions, 20% preferred home-based training/counselling and 30% found both forms acceptable. Patients were willing to perform prehabilitation activities on 2.6 days/week for a total of 162 min/week. Participating in peer groups was desired by only 25%. Conclusions: Patients with lung resection were highly interested in participating in prehabilitation, albeit only for a mean time cost of 2.7 h per week. Offering a prehabilitation programme with a combination of in-hospital group sessions and home-based training seems feasible.

Exploring the role of respiratory intervention as an effective adjunct tool in the management of chronic low back pain: A scoping systematic review.

BACKGROUND: Individuals with chronic low back pain (CLBP) are usually prescribed manual therapy and exercise programs. Respiratory exercise interventions are also recommended by some researchers for CLBP. However, the evidence for the relative effectiveness of these treatments is limited, and the question of which sort of intervention is most suited remains unanswered. OBJECTIVE: This systematic review aims to evaluate the effectiveness of respiratory interventions in CLBP. METHODS: A systematic search was performed using databases: PubMed, Web of Science, PEDro, Cochrane Library, and Science Direct. The review was registered in PROSPERO (CRD42021233739). RESULTS: Seven studies met the inclusion criteria. Out of these, one was of poor, three were of fair, and three were of good qualities. A total of 293 subjects were included in seven studies, the mean age of subjects ranged from 21 to 53 years. The largest effect size was reported for pain (d = 1.5) and maximum inspiratory pressure (d = 1.38). No detrimental effects were reported for any of the intervention programs. CONCLUSIONS: Since most of the research has been done on pain and MIP, and both of these parameters have revealed significant changes with large effect size, therefore it can be concluded that respiratory interventions improve pain and MIP in CLBP. Owing to the limited number of studies available, a definitive outcome could not be documented for other parameters. Thus, further research is needed to provide a more robust piece of evidence and understanding.

A short course of high-resistance, low-volume breathing exercise extends respiratory endurance and blunts cardiovascular responsiveness to constant load respiratory testing in healthy young adults.

Our objective was to evaluate the effects of 6-weeks high-resistance, low-volume inspiratory muscle strength training (IMST) on respiratory endurance, blood pressure (BP) and heart rate (HR) responsiveness to high respiratory workloads. Ten healthy young adults completed two constant-load resistive breathing tests to exhaustion (Tlim) (target pressure =65 % maximal inspiratory pressure [PImax]; duty cycle = 0.7; breathing frequency matched to eupnea) separated by 6-weeks high-resistance (75 % maximal inspiratory pressure, PImax), low-volume (30 inspiratory efforts/day, 5 days/week) IMST. Throughout resistive breathing trials we measured beat-to-beat changes in BP and HR, mouth pressure, inspiratory muscle work and perceived exertion. POST resistive breathing tests revealed significant gains in endurance (PRE: 362.0 ± 46.6 s vs. POST: 663.8 ± 110.3 s, p = 0.003) and increases in respiratory muscle work (PRE: -9445 ± 1562 mmHg.s vs. POST: -16648 ± 3761 mmHg.s, p = 0.069). Conversely, systolic and diastolic BP responses, HR and ratings of perceived exertion all declined. Consistent with previous observations, 6 weeks high resistance, low volume IMST lowered casual resting SBP (p = 0.002), DBP (p = 0.007) and mean arterial pressure (p = 0.001) and improved static inspiratory pressure. High resistance, low volume inspiratory muscle strength training extends respiratory endurance and attenuates BP responsiveness in healthy, recreationally-active young adults. The outcomes have implications for improved athletic performance and for attaining and/or maintaining cardiorespiratory fitness.

Effect of transcranial direct current stimulation combined with respiratory training on dysphagia in post-stroke patients.

BACKGROUND: Transcranial direct current stimulation (tDCS) has a considerable advantage in the rehabilitation treatment of dysphagia. OBJECTIVE: The purpose of this study was to explore the effect of tDCS combined with respiratory training on dysphagia in post-stroke patients. METHODS: From December 2017 to January 2019, 64 post-stroke patients who were hospitalized in the Department of Neurology of the Second Hospital of Hebei Medical University were enrolled in this study. They were randomly divided into control and treatment groups (n= 32). Patients in the two groups received routine swallowing rehabilitation training and respiratory training. On this basis, the patients in the treatment group received tDCS. The anode was placed in the movement area of the pharyngeal cortex on the unaffected side of the patients' bodies, and the cathode was placed in the upper orbital orbit on the opposite side. The current intensity was 1.5 mA, 20 min/time, 1 time/d, and 6 d/w. Before and after the treatment, the water swallow text, functional oral intake scale (FOIS), forced vital capacity (FVC) and peak expiratory flow (PEF) were assessed, and the correlation among them was evaluated. RESULTS: There were no differences in all indexes before and after treatment. After treatment, water swallow text, FOIS, FVC and PEF were all better than before treatment, and the clinical efficacy in the treatment group was significantly better than that in the control group. FVC and PEF were positively correlated with water swallow text and FOIS. CONCLUSION: tDCS combined with respiratory training may have a significant therapeutic effect on dysphagia in post-stroke patients.

Acute upper and lower limb hemodynamic responses during single sessions of low- versus high-intensity inspiratory muscle strength training.

Inspiratory muscle strength training (IMST) has shown potential to improve both respiratory and cardiovascular function in health and disease. Less is known about acute hemodynamic responses to a single IMST session, therefore we assessed upper and lower limb blood flow via Doppler ultrasound in the brachial and popliteal arteries, respectively. Mean, anterograde, and retrograde blood flow (BF) and shear rate (SR) were assessed relative to baseline during low-intensity (15% maximal inspiratory pressure - PImax) and high-intensity (75% PImax) IMST. During low-intensity IMST, popliteal BF and SR were reduced by ∼10%, and brachial BF and SR were reduced by ∼40%. During high-intensity IMST, popliteal BF and SR were reduced by ∼20%, and brachial BF and SR were reduced by ∼35%. BF and SR responses were not statistically different between low-intensity and high-intensity training for either blood vessel (P > 0.05). In addition, anterograde BF and SR were significantly decreased in the brachial artery for both low-intensity and high-intensity training (P < 0.05), but not the popliteal artery (P > 0.05). Finally, during IMST retrograde BF and SR were significantly increased in both the upper and lower limbs during low-intensity and high-intensity training (P < 0.05). These data provide novel insight into the acute BF and SR responses to a single bout of IMST and may enhance our understanding of the mechanism(s) by which IMST imparts its beneficial chronic effects on cardiovascular function.NEW & NOTEWORTHY Herein, we demonstrate for the first time that upper and lower limb blood flow and shear rate patterns are altered during a single bout of IMST, at low- and high-intensity training. Specifically, anterograde blood flow and shear rate are significantly reduced in the brachial artery, whereas retrograde blood flow is significantly elevated in both the brachial and popliteal arteries. These findings provide insight into the vascular impact of IMST, which may inform future mechanistic studies.

Respiratory training combined with core training improves lower limb function in patients with ischemic stroke.

OBJECTIVE: To analyze the effect of respiratory training combined with core training on lower limb function and quality of life in patients with ischemic stroke. METHODS: Data of 88 patients with hemiplegia after stroke admitted to Affiliated Sichuan Provincial Rehabilitation Hospital of Chengdu University of TCM from January 2019 to January 2021 were retrospectively analyzed. Quality of life and lower limb function were evaluated in the control group (conventional rehabilitation training, n = 40) and the research group (respiratory training combined with core stabilization training, n = 48) using Short Form-36 (SF-36) and with Wisconsin Gait Scale (WGS), respectively. According to the mean value of life quality after treatment, patients were divided into a low quality of life group and a high quality of life group. Logistics regression was used to analyze the risk factors affecting patients' quality of life. Changes in pulmonary function parameters (including forced expiratory volume in the first second (FEV1) and forced vital capacity (FVC)) were observed before and after treatment. Patients' balance ability was assessed using the Berg Balance Scale (BBS). RESULTS: Compared with the control group, the research group had evidently higher SF-36 score (P < 0.001), markedly lower WGS score (P < 0.001) and much better FEV1 and FVC (P < 0.001). After treatment, the BBS score of the research group increased evidently compared with that of the control group (P < 0.001). Logistics regression revealed that the duration of education, national institutes of health stroke scale (NIHSS) score at admission and rehabilitation program were independent risk factors affecting the quality of life of patients (P < 0.05). CONCLUSION: Breathing training combined with core muscle training can effectively improve lower limb function and daily living activities in stroke patients. In addition, duration of education, NIHSS score at admission and rehabilitation program were identified as independent risk factors affecting the life quality of stroke patients.

Adaptive Training: A New Method to Improve the Image Quality of Abdominal Magnetic Resonance Imaging.

BACKGROUND: In abdominal magnetic resonance imaging (MRI), the late hepatic arterial phase is particularly important for the diagnosis of hepatocellular carcinoma (HCC). However, poor patient compliance with breath-hold imaging acquisition protocols and the administration of the liverspecific contrast agent gadolinium ethoxybenzyl-diethylenetriaminepentaacetic acid (Gd-EOB-DTPA) increases the motion artifacts that degrade the quality of the images making it more difficult to interpret the images. OBJECTIVE: This study aimed to evaluate the role of adaptive respiratory training in improving the quality of the MRI by reducing the motion artifacts and improving the signal intensity from the regions of interest (ROI) in the late hepatic arterial phase. METHODS: A total of 120 patients who underwent an abdominal MRI between 2021 to 2022 to assess for the liver disease were included in the study. These patients were divided into two groups: the experimental group and the control group. The patients in the experimental group received adaptive training. The incidence of motion artifacts and the signal intensity in the late hepatic arterial phase within the abdominal aorta, hepatic artery, splenic artery, and hepatic parenchyma between the experimental group and the control group were compared. RESULTS: The incidence of motion artifacts in the experimental group was significantly reduced by 28.3% (p = 0.001, Chi-square value = 12.079). In the late hepatic arterial phase, the signal intensity of the abdominal aorta, the hepatic artery, the splenic artery, and the hepatic parenchyma increased by 7.3%, 27.4%, 29.5%, and 6.9%, respectively. CONCLUSION: Adaptive respiratory training reduced the incidence of motion artifacts and improved the signal intensity for various ROI. The improved image quality could potentially facilitate image interpretation and reduce the number of repeat MRI scans.