Effects of respiratory muscle training on post-stroke rehabilitation:A systematic review and meta-analysis

BACKGROUND Stroke often results in significant respiratory dysfunction in patients.Respiratory muscle training(RMT)has been proposed as a rehabilitative intervention to address these challenges,but its effectiveness compared to routine training remains debated.This systematic review and meta-analysis aim to evaluate the effects of RMT on exercise tolerance,muscle strength,and pulmonary function in post-stroke patients.AIM To systematically assess the efficacy of RMT in improving exercise tolerance,respiratory muscle strength,and pulmonary function in patients recovering from a stroke,and to evaluate whether RMT offers a significant advantage over routine training modalities in enhancing these critical health outcomes in the post-stroke population.METHODS Following the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines,a comprehensive search across PubMed,Embase,Web of Science,and the Cochrane Library was conducted on October 19,2023,without temporal restrictions.Studies were selected based on the predefined inclusion and exclusion criteria focusing on various forms of RMT,control groups,and outcome measures[including forced expiratory volume in the first second(FEV1),forced vital capacity(FVC),maximal voluntary ventilation(MVV),peak expiratory flow(PEF),maximal inspiratory pressure(MIP),maximal expiratory pressure(MEP),and 6-min walking test(6MWT)].Only randomized controlled trials(RCTs)were included.Data extraction and quality assessment were conducted independently by two reviewers using the Cochrane Collaboration's risk of bias tool.Statistical analyses,including those using the fixed-effect and random-effects models,sensitivity analysis,and publication bias assessment,were performed using Review Manager software.RESULTS A total of 15 RCTs were included.Results indicated significant improvements in MIP(12.51 cmH2O increase),MEP(6.24 cmH2O increase),and various pulmonary function parameters(including FEV1,FVC,MVV,and PEF).A substantial increase in 6MWT distance(22.26 meters)was also noted.However,the heterogeneity among studies was variable,and no significant publication bias was detected.CONCLUSION RMT significantly enhances walking ability,respiratory muscle strength(MIP and MEP),and key pulmonary function parameters(FEV1,FVC,MVV,and PEF)in post-stroke patients.These findings support the incorporation of RMT into post-stroke rehabilitative protocols.

Perioperative respiratory muscle training improves respiratory muscle strength and physical activity of patients receiving lung surgery:A meta-analysis

BACKGROUND The clinical role of perioperative respiratory muscle training(RMT),including inspiratory muscle training(IMT)and expiratory muscle training(EMT)in patients undergoing pulmonary surgery remains unclear up to now.AIM To evaluate whether perioperative RMT is effective in improving postoperative outcomes such as the respiratory muscle strength and physical activity level of patients receiving lung surgery.METHODS The PubMed,EMBASE(via OVID),Web of Science,Cochrane Library and Physiotherapy Evidence Database(PEDro)were systematically searched to obtain eligible randomized controlled trials(RCTs).Primary outcome was postoperative respiratory muscle strength expressed as the maximal inspiratory pressure(MIP)and maximal expiratory pressure(MEP).Secondary outcomes were physical activity,exercise capacity,including the 6-min walking distance and peak oxygen consumption during the cardio-pulmonary exercise test,pulmonary function and the quality of life.RESULTS Seven studies involving 240 participants were included in this systematic review and meta-analysis.Among them,four studies focused on IMT and the other three studies focused on RMT,one of which included IMT,EMT and also combined RMT(IMT-EMT-RMT).Three studies applied the intervention postoperative,one study preoperative and the other three studies included both pre-and postoperative training.For primary outcomes,the pooled results indicated that perioperative RMT improved the postoperative MIP(mean=8.13 cmH_(2)O,95%CI:1.31 to 14.95,P=0.02)and tended to increase MEP(mean=13.51 cmH_(2)O,95%CI:-4.47 to 31.48,P=0.14).For secondary outcomes,perioperative RMT enhanced postoperative physical activity significantly(P=0.006)and a trend of improved postoperative pulmonary function was observed.CONCLUSION Perioperative RMT enhanced postoperative respiratory muscle strength and physical activity level of patients receiving lung surgery.However,RCTs with large samples are needed to evaluate effects of perioperative RMT on postoperative outcomes in patients undergoing lung surgery.

Effects of Inspiratory Muscle Training on Heart Rate Variability in Children with Cystic Fibrosis:A Pilot Study

Purpose Cystic Fibrosis(CF)is a multisystem disease associated with symptoms such as dyspnoea,tachycardia and tachyp-nea that may be related to changes in autonomic function and sensitive to improvement following inspiratory muscle training(IMT).The aim of the present study was to investigate the effect of IMT on heart rate variability(HRV)and respiratory function in children.Methods Five CF and five matched controls(40%boys)performed a 4-weeks IMT programme,involving 30 breaths,twice a day.Weeks 1-2 of training were set at 40%of a participant's maximal strength index(S.Index),with week's 3-4 set at 50%.Participants wore an ActiHeart for three consecutive days at baseline and post-intervention and indices of HRV were derived.Standard measures of lung function were obtained along with health-related quality of life(HRQoL)using the CF-specific questionnaire(CFQ-R).Results IMT elicited clinically meaningful increases in respiratory muscle strength and respiratory symptom domain scores,but no improvements in respiratory volume,irrespective of group.Similarly,no significant improvements were found in HRQoL despite 62.5%of the population increased their HRQoL score.Post-intervention,CF participants showed a clinically meaningful decrease in the very low frequency(VLF)domain.Conclusion These results may indicate clinically meaningful changes in HRV and inspiratory muscle strength following a 4-week IMT intervention,although a more powerful study is required to draw further conclusions.Indeed,the trends for improved HRQoL support the need for such studies to ascertain the potential therapeutic role of IMT in those with CF.