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.

Relationship between Respiratory Muscle Strength and Static Balance in Older People Requiring Support and Care

Purpose: This study aimed to clarify the relationship between respiratory muscle strength and balance in older people requiring support or nursing care. Methods: Thirty-seven older subjects aged 65 years or older who were certified as requiring nursing care or support were included in the study. Maximal inspiratory pressure (PIMAX), maximal expiratory pressure (PEMAX), and one-leg standing time were measured. Additionally, the Functional Reach Test (FRT) was performed. Pearson correlation coefficient and multiple regression analyses were performed. Results: One-leg standing time was positively correlated with PEMAX, and was particularly correlated with PIMAX, while FRT score was not correlated with respiratory muscle strength. Multiple regression analysis with one-leg standing time as the dependent variable and PIMAX and PEMAX as independent variables showed that only PIMAX was significantly correlated with one-leg standing time. Conclusion: Focusing on expiratory and inspiratory muscle strength is important for improving one-leg standing ability and thus preventing falls in older people.

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 Water Immersion in Different Water Depths on Respiratory Function and Respiratory Muscle Strength among Elderly People: An Observational Study

The aim was to investigate the effect of three water levels (umbilical, 4th rib, and clavicular) on the respiratory function and respiratory muscle strength among elderly. Spirometry and respiratory strength were measured on land as baseline data. Next, water depth conditions were determined randomly, and spirometry and respiratory muscle strength were measured at each water level. The Vital Capacity and Expiratory reserve volume in the clavicular level were significantly lower than those in the land and umbilical trials. No significant difference was observed in other respiratory functions. Chest circumference and respiratory muscle strength were not significantly different among all conditions.

Respiratory Muscle Strength Evaluation in Healthy Adult and Elderly Women—Respiratory Muscle Strength Assessment in Adult and Elderly

Measurement of respiratory muscle strength is performed through static measurements of maximal respiratory pressures and is an important tool for determining the existence and prognosis of neuromuscular and pulmonary disorders, such as weakness or fatigue of this musculature. Objectives: To evaluate and compare respiratory muscle strength among healthy adult and elderly women. Methods: A total of 163 healthy women were recruited through convenience sampling at the family centers of the city of Manaus (AM, Brazil), divided into two groups: adult women (age 20 - 59 years) and elderly women (over 60 years of age). The evaluation was performed by Manovacuometry, in order to measure the maximum inspiratory pressure (MIP) and maximum expiratory pressure (MEP). For statistical analysis we used the Student’s T test, considering significant p value ≤ 0.05. Results: The final sample consisted of 116 adult women and 47 elderly women. The mean age in the group of women between 20 - 59 years was 44.5 ± 12 and the elderly group was 65 ± 6.6. MIP values in adult women were significantly higher when compared to the elderly (−108 ± 5.3 cmH2O × −79.5 ± 4 cmH2O, p = 0.0014, respectively). The same behavior was observed in the evaluation of MEP (87.1 ± 2.9 cmH2O in adults and 69.8 ± 3.5 cmH2O in the elderly;p = 0.0008). Conclusion: The results indicate that inspiratory and expiratory muscle strength is lower in older women, suggesting that the aging process tends to interfere with those muscles, resulting in altered respiratory system function.

Prolonged Intermittent Running Induces Inspiratory-Muscle Fatigue in Female Runners

Inspiratory-muscle fatigue （IMF） may occur after long-duration or continuous short-duration exercise and may limit exercise performance. Daily athletics training is often intermittent, but it is unclear if intermittent running induces IMF. We investigated IMF after a maximal anaerobic running test （MART） and maximal intermittent graded exercise test. Nine female middle-distance （400 or 800 m） runners performed MART and maximal intermittent graded exercise tests. Maximal inspiratory pressure （MIP） was measured before and after each test using a portable autospirometer. There was no significant difference in mean MIPs before （105 ± 24 cm H2O） and after （104 ± 28 cm H2O） the MART （P = 0.95, effect size [ES] as partial η2 = 0.01）. Mean M IP after the maximal intermittent graded exercise test （97 ± 26 cm H2O） was lower than before exercise （105 ± 27 cm H2O） （P = 0.01, 1]2 = 0.83） Mean IMF was higher for the maximal intermittent graded exercise test （8.5 ± 4.2 cm H2O） than for the MART （0.8 ± 4.1 cm H2O） （P = 0.01, ES as Cohen＇s d = 1.88）. IMF occurs after relatively long-duration intermittent running exercise. Coaches may consider recommending inspiratory-muscle training or warm-up to reduce IMF resulting from relatively long-duration intermittent running exercise.

Evaluation of Pulmonary Function in Adults with Grade Ⅲ Obesity

Pulmonary function studies in obese individuals have alerted the pathophysiological changes due to weight gain. However, these changes are not fully explained yet. Objective: To evaluate and analyze the pulmonary function of obese adults in the city of Manaus (AM, Brazil) and to correlate the parameters of spirometry with weight and BMI. Method: A descriptive cross-sectional study, in which pulmonary function of 22 adults with grade III obesity was evaluated pre and post bronchodilator administration, performed at the Adriano Jorge Hospital Foundation—FHAJ. Results: Of the 22 patients evaluated, 6 were male and 16 were female;mean age was 37.1 ± 7.4 years, with a weight of 134.2 ± 28.6 kg and a BMI of 51.1 ± 9.4 kg/m2, corresponding to grade III obesity. Spirometry showed a reduction in values obtained from Forced Vital Capacity (FVC), Forced Expiratory Volume in the first second (FEV1) and Peak Expiratory Flow (PEF) in relation to those predicted, with 23% of restrictive disorders. There were negative correlations between BMI and PEF, weight and FVC, weight and PEF. The P value for correlation of weight and FEV1 is not statistically significant. Conclusion: Restrictive and obstructive disorders are prevalent in the population with grade III obesity. Correlations between pulmonary function and BMI/weight were negative for this specific population.

Comparison of Effects of Liuzijue Exercise and Conventional Respiratory Training on Patients after Cardiac Surgery:A Randomized Controlled Trial

Objective To evaluate the feasibility and safety of Liuzijue exercise(LE)for the clinical effect in patients after cardiac surgery.Methods Totally 120 patients who underwent cardiac surgery and were admitted to the Cardiothoracic Intensive Care Unit of Nanjing Drum Tower Hospital between July and Oclober,2022 were allocated to the LE group,the conventional respiratory training(CRT)group,and the control group by a random number table at a ratio of 1:1:1;40 patients in each group.All patients received routine treatment and cardiac rehabilitation.LE group and CRT group respectively performed LE and CRT once a day for 30 min for 7 days.Control group did not receive specialized respiratory training.The forced vital capacity,forced expiratory volume in 1 s,peak inspiratory flow rate,peak expiratory flow rate,maximum inspiratory pressure,maximum expiratory pressure,modified Barthel index(MBI),and Hamilton Rating Scale for Anxiety(HAM-A)were evaluated before,after 3 and 7 days of intervention.In addition,the postoperative length of hospital stay(LOS)and the adverse events that occurred during the intervention period were compared.Results A total of 107 patients completed the study,120 patients were included in the analysis.After 3 days of intervention,the pulmonary function,respiratory muscle strength,MBI and HAM-A of all 3 groups improved compared with that before the intervention(P<0.05 or P<0.01).Compared with the control group,pulmonary function and respiratory muscle strength were significantly improved in the CRT and LE groups(P<0.05 or P<0.01).MBI and HAM-A were significantly improved in the LE group compared with the control and CRT groups(P<0.05 or P<0.01).On the 7th day after intervention,the difference was still statistically significant(P<0.01),and was significantly different from that on the 3rd day(P<0.05 or P<0.01).In addition,on the 7th day of intervention,the pulmonary function and respiratory muscle strength in the LE group were significantly improved compared with those in the CRT group(P<0.01).MBI and HAM-A were significantly improved in the CRT group compared with the control group(P<0.01).There were no significant differences in postoperative LOS among the 3 groups(P>0.05).No training-related adverse events occurred during the intervention period.Conclusions LE is safe and feasible for improving pulmonary function,respiratory muscle strength,the ability to complete activities of daily living and for relieving anxiety of patients after cardiac surgery(Registration No.ChiCTR2200062964).

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.

Early use of non-invasive positive pressure ventilation for acute exacerbations of chronic obstructive pulmonary disease:a multicentre randomized controlled trial

Background Respiratory muscle fatigue plays an important role in acute exacerbations of chronic obstructivepulmonary disease (AECOPD)·In previous clinical studies, non-invasive positive pressure ventilation (NPPV)was proved to be successful only for AECOPD patients with severe respiratory failure·We hypothesized that, theoutcomes of AECOPD would be improved if NPPVis early (within 24 to 48 hours of admission) administered inthose patients with respiratory muscle fatigue and mild respiratory insufficiency, especially in patients withoutfulfilling the conventional criteria of mechanical ventilatory support·Methods Aprospective multicentre randomized controlled trial was conducted in19 hospitals in China over16months·Three hundred and forty-two AECOPD patients with pH≥7·25 and PaCO2>45 mmHg were recruitedon general ward and randomly assigned to standard medical treatment (control group) or early administration ofadditional NPPV (NPPV group)·Results The characteristics of two groups on admission were similar·The number of AECOPD patientsrequiring intubations in NPPV group was much fewer than that of the control group (8/171 vs 26/71,P=0·002)·Subgroup analysis showed the needs for intubation in mildly (pH≥7·35) and severe (pH<7·30)acidotic patients in NPPVgroup were both decreased (9/80 vs2/71,P=0·047 and 8/30 vs3/43,P=0·048,respectively)·The mortality in hospital was reduced slightly by NPPV but with no significant difference (7/171vs 12/171,P=0·345)·Respiratory rate (RR),scale for accessory muscle use and arterial pHimproved rapidlyat the first 2 hours only in patients of NPPV group·After 24 hours, the differences of pH, PaO2, scale foraccessory muscle use and RR in NPPV group [(7·36±0·06) mmHg, (72±22) mmHg, (2·5±0·9) /min,(22±4) /min] were statistically significant compared with control group (7·37±0·05) mmHg, (85±34)mmHg, (2·3±1·1) /min, (21±4) /min,P<0·01 for all comparisons]·Conclusions The early use of NPPV on general ward improves arterial blood gas and respiratory pattern,decreases the rate of need for intubation in AECOPD patients·NPPV is indicative for alleviating respiratorymuscle fatigue and preventing respiratory failure from exacerbation·