Abstract
BackgroundChronic obstructive pulmonary disease (COPD) leads to peripheral and respiratory muscle dysfunctions. Nowadays, inspiratory muscle training can be geared toward strength or endurance gains. This study aims to investigate the effects of an inspiratory muscle training (IMT) protocol using different therapeutic modalities to be implemented in pulmonary rehabilitation programs. The effects of IMT on exercise capacity were considered as the primary endpoint, and the effects of IMT on inspiratory muscle function, health-related quality of life, and daily physical activity level were considered as the secondary outcomes.MethodsThis study is a blinded-investigator randomized controlled clinical trial. Sixty subjects will be randomly allocated into three groups: (1) pulmonary rehabilitation (PR) associated with inspiratory muscle training without any load (PRWIMT), (2) PR associated with inspiratory muscle training with a linear load (PRIMTLL), and (3) PR associated with inspiratory muscle training with isocapnic voluntary hyperpnea (PRIMTIVH). The protocol will be performed 5 days a week (3 days with supervision) for 10 weeks. The study will assess anthropometric data, lung function, respiratory muscle strength, and functional capacity by the Incremental Shuttle Walking Test and the Six-Minute Walk Test, lung volumes during the submaximal endurance test, peripheral muscle strength of the upper and lower limbs, dyspnea, and quality of life related to health, before and after the training protocol. Normality will be tested using the Kolmogorov-Smirnov test, and variables will be compared by two-way analysis of variance. The significance level was set at p < 0.05. Ethics approval was obtained from the Institutional Ethics Committee in Research (1.663.411). The study results will be disseminated through presentation at specific scientific conferences and publication in peer-reviewed journals.DiscussionThe different IMT protocols used in our study will be able to guide respiratory therapists to understand and to include in conventional PR programs the most effective respiratory muscle training type in subjects with COPD.Trial registrationBrazilian Clinical Trials Registry, RBR-94v6kd. Registered on 11 March 2017.
Highlights
Chronic obstructive pulmonary disease (COPD) leads to peripheral and respiratory muscle dysfunctions
The different inspiratory muscle training (IMT) protocols used in our study will be able to guide respiratory therapists to understand and to include in conventional pulmonary rehabilitation (PR) programs the most effective respiratory muscle training type in subjects with COPD
Subjects presenting musculoskeletal comorbidities that impair the subject’s gait, peripheral oxygen saturation (SpO2) < 90% during the Six-Minute Walk Test (6MWT), hypertensive subjects without control medication as well as those presenting with a hypertensive peak (> 140/90 Millimeters of mercury (mmHg)) [12] for more than 3 consecutive days, those with an intellectual understanding impairment that interferes with the evaluation tests, or those who stop the therapeutic program, miss activity for more than 1 week, or miss reevaluation will be excluded from the study
Summary
Chronic obstructive pulmonary disease (COPD) leads to peripheral and respiratory muscle dysfunctions. This study aims to investigate the effects of an inspiratory muscle training (IMT) protocol using different therapeutic modalities to be implemented in pulmonary rehabilitation programs. PR is defined as an embracing intervention based on the complete evaluation of the patient followed by specific therapies that include but are not limited to training, education, and behavior changes, aiming to improve the physical performance and psychological status of individuals with chronic respiratory disease and to promote long-term adherence and behavior changes [3]. IMT may generate strength increase in patients with COPD; studies have shown that the training may overload these muscles when not well performed [4]. Studies have shown that IMT does not determine exercise performance improvement in COPD, or that there is a weak correlation between respiratory muscle changes due to IMT and exercise performance [5]
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