Effects of specific inspiratory muscle training combined with whole-body endurance training program on balance in COPD patients: Randomized controlled trial.

Bilel Tounsi,Zouhair Tabka,Said Ahmaidi,Thierry Lelard,Amal Acheche,Yassine Trabelsi,Walid Kamal Abdelbasset

doi:10.1371/journal.pone.0257595

Abstract

PurposeThis study aims to assess the effect of inspiratory muscle training (IMT) combined with endurance training (ET) on balance in patients with chronic obstructive pulmonary disease (COPD).MethodsWe studied 32 male patients (62 ± 6 years) with moderate to very severe COPD. They were randomly assigned to an experimental group (IMT+ET) n = 16 or a control group (ET) n = 16 with similar characteristics. The evaluations were carried out at inclusion and after eight weeks of the training period. Functional balance was assessed by the Berg Balance Scale (BBS), the Timed-up and Go (TUG), the Single Leg Stance test (SLS), and the Activities-specific Balance Confidence (ABC) scale. The strength of the inspiratory muscles (PImax) was assessed by maximal inspiratory mouth pressure. Functional exercise performance was assessed by the 6 minutes walking test (6MWT). IMT program consists in performing two daily sets of 30 inspirations with 50% of PImax increased by 10% every two weeks. ET program consists in performing 30 min treadmill exercise at 60% to 80% of the average speed achieved during the 6MWT three days per week.ResultsAfter the training period, the experimental group demonstrated greater improvements in BBS (IMT+ET vs. ET; p = 0.019), and in ABC (IMT+ET vs. ET; p = 0.014). However, no significant differences between groups were observed for TUG, SLS, and 6MWT. There was a significant difference between groups in PImax (IMT+ET vs. ET; p = 0.030). Significant moderate correlations were obtained between ΔPImax and ΔBBS for both groups (IMT+ET: r = 0.624, p = 0.010; ET r = 0.550, p = 0.027) as well as for ΔABC but only in the experimental group (IMT+ET: r = 0.550, p = 0.027).ConclusionCompared to ET alone, the results suggest that IMT combined with ET enhances inspiratory muscle function and functional balance according to BBS and ABC in patients with COPD. We suggest that inspiratory muscle training might be introduced as additional training to pulmonary rehabilitation programs aimed at improving balance in COPD patients.Trial registrationThe trial registry name: Clinical Trials; Registration number: NCT04084405; URL: https://clinicaltrials.gov/ct2/show/NCT04084405.

Highlights

Chronic obstructive pulmonary disease (COPD) is characterized by persistent airflow limitation and respiratory symptoms, which are due to airflow or alveolar abnormalities [1]
Compared to endurance training (ET) alone, the results suggest that inspiratory muscle training (IMT) combined with ET enhances inspiratory muscle function and functional balance according to Berg Balance Scale (BBS) and Activitiesspecific Balance Confidence (ABC) in patients with COPD
Our findings, which demonstrate significant improvement in the functional balance according to BBS and ABC in the favor of the experimental group (IMT+ET), could be explained by potential physiological mechanism(s), as it was described by Ferraro et al [27], by which IMT added to ET improves balance

Summary

Introduction

Chronic obstructive pulmonary disease (COPD) is characterized by persistent airflow limitation and respiratory symptoms, which are due to airflow or alveolar abnormalities [1]. COPD comorbidities, especially peripheral muscle atrophy [4] and peripheral muscle weakness comparing with healthy peers [5], had a significant impact on falls in patients with COPD by increasing both the number of falls and the fear of falling [6]. These consequences lead to reduced activity, agility, strength, balance, and often bring about a loss of functional independence during normal daily activities [7]. It was demonstrated that trunk instability might negatively influence postural control in COPD patients [15]

Objectives

Methods

Results

Discussion

Conclusion