Impact of pulmonary rehabilitation on aerobic capacity and exploratory muscle strength outcomes in idiopathic pulmonary fibrosis: a systematic review and meta-analysis

This cross-sectional, observational study was planned to compare pulmonary function, respiratory and peripheral muscle strength, and functional capacity in different functional classes of heart failure patients. Thirty-four heart failure patients, in New York Heart Association (NYHA) Class II and III (68.59±9.84 years, left ventricular ejection fraction (LVEF) =34.24±7.59%) were included. Class II and III patients' pulmonary function was assessed using spirometry, respiratory muscle strength using a mouth pressure device, functional capacity using six minute walk test (6MWT), quadriceps femoris and biceps brachii muscle strength were evaluated using a hand-held dynamometer, and variables were compared. Student t, Chi-square, Mann-Whitney U tests, and Spearman correlation coefficients were used for statistical analysis. There were no statistically significant differences in pulmonary function and respiratory muscle strength between the two groups (p>0.05). The 6MWT distance (328.35±101.56 m; vs. 480.05±104.19 m) quadriceps femoris (218.83±63.62 N; vs. 290.69±115.53 N) and biceps brachii (164.22±44.78 N; vs. 219.19±49.37 N) muscle strength of Class III patients were significantly lower than of Class II patients (p<0.05 for all). The NYHA classification system was significantly correlated with measured and predicted 6MWT distance (r=-0.59, r=-0.65, respectively), biceps brachii muscle strength (r=-0.46, r=-0.40, respectively), and % quadriceps femoris muscle strength (r=-0.43) (p<0.05). Functional capacity and peripheral muscle strength decrease as the illness progresses in heart failure. Pulmonary function and respiratory muscle strength are preserved. The NYHA classification system is a reliable method in the detection of changes in functional capacity and peripheral muscle strength. Changes in functional capacity and peripheral muscle strength are consistent with the NYHA classification system.

Effects of Interleukin-1 Blockade With Anakinra on Aerobic Exercise Capacity in Patients With Heart Failure and Preserved Ejection Fraction (from the D-HART Pilot Study)

Resistance training and exercise tolerance during high-intensity exercise: moving beyond just running economy and muscle strength.

A comparison of the effects of inspiratory muscle strength and endurance training on exercise capacity, respiratory muscle strength and endurance, and quality of life in pacemaker patients with heart failure: A randomized study

Reduced maximal, peripheral muscle strength is associated with exercise intolerance in patients with chronic obstructive pulmonary disease (COPD). Therefore, it is important to accurately evaluate muscle strength to identify patients with muscle weakness and to prescribe adequate loads for resistance training. The objective here was to systematically identify and summarize the literature on measurement of peripheral muscle strength in individuals with COPD and to make recommendations for strength testing in clinical and research settings. A literature search was conducted of electronic databases between 1999 and 2009 of all English language articles utilizing muscle strength measurements. The search resulted in retrieval of 178 articles, of which 66 were reviewed. Isometric muscle strength was measured using handgrip (n = 30), strain gauge (n = 15), computerized dynamometer (n = 13), magnetic stimulation (n = 8), handheld dynamometer (n = 6), or manual testing (n = 3). Isotonic muscle strength was measured using a hydraulic system (n = 3) or 1-repetition maximum (n = 9), and isokinetic muscle strength was measured using computerized dynamometer (n = 16). Methodological issues such as limb position, number of trials, subject familiarization, test instructions, rest periods, and muscle group tested were all identified as important variables to consider when developing a strength-testing protocol. Muscle strength has been measured in people with COPD using similar methods as in other clinical populations. Each method presents advantages and disadvantages that need to be considered when selecting the most relevant measure. Standardization of the test procedures is essential in both clinical and research settings to obtain valid and reliable measurements of muscle strength.

Background/Introduction Frailty is associated with a higher incidence of cardiovascular disease and risks of all-cause mortality, leading to a reduction in life expectancy. Cardiorespiratory fitness and peripheral muscle strength are shown to be the strongest predictors of the level of frailty and the potential for frailty to decrease over time. Purpose The aim of this study was to compare peripheral muscle strength, functional capacity and activities of daily living in frail and non-frail adult individuals with congenital heart disease (ACHD). Methods A cross-sectional study design was used. A total of 36 individuals with ACHD, 14 frail (24.50±10.14 years) and 22 non-frail (24.68±6.24 years) were included in the study. Frailty; according to the Fried criteria, which consist of parameters as muscle strength weakness, involuntary weight loss, decreased physical activity, decreased mobility, and fatigue. Peripheral muscle strength was assessed using a digital dynamometer, functional capacity using the Six Minute Walk Test (6MWT) and activities of daily living using the Glittre Activities of Daily Living Test. Results Knee extensor muscle strength (p=0.011), shoulder abduction muscle strength (p=0.012) and 6MWT distance (p=0.007) in frail individuals with ACHD was lower than non-frail individuals. Glittre Activities of Daily Living Test duration was higher in frail individuals with ACHD than in non-frail individuals (p=0.023). Conclusion(s) Upper and lower peripheral muscle strength, functional capacity and activities of daily living were impaired in individuals with frail ACHD. Early assessment of frailty in individuals with ACHD and implementation of individualized exercise training programs in frail individuals may be useful in reducing the impact associated with frailty.

Background: Many pulmonary and extrapulmonary factors may impair balance in patients with chronic obstructive pulmonary disease (COPD), but the determinants of this impairment are still debated. The primary aim was to compare both balance-related and independent variables that may affect balance with healthy subjects. The secondary aim was to investigate the potential determinants of balance in patients with COPD. Methods: This comparative study recruited 23 patients with COPD and 23 age- and comorbidity-matched healthy subjects. Participants were assessed regarding demographic and clinical data, "Postural Stability Test" (PST), "Limits of Stability Test" (LOST), "Clinical Test of Sensory Integration of Balance" (CTSIB), pulmonary function, respiratory and peripheral muscle strength, functional capacity, and cognitive function. Results: There were significant differences in all outcome measures assessing balance, pulmonary function, respiratory muscle strength, peripheral muscle strength, and functional capacity, but not cognitive function, in the COPD group compared to the healthy group (p < 0.05). The PST had a significant and strong correlation with maximal inspiratory pressure (MIP) (r = -0.630, p = 0.001) and a significant and moderate correlation with m. quadriceps strength and 6 min walk test (6MWT) distance (r = -0.472, p = 0.023; r = -0.496, p = 0.016; respectively). MIP, m. quadriceps strength, and 6MWT distance were independent predictors to explain the PST with an R2 = 0.336 (p = 0.004). Conclusions: The present study revealed that balance is impaired in adults with COPD, even if compared with age- and comorbidity-matched healthy subjects. Assessing and improving balance and its determinants, inspiratory and peripheral muscle strength, and functional capacity may be important for fall prevention and disease management in patients with COPD.

BackgroundPathological changes were observed in the diaphragm due to abnormal renal function in chronic kidney disease (CKD). Inspiratory muscle training (IMT) has been suggested for patients with CKD; however, the most appropriate intensity for IMT has not been determined. Therefore, this study aimed to investigate the effects of different IMT protocols on respiratory muscle strength, quadriceps femoris muscle strength (QMS), handgrip muscle strength (HGS), functional exercise capacity, quality of life (QoL), pulmonary function, dyspnoea, fatigue, balance, and physical activity (PA) levels in patients with CKD.MethodsThis randomized, controlled, single-blind study included 47 patients and they were divided into three groups: Group 1 (n = 15, IMT with 10% maximal inspiratory pressure (MIP)), Group 2 (n = 16, IMT with 30% MIP), and Group 3(n = 16; IMT with 60% MIP). MIP, maximal expiratory pressure (MEP), 6-min walking test (6-MWT), QMS, HGS, QoL, pulmonary function, dyspnoea, fatigue, balance, and PA levels were assessed before and after eight weeks of IMT.ResultsIncreases in MIP, %MIP, 6-MWT distance, and %6-MWT were significantly higher in Groups 2 and 3 than in Group 1 after IMT (p < 0.05). MEP, %MEP, FEF25-75%, QMS, HGS, and QoL significantly increased; dyspnoea and fatigue decreased in all groups (p < 0.05). FVC, PEF, and PA improved only in Group 2, and balance improved in Groups 1 and 2 (p < 0.05).ConclusionsIMT with 30% and 60% MIP similarly improves inspiratory muscle strength and functional exercise capacity. IMT with 30% is more effective in increasing PA. IMT is a beneficial method to enhance peripheral and expiratory muscle strength, respiratory function, QoL and balance, and reduce dyspnoea and fatigue. IMT with %30 could be an option for patients with CKD who do not tolerate higher intensities.Trial registrationThis study was retrospectively registered (NCT06401135, 06/05/2024).

Background Systemic Sclerosis (SSc) is a rare, systemic connective tissue disease characterized by widespread microvascular damage and by increased production and deposition of extracellular matrix components both in the skin and internal organs (1). Objectives The aim of this study was to investigate the functional capacity and affecting factors in SSc patients. Methods Twenty-two SSc patients were included in the study. Functional capacities of patients were measured by 6 Minute Walking Test (6MWT). Lung volumes (FVC, FEV1, FEV1/FVC, PEF, VC) were performed with Pulmonary function tests-PFT. Respiratory muscle strength was evaluated with a muscle inspiratory pressure(MIP)-muscle expiratory pressure(MEP) modulated spirometer known as respiratory muscle strength meter. Peripheral muscle strengths (deltoid, biceps, quadriceps and iliopsoas muscles) were also evaluated with manual muscle strength meter. Results The mean age of the patients was 52.00±11.23 years and duration of diagnosis was 7.63±4.86 years. The patients’ mean 6DWT distance was 430.40±50.25 meters, FEV1% were 78.52±22. 23 L, FVC% were 80.95±23.02 L, FEV1/FVC% were 102.56±9.58 L, VC% values were 72.95±22.75 L, MIP% were 54.27±34.85 L, and MEP% values were 56.59±3.56. The mean deltoid muscle strength of the patients was 5.88±1.26 kg, biceps were 6.48±1.68 kg, quadriceps were 6.06±1.55 kg, iliopsoas were 5.93±1.74 kg. It was found that there was a significant correlation between 6MWT distance and VC (p =0.009, r = 0.529), FEV1 (p =0.001, r = 0.659), FVC (p =0.005, r = 0.568), MIP (p =0.014, r = 0.506) and MEP (p =0.036, r = 0.449). There was significant correlation between the 6MWT distance and Deltoideus (p =0.024, r = 0.470), Biceps (p =0.001, r = 0.646), Quadriceps (p Conclusion The decrease in the functional capacity of the patients is accompanied by a decrease in pulmonary function, loss of respiratory and peripheral muscle strength in parallel. 6-min walk test showed negative effects in the pulmonary and musculoskeletal system or in the patients’ clinic on SSc patients. To evaluate and improve functional capacity while performing medical and rehabilitation follow-up, respiratory functions, respiratory and peripheral muscle strengths should be evaluated and improved. Reference [1] Hinchcliff, M., & Varga, J. (2008). Systemic sclerosis/scleroderma: A treatable multisystem disease. American Family Physician, 78(8), 961–968. Disclosure of Interests None declared

Individuals with Down syndrome (DS) have low levels of muscle strength and aerobic capacity. It has been suggested that the low level of muscle strength impacts the low aerobic capacity in persons with DS, but the relationship between muscle strength and aerobic capacity remains unclear. PURPOSE: To investigate the relationship between muscle strength and aerobic capacity in adults with DS. METHODS: Thirty-six adults (age = 27.6 + 8.1 yrs; weight = 76.1 + 15.1 kg) with DS were recruited. None of the subjects were institutionalized and all were free of cardiovascular disease or muscle problems. Subjects completed a treadmill test to exhaustion with oxygen uptake measurements using validated individualized protocols, and several test of leg muscle strength. Maximal leg extension and flexion strength were evaluated with isokinetic tests at 60 degrees/second, and isometric tests at 45, 60 and 75 degrees of extension. The relationship between aerobic capacity and muscle strength was evaluated using Pearson correlations and a stepwise multiple regression. RESULTS: Aerobic capacity was significantly (p< 01) related to isokinetic extension and flexion peak torque (r=.47 and r=.42 respectively), and to isometric peak torque for both extension and flexion at each of the positions evaluated (correlation coefficients between 0.46-0.57). The stepwise multiple regression revealed that only the peak torque during the isometric leg extension at 75 degrees and the peak torque during the isokinetic leg extension were included in the model as significant predictors of aerobic capacity, yielding the following prediction equation explaining 42% of the variance: VO2 (ml/min) = 2.982 (isometric peak torque) + 3.043 (isokinetic peak torque) + 1024 (R=0.645; p< .001). CONCLUSION: Leg muscle strength was significantly related to aerobic capacity in individuals with DS, and the relationship was higher than what has been reported for other non-disabled populations. However, only two leg extension variables were included in the final model, suggesting the leg flexion strength does not influence aerobic capacity in this population. If aerobic capacity and leg strength are causally related in this population, our data suggest that resistance training may improve aerobic capacity in individuals with DS.

BackgroundTo date, published systematic reviews concerning the effects of Kinesio Taping (KT) on muscle strength have not analysed facilitatory and inhibitory applications separately. As a result, their results could be substantially affected by clinical heterogeneity. This meta-analysis was conducted to determine the effectiveness of using a facilitatory application of KT for lower limb muscle strength and functional performance (distance in a single-leg hop and vertical jump height) in individuals without disabilities and in those with musculoskeletal conditions (muscle fatigue, chronic musculoskeletal diseases, and post-operative orthopaedic conditions).MethodsSearches were conducted on six major electronic databases. Randomised controlled trials that used facilitatory KT were included. Standardised mean differences (SMDs) were calculated and random-effects models were used for analysis.ResultsThirty-seven randomised controlled trials were included. KT was superior to controls for improving lower limb muscle strength in individuals with muscle fatigue (short-term effect, pooled SMD = 0.53, 95% CI = 0.09 to 0.96; long-term effect, pooled SMD = 0.61, 95% CI = 0.12 to 1.11) and in individuals with chronic musculoskeletal diseases (pooled SMD = 1.24, 95% CI = 0.33 to 2.16) with large effect sizes. The use of KT in populations without disabilities was not supported. There is insufficient evidence for the effect of KT on functional performance in individuals with musculoskeletal conditions.ConclusionsContrary to prior research, the existing evidence shows that KT can improve lower limb muscle strength in individuals with muscle fatigue and chronic musculoskeletal diseases. The effect sizes produced in this meta-analysis show that KT may be superior to some existing treatments for these conditions. In addition, this study suggests that practitioners may wish to avoid the use of KT in individuals without disabilities.Trial registrationPROSPERO registration number CRD42017075490, registered on 21 November 2017.

Objectives: Down syndrome (DS) is associated with challenges like increased fat mass and reduced muscle tone. This study aims to analyze the impact of resistance training on improving muscle strength and physical function in individuals with DS. Methods: We conducted a comprehensive search of PubMed, Scopus, Google Scholar, Cochrane Library, and China National Knowledge Infrastructure for studies published up to August 2023. Standardized mean differences and 95% confidence intervals were used to evaluate the efficacy of resistance training. Results: Eight randomized controlled trials (RCTs), including 127 participants with DS, met the inclusion criteria. Resistance training significantly improved muscle strength in the knee extensors (SMD: 1.009, 95% CI: 0.505-1.513), knee flexors (SMD: 1.133, 95% CI: 0.106 to 2.16), and upper limbs (SMD: 0.748, 95% CI: 0.152-1.343). The SMD for upper limb function was 0.385 (95% CI: 0.004-0.765), showing a small improvement. For walking ability, the SMD was 0.259 (95% CI: -0.171-0.690), and for stair climbing ability, the SMD was 0.257 (95% CI: -0.189-0.703), both indicating no significant changes. Improvements in upper limb physical function were significant, but no notable improvements were seen in lower limb functions. Conclusions: Resistance training for more than four weeks enhances muscle strength in individuals with DS, with greater gains seen in younger participants. While improvements were noted in upper limb physical function, lower limb function remained largely unchanged. These findings suggest that resistance training is a valuable exercise for improving muscle strength and physical function in individuals with DS.

Purpose: To compare the effects of three modalities of resistance training, two using elastic components and one using conventional weight machine on peripheral muscle strength in Individuals with chronic obstructive pulmonary disease (COPD). Effects on exercise capacity, impact of disease on health status, body composition and daily level of physical activity were investigated as secondary endpoints. Methods: Forty-eight participants were randomly allocated (Trials Registry #RBR-6V9SJJ) into Elastic band group (Theraband®) (EBG), Elastic tubes training using Lemgruber® (ETG), and Conventional training with weight machine equipment (CG). Participants were evaluated before and after 12 weeks of training regarding peripheral muscle strength by dynamometry; impact of disease on health status via COPD Assessment Test, CAT; exercise capacity by 6-min walk test, 6MWT; body composition by bioelectrical impedance; and daily level of physical activities via accelerometry. Results: Inter-group comparison of training effects did not elucidate significant differences between the modalities in muscle strength (p ≥ .2). Likewise, all training modalities showed similar effects on CAT, body composition and daily physical activity variables with no statistical significance observed (p ≥ .15). Conclusions: Modalities of resistance training using elastic components presented similar effects on muscle strength, health status, exercise capacity, body composition and daily level of physical activity in individuals with COPD. The effects of elastic resistance were similar to conventional resistance training.

A comparison of respiratory and peripheral muscle strength, functional exercise capacity, activities of daily living and physical fitness in patients with cystic fibrosis and healthy subjects

Aims: The aims of this study were to investigate the relationship between functional capacity and pulmonary function, respiratory and peripheral muscle strength, and find out the best predictor of functional capacity in patients with heart failure. Design: A prospective, cross sectional study. Subjects and Methods: Thirty-four clinically stable patients with heart failure (68.59 ± 9.85 years, left ventricular ejection fraction = 34.24% ± 7.59%, New York Heart Association class II/III) were included. Patients’ characteristics were recorded. Functional capacity was evaluated using 6-minute walk test (6MWT). Pulmonary function was measured using spirometry, respiratory muscle strength (maximum inspiratory pressure and maximum expiratory pressure) was measured using a mouth pressure device, and quadriceps femoris and biceps brachii muscle strengths were assessed using a hand-held dynamometer. Results: There were statistically significant positive correlations between 6MWT distance and pulmonary function, maximum inspiratory pressure, maximum expiratory pressure, quadriceps femoris and biceps brachii muscle strengths (P < .05). In the multiple regression analysis conducted in the 34 heart failure patients, 79% of the variance in the 6MWT distance was explained by qaudriceps femoris (R 2 = 0.70, P < .001) and the biceps brachii (R 2 = .09, P = .007) muscle strengths. When the 6MWT distance was expressed as the percentage of predicted values, 58% of the variance in the 6MWT distance was explained by qaudriceps femoris (R 2 = 0.40, P = .001) and the percent biceps brachii muscle strength (R 2 = 0.18, P = .007). Conclusions: Upper and lower extremity muscle strength is a factor significantly contributing to impaired functional capacity in patients with heart failure. These findings suggest that routine screening of upper and lower extremity muscle strengths is advisable in patients with heart failure. Key words: functional capacity, heart failure, muscle strength, pulmonary function