Abstract
Background: Prior systematic reviews and meta-analysis addressed that inspiratory muscle training (IMT) improved inspiratory muscle weakness, cardiorespiratory fitness and quality of life similar to conventional exercise training as a first alternative in deconditioned patients with heart failure (HF) lead to a better adaptation to posterior exercise training. The heterogeneity and variability in a wide range of new studies about this topic led to the necessity of an updated and comprehensive narrative review. The present review aimed to analyze and update the most relevant studies about IMT in patients who suffer from HF. Methods: A narrative review was carried out about IMT in HF patients including 26 experimental studies divided into 21 clinical trials and 5 quasi-experimental studies identified through database searching in PubMed, Cochrane and PEDro. Results: There is enough evidence to state that IMT produces improvements in functional capacity of patients with HF. Nevertheless, there is not enough evidence to support that IMT could improve cardiovascular parameters, blood biomarkers or quality of life in these patients. Conclusions: Thus, IMT may be recommended to improve functional capacity in patients who suffer from HF; nevertheless, more evidence is needed regarding cardiovascular parameters, biomarkers and quality of life. Furthermore, mortality or HF hospitalization was not evaluated and most studies were not longer than 3 months. According to IMT protocols and study designs heterogeneity and mid-term follow-up, further investigations through high-quality long-term randomized clinical trials should be performed to achieve systematic reviews and meta-analysis to support strong evidence for IMT in HF patients.
Highlights
Worldwide, heart failure (HF) syndrome affects up to 23 million persons [1]
This narrative review was performed in order to update the available data from prior systematic reviews about inspiratory muscle training (IMT) in patients who suffer from HF [33,44] but including different studies types, such as clinical trials, quasi-experimental studies and case-series, published up to January 2020
From 218 records identified through the searching process, 192 records were removed due to duplicates and exclusions (Supplemental Table S1), and 26 studies were included in narrative sJ.yCnlitnh. eMseids. (2F02ig0,u9r,ex 1FO).R PEER REVIEW
Summary
Heart failure (HF) syndrome affects up to 23 million persons [1]. HF epidemic produces a key impact on quality of life, functional capacity and aging, as well as a high economic burden in the health system. HF may be considered as a multifactorial systemic disease involving structural, neuro-humoral, cellular and molecular mechanisms, which may be activated as a network in order to maintain physiological functioning These complex and coordinated processes lead to an overload of the ventricles, an increased sympathetic-adrenal activity and a redistribution of the circulation, resulting in a complex clinical syndrome [2]. Conclusions: IMT may be recommended to improve functional capacity in patients who suffer from HF; more evidence is needed regarding cardiovascular parameters, biomarkers and quality of life. According to IMT protocols and study designs heterogeneity and mid-term follow-up, further investigations through high-quality long-term randomized clinical trials should be performed to achieve systematic reviews and meta-analysis to support strong evidence for IMT in HF patients
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