Changes In Respiratory Muscle Strength Research Articles

Incremental Load Respiratory Muscle Training Improves Respiratory Muscle Strength and Pulmonary Function in Children with Bronchiectasis.

Participants underwent respiratory muscle training for 24 weeks. The main results were changes in respiratory muscle strength and pulmonary function indices (forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC), FEV1/FVC, peak expiratory flow rate (PEF), forced expiratory flow 25-75% (FEF25-75%), and maximal midexpiratory flow 75/25 (MMEF75/25)) before, 12 weeks after, and 24 weeks after the intervention. The secondary outcomes were changes in the exercise load and work rate, exercise work, Leicester Cough Questionnaire (LCQ) scale, and Fatigue Severity Scale (FSS). Compared with before the intervention, after 24 weeks of respiratory muscle training, the maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP) were significantly enhanced (P < 0.05), while FVC, FEV1, and PEF were significantly increased (P < 0.01). FEF25-75 and MMEF75/25 values showed significant improvement compared to those before training (P < 0.05). The exercise loading, work, and exercise work rate of expiratory muscle training were significantly improved compared to those before intervention (P < 0.05). The LCQ score increased significantly (P < 0.001), and the FSS score decreased significantly (P < 0.001). Incremental load respiratory muscle training effectively improved children's lung function over the long term, improved the strength of their inspiratory and expiratory muscles, and improved their quality of life.

The Effects of Various Approaches to Lobectomies on Respiratory Muscle Strength, Diaphragm Thickness, and Exercise Capacity in Lung Cancer.

The most common surgery for non-small cell lung cancer is lobectomy, which can be performed through either thoracotomy or video-assisted thoracic surgery (VATS). Insufficient research has examined respiratory muscle function and exercise capacity in lobectomy performed using conventional thoracotomy (CT), muscle-sparing thoracotomy (MST), or VATS. This study aimed to assess and compare respiratory muscle strength, diaphragm thickness, and exercise capacity in lobectomy using CT, MST, and VATS. The primary outcomes were changes in respiratory muscle strength, diaphragm thickness, and exercise capacity. Maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP) were recorded for respiratory muscle strength. The 6-min walk test (6MWT) was used to assess functional exercise capacity. Diaphragm thickness was measured using B-mode ultrasound. The study included 42 individuals with lung cancer who underwent lobectomy via CT (n = 14), MST (n = 14), or VATS (n = 14). Assessments were performed on the day before surgery and on postoperative day 20 (range 17-25 days). The decrease in MIP (p < 0.001), MEP (p = 0.003), 6MWT (p < 0.001) values were lower in the VATS group than in the CT group. The decrease in 6MWT distance was lower in the MST group than in the CT group (p = 0.012). No significant differences were found among the groups in terms of diaphragmatic muscle thickness (p > 0.05). The VATS technique appears superior to the CT technique in terms of preserving respiratory muscle strength and functional exercise capacity. Thoracic surgeons should refer patients to physiotherapists before lobectomy, especially patients undergoing CT. If lobectomy with VATS will be technically difficult, MST may be an option preferable to CT because of its impact on exercise capacity.

Relationship between motor dysfunction, the respiratory muscles and pulmonary function in stroke patients with hemiplegia: a retrospective study

BackgroundThe interaction between motor dysfunction and respiratory functions in stroke patients with hemiplegia are not fully understood, particularly with regard to the relationship between changes in trunk control, balance, and daily activities, and changes in respiratory muscle strength and pulmonary volume. Investigating this relationship will facilitate the optimization of stroke rehabilitation strategies.MethodsClinical history data were collected from 134 patients to analyze the relationship between motor function scales scores and spirometric data. The data from 60 patients’ data were used to evaluate the relationship between motor function scales scores and spirometric data at baseline and after 3-weeks rehabilitation.Results(1) Patients with lower scores on Trunk impairment Scale (TIS), Berg Balance Scale (BBS) and Barthel Index (BI) had weaker respiratory muscle strength and pulmonary function. (2) Stroke patients’ BBS and BI scores showed differences between normal and unnormal maximal inspiratory pressure (MIP), but not in TIS. (3) Improvements in motor function led to promotion of enhanced respiratory function. Patient exhibited less MIP improvement at the severe level of TIS and BBS.ConclusionsPatients with hemiplegia exhibited diminished respiratory muscle strength and pulmonary function at a more severe motor dysfunction level. Impaired inspiratory muscle strength was associated with reduced balance ability and limitations in activities required for daily living. Enhanced motor function improved respiration and rehabilitation programs should prioritize the activation of diaphragm function to improve overall outcomes.

The effect of inspiratory muscle training and detraining on the respiratory metaboreflex.

What is the central question of this study? Is the attenuation of the respiratory muscle metaboreflex preserved after detraining? What is the main finding and its importance? Inspiratory muscle training increased respiratory muscle strength and attenuated the respiratory muscle metaboreflex as evident by lower heart rate and blood pressure. After 5weeks of no inspiratory muscle training (detraining), respiratory muscle strength was still elevated and the metaboreflex was still attenuated. The benefits of inspiratory muscle training persist after cessation of training, and attenuation of the respiratory metaboreflex follows changes in respiratory muscle strength. Respiratory muscle training (RMT) improves respiratory muscle (RM) strength and attenuates the RM metaboreflex. However, the time course of muscle function loss after the absence of training or 'detraining' is less known and some evidence suggest the respiratory muscles atrophy faster than other muscles. We sought to determine the RM metaboreflex in response to 5weeks of RMT and 5weeks of detraining. An experimental group (2F, 6M; 26±4years) completed 5weeks of RMT and tibialis anterior (TA) training (each 5days/week at 50% of maximal inspiratory pressure (MIP) and 50% maximal isometric force, respectively) followed by 5weeks of no training (detraining) while a control group (1F, 7M; 24±1years) underwent no intervention. Prior to training (PRE), post-training (POST) and post-detraining (DETR), all participants underwent a loaded breathing task (LBT) to failure (60% MIP) while heart rate and mean arterial blood pressure (MAP) were measured. Five weeks of training increased RM (18±9%, P<0.001) and TA (+34±19%, P<0.001) strength and both remained elevated after 5weeks of detraining (MIP-POST vs. MIP-DETR: 154±31 vs. 153±28cmH2O, respectively, P=0.853; TA-POST vs. TA-DETR: 86±19 vs. 85±16N, respectively, P=0.982). However, the rise in MAP during LBT was attenuated POST (-11±17%, P=0.003) and DETR (-9±9%, P=0.007) during the iso-time LBT. The control group had no change in MIP (P=0.33), TA strength (P=0.385), or iso-time MAP (P=0.867) during LBT across all time points. In conclusion, RM and TA have similar temporal strength gains and the attenuation of the respiratory muscle metaboreflex remains after 5weeks of detraining.

Short-Term Effects of Weight Loss after Bariatric Surgery on Respiratory and Skeletal Muscles’ Strength

Background: Bariatric surgery leads to weight loss and body fat percentage reduction, but patients are prone to lean tissue loss which itself reduces the quality of life, and increases the risk of deatand h. This study evaluated the effects of bariatric surgery and changes in Fat Mass (FM) and Fat-Free Mass (FFM) on the respiratory and skeletal muscles’ strength three months after bariatric surgery.&#x0D; Methods: After obtaining demographic information, anthropometric measurements and body composition analysis, including Body Mass Index (BMI), FM, FFM, Percent Body Fat (PBF), handgrip isometric force, respiratory muscle forces and spirometry volumes, were assessed before and three months after bariatric surgery in 50 men and women undergoing this surgery.&#x0D; Results: Weight, BMI, FM, PBF and FFM isometric muscle force were decreased significantly. In contrast, respiratory muscle forces and respiratory volumes were increased significantly three months after the surgery. Reduction in FFM 3 months after the surgery did not lead to a change in respiratory muscle strength (p-values≥0.05).&#x0D; Conclusion: According to our findings, FM and FFM along with weight and BMI decrease significantly after bariatric surgery. These alternations were accompanied by a significant increase in respiratory muscle strength but were not correlated with handgrip muscle force changes.

Patterns of Changes in Respiratory Muscle Strength over 1 Year in Non-Sarcopenia, Sarcopenia, and Severe Sarcopenia

In this prospective longitudinal cohort study, we explored the characteristics of older people with lower respiratory muscle strength, according to sarcopenia severity, over the course of 1 year. The maximum expiratory pressure (MEP), grip strength, walking speed, and skeletal muscle mass index of 58 participants (28 men, 30 women; mean age, 76.9 ± 7.7 years) were measured at baseline and at the 1-year follow-up. Participants were classified into a decreased MEP group (n = 29; MEP decreased by ≥10% after 1 year) and a non-decreased MEP group (n = 29; MEP decreased by <10%). Sarcopenia status in the mild direction at baseline was significantly associated with MEP decline after one year. Repeated two-way analysis of variance showed significant main effects of measurement time (p < 0.001) and severity of sarcopenia (p = 0.026), as well as a significant interaction effect (p = 0.006). Surprisingly, MEP decreased significantly in the non-sarcopenia and sarcopenia groups, but not in the severe sarcopenia group. Thus, individuals without sarcopenia and those with moderate sarcopenia at baseline are predisposed to MEP decline and should be closely monitored for signs of such decline and associated adverse events.

Recovery of respiratory muscle strength, physical function, and dyspnoea after lobectomy in lung cancer patients undergoing pulmonary rehabilitation: A retrospective study.

To characterise changes in respiratory muscle strength, physical function, and dyspnoea in patients who underwent pre- and post-operative exercise intervention following lobectomy for non-small-cell lung cancer (NSCLC). This retrospective study included NSCLC patients who underwent lobectomy via video-assisted thoracoscopic surgery (VATS) or posterolateral thoracotomy (PLT) and pre- and post-operative exercise intervention consisting of breathing, flexibility, resistance, aerobic exercises, coughing/huffing techniques, and early mobilisation. Maximum mouth inspiratory (Pimax) and expiratory pressures (Pemax), 6-min walk distance (6MWD), quadriceps force (QF), and modified Medical Research Council (mMRC) dyspnoea scale were evaluated preoperatively, at hospital discharge, and post-lobectomy 1 and 3months. Data from 41 patients were analysed. At hospital discharge, the Pimax, Pemax, 6MWD, and mMRC dyspnoea scores were lower than pre-operatively; QF remained unchanged; Pimax and 6MWD recovered to pre-operative values at post-lobectomy 1month; and Pemax and mMRC dyspnoea scores recovered at 3months. During sub-analysis, Pimax and mMRC dyspnoea scores in the VATS (n = 24) and PLT groups (n = 17) recovered to pre-operative values at post-lobectomy 1 and 3months. After lobectomy, respiratory muscle strength, physical function, and dyspnoea in patients who underwent exercise intervention returned to pre-operative values at post-lobectomy 3months.

Comprehensive physical rehabilitation of patients with heart failure: impact on clinical and functional status and analysis of problems related to the enrollment

Aim. To evaluate functional, clinical and psychological status of patients with class II-III heart failure, who underwent comprehensive cardiac rehabilitation program.Material and methods. Patients of both sexes with class II-III heart failure who met the inclusion criteria, did not have the exclusion criteria, and signed informed consent were included. The training process consisted of a 4-week respiratory muscle (RM) training using the THRESHOLD® IMT breathing trainer followed by a 12-week moderate intensity aerobic exercise (AE). AE were conducted under the supervision of an instructor 3 times a week for 40 minutes. RM training was carried out by patients at home on their own 5-7 times a week. Minnesota Living With Heart Failure Questionnaire (MLwHFQ.23) was used to assess quality of life. In addition, we applied Hospital Anxiety and Depression Scale (HADS). The evaluation was performed before the start of the study (visit 1), after 4 weeks of respiratory training (visit 2) and at the end of 16 weeks of AE (visit 3). The baseline characteristics of patients who were screened and not enrolled in the study were compared with those who participated in training.Results. A total of 102 patients were included in the study (passed the first visit). Subsequently, for various reasons, including due to the pandemic, 82 patients refused to participate in the study. Only 20 patients participated in RM training for 4 weeks followed by a 12-week cycle of moderate-intensity AR (median age, 67,0 (58,7-74,3) years; men, 70%; Δ peak oxygen uptake (VO2peak) (1-2) =1,1, p=0,3863; ΔVO2 peak (1-3) =2,3 ml/kg/min, p=0,139. During 16-week training, we revealed an increase in expiratory muscle strength (EMS) (ΔEMS =10 cmH2O (p=0,037), six-minute walk test (6MWT) (Δ6MTX=60 meters, p=0,005), and SHOKS score (p=0,0117), as well as improvement in anxiety and depression symptoms (ΔHADS =-2 points, p=0,0346). Patients who refused to be included in the study were older, had lower blood pressure, and had a worse quality of life. The groups did not differ significantly in other clinical, functional and laboratory parameters.Conclusion. Patients’ motivation to exercise was associated with younger age and better subjective health perception and did not depend on objective status. In patients undergoing a comprehensive rehabilitation program, there was a significant change in RM strength, as well as an increase in 6MWT distance, clinical and psychological status already at the stage of respiratory training. This trend continued at the AE stage as well.

Recovery process of respiratory muscle strength in patients following stroke: A Pilot Study.

To determine the recovery process of respiratory muscle strength during 3 months following stroke, and to investigate the association of change in respiratory muscle strength and physical functions. Additionally, we compared respiratory muscle strength with those of healthy subjects. In this prospective, observational study, 19 stroke patients and 19 healthy subjects were enrolled. Maximal inspiratory pressure (MIP), maximal expiratory pressure (MEP), motricity index, trunk control test, 6-minute walk test (6MWT) and functional independence measure were assessed at 1, 2, and 3 months from stroke onset in stroke patients. MIP and MEP were assessed at arbitrary times in healthy subjects. Repeated one-way analysis of variance with Bonferroni post-hoc test was used to compare the change in respiratory muscle strength in each period in stroke patients. Pearson's correlation coefficient was computed for changes in respiratory muscle strength and physical functions. Student's t-test was used to compare respiratory muscle strength between stroke patients at 3 months from onset and healthy subjects. MIP was significantly increased at 3 months compared to 1 month. MEP was significantly increased in 2 months and 3 months, compared to 1 month. MIP changes associated with 6MWT changes. Compared to healthy subjects, MIP and MEP at 3 months were significantly lower in stroke patients. Respiratory muscle strength significantly increased during 3 months following stroke. However, the trend of recovery may be different. MIP changes may associated with walking endurance changes. During 3 months following stroke, respiratory muscle strength did not recover to healthy subjects.

Inspiratory Muscle Training With an Electronic Resistive Loading Device Improves Prolonged Weaning Outcomes in a Randomized Controlled Trial.

To test if the use of an inspiratory muscle training program with an electronic resistive loading device is associated with benefits as to muscle strength, weaning, and survival in the ICU. Prospective randomized controlled trial. Study conducted at the ICU of a Navy's hospital, Rio de Janeiro, Brazil, from January 2016 to September 2018. Tracheostomized patients (18-86 yr) on prolonged weaning. Participants were assigned to inspiratory muscle training (intervention group) or a traditional T-piece protocol (control group). In the inspiratory muscle training group, participants underwent training with an electronic inspiratory training device (POWERbreathe K-5; Technologies Ltd, Birmingham, United Kingdom). Changes in respiratory muscle strength and rates of ICU survival and weaning success were compared between groups. Forty-eight participants in the inspiratory muscle training group and 53 ones in the control group were included in the final analysis. The inspiratory muscle training was associated with a substantially higher gain on muscle strength as assessed by the maximal inspiratory pressure (70.5 [51.0-82.5] vs -48.0 cm H2O [36.0-72.0 cm H2O]; p = 0.003) and the timed inspiratory effort index (1.56 [1.25-2.08] vs 0.99 cm H2O/s [0.65-1.71 cm H2O/s]; p = 0.001). Outcomes at the 60th day of ICU were significantly better in the intervention group regarding both survival (71.1% vs 48.9%; p = 0.030) and weaning success (74.8% vs 44.5%; p = 0.001). The use of an inspiratory muscle training program with an electronic resistive loading device was associated with substantial muscle strength gain and positive impacts in two very relevant clinical outcomes: the rates of ICU survival and successful weaning.

Integrative respiratory and skeletal musculature training in patients with functional class II–IV chronic heart failure and low or intermediate left ventricular ejection fraction: Design and rationale

Respiratory system remodeling plays an important role in the progression of congestive heart failure (CHF). Decreased oxygenation of the respiratory muscles during intense physical exertion in patients with CHF may aggravate respiratory failure and provoke hyperactivation of the inspiratory metaborefl ex, thereby aggravating exercise intolerance due to a decrease in muscular system perfusion. Respiratory muscle training can minimize the eff ects of inspiration metaborefl ex activation and prolong the duration of exercise.Trial design. This is a prospective randomized trial with a sham control. The trial will include 40 adult patients of both genders with NYHA II-III CHF and with ejection fraction (EF) ≤ 49%. Patients will be randomized in a 1:1 ratio to either Active or Control group. Active group will receive four-week guided respiratory muscles training followed by 12-week guided aerobic training (treadmill walking). Control group will receive four-week sham respiratory muscles training (THRESHOLD® IMT breathing trainer with level slightly above 0), followed by 12 weeks guided aerobic training (treadmill walking). The primary aim is to compare the eff ect of diff erent training modalities on functional capacity (peak VO2 ). Secondary outcome measures include changes in respiratory muscle strength, serum biomarkers (NT-proBNP and ST2) and Angiotensin II. Health-related quality of life (MLwHFQ.23) and psycho-emotional state of patients also will be assessed.The study also planned an additional analysis with a suitable group of patients who were screened but refused to participate in the study.Conclusion. Heart failure patients often give up exercise due to symptoms of shortness of breath and muscle weakness. We suggest that the training technique based on the inclusion of respiratory muscle training as the fi rst stage of cardiac rehabilitation will positively aff ect the eff ectiveness of subsequent aerobic training in patients with heart failure, by reducing the activity of RAAS and SAS and increasing respiratory effi ciency.

Changes in Respiratory Muscle Strength Following Cardiac Rehabilitation for Prognosis in Patients with Heart Failure.

Respiratory muscle weakness, frequently observed in patients with heart failure (HF), is reported as a predictor for poor prognosis. Although increased respiratory muscle strength ameliorates exercise tolerance and quality of life in HF patients, the relationship between changes in respiratory muscle strength and patient prognosis remains unclear. A total of 456 patients with HF who continued a 5-month cardiac rehabilitation (CR) were studied. We measured maximal inspiratory pressure (PImax) at hospital discharge as the baseline and five months thereafter to assess the respiratory muscle strength. Changes in PImax during the 5-month observation period (⊿PImax) were examined. We investigated the composite multiple incidence of all-cause death or unplanned readmission after 5-month CR. The relationship between ⊿PImax and the incidence of clinical events was analyzed. Over a median follow-up of 1.8 years, 221 deaths or readmissions occurred, and their rate of incidence was 4.3/100 person-years. The higher ⊿PImax was significantly associated with lower incidence of clinical event. In multivariate Poisson regression model after adjustment for clinical confounding factors, ⊿PImax remained a significant and independent predictor for all-cause death/readmission (adjusted incident rate ratio for ⊿PImax increase of 10 cmH2O: 0.77, 95% confidence interval: 0.70–0.86). In conclusion, the changes in respiratory muscle strength independently predict the incidence of clinical events in patients with HF.

298Change in respiratory muscle strength predicts clinical events in patients with chronic heart failure

Abstract Background Respiratory muscle weakness, frequently observed in patients with chronic heart failure (CHF), has been documented as a predictor for poor prognosis. Several studies have reported that respiratory muscle training increases respiratory muscle strength and consequently improves exercise tolerance and quality of life in these patients. However, the relationship between the change in respiratory muscle strength and prognosis is still unclear. Purpose We aimed to investigate whether the change in respiratory muscle strength following cardiac rehabilitation predicts the incidence of clinical events in CHF patients. Methods We studied 348 patients with CHF who were hospitalized because of decompensated heart failure and received 5-month cardiac rehabilitation during hospitalization and after hospital discharge. Clinical characteristics including aetiology of heart failure, comorbidity conditions, medications, blood examination and echocardiographic variables were obtained from clinical records. We also measured maximal inspiratory pressure (PImax) as respiratory muscle strength at hospital discharge and 5 months later. The change of PImax (ΔPImax) between the 5-month observation period was examined. We followed up the patients after the observation period and investigated the incidence of all-cause mortality or all-cause unplanned readmission. In statistical analysis, patients were divided into two groups based on the median value of ΔPImax. We compared the event-free survival rate between the two groups using the Kaplan-Meier method with a log-rank test. We also performed the Cox proportional hazard model to clarify whether the ΔPImax was an independent predictor for the incidence of clinical events. Results Over a median follow-up of 1.6 years, 121 patients (34.8%) died or readmitted, and their rate of incidence was 21.7/100 person-years. The higher ΔPImax was associated significantly with a higher rate of event-free survival (Log-rank: 8.085, P=0.004, Figure 1). In univariate Cox proportional hazard model, ΔPImax was a significant predictor for the all-cause mortality/readmission (unadjusted hazard ratio for PImax increase of 10 cmH2O: 0.842, 95% CI: 0.763 - 0.931, P=0.001). Even after adjustment for clinical confounding factors including baseline PImax, ΔPImax remained significant and independent predictor for the all-cause mortality/readmission (adjusted hazard ratio for PImax increase of 10 cmH2O: 0.862, 95% CI: 0.763 - 0.974, P=0.017, Figure 2). Conclusion This study is the first to demonstrate that the change in respiratory muscle strength following cardiac rehabilitation independently predicts the incidence of clinical events in patients with CHF. The increase in PImax of 10 cmH2O was associated significantly with a 14% decrease in the rate of all-cause mortality or readmission. Acknowledgement/Funding JSPS KAKENHI JP16K16442

Correlation between change in respiratory muscle strength and cough ability in patients submitted to open-heart surgery

Correlation between change in respiratory muscle strength and cough ability in patients submitted to open-heart surgery

Effect of Lung Volume Reduction Surgery on Respiratory Muscle Strength in Advanced Emphysema.

Background: Long-term effects of lung volume reduction surgery (LVRS) on respiratory muscle strength and effects of age, sex, and emphysema pattern on these changes are unknown. Therefore, we aimed to determine the long-term effect of LVRS on respiratory muscle strength changes in severe emphysema. Methods: The National Emphysema Treatment Trial was a prospective controlled multicentered trial, comparing LVRS to optimal medical treatment on survival and maximal exercise capacity. We examined percentage change in maximum inspiratory pressure (MIP) from baseline to 36 months follow-up to determine impact of LVRS as well as age, sex, emphysema pattern and exercise capacity on changes in MIP compared to medical treatment. Results: LVRS individuals had significantly greater increases in MIP from baseline compared to medical individuals at all follow-ups (LVRS 19.8 ± 42.3%, medical 3.2 ± 29.3%, p<0.0001, 12 months). The LVRS group had significant decreases in total lung capacity (TLC), residual volume (RV), functional residual capacity (FRC) and RV/TLC compared to the medical arm at all follow-up periods. Males and individuals 65-70 years of age had significantly greater increases in MIP following LVRS compared to the medical arm at all follow-ups; this same relationship was seen at up to 24 months for low exercise capacity, upper lobe predominant emphysema. Conclusions: LVRS significantly increases inspiratory muscle strength up to 3 years post-operatively, with male sex, age 65-70 years and low exercise capacity, upper lobe predominant emphysema especially associated with increased MIP. Inspiratory muscle strength increases were associated with decreases in non-invasive markers of dynamic hyperinflation, suggesting that LVRS allows inspiratory muscles to return to their optimal length-tension relationship.

Combined aerobic exercise and high-intensity respiratory muscle training in patients surgically treated for non-small cell lung cancer: a pilot randomized clinical trial.

Lung resection surgery further decreases exercise capacity and negatively affects respiratory muscle function in patients with non-small cell lung cancer (NSCLC). The best design for exercise interventions in these patients has not been determined yet. To assess the impact of aerobic exercise and high-intensity respiratory muscle training on patient outcomes following lung cancer resection surgery. Prospective, single-blind, pilot randomized controlled trial. Outpatient cardiopulmonary rehabilitation unit of two university hospitals. Thirty-seven patients with NSCLC after tumor resection. Patients were randomly assigned to exercise training or usual post-operative care. The training program consisted of aerobic exercises and high-intensity respiratory muscle training (24 supervised sessions, 3 per week, 8 weeks). Primary outcome was exercise capacity assessed with peak oxygen uptake (VO2peak) during cardiopulmonary exercise test. Secondary outcomes included changes in respiratory muscle strength, levels of serum insulin growth factor I (IGF-I) and IGF binding protein 3 (IGFBP-3), and quality of life assessed with the European Organization for Research and Treatment of Cancer (EORTC QLQ-C30) questionnaire. The 8-week training program was associated with significant improvement in VO2peak (2.13 mL/Kg/min [95%CI 0.06 to 4.20]), maximal inspiratory and expiratory pressures (18.96 cmH2O [95% CI 2.7 to 24.1] and 18.58 cmH2O [95% CI 4.0 to 33.1], respectively) and IGFBP-3 (0.61 µg/mL [%95 CI 0.1 to 1.12]). No significant differences were observed in the EORTC QLQ-C30. An 8-week exercise program consisting of aerobic exercise and high-intensity respiratory muscle training improved exercise capacity, respiratory muscle strength, and serum IGFBP-3 levels in NSCLC patients after lung resection. There was no impact on the other outcomes assessed. A combination of aerobic exercise and respiratory muscle training could be included in the rehabilitation program of deconditioned patients with NSCLC after lung resection surgery.

Respiratory muscle power and lung function in healthy obese Sudanese medical students

There is an increasing prevalence of obesity worldwide (Body Mass Index equals or above 30kg/m2). Obesity may cause changes in pulmonary mechanics, as measured by spirometric values: mild reduction in vital capacity and proportionate reduction in Forced Expiratory volume in the first second (FEV1) depending upon the age, type of body fat distribution and severity of obesity. Changes in respiratory muscle strength in healthy obese individuals have not been widely investigated. The aim of this study is to assess the effect of obesity on respiratory muscle strength and pulmonary function in healthy obese subjects. A cross sectional study was carried out at National Ribat University, Faculty of Medicine, among ninety-five healthy male and female medical students aged 17-25 years (52 obese with BMI equals or above 30kg/m2, 43 non-obese with BMI&lt; 0.05). These results were also found to be consistent in female subjects. Significant negative correlation was also observed between % fat and lung function parameters (FVC, FEV1). Increased strengthening of respiratory muscles in healthy obese adults (as measured by elevated MEP and MIP) might be a compensatory effect to bring lung function to comparable values of the non- obese. Percent of body fat could be a good predictor for decline in lung function in obese individuals.

Functional capacity, pulmonary and respiratory muscle strength in individuals undergoing hemodialysis

Abstract Introduction: Individuals with chronic kidney disease (CKD) undergoing hemodialysis (HD) present low cardiorespiratory fitness and functional capacity. Metabolic changes, due to the disease, can result in a variety of pathophysiological conditions that favor the development of respiratory muscle weakness. However, very little is known about the performance of the respiratory muscles and the influence of HD on them. Aim: To evaluate and correlate pulmonary function, functional capacity and respiratory muscle strength in patients with CKD undergoing HD. Methods: Cross-sectional study comprising 23 patients with CKD, that met the following inclusion criteria: patients of both genders, who perform HD three times a week for a minimum period of three months. Respiratory muscle strength was evaluated using a respiratory pressure meter, lung function through spirometry and functional capacity through the 6-minute walk test (6MWT) before the HD session. Results: All patients were male and mean age was 50.2 ± 15.8 years. The median duration of HD was 3 (1.5 to 6.0) years. The mean values obtained in comparison to those predicted were MIP% 36.0 ± 13.6, MEP% 49.5 ± 15.8, FVC% 93.8 ± 21.1, FEV1% 93.7 ± 21.1, FVC/VEF1% 104.1 ± 10.3, and 6MWT% 66.33 ± 20.53. A statistically significant positive correlation was observed between the 6MWT and MIP (r = .63, p =.001) and MEP (r = .67, p &lt; .001), between the MIP and MEP (r =.79, p &lt; .001) and between the FEV1 and FVC (r = .91, p &lt; .001). Conclusion: Patients with CKD undergoing HD present changes in respiratory muscle strength, with the predicted values decreasing for age and gender, as well as the distance covered in the 6MWT, although, with normal spirometric values. Functional capacity was dependent on respiratory muscle strength, as well as the values of MIP and MEP, and the values of FVC and FEV1.

Avaliação da força muscular respiratória em indivíduos com síndrome de down

As a result of muscle changes caused by the generalized hypotonia found in individuals with Down syndrome (DS), these subjects develop changes in respiratory muscle strength. The objective of the study was to assess respiratory muscle strength (RMS) of individuals having DS. Thus, the objective of the study was to evaluate the respiratory muscle strength (RMS) in individuals with DS. It was cross-sectional study, conducted at the Association of Parents and Friends of Exceptional (APFE) of countryside of Sao Paulo. 20 volunteers were evaluated, divided into two groups, 10 non-syndromic individuals and 10 individuals diagnosed with DS, aged between 18 and 35 years, of both genders. The evaluation of RMS was performed by an analog manometer through which were measured maximal inspiratory pressures (MIP) and maximum expiratory pressures (MEP). For data analysis, were used the BioEstat version 5.3. Data normality was verified by the Shapiro-Wilk test. After, comparison tests were used for two independent samples (Student’s t and Mann-Whitney tests), adopting a significance level of 5%. When comparing both groups, we can find a significant difference in MIP (p= 0.0011) and MEP (p= 0.0002), and lower RMS values were obtained in the group of individuals with DS. SD (MIP: -109±49.49 x -29.50±9.07) and (MEP: 127±44.06 x 45.50±10.11) Therefore, individuals with Down syndrome have decreased RMS. It is believed that these individuals would benefit from a rehabilitation program, including physiotherapy, thus minimizing possible respira-tory complications.

Inspiratory muscle training did not accelerate weaning from mechanical ventilation but did improve tidal volume and maximal respiratory pressures: a randomised trial

Does inspiratory muscle training accelerate weaning from mechanical ventilation? Does it improve respiratory muscle strength, tidal volume, and the rapid shallow breathing index? Randomised trial with concealed allocation and intention-to-treat analysis. 92 patients receiving pressure support ventilation were included in the study and followed up until extubation, tracheostomy, or death. The experimental group received usual care and inspiratory muscle training using a threshold device, with a load of 40% of their maximal inspiratory pressure with a regimen of 5 sets of 10 breaths, twice a day, 7 days a week. The control group received usual care only. The primary outcome was the duration of the weaning period. The secondary outcomes were the changes in respiratory muscle strength, tidal volume, and the rapid shallow breathing index. Although the weaning period was a mean of 8 hours shorter in the experimental group, this difference was not statistically significant (95% CI -16 to 32). Maximal inspiratory and expiratory pressures increased in the experimental group and decreased in the control group, with significant mean differences of 10cmH2O (95% CI 5 to 15) and 8cmH2O (95% CI 2 to 13), respectively. The tidal volume also increased in the experimental group and decreased in the control group (mean difference 72 ml, 95% CI 17 to 128). The rapid shallow breathing index did not differ significantly between the groups. Inspiratory muscle training did not shorten the weaning period significantly but it increased respiratory muscle strength and tidal volume.