Decrease In Respiratory Muscle Strength Research Articles

Effects of Delayed-Onset Muscle Pain on Respiratory Muscle Function

Background: Delayed-onset muscle soreness (DOMS) has been widely examined in the peripheral muscles; however, studies showing the potential effects of DOMS on respiratory function are limited. Hypothesis: DOMS in trunk muscles has a negative effect on respiratory function parameters, respiratory muscle strength, respiratory muscle endurance, and exercise capacity. Study Design: Prospective cohort study. Level of Evidence: Level 2. Methods: In 24 healthy participants with a mean age of 21 ± 2 years, DOMS was induced for the trunk muscles with a load equal to 80% of the maximum repetitive voluntary contraction. Pulmonary function parameters, respiratory muscle strength and endurance, exercise capacity, pain, fatigue, and dyspnea perception severity were recorded before DOMS and at 24 and 48 hours after DOMS. Results: After DOMS, decreases were observed in respiratory function parameters, namely, forced vital capacity, forced expiratory volume in the first second, vital capacity, and 25% to 75% flow rate value of forced expiratory volume (25% to 75%) ( P = 0.02, P = 0.02, P < 0.01, P = 0.01, respectively). Maximal inspiratory pressure and exercise capacity also decreased ( P = 0.02, P < 0.01, respectively). No difference was observed between all 3 measurements of maximal expiratory pressure (MEP) and MEP% values ( P1 = P2 = P3 ≥ 0.99). The results of the respiratory muscle endurance tests did not reveal a significant difference in terms of load and time in all 3 conditions ( P > 0.05). Conclusion: After DOMS, there was a 4% to 7.5% decrease in respiratory function parameters, and a 6.6% decrease in respiratory muscle strength. Clinical Relevance: The occurrence of DOMS before a competition can have a detrimental impact on pulmonary performance. Hence, it is imperative to consider this factor when devising training and exercise programs. In addition, the development of treatment protocols becomes crucial if DOMS arises.

Aging and Susceptibility to Pulmonary Disease.

The lungs are continually subjected to noxious and inert substances, are immunologically active, and are in a constant state of damage and repair. This makes the pulmonary system particularly vulnerable to diseases of aging. Aging can be understood as random molecular damage that is unrepaired and accumulates over time, resulting in cellular defects and tissue dysfunction. The breakdown of cellular mechanisms, including stem cell exhaustion, genomic instability, telomere attrition, epigenetic alteration, loss of proteostasis, deregulated nutrient sensing, mitochondrial dysfunction, cellular senescence, altered intercellular communication, and changes in the extracellular matrix is thought to advance the aging process itself. Chronic obstructive pulmonary disease (COPD), idiopathic pulmonary fibrosis (IPF), and cancers illustrate a pathologic breakdown in these mechanisms beyond normal aging. The immune system becomes less effective with advancing age. There is a low-level state of chronic inflammation termed inflammaging which is thought to be driven by immunosenescence, the changes in the innate and adaptive immune systems with advancing age that lead to dysregulation and decreased effectiveness of the immune system. These processes of aging lead to expected changes in the form and function of the respiratory system, most notably a loss of lung elasticity, decrease in respiratory muscle strength, increase in ventilation-perfusion mismatching, and stiffening of the vasculature. The astute clinician is aware of these expected findings and does not often attribute dyspnea to aging alone. Maintaining a low threshold to investigate for comorbid disease and understanding how pulmonary disease presents differently in the elderly than in younger adults can improve clinical outcomes. © 2022 American Physiological Society. Compr Physiol 12:3509-3522, 2022.

Improved respiratory characteristics in non-specific low back pain: Comparison of Feldenkrais method versus routine physiotherapy

PURPOSE: Abnormal breathing patterns, decrease in respiratory muscle strength and endurance are some of the alterations, which are observed in non-specific low back pain (NS-LBP). The purpose of this study was to determine the efficacy of the Feldenkrais method (FM) on respiratory muscle strength, Maximum Voluntary Ventilation (MVV), Total Faulty Breathing Scale (TFBS), Cloth Tape Measure (CTM) and core stability among NS-LBP participants. METHODS: Participants were recruited from a rehabilitation clinic and randomized either to experimental group (EG) or the control group (CG). For the EG (FM and routine physiotherapy), and for the CG routine physiotherapy alone were carried out three days per week over a period of 8 weeks. Outcome measures including Respiratory Muscle Strength, MVV, TFBS, Numeric Rating Scale (NRS), CTM, and Pressure biofeedback device (PBU) were evaluated at baseline and 8 weeks. RESULTS: Forty participants were assigned to an EG (n = 20) and CG (n = 20) based on the study criteria. There was a significant increase in inspiratory muscle strength (MIP) (p = 0.004) for the EG, but no significant change in the CG (p = 0.455). There was also a significant increase in the expiratory muscle strength (MEP) for the EG (p = 0.001), but no changes in the CG (p = 0.574). In addition, decrease in pain, increase in xiphoid process chest expansion and improvement in core stability were observed in EG and improvement in MVV was observed in CG. CONCLUSIONS: FM is a potential training program that can improve respiratory variables among NS-LBP.

AVALIAÇÃO DA FORÇA MUSCULAR RESPIRATÓRIA E SINTOMAS DE DISPNEIA EM GESTANTES NO SEGUNDO TRIMESTRE GESTACIONAL

The purpose of the study was to evaluate respiratory muscle strength and dyspnea symptoms in healthy pregnant women in the second trimester of pregnancy. This is a descriptive study, in which seven pregnant women were forwarded to the university extension project of physical therapy in pregnant womenattended on SUS. An initial evaluation form was applied to collect personal and specific data related to gestation; the Borg scale based on some daily situations of the pregnant woman’s life for the subjective perception of effort and the manovacuometry test. The research showed that inspiratory and expiratory muscle forces were decreased in the second gestational trimester, also the situation of greater subjective perception of effort was to clean the house. We concluded that there wasa decrease in respiratory muscle strength and that it may be associated with dyspnea symptoms presented.

Effect of cardiac surgery on respiratory muscle strength.

ObjectivesPulmonary complications, such as atelectasis, pulmonary oedema, pleural effusion, bronchospasm, and pneumonia, have been reported following cardiac surgery. Shallow breathing leading to impaired lung function is the major cause of respiratory complications. Decreases in respiratory muscle strength can be measured using the maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP) produced in the oral cavity. This study aimed to determine the decrease in respiratory muscle strength 8 weeks following cardiac surgery. Moreover, the relationship between lung function and respiratory muscle strength was studied.MethodsIn this observational study, 42 adult cardiac surgery patients (10 women, 32 men; mean age 65 ± 7 years) were investigated. Lung function and respiratory muscle strength were measured preoperatively and at 2 months postoperatively.ResultsThe pre- and postoperative respiratory muscle strengths were in accordance with the predicted values. The MIP was 81.75 ± 22.04 cmH2O preoperatively and 74.56 ± 18.86 cmH2O at the 2-month follow-up (p = 0.146). The MEP was 98.55 ± 22.24 cmH2O preoperatively and 88.86 ± 18.14 cmH2O at the 2-month follow-up (p = 0.19). The preoperative lung function was in accordance with the predicted values; however, lung function significantly decreased postoperatively. At the 2-month follow-up, there was a moderate correlation between the MIP and forced expiratory volume (r = 0.59, p = 0 .0078).ConclusionsThe respiratory muscle strength was not impeded either before or 2 months after cardiac surgery. However, the exact mechanism for the alteration in lung function remains unclear. Measures to re-establish the ideal postoperative lung capacity should concentrate on different perioperative pulmonary exercises.

Correlation between thoracolumbar curvatures and respiratory function in older adults.

Aging is associated with alterations in thoracolumbar curvatures and respiratory function. Research information regarding the correlation between thoracolumbar curvatures and a comprehensive examination of respiratory function parameters in older adults is limited. The aim of the present study was to examine the correlation between thoracolumbar curvatures and respiratory function in community-dwelling older adults. Thoracolumbar curvatures (thoracic and lumbar) were measured using a motion tracker. Respiratory function parameters such as lung function, respiratory rate, respiratory muscle strength and respiratory muscle thickness (diaphragm and intercostal) were measured using a spirometer, triaxial accelerometer, respiratory pressure meter and ultrasound imaging, respectively. Sixty-eight community-dwelling older males and females from Kuala Lumpur, Malaysia, with mean (standard deviation) age of 66.63 (5.16) years participated in this cross-sectional study. The results showed that mean (standard deviation) thoracic curvature angle and lumbar curvature angles were −46.30° (14.66°) and 14.10° (10.58°), respectively. There was a significant negative correlation between thoracic curvature angle and lung function (forced expiratory volume in 1 second: r=−0.23, P<0.05; forced vital capacity: r=−0.32, P<0.05), quiet expiration intercostal thickness (r=−0.22, P<0.05) and deep expiration diaphragm muscle thickness (r=−0.21, P<0.05). The lumbar curvature angle had a significant negative correlation with respiratory muscle strength (r=−0.29, P<0.05) and diaphragm muscle thickness at deep inspiration (r=−0.22, P<0.05). However, respiratory rate was correlated neither with thoracic nor with lumbar curvatures. The findings of this study suggest that increase in both thoracic and lumbar curvatures is correlated with decrease in respiratory muscle strength, respiratory muscle thickness and some parameters of lung function. Clinically, both thoracic and lumbar curvatures, respiratory muscles and lung function should be taken into consideration in the holistic management of respiratory function among older adults.

Respiratory function and functional capacity in chronic stroke patients 1

Abstract Introduction: Cerebrovascular accident (CVA) or stroke results in weakness of the trunk muscles and physical unfitness. Objectives: To evaluate respiratory changes caused by stroke and correlate them with the functional capacity of chronic stroke patients who were treated at the Clinical Center of Physical Therapy of the Pontifical Catholic University of Minas Gerais, Betim. Methods: Fifteen patients were recruited for assessment of respiratory function and functional capacity. We measured maximum inspiratory pressure (MIP), maximal expiratory pressure (MEP), peak expiratory flow (PEF), vital capacity (VC), and functional capacity using the six-minute walk test (6MWT). Test results were compared with reference values using an unpaired Student's t-test or the Mann-Whitney test. Respiratory variables were correlated with the distance walked in the 6MWT using Spearman's correlation test. Results: The sample had a mean age of 58.2 ± 13.4 years, and most patients had a diagnosis of ischemic stroke and left hemiparesis. The following values were obtained: MIP (47.7 ± 22.2 cmH2O); MEP (47.5 ± 20.3 cmH2O); PEF (351.3 ± 90.8 L/min); VC (3.0 ± 0.91 L); and 6MWT (222.4 ± 101.6 m). The MIP, MEP, PEF, and 6MWT values measured in this study were statistically significantly lower (p &lt; 0.001) than the reference values. There was no statistically significant correlation between the distance walked in the 6 MWT and respiratory variables (p &gt; 0.005). Conclusion: Our results suggest that, despite the decrease in respiratory muscle strength, PEF, and VC, these variables did not correlate with the functional capacity of the chronic stroke patients assessed in this study.

Força muscular respiratória em idosas hipertensas fisicamente ativas e sedentárias

Introdução: O envelhecimento relaciona-se ao aumento da incidência da hipertensão arterial sistêmica, bem como à diminuição da força muscular respiratória. Objetivo: Comparar a força muscular respiratória entre idosas hipertensas fisicamente ativas e sedentárias. Métodos: A amostra foi composta por 53 idosas, hipertensas, classificadas em dois grupos mediante aplicação do Questionário Internacional de Nível de Atividade Física (IPAQ): grupo sedentárias – G1 (n=31) e grupo ativas – G2 (n=22). Cada voluntária foi avaliada quanto à pressão inspiratória máxima (PImáx) e pressão expiratória máxima (PEmáx). Os resultados foram comparados entre os grupos, adotando-se como significativo um p

Força muscular respiratória e perfil postural e nutricional em crianças com doenças neuromusculares

INTRODUÇÃO: As doenças neuromusculares infantis são crônicas, degenerativas e determinam alterações funcionais, musculares e nutricionais. OBJETIVOS: Avaliar sistematicamente a força muscular respiratória e o perfil postural e nutricional de crianças com doenças neuromusculares em seguimento multidisciplinar institucional. MATERIAIS E MÉTODOS: Foram estudados pacientes com diferentes doenças neuromusculares por meio da verificação da força muscular respiratória, da avaliação nutricional de massa muscular, do índice de massa corpórea e da porcentagem (%) de gordura corporal, além de avaliação postural e dos padrões de movimento. RESULTADOS: Foram avaliados 41 sujeitos. As crianças do sexo masculino predominaram na população em estudo, sendo 82,9% dela (n = 34), e os outros 17,1% (n = 7) eram do sexo feminino. A média de idade encontrada foi de 9,65 ± 3,11 anos. O principal diagnóstico encontrado foi Distrofia Muscular de Duchenne, 43,9% (n = 18), seguido de Atrofia Muscular Espinhal, 9,75% (n = 4), Distrofia Congênita, 7,31% (n = 3), Distrofia Muscular de Cinturas, Polineuropatia e Miopatia Congênita, todos com 4,9% (n = 2), além de Distrofia Muscular Progressiva, Miastenia Grávis, Charcoot Marie Toot, Emery Dreifuss, encontrados em 2,43% (n = 1). Foi verificada uma diminuição da força muscular respiratória (PImáx = 81 ± 24,3 cmH2O, 91% predito e PEmáx = 70 ± 29,6 cmH2O, 72% predito), mais evidente nos músculos expiratórios. A Hiperlordose lombar foi encontrada em 26 pacientes (64%) e 9 pacientes (22%) já haviam perdido a capacidade de deambular. Em relação ao perfil nutricional, 90% dos pacientes (n = 30) mostraram uma alta incidência de perda de reserva muscular e 52% deles (n = 13) apresentaram a porcentagem de gordura corporal abaixo do aceitável. CONCLUSÃO: A avaliação multidisciplinar das doenças neuromusculares pediátricas podem auxiliar no estabelecimento de tratamento precoce da Fisioterapia para melhorar a qualidade de vida dos pacientes e cuidadores.

Dreno pleural subxifoide confere menor comprometimento da força muscular respiratória, oxigenação e menor dor torácica após cirurgia de revascularização do miocárdio sem circulação extracorpórea

To evaluate respiratory muscle strength, oxygenation and chest pain in patients undergoing off-pump coronary artery bypass (OPCAB) using internal thoracic artery grafts comparing pleural drain insertion site at the subxyphoid region versus the lateral region. Forty patients were randomized into two groups in accordance with the pleural drain site. Group II (n = 19) -pleural drain exteriorized in the intercostal space; group (SI) (n = 21) chest tube exteriorized at the subxyphoid region. All patients underwent assessment of respiratory muscle strength (inspiratory and expiratory) on the pre, 1, 3 and 5 postoperative days (POD). Arterial blood gas analysis was collected on the pre and POD1. The chest pain sensation was measured 1, 3 and 5 POD. A significant decrease in respiratory muscle strength (inspiratory and expiratory) was seen in both groups until POD5 (P <0.05). When compared, the difference between groups remained significant with greater decrease in the II (P <0.05). The blood arterial oxygenation fell in both groups (P <0.05), but the oxygenation was lower in the II (P <0.05). Referred chest pain was higher 1, 3 and 5 POD in the II group (P <0.05). The orotracheal intubation time and postoperative length of hospital stay were higher in the II group (P <0.05). Patients submitted to subxyphoid pleural drainage showed less decrease in respiratory muscle strength, better preservation of blood oxygenation and reduced thoracic pain compared to patients with intercostal drain on early OPCAB postoperative.

Relationship Between Expiratory Muscle Dysfunction and Dynamic Hyperinflation in Advanced Chronic Obstructive Pulmonary Disease

Background and objectives Dynamic hyperinflation and expiratory flow limitation, which are physiologically linked phenomena, play a role in the pathophysiology of dyspnea and have a negative impact on quality of life in patients with chronic obstructive pulmonary disease (COPD). The expiratory muscle dysfunction associated with advanced COPD may be involved in the genesis of dynamic hyperinflation. Our objective was to study the relationship between expiratory muscle dysfunction and dynamic hyperinflation and to analyze their association with dyspnea and quality of life in patients with advanced COPD. Patients and methods In 25 patients we measured lung function, exercise capacity (measured by incremental ergometry and the 6-minute walk test), expiratory flow limitation and end-expiratory lung volume (EELV) during exercise, respiratory muscle function, dyspnea, and quality of life (using the St George's Respiratory Questionnaire [SGRQ]). Results The patients, whose mean forced expiratory volume in 1 second (FEV1) was 31% of predicted, exhibited a moderate decrease in respiratory muscle strength and resistance to fatigue. Expiratory flow limitation was observed in 19 patients at rest and in 24 patients at 70% of maximal workload (W max). EELV increased from rest to 70% of W max (9% of predicted forced vital capacity). At 70% of W max, EELV correlated inversely with expiratory flow limitation (ρ=−0.42), inspiratory (ρ=−0.43) and expiratory (ρ=−0.42) muscle endurance, and maximal oxygen uptake (ρ=−0.52). The increase in EELV from resting to 70% of W max correlated with dyspnea (ρ=0.53), and expiratory flow limitation at 70% of W max correlated with the activity score on the SGRQ (ρ=−0.56). FEV1, expiratory muscle endurance and expiratory flow limitation were independent predictors of EELV at 70% W max. Conclusion In advanced COPD, decreased resistance to fatigue in expiratory muscles is associated with an increase in dynamic hyperinflation (and less expiratory flow limitation) during exercise, a pattern that in turn correlates with more severe dyspnea and reduced quality of life.

Prévalence et conséquences de la dénutrition au cours de la bronchite chronique de l’enfant

To study nutritional status in children with chronic bronchitis (CB) in relation with lung function. In this cohort of study, 46 patients aged 6.0 to 17.5 years (mean: 11.9 years) with chronic bronchitis were recruited. None had cystic fibrosis. Body weight, height, skinfold thicknesses, percentage of ideal body weight-for-height (percentage of IBW), body mass index (BMI), BMI Z-score, fat mass and fat-free mass were used to evaluate nutritional status. Arterial blood gases, vital capacity (VC), forced expiratory volume in one s (FEV1), functional residual capacity (FRC) and maximum inspiratory (Pi(max)) and expiratory (Pe(max)) pressures at the mouth were used to evaluate respiratory function. Thirteen children (28%) had malnutrition defined as percentage of IBW lower than 90%, with a predominant fat mass depletion. VC (65+/-13% versus 79+/-15%; p=0.006) and FEV1 (59+/-16% versus 69+/-14%; p=0.03) were significantly lower in children with malnutrition than in children without malnutrition, but no significant differences were observed with regard to the FEV1/VC ratio and blood gases. Pi(max) (56+/-11% versus 88+/-37%, p=0,02) and Pe(max) (46+/-12% versus 58+/-19%, p=0,3) were also lower in children with malnutrition as compared to than without malnutrition. Malnutrition can be observed in children with CB and is associated with significant lower lung function parameters. This could be explained by decrease in respiratory muscle strength.

Respiratory Muscle Strength May Explain Hypoxia-Induced Decrease in Vital Capacity

High altitude exposure has consistently been reported to decrease forced vital capacity (FVC), but the mechanisms accounting for this observation remain incompletely understood. We investigated the possible contribution of a hypoxia-related decrease in respiratory muscle strength. Maximal inspiratory and expiratory pressures (MIP and MEP), sniff nasal inspiratory pressure (SNIP), FVC, peak expiratory flow rate (PEF), and forced expiratory volume in 1 s (FEV1) were measured in 15 healthy subjects before and after 1, 6, and 12 h of exposure to an equivalent altitude of 4267 m in a hypobaric chamber. Hypoxia was associated with a progressive decrease in FVC (5.59 +/- 0.24 to 5.24 +/- 0.26 L, mean +/- SEM, P < 0.001), MIP (130 +/- 10 to 114 +/- 8 cm H2O, P < 0.01), MEP (201 +/- 12 to 171 +/- 11 cm H2O, P < 0.001), and SNIP (125 +/- 7 to 98 +/- 7 cm H2O, P < 0.001). MIP, MEP, and SNIP were strongly correlated to FVC (r ranging from 0.77 to 0.92). FEV1 didn't change, and PEF increased less than predicted by the reduction in air density (11-20% of sea-level value compared with 32% predicted). We conclude that a decrease in respiratory muscle strength may contribute to the decrease in FVC observed at high altitude.

Respiratory muscle injury in animal models and humans.

Respiratory muscle injury may result from excessive loading due to a decrease in respiratory muscle strength, an increase in the work of breathing, or an increase in the rate of ventilation. Other conditions such as hypoxemia, hypercapnia, aging, decreased nutrition, and immobilization may potentiate respiratory muscle injury. Respiratory muscle injury has been shown in animal models using direct muscle or phrenic nerve stimulation, acute inspiratory resistive loading, tracheal banding, corticosteroids, phrenic nerve section, and the mdx mouse. Although numerous examples of diaphragm injury have been shown in animal models, evidence in humans is sparse. Potential mechanisms which may contribute to respiratory muscle injury include high levels of intracellular calcium-activated degradative enzymes, non-uniformity of stresses and strains, plasma membrane disruptions, and activation of the inflammatory process.

Control of Breathing in a Subset of Patients With Systemic Lupus Erythematosus

Inspiratory muscle weakness and abnormalities in breathing pattern and in respiratory drive have been reported in patients with multisystem disorders. In patients with systemic lupus erythematosus (SLE), data on respiratory muscle strength and control of breathing are scarce. We studied a subset of nine female patients with SLE with no major findings of cardiovascular, renal, or neurologic involvement, and with a normal routine chest radiograph. An age- and sex-matched normal group was also studied as a control. We evaluated lung volumes, diffusing lung properties (TLCO, TLCO/VA), maximal inspiratory (MIP) and expiratory (MEP) pressures, end-tidal carbon dioxide tension (PCO2), and breathing pattern: ventilation (VE), tidal volume (VT), inspiratory time (TI), and respiratory frequency (Rf). Neural respiratory drive, assessed in terms of mean inspiratory flow (VT/TI), mouth occlusion pressure (P0.1), and surface electromyographic activity of the diaphragm (Edi) and intercostal (Eps) muscles was also evaluated. As a whole, patients exhibited mild decrease in MIP; vital capacity was slightly reduced in two patients and TLCO/VA was moderately reduced in three. During a hypercapnic rebreathing test, delta VT/delta PCO2 was lower, delta P0.1/delta PCO2 was normal, while delta Edi/delta PCO2 and delta Eps/delta PCO2 were higher in patients compared with normal control subjects. delta VT/delta PCO2 significantly related to MIP. At 60 mm Hg of PCO2 patients maintained the rapid and shallow pattern of breathing (RSB) exhibited during room-air breathing: lower VT, shorter TI, and greater Rf, with VE, VT/TI, and Edi being greater compared with the normal control subjects. These data seem to indicate that in this SLE subset, mild decrease in respiratory muscle strength may accompany an increased respiratory drive, and contribute to a qualitatively abnormal ventilatory response (RSB) to carbon dioxide stimulation.

The Aging Lung

Structural changes occur in the respiratory system with advancing age. Lung elasticity decreases, stiffness of the chest wall increases, and respiratory muscle strength declines. These alterations contribute to gradual, but progressive, reductions in forced vital capacity, expiratory flow rates, diffusing capacity, gas exchange, ventilatory drive, and respiratory sensation. Cigarette smoking accelerates the age-related decline in flow rates. Understanding the effects of aging on the lung is important in order to distinguish pathologic changes from changes that are part of the normal aging process.