Inspiratory Muscle Training Research Articles

Benefits from Implementing Low- to High-Intensity Inspiratory Muscle Training in Patients Undergoing Cardiac Surgery: A Systematic Review

Cardiac surgery procedures are among the main treatments for people with cardiovascular disease, with physiotherapy playing a vital part. Respiratory complications are common and associated with prolonged Intensive Care Unit (ICU) and hospital stay, as well as increased mortality. Inspiratory muscle training has been found to be beneficial in improving respiratory muscle function in critically ill patients and patients with heart failure. The purpose of this review is to present the results of implementing inspiratory muscle training (IMT) programs in patients before and/or after cardiac surgery. The PubMed, Embase and Science Direct databases were searched from January 2012 to August 2023. In the present review, randomized controlled clinical trials (RCTs), clinical trials and quasi-experimental studies conducted in adult patients pre and/or post cardiac surgery were included. Fifteen studies were considered eligible for inclusion in the review. The results revealed that the IMT programs varied in intensity, repetitions, and duration in all included studies. Most studies implemented the IMT after the surgery. Statistical significance between groups was noted in Maximal Inspiratory Pressure and the 6-Minute Walk Distance Test. Preoperative and postoperative programs could improve inspiratory muscle strength, pulmonary function, and functional capacity as well as decrease the length of hospital stay in patients undergoing cardiac surgery. No clear evidence emerged favoring low or higher IMT intensities. The combination of IMT with other forms of exercise might be beneficial in patients undergoing cardiac surgery. However, further RCTs are required to provide confirming evidence.

Effect of prehabilitation on outcomes following upper gastrointestinal surgery: a systematic review and meta-analysis

It is accepted in several areas of surgery that prehabilitation can improve post-operative outcomes. Prehabilitation describes preoperative interventions aimed at optimizing patient condition prior to surgery to improve postoperative outcomes. It is hypothesized that prehabilitation reduces postoperative complications in the setting of upper gastrointestinal surgery. A systematic search strategy was performed based on a research question formulated with reference to the PICO framework. Eligible studies were those that included a predefined prehabilitation intervention, a comparison to usual care and conducted on patients undergoing upper gastrointestinal surgery. Included studies were evaluated for bias and underwent data extraction. Meta-analysis was also performed for outcomes where possible. Eight studies met criteria for inclusion in this review. The nature and length of prehabilitation programs varied widely, with interventions lasting from two to six weeks. Reported outcomes included post-operative pulmonary complications, mortality and length of hospital stay. A meta-analysis was undertaken for mortality and postoperative pulmonary complications. Meta-analysis showed postoperative pulmonary complications were reduced (RR0.68, 95% CI 0.50-0.93) in the intervention group compared to the control group, as was mortality (RR 0.59, 95% CI 0.35-1.00). Prehabilitation, especially inspiratory muscle training appears to be effective in reducing pulmonary complications in patients scheduled for upper gastrointestinal surgery. With the available data it is uncertain if this translates to reduced length of stay or mortality. There is scope for further research to better define a role for prehabilitation in upper gastrointestinal surgery, specifically the optimal prehabilitation modality and length.

Interventions for the management of long covid (post-covid condition): living systematic review

ObjectiveTo compare the effectiveness of interventions for the management of long covid (post-covid condition).DesignLiving systematic review.Data sourcesMedline, Embase, CINAHL, PsycInfo, Allied and Complementary Medicine Database, and Cochrane Central Register of...

The Effect of Added Mass on Pulmonary Function

A comparative study of the volume-velocity parameters of the human external respiration system was carried out under the influence of an additional weight load: a body armor weighing 11 kg and a backpack weighing 15 kg. The nature of changes in the main spirometric parameters under the influence of an added mass is typical for restrictive disorders of pulmonary function. A marked decrease in forced vital capacity (FVC) and forced expiratory volume in 1 second (FEV1) values was observed when performing the test with a protective vest. In the conditions of a combination of body armor and a backpack, these changes were more pronounced (p 0.01). At the same time, there were no significant changes in the Tiffno index values (FEV1/FVC). In addition, a significant decrease in the values of maximum voluntary ventilation (MVV) was revealed by 8.1% under the influence of body armor, and by 18.5% with a combination of a vest and a backpack relative to the control (p 0.01). A significant correlation was shown between the maximum force of contraction of the inspiratory muscles and the maximum voluntary ventilation of the lungs both in the control and with an additional weight load. It is possible that the inspiratory muscles training, aimed at increasing their strength and endurance, can be an effective strategy for minimizing the adverse effects of increased weight load when performing work with special protective equipment in various areas of human professional activity.

OGC SO28 - Predictors of Pulmonary Complications Following Thoracoscopic Oesophagectomy

Abstract Background Thoracoscopic oesophagectomy, a minimally invasive technique, is associated with less postoperative pain and reduced pulmonary dysfunction. There is a correlation between preoperative cardiopulmonary fitness and postoperative outcomes, with certain variables linked to a higher risk of complications following oesophagogastric cancer surgery. This review aims to identify variables that correlate with pulmonary complications after oesophagectomy. Method A retrospective review of patients undergoing thoracoscopic oesophagectomy between 2014 -2022 at a single oesophagogastric unit was performed. 96 patients were identified and separated into two groups (19 with serious complications (SC) (greater than Clavien Dindo 3b), and 77 without serious complications (Clavien Dindo 3a and below)(NC). The primary outcomes measured included FEV1, FVC, VE/VCO2, VO2 Peak, anaerobic threshold, Estimated Met Score (EMS). Secondary outcomes measured preexisting pulmonary complications, smoking status and operating (chest time, one lung ventilation time (OLVT)). Results Groups were similar in age, gender, BMI, ASA, and clinical stage. SC had a significantly less number of smokers (p=0.004) and less individuals with pulmonary disease (p=0.019). AT was higher in NC (14.15 vs 13.50, p=0.355) and VE/VCO2 was significantly greater in SC (28 vs 32, p=0.018). SC had a significantly lower FEV1 and FVC (2.12 vs 2.81, p=0.009 and 3.11 vs 3.80, p=0.010) and a trend towards a lower EMS (6.95 vs 7.25, p=0.245). There was no significant difference in chest time between NC and SC (295min vs 265min, p=0.151) and OLVT (270min vs 245min, p=0.381) in both groups. Conclusion VE/VCO2 ratio in thoracoscopic oesophagectomy patients is a significant predictor of postoperative complications and has increasing links to adverse outcomes. Smoking status and pulmonary history do not significantly correlate with pulmonary complications in our cohort. Lower EMS, FEV1, and FVC are significantly associated with complications. Although preoperative inspiratory muscle training has not broadly impacted postoperative outcomes, it may benefit specific groups. These variables are crucial for clinicians to consider when counselling patients and planning prehabilitation.

Effects of Inspiratory Muscle Training in People with Chronic Obstructive Pulmonary Disease: A Systematic Review and Meta-Analysis.

This study aimed to investigate the effects of inspiratory muscle training (IMT) on inspiratory muscle strength, dyspnea, and quality of life (QOL) in COPD patients. A comprehensive search was undertaken on the Web of Science, Scopus, Embase, Cochrane, and PubMed databases, encompassing data published up to 31 March 2024. A meta-analysis was subsequently conducted to quantify the standardized mean difference (SMD) and 95% confidence interval (CI) for the effects of IMT in COPD patients. Sixteen studies met the inclusion criteria. IMT significantly improved inspiratory muscle strength (SMD, 0.86, p < 0.00001), dyspnea (SMD = -0.50, p < 0.00001), and QOL (SMD = 0.48, p = 0.0006). Subgroup analysis showed that <60% maximal inspiratory muscle pressure (PImax) IMT (inspiratory muscle strength, SMD = 1.22, p = 0.005; dyspnea, SMD = -0.92, p < 0.0001), IMT conducted for ≤20 min (inspiratory muscle strength, SMD = 0.97, p = 0.008; dyspnea, SMD = -0.63, p = 0.007; QOL, SMD = 1.66, p = 0.007), and IMT conducted >3 times per week (inspiratory muscle strength, SMD = 1.06, p < 0.00001; dyspnea, SMD = -0.54, p < 0.00001; QOL, SMD = 0.48, p = 0.0009) had greater effects. This meta-analysis provides clinicians with evidence supporting the recommendation that COPD patients engage in IMT at <60% PImax for more than 3 times per week, with each session lasting no more than 20 min, to improve inspiratory muscle strength, dyspnea, and QOL.

Effects of Inspiratory Muscle Training in Patients with COPD Exacerbations: A Randomized Controlled Trial

Abstract Objective Pulmonary rehabilitation (PR) is considered for patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). However, the impact of adding inspiratory muscle training (IMT) to PR on inspiratory muscle function is underexplored. This study aimed to evaluate the effects of IMT in addition to PR on inspiratory muscle function, functional exercise capacity (FEC), and quality of life (QoL) in patients with AECOPD. Design 16 patients with AECOPD and a maximal inspiratory pressure (PImax) &lt; 80 cmH2O were randomized into the experimental (PR + IMT) or the control (PR + sham IMT) group for an eight-week intervention. Inspiratory muscle activation was measured using surface electromyography, FEC was examined by six-minute walk distance (6MWD), and QoL was assessed with COPD Assessment Test (CAT). Results The experimental group showed sustained and significant improvements in inspiratory muscle function, 6MWD, and QoL after intervention (all p &lt; 0.05). The experimental group had higher PImax with less diaphragm activation (both p &lt; 0.001) and more improvements in 6MWD and QoL after intervention (both p &lt; 0.05). Conclusions Adding IMT to PR resulted in more improvements in inspiratory muscle function, FEC, and QoL for patients with AECOPD, suggesting IMT as a beneficial addition to PR.

The optimal treatment duration for inspiratory muscle strengthening exercises in stroke patients: a double-blinded randomized controlled trial

ABSTRACT Background Little is known about the ideal duration of inspiratory muscle training in stroke patients. Objective The aim of this study was to assess the effects of short-term and long-term inspiratory muscle strengthening exercises in stroke patients. Methods This study was a prospective, double-blind, randomized controlled trial involving 50 stroke patients. Based on baseline maximum inspiratory pressure (MIP) values, participants were divided into two strata: those with severely weak inspiratory muscle (stratum A) and those with moderately weak inspiratory muscle (stratum B). Within each stratum, individuals were randomly assigned to either the 4-week exercise group, the 8-week exercise group, or the sham group. The exercise groups underwent inspiratory muscle strengthening exercises. The MIP, 6-minute walk test (6MWT), and the Nottingham Extended Activities of Daily Living (NEADL) Index were assessed at baseline, 8, 12, and 24 weeks. Results Subjects in Stratum A exhibited notably greater improvement after 8 weeks of training compared to those in Stratum B. Furthermore, both Stratums displayed significantly greater improvement following 8 weeks of training compared to sham training. In Stratum B cases, a significantly higher level of improvement was noted with the 4-week training in comparison to the sham training. A significant increase in NEADL index and 6MWT score was observed during the 24-week follow-up period. Conclusion For individuals with moderately weak inspiratory muscle strength, a 4-week exercise program proves sufficient in enhancing inspiratory muscle strength, walking capacity, and daily life activities. However, individuals with severely weak inspiratory muscle strength benefit more from an 8-week treatment.

Effects of Respiratory Muscle Training Pre- and Post-Cardiac Surgery in Adults: A Scoping Review.

Coronary artery bypass grafts (CABGs) and cardiac valve replacement surgeries (CVRSs) are common lifesaving cardiac surgeries. They are linked to an increased risk of postoperative pulmonary complications (PPCs). This review scopes the effects of inspiratory muscle training (IMT) on adult patients, considering mainly exercise capacity, lung function, and the occurrence of PPCs. This scoping review was built using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). Four databases were searched in May 2024. Three reviewers independently screened the articles. The data were extracted and summarised in text and tables. Five studies were included in the final analysis, where IMT was compared to sham or placebo IMT, and some studies added an exercise program to both groups. PeakVO2, the six-minute walking test (6MWT), maximal inspiratory pressure (MIP), quality of life (QoL), PPCs, and spirometry outcomes showed significant improvements between the intervention group (IG) and control group (CG) and intragroup over time. IMT can be a non-conventional training method to prevent respiratory muscle weakness. It can be applied in pre- or post-surgical contexts, potentially affecting exercise capacity and quality of life in adult patients undergoing cardiac surgery.

Effects of Respiratory Training on Pulmonary Function, Cough, and Functional Independence in Patients with Amyotrophic Lateral Sclerosis.

Respiratory complications in patients with amyotrophic lateral sclerosis (ALS), due to the involvement of respiratory muscles, are the leading cause of death, and respiratory physiotherapy (RP) focuses on addressing these complications. The objective was to evaluate the effectiveness of an RP intervention that combines the four specific techniques (inspiratory muscle training, lung volume recruitment, manually assisted coughing, and diaphragmatic breathing training) in patients with ALS. A quasi-experimental study was carried out, and a specific RP programme was implemented in 15 patients with ALS (12 sessions, 30 min/session, one session/week, duration of three months), based on directed ventilation techniques, lung volume recruitment, manually assisted coughing, and the use of incentive spirometry and a cough assist device, along with a daily home exercise programme. Respiratory functions were assessed (pre- and post-intervention, with follow-up at three months) using Forced Vital Capacity (FVC) and Peak Expiratory Cough Flow (PECF); functionality was assessed using the Revised ALS Functional Rating Scale (ALSFRS-R) and the Modified Barthel Index by Granger. FVC experienced an increase after three months of the intervention initiation (p = 0.30), which was not sustained at the three-month follow-up after the intervention ended. All other variables remained practically constant after treatment, with their values decreasing at follow-up. A specific RP intervention could have beneficial effects on respiratory functions, potentially preventing pulmonary infections and hospitalisations in patients with ALS. It may improve FVC and help stabilize the patient's functional decline. Considering the progressive and degenerative nature of the disease, this finding could support the usefulness of these techniques in maintaining respiratory function.

Effect of preoperative inspiratory muscle training combined with preoperative education on postoperative pulmonary complications in high-risk patients with lung cancer: protocol for a randomised controlled trial

IntroductionPreoperative inspiratory muscle training (IMT) is recognised as an important component of the preoperative management of lung cancer, although there is limited evidence for the delivery of a home-based IMT...

Does Inspiratory Muscle Training Affect Respiratory Parameters? The Different Effects of Diaphragm Muscle-Focused Respiratory Exercise

Does Inspiratory Muscle Training Affect Respiratory Parameters? The Different Effects of Diaphragm Muscle-Focused Respiratory Exercise

The value of inspiratory muscle training on poststroke sarcopenia and its effect on rehabilitation outcomes: A randomized controlled trial

Objectives: The purpose of the study was to validate the effectiveness of inspiratory muscle training (IMT) in preventing poststroke sarcopenia and to examine the impact of IMT on the prognosis for stroke recovery. Patients and methods: In the randomized controlled trial, 367 patients with a first stroke event between December 2021 and May 2023 were randomly allocated to an experimental group and a control group. Of the patients, 329 (179 males, 150 females; mean age: 61.0±8.7 years; range, 35 to 78 years) completed the experiment and were included in the analyses (experimental group, n=164; control group, n=165). Both groups received conventional neurological rehabilitation treatment, and the experimental group also received IMT. The incidence of poststroke sarcopenia and pneumonia during four weeks of treatment were examined and compared. Additionally, an analysis was conducted on the variations between the two groups in maximal inspiratory pressure (MIP), modified Rankin scale (mRS), trunk impact scale (TIS), and modified Barthel index (MBI). Results: Following four weeks of therapy, the experimental group experienced a reduced incidence of poststroke sarcopenia (p=0.004) and pneumonia (p=0.017) than the control group. The trial group performed better than the control group in MBI (p=0.002), TIS (p&lt;0.001), MIP (p&lt;0.001), and mRS (p=0.011) scores after intervention. Conclusion: In conclusion, the findings demonstrate that early IMT can significantly lower the risk of poststroke sarcopenia and pneumonia while also improving the prognosis for stroke patients’ recovery.

Inspiratory Muscle Training Using Tapered Flow Resistive Loading to Enhance Pulmonary Function in Smokers: A Randomized Controlled Trial

Inspiratory Muscle Training Using Tapered Flow Resistive Loading to Enhance Pulmonary Function in Smokers: A Randomized Controlled Trial

The impact of exercise training in Fontan procedure patients: a systematic review and meta-analysis

Abstract Background Patients undergoing the Fontan procedure experience long-term complications related to decreased exercise capacity. Exercise training(ET) has emerged as a non-pharmacological solution for increasing cardiorespiratory fitness. However, the effect and safety of exercise training in patients following the Fontan procedure are still unclear. Objectives We aimed to perform a meta-analysis comparing ET versus no exercise intervention for patients following Fontan operation in efficacy and safety outcomes. Methods We systematically searched PubMed, Embase, and Cochrane databases on November 23, 2023, for randomized controlled trials (RCTs) comparing ET, including aerobic, endurance, or inspiratory muscle training, versus no exercise intervention in patients following Fontan operation. We computed mean differences (MD) with a 95% confidence interval (CI) for continuous endpoints. The primary endpoint was (1) peak O2 consumption. Our study also included the secondary endpoints of: (2) maximum workload; (3) peak heart rate(HR); and (4) peak saturation of O2. We performed a subgroup analysis between different exercise therapies. Results This meta-analysis included five RCTs and 154 patients. Follow-up ranged from 3 to 6 months. Regarding ET, two studies used aerobics, one used endurance, and three used inspiratory muscle therapy as exercise therapy for patients with Fontan operations. Our findings on the maximum workload endpoint were more significant for exercise therapy (MD 20.98W; 95% CI 5.32 to 36.65; p&amp;lt;0.01; Fig. 1A) compared to no intervention group. However, there was no significant difference in peak oxygen (MD 2.03 ml/kg/min; 95% CI -0.29 to 4.35; p=0.095; Fig. 1B), peak HR (MD 1.10 bpm; 95% CI -4.07 to 6.27; p=0.68); and peak saturation of O2 (MD 0.39%; 95% CI -1.93 to 2.72; p=0.74). A subgroup analysis between different ET types (aerobic vs. endurance vs. inspiratory muscle training) showed no significant subgroup interaction(p=0.91; Fig. 1B). Conclusion In this meta-analysis, ET is associated with a slight increase in maximum workload in patients following the Fontan procedure. Further multicenter RCTs are warranted to assess the efficacy of comparing different types of ET and their impact on peak oxygen consumption.

Prehabilitation Interventions for Cardiac Surgery to Prevent Postoperative Pulmonary Complications: Systematic Review and Meta-Analysis.

Postoperative pulmonary complications (PPCs) are associated with a higher risk of morbidity and mortality in patients undergoing cardiac surgery. We aimed to investigate the effect of preoperative interventions on PPCs and length of intensive care unit and hospital stay in patients undergoing cardiac surgery. A systematic review and meta-analysis was conducted on randomized or quasi-randomized trials by searching PubMed, Medline, ISI Web of Science, Science Direct, Physiotherapy Evidence Database (PEDro), and the Cochrane Library for all available years until December 2023. Our primary outcomes were PPCs including atelectasis and Pneumonia and secondary outcomes were length of intensive care unit and hospital stay. Twenty-one included trials provide data on 2895 participants. The preoperative intervention of inspiratory muscle training (IMT) significantly reduced the PPCs including atelectasis (OR: 0.49, 95%CI: 0.28, 0.86) and Pneumonia (OR: 0.41, 95%CI: 0.25, 0.67) in cardiac patients compared with the control group. Preoperative exercise training intervention is significantly associated with a lower risk (OR: 0.15, 95%CI: 0.06, 0.38) of composite PPCs (i.e. atelectasis and Pneumonia) in the intervention group. Preoperative IMT significantly reduced the postoperative hospital stay by -1.57 days (95% CI: -2.33, -0.81) in the intervention group. Preoperative exercise training significantly decreased the postoperative intensive care unit stay by -2.22 hours (95% CI: -3.05, -1.38) and hospital stay by -1.82 days (95% CI: -3.38, -0.27) in the intervention group. Preoperative intervention of IMT and exercise training significantly reduce PPCs and hospital stay in patients undergoing cardiac surgery.

Efficacy of Inspiratory Muscle Training in Patients With Acute Decompensated Heart Failure.

Inspiratory muscle training (IMT) is supported for outpatients with stable chronic heart failure, but its efficacy in hospitalized patients with acute decompensated heart failure (ADHF) remains unclear. The aim of the present study was to clarify IMT efficacy and safety in hospitalized ADHF patients. Patients with inspiratory muscle weakness who underwent cardiac rehabilitation (CR) were analyzed. The control group was historical control data of patients admitted to the same facility. IMT was performed at 30% maximal inspiratory mouth pressure (15 reps/set, 2 sets/day, 5 times/week) with usual CR. Associations between IMT and changes in the 2-min walking distance (2MWD) were assessed using a linear mixed model. In total, 31 and 29 patients in the IMT and control groups (median age 83 [71-88] vs. 86 [77-88] years), respectively, were analyzed. After adjustment for covariates and propensity scores, calculated on the basis of heart-failure severity, frailty, physical function, nutritional status, and inspiratory muscle strength, the 2MWD was significantly higher in the IMT group than in the control group (F=4.697; P=0.035; ∆2MWD; +31.9 vs. +16.3 m). Among 348 IMT sessions, no adverse cardiovascular events or absolute termination criteria were identified. Eleven (3.2%) IMT sessions met relative termination criteria. Adding IMT to usual CR improves the 2MWD, can be safely performed in hospitalized patients with ADHF, and may represent a novel CR approach in patients with ADHF.

Nursing Practices for Dyspnea Management in Patients with Cancer Based on Monthly and Weekly Prognoses: A Multi-Site Cross-Sectional Study of Palliative Care Nurses in Japan.

Dyspnea in patients with terminal cancer worsens near death, necessitating effective nonpharmacological management. Despite guideline recommendations, detailed studies on nonpharmacological nursing practices are scarce. This study aimed to elucidate nursing practices for dyspnea in patients with cancer based on monthly and weekly prognoses. A multi-site cross-sectional study was conducted among nurses in 389 palliative care units in Japan. The study surveyed the frequency of direct care practices for dyspnea management (nurse-led intervention, multidisciplinary intervention, psychoeducational programs, breathing techniques, walking therapy, inspiratory muscle training, respiratory rehabilitation, yoga, acupressure, fan therapy, guided imagery, abdominal massage, aromatherapy, and a reduction in room temperature and humidity) in patients with cancer with monthly and weekly prognoses. Of the 389 invited units, 162 participated. From these, 2448 registered nurses were invited and 539 (22.3%) responded. Almost similar nursing practices were provided regardless of patient prognosis. Nurse-led intervention was the most frequently practiced, followed by room temperature and humidity reduction, multidisciplinary intervention, and fan therapy. Yoga, respiratory rehabilitation, and acupressure were rarely practiced. Nursing practices for dyspnea are similar, irrespective of prognosis. Nurse-led interventions, reducing room temperature and humidity, multidisciplinary intervention, and fan therapy are frequently used for dyspnea in patients with cancer. Future studies should evaluate the effectiveness of these nursing practices.

Inspiratory muscle training improves autonomic function in myalgic encephalomyelitis/chronic fatigue syndrome and post-acute sequelae of SARS-CoV-2: A pilot study

Post-acute sequelae of SARS-CoV-2 (PASC), or Long COVID, and myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) are debilitating post-viral conditions with many symptomatic overlaps, including exercise intolerance and autonomic dysfunction. Both conditions are growing in prevalence, and effective safe treatment strategies must be investigated. We hypothesized that inspiratory muscle training (IMT) could be used in PASC and mild to moderate ME/CFS to mitigate symptoms, improve exercise capacity, and improve autonomic function. We recruited healthy controls (n=12; 10 women), people with PASC (n=9; 8 women), and people with mild to moderate ME/CFS (n=12; 10 women) to complete 8 weeks of IMT. This project was registered as a clinical trial (NCT05196529) with clinicaltrials.gov. After completion of IMT, all groups experienced improvements in inspiratory muscle pressure (p<0.001), 6-minute walk distance (p=0.002), resting heart rate (p=0.037), heart rate variability (p<0.05), and symptoms related to sleep (p=0.009). In the ME/CFS group only, after completion of IMT, there were additional improvements with regard to vascular function (p=0.001), secretomotor function (p=0.023), the total weighted score (p=0.005) of the COMPASS 31 autonomic questionnaire, and symptoms related to pain (p=0.016). We found that after 8 weeks of IMT, people with PASC and/or ME/CFS could see some overall improvements in their autonomic function and symptomology.

Effectiveness of Threshold-Pressure Inspiratory Muscle Training on Pulmonary Rehabilitation in Children and Adolescents with Asthma.

The objective of this systematic review and meta-analysis was to assess the effectiveness of TIMT on pulmonary function in children and adolescents with asthma. We searched for randomized controlled clinical trials in the MEDLINE, Embase, the Cochrane Library, Web of Science, CINAHL, Sino Med, Wan fang, CNKI, and VIP until March 2024. In addition, the references included in the literature and the relevant systematic evaluation were manually traced in order to avoid the omission of any relevant literature. These trials compared TIMT against blank TIMT and conventional care. Eligible studies were assessed in terms of risk of bias and quality of evidence using RoB II tool. Where feasible, data were pooled and subjected to meta-analysis. The mean difference (MD) and 95% confidence interval (CI) were estimated by fixed effect models or random effect models. Six studies were included in the present meta-analysis involving 337 children and adolescents ranged from 4 to 18 years. The meta-analysis showed that TIMT could significantly improve lung function. Compared to the control group, TIMT can significantly improve FEV1 (MD 4.63 mL, 95% CI 2.64 to 6.62 mL, I2 = 4%), FVC (to the control group (MD 7.46 mL, 95% CI 5.09 to 9.82 mL, I2 = 0%), FEV1/FVC (MD 7.33%, 95% CI: 5.01 to 9.65%) and ACT (MD 1.86, 95% CI 0.96 to 2.75 mL, I2 = 12%) of patients at the end of intervention. There was no significant heterogeneity in these meta-analyses. In conclusion, the results of this systematic review and meta-analysis support the effectiveness of TIMT training in restoring lung function and relieving asthma symptoms of asthmatic children. More high-quality and RCTs with large sample size are urgently required to verify the conclusion.