Maximum Inspiratory Research Articles

Noninvasive Ventilation as an Important Adjunct to an Exercise Training Program in Subjects With Moderate to Severe COPD.

The primary objective of this study was to investigate whether noninvasive ventilation (NIV) can positively affect exercise capacity, maximum oxygen uptake (V̇O2 ), and symptoms after a 6-week physical training program for subjects with moderate to very severe COPD. 47 subjects with COPD who were enrolled in a physical training program were randomized to either physical training alone or NIV + physical training (NIV-Physical training). Physical training consisted of dynamic aerobic exercises on a treadmill 3 times/week for 6 weeks, for a total of 18 sessions. NIV was titrated according to the subject's tolerance at rest and during exercise. Assessments included physiological responses and symptoms at the incremental cardiopulmonary exercise test peak and during submaximal exercise on a treadmill, 6-min walk distance, maximum inspiratory (PImax) and expiratory pressure (PEmax), BODE index, and health-related quality of life. 43 subjects completed the 6-week physical training program. Both groups improved 6-min walk distance, PImax, BODE index, and quality of life, and no differences were found between groups. However, significant improvements were observed for subjects in the NIV-Physical training group with regard to PEmax, maximum V̇O2 , maximum metabolic equivalents, circulatory power, and maximum SpO2 . A 6-week physical training program alone can improve tolerance for exercise and quality of life, in addition to reducing the risk of mortality. However, NIV associated with a physical training program was shown to have an additive beneficial effect on powerful prognostic markers (maximum V̇O2 and circulatory power) and to reduce symptoms and improve oxygen saturation in subjects with moderate to very severe COPD.

PECULIARITIES OF THE CHANGE IN THE RESPIRATORY MUSCLES STRENGTH IN PATIENTS WITH 2 TYPE OF DIABETES MELLITUS COMPLICATED BY THE DIABETIC FOOT SYNDROME

The relationship between cardiorespiratory disorders and diabetic foot syndrome has not been adequately studied. In particular, there is no information on the strength of the respiratory muscles in this category of patients. The purpose of the study: to determine the presence of respiratory muscles weakness in patients with type 2 diabetes mellitus complicated by diabetic foot syndrome. Materials and methods. 72 patients were examined, 16 of them with type 2 diabetes mellitus complicated by the neuroischemic type of diabetic foot syndrome I-IV st. Wagner made up the first (main) group. The second group (comparisons) included 29 patients with type 2 diabetes mellitus not complicated by diabetic foot syndrome. The third group (comparisons) were 27 patients without diabetes. The groups were randomized by sex and exclusion criteria. Determination of the strength of the respiratory muscles was carried out by measuring the maximum static pressure levels at the mouth level that the patient created during maximum inspiration and maximum expiration in closed airways. Results. The forces of the respiratory muscles with inspiratory effort in patients with type 2 diabetes mellitus complicated by diabetic foot syndrome was reduced by 18.5 cm of water column (p <0.01) compared with diabetic patients without diabetic foot syndrome and by 17.3 cm water column (p <0.01) compared with patients without diabetes. The expiratory effort showed a decrease in the forces of the respiratory muscles in the patients of the first group by 49.4 cm of water column (p <0.01) compared to patients of the second group and by 27.4 cm of water column (p <0.05) compared to patients third group. In women with diabetic foot syndrome, the inspiratory muscular forces was reduced in comparison with patients without diabetic foot and without diabetes syndrome by 27.1 (p <0.01) and by 23.3 (p< 0.05) cm of water column, respectively. In men with diabetic foot syndrome, the same index was lowered by 13.9 (p> 0.05) and 17.7 (p <0.05) cm of water column, respectively, compared to the second and third groups, respectively. The expiratory effort revealed a decrease in the forces of the respiratory muscles in men in all groups in approximately the same range, without a significant difference between the groups. In women with diabetic foot syndrome, there is a marked decrease in the strength of the expiratory muscles: by 48.4 cm of water column (p <0.01), compared to women of the second group and by 20.6 cm of water column (p <0.05) patients of the third group. Conclusions. Patients with diabetes mellitus complicated by diabetic foot syndrome showed a decrease in the strength of inspiratory and expiratory muscle. In women with diabetic foot syndrome, there is a more pronounced decrease in the strength of the respiratory muscles during exhalation compared to men with this pathology.

Effect of Manual Therapy, Motor Control Exercise, and Inspiratory Muscle Training on Maximum Inspiratory Pressure and Postural Measures in Moderate Smokers: A Randomized Controlled Trial

ObjectiveThe aim of this study is to assess whether adding manual therapy to motor control exercises protocol with inspiratory muscle training (IMT) (combined intervention) resulted in a greater effect than IMT alone in enhancing maximum inspiratory pressure (MIP) in the short term. MethodsThis was a single-blind, randomized, controlled trial. Fifty-one healthy moderate smokers were randomized into 2 groups: (1) IMT and (2) combined intervention. All participants received 8 individual sessions, 2 per week during a 4-week period. The primary outcome (MIP) and the secondary outcome (pulmonary function, forward head posture, and thoracic kyphosis) were recorded at baseline and after the treatments. ResultsThere were differences between groups in change score for MIP (mean, 23.8; 95% confidence interval [CI]: 16.48-31.12), forward head posture (−1.57; 95% CI: –2.79 to –0.35), and thoracic kyphosis (–0.92; 95% CI: –1.74 to –0.1). The combined intervention revealed statistically significant differences for MIP (mean, –34; 95% CI: –39.12 to –28.88) and for postural measures (forward head posture 2.31; 95% CI: 1.45-3.16; thoracic kyphosis, 1.39; 95% CI: 0.8-1.97), whereas the IMT was only observed for MIP (mean, –10.2; 95% CI: –15.42 to –4.98). In addition, the intraclass correlation coefficient and minimal detectable change for MIP were 0.96; 95% CI: 0.93-0.97, and 17.70, respectively. ConclusionInspiratory muscle training protocol combined with manual therapy and motor control exercise had greater effect in enhancing MIP than did IMT in isolation in moderate smokers in the short term. In addition, both groups experienced changes in MIP but not in lung function.

Maximal Respiratory Pressures, their Association with Spirometric Parameters, Swimming Skills and Changes Due to Immersion in Water

Research background and hypothesis. We checked hypothesis that swimming skill improvement is more dependent on inspiratory muscle strength than endurance volume to be ventilated.Research aim was to determine associations between maximal static inspiratory (MIP) and expiratory (MEP) pressures, swimming skills, parameters of forced spirometry. Research methods. Investigation involved 62 female students (age 22.13 ± 1.3 years, height 168.4 ± 6.6 cm, and weight 61.3 ± 7.0 kg) of the Latvian Academy of Sports Education. All of them were non-smokers. Swimming skills in four strokes were evaluated by a swimming coach. MIP and MEP were measured at the mouth level outside the swimming pool and repeated in the swimming pool while the subject was immersed up to the neck level. Forced spirometry was performed according ATS guidelines outside the water. Research results. Average value for MIP outside the water was 109 ± 30 cm H 2 0 and for MEP it was 147 ± 33 cm H 2 0. There was positive correlation between peak expiratory flow and MIP, MEP, and the rate of increase of both pressures (p < 0.05). Forced vital capacity was not related to maximal pressures. Faster rate of inspiratory pressure increase was positively related to forced inspiratory volume in one second (p < 0.05). There was a significant decrease of MIP and the rate of increase of inspiratory pressure in the immersion state while no changes of expiratory parameters were observed. Discussion and conclusions. Swimming skill improvement is more dependent on inspiratory muscle strength than volume to be ventilated. Students with higher PEF have higher respiratory pressure parameters. Immersion in water decreases MIP, IMRPD and increases IMMRR. Changes of these parameters due to immersion are not related to swimming skills.Keywords: maximal inspiratory pressure, maximal expiratory pressure, swimming education, immersion in water.

A Role for Resistance Exercise in Cancer: Destruction of Circulating Tumor Cells in Contracting Muscle

OBJECTIVEAt the Roswell Park Cancer Institute in the 1980s, Leonard Weiss explored why muscle tissue gets few cancer metastases, despite its large blood flow. (Weiss, L., 1992. Biomechanical interactions of cancer cells with the microvasculature Cancer Metastasis Rev, 11(3), pp.227–235). He found that circulating tumor cells were destroyed in contracting quadriceps muscles and cardiac tissue, and during maximal lung inspiration. He further showed that as cancer cells squeeze through the much smaller capillaries, they elongate to the maximum extension of the cell membrane and hypothesized that additional forces on the cancer cell wall caused cell rupture. We analyzed Weiss' published lung data during a maximal inspiration, and found this induces radial stress of 8.7 KpA on a 4.6 mm diameter lung capillary. In our study, mathematical models were applied to ultrasound generated architectural data of the contracting biceps muscle, to determine radial stress under different exercise conditions.METHODS12 healthy males age 20–30 were asked to flex the right elbow from 5° to 90°, with no load, and then with a 10 pound weight, in supine and standing. Longitudinal 2D B‐mode ultrasound was performed of the long head of the biceps brachii muscle at specific measured locations based upon its proximal portion at the intertubercular groove and distal region at the anterior elbow joint line. Muscle length and maximum diameter was recorded and the truncated cone of the muscle image was converted to a cylinder of the same maximum diameter and shorter length (to keep constant volume). Odegard's strain energy function for small and large deformations associated with the active and passive response of transversely isotropic skeletal muscle was used to determine longitudinal and radial strain and stress, Young's modulus, and stiffness.RESULTSWe found the radial stress during biceps contraction to be: 1) 46 ± 26 KpA with the elbow unloaded at 90°; 2) 42 ± 17 KpA with participant in supine, the elbow at 90° and a 10 pound load on the biceps; and 3) 48±24 KpA with the participant standing and the biceps loaded with 10 pounds. With the elbow in 5° flexion, the radial stress is much lower, (15 KpA), at both loads and in both supine and standing.CONCLUSIONSShortening of biceps muscle results in radial stress well above the level calculated to rupture circulating tumor cells in the lungs. Muscle capillaries have stiffening of their wall, so the high radial stress of a short length contraction may be necessary for tumor cell destruction in muscle tissue. Large muscle metastases are found in very few persons with common cancers – lung (2%), colon (1%), breast and prostate (<.5%). In contrast, extraocular muscles rarely contract to their shortest, and metastases are found here in 6% of persons with locally advanced or metastatic breast cancer, and in 12% of all persons dying of cancer. Normal resting cardiac output (CO) is 5 l/min, with a pulse of 80 and a blood volume of 5 liters. Resistance exercise sufficient to raise pulse rate 50% to 120 will raise CO similarly 50% to 7.5 liters/min, with 1/3 the cardiac output now going through the exercising muscle. Every minute of exercise thus leaves 2/3 blood volume unfiltered. After a short 7 minutes of this level of exercise, all but .677 or 0.02% of the blood volume will have passed through the exercising muscle. We suggest design of exercise for persons with cancer based on aspects of muscle and capillary architecture.This abstract is from the Experimental Biology 2018 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

EP-2053: Treating moving targets with scanned proton therapy: Is 5 mm initial tumour motion a safe threshold?

Purpose/Objective Pencil beam scanning (PBS) is a highly conformal technology to treat cancer. The time structure of PBS makes the treatment of moving tumours challenging due to the interplay effect. According to literature, PBS in combination with rescanning can be safely applied without motion mitigation strategies to lung tumours that move 5 mm or less. However, the question is whether the motion measured during treatment simulation will remain below 5 mm during the course of treatment. We investigated the inter-fractional lung tumour motion variation in a unique data set providing five repeated 4DCTs per patient, to evaluate if a 5 mm threshold is a reliable indicator for considering PBS treatments. Material/Methods For 19 NSCLC patients (11 male, 8 female, age: 47-89, stage: II-IV) weekly 4DCT imaging was performed during treatment simulation before and during the treatment course to monitor the anatomical changes and differences in motion. Gross tumour volumes (GTV) were delineated on the maximum inspiration and expiration phases of the planning 4DCT and on the weekly repeat 4DCTs. GTV volume changes were acquired and the weekly inter-fraction motion variation was evaluated by measuring the GTV centroid translations in all three directions. Results The patients showed a median initial tumour motion of 1.3 mm (range: 0.0 – 5.1 mm) for a median initial GTV volume of 28.7 cm3 (range: 1.9 – 430.0 cm3). Figure 1 shows the measured 3D-vector motion for week 0 (before start treatment) and week 1-5 (treatment course). The maximum deviation from the initial measured motion for the patients was on average 2.1 mm (range: 0.3 – 7.9 mm). Centroid displacements remained under 5 mm for 16 out of 19 patients over the entire course of treatment. For patients number 3, 4 and 11, an increase in motion up to a maximum of respectively 9.1, 11.2, and 6.5 mm was observed (Figure 2). GTV volumes for 15 out of 19 patients shrank during treatment with a median decrease of 35.4% (range: 10.8% - 63.7%), and a median absolute volume change of 8.3 cm3 (range: 0.5 - 105.9 cm3). Conclusion Even if the lung tumour motion during planning simulation is under 5 mm, variations in motion amplitude and larger motions can still occur during the course of treatment. This indicates that the use of daily tumour motion evaluation is required for PBS treatments, especially for hypo-fractionated treatments. Future work will include a risk-stratification for motion variations in lung patients based on initial tumour motion, tumour position and tumour volume for different PBS spot sizes, time structure and prescribed treatment courses.

Time to Exhale: Additional Value of Expiratory Chest CT in Chronic Obstructive Pulmonary Disease.

Objectives Diagnostic guidelines for chronic obstructive pulmonary disease (COPD) are based on spirometry and clinical criteria. However, this does not address the pathophysiological complexity of the disease sufficiently. Until now, inspiratory chest computed tomography (CT) has been considered as the preferred imaging method in these patients. We hypothesized that expiratory CT may be superior to demonstrate pathophysiological changes. The aim of this prospective study was to systematically compare lung function tests with quantified CT parameters in inspiration and expiration. Materials and Methods Forty-six patients with diagnosed COPD underwent spirometry, body plethysmography, and dose-optimized CT in maximal inspiration and expiration. Four quantified CT parameters were acquired in inspiration, expiration, and their calculated delta values. These parameters were correlated with seven established lung function parameters. Results For inspiratory scans, a weak-to-moderate correlation with the lung function parameters was found. These correlations significantly improved when adding the expiratory scan (p < 0.05). Moreover, some parameters showed a significant correlation only in expiratory datasets. Calculated delta values showed even stronger correlation with lung function testing. Conclusions Expiratory quantified CT and calculated delta values significantly improve the correlation with lung function parameters. Thus, an additional expiratory CT may improve image-based phenotyping of patients with COPD.

Impact of group-singing on older adult health in senior living communities: A pilot study

PurposeParticipating in a group-singing program may be beneficial to healthy aging through engaging in active music-making activities and breathing exercises. The purpose of this study was to assess the feasibility, acceptability, and impact of a 12-week group singing program on cognitive function, lung health and quality of life (QoL) of older adults. Materials and methodsA pre and post-test quasi-experimental design evaluated the impact of a group-singing program on older adult health. The intervention consisted of pre-singing exercises, song-singing and learning, and socialization. Classes were 75 min/week for 12 weeks. Inclusion criteria were age ≥60, no self-reported diagnosis of dementia, and able to hear conversations within 2 feet. Participants were recruited from 3 senior living communities. Outcome measures included cognition, lung function, QoL, and program feasibility and acceptability. A paired t-test with 2-sided alpha level at 0.05 was used to test the null hypotheses. ResultsWe enrolled 49 participants (mean age 83.6). Forty-two (86%) completed the posttests and exit survey. At the 12th week there was significant improvement in phonological (p < 0.0001) and animal (p = 0.0004) semantic Verbal Fluency Tests, immediate Word Recall Test (p < 0.0001), Maximum Inspiratory Pressure (p = 0.0001), Maximum Expiratory Pressure (p < 0.0001), and in-session oxygen saturation (p = 0.03). Program satisfaction was rated, on average, 9 on a 10-point scale. ConclusionA group-singing program with deep breathing training and song-learning may promote memory, language, speech information processing, executive function, and respiratory muscle strength in older adults. The program was feasible and well-accepted. A clinical trial with a larger sample is indicated.

Clinical Determinants of Incremental Shuttle Walk Test in Adults with Bronchiectasis.

Exercise capacity is impaired in patients with bronchiectasis. Incremental shuttle walk test (ISWT) stresses cardiorespiratory system physiologically to symptom-limited maximal exercise capacity. The purpose of this study was to investigate the clinical determinants of ISWT in adults with non-cystic fibrosis (CF) bronchiectasis. Forty-one clinically stable bronchiectasis patients aged 18-72years (27 females, 14 males) participated in the study. Subjects' demographics and physical characteristics were recorded. Bronchiectasis Severity Index was used to identify disease severity. Pulmonary function test was performed. Dyspnea perception was assessed using the modified Medical Research Council Dyspnea Scale. Maximum inspiratory and expiratory pressures were measured. Peripheral muscle strength using a hand held dynamometer was measured. ISWT was performed to determine exercise capacity. Fatigue Severity Scale, Hospital Anxiety and Depression Scale, Leicester Cough Questionnaire were used to determine fatigue, psychosocial status, and quality of life. Patients' mean ISWT distance was 469.5m. The ISWT distance was significantly related with age (r = - 0.472), height (r = 0.469), gender (r = 0.520), FEV1 (r = 0.651), and FVC (r = 0.545, p < 0.05). Quadriceps muscle strength was higher in males (p = 0.001) as compared to females. Age and gender were identified as independent predictors of the ISWT, explaining 42% of variance in ISWT distance (r = 0.649, r2 = 0.421, F(2,38) = 13.794, p < 0.001). The clinical determinants of ISWT in clinically stable patients with non-CF bronchiectasis are age and gender. Pulmonary function, dyspnea perception, muscle strength, disease severity, fatigue, psychosocial factors, and health-related quality of life seems to have an independent effect on ISWT in this group of patients with bronchiectasis.

Comparison of the effects of alfaxalone and propofol with acepromazine, butorphanol and/or doxapram on laryngeal motion and quality of examination in dogs

ObjectiveTo compare the effects of alfaxalone and propofol, with and without acepromazine and butorphanol followed by doxapram, on laryngeal motion and quality of laryngeal examination in dogs. Study designRandomized, crossover, blinded study. AnimalsTen female Beagle dogs, aged 11–13 months and weighing 7.2–8.6 kg. MethodsThe dogs were administered four intravenous (IV) treatments: alfaxalone (ALF), alfaxalone+acepromazine and butorphanol (ALF–AB), propofol (PRO) and propofol+AB (PRO–AB). AB doses were standardized. Dogs were anesthetized 5 minutes later by administration of alfaxalone or propofol IV to effect. Arytenoid motion during maximal inspiration and expiration was captured on video before and after IV doxapram (0.25 mg kg−1). The change in rima glottidis surface area (RGSA) was calculated to measure arytenoid motion. An investigator blinded to the treatment scored laryngeal examination quality. ResultsA 20% increase in RGSA was the minimal arytenoid motion that was detectable. RGSA was significantly less in ALF before doxapram compared with all other treatments. A <20% increase in RGSA was measured in eight of 10 dogs in PRO and in all dogs in ALF before doxapram. After doxapram, RGSA was significantly increased for PRO and ALF; however, 20% of dogs in PRO and 50% of dogs in ALF still had <20% increase in RGSA. A <20% increase in RGSA was measured in five of 10 dogs in PRO–AB and ALF–AB before doxapram. All dogs in PRO–AB and ALF–AB with <20% increase in RGSA before doxapram had ≥20% increase in RGSA after doxapram. Examination quality was significantly better in PRO–AB and ALF–AB. Conclusions and clinical relevanceThe use of acepromazine and butorphanol improved the quality of laryngeal examination. Any negative impact on arytenoid motion caused by these premedications was overcome with doxapram. Using either propofol or alfaxalone alone is not recommended for the evaluation of arytenoid motion.

Effects of 8 Weeks of Inspiratory Muscle Training on Pulmonary Function and Maximum Inspiratory Pressure and Skill-related Physical Fitness in Women

Effects of 8 Weeks of Inspiratory Muscle Training on Pulmonary Function and Maximum Inspiratory Pressure and Skill-related Physical Fitness in Women

Effects of expiratory muscle training on the frail elderly's respiratory function.

[Purpose] The present study examined the effects of expiratory muscle training on elderly day care service users, who had been classified into Care Grades 1 and 2 based on Japan’s long-term care insurance system. [Subjects and Methods] Intervention was provided for 29 Care Grade 1 or 2 day care service users. During intervention, expiratory muscle training was performed by slowly expiring using the abdominal muscles and a device after maximal inspiration. Each intervention session lasted for approximately 10 minutes, and 2 sessions were held weekly for 3 months to compare respiratory function test values before and after intervention. [Results] The results were favorable. The vital capacity (VC) and peak expiratory flow (PEF) significantly varied between before and after intervention. [Conclusion] Expiratory muscle training generally improved their respiratory function, particularly their VC and PEF that significantly varied between before and after intervention. As both of these items influence the cough capacity, they may be key to the prevention of aspiration pneumonia. Expiratory muscle training may also contribute to activities of daily living (ADL) and the quality of life, and it is expected to play an important role in rehabilitation as a field of preventive medicine.

An Evaluation of Maximum Inspiratory Pressure in Patients with Obstructive Sleep Apnea

Patients with obstructive sleep apnea (OSA) had repetitive partial or complete upper airway collapse during sleep with preservation of respiratory effort and increased level of neural respiratory drive to sustain ventilation in sleep.

Effects of Physiotherapeutic Interventions on Quality of Life and Respiratory Function of subjects with COPD

Background: Chronic Obstructive Pulmonary Disease (COPD) treatment includes a multidisciplinary approach, with physiotherapy a prominent role that promotes a positive impact on the quality of life (QOL) of these patients. Objective: To analyze the effects of physiotherapeutic interventions on QOL, lung volumes and capacities, and respiratory muscle strength in COPD patients. Methods: 17 subjects participated in the study, randomly divided into 2 groups: 1) Maneuvers: 62.7 ± 15.4 years, 1.65 ± 0.12 m, 81.4 ± 18.2 kg, body Mass Index (BMI) 29.9± 5.0 kg/m2 ; 2) Threshold: 64.4 ± 11.2 years, 1.58 ± 0.08 m, 70.7 ± 9.4 kg, BMI 28.6 ± 3.7 kg/m2 , with COPD, without neurological, musculoskeletal, cardiovascular or cognitive impairment, which made it impossible to participate in the physiotherapeutic intervention programs. QOL was analyzed using the Saint George Hospital questionnaire on Respiratory Disease (SGRQ); spirometry and respiratory muscle strength were analyzed by manovacuometry using a pneumotachograph. Data were analyzed in SPSS (20.0), Student’s t-test (paired) and Wilcoxon test were used for pre and post-intervention comparison of the SGRQ domains and total score, Vital Capacity (VC), Forced Vital Capacity (FVC), Forced Expiratory Volume (FEV1 ), Maximal Inspiratory Pressure (MIP) and Maximal Expiratory Pressure (MEP); and Student’s t-tests (independent) and Mann-Whitney were used in the intergroup comparison, all with a significance level of 5%. Results: There was a significant difference in both groups (P&lt;0.05) in the pre- and post-intervention comparison of the three domains (Symptoms, Activities and Psychosocial Impact) and total SGRQ score, but this did not occur with spirometric variables. In the manovacuometry, the Wilcoxon test showed a significant difference in the pre and post-intervention values of MIP and MEP. Conclusion: Improved QOL and MIP and MEP muscle strength of all COPD patients was observed, regardless of the groups Maneuvers or Threshold.

Respiratory muscle strength is decreased after maximal incremental exercise in trained runners and cyclists

The respiratory muscle fatigue seems to be able to limit exercise performance and may influence the determination of maximal oxygen uptake (V̇O2max) or maximum aerobic work rate during maximal incremental test. The aim of this study was therefore to investigate whether maximal incremental exercise decreases respiratory muscle strength. We hypothesized that respiratory muscle strength (maximal pressure) will decrease after maximal incremental exercise to exhaustion. 36 runners and 23 cyclists completed a maximal incremental test on a treadmill or a cycle ergometer with continuous monitoring of expired gases. Maximal inspiratory (MIP) and expiratory (MEP) pressure measurements were taken at rest and post- exercise. At rest, the MIP and MEP were 140±25 and 172±27 in runners vs. 115±26 and 146±33 in cyclists (p<0.05 between groups, respectively). The rest values of MIP and MEP were correlated to the V̇O2peak in all athletes, r=0.34, p<0.01 and r=0.36, p<0.01, respectively. At exhaustion, the MIP and MEP decreased significantly post- test by 13±7% and 13±5% in runners vs. 17±11% and 15±10% in cyclists (p>0.05), respectively. Our results suggest that respiratory muscle strength is decreased following maximal incremental exercise in trained runners and cyclists.

3D analysis of sexual dimorphism in size, shape and breathing kinematics of human lungs.

Sexual dimorphism in the human respiratory system has been previously reported at the skeletal (cranial and thoracic) level, but also at the pulmonary level. Regarding lungs, foregoing studies have yielded sex-related differences in pulmonary size as well as lung shape details, but different methodological approaches have led to discrepant results on differences in respiratory patterns between males and females. The purpose of this study is to analyse sexual dimorphism in human lungs during forced respiration using 3D geometric morphometrics. Eighty computed tomographies (19 males and 21 females) were taken in maximal forced inspiration (FI) and expiration (FE), and 415 (semi)landmarks were digitized on 80 virtual lung models for the 3D quantification of pulmonary size, shape and kinematic differences. We found that males showed larger lungs than females (P < 0.05), and significantly greater size and shape differences between FI and FE. Morphologically, males have pyramidal lung geometry, with greater lower lung width when comparing with the apices, in contrast to the prismatic lung shape and similar widths at upper and lower lungs of females. Multivariate regression analyses confirmed the effect of sex on lung size (36.26%; P < 0.05) and on lung shape (7.23%; P < 0.05), and yielded two kinematic vectors with a small but statistically significant angle between them (13.22°; P < 0.05) that confirms sex-related differences in the respiratory patterns. Our 3D approach shows sexual dimorphism in human lungs likely due to a greater diaphragmatic action in males and a predominant intercostal muscle action in females during breathing. These size and shape differences would lead to different respiratory patterns between sexes, whose physiological implications need to be studied in future research.

Long-term benefit of enzyme replacement therapy in Pompe disease: A 5-year prospective study.

To determine the effect of enzyme replacement therapy (ERT) after 5 years and to identify predictors for a favorable response because few data are available on the long-term efficacy of ERT in Pompe disease. We included 102 adult patients with Pompe disease in a nationwide, prospective cohort study. We assessed muscle strength (manual muscle testing with Medical Research Council [MRC] grading, handheld dynamometry [HHD]), muscle function (6-minute walk test, Quick Motor Function Test), daily life activities (Rasch-Built Pompe-Specific Activity [R-PAct] Scale), and pulmonary function (forced vital capacity [FVC] in upright and supine positions, maximum inspiratory and expiratory pressures) at 3- to 6-month intervals before and after the start of ERT. Data were analyzed with linear mixed-effects models for repeated measurements. Median follow-up duration was 6.1 years (range 0.4-7.9 years), of which 5.0 years (range 0.2-7.3 years) were during ERT. Treated patients had better muscle strength (MRC sum score +6.6 percentage points [pp]; HHD sum score +9.6 pp, both p < 0.0001), activity levels (R-PAct +10.8 pp, p < 0.002), and pulmonary function (FVC upright +7.3 pp, FVC supine +7.6 pp, both p < 0.0003) than expected for their untreated disease course. Walking distance improved (416 vs 376 m at baseline, p = 0.03). The largest increase was seen during the first 2 to 3 years of treatment. Response to treatment was similar between groups regardless of sex, age, or disease duration. Long-term ERT positively affects muscle strength, pulmonary function, and daily life activities in adult patients with Pompe disease, with a peak effect at ≈2 to 3 years of treatment. This study provides Class IV evidence that for patients with Pompe disease, long-term ERT positively affects muscle strength, pulmonary function, and daily life activities.

Pengaruh Pursed LIP Breathing Dan Sustained Maximal Inspiration Terhadap Peningkatkan Kekuatan Otot Pernapasan Untuk Mengurangi Keluhan Sesak Napas Pada Kasus Kardio Respirasi

Abstract : Sustained Maximal Inspiration, Pursed Lip Breathing, Shortness Of Breath. Currently lung disease is a major cause of chronic morbidity and mortality worldwide, many people suffer from this disease for many years and die prematurely due to unhealthy lifestyles such as smoking and work environments that are exposed to much air pollution due to under-employed workers personal protector. One sign of lung disease is airway obstruction in nonreversible or partial reversible airway. One result of lung disease is a lack of respiratory muscle strength resulting in complaints of shortness of breath. Disturbances or complaints of breathlessness can occur towards inspiration or expiration. There is a theory of the effect of breathing exercises on respiratory muscle enhancement in people with shortness of breath. In this study was conducted with the aim to prove the provision of Sustained maximal inspiration (SMI) and pursed lip breathing (PLB) to increase respiratory muscle strength in patients with shortness of breath. This research uses true experimental research with pre-test and post-test design. The study was conducted at the physiotherapy laboratory located in Tabanan, Badung and Denpasar with a sample of 17 patients who experienced complaints of shortness of breath. The number of research subjects was grouped randomly in one group. In this study the group was given treatment as much as 1 time a week and performed for 24 weeks. The expected result of this study was to reduce complaints of shortness of breath without the use of medicines from doctors in cases of cardio respiration

Effect of preoperative physical and respiratory therapy on postoperative pulmonary functions and complications after laparoscopic upper abdominal surgery in obese patients

Aim of the studyTo investigate the effects of preoperative physical and respiratory therapy on pulmonary functions and complications after elective laparoscopic upper abdominal surgery in obese patients. MethodologyPatients were randomly assigned to receive respiratory and general exercise for 2 weeks before operation (group I; n = 26) two physical and specialized respiratory therapy sessions per week (each one 40 min) in comparison to non-engaged group in any exercise (group II; n = 24) Pulmonary functions outcome variables including slow vital capacity(SVC), inspiratory capacity(IC), maximum inspiratory and expiratory pressures (MIP and MEP and 6-min walk test were recorded as a baseline, after two weeks of exercise day two, five and one month post-operative. Any postoperative pulmonary complications were recorded. ResultsThere were statistically significant difference between groups, patients in the intervention group (group I) had higher pulmonary function in all parameters than (group II) P < .05) in all the post-operative periods. Postoperative pulmonary complications occurred in 15 patients (62%) in the control group (group II) and in 7 patients (27%) in the intervention group (group I) (P < .05). ConclusionPreoperative physical and respiratory therapy improved pulmonary functions and decreased the incidence of post-operative pulmonary complications in obese patients undergoing to laparoscopic upper abdominal surgery.

P.455 - Outcome measures for Duchenne muscular dystrophy from ambulant to non-ambulant patients: implications for clinical trials

The need for a better understanding of Duchenne muscular dystrophy (DMD) natural history and the role of novel outcome measures and their impact in current and future clinical trials is well recognized. We aimed to assess the natural history of ambulant and non-ambulant DMD patients in an international multicentre study across 5 centres (London, Newcastle, Paris, Leiden, Nijmegen) with patients being assessed 6-monthly according to a shared protocol. Assessments included 6-minute walk distance (6MWD), North Star Ambulatory Assessment (NSAA), Performance of Upper Limb (PUL 1.2), MyoSet, respiratory function (forced vital capacity – FVC, maximum inspiratory and expiratory pressures – MEP and MIP, peak expiratory flow – PEF, peak cough flow – PCF). A subgroup performed annual whole body DEXA scans. We analysed longitudinal data for 82 patients (at recruitment 53 ambulant, mean age = 7.7 ± 2.3 years and 29 non-ambulant, mean age = 14.4 ± 1.9 years). For ambulant patients >7years old we observed a decline of 2.6 points per year in the NSAA (p < 0.001) and an increase of 1.04 seconds per year in the time to run 10 meters (p < 0.001). In non-ambulant patients, we observed a loss of 3.96 points on the PUL per year (p < 0.001) and a decrease in most of the %predicted respiratory measures (6.5% in FVC p < 0.001, 3.7% in PEF p < 0.01, 3.4% MIP p < 0.001 and 2.5% MEP p < 0.001) over the year. We observed a strong correlation between the PUL total and %predicted FVC (r = 0.73, p < 0.001) and between best MIP and moviplate (r = 0.71, p < 0.001). Patients with a lower limb lean body mass >30% were all ambulant except for 1 patient who lost ambulation less than 6 months later. This study adds to the current knowledge on DMD natural history. In particular, herein we explored the mean changes per year expected for non-ambulant patients for the different respiratory outcome measures and for functional measures that will be relevant for trials targeting this population. We also characterized the relationship between respiratory measures and upper limb function.