Maximal Expiratory Pressure Research Articles

Effects of inspiratory muscle training on walking capacity of individuals after stroke: A double-blind randomized trial

Objectives: Identify the effects of inspiratory muscle training (IMT) on walking capacity, strength and inspiratory muscle endurance, activities of daily living, and quality of life poststroke. Design: Double-blind randomized trial. Setting: The Sarah Network of Rehabilitation Hospitals. Subjects: Adult poststroke inpatients with inspiratory muscle weakness. Interventions: The Experimental Group (EG) (n = 23) underwent IMT for 30 minutes/day, five times/week over six weeks. The Control Group (CG) (n = 27) performed sham IMT. Both groups underwent standard rehabilitation. Main measures: Primary outcome was post-intervention six-minute walking test (6MWT) distance. We also measured maximal inspiratory pressure (MIP), maximal expiratory pressure (MEP), inspiratory muscle endurance, activities of daily living (functional independence measure – FIM), and quality of life at baseline and post-intervention. Three months after intervention, we measured MIP, walking capacity and quality of life. Results: Baseline characteristics were similar, with mean age 53 ± 11 years and FIM 74 ± 10p. Both groups similarly increased the walking capacity at six weeks (63 vs 67 m, P = 0.803). Compared to the CG, the EG increased the inspiratory endurance (22 vs 7 cmH2O, P = 0.034) but there was no variation in MEP (14 vs 5 cmH2O, P = 0.102), MIP (27 vs 19 cmH2O, P = 0.164), FIM (6 vs 6, P = 0.966) or quality of life (0 vs 0.19, P = 0.493). Gains in both groups were sustained at three months. Conclusion: Adding IMT to a rehabilitation program improves inspiratory muscle endurance, but does not further improve MIP, 6-MWT distance, activities of daily living or quality of life of individuals after stroke beyond rehabilitation alone. Registered in Clinical Trials, NCT03171272.

Current practice and evolution of pediatric respiratory management of Duchenne muscular dystrophy in Canada

RATIONALE: Respiratory management practices for Duchenne muscular dystrophy (DMD) vary across Canada, according to a web-based survey conducted in 2010. Since then, new guidelines for respiratory management of DMD have been published. OBJECTIVES: This study aimed to describe current respiratory management practices of Canadian Pediatric Respirologists for children with DMD across the country. METHODS: A web-based survey on timing and indications for respiratory diagnostic tests and interventions was sent to all practicing Pediatric Respirologists at tertiary care centers in Canada who are involved in the longitudinal management of boys with DMD (N = 20). MEASUREMENTS AND MAIN RESULTS: Responses were received from 17 (85%) Pediatric Respirologists. Pulmonary function testing is regularly performed at least twice yearly after 5-6 years of age or after a patient becomes nonambulatory (13/17, 76%). Maximal expiratory pressures (15/17, 88%) and peak cough flow (12/17, 71%) are used to assess respiratory muscle strength. Sleep evaluation is most commonly performed with polysomnography (14/17, 82%), and is requested with the onset of symptoms (14/17, 82%) or with a forced vital capacity (FVC) < 60% predicted (6/9, 67%). At least once-daily lung volume recruitment exercises are prescribed by 94% (16/17) of respondents during periods of clinical stability, with the most common indication being an FVC < 80% predicted (9/17, 53%). CONCLUSIONS: The majority of Canadian Pediatric Respirologists are providing respiratory care to boys with DMD according to the current guidelines. The greatest change over time is the increased usage of regular LVR/airway clearance during periods of clinical stability.

Composição corporal, função pulmonar e força muscular respiratória em pessoas com Síndrome de Down

Objetivo: investigar se há correlação nas variáveis da composição corporal com a função pulmonar e com a força muscular respiratória em pessoas com Síndrome de Down. Método: Analítico transversal, com 26 pessoas com Síndrome de Down, sendo 14 do sexo feminino e 12 do masculino. Foi realizada a espirometria para a obtenção do Volume Expirado Forçado no primeiro segundo (VEF1), Capacidade Vital Forçada (CVF) e Pico de Fluxo Expiratório (PFE); a manovacuometria para a mensuração da Pressão Inspiratória máxima (PImáx) e Pressão Expiratória máxima (PEmáx) e para a avaliação do percentual de gordura corporal (%GC) por meio da Dual Energy X-Ray Absormetry (DXA). Foi aplicado o teste de normalidade de Shapiro-Wilk, considerando p&lt;0,05 e o teste paramétrico por meio do coeficiente de correlação de Pearson. Resultados: Correlação negativa (%GC-VEF1), sem diferença significativa para os homens (p&lt;0,5244), com diferença altamente significativa para mulheres (p&lt;0,0045); % GC-CVF correlação negativa com diferença significativa (p&lt;0,0137) para mulheres, sem diferença significativa para homens (p&lt;0,4910); PFE correlação negativa, sem diferença significativa nas mulheres (p&lt;0,3165) e nos homens (p&lt;0,7165); %GC-PImáx correlação negativa para mulheres sem diferença significativa (p&lt;0,7871) e correlação positiva para os homens sem diferença significativa (p&lt;0,8307); %GC-PEmáx correlação negativa sem diferença significativa nas mulheres (p&lt;0,9070) e nos homens (p&lt;0,11369). Conclusão: Pessoas com Síndrome de Down apresentam %GC mais elevado frente aos valores de referência para a população brasileira sem a Síndrome de Down.

The effects of core stabilization training on dynamic balance and pulmonary parameters in patients with asthma.

In the literature, novel physiotherapy and rehabilitation approaches are getting significant attention as a way to cope with secondary complications in the management of asthma. To investigate the effectiveness of core stabilization exercises combined with the Asthma Education Program (AEP) and breathing exercises in patients with asthma. The study sample consists of 40 asthmatic patients (age 52.25 ± 11.51 years) who were randomly divided into a Training Group (TG) (n= 20) and a Control Group (CG) (n= 20). All subjects were included in the AEP, and both groups were trained in breathing retraining exercises (2 times/wk, 6-week duration in the clinic). The core stabilization exercise program was also applied in the TG. Respiratory muscle strength (maximum inspiratory and expiratory pressures), physical activity level (International Physical Activity Questionnaire Short Form (IPAQ)), health-related quality of life (Asthma Quality of Life Questionnaire (AQOL)), functional exercise capacity (six-minute walking test (6MWT)), and dynamic balance (Prokin PK200) were assessed before and after the interventions. The TG showed more significant improvements in MIP (ΔTG:4.55 cmH2O, ΔCG:0.95 cmH2O), IPAQ (ΔTG:334.15 MET-min/wk., ΔCG:99 MET-min/wk.), 6MWT (ΔTG:24.50 m, ΔCG:11.50 m), and dynamic balance sub-parameters compared to the mean difference between the initial assessment and after a 6-week intervention program, which included twelve exercise sessions (p< 0.01). The findings present greater improvements in inspiratory muscle strength, physical activity level, functional exercise capacity, and dynamic balance when core stabilization exercises are included in the pulmonary rehabilitation program for the management of asthma.

Handgrip Force and Maximum Inspiratory and Expiratory Pressures in Critically Ill Patients With a Tracheostomy.

The association between peripheral striated muscle strength and respiratory muscle strength has been confirmed in a number of disorders. However, this association is unknown in intensive care unit patients with tracheostomies. To examine correlations between handgrip force, maximum inspiratory pressure (MIP), and maximum expiratory pressure (MEP) in intensive care unit patients with tracheostomies. Twenty patients (7 women, 13 men) with tracheostomies, in the intensive care unit longer than 11 days, in stable condition, with functional limbs, and with Glasgow Coma Scale scores of 15 were recruited. Both MIP and MEP were measured with a membrane manometer; handgrip force was measured with a hydraulic hand dynamometer. Handgrip force was significantly correlated with MIP (r = 0.45, P = .04) and MEP (r = 0.78, P = .001). Handgrip force was significantly predicted by MIP and MEP when the effect of sex was controlled for (P < .05). However, when MIP and MEP were included as predictors in a regression model, MEP was the only significant predictor (R = 0.80, R2 = 0.63, adjusted R2 = 0.57). Strength of the hand flexors and strength of the expiratory muscles (abdominal) were significantly correlated in intensive care unit patients. Handgrip strength appears to be an easy, fast way to evaluate expiratory muscle strength by using a simple handhold command without special equipment. A strong handhold may also correspond to strong expiratory muscles. ClinicalTrials.gov: NCT03457376.

Acute impairment in respiratory muscle strength following a high-volume versus low-volume resistance exercise session

Diminished respiratory muscle strenght has been shown following a strenuous bout of sit-ups; however, there is a paucity of evidence for this effect following a strenuous upper and lower body resistance training session. This study investigated the acute effect of a high-volume compared to a low-volume resistance exercise session on respiratory muscle strength. Twenty resistance-trained males (age 25.1±7.4 y) participated in this randomized and cross-over design study. Participants completed two resistance training protocols (high- and low-volume) and a control session (no exercise). Sessions involved 5 sets (high-volume) and 2 sets (low-volume) of 10 repetitions at 65% one-repetition maximum for each exercise (bench press, squat, seated shoulder press, and deadlift) with 90 s recovery between sets. Maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP) was assessed pre- and post-session and respiratory gases were measured during the recovery between sets. Following the high-volume session MIP and MEP decreased by a median of 10.0% (interquartile range, IQR=-15.2 to -2.6%) and 12.1% (IQR=-22.2 to -3.9%), respectively, which was significant compared to the low-volume (P<0.001) and control sessions (P≤0.001). At 20 min post-high-volume session MEP returned to baseline whereas MIP returned to baseline values at 40 min. Greater metabolic stress was associated with the higher-volume session as demonstrated by a lower recovery end-tidal CO<inf>2</inf> partial pressure across the majority of exercises (P≤0.008). Findings suggest that respiratory muscle strength is impaired following a high-volume resistance exercise session, however it appears to be restored within an hour post-exercise.

Effects of smartphone addiction on children's lung function.

With an increase in smartphone usage, constant neck flexion can lead to improper posture, which may impact on lung function. Therefore, the purpose of this study was to examine and compare the craniovertebral angle (CVA) and lung function between addicted and non-addicted boys and girls aged between 8-13 years who use smartphones for long periods of time. A cross-sectional study was conducted on 24 boys and 26 girls (mean age 10.5±1.6years and body mass index 18.6±3.0kg/m2) . Participants were assigned to two groups based on their scores on the Smartphone Addiction Scale-Short Version (SAS-SV) for Adolescents: addicted group (score>32, n=32) and non-addicted group (score≤32, n=18). The outcome variables were CVA, forced vital capacity (FVC), forced expiratory volume in 1second (FEV1), peak expiratory flow (PEF), maximal voluntary ventilation (MVV), maximum inspiratory pressures (PImax), and maximum expiratory pressures (PEmax). There was a significant difference in mean CVA between addicted and non-addicted boys (49.4±6.7 vs 55.5±7.6, η2 =0.9, P=0.03) and girls (47.3±6.3 vs 52.9±6.1, η2 =0.9, P=0.02). Mean FVC, FEV1, and FEV6 were significantly lower in addicted versus non-addicted boys (P=0.04, P=0.05, and P=0.02, respectively). PImax was significantly less in addicted compared to non-addicted girls (55.2±16.4 vs 65.3±13.8, η2 =0.7, P=0.05). Our findings showed that children addicted to smartphones (when using the SAS-SV as an indicator for addiction) revealed lower CVA and lung function results. Therefore, education on proper posture while holding smartphones is essential to the children's postural and lung function status.

Reldesemtiv in Patients with Spinal Muscular Atrophy: a Phase 2 Hypothesis-Generating Study

This phase 2, double-blind, placebo-controlled, hypothesis-generating study evaluated the effects of oral reldesemtiv, a fast skeletal muscle troponin activator, in patients with spinal muscular atrophy (SMA). Patients ≥ 12 years of age with type II, III, or IV SMA were randomized into 2 sequential, ascending reldesemtiv dosing cohorts (cohort 1: 150 mg bid or placebo [2:1]; cohort 2: 450 mg bid or placebo [2:1]). The primary objective was to determine potential pharmacodynamic effects of reldesemtiv on 8 outcome measures in SMA, including 6-minute walk distance (6MWD) and maximum expiratory pressure (MEP). Changes from baseline to weeks 4 and 8 were determined. Pharmacokinetics and safety were also evaluated. Patients were randomized to reldesemtiv 150 mg, 450 mg, or placebo (24, 20, and 26, respectively). The change from baseline in 6MWD was greater for reldesemtiv 450 mg than for placebo at weeks 4 and 8 (least squares [LS] mean difference, 35.6 m [p = 0.0037] and 24.9 m [p = 0.058], respectively). Changes from baseline in MEP at week 8 on reldesemtiv 150 and 450 mg were significantly greater than those on placebo (LS mean differences, 11.7 [p = 0.038] and 13.2 cm H2O [p = 0.03], respectively). For 6MWD and MEP, significant changes from placebo were seen in the highest reldesemtiv peak plasma concentration quartile (Cmax > 3.29 μg/mL; LS mean differences, 43.3 m [p = 0.010] and 28.8 cm H2O [p = 0.0002], respectively). Both dose levels of reldesemtiv were well tolerated. Results suggest reldesemtiv may offer clinical benefit and support evaluation in larger SMA patient populations.

Respiratory Muscle Weakness as a Risk Factor for Pneumonia in Older People

Introduction: The respiratory muscle strength regulates the effectiveness of coughing, which clears the airways and protects people from pneumonia. Sarcopenia is an aging-related loss of muscle mass and function, the worsening of which is associated with malnutrition. The loss of respiratory and swallowing muscle strength occurs with aging, but its effect on pneumonia is unclear. This study aimed to determine the risks of respiratory muscle weakness on the onset and relapse of pneumonia in older people in conjunction with other muscle-related factors such as malnutrition. Methods: We conducted a longitudinal study with 47 pneumonia inpatients and 35 non-pneumonia controls aged 70 years and older. We evaluated the strength of respiratory and swallowing muscles, muscle mass, and malnutrition (assessed by serum albumin levels and somatic fat) during admission and confirmed pneumonia relapse within 6 months. The maximal inspiratory and expiratory pressures determined the respiratory muscle strength. Swallowing muscle strength was evaluated by tongue pressure. Bioelectrical impedance analysis was used to evaluate the muscle and fat mass. Results: The respiratory muscle strength, body trunk muscle mass, serum albumin level, somatic fat mass, and tongue pressure were significantly lower in pneumonia patients than in controls. Risk factors for the onset of pneumonia were low inspiratory respiratory muscle strength (odds ratio [OR], 6.85; 95% confidence interval [CI], 1.56–30.11), low body trunk muscle mass divided by height2 (OR, 6.86; 95% CI, 1.49–31.65), and low serum albumin level (OR, 5.46; 95% CI, 1.51–19.79). For the relapse of pneumonia, low somatic fat mass divided by height2 was a risk factor (OR, 20.10; 95% CI, 2.10–192.42). Discussion/Conclusions: Respiratory muscle weakness, lower body trunk muscle mass, and malnutrition were risk factors for the onset of pneumonia in older people. For the relapse of pneumonia, malnutrition was a risk factor.

Effect of Inspiratory Muscle Training with Royal Jelly Supplement on Iron Metabolism in Cigarette Addicts.

The strength or weakness of the respiratory muscles compared with other skeletal muscles owing to their more specialized structures is considered as an indicator or cause of a disease. This study aimed to investigate the effects of inspiratory muscle training with royal jelly (RJ) supplement on iron metabolism in cigarette addicts. A total of 40 male volunteers participated in the study who were divided into 4 groups before the study as follows: smoker control group (n=10), inspiratory muscle training (IMT) group (n=10), RJ group (n=10), and RJ+IMT (n=10) group. Blood samples were taken from all the participants for analysis of iron, iron binding, and total iron binding capacity. Maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP) measurements for the groups to perform training were carried out with 40% of their MIP values. The training sessions were carried out at the same time every day for 4 weeks (5 days per week). The Statistical Package for Social Sciences version 22.0 program was used for statistical analyses. The results of the analysis found that the iron, iron binding, and total iron binding capacities were in favor of post-tests in the RJ supplement IMT, and RJ+IMT groups compared with those in the control group (p<0.05). There was a statistically significant difference between the RJ supplement, IMT, and RJ+IMT groups compared with the control group (p<0.05). Therefore, it could be concluded that the IMT and RJ supplements positively affected these parameters by altering the iron metabolism of the cigarette addicts.

Interval versus constant-load exercise training in adults with Cystic Fibrosis

BackgroundThe efficacy of interval exercise (IE) compared to constant-load exercise (CLE) training remains unsettled in adults with Cystic Fibrosis (CF). MethodsTwenty-four adults with CF were randomised to 30-min IE (100 % peak work capacity (WRpeak) for 30-s alternated with 40 % WRpeak for 30-s; n = 12) or 30-min CLE (70 % WRpeak; n = 12) training, 3 times weekly, for 12 weeks. Isometric quadriceps muscle strength was assessed using a strain gauge Myometer. ResultsThe magnitude of improvement in quadriceps muscle strength was greater (p = 0.037) in the IE (by 32 ± 13 Nm) compared to the CLE (by 23 ± 12 Nm) groups. Maximum inspiratory and expiratory mouth pressures were significantly improved only in the IE group (by 30 ± 10 cmH2O; p = 0.009 and 13 ± 4 cmH2O; p = 0.007, respectively). Arterial oxygen saturation during training was higher (p = 0.002) for IE (94 ± 1%) compared to CLE (91 ± 1%), whereas dyspnoea scores were lower (p = 0.001) for IE (3.8 ± 0.7) compared to CLE (5.9 ± 0.8) ConclusionsIE is superior to CLE in improving peripheral and respiratory muscle strength and preferable to CLE because it is associated with lower exercise-induced arterial oxygen desaturation and breathlessness.

How Many Maneuvers Should We Do for Maximal Inspiratory and Expiratory Muscle Pressure Testing in Children: A Retrospective Review in Children with Cystic Fibrosis

Maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP) could be useful clinical parameters in monitoring many conditions including cystic fibrosis (CF). However, current protocols for undertaking the measurements lack standardization including the number of repeated attempts to achieve best values. We aimed to (a) determine the optimum number of attempts to achieve best MIP/MEP values, and (b) evaluate if the number of attempts is consistent across two different test days. We analyzed data of a previous randomized controlled trial involving the effect of singing on respiratory muscle strength in 35 children with CF. On two different days (T1, T2) children performed MIP/MEP with at least ten attempts each to achieve < 10% repeatability. All children achieved repeatable MIP/MEP values within 10-11 attempts with 24 (68.6%) and 26 (74.3%) of these achieving best values of MIP and MEP, respectively, at attempts 6-11. Median values of the pressures by three, five, eight and all attempts significantly increased with more attempts (all p < 0.05). At T2, 56% required fewer attempts to achieve best values, but 32% required more attempts, indicating that the number of attempts required was inconsistent between test days. It is likely that at least ten attempts (best two within < 10% variability) is required to achieve best and reliable MIP/MEP in children with CF. A larger sample size in children with CF and various conditions is required to consolidate these findings.

Influence of Lung Hyperinflation on Respiratory Muscles Pressures During a Submaximal Test in Patients With COPD: A Clinical Perspective

Background and Objective: Reduction of exercise tolerance is associated with expiratory flow-limitation (EFL) and lung hyperinflation; those are only partially reversible to bronchodilator. Lung hyperinflation lowers the diaphragm muscle provoking a mechanical disadvantage that, eventually, reduces maximal inspiratory (MIP) and expiratory (MEP) pressures. We aimed to assess the influence of the dynamic lung hyperinflation on respiratory pressures changes at rest and after a submaximal exercise test in COPD patients with and without a bronchodilator. Methods:: We prospectively analyzed 16 COPD patients (FEV1 36.4±10% pred.; age 61.0±8 years, height 165±12 cm and BMI 25.9±6 kg/m2). MIP and MEP were measured before and after performing the six minutes walking test (6MWT) with and without bronchodilator (400 mcg of albuterol). Results:: Nine of 16 patients increased IC more than 150 ml after bronchodilator use. Right after the 6MWT was accomplished without bronchodilator, IC decreased by 7.05% as compared to the 6MWT baseline value (p&lt;0.01). Nine patients decreased IC more than 150ml. After bronchodilator use, patients performed the 6MWT without any IC significant reduction (p&gt;0.05). Twelve patients increased the MIP (ranging from 70±11cmH2O to 77±10cmH2O, p = 0.0043) using 400mcg of albuterol. Thirteen patients reduced MIP after the 6MWT without bronchodilator use (p &lt;0.007). There was no significant reduction (p&gt; 0.05) in MIP when patients performed the 6MWT after bronchodilator use. We also found a significant correlation between MIP and inspiratory capacity (IC) and MEP and the IC before and after the 6MWT (r=0.61, p=0.0054; r=0.60, p=0.0031, respectively). Conclusions:: Dynamic pulmonary hyperinflation directly interferes with the ability of respiratory muscles to generate inspiratory and expiratory pressures. The previous use of bronchodilators in patients with COPD reduced dynamic hyperinflation when accomplishing a sub-maximal exercise.

Effect of physical exercise in bariatric surgery patients: protocol of a randomized controlled clinical trial

BackgroundBariatric surgery is an effective approach to weight loss and long-term comorbidity resolution. Although recommended in several guidelines, supervised exercise has not been systematically prescribed after bariatric surgery. The aim of this study is to determine the effects of two types of exercise, moderate-intensity continuous training (MICT) and high-intensity interval training (HIIT), on body composition, cardiopulmonary function, and perceived quality of life in bariatric surgery patients.MethodsThis randomized controlled exploratory pilot trial will include 75 adults of both sexes scheduled for bariatric surgery. They will be randomly assigned to one of three groups: (1) MICT, (2) HIIT, or (3) a control group. The intervention will occur 2 days a week for 4 months. Outcomes will be assessed at four points: (1) 1 week before surgery, (2) 21 days after surgery (baseline before the exercise program), (3) 8 weeks after beginning the exercise program, and (4) 1 week after the end of intervention. Primary outcomes will include body composition, heart rate variability, and 6-min walk test and quality of life scores. Secondary outcomes will be maximal respiratory pressure, flowmeter, hand dynamometry, and 30-s sit-to-stand test results.DiscussionBoth exercise protocols in this study were developed according to evidence-based practice. It is expected that, after 16 weeks of intervention, body composition (measured by electrical bioimpedance), cardiopulmonary function (measured by heart rate variability, maximal inspiratory pressure, maximal expiratory pressure, peak expiratory flow, handgrip strength, and the 6-min walk test), and perceived quality of life (measured by the Moorehead-Ardelt quality of life questionnaire II and bariatric analysis and reporting outcome system scores) will improve, especially in the HIIT group.Trial registrationClinicalTrials.gov NCT04235842. Registered on 22 January 2020.

Usefulness of Maximal Expiratory Pressure in Evaluating Dysphagia after Ischemic Stroke

Bo Seong Jang, M.D., Ho Joong Jeong, M.D., Ph.D., Han Eum Choi, M.D., Jae Hyun Lee, M.D., Young Joo Sim, M.D., Ph.D., Ghi Chan Kim, M.D., Ph.D.. J Korean Dysphagia Soc 2021;11:59-66. https://doi.org/10.34160/jkds.2021.11.1.008

Effect of expiratory muscle training on peak cough flow in children and adolescents with cystic fibrosis: A randomized controlled trial.

Cough is an important defense and airway clearance mechanism for removing thick and viscous secretions in cystic fibrosis (CF). The primary aim of this study was to investigate the effect of expiratory muscle training (EMT) on peak cough flow (PCF) and secondly on respiratory muscle functions, functional exercise capacity, and quality of life (QoL) in CF. Thirty patients were randomized as training and sham groups. Both groups were trained with the EMT protocol, which involved twice per day for at least 5 days per week for 6 weeks. The training intensity in the training group was 30% of the maximal expiratory pressure (MEP). In the sham group, it remained at the lowest pressure (5 cmH2 O). The primary outcome was PCF. The secondary outcomes were MEP, maximal inspiratory pressure (MIP), spirometric measures, six-minute walking distance (6MWD), and QoL (Cystic Fibrosis Questionnaire-Revised). Twenty-eight patients completed the study. Changes in PCF (p = .041) and MEP (p = .003) were higher in the training group than the sham group. Also, treatment burden (p = .008), digestive symptoms (p = .019), and vitality (p = .042) in QoL were more improved in the training group. MIP (p = .028) and 6MWD (p = .035) changed significantly only in the training group. Spirometric measurements did not change (p > .05). The results of the study show that EMT could improve PCF, MEP, treatment burden, digestive symptoms, and vitality domains of QoL in patients with CF. Moreover, MIP and functional exercise capacity improved in the training group with EMT.

Biphasic (Subtherapeutic) Levodopa-Induced Respiratory Dysfunction in Parkinson Disease.

To evaluate 3 cases illustrating a rarely recognized phenotype of Parkinson disease (PD), namely, biphasic levodopa-induced respiratory dysfunction manifesting as dyspnea. To appreciate the nature of the fluctuations of respiratory function in response to levodopa, we measured changes in respiratory muscle control before and after the best therapeutic response to levodopa in 3 PD patients with fluctuating dyspnea. Episodes of breathlessness were accompanied by shallow tachypnea and reduced respiratory muscle control, as measured by maximal expiratory pressure, peak cough flow, and forced expiratory volume in 1 second. The spectrum of respiratory dysfunction in PD includes a biphasic reduced respiratory muscle control accompanying periods when the effect of levodopa is subtherapeutic. This biphasic levodopa-related complication represents a rarely recognized nonmotor phenomenon in PD. Management requires increasing the levodopa dose, shortening the interdose interval, or implementing a program of continuous dopaminergic stimulation.

Agreement and reliability of repeated bedside respiratory muscle strength measurements in acute and subacute stroke.

Many stroke trials include maximal inspiratory pressure (MIP), maximal expiratory pressure (MEP), and sniff nasal inspiratory pressure (SNIP) outcome measurements. However, data on agreement and reliability of repeated MIP, MEP, and SNIP measurements in acute and subacute stroke patients are scarce. This study employed a test-retest design. Eighteen patients (seven female) with mean (SD) age 59 (14.5) years were recruited from neurological wards. Median (range) time since first stroke was 50.5 (21-128) days. MIP, MEP, and SNIP were measured repeatedly in three testing sessions (S1-3) conducted within 24h and following international standards. Intra-rater agreement between testing sessions was analyzed using the Bland-Altman method. Test-retest reliability was analyzed using intra-class correlation coefficient (ICC). Association between individual measurement variability, time poststroke, and level of stroke impairment was analyzed using Spearman's rho. Mean difference and 95% limits of agreement for MIP were -0.40 (-23.02, 22.22) cmH2 O between S1 and S2, and 2.14 (-12.79, 16.99) cmH2 O between S2 and S3; for MEP, -4.56 (-29.01, 19.90) cmH2 O between S1 and S2, and 0.29 (-24.28, 24.87) cmH2 O between S2 and S3; and for SNIP, -10.56 (-38.48, 17.37) cmH2 O between S1 and S2, and -6.06 (-27.32, 15.20) cmH2 O between S2 and S3. ICCs for MIP, MEP, and SNIP were ≥0.9 throughout. There were no strong correlations between individual measurement variability and time poststroke or level of stroke impairment. MIP, MEP, and SNIP in acute and subacute stroke patients show good test-retest reliability for group averages; however, absolute agreement can vary considerably for some individuals.

The product of trunk muscle area and density on the CT image is a good indicator of energy expenditure in patients with or at risk for COPD

BackgroundPhysical inactivity due to cachexia and muscle wasting is well recognized as a sign of poor prognosis in chronic obstructive pulmonary disease (COPD). However, there have been no reports on the relationship between trunk muscle measurements and energy expenditure parameters, such as the total energy expenditure (TEE) and physical activity level (PAL), in COPD. In this study, we investigated the associations of computed tomography (CT)-derived muscle area and density measurements with clinical parameters, including TEE and PAL, in patients with or at risk for COPD, and examined whether these muscle measurements serve as an indicator of TEE and PAL.MethodsThe study population consisted of 36 male patients with (n = 28, stage 1–4) and at risk for (n = 8) COPD aged over 50 years. TEE was measured by the doubly labeled water method, and PAL was calculated as the TEE/basal metabolic rate estimated by the indirect method. The cross-sectional areas and densities of the pectoralis muscles, rectus abdominis muscles, and erector spinae muscles were measured. We evaluated the relationship between these muscle measurements and clinical outcomes, including body composition, lung function, muscle strength, TEE, and PAL.ResultsAll the muscle areas were significantly associated with TEE, severity of emphysema, and body composition indices such as body mass index, fat-free mass, and trunk muscle mass. All trunk muscle densities were correlated with PAL. The product of the rectus abdominis muscle area and density showed the highest association with TEE (r = 0.732) and PAL (r = 0.578). Several trunk muscle measurements showed significant correlations with maximal inspiratory and expiratory pressures, indicating their roles in respiration.ConclusionsCT-derived measurements for trunk muscles are helpful in evaluating physical status and function in patients with or at risk for COPD. Particularly, trunk muscle evaluation may be a useful marker reflecting TEE and PAL.

Lung function and respiratory muscle strength and their relationship with weightlifting strength and body composition in non-athletic males

The aim of this study was to examine whether lung function and respiratory muscle strength are associated with weightlifting strength and body composition in non-athletic males. A total 51 males with resistance training experience participated. One-repetition maximum tests were performed for the bench press, squat and deadlift and body composition was assessed. Lung function was evaluated with a pulmonary testing system and respiratory muscle strength was assessed with a handheld mouth-pressure manometer. Moderate to strong positive relationships were found between all weightlifting strength variables and maximal expiratory pressure (r = 0.36−0.54, p = ≤0.01). Small to strong positive correlations were found between fat-free mass, appendicular lean mass and most lung function variables (r = 0.29−0.54, p ≤ 0.039). However, fat-free mass and appendicular lean mass indexes were only related with respiratory muscle strength and not lung function. Expiratory muscle strength appears to influence weightlifting performance. Special exercises targeting the expiratory muscles may assist with improving weightlifting performance, especially for squats and deadlifts.