Maximal Inspiratory Pressure Research Articles

Investigation of respiratory muscle strength and its influence on exercise capacity and quality of life in patients with idiopathic pulmonary fibrosis.

Adequate respiratory muscle strength is required to meet the increased ventilatory demand during physical activities. However, it is not well known whether respiratory muscle strength is impaired in patients with idiopathic pulmonary fibrosis (IPF). This study aimed to investigate the relationship between respiratory muscle strength and exercise capacity, quality of life, physical activity level, and fatigue in IPF patients. The study comprised 30 individuals with idiopathic pulmonary fibrosis (IPF) and 30 healthy controls. Maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP) were measured to assess respiratory muscle strength. The International Physical Activity Questionnaire-Short Form, 6-minute walk test distance (6MWD), St George Respiratory Questionnaire (SGRQ), and Fatigue Severity Scale (FSS) were employed to evaluate physical activity level, exercise capacity, quality of life, and fatigue severity, respectively. MIP (81±29 vs.73±20 cmH2O) and MEP (93±31 vs. 93±34 cmH2O) did not differ significantly between IPF patients and controls (p>0.05). In patients with IPF, MIP was significantly correlated with 6MWD (r=0.533), SGRQ (r=-0.428), and FSS (r=-0.433). Multivariate models including MIP, MEP, FEV1, FVC, and PA level explained 74% of the variance in the 6MWD (p<0.001), and MIP, FEV1, and PA level were independent predictors of the 6MWD, with FEV1 being the strongest predictor (β=0.659). Multivariate models predicting SGRQ revealed none of MIP, FEV1 or PA level was directly influencing the SGRQ score. This study suggests that patients with IPF do not have respiratory muscle weakness. Inspiratory muscle strength has a direct influence on exercise capacity but an indirect effect on quality of life, probably by influencing exercise capacity.

“Effects of threshold respiratory muscle training on respiratory muscle strength, pulmonary function and exercise endurance after stroke: a meta-analysis”

BackgroundMost studies on improvements in respiratory muscle strength, activities of daily living (ADL) and quality of life (QoL) in stroke patients receiving threshold respiratory muscle training (TRMT) have small sample sizes, and some studies have contradictory results. ObjectivesTo evaluate the effectiveness of TRMT on respiratory muscle strength, pulmonary function and exercise endurance in stroke patients. Materials and MethodsPubMed, Cochrane Library, Physical Therapy Evidence Database (PEDro), Embase (via OVID) and Web of Science databases were searched for randomized controlled trial (RCT) from inception to January 17, 2024. The primary outcome was maximum inspiratory pressure (MIP) or maximum expiratory pressure (MEP). Secondary outcomes included pulmonary function measured by forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1) and peak expiratory flow (PEF), and exercise endurance measured by 6-minute walk test (6MWT). ResultsA total of eight randomized controlled trials(RCTs), including 305 persons, were included in this study. The training time ranged from 3 weeks to 10 weeks. Among them, the intervention group in 4 studies used inspiratory muscle training, and the other 4 studies used inspiratory muscle training and expiratory muscle training. For the primary outcome, TRMT significantly improved MIP (mean=14.68 cmH2O, 95 %CI=2.28 to 27.09 cmH2O, P=0.02) and MEP (mean=9.37 cmH2O, 95 %CI=2.89 to 15.84 cmH2O, P=0.005) in stroke patients. Regarding the secondary outcomes, TRMT improved FVC, FEV1 and 6MWT (P<0.05) but did not significantly improve PEF. ConclusionTRMT improved inspiratory muscle strength and expiratory muscle strength, improved exercise endurance, and improved FVC and FEV1 of pulmonary function but did not significantly improve PEF.

Structured different exercise protocols improve lung function, respiratory muscle strength, and thickness in stroke patients. A randomized controlled trial

ABSTRACT Background The effect of core stabilization exercises (CSE) alone, or in combination with neuromuscular electrical stimulation (NMES) and Kinesio taping (KT) on lung function, respiratory muscle strength, and thickness in patients with stroke is not fully known. Objective To compare the efficacy of NMES and KT applied with CSE on lung functions, respiratory muscle strength, and thickness in patients with stroke. Methods A total of 45 stroke patients were randomly assigned to the core stabilization exercises (CSE) group, CSE+KT group or CSE+NMES group, respectively. All groups received the training protocol for 30–45 minutes, 3 days a week, for 6 weeks. Lung functions were measured using portable spirometry. Respiratory muscle strength was assessed using an analog manometer to measure maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP). Peak cough flow (PCF) was measured with a peak flow meter. Respiratory muscles thickness were determined using ultrasonography. Results Except for FVC (%pred) (F=4.432, p=0.018, np2=0.174), FEV1(%pred) (F=3.725, p=0.032, np2=0.151), and MEP (F=3.861, p=0.029, np2=0.155), the overall group by time interaction for rmANOVA showed that there was no statistically significant difference between groups (p>0.05). After post hoc analysis, it was determined that there was no statistically significant difference between the groups in terms of FVC (%pred), FEV1(%pred) and MEP (p>0.025). Conclusions The addition of NMES or KT to core stabilization exercises did not appear to provide additional benefit in improving lung function, respiratory muscle strength, and thickness in stroke patients.

The Relationship of Diaphragmatic Ultrasound-Based and Manometric Indices With Difficult Weaning in Tracheostomized Patients.

Patients with a tracheostomy and difficult weaning from invasive mechanical ventilation constitute a challenging problem in critical care. An increased duration of ventilation may lead to diaphragmatic dysfunction and a noninvasive assessment of the diaphragm, such as ultrasound, attracts interest in the clinical practice. We evaluated the relationship of ultrasound-derived indices with weaning outcome and with established indices of respiratory strength and load in subjects who are tracheostomized and undergoing weaning. This prospective study was conducted at an academic ICU in Greece. Twenty subjects with tracheostomy and difficult weaning, during a spontaneous breathing trial, underwent time synchronous diaphragmatic sonography and esophageal manometry, to assess diaphragmatic excursion and thickening fraction, esophageal and transdiaphragmatic pressures, pressure-time product of the esophageal pressure, and maximum inspiratory pressure. The primary outcome was liberation from mechanical ventilation at 48 h. The relationship of diaphragmatic ultrasound with esophageal pressure-derived indices was also evaluated. Weaning from invasive ventilation failed in 10 subjects. Diaphragmatic excursion exhibited a significant difference between weaning success and failure (1.34 ± 0.56 versus 0.79 ± 0.44; P = .044), a strong correlation with transdiaphragmatic pressure (r = 0.7, P = .02), and a moderate correlation with the pressure-time product of the esophageal pressure (r = 0.65, P = .02) and the maximum inspiratory pressure (r = 0.66, P = .02). Transdiaphragmatic pressure presented the highest area under the curve (0.97). However, when transdiaphragmatic pressure was compared with diaphragmatic excursion (area under the curve, 0.84) for predictive accuracy, no significant difference was found. Diaphragmatic excursion is a valuable tool for the assessment of diaphragmatic strength, respiratory load, and weaning prediction.

Exercise capacity in COVID-19 surviving patients: impact of physical rehabilitation

Background: At least 65 million individuals worldwide have Long COVID and despite efforts to explain the effects of exercise prescription on the recovery of these individuals, there is a need to explore its effects on exercise tolerance and cardiorespiratory fitness. Therefore, our main objective was to evaluate the effect of the Physical Rehabilitation Program (PRP) on muscle strength and physical exercise capacity of COVID-19 survivors. Methods: The cohort included 28 patients post COVID-19, each participant performed a comprehensive and multisystem evaluation in two visits, in the pre- and post-PRP: 1st visit = clinical evaluation periods (maximal inspiratory pressure (MIP); maximal expiratory pressure (MEP) and Duke Activity Status Index (VO2peak). 2nd visit= physical evaluation [6-minute Step Test (6MST) and Handgrip Strength (HGS)]. The PRP consisted of breathing exercises, muscle strength exercises for upper and lower limbs and aerobic exercise, 2 or 3 times/week for 03 months. Results: The post-PRP we found: improvement in peripheral [95%CI 2.7 (2.0-3.4), p=0.001, Huge] and respiratory [MIP 95%CI 1.6 (0.9-2.3), p&lt;0.001, Very large) and MEP 95%CI 2.7 (2.0-3.4), p=0.001, Huge)] muscle strength; increase in cardiorespiratory fitness according to estimated-VO2peak [95%CI 2.3 (1.5-3.1), p&lt;0.001, Huge] and the number of steps climbed in the 6MST [95%CI 1.6 (0.9-2.3), p&lt;0.001, Very large]; adaptations resulting lower resting heart rate (HR), higher peak HR, good modulation of HR resulting from stress caused by 6MST; linear and positive association between peripheral and respiratory muscle strength and the number of steps climbed 6MST and greater HR recovery especially post-PRP; recovery-first minute HR remained unchanged post-PRP. Conclusion: In patients post COVID19, we emphasize the great effect of individualized and supervised PRP on the increase in peripheral and respiratory muscle strength/ quality and cardiorespiratory fitness. Despite the gains obtained in PRP, the risk of death based on HR recovery did not change.

Effect of Inspiratory Muscle Training on Cough Strength in Older People With Frailty: A Single-Blind Randomized Controlled Trial

ObjectiveTo investigate the effect of inspiratory muscle training (IMT) on cough strength in older people with frailty. DesignSingle-blind randomized controlled trial. SettingDay health care centers at 2 sites. ParticipantsOlder people with frailty (N=60). InterventionsEligible people were randomly assigned to receive IMT program in addition to general exercise training (IMT group), or general exercise training alone (control group). The IMT group performed training using a threshold IMT device with the load set at 30% of maximum inspiratory mouth pressure in addition to the general exercise training program throughout the 8 weeks. The IMT took place twice a day and each session consisted of 30 breaths. Main Outcome MeasuresPrimary outcome was cough strength, measured as the cough peak flow (CPF), at the beginning and the end of the program. ResultsData from 52 participants (26 in each group) were available for the analysis. The mean age was 82.6 years; 33% were men. The change in CPF at the end of the program was 28.7±44.4 L/min in the IMT group and −7.4±26.6 L/min in the control group. A linear regression model showed that the presence or absence of IMT was associated with changes in CPF (mean difference between groups, 36.3; 95% confidence interval, 16.7-55.9; effect size, 0.99). ConclusionsIMT may be a useful intervention to improve cough strength in frail older people.

The role of inspiratory muscle fatigue and its impact on strength and respiratory function

Inspiratory muscles are essential for breathing and during exercise. However, excessive effort on the respiratory system can cause the inspiratory muscles, such as the external intercostals and the diaphragm, to become fatigued, therefore impairing performance (Wuthrich et al., 2013, Exp Physiol, 12, 1705–1717). Inspiratory muscle fatigue is when there is a loss in the capacity to produce force and/or velocity in a muscle, meaning they become tired and weak due to increased work demands (Tsukamoto et al., 2019, J Phys Ther Sci, 31, 318–325). Inspiratory muscle fatigue impacts performance because the force produced by the inspiratory muscles starts to decline which therefore causes them to fatigue as they cannot work to the maximum capacity no longer. This is vital in aerobic exercises such as rowing, cycling and running as the demand for oxygen is higher to perform the tasks. The diaphragm is the most dominant respiratory muscle involved in inspiration, alongside the external intercostal muscles. During inspiration, the diaphragm contracts and flattens, and the external intercostal muscles contract, pulling the ribcage up and outwards. The main function of these muscles is to allow a maximum amount of oxygen into the lungs by increasing the surface area in the thoracic cavity (Siafakas et al., 1999, Thorax, 54, 458–465). Several studies have explored delaying muscle fatigue by using inspiratory muscle training in healthy individuals. This is because it improves the strength of the respiratory muscles by increasing the endurance and capacity of the diaphragm. Results highlighted that maximum inspiratory pressure increased between 16 and 18% (Segizbaeva et al., 2014, Hum Physiol, 40, 683-689), a 7% increase in inspiratory muscle strength (Smith et al., 2021, Am J Physiol, 312, 1013-1018), a delay in muscle fatigue, and an improvement in performance. There is limited research on cycling, rowing, and running; therefore, this study aims to determine whether any of these exercises delay or increase muscle fatigue and to determine if maximal inspiratory pressure and maximal expiratory pressure improve respiratory function. This study aims to recruit 9–12 participants, which will involve four visits to the laboratory. Exercises include a 10-kilometre cycling session, a 3-kilometre treadmill running session, and a 2-kilometre rowing session, and these will be done in a randomised order. Visit 1 includes familiarisation; visit 2 involves baseline measures being recorded and test 1 being conducted; visit 3 includes test 2 being administered; and visit 4 involves test 3 being conducted. The measurements that will be collected at each kilometre are heart rate, rate of perceived exertion, and dyspnea. Blood lactate, maximal inspiratory pressure, and maximum expiratory pressure, however, will be collected before and after each test. At this present time, results are pending. My hypothesis for this study would be that all the cardio-based exercises will see an improvement in respiratory function and strength, with treadmill running having the biggest improvement as, throughout the 4 weeks, adaptation would have occurred.

A Secondary Analysis of Gender Respiratory Features for Ultrasonography Bilateral Diaphragm Thickness, Respiratory Pressures, and Pulmonary Function in Low Back Pain.

The aim of the present study was to determine the gender respiratory differences of bilateral diaphragm thickness, respiratory pressures, and pulmonary function in patients with low back pain (LBP). A sample of 90 participants with nonspecific LBP was recruited and matched paired by sex (45 women and 45 men). Respiratory outcomes included bilateral diaphragm thickness by ultrasonography, respiratory muscle strength by maximum inspiratory (MIP) and expiratory (MEP) pressures, and pulmonary function by forced expiratory volume during 1 s (FEV1), forced vital capacity (FVC) and FEV1/FVC spirometry parameters. The comparison of respiratory outcomes presented significant differences (p < 0.001), with a large effect size (d = 1.26-1.58) showing means differences (95% CI) for MIP of -32.26 (-42.99, -21.53) cm H2O, MEP of -50.66 (-64.08, -37.25) cm H2O, FEV1 of -0.92 (-1.18, -0.65) L, and FVC of -1.00 (-1.32, -0.69) L, with lower values for females versus males. Gender-based respiratory differences were presented for maximum respiratory pressures and pulmonary function in patients with nonspecific LBP. Women presented greater inspiratory and expiratory muscle weakness as well as worse lung function, although these differences were not linked to diaphragm thickness during normal breathing.

The Relationship between Inspiratory Muscle Strength and Cycling Performance: Insights from Hypoxia and Inspiratory Muscle Warm-Up.

Hypoxia increases inspiratory muscle work and consequently contributes to a reduction in exercise performance. We evaluate the effects of inspiratory muscle warm-up (IMW) on a 10 km cycling time trial in normoxia (NOR) and hypoxia (HYP). Eight cyclists performed four time trial sessions, two in HYP (FiO2: 0.145) and two in NOR (FiO2: 0.209), of which one was with IMW (set at 40% of maximal inspiratory pressure-MIP) and the other was with the placebo effect (PLA: set at 15% MIP). Time trials were unchanged by IMW (NORIMW: 893.8 ± 31.5 vs. NORPLA: 925.5 ± 51.0 s; HYPIMW: 976.8 ± 34.2 vs. HYPPLA: 1008.3 ± 56.0 s; p > 0.05), while ventilation was higher in HYPIMW (107.7 ± 18.3) than HYPPLA (100.1 ± 18.9 L.min-1; p ≤ 0.05), and SpO2 was lower (HYPIMW: 73 ± 6 vs. HYPPLA: 76 ± 6%; p ≤ 0.05). A post-exercise-induced reduction in inspiratory strength was correlated with exercise elapsed time during IMW sessions (HYPIMW: r = -0.79; p ≤ 0.05; NORIMW: r = -0.70; p ≤ 0.05). IMW did not improve the 10 km time trial performance under normoxia and hypoxia.

The effects of adding a six-month Pilates exercise program to three months of traditional community-based pulmonary rehabilitation in individuals with COPD: a prospective cohort study.

Pilates exercise may complement traditional pulmonary rehabilitation in individuals with chronic obstructive pulmonary disease (COPD). The objective was to analyze the effects of adding a six-month Pilates exercise program to a three-month pulmonary rehabilitation for individuals with COPD. Thirty-five participants with COPD (GOLD B) were assigned to the intervention (n=14) or control (n=21) group. Both groups received an initial three months of a pulmonary rehabilitation program. The intervention group further underwent six months of pilates. Participants were evaluated at baseline and at three, six, and nine months. Lung function and strength of respiratory muscles were defined as primary outcomes. Secondary outcomes included cardiac, physical function, and exacerbation episodes. There were no consistent statistically significant differences between groups for the lung function outcomes (p\<0.05). Maximal inspiratory and expiratory pressure increased significantly at three months in both groups (p\<0.05). It was significantly superior in the intervention group at nine months for maximal inspiratory pressure (p=0.005) and six and nine months for maximal expiratory pressure (p=0.027 and p\<0.001, respectively). Changes in muscle strength (knee extension and handgrip) were comparable between groups (p>0.05), but exercise-induced fatigue and balance were significantly superior in the intervention group at the six- and nine-month follow-ups (p\<0.05). Pilates exercise programs may be implemented to augment traditional pulmonary rehabilitation with the goal of improving the strength of respiratory muscles. Adding a Pilates exercise program to pulmonary rehabilitation resulted in superior strength of respiratory muscles, higher resistance to exercise-induced fatigue, and improved balance.

Effects of different inspiratory muscle training protocols on functional exercise capacity and respiratory and peripheral muscle strength in patients with chronic kidney disease: a randomized study

BackgroundPathological changes were observed in the diaphragm due to abnormal renal function in chronic kidney disease (CKD). Inspiratory muscle training (IMT) has been suggested for patients with CKD; however, the most appropriate intensity for IMT has not been determined. Therefore, this study aimed to investigate the effects of different IMT protocols on respiratory muscle strength, quadriceps femoris muscle strength (QMS), handgrip muscle strength (HGS), functional exercise capacity, quality of life (QoL), pulmonary function, dyspnoea, fatigue, balance, and physical activity (PA) levels in patients with CKD.MethodsThis randomized, controlled, single-blind study included 47 patients and they were divided into three groups: Group 1 (n = 15, IMT with 10% maximal inspiratory pressure (MIP)), Group 2 (n = 16, IMT with 30% MIP), and Group 3(n = 16; IMT with 60% MIP). MIP, maximal expiratory pressure (MEP), 6-min walking test (6-MWT), QMS, HGS, QoL, pulmonary function, dyspnoea, fatigue, balance, and PA levels were assessed before and after eight weeks of IMT.ResultsIncreases in MIP, %MIP, 6-MWT distance, and %6-MWT were significantly higher in Groups 2 and 3 than in Group 1 after IMT (p < 0.05). MEP, %MEP, FEF25-75%, QMS, HGS, and QoL significantly increased; dyspnoea and fatigue decreased in all groups (p < 0.05). FVC, PEF, and PA improved only in Group 2, and balance improved in Groups 1 and 2 (p < 0.05).ConclusionsIMT with 30% and 60% MIP similarly improves inspiratory muscle strength and functional exercise capacity. IMT with 30% is more effective in increasing PA. IMT is a beneficial method to enhance peripheral and expiratory muscle strength, respiratory function, QoL and balance, and reduce dyspnoea and fatigue. IMT with %30 could be an option for patients with CKD who do not tolerate higher intensities.Trial registrationThis study was retrospectively registered (NCT06401135, 06/05/2024).

Effect of lung breather on hospital stay in patients with acquired pneumonia: a randomized clinical study

INTRODUCTION. Acquired pneumonia is a severe medical condition that is addressed as life-threating issue requiring intensive care. The Medical Breather device can activate and strengthen both the inspiratory and expiratory muscles, so it can be useful for patients with pneumonia. AIM. To investigate the breather effect on length of hospital stay in patients with pneumonia. MATERIALS AND METHODS. Sixty participants diagnosed with acquired pneumonia “30 women, 30 men stayed in hospital in ICU for two weeks; aged 30–40 years old” selected from chest department of Kasr Al-Aini Intensive Care Unit (ICU) at Cairo University. They were randomly allocated into equal groups; Group A received respiratory training via incentive spirometer, and traditional chest physiotherapy; and Group B received respiratory training via Breather, and traditional chest physiotherapy, both received 3 session daily/2 weeks. Diaphragmatic excursion, Respiratory Distress Observation Scale, and ICU discharge were assessed before and after the treatment. RESULTS. Both groups revealed significant improvement after the treatment, while Breather group showed a high significant increase in pH 1.23 %, PaO2 11.79 %, SaO2 6.1 %, and diaphragmatic excursion by 36.97 %, also decrease in PaCO2 2.78 %, RDOS 39.06 % and NEWS2 by 50.72 % in comparison to incentive spirometer group that recorded significant increase in pH 0.68 %, PaO2 6.69 %, SaO2 by 2.66 %, and diaphragmatic excursions by 8.15 %, also significant decrease in PaCO2 12.12 %, RDOS 15.01 % and NEWS2 by 20.93 %. HCO3 revealed no significant difference post treatment (p 0.05). DISCUSSION. Breather usage in inspiratory musculatures training (IMT) gained Maximum Inspiratory Pressure (Pimax) significant improvement. IMT enforces both diaphragm and accessory respiratory musculatures. Probably functional capabilities improvements based on enhanced respiratory musculatures’ both endurance and strength that improve pulmonary oxygen uptake thus minimize dyspnea severity. Respiratory muscles training program improves not only cognitive function. Moreover, IMT could be addressed as a prime component of respiratory training in combine with expiratory one that is why whom has preserved pulmonary function. CONCLUSION. Breather as a respiratory training technique has remarkable results in reducing hospital stays in patients with acquired pneumonia, and significant positive effects on diaphragmatic function, oxygenation levels. Therefore, it is recommended to use Breather for routine acquired pneumonia care. REGISTRATION: Clinicaltrials.gov identifier: No NCT06062862; registered April 30, 2022.

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

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

Establishing an optimal diagnostic criterion for respiratory sarcopenia using peak expiratory flow rate

BackgroundThe skeletal muscle changes as aging progresses, causing sarcopenia in the older adult population, which affects the respiratory muscles’ mass, strength, and function. The optimal cut-off point of peak expiratory flow rate (PEFR) for respiratory sarcopenia (RS) diagnosis in accordance with sarcopenia identification is needed.AimTo establish an optimal cut-off point of PEFR for RS diagnosis in community-dwelling Asian older women.MethodsSarcopenia diagnostic indicators were evaluated according to the Asian Working Group for Sarcopenia 2019 (AWGS) criteria. The respiratory parameters composed of respiratory muscle strength and respiratory function were evaluated by assessing maximal inspiratory pressure (MIP), percent predicted forced vital capacity (Pred FVC), and PEFR.ResultsA total of 325 community-dwelling older women were included in this study. PEFR was negatively associated with RS (OR: 0.440; 95% CI: 0.344–0.564). The area under the curve (AUC) of PEFR was 0.772 (p < 0.001). The optimal cut-off point of PEFR for RS diagnosis was 3.4 l/s (sensitivity, 63.8%; specificity, 77.3%). Significant differences were found between the robust, possible sarcopenia, sarcopenia, and RS groups in terms of both sarcopenia diagnostic indicators and respiratory parameters (p < 0.05).ConclusionsThe cut-off point of PEFR can be used as a reasonable standard for RS diagnosis. This study finding can serve as a cornerstone for developing concrete criteria of RS in older women, supporting clinical judgment, which is crucial for providing appropriate treatment through accurate diagnosis.

Upper limb muscle strength and exercise endurance as predictors of successful extubation in mechanically ventilated patients

BackgroundFailed extubation increases the intensive care unit (ICU) length of stay, hospital length of stay, and financial costs and it reduces the patient’s functional ability. Avoiding failed extubation is of utmost importance, therefore predictors for successful extubation are paramount.ObjectiveTo determine if successful extubation in mechanically ventilated patients can be predicted by physiotherapists using upper limb muscle strength and exercise endurance.MethodsFifty-seven patients from the medical and trauma ICUs of a large academic hospital were eligible for testing. Muscle strength was evaluated using the Oxford grading scale, Medical Research Council score (MRC score), handgrip dynamometer, and maximum inspiratory pressure (MIP). Exercise endurance was tested while the patient was actively riding the MOTOmed® letto2 cycle ergometer for six minutes with the upper limbs.ResultsExercise endurance (time the patient rode actively) (P = 0.005), MRC-score (P = 0.007), and number of days ventilated (P = 0.005) were associated with successful extubation. The handgrip strength (P = 0.061), MIP (P = 0.095), and muscle strength of the sternocleidomastoid (P = 0.053) and trapezius muscles (P = 0.075) were marginally associated with successful extubation. Due to multicollinearity when developing the prediction equation, the final multivariable logistic regression prediction model included only exercise endurance and the number of days ventilated. The newly developed prediction equation conferred a sensitivity of 81.82% and a specificity of 77.14% to predict successful extubation.ConclusionSuccessful extubation of mechanically ventilated patients can be predicted by physiotherapists using the newly developed prediction equation consisting of exercise endurance and number of days ventilated.

Sleep Quality in Greek Adolescent Swimmers.

The aim of our study was to investigate the relationship between sleep quality and functional indices, swimming distance and gender in adolescent competitive swimmers. Forty-eight adolescent swimmers (boys, n = 22, 15.7 ± 1.0 years and girls, n = 26, 15.1 ± 0.8 years) were included in our study. They were assessed for handgrip strength, respiratory muscle strength and pulmonary function, answered a Pittsburg Sleep Quality Index questionnaire (PSQI), and recorded their anthropometric and morphological characteristics and training load for the last four weeks. The results showed differences between swimming distance and chest circumference difference, between maximal inhalation and exhalation (Δchest) (p = 0.033), PSQI score (p < 0.001), and sleep quality domains for "cannot breathe comfortably" (p = 0.037) and "have pain" (p = 0.003). Binary logistic regression (chi-square = 37.457, p = 0.001) showed that the variables Δchest (p = 0.038, 95% CI: 1.05-6.07) and PSQI score (p = 0.048, 95% CI: 0.1-1.07) remained independent predictors of the swim distance groups. Girls had a lower percentage of predicted values for the maximal inspiratory pressure (p < 0.001), maximal expiratory pressure (p = 0.027), forced expiratory volume within the first second (p = 0.026), forced vital capacity (p = 0.008) and sleep quality domains for "cough or snore loudly" (p = 0.032) compared to boys. A regression analysis showed that the sleep quality score was explained by the six independent variables: respiratory muscle strength (t = 2.177, β = 0.164, p = 0.035), Δchest (t = -2.353, β = -0.17, p = 0.023), distance (t = -5.962, β = -0.475, p < 0.001), total body water (t = -7.466, β = -0.687, p < 0.001), lean body mass (t = -3.120, β = -0.434, p = 0.003), and handgrip (t = 7.752, β = 1.136, p < 0.001). Our findings demonstrate that sleep quality in adolescent swimmers is a multifactorial result of morphometric characteristics, strength and respiratory function.

Functional Physical Analysis and Quality of Life in the Preoperative and Early Postoperative Periods of Cardiac Surgery and 30 Days After Hospital Discharge.

The analysis of patients submitted to heart surgery at three assessment times has been insufficiently described in the literature. To analyze chest expansion, maximum inspiratory pressure (MIP), maximum expiratory pressure (MEP), distance traveled on the six-minute walk test (6MWT), and quality of life in the preoperative period, fourth postoperative day (4th PO), and 30th day after hospital discharge (30th-day HD) in individuals submitted to elective heart surgery. A descriptive, analytical, cross-sectional study was conducted with 15 individuals submitted to elective heart surgery between 2016 and 2020 who did not undergo any type of physiotherapeutic intervention in Phase II of cardiac rehabilitation. The outcome variables were difference in chest expansion (axillary, nipple, and xiphoid), MIP, MEP, distance on 6MWT, and quality of life. The assessment times were preoperative period, 4th PO, and 30th-day HD. Chest expansion diminished between the preoperative period and 4th PO, followed by an increase at 30th-day HD. MIP, MEP, and distance traveled on the 6MWT diminished between the preoperative period and 4th PO, with a return to preoperative values at 30th-day HD. General quality of life improved between the preoperative period and 4th PO and 30th-day HD. An improvement was found in the social domain between the preoperative period and the 30th-day HD. Heart surgery causes immediate physical deficit, but physical functioning can be recovered 30 days after hospital discharge, resulting in an improvement in quality of life one month after surgery.

The health-related physical fitness of university female students with and without generalized joint hypermobility: A case-control study

Objective: To evaluate the effect of generalized joint hypermobility (GJH) on health-related physical fitness. Participants: Female university students between the ages of 18-23. Methods: Cardiorespiratory fitness ((maximal cycling ergometer tests, six-minute walking tests (6MW)), respiratory function tests, respiratory muscle strength (maximal inspiratory and expiratory pressure), body composition (bioelectrical impedance analyses), flexibility (sit and reach tests (SRT), muscle strength and endurance (isometric and isokinetic tests) were evaluated for health-related physical fitness. Results: The mean VO2max (23.6 vs. 21.8, p=.049), MET (6.7 vs. 6.3, p=0.049), W/kg (1.6 vs. 1.5, p=0.035), and SRT scores (23.3 vs. 18.7, p=0.016) were higher in 39 students with asymptomatic GJH compared to 42 non-GJH students. No significant differences found between groups for 6MW, FVC, FEV1, MIP, MEP, body composition, muscle strength, and endurance (p&gt;.05). Conclusion: Females with generalized joint hypermobility have the same or even higher levels of physical fitness capacity as those without the hypermobility.

Efficacy of POWERbreathe Medic Plus device on maximal inspiratory pressure, functional capacity and quality of life in coronary artery bypass graft patients: A randomized controlled trial protocol

Coronary artery disease (CAD) is a prominent cause of illness and mortality worldwide, with a significant amount of coronary artery bypass graft (CABG) surgeries performed each year. It is a complicated technique that results in several clinical and functional issues. While CABG is an effective treatment, it comes with clinical and functional challenges, including reduced lung volume, maximal inspiratory and expiratory pressure, and thoracic mobility after surgery. Incisional pain has been associated with a decline in postoperative lung function; however, this resolves a month following surgery. There is no documented association between respiratory muscle strength and lung function after heart surgery. The POWERbreathe Medic Plus is intended for patients who have extremely weak breathing muscles as a result of illness, hospitalization, or existing respiratory health disorders such as Chronic Obstructive Pulmonary Disease (COPD) and asthma. To address these challenges, a study will investigate the efficacy of the POWERbreathe Medic Plus device in improving maximal inspiratory pressure, functional capacity, and quality of life in CABG patients. CTRI no. – CTRI/2023/04/052116 Link-https://ctri.nic.in/Clinicaltrials/pmaindet2.php?EncHid=ODMxNTA=&amp;Enc=&amp;userName=CTRI/2023/04/052116 CTRI registration date – 28/04/2023

Office-based respiratory assessment in patients with generalized myasthenia gravis

Patients with myasthenia gravis (MG) can present with respiratory dysfunction, ranging from exercise intolerance to overt respiratory failure, increased fatigue, or sleep-disordered breathing. To investigate the value of multiple respiratory tests in MG, we performed clinical and respiratory assessments in patients with mild to moderate generalized disease. One-hundred and thirty-six patients completed the myasthenia gravis quality-of-life score(MG-QOL-15), myasthenia gravis impairment index(MGII), Epworth sleepiness scale(ESS), University of California-San Diego Shortness of Breath Questionnaire(UCSD-SOB), Modified Medical Research Council Dyspnea Scales(MRC-DS), supine and upright forced vital capacity(FVC), maximal inspiratory pressures(MIPs) and sniff nasal inspiratory pressures(SNIP). Seventy-three (54 %) had respiratory and/or bulbar symptoms and 45 (33 %) had baseline abnormal FVC, with no significant postural changes (p = 0.89); 55 (40.4 %) had abnormal MIPs and 50 (37 %) had abnormal SNIPs. Overall, there were low scores on respiratory and disability scales. Females had increased odds of presenting with abnormal FVC (OR 2.89, p = 0.01) and MIPs (OR 2.48, p = 0.022). There were significant correlations between MIPs, FVC and SNIPs; between MGII/MG-QOL15 and UCSD-SOB/MRC-DS and between ESS and respiratory scales in the whole group. Our data suggests that office-based respiratory measurements are a useful screening method for stable MG patients, even when presenting with minimal respiratory symptoms and no significant disability.