Peripheral Muscle Training Research Articles

EXERCISE PRESCRIPTION IN A MULTIDISCIPLINARY LONG COVID CLINIC: METHODOLOGY FROM AN AUSTRALIAN EXPERIENCE

INTRODUCTION & AIMS The University of Canberra Hospital Post-COVID Recovery Clinic is one of Australia’s few multidisciplinary outpatient clinics. Our model includes personally-prescribed exercise of both inspiratory and peripheral muscles. We have treated > 200 people with Long COVID with no serious adverse events, and our model is highly acceptable to consumers. This paper offers a detailed description of our methodology capturing how we achieve safe, tailored personal exercise, and carefully manage post-exertional symptom exacerbation (PESE). METHODOLOGY Initial screening appointments last 2 hours, and clients are referred for medical review if they have signs or symptoms of an acute or life-threatening complication (e.g. unexplained chest pain). Individualised exercise programs are prescribed, progressed, and monitored by an Exercise Physiologist or Physiotherapist initially on an individual basis, then in a supervised group setting. The group program consists of twice weekly sessions of 60 minutes duration. Clients attending group therapies are provided with a home exercise program to enable self-management. Clients are screened at baseline assessment for PESE triggered by participation in activities of daily living. All clients receive education about activity modification and pacing strategies. For clients experiencing PESE, activity is not progressed until they can tolerate 2 weeks of activity without PESE. For peripheral muscles, progressive resistance exercises are prescribed at a submaximal intensity (RPE 4-6/10), with 4-6 exercises completed 3 days/week. Once able to tolerate ADLs, low intensity cardiovascular exercise is gradually introduced with increased monitoring from a clinician. For patients with dyspnoea, high-intensity inspiratory muscle training is prescribed as 5 sets of 6 breaths at least 50% of their maximal inspiratory pressure (30 breaths total) 5 days per week. CONCLUSION Our experience indicates that it is possible to safely prescribe exercise in people with Long COVID, incorporating both peripheral and inspiratory muscle training, while carefully monitoring and managing PESE.

Evaluation of respiratory and peripheral muscle training in individuals undergoing myocardial revascularization.

To investigate the effect of peripheral muscle strength training (PMT) and respiratory muscle strength training (RMT) muscle strength training associated with conventional physical therapy on the respiratory muscle strength, functional capacity, and quality of life in the immediate postoperative period of patients undergoing coronary artery bypass graft (CABG). This was a randomized controlled trial. Eighty-three patients undergoing CABG were divided into two groups: Intervention group, patients that received PMT and RMT associated with conventional physical therapy, one session a day for 5 days; control group, patients that received conventional physical therapy, one session a day for 5 days. All patients had respiratory muscle strength, peripheral muscle strength, functional capacity, and quality of life evaluated by manovacuometry, dynamometry, 6-minwalking test, and 36-item Short-Form Health Survey Questionnaire, respectively, before and 5 days after CABG. Both groups showed a significantly reduced respiratory muscle strength after CABG; however, in the intervention group, the inspiratory muscle strength reduction was lower (confidence interval [CI] 95%: 2.29 [1.9; 27.54]). The quality of live domains for pain (CI 95%: 3.08 [5.21; 24.97])and vitality perception (CI 95%: 2.51 [2.12; 19.53]) worsened in the control and improved in the intervention group (pain: CI 95%: 1.19 [-3.38; 13.09]; vitality CI 95%: 0.07 [-6.55; 7.04]). Both groups showed reduced functional capacity and expiratory muscle strength after CABG. Conventional physical therapy combined with PMT and RMT may reduce inspiratory muscle strength loss and improve pain and vitality perception in the immediate postoperative period after CABG.

Effects of peripheral and different inspiratory muscle training methods in coronary artery disease patients with metabolic syndrome: A randomized-controlled trial

Background ObjectiveTo investigate the effects of peripheral muscle training (PMT) and different inspiratory muscle training (IMT) methods on respiratory functions, exercise capacity, and biochemistry parameters in coronary artery disease patients with metabolic syndrome. MethodsThis prospective, single-blind, randomized-controlled study included 60 patients of stable coronary artery disease with metabolic syndrome (New York Heart Association [NYHA] Class I-II, left ventricular ejection fraction >40%). Patients were randomly divided into three groups: neuromuscular electrical stimulation (NMES) plus PMT group (NMES + PMT group, n = 20), IMT plus PMT group (IMT + PMT group, n = 20) and PMT group (PMT group, n = 20). Treatment continued for six weeks for all groups. The NMES was applied to rectus abdominis, IMT was applied with 30% of maximal inspiratory pressures, and PMT was applied at home. Spirometry, maximal inspiratory and expiratory pressure, dyspnea scores, exercise stress test, and biochemistry parameters were measured before and after training. ResultsThere were significant improvements in spirometric tests, respiratory muscle strength, dyspnea scores, exercise capacity, fasting blood glucose, and antistreptolysin O after treatment in all groups (p < 0.05). Significant improvements in C-reactive protein and erythrocyte sedimentation rate were observed in NMES + PMT and IMT + PMT groups (p < 0.05). Among the groups, there was a significant difference in maximal inspiratory pressure (p = 0.02) and erythrocyte sedimentation rate (p = 0.037) in favor of NMES + PMT group (p < 0.05). ConclusionOur study results showed significant improvements in respiratory functions, exercise capacity, and biochemistry markers in all groups. Different IMT methods can be used in cardiopulmonary rehabilitation to improve exercise intolerance in coronary artery disease patients with metabolic syndrome. Clinical Trial registration numberNCT03523026.

Difficulty in weaning and cardiopulmonary rehabilitation in inoperable severe mitral regurgitation: a case report

Objective: Severe mitral valve insufficiency may lead to heart failure and associated hemodynamic repercussions, such as congestion and weaning-induced pulmonary oedema. This slows weaning from mechanical ventilation, increases the length of the hospital stay, and worsens the patient’s prognosis. Case report: The present report describes one strategy used for cardiopulmonary rehabilitation and to help wean a patient from mechanical ventilation, with prohibitive comorbidities that contra-indicate surgical mitral valve repair, using respiratory and peripheral muscle training associated with positive pressure ventilation. Discussion: The severe dysfunction of the mitral valve was considered to be surgically inoperable by the surgeon team. However, the weaning and rehabilitation challenges in this patient with severe chronic obstructive pulmonary disease, even with weaning-induced pulmonary edema occurrence, were overcome. The strategy to rehabilitate respiratory muscle force during positive pressure ventilation, concomitantly to a cardiopulmonary rehabilitation program, improved peripheral muscle strength and functionality, reducing energetic demand, allowing the weaning from mechanical ventilation. Conclusion: Despite the severity of the disease, with the adopted strategy it was possible to perform weaning of the mechanical ventilation, allowing the patient to survive with his relatives.

Effects of Resistance Training of Peripheral Muscles Versus Respiratory Muscles in Older Adults With Sarcopenia Who are Institutionalized: A Randomized Controlled Trial.

This study compares the effects of two resistance training programs in peripheral and respiratory musculature on muscle mass and strength and physical performance and identifies the appropriate muscle mass parameter for assessing the intervention effects. Thirty-seven institutionalized older Spanish adults with sarcopenia were analyzed: control group (n = 17), respiratory muscle training group (n = 9), and peripheral muscle training group (n = 11). Measured outcomes were appendicular skeletal muscle mass (ASM/height2, ASM/weight, and ASM/BMI), isometric knee extension, arm flexion and handgrip strength, maximal inspiratory and expiratory pressures, and gait speed pre- and postintervention. Trained groups participated in a 12-week program and improved in maximum static inspiratory pressure, maximum static expiratory pressure, knee extension, and arm flexion (p < .05), whereas nonsignificant changes were found in gait speed and ASM indexes pre- and postintervention in the three groups. In conclusion, resistance training improved skeletal muscle strength in the studied population, and any ASM index was found to be appropriate for detecting changes after physical interventions.

Peripheral muscle training with resistance exercise bands in patients with chronic heart failure. Long-term effects on walking distance and quality of life; a pilot study.

AimsThis study aimed to describe a method of peripheral muscle training with resistance bands in patients with chronic heart failure (CHF) and to evaluate its effects on the 6 min walk test and quality of life up to 12 months using a home‐based programme.Methods and resultsTwenty‐two patients with stable CHF (19 men and 3 women), mean age 63.2 years (SD 8.1), New York Heart Association class II–III were randomized to individual home‐based training (HT group), or home‐based training with a group‐based start‐up in a hospital setting (GT group). A 6 min walk test, the Minnesota Living with Heart Failure Questionnaire (MLHFQ), and Short Form with 36 items (SF‐36) were administered at baseline and after 3, 6, 9, and 12 months. Exercise training resulted in statistically significant increased walking distance in both groups. The HT group increased on average 107 (80) m from baseline to 12 months, and the GT group by 100 (96) m. Health‐related quality of life, measured with MLHFQ and SF‐36, reached statistically significant improvements in both groups but at different time points. There were no statistically significant differences between groups on any parameters or follow‐ups.ConclusionsLong‐term home‐based peripheral muscle training in patients with CHF, with or without an introductory period in a hospital setting, can be used for initial improvement and retention of walking distance and health‐related quality of life.

Erratum to: Is there any benefit using low-intensity inspiratory and peripheral muscle training in heart failure? A randomized clinical trial.

Erratum to: Is there any benefit using low-intensity inspiratory and peripheral muscle training in heart failure? A randomized clinical trial.

Peripheral Muscle Strength Indicates Respiratory Function Testing in Renal Recipients.

Muscle wasting occurs in renal recipients due to decreased physical performance, and decreased respiratory muscle strength may occur due to changes in structure and function. Data are scarce regarding the roles of sarcopenia and nutritional status on respiratory muscle function in these patients. Here, we evaluated interactions among peripheral muscle strength, sarcopenia, nutritional parameters, and respiratory muscle function in renal transplant recipients. Ninety-nine patients were prospectively enrolled between September and April 2016 at Baskent University. Forced vital capacity values (via pulmonary function tests), respiratory muscle strength (via maximal static inspiratory and expiratory pressures), and peripheral muscle strength (via hand grip strength test) were recorded. Nutritional parameters, fat weight, arm circumference, waist circumference, and C-reactive protein levels were also recorded. Of 99 patients, 68 were renal transplant recipients (43 men, mean age: 39.09 ± 10.70 y) and 31 were healthy participants (14 men, mean age: 34.94 ± 10.95 y). Forced vital capacity (P < .001, r = 0.65), maximal inspiratory (P = .002, r = 0.39) and expiratory (P < .001, r = 0.4) pressure, and hand grip strength showed significant relations in transplant recipients. Positive correlations were found between serum albumin levels and both hand grip strength (P = .16, r = 0.347) and forced vital capacity (P = .03, r = 0.436). Forced vital capacity was statistically different between renal recipients and healthy participants (P = .013), whereas maximal inspiratory and expiratory pressures were not (P > .05). No statistically significant relation was observed between biochemical parameters and maximal inspiratory and expiratory pressures (P ? .05). Respiratory function and peripheral muscle strength were significantly related in renal transplant recipients, with significantly lower peripheral muscle strength suggesting the presence of inadequate respiratory function. Peripheral and respiratory muscle training and nutritional replacement strategies could help to improve postoperative respiratory function.

Abstract 11395: Enhanced External Counter Pulsation Improves Lipid Abnormalities in Patients With Chronic Ischemic Heart Disease

Introduction: Enhanced external counter pulsation (EECP) is effective in improving anginal symptoms in patients with ischemic heart disease (IHD); however its effect on the lipid profile has not yet been reported. Hypothesis: Exercise like peripheral muscle training effect of EECP could improve lipid profile. Methods: Two hundred and twenty nine consecutive patients, age 61.2+/-9.5 years, 207 (90.3%) males, left ventricular ejection fraction 35.5+/-11.7%, referred for EECP therapy between 2013 and 2016 were included in the study. All patients had symptomatic IHD and were on anti-ischemic and statin therapy. Patients were subjected to 35 EECP sessions of one hour each. All patients were subjected to a thorough clinical evaluation and a 12 hour fasting lipid profile estimation at the baseline and after completion of 35 sessions of EECP therapy. Concomitant medical therapy, including statins, remained unaltered during the course of EECP. Results: Significant improvement was noted in functional class, 6 minute hall walk test and activity scale after EECP therapy. Lipid abnormalities were common in these patients at baseline with 104 (45.4%) subjects having low density lipoprotein cholesterol (LDLC) &gt; 70 mg/dl, 128 (55.8%) having high density lipoprotein cholesterol (HDLC) &lt;35mg/dl and 79 (34.5%) having triglycerides &gt;140mg/dl. EECP resulted in significant improvement in lipid parameters in these patients- LDLC decreased by 18.5% (from 95.1+/-26.7 to 77.5+/-24.3 mg/dl, P value &lt;0.0001), triglycerides decreased by 18.9% (from 198.3+/-76.4 to 160.8+/-56.6 mg/dl, , P value &lt;0.0001) and HDLC increased by 14.2% (from 28.1+/-5.2 to 32.1+/-9.1 mg/dl, P value &lt;0.0001). The subgroups with worse baseline lipid levels showed larger improvement- patients having baseline LDLC &gt;100mg/dl showed 29.6% reduction in LDLC and those with HDLC &lt;25mg/dl showed 41.3% increase in HDLC after EECP therapy. Conclusions: Patients with IHD having abnormal baseline lipid levels despite statin therapy show significant improvement in LDLC, triglyceride and HDLC levels after EECP therapy. This improvement is likely to be due to the exercise like peripheral muscle training effect of EECP and needs further evaluation.

Exercise-based cardiac rehabilitation in patients with chronic heart failure: a Dutch practice guideline.

RationaleTo improve the quality of exercise-based cardiac rehabilitation (CR) in patients with chronic heart failure (CHF) a practice guideline from the Dutch Royal Society for Physiotherapy (KNGF) has been developed.Guideline developmentA systematic literature search was performed to formulate conclusions on the efficacy of exercise-based intervention during all CR phases in patients with CHF. Evidence was graded (1–4) according the Dutch evidence-based guideline development criteria.Clinical and research recommendationsRecommendations for exercise-based CR were formulated covering the following topics: mobilisation and treatment of pulmonary symptoms (if necessary) during the clinical phase, aerobic exercise, strength training (inspiratory muscle training and peripheral muscle training) and relaxation therapy during the outpatient CR phase, and adoption and monitoring training after outpatient CR.Applicability and implementation issuesThis guideline provides the physiotherapist with an evidence-based instrument to assist in clinical decision-making regarding patients with CHF. The implementation of the guideline in clinical practice needs further evaluation.ConclusionThis guideline outlines best practice standards for physiotherapists concerning exercise-based CR in CHF patients. Research is needed on strategies to improve monitoring and follow-up of the maintenance of a physical active lifestyle after supervised CR.

Variabilidad en la asistencia hospitalaria. El caso de la rehabilitación respiratoria en Colombia

ObjectiveTo describe variations in the management of pulmonary rehabilitation (PR) programs in patients with Chronic Obstructive Pulmonary Disease (COPD) by Colombian physiotherapists. Materials and methodWe conducted a cross-sectional, observational study with 250 Colombian physiotherapists who routinely work with COPD patients from Colombia. A survey was made to identify variations in procedures, components, structure and characteristics of PR programs according to the «Guidelines for the physiotherapy management in patients with pulmonary disease with spontaneously breathing» published by British Thoracic Society Physiotherapy (BTS). Additionally, socio-demographic data were collected. ResultsThe response rate was 89.6% (n=224). At the time of the survey, 92% of those surveied spent most of their time working in rehabilitation programs. Regarding variations in the clinical practice, the physiotherapists mainly answered «always perform» activities with low level of evidence (Grade C and D) such as diaphragmatic breathing techniques (48.7%), pursed-lip breathing during exercise (62.9%) and techniques of breath control (37.5%). A high percentage of professionals also included interventions with a higher degree of recommendation (Grade A) such as peripheral muscle training (42.9%), respiratory muscle training (52.2%), education or counseling disease (56.7%), use of intermittent positive pressure ventilation (31.7%), and application of oxygen (40.6%). ConclusionsThe study confirms that there are important variations in therapeutic care components of the PR proposed by the BTS for patients with Chronic Obstructive Pulmonary Disease.

Effect of Peripheral and Respiratory Muscle Training on the Functional Capacity of Hemodialysis Patients

Patients on hemodialysis (HD) show changes in muscle structure and function reducing their functional capacity. This study was conduted to assess the effects of respiratory muscle training (RMT) and peripheral muscle training (PMT) during dialysis on functional parameters, inflammatory state, and quality of life (QoL) in patients on HD. Randomized controlled trial included 39 patients on HD, and they were divided into three groups: RMT (n = 11), PMT (n = 14), and controls (C, n = 14). Training was performed during the HD session for 10 weeks. Maximal inspiratory pressure (PImax), maximal expiratory pressure (PEmax), forced vital capacity (FVC), six-minute walk test (6MWT), Kt/Vsp, biochemical parameters, and inflammatory state (i.e., level of high sensitivity C-reactive protein) were evaluated. Variation from baseline was calculated by Analysis of Covariance (ANCOVA). The ΔPImax was 22.5 ± 3.2, 9.1 ± 2.9, and −4.9 ± 2.8 cmH2O in the RMT, PMT and C, respectively (p < 0.001); ΔPEmax was 10.8 ± 6.6, 3.7 ± 5.9, and −15.6 ± 5.9 cmH2O respectively (p = 0.014). The Δ6MWT was significantly greater in RMT and PMT (65.5 ± 9; 30.8 ± 8 m) than in C (−0.5 ± 8.1 m), p < 0.001. Although biochemical parameters decreased after training, Kt/V remained unchanged. CRP decreased only in the RMT and PMT groups. There was a significant increase in QoL scores in the training groups (vs. C) in energy/fatigue (p = 0.002), sleep (p < 0.001), pain (p < 0.001), and list of symptoms/problems (p = 0.014). A short period of RMT or PMT during HD significantly improved functional capacity, with RMT showing greater effect than PMT. Muscle training improved biochemical and inflammatory markers, but a direct cause and effect relationship could not be established by this study.

Efectividad de un programa de fisioterapia en la enfermedad pulmonar obstructiva crónica

IntroductionPatients with chronic obstructive pulmonary disease (COPD) experience progressive worsening of their physical capacity due to loss of muscle strength and resistance, which in turn affects their quality of life. Physiotherapy helps to improve physical capacity and thus health-related quality of life (HRQoL). This study has aimed to determine the effectiveness of an outpatient program of respiratory physiotherapy for patients with COPD on their physical capacity, HRQoL, pulmonary function, lower chest flexibility (LCF), and dyspnea. Patients and methodsWe conducted a prospective, intervention study in a series of cases with pre- and post-trial measurements. The study included 42 consecutive patients with COPD (stages II, III and IV of the GOLD classification). The patients underwent a 7-week physiotherapy program that included education, respiratory exercises and low-intensity peripheral muscle training. ResultsImprovements were seen in physical capacity (6minute walk test; P=.00), HRQoL as determined with the Chronic Respiratory Questionnaire (P=.00), LCF measured with a metric tape (P=.00), pulmonary function as measured by the FEV1(P=.01), and dyspnea as measured with the Medical Research Chronic scale (P=.00) ConclusionsThis study shows that a respiratory physiotherapy program improves physical capacity, HRQoL, dyspnea, pulmonary function and chest flexibility.

Peripheral Muscle Training Augments Cardiac Filling, Stroke Volume and Exercise Capacity in Adults with Single Ventricle Hearts and Fontan-Type Physiology

Peripheral Muscle Training Augments Cardiac Filling, Stroke Volume and Exercise Capacity in Adults with Single Ventricle Hearts and Fontan-Type Physiology

Factors influencing exercise performance in thoracic cancer

Patients with incurable thoracic cancer often complain of a reduced ability to exercise, but the cause of this has been little studied. Thus, we have explored how various physiological and psychological factors relate to exercise performance in this group. Inspiratory muscle strength, peripheral muscle power, lung function and mastery over breathlessness were assessed using sniff nasal inspiratory pressure, leg extensor power, simple spirometry and the mastery domain of the Chronic Respiratory Disease Questionnaire respectively. Exercise performance was assessed using the Incremental Shuttle Walking Test (ISWT) during which patients wore a K4 b(2) system permitting measurement of resting and breakpoint heart rate, minute ventilation (VE) and oxygen uptake (VO(2)). Relationships between ISWT distance and the four factors were determined using correlation and β regression coefficients. Forty-one patients (21 male, mean (SD) age 64 (8) years) walked a median [IQR] of 320 [250-430] metres and reached a mean (SD) of 76 (10), 77 (25), and 48 (14) of their percent predicted maximum heart rate, VO(2), and VE respectively. Exercise performance was significantly associated only with inspiratory muscle strength (r = 0.42, P < 0.01) and peripheral muscle power (r = 0.39, P = 0.01). These factors were also significant determinants of exercise performance (β coefficients [95%CI] 1.77 [0.53, 3.01] and 1.22 [0.31, 2.14] respectively). Of the factors examined, only inspiratory and peripheral muscle performance were significantly related to and predictive of exercise performance. Rehabilitation interventions which include inspiratory and peripheral muscle training are worth exploring further in this group of patients with thoracic cancer.

Is preoperative physiotherapy/pulmonary rehabilitation beneficial in lung resection patients?

A best evidence topic in thoracic surgery was written according to a structured protocol. The question addressed was whether preoperative physiotherapy/pulmonary rehabilitation is beneficial for patients undergoing lung resection. Ten papers were identified using the reported search, of which five represented the best evidence to answer the clinical question. In 2007 a report showed in 13 subjects receiving a preoperative rehabilitation programme (PRP) an improvement of maximum oxygen uptake consumption (VO(2) max) of an average 2.4 ml/kg/min (95% confidence interval 1-3.8; P=0.002). A report in 2008 showed in 12 patients with chronic obstructive pulmonary disease (COPD) and VO(2) max <15 ml/kg/min that PRP could effect a mean improvement in VO(2) max of 2.8 ml/kg/min (P<0.001). An earlier report in 2005 demonstrated a reduced length of hospital stay (21±7 days vs. 29±9 days; P=0.0003) in 22 subjects who underwent PRP for two weeks compared with a historical control of 60 patients with COPD. It was shown in 2006 that by using a cross-sectional design with historical controls that one day of chest physiotherapy comprising inspiratory and peripheral muscle training compared with routine nursing care was associated with a lower atelectasis rate (2% vs. 7.7%) and a median length of stay that was 5.73 days vs. 8.33 days (P<0.0001). A prospective randomised controlled study in 1997, showed that two weeks of PRP followed by two months of postoperative rehabilitation produced a better predicted postoperative forced expiratory volume in one second in the study group than in the control group at three months (lobectomy + 570 ml vs. -70 ml; pneumonectomy + 680 ml vs. -110 ml). We conclude that preoperative physiotherapy improves exercise capacity and preserves pulmonary function following surgery. Whether these benefits translate into a reduction in postoperative pulmonary complication is uncertain.

Functional Recovery Following Physical Training in Tracheotomized and Chronically Ventilated Patients

Rehabilitation is a non-pharmacologic therapy that can restore health and reverse the patient's disability, but the efficacy of rehabilitation in critically ill patients is not well documented. In a prospective cohort study, we assessed whether the degree of change in functional status after comprehensive rehabilitation influenced clinical outcomes in 77 tracheotomized patients (mean ± SD age 75 ± 7 y) admitted for difficult weaning to our regional weaning center. The care plan, including peripheral muscle training, was delivered daily. We recorded admission demographic, anthropometric, and functional characteristics. We measured the change in basic activities of daily living score (ΔBADL), survival, and weaning success rate as clinical outcomes. We performed the Pearson correlation analysis and linear regression, with ΔBADL as the dependent variable, to test the predictive power of the baseline measurements. Sixty-seven patients (87%) survived, and 55 of them (74%) succeeded in weaning during their stay in the weaning center. The mean ± SD ΔBADL improvement was 2.5 ± 2.0 points (median 2 points). Baseline performance of the latissimus dorsi predicted ΔBADL (β = 0.388, 95% CI 0.111-1,664, P = .03). The probability of remaining ventilator-free (P = .043) and survival (P = .001) differed across the 4 ΔBADL categories (0 = no change, 1-2 = least improvement, and > 2 = improvement above median change). Mortality rate and weaning success differ according to ΔBADL following active rehabilitation/training in tracheotomized, ventilated, difficult-to-wean patients. The performance of the latissimus dorsi was the only significant predictor of change.

Use of functional independence measure in rehabilitation of inpatients with respiratory failure

Most outcomes do not deeply express the degree of disability in patients with respiratory failure (RF) following inpatient pulmonary rehabilitation (IPR). The aim of our study was to evaluate the efficacy of an IPR in patients with confirmed COPD and RF using functional independence measure (FIM) that determines the degree of disability experienced by patients and the progress they make during rehabilitation. This scale includes several items: self care, mobility, locomotion, communication and social recognition. Twenty-two patients (age 70+/-2 years, PO(2) 58.18+/-7.63mmHg, PCO(2) 46.82+/-9.11mmHg) were prospectively observed and studied. IPR included respiratory and peripheral muscle training, mucus evacuation techniques, and energy conservation techniques. FIM, Medical Research Council dyspnoea scale (MRC), St. George's Respiratory Questionnaire (SGRQ), and 6-min walking distance (6-MWD) were assessed on admission (pre) and discharge (post) from IPR. After IPR there was a statistically significant improvement (p<0.01) in all the FIM items (total score in self care, mobility, locomotion, social recognition) except for communication. Changes of MRC (pre 4.32+/-0.84; post 3.00+/-1.15, p<0.001), SGRQ (%) (pre 69.86+/-4.62; post 46.50+/-11.94, p<0.001), and 6-MWD (pre 164.54+/-98.63; post 214.32+/-97.64, p<0.001) paralleled those improvements. An inverse correlation between MRC and FIM (r=-0.5042, p=0.016) was observed. Our preliminary study has shown that the benefits of IPR in COPD with RF do not only translate in dyspnoea, exercise capacity and quality of life but also within neuromotor disabilities as assessed by FIM. Our results warrant future studies in pulmonary rehabilitation using FIM as an outcome measure.

Physical therapy in adults with respiratory disorders: where are we?

Introduction: Physical therapy is involved in the non-medical treatment of patients with acute and chronic respiratory diseases, including obstructive and restrictive pulmonary diseases, patients with neuromuscular disorders, patients admitted for major surgery and patients with critical illness in intensive care. Physical therapy contributes towards assessing and treating various aspects of respiratory disorders such as airflow obstruction, mucus retention, alterations in ventilatory pump function, dyspnea, impaired exercise performance and quality of life. Conclusion: Exercise training, peripheral and respiratory muscle training, airway clearance techniques and lung expansion in spontaneous breathing patients (lung expansion maneuvers, huffing and assisted coughing) and in mechanically ventilated patients (bagsqueezing), and breathing retraining (pursed lips breathing, active expiration) have been shown effective in selected patients with disorders affecting the respiratory system. Assessment of patients is critical to identify patient characteristics that allow appropriate selection of treatment modalities providing optimal effectiveness and efficacy.

Physiotherapy in respiratory disease

<h3>Key points</h3> Physiotherapy enhances airway clearance in respiratory diseases associated with hypersecretion. Forced expiratory techniques are the most important treatment modalities to improve short-term airway clearance. Respiratory muscle training enhances strength, endurance and symptoms in various conditions associated with respiratory muscle weakness. Exercise training and peripheral muscle training are effective components in the rehabilitation of patients with respiratory disease. <h3>Educational aims</h3> To motivate the interest of chest physicians in physiotherapy. To provide a conceptual framework of physiotherapy in a variety of respiratory conditions. To provide details about efficacy of physiotherapy in respiratory conditions. <h3>Summary</h3> Physiotherapy is relevant to the treatment of patients with acute and chronic lung disease, but it is also effective in patients with advanced neuromuscular disorders, in patients admitted for major surgery and patients with critical illness in the intensive care unit (ICU). Physiotherapy contributes to the assessment and treatment of various aspects of respiratory disorders, such as airflow obstruction, atelectasis, mucus retention, respiratory and peripheral muscle weakness, impaired exercise performance, dyspnoea, and quality of life. This overview discusses the contribution of physiotherapy in three conditions related to respiratory disease: deconditioning; dyspnoea and respiratory pump dysfunction; and impaired airway clearance and lung inflation.