Respiratory Training Research Articles

Alternating Expiration and Inspiration Breath-Hold Spares the Chest Wall During Stereotactic Body Radiation Therapy for Peripheral Lung Malignancies

The proximity of tumors to the chest wall brings additional risks of chest wall pain during stereotactic body radiation therapy. Herein, we dosimetrically compared alternated breath-hold (ABH) plans with single BH plans and determined the common characteristics of eligible patients who may obtain better chest wall sparing using this technique. Twenty patients with lung lesions adjacent to the chest wall were enrolled and received respiratory training. Their half-fraction end expiration BH and deep inspiration BH plans were summed to generate the ABH plans. Dosimetric parameters of the chest wall were compared between single and alternated BH plans, and the correlation between tumor location and the outcome of chest wall sparing was quantitatively evaluated. Pretreatment cone beam computed tomography variations in eligible patients were recorded as well. Compared with the end expiration BH and deep inspiration BH plans, the ABH plans reduced chest wall dosimetric results with median reductions of 2.0% and 3.9% (Dmax: maximum point dose), 15.4% and 14.8% (D1cc: dose to a volume of 1cm3), and 48.8% and 63% (V30: volume receiving 30 Gy or more), respectively. Relative tumor displacements (ratio of tumor displacement in the superior-inferior direction to planning target volume diameter) were greater in the lower lobe than in the upper and middle lobes (1.17 vs 0.18). Meanwhile, better median reductions of 44% (Dmax), 46% (D1cc), and 98% (V30) were obtained in the lower lobe cohort using the ABH technique. Pretreatment variations for all BHs met the 5-mm threshold. The ABH technique can significantly spare the adjacent chest wall without compromising planning target volume coverage in comparison with the single BH, and patients with tumors in the lower lobes can obtain better chest wall sparing than in the upper and middle lobes. Further investigation is warranted to validate these findings.

Inspiratory–Expiratory Muscle Training Improved Respiratory Muscle Strength in Dialysis Patients: A Pilot Randomised Trial

End-stage kidney disease (ESKD) exposes patients to progressive physical deconditioning involving the respiratory muscles. The aim of this pilot randomized controlled trial was to determine the feasibility and effectiveness of low-intensity respiratory muscle training (RMT) learned at the hospital and performed at home. A group of ESKD patients (n = 22) were randomized into RMT or usual care (control group, CON) in a 1:1 ratio. The respiratory training was performed at home with an inspiratory-expiratory system for a total of 5 min of breathing exercises in a precise rhythm (8 breaths per minute) interspersed with 1 min of rest, two times per day on nondialysis days for a total of 4 weeks, with the air resistance progressively increasing. Outcome measures were carried out every 4 weeks for 3 consecutive months, with the training executed from the 5th to the 8th week. Primary outcomes were maximal inspiratory and expiratory pressure (MIP, MEP), while secondary outcomes were lung capacity (FEV1, FVC, MVV). Nineteen patients without baseline between-group differences completed the trial (T: n = 10; Age: 63 ± 10; Males: n = 12). Both MIP and MEP significantly improved at the end of training in the T group only, with a significant difference of MEP of 23 cmH2O in favor of the RMT group (p = 0.008). No significant variations were obtained for FVC, FEV1 or MVV in either group, but there was a greater decreasing trend over time for the CON group, particularly for FVC (t = -2.00; p = 0.046). Low-fatiguing home-based RMT, with a simple device involving both inspiratory and expiratory muscles, may significantly increase respiratory muscle strength.

The Effects of Respiratory Training Combined with Limb Exercise on Pulmonary Function and Quality of Life in Patients with Bronchiectasis.

To investigate the effects of respiratory rehabilitation training combined with limb rehabilitation on sputum clearance and quality of life in patients with bronchiectasis. A retrospective analysis of 86 patients with bronchiectasis was divided into an intervention group and an observation group, with 43 cases in each group. All patients were above 18 years of age with no history of relevant drug allergies. Patients in the observation group were treated with conventional drugs, and those in the intervention group were given respiratory rehabilitation training and limb rehabilitation on this basis. After three months of treatment, the indexes of sputum discharge, sputum traits, lung function, and the 6-minute walk distance (6MWD) were compared and quality of life and survival skills were assessed using the Barthel index and a quality-of-life comprehensive assessment questionnaire (GQOLI-74). The percentage of patients with mild Barthel index in the intervention group was higher than that in the observation group, and the difference between the groups was statistically significant (P < 0.05). After treatment, the scores of life quality and the lung function in the intervention group were higher than those in the observation group (both P < 0.05). After three months of treatment, the sputum volume and sputum viscosity scores of the two groups were higher than those before treatment (P < 0.05). Respiratory rehabilitation training with limb exercise rehabilitation can effectively improve the sputum clearance rate, lung function, and quality of life of patients with bronchiectasis and is thus worthy of clinical promotion and application.

Clinical aspects and targeted inspiratory muscle training in children and adolescents with Fontan circulation: a randomized controlled trial.

Since 1968, thousands of patients with a morphologically or functionally univentricular heart have been treated with a total cavopulmonary connection/Fontan operation. Because of the resulting passive pulmonary perfusion, blood flow is assisted by the pressure shift during respiration. Respiratory training is known to improve exercise capacity and cardiopulmonary function. However, there are limited data on whether respiratory training can also improve physical performance after Fontan surgery. The aim of the present study was to clarify the effects of six months of daily home-based inspiratory muscle training (IMT) aimed at increasing physical performance by strengthening respiratory muscles, improving lung function and peripheral oxygenation. In this non-blinded randomized controlled trial, the effects of IMT on lung capacity and exercise capacity were measured in a large cohort of 40 Fontan patients (25% female; 12.3±2.2 years) who were under regular follow-up by the outpatient clinic of the Department of Congenital Heart Defects and Pediatric Cardiology of the German Heart Center Munich. After a lung function test and a cardiopulmonary exercise test, patients were randomly assigned in a parallel arm design to either an intervention group (IG) or a control group (CG) via stratified and computer-generated letter randomization from May 2014 to May 2015. The IG completed a daily, telephone-monitored IMT of three sets of 30 repetitions for six months with an inspiratory resistive training device (POWERbreathe medic®), the CG continued their usual daily activities without an IMT until the second examination within the timeframe of November 2014 until November 2015. After six months of IMT, lung capacity values in the IG (n=18) did not increase significantly compared to the CG [n=19; ΔFVC: IG: 0.21±0.16 l vs. CG 0.22±0.31 l; P=0.946 (CI: -0.16, 0.17); ΔFEV1: CG: 0.14±0.30 vs. IG: 0.17±0.20 P=0.707 (CI: -0.20, 0.14)]. Exercise capacity did not improve significantly, yet the maximum workload achieved trended to improve with an increase of 14% in the IG vs. 6.5% in the CG [P=0.113 (CI: -15.8, 1.76)]. There was a significant increase of oxygen saturation at rest in the IG compared to the CG [IG: 3.31%±4.09% vs. CG: 0.17%±2.92%, P=0.014 (CI: -5.60, -0.68)]. Compared to the CG, the mean oxygen saturation at peak exercise no longer dropped below 90% in the IG. This observation is thus not statistically significant, yet of clinical relevance. The results of this study show benefits of an IMT in young Fontan patients. Even if some data are not statistically significant, they may still be clinically relevant and may contribute to a multidisciplinary approach in patient care. IMT should therefore be an additional target and integrated into the training program to improve the prognosis of Fontan patients. German Clinical Trials Register; DRKS.de; registration ID: DRKS00030340.

Pneumological Rehabilitation in Patients with Long Covid - Health Changes at the End of the Inpatient Rehabilitation Measure

Some people suffering from Covid-19 can be affected by persistent symptoms and long-term consequences of the disease (Long Covid) beyond their acute phase. Consequently, this can lead to restrictions in participation. Therefore, the focus is on medical rehabilitation in which Long Covid is treated as a new challenge. A prospective, exploratory observational study will be conducted. The written survey of Long Covid rehabilitants takes place at the beginning and end of the pneumological rehabilitation. The aim of the study is to describe the rehabilitation contents and goals, the subjective burdens, the social and occupational participation as well as the health-related changes. Among other factors, disease-specific symptoms, quality of life, participation, psychological impairments, fatigue, and performance were recorded. Long Covid rehabilitants (N=221) participate in the written survey. At the end of rehabilitation, the questionnaire survey indicated significant improvements in almost all outcome parameters with a large effect (p<0.01; ES between 0.76 (anxiety) and 1.30 (fatigue)). All corona symptoms, such as breathlessness on exertion, fatigue or lack of strength improved significantly at the end of rehabilitation. Moreover, the rehabilitants most frequently name the improvement of their health (92%), the increase of their performance (92%) and the improvement of the respiratory muscle strength (78%) as rehabilitation goals. In fact, these goals are achieved by 60 to 70%, significantly fewer rehabilitation patients reach the restoration of their ability to work (32%) or a better ability to concentrate (17%). Respiratory physiotherapy, endurance training and medical training therapy are described as most helpful. At the end of rehabilitation, 76% rated their rehabilitation success as good to excellent based on a single question. The first data of the study reveal that Long Covid rehabilitants are exposed to substantial burdens. Through medical rehabilitation, the patients experience medical and social support and experience significant improvements in all recorded health-related outcomes.

Exercise in patients with repaired tetralogy of Fallot: a systematic review and meta-analysis

ObjectiveChildren and adults with repaired tetralogy of Fallot (rTOF) have an impaired exercise capacity, a less active lifestyle and an increased long-term risk of adverse outcomes compared with healthy peers....

Respiratory muscle interval training improves exercise capacity in obese adolescents during a 3-week In-hospital multidisciplinary body weight reduction program

Respiratory muscle interval training improves exercise capacity in obese adolescents during a 3-week In-hospital multidisciplinary body weight reduction program

Effect of transcranial direct current stimulation combined with respiratory training on dysphagia in post-stroke patients.

Transcranial direct current stimulation (tDCS) has a considerable advantage in the rehabilitation treatment of dysphagia. The purpose of this study was to explore the effect of tDCS combined with respiratory training on dysphagia in post-stroke patients. From December 2017 to January 2019, 64 post-stroke patients who were hospitalized in the Department of Neurology of the Second Hospital of Hebei Medical University were enrolled in this study. They were randomly divided into control and treatment groups (n= 32). Patients in the two groups received routine swallowing rehabilitation training and respiratory training. On this basis, the patients in the treatment group received tDCS. The anode was placed in the movement area of the pharyngeal cortex on the unaffected side of the patients' bodies, and the cathode was placed in the upper orbital orbit on the opposite side. The current intensity was 1.5 mA, 20 min/time, 1 time/d, and 6 d/w. Before and after the treatment, the water swallow text, functional oral intake scale (FOIS), forced vital capacity (FVC) and peak expiratory flow (PEF) were assessed, and the correlation among them was evaluated. There were no differences in all indexes before and after treatment. After treatment, water swallow text, FOIS, FVC and PEF were all better than before treatment, and the clinical efficacy in the treatment group was significantly better than that in the control group. FVC and PEF were positively correlated with water swallow text and FOIS. tDCS combined with respiratory training may have a significant therapeutic effect on dysphagia in post-stroke patients.

Impact of Association between Functional Training and Respiratory Muscle Training in Elderly: A Randomized Controlled Trial

The elderly population in Brazil has been growing exponentially according to data presented by the IBGE. It is estimated that by 2025 the population will have reached 32 million, placing the country sixth in the world in the population of elderly people. To assess the results of respiratory training associated with functional training on respiratory muscle strength, lung function, and functionality of the elderly. The sample was composed of 40 elderlies, divided into four groups, the experimental group with functional training, one experimental group with functional training associated with respiratory training, one experimental group with respiratory training, and the fourth group, the control group. After the initial and final evaluations, the variables measured were: The Breathing Test, Sit to Stand Test, the SF-36 Quality of Life Questionnaire, and Spirometry. Twenty appointments were conducted twice a week. There were significant differences for variables maximum inspiratory and expiratory pressure; more accentuated in the associated group when compared to the respiratory group; forced vital capacity and forced expiratory volume in the first second/forced vital capacity were meaningful in the associated group; peak expiratory flow means values increased after the intervention; in the six-minute walk test, we noticed a trend to increase values after the intervention. Functional training as well as associated respiratory muscle training provide the most beneficial changes compared only to functional and respiratory training. Therefore, this may be an effective clinical training method for patients’ elderly.

Incentive Spirometry and Deep Breathing Exercise for Improving Respiratory Volume in Preoperative Spine Surgery Patients

Objective: To investigate the effects of incentive spirometry and deep breathing exercises on forced vital capacity (FVC) and chest expansion in preoperative spine surgery patients. Material &amp; Methods: Fifty-eight patients who were scheduled for spine surgery were recruited from December 2016 to January 2019. Twenty-eight and 30 patients were scheduled for cervical and thoracic/lumbar spine surgery, respectively. All patients were informed of the study protocol, evaluated by a physical therapist, and provided with respiratory training via incentive spirometry and deep breathing exercises. FVC and chest expansion were measured and recorded prior to training, as well as two weeks and four weeks after respiratory training. Results: In preoperative spine patients, FVC and chest expansion were significantly increased (p&lt;0.05) after respiratory training with incentive spirometry and deep breathing exercises. The FVC in a seated position prior to respiratory training, after 2 weeks of training, and after 4 weeks of training is 2,277.9±599, 2,446.6±614.2, and 2,546.5±591.7 milliliters, respectively. The FVC in the supine position prior to respiratory training, after 2 weeks of training, and after 4 weeks of training is 2,080.2±589, 2,268.3±604.3, and 2,365.9±596.1 milliliters, respectively. Chest expansion in a seated position before respiratory training, after 2-week training, and after 4-week training is 4.2±1.3, 4.6±1.2 and 4.7±1.3 centimeters. Chest expansion in supine position before respiratory training, after 2-week training, and after 4-week training is 3.9±1.2, 4.5±1.3 and 4.5±1.2 centimeters respectively. Conclusion: Preoperative respiratory training for 2 weeks and 4 weeks using incentive spirometry and conventional deep breathing exercises significantly increased both FVC and chest expansion in patients undergoing spine surgery.

The Effect of Respiratory Training on Anxiety Level and Sleep Quality in Patients after Transnasal Pituitary Tumour Removal

To investigate the effects of breathing training on the anxiety status and sleep quality of patients after transsphenoidal pituitary tumor resection, one hundred and two patients with pituitary tumour in the Department of Neurosurgery of the Affiliated Hospital of Jining Medical College were selected as study subjects and randomly divided into a control group and a test group, with 51 cases in each group. The control group underwent routine nursing operations, while the experimental group added breathing training to the routine nursing operations. The study effects were analyzed by the scoring status and grade classification of SAS scale and PSQI scale. By introducing breathing training, the SAS scale and PSQI scale of the two groups were significantly different, and the test group was better than the control group in terms of anxiety status and sleep quality (p<0.05). Respiratory training has a significant positive effect on the anxiety status and sleep quality of patients after transsphenoidal pituitary tumour resection, providing a clinical case and reference value for postoperative care after transsphenoidal pituitary tumour removal.

Respiratory Stabilization Training System with Multimodal Induction Stimulation

Respiratory Stabilization Training System with Multimodal Induction Stimulation

Retracted: Application of Nursing Outcome-Oriented Integrated Zero-Defect Nursing Combined with Respiratory Function Training in Long-Term Bedridden Patients Undergoing Stroke.

[This retracts the article DOI: 10.1155/2022/4425680.].

The efficacy of different training programs guided by cardiopulmonary exercise test goals for the treatment of male patients with chronic obstructive pulmonary disease

To explore the therapeutic effect of aerobic exercise nursing plans based on target heart rate in cardiopulmonary exercise tests on male patients with chronic obstructive pulmonary disease. This study recruited 90 male patients with chronic obstructive pulmonary disease who met specific screening criteria and were evenly divided into a control group and an experimental group based on a random number table. The control group received respiratory training based on the target heart rate in the cardiopulmonary exercise test, while the experimental group received aerobic exercise based on the target heart rate in the cardiopulmonary exercise test. Both groups received 12 weeks of exercise each. Cardiopulmonary function tests showed that peak oxygen consumption (peak VO2), anaerobic threshold (AT), forced expiratory volume in the first second (FEV1), forced vital capacity (FVC), and the FEV1/FVC ratio in the test group were significantly higher than those in the control group (p &lt; 0.05); furthermore, the carbon dioxide ventilation equivalent (VE/VCO2) slope was significantly lower than that in the control group (p &lt; 0.05). The 6MWT of the test group was significantly higher than that in the control group (p &lt; 0.05). The CAT score, Borg score and scores related to the symptoms, activities, and impacts related to quality-of-life were significantly reduced after intervention (p &lt; 0.05). Aerobic exercise based on cardiopulmonary exercise testing can improve the health status, quality of life and prognosis of COPD patients.

Retracted: Efficacy of Respiratory Training in Relieving Postoperative Pain in Patients with Spinal Nerve Root Entrapment Syndrome.

[This retracts the article DOI: 10.1155/2022/7703835.].

목척수손상환자의 호흡근훈련의 효과

Purpose: This systematic review was designed to analyze studies examining the effects of respiratory muscle training on cervical spinal cord injury.&#x0D; Methods: Randomized controlled trials on the rehabilitation of patients with cervical spinal cord injury were searched using four databases: Physiotherapy Evidence Database (PEDro), PubMed, and Google Scholar. Five studies were selected according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines, and the PEDro scale was used for qualitative analysis. For rehabilitation, a protocol including respiratory training and physical activity was selected.&#x0D; Results: Of the 135 studies identified in the 2019-2022 period, three were finally selected. All studies performed respiratory muscle training for 30-40 min a day, 5 days a week, for 6-12 weeks. Performing a meta-analysis was difficult because of differences in the study design, and all studies reported significant improvement in respiratory function compared with that in the control group.&#x0D; Conclusion: The literature on various respiratory muscle training for cervical spinal cord injury is scarce. However, it is confirmed that respiratory muscle training has a positive effect on not only respiratory function but also neuroplasticity, cardiovascular autonomic function, and quality of life in patients with cervical spinal cord injury.

Post COVID-19 목척수손상환자에 대한 인센티브 폐활량계을 동반한 호흡훈련의 효과: 사례연구

Purpose: This study was designed to determine the effects of respiratory training on the respiratory function and quality of life of a patient with post-coronavirus disease 2019 (COVID-19) with cervical spinal cord injury.&#x0D; Methods: A case study design was used. A patient with post-COVID-19 with cervical spinal cord injury was enrolled and received general rehabilitation therapy (5 days per week). The Tri-ball incentive spirometry training was performed 5 times a week for 20 min for 8 weeks, gradually increasing the intensity and frequency according to the patient’s condition. The respiratory function was evaluated using spirometry, and the patient’s quality of life was assessed using the 36-item Short Form Health Survey (SF-36) before and 4 and 8 weeks after training.&#x0D; Results: After training, the respiratory function parameters, particularly forced vital capacity (FVC), forced expiratory volume at 1 s (FEV1), and peak expiratory flow (PEF), increased. The SF-36 score remarkably increased after training.&#x0D; Conclusion: The results of the application of incentive spirometry training to a patient with post-COVID-19 with cervical spinal cord injury showed that respiratory training is important for improving the respiratory function and quality of life.

An Augmented Reality (AR) App Enhances the Pulmonary Function and Potency/Feasibility of Perioperative Rehabilitation in Patients Undergoing Orthopedic Surgery

Perioperative rehabilitation is crucial for patients receiving surgery in order to reduce complications and mortality. Conventional methods such as verbal instructions and pre-recorded video are commonly used, but several disadvantages exist. Therefore, we developed an augmented reality (AR) app that includes respiration training, resistance muscle training, and walking training for surgery preparation. The aim of this pilot study was to compare the effects of AR-based training rehabilitation programs with conventional (non-AR-based) programs considering the objective pulmonary function and subjective feasibility and potency in orthopedic patients. This prospective study was conducted in a medical center in Taiwan between 2018 to 2021. Sixty-six patients undergoing elective orthopedic surgery were allocated with a 1:1 ratio to non-AR or AR groups according to their wishes. After training, the inspiratory flow rate of the AR group was higher than that of the non-AR group pre-operatively. As for the subjective assessment, the feasibility (level of confidence and anxiety reduction) and potency (cooperation and educative effect) were superior in AR-based training, compared with the conventional training model. Our study showed that patients using our AR app had better subjective and objective outcomes compared with a conventional model for perioperative rehabilitation.

Respiratory Muscle Interval Training Improves Exercise Capacity in Obese Adolescents during a 3-Week In-Hospital Multidisciplinary Body Weight Reduction Program.

The purpose of this study was to determine whether a novel approach of interval training targeted to the respiratory muscles (RMIT; normocapnic hyperpnea with resistance) in addition to a multidisciplinary in-hospital body weight reduction program (BWRP) was able to improve the integrative response to exercise in young patients with obesity. Nine male patients (17.9 ± 4.9 (x ± SD) years; 113.8 ± 16.3 kg) underwent 12 sessions of RMIT and eight age-and sex-matched patients underwent 12 sessions of a sham protocol (CTRL) during the same 3-week BWRP. Before and after the interventions the patients performed an incremental and a heavy-intensity constant work-rate (CWR>GET) cycling exercise to voluntary exhaustion. Body mass decreased by ~4.0 kg after both RMIT (p = 0.0001) and CTRL (p = 0.0002). Peak pulmonary O2 uptake (V˙O2) increased after RMIT (p = 0.02) and CTRL (p = 0.0007). During CWR>GET at ISO-time, V˙O2 (p = 0.0007), pulmonary ventilation (p = 0.01), heart rate (p = 0.02), perceived respiratory discomfort (RPER; p = 0.03) and leg effort (p = 0.0003) decreased after RMIT; only RPER (p = 0.03) decreased after CTRL. Time to exhaustion increased after RMIT (p = 0.0003) but not after CTRL. In young patients with obesity, RMIT inserted in a 3-week BWRP reduced the cardiorespiratory burden, the metabolic cost, the perceived effort, and improved exercise tolerance during heavy-intensity cycling.

Respiratory training in older women: Unravelling central and peripheral hemodynamic slow oscillatory patterns

We hypothesized that inspiratory muscle training (IMT) increases the respiratory-induced low-frequency oscillations of mean blood pressure (MBP) and middle cerebral artery blood velocity (MCAv), upregulating cerebrovascular function in older women. Firstly, participants were recorded with free-breathing (FB) and then breathed at a slow-paced frequency (0.1 Hz; DB test) supported by sonorous metronome feedback. Blood pressure was recorded using finger photoplethysmography method, ECG, and respiration using a thoracic belt. To obtain the MCAv a transcranial ultrasound Doppler device was used. Spectral analysis of MBP, R-R intervals, and mean MCAv time series was obtained by an autoregressive model. The transfer function analysis (TFA) was employed to calculate the coherence, gain, and phase. After that, older women were enrolled in a randomized controlled protocol, the IMT-group (n = 8; 64 ± 3 years-old) performed IMT at 50 % of maximal inspiratory pressure (MIP), and Sham-group, a placebo training at 5 % MIP (Sham-group; n = 6; 66 ± 3 years-old). Participants breathed against an inspiratory resistance twice a day for 4-weeks. DB test is repeated post IMT and Sham interventions. IMT-group, compared to Sham-group, augmented tidal volume responses to DB (Sham-group 1.03 ± 0.41 vs. IMT-group 1.61 ± 0.56 L; p = 0.04), increased respiratory-induced MBP (Sham-group 26.37 ± 4.46 vs. IMT-group 48.21 ± 3.15 mmHg2; p = 0.04) and MCAv (Sham-group 14.16 ± 31.26 vs. IMT-group 79.90 ± 21.76 cm2s−2; p = 0.03) slow oscillations, and reduced TFA gain (Sham-group 2.46 ± 1.32 vs. IMT-group 1.78 ± 1.30 cm·s−1.mmHg−1; p = 0.01). Our findings suggest that IMT increases the respiratory-induced oscillations in MBP and MCAv signals and reduces TFA gain. It seems compatible with an improved dynamic cerebrovascular regulation following IMT in older women.