Respiratory Muscle Strength Research Articles

Respiratory muscle strength and oxygenation as predictors of length of hospital stay in patients with COVID-19

The aim was to analyze the prognostic value of ventilation/ gas exchange dissociation markers to predict the treatment length in patients with the acute phase of COVID-19.Materials and methods: The analysis was performed using a database of 384 randomly selected patients from December 2021 to May 2022 with a confirmed diagnosis of the acute phase of COVID-19, aged 61±16 years. Spirometry of maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP) was performed on 2,2±0,2 day of hospitalization with a portable MicroRPM device (CareFusion, UK) and measurement of surrogate oxygenation index (SpO2/FiO2), ROX index (SpO2/ FiO2)/respiratory rate) was carried out in all patients. Log-regression models were used (STATISTICA 10) to determine cutoff values for these functional variables and their ability to predict the patients length of hospital stay from the date of examination (≤ 7 vs > 7 days).Results: The lowest sensitivity (SE) and specificity (SP) were shown in models using only the respiratory muscle strength markers MIP (SE=54%, SP=70%) and MEP (SE=73%, SP=47%), that were the same in the combination of MIP and MEP (SE=65%, SP=58%). The areas under ROC were equal to 0.6 in all three models. The models based on hypoxia markers had a higher classification power (AUC 0,7) compared to the previous three, and the sensitivity value was higher in the model using the ROX index (SE = 58% and SP = 78%), but the specificity was better in the surrogate oxygenation index model (SE = 48% and SP = 88%). A complex model based on a combination of the two integral hypoxia indices, as well as a diaphragm strength marker (SpO2/FiO2+MIP*ROX+MIP) had the best sensitivity (67%) and specificity (84%), and the area under ROC reached 0.8.Conclusion: Indicators of respiratory muscle strength and oxygenation are suitable markers for combined models and algorithms for predicting hospital length of stay in COVID-19 patients.

Reference values for respiratory muscle strength measured with the S‐Index Test in well‐trained athletes, e‐sports athletes and age‐matched controls

AbstractRespiratory function assessment is crucial in optimizing athletic performance, safeguarding respiratory health, and ensuring athletes can perform at their peak potential while minimizing the risk of respiratory‐related issues. The S‐Index Test is a dynamic evaluation of respiratory muscle strength. However, no comprehensive reference values regarding the S‐Index Test have been reported yet. A total of 597 participants performed the S‐Index Test. They were either well‐trained athletes (WTA), or e‐sports athletes (ESA), or age‐matched controls (AMC) groups. The differences in S‐Index Test results between sexes and for group–sex, and performance calibre tier–sex interactions were examined. The relationships between S‐Index Test results and age, anthropometric indices and training experience were assessed. Reference values for all the groups were provided. Amongst athletes, the highest values were observed in swimmers and rowers, and the lowest in figure skaters and runners. The S‐Index Test results were different for the group–sex interaction (P = 0.004, 151.6 ± 29.0 cmH2O for WTA males and 109.8 ± 21.6 cmH2O for WTA females, 136.7 ± 28.0 cmH2O for ESA males and 101.8 ± 22.0 cmH2O for ESA females, 128.7 ± 28.8 cmH2O for AMC males and 70.3 ± 24.7 cmH2O for AMC females) and higher in males than females (P < 0.001, 145.1 ± 30.5 cmH2O for males and 100.8 ± 27.6 cmH2O for females). The higher athletic level, presented as performance calibre tier, was not linked to higher respiratory muscle strength in the WTA group (P = 0.094). However, the Bonferroni correction revealed that except for the singular tier in females, there was a significant effect for all the other tiers and sexes (P < 0.001). The obtained results confirm that regardless of the level of physical activity, the anthropometric features are positively linked with respiratory muscle strength. Furthermore, age and training experience were positively correlated with the S‐Index Test results in the WTA group.

Expiratory muscle strength training reduces oxidative stress and systemic inflammation in men with obstructive sleep apnea syndrome: a double-blinded, randomized parallel trial

Abstract Study Objectives This study aimed to evaluate and compare the effects of high and low-intensity expiratory muscle strength training (EMST) on disease severity, systemic inflammation, oxidative stress, respiratory muscle strength, exercise capacity, symptoms, daytime sleepiness, fatigue severity, and sleep quality in male patients with obstructive sleep apnea syndrome (OSAS). Methods Thirty-one male patients diagnosed with moderate OSAS were included in this double-blind, randomized, parallel study. Patients were randomized into two groups: High-EMST and Low-EMST groups. EMST was used at home 7 days/week, once a day, for 25 breaths, 12 weeks. Respiratory muscle strength was measured using a mouth pressure device. Disease severity (Apnea–Hypopnea Index [AHI]) and, respiratory sleep events by polysomnography, total oxidant level(TOS), total antioxidant level(TAS), oxidative stress index (OSI), C-reactive protein (CRP), tumor necrosis factor-alpha (TNF-α), interleukin-6 (IL-6), and interleukin-10 (IL-10) levels by blood serum were evaluated. Results The percentage of AHI change in the high-EMST group(50.8%) was significantly higher than in the low-EMST group(6.3%; p = .002, d = 1.31). In general, as MEP increased by one unit, AHI decreased by 0.149 points (b = −0.149; CR = −3.065; p = .002), and as AHI increased by one unit, ODI increased by 0.746 points (b = 0.746; CR = 10.604; p < .001). TOS, OSI, TNF-α and IL-6 levels decreased at similar rates in both groups. Conclusions EMST significantly reduces systemic inflammation and oxidative stress while improving expiratory muscle strength in male patients with moderate OSAS. High-EMST is more effective in enhancing the severity of disease than low-EMST. EMST is a practical, effective, and promising treatment for pulmonary rehabilitation in patients with moderate OSAS. Clinical Trials Effect of EMST systemic inflammation and oxidative stress in patients with moderate OSAS, https://clinicaltrials.gov/study/NCT05242406, with the number NCT05242406.

Effects of Home-Based Daily Respiratory Muscle Training on Swallowing Outcomes in Patients with Chronic Stroke: Protocol for a Randomized Controlled Trial.

(1) Background: Swallowing disorders are common following a stroke. This study aims to evaluate the effects of a home-based daily intervention focused on inspiratory and expiratory muscle training on swallowing outcomes in patients with chronic stroke. (2) Methods: This manuscript presents the protocol of a single-blind randomized clinical trial. Patients with chronic stroke will be randomly assigned to either an experimental or a control group. The experimental group will undergo daily home-based respiratory muscle training in addition to standard speech and language therapy, while the control group will receive only the standard intervention. The main outcome measures will include the aspiration risk, the strength of respiratory muscles, and peak cough flow. (3) Results: It is hypothesized that patients receiving home-based respiratory training in addition to standard therapy will achieve significant improvements in aspiration risk, respiratory muscle strength, and cough efficacy in comparison with those included in the control group. The results will be published as a manuscript. (4) Conclusions: This study aims to provide evidence on the effectiveness of home-based respiratory muscle training in enhancing swallowing function and respiratory parameters in patients with chronic stroke.

Influence of bilateral transcranial direct-current stimulation on muscle strength and respiratory endurance: Randomized, placebo-controlled, double-blind trial protocol

Transcranial direct current stimulation (tDCS) has become established as an effective therapeutic approach, employed to modulate cortical excitability in various conditions. Nonetheless, few studies have assessed the use of tDCS in improving respiratory performance both in healthy and in subjects with respiratory disfunction. This randomized double-blind placebo-controlled trial evaluated the outcomes of lung function, strength of inspiratory muscles, general strength after intervention with bilateral tDCS both in young and elderly female subjects. Eighty subjects were randomized into four groups divided by age (40 young and 40 elderly) and intervention vs. placebo. After a basal (day 1) evaluation all subjects performed two evaluation/intervention rounds with 48 to 72 h interval. Lung function evaluated with spirometry evaluation with Forced vital capacity (FVC), Forced Expiratory Volume in 1 S (FEV1), FEV1/FVC Ratio, Maximal Voluntary Ventilation (MVV); Dynamic Inspiratory muscle strength evaluated with Powerbreathe and general strength with dynamometer. This study intends to understand the behavior of respiratory muscle strength and endurance after intervention with bilateral cathodal tDCS over the primary motor cortex in healthy young and elderly subjects, as a bridge for larger studies both in healthy and rehabilitation setting.

Effects of Inspiratory Muscle Training on Stress Urinary Incontinence in North African Women: A Randomized Controlled Trial.

Pelvic floor muscles (PFMs) are involved in respiratory mechanisms. Additionally, stress urinary incontinence (SUI) can affect physical function. This randomized controlled trial was aimed at investigating the effects of inspiratory muscle training (IMT) on SUI severity, PFM function, and physical function in Tunisian women with SUI. Twenty-seven incontinent women were randomly assigned to either the experimental group or the control group. The following parameters were assessed: respiratory muscle strength (RMS; maximal inspiratory and expiratory pressures), SUI severity (Urogenital Distress Inventory-6; Incontinence Impact Questionnaire-7; pad test), PFM function (Modified Oxford Scale, electromyography, and endurance), and physical function (Timed Up & Go test; 6-min walk test; incremental shuttle walking test). IMT was conducted using threshold IMT. The IMT program significantly reduced the severity of SUI (p < 0.01), improved PFM function (p < 0.001), enhanced physical function (p < 0.01), and increased RMS (p < 0.001). Inspiratory muscle training could be an effective method for improving pelvic floor disorders and physical function in women with SUI.

The Effectiveness and Validity of Inspiratory Muscle Training in the Training Process of Disabled Swimmers.

Objectives: The aim of this study was to evaluate the effect of medium-intensity inspiratory muscle training added to standard swimming training on inspiratory muscle strength and aerobic endurance levels and training status in disabled swimming athletes. Methods: This study involved 16 disabled athletes: group I-athletes performing swimming training with 8 weeks inspiratory muscle training-IMT (50% of the maximum inspiratory pressure); group II-athletes performing standard swimming training with 8 weeks inspiratory muscle training (15% MIP). The following tests were performed three times: MIP, MEP, Borg RPE scale and swimming test: T-30 test; 8 × 100 progressive test. Results: There was a significant increase in the MIP and MEP in group I after IMT. There was a significant increase in the distance swam during the T-30 only in group I after IMT. Significant differences were found between the first and third measurements in group I, and the effect was maintained at follow-up. There was also a significant reduction in La concentration in group I after IMT. There was a significant reduction in heart rate at 88% and 93% of the maximum speed in group I after the applied training. Conclusion: Inspiratory muscle training with 50% of the maximum inspiratory pressure load significantly increased the respiratory muscle strength of disabled swimmers. The application of higher-intensity IMT effectively improved the training level and physiological parameters of the swimmers' effort, indicating the need to include this type of training in the standard preparation of disabled swimmers.

Normative Values and Calculation Formulas of Respiratory Muscle Strength of Adults in Turkish Society: A Population-based Study.

This study aimed to establish normative values for maximum inspiratory pressure and maximal expiratory pressure in the Turkish population while creating specific equations to calculate these values. The study involved 219 healthy adults, with a minimum of 50 individuals in specific age ranges: 20-29, 30-39, 40-49, and 50-60 years. Each age group comprised at least 25 males and 25 females. Participants were required to be free from health conditions influencing respiratory muscle strength and non-smokers. Measurements of maximum inspiratory pressure and maximal expiratory pressure were recorded for all participants. As a result of the regression analysis performed for the maximum inspiratory pressure values, the model P value was < .001, and the R2 value was found to be 0.261. The equation obtained as a result of the model was: 82.583 - 3.218 × gender - 0.093 × age+9.534 × height+0.343 × weight. As a result of the regression analysis performed for maximal expiratory pressure values, the model P value was <.001, and the R2 value was found to be 0.285. The equation obtained as a result of the model was: 157.165 - 35.522 × gender - 0.271 × age-42.036 × height+0.787 × weight. The newly developed equations offer valuable tools for evaluating respiratory muscle strength in the Turkish population. These results confirm the importance of using maximum inspiratory pressure and maximal expiratory pressure to monitor changes in each patient, while also emphasizing the necessity of reliable reference equations.

The Effects of a Pulmonary Rehabilitation Programme on Functional Capacity and Strength of Respiratory Muscles in Patients with Post-COVID Syndrome.

The aim of this study was to estimate the effects of a pulmonary rehabilitation programme (PR) on the functional capacity and respiratory muscle strength of patients with post-COVID syndrome. A cross-sectional study was conducted using hospital data on patients who participated in a pulmonary rehabilitation programme at the Clinic for Lung Diseases, University Hospital Centre Zagreb, Croatia, between January 2021 and December 2022. Data on the spirometry, respiratory muscle strength, and functional exercise capacity of patients were collected at baseline and three weeks after the start of rehabilitation. The study included 80 patients (43 females, 37 males) with a mean age of 51±10 years. A significant increase in respiratory muscle strength (P<0.001) was observed after pulmonary rehabilitation, with effect sizes ranging from small to large (Cohen's d from 0.39 to 1.07), whereas the effect for PImax expressed as a percentage was large (Cohen's d=0.99). In addition, the pulmonary rehabilitation programme significantly improved the parameters of the six-minute walk test in patients, and the parameters of lung function, FVC, FEV1, and DLCO also improved significantly after PR (P<0.05). The results showed that the pulmonary rehabilitation programme has clinically significant effects on functional capacity and respiratory muscle strength in patients with post-COVID syndrome.

Comparison of functionality, physical activity, cardiac and respiratory parameters between patients with mood disorders and healthy controls

Background The cardiorespiratory effect in mental illnesses has recently received much attention. However, the cardiovascular and pulmonary effects of mood disorders have not been clearly demonstrated. Aims This study aims to compare individuals with mood disorders and healthy people in terms of exercise capacity, functionality, respiratory muscle strength, pulmonary function, dyspnoea and physical activity level. Method This cross-sectional study involved 30 patients with mood disorders and 35 age- and gender-matched healthy individuals. Exercise capacity (6-Minute Walk Test (6MWT), 3-Minute Step Test (3MST)), functionality (vertical jump test, functional reach test), respiratory parameters (respiratory muscle strength, pulmonary function test), dyspnoea (Modified Medical Research Council Dyspnoea Scale) and physical activity level (Short-Form International Physical Activity Questionnaire (IPAQ)) were evaluated. Results 6MWT results (P &lt; 0.001) and functional test scores (vertical jump test, P = 0.006; functional reach test, P &lt; 0.001) were significantly lower, and heart rate recovery after 3MST (P &lt; 0.001) was higher in mood disorder patients. Although patients' respiratory parameters were lower than healthy individuals, only measured and predicted respiratory muscle strength (P &lt; 0.001), peak expiratory flow rate litres (P &lt; 0.001), forced vital capacity predicted (P = 0.010) and forced expiratory volume in 1 s predicted (P = 0.002) values were statistically significantly different. Dyspnoea with activities was higher in patients (P &lt; 0.001). Patients spent more time sitting (IPAQ, P &lt; 0.001), but overall physical activity levels were similar between the two groups (P &gt; 0.05). Conclusions Patients with mood disorders had decreased exercise capacity and pulmonary function, lower functionality scores and respiratory muscle strength, and increased dyspnoea. Exercise-based rehabilitation protocols are recommended for the management of risk factors affecting the mood disorder patients' cardiorespiratory status.

High-intensity intermittent inspiratory and abdominal muscle combined training in respiratory, swallowing and systemic muscles of healthy adults.

Low-intensity continuous inspiratory muscle training improves its strength. The abdominal muscles are the main expiratory muscles, and their training may improve expiratory muscle strength. Respiratory muscle strength regulates coughing effectiveness, which is critical for pneumonia management. In older people, risk factors for the development of pneumonia were respiratory muscle weakness and swallowing impairment. Currently, the impact of high-intensity intermittent inspiratory and abdominal muscle combined training on the respiratory, swallowing, and systemic muscles is unclear. We aimed to explore the effects of high-intensity inspiratory muscle training combined with or without abdominal muscle training on respiratory muscle strength as well as the strength, mass, and performance of swallowing and systemic muscles. Twenty-eight healthy adults were divided into two groups. Participants performed high-intensity intermittent inspiratory muscle single or its combination with abdominal muscle training for 4 weeks. Respiratory muscle strength, swallowing muscle strength and mass, systemic muscle strength, mass and performance were measured at baseline, Week 2 and Week 4. Both groups showed greater maximal respiratory pressures at Week 2 and Week 4 than baseline. Both groups showed improved tongue pressure and geniohyoid muscle thickness at Week 4. In addition, the combined training group improved body trunk muscle mass, handgrip strength and five-time chair stand test, whereas the single training group did not. This study revealed that high-intensity inspiratory muscle training improved inspiratory muscle strength and swallowing muscle strength and mass. Moreover, inspiratory and abdominal muscle combined training showed an additional benefit of improving systemic muscle strength, mass and performance. UMIN000046724; https://upload.umin.ac.jp/cgi-open-bin/ctr/index.cgi?ctrno=UMIN000046724.

Benefits of inspiratory muscle training therapy in institutionalized adult people with cerebral palsy: A double-blind randomized controlled trial.

Respiratory health problems are one of the main causes of morbidity and mortality in adult people with cerebral palsy (CP). The influence of respiratory muscle training has not yet been studied in this population group. The objective of the study was to evaluate and compare the efficacy of two protocols with inspiratory muscle training (IMT), low intensity and high intensity, to improve respiratory strength and pulmonary function in adults with CP. The study was a controlled, randomized, double-blind trial with allocation concealment. Twenty-seven institutionalized CP patients were recruited and randomly distributed in the high-intensity training group (HIT) or low-intensity training group (LIT). Over 8 weeks, an IMT protocol was followed 5 days/week, 10 series of 1min with 1min rest between them. HIT trained with a load of 40% of the maximum inspiratory pressure (MIP) and LIT with 20%. Respiratory strength and pulmonary function were evaluated. After IMT intervention, MIP, maximum expiratory pressure, forced expiratory volume in 1s (FEV1) and peak expiratory flow increased in both groups; in HIT 29%, 19%, 13%, and 8%, respectively (p=0.000, p=0.000, p=0.002, p=0.001) and in LIT 17%, 7%, 3%, and 4%, respectively (p=0.000, p=0.000, p=0.049, p=0.113). All the improvements were significantly higher in HIT than in LIT. Inspiratory muscle training improved respiratory muscle strength and pulmonary function in adults with CP. Training with a 40% MIP load improved all the evaluated parameters and was the most effective treatment for adults with CP.

Effects of respiratory muscular training in post-covid-19 patients: a systematic review and meta-analysis of randomized controlled trials

BackgroundPost-Covid-19 syndrome is defined as non-self-sustaining signs and/or symptoms lasting more than 12 weeks, occurring during or after a Covid-19 infection. The primary outcome was the analysis of the respiratory muscle training (RMT) result in respiratory muscle strength, (maximum inspiratory pressure (MIP) e maximum expiratory pressure (MEP)); and the secondary results were the analysis of lung function, dyspnea, quality of life (QoL), fatigue and functional performance. Methods: The PICO description for this research was: P: patients diagnosed with post-Covid-19; I: RMT; C: Sham or simulated inspiratory or expiratory muscle training and usual care; O: MIP, MEP, Lung Function, level of dyspnea, QoL and functional performance. On January 15, 2024, the following databases were consulted: PubMed, Lilacs, Cochrane Library, PEDro and EMBASE. Randomized clinical trials were included without restrictions on year of publication or language. The data selection and extraction steps were carried out by two independent reviewers. Results: The search in the databases resulted in a total of 14,216 studies, and after the eligibility process, 7 studies were included with a sample of 527 patients. The MIP results suffered a statistically significant increase, that is, the RMT was favorable to improve the MIP (MD = 29.55cmH2O IC 95%: 7.56cmH2O to 51.54cmH2O, p = 0,00001). For the MEP outcome, the results were statistically significant in favor of RMT (MD = 10.93cmH2O CI 95%: 3.65cmH2O to 18.21cmH2O, p = 0.00001). We also noticed a significant improvement for the group that received the RMT in the distance covered in the 6-Minute Walk Test (6MWT) MD = 40.70 m CI 95%: 18.23 m to 65.17 m%, p = 0.01). Conclusion: We noticed that RMT is being used in patients with respiratory diseases, including post-Covid-19. Our systematic review observed that this training provides an increase in inspiratory and expiratory muscle strength, a reduction in dyspnea levels, and an increase in the distance covered in the 6MWT and improved QoL in post-covid patients after intervention.

Effect of Inspiratory Muscle Training on Outcomes After Cardiac Surgery: A Comprehensive Meta-Analysis of Randomized Controlled Trials.

Inspiratory muscle training (IMT) has emerged as a potential intervention to improve respiratory outcomes for patients undergoing cardiac surgery. However, the extent of the IMT effects on preoperative and postoperative respiratory metrics remains uncertain. Hence, we designed this study to determine the effects of IMT on various outcomes of patients undergoing cardiac surgery. We conducted a comprehensive meta-analysis of studies evaluating the impact of preoperative and postoperative IMT on various respiratory variables and postsurgical outcomes. We synthesized data from multiple studies, encompassing diverse patient populations and IMT protocols. The key outcomes included the maximal inspiratory pressure (MIP), forced expiratory volume in 1sec (FEV1), forced vital capacity (FVC), and others. Our meta-analysis results showed that preoperative IMT significantly improved the MIP values with a pooled standard mean difference (SMD) of 0.62. The hospital stay length was also reduced with a SMD of-0.4. Other variables such as FEV1 and FVC also improved significantly. Postoperative IMT improved the MIP and peak flow rate values, but the evidence was less robust than with preoperative interventions. We observed high heterogeneity across studies for several outcomes and found evidence of publication bias for some postoperative measures. Both preoperative and postoperative IMT offer benefits for patients undergoing operations, especially by enhancing respiratory muscle strength and potentially reducing hospital stays. However, the presence of heterogeneity and publication bias underscores the need for further standardized research to consolidate these findings and standardize IMT protocols for optimal patient outcomes.

Validation of a Low-Cost Manometer to Assess of Tongue, Lip, Cheek, and Respiratory Strength: A Laboratory-Based Study.

The objective of this study was to characterize the level of agreement between three manometers: (1) Iowa Oral Performance Instrument (IOPI)-the reference standard for tongue, lip, and cheek strength assessments; (2) MicroRPM Respiratory Pressure Meter (MicroRPM)-the reference standard for respiratory strength assessments; and (3) Digital Pressure Manometer (DPM)-an alternative, low-cost pressure testing manometer. Manual pressures were simultaneously applied to the IOPI and DPM, and to the MicroRPM and DPM, within a controlled laboratory setting. Agreement in pressure readings were analyzed using descriptive statistics, Lin's concordance correlation, and Bland-Altman Plots. Agreement was interpreted as "poor" if ρc < 0.90, "moderate" if ρc = 0.90 - < 0.95, "substantial" if ρc = 0.95 - < 0.99, and "excellent" if ρc ≥ 0.99. Differences in pressure readings between the DPM and clinical reference standards were consistently present yet highly predictable. There was a median absolute difference of 2.0-3.9 kPa between the IOPI and DPM, and 4.5-9.8 cm H2O between the MicroRPM and DPM. Lin's concordance revealed "substantial" agreement between the IOPI and DPM (ρc = 0.98) and the MicroRPM and DPM (ρc = 0.99). The DPM revealed higher pressure readings when compared to the IOPI and MicroRPM. However, differences in pressure readings were relatively small, highly predictable, and yielded substantial overall agreement. These findings suggest the DPM may be a valid, lower-cost alternative for objective assessments of tongue, lip, cheek, and respiratory muscle strength. Future research should expand on the present findings in clinical patient populations. NA Laryngoscope, 2024.

Respiratory functions, respiratory muscle strength and fatigue in patients with pediatric-onset multiple sclerosis: a comparative cross-sectional study.

To compare PwPOMS and healthy controls in terms of respiratory functions, respiratory muscle strength, and fatigue, and investigate the determining role of fatigue on respiratory parameters. Twenty-five PwPOMS and 15 healthy controls were included in the study. Maximum inspiratory pressure (MIP) and expiratory pressures (MEP) were measured. Respiratory functions were evaluated using spirometry, and predicted values were recorded for FEV1, FVC, FEV1/FVC, and PEF. Fatigue levels were assessed using the Pediatric Quality of Life Inventory Multidimensional Fatigue Scale (PedsQL-MFS). The FEV1%pred (p = 0.022), PEF%pred (p = 0.003), MIP (p = 0.001), and MEP (p = 0.019), cognitive fatigue self-reported score of PedsQL-MFS (p = 0.037), sleep-rest fatigue (p = 0.034), cognitive fatigue (p = 0.010), and total score (p = 0.005) of PedsQL-MFS Proxy Report were significantly decreased in PwPOMS compared with their healthy peers. Regression analysis showed that the general fatigue of self-reported PedsQL-MFS was a determinator for FEV1%pred (β= -0.467) and PEF% (β= -0.553), and total score PedsQL-MFS was a determinator for FEV1/FVC %pred (β= -0.599). PwPOMS had decreased respiratory muscle strength, FEV1, and PEF, with preserved FEV1/FVC and higher fatigue levels than their healthy peers. In addition, self-reported fatigue had a determining role in respiratory functions but not respiratory muscle strength in PwPOMS. This trial is registered on ClinicalTrials.gov under "NCT05123924" available at: https://clinicaltrials.gov/ct2/show/NCT05123924 .

Effects of scapulothoracic exercises on chest mobility, respiratory muscle strength, and pulmonary function in male COPD patients with forward shoulder posture: A randomized controlled trial.

Background The postural abnormality, forward shoulder posture (FSP), is the most common cause of respiratory impairment in older individuals with chronic obstructive pulmonary disease (COPD). A recent study found that performing pectoral stretching and scapular strengthening exercises for eight weeks could reduce FSP in healthy participants. We aimed to determine the effects of pectoral stretching and scapular stabilizer strengthening exercises on FSP, chest wall mobility, respiratory muscle strength, and pulmonary function in male patients with COPD. Methods This study was randomized clinical trial. Forty male COPD patients with FSP aged 60-90 years were included and randomly allocated to control (n=20) and exercise (n=20) groups. Following completion of the scapulothoracic exercises (three days/week, for eight weeks), respiratory functions were assessed by measuring the magnitude of FSP, chest mobility, respiratory muscle strength, and pulmonary functions. Results FSP and thoracic kyphosis angle significantly decreased compared to controls (p<0.001, p<0.001). Middle and lower chest mobility markedly increased (p<0.001, p<0.001) and the pectoralis minor index significantly improved (p<0.001). The strength of the lower trapezius and serratus anterior muscles significantly increased at week eight of the exercise training (p<0.003, p<0.001). There was a marked increase in maximum inspiratory pressure and maximum expiratory pressure (p<0.001, p<0.001). Conclusions The eight-week combined pectoral muscles self-stretching and serratus anterior and lower trapezius strengthening exercises could be an effective treatment and/or prevention strategy for FSP reduction, leading to improved respiratory function in male COPD patients.

Unveiling the Respiratory Muscle Strength in Duchenne Muscular Dystrophy: The Impact of Nutrition and Thoracic Deformities, Beyond Spirometry.

Duchenne muscular dystrophy (DMD) is the most prevalent progressive muscular dystrophy, and the guidelines recommend the regular assessment of respiratory muscle function. This study aimed to assess the relationship between maximum inspiratory pressure (MIP), maximum expiratory pressure (MEP) and sniff nasal inspiratory pressure (SNIP) measurements and upright-supine spirometry parameters in children with DMD, the predictability of upright-supine spirometry in terms of diaphragm involvement, and the impact of nutrition on muscle strength. This prospective cross-sectional study examined patients with DMD by comparing upright and supine FVC, MIP, MEP, and SNIP measurements. The effects of the ambulatory status, kyphoscoliosis, chest deformity, and low BMI on respiratory parameters were investigated. Forty-four patients were included in the study. The mean patient age was 10.8 ± 2.9 years. Twenty-five patients were ambulatory. A significant decrease in FVC, FEV1, and FEF25-75 values was detected in the supine position in both ambulatory and non-ambulatory patients (p < 0.05). All patients had low MIP, MEP, and SNIP measurements (less than 60 cm H2O). MIP, MEP, and SNIP values were significantly lower in patients with a low BMI than in those without (p < 0.05). To accurately assess respiratory muscle strength, supine FVC should be combined with upright FVC, MIP, MEP, and SNIP measurements. It is crucial to regularly screen patients for nutrition, as this can significantly affect respiratory muscle function during pulmonology follow-up.

Pulmonary Function, Functional Capacity, Respiratory, and Locomotor Muscle Strength after Severe to Critically Ill COVID-19: A Long-Term Study.

The sequelae of post-coronavirus disease 2019 (COVID-19) pneumonia on lung function, exercise capacity, and quality of life were observed in both shortterm and long-term. However, the study about the respiratory and locomotor muscle strength in severe and critically ill COVID-19 survivors are still limited. Therefore, we aimed to examine long-term pulmonary function, functional capacities, and respiratory and locomotor body muscle strength in severe to critically ill post-COVID-19 survivors. A prospective observational study was conducted in 22 post-COVID-19 pneumonia and healthy adults. Clinical characteristics during admission, pulmonary function, functional capacity, respiratory muscles, and locomotor muscles strength were examined at 1, 3, and 6 months after discharge from the hospital. The generalized linear mixed model showed that percent predicted of forced expiratory volume in the 1 second (%FEV1), percent predicted of forced vital capacity (%FVC), maximum inspiratory pressure (MIP), handgrip strength, 6-minute walk distance, and five times sit to stand (5TSTS) were significantly lower in post-COVID-19 pneumonia patients than in healthy subjects during the follow-up period. The percent predicted of maximal voluntary ventilation (%MVV), and locomotor muscle strength were not different between the two groups throughout the follow-up period. Among post-COVID-19 pneumonia patients, %FEV1, %FVC, %MVV, 5TSTS, locomotor muscle strength significantly improved at three months compared to baseline at 1 month. Pulmonary function, functional capacity, respiratory, and locomotor muscle strength of survivors from COVID-19 were impaired and recovery was observed after three to six months. These emphasized the need to evaluate the long-term consequences of COVID-19.

Impact of pulmonary rehabilitation on exercise capacity, health-related quality of life, and cardiopulmonary function in lung surgery patients: a retrospective propensity score-matched analysis.

Pulmonary rehabilitation is considered beneficial for patients undergoing lung surgery, yet its specific impacts on exercise capacity, health-related quality of life (HRQL), and cardiopulmonary function require further elucidation. This study aimed to evaluate the effect of PR on these outcomes in patients undergoing lung surgery using a retrospective propensity score-matched analysis. We retrospectively analyzed 420 patients with non-small cell lung cancer (NSCLC) who underwent lung surgery from January 2022 to May 2024. Among these, 84 patients received PR while 336 did not (control group). Propensity score matching (PSM) at a 1:1 ratio yielded 46 patients in each group. Baseline characteristics, spirometry, cardiopulmonary exercise testing, respiratory muscle strength, HRQL, and muscle measurements were assessed pre-and post-surgery. Before PSM, significant differences existed between groups, with the PR group being older and having different pulmonary function baselines. After PSM, groups were well-balanced. Postoperatively, the PR group showed significant improvements in FEV1/FVC (64.17% vs. 50.87%, p < 0.001), FEV1 (2.31 L/min vs. 1.75 L/min, p < 0.001), and predicted FVC percentage (88.75% vs. 68.30%, p < 0.001). Cardiovascular responses showed a lower CI during exercise in the PR group post-PSM (6.24 L/min/m2 vs. 7.87 L/min/m2, p < 0.001). In terms of exercise capacity, the PR group had higher maximal WR percentage (104.76% vs. 90.00%, p = 0.017) and peak VO2 (1150.70 mL/min vs. 1004.74 mL/min, p = 0.009). PR also resulted in less leg soreness and lower total CAT scores postoperatively. Muscle measurements indicated significantly smaller reductions in ΔHUESMCSA and percentage change in the PR group. Pulmonary rehabilitation significantly enhances exercise capacity, HRQL, and cardiopulmonary function in patients undergoing lung surgery. It also mitigates postoperative muscle loss, underscoring its importance in the postoperative management of lung surgery patients.