RESUMEN

Persistent shortcomings of invasive positive pressure ventilation make it less than an ideal intervention. Over the course of more than seven decades, clinical experience and scientific investigation have helped define its range of hazards and limitations. Apart from compromised airway clearance and lower airway contamination imposed by endotracheal intubation, the primary hazards inherent to positive pressure ventilation may be considered in three broad categories: hemodynamic impairment, potential for ventilation-induced lung injury, and impairment of the respiratory muscle pump. To optimize care delivery, it is crucial for monitoring and machine outputs to integrate information with the potential to impact the underlying requirements of the patient and/or responses of the cardiopulmonary system to ventilatory interventions. Trending analysis, timely interventions, and closer communication with the caregiver would limit adverse clinical trajectories. Judging from the rapid progress of recent years, we are encouraged to think that insights from physiologic research and emerging technological capability may eventually address important aspects of current deficiencies.

Asunto(s)

Ventiladores Mecánicos , Humanos , Ventiladores Mecánicos/efectos adversos , Respiración con Presión Positiva/métodos , Respiración con Presión Positiva/tendencias , Respiración Artificial/métodos , Respiración Artificial/tendencias , Respiración Artificial/efectos adversos , Lesión Pulmonar Inducida por Ventilación Mecánica/prevención & control , Hemodinámica/fisiología

RESUMEN

BACKGROUND: The diagnostic criteria for respiratory sarcopenia have been recently reported. However, no studies have clarified the characteristics of skeletal muscle impairment of the limbs in subjects with respiratory sarcopenia. This study aimed to explore the factors, including skeletal muscle, associated with probable respiratory sarcopenia in elderly subjects. METHODS: Subjects were classified into the probable respiratory sarcopenia group and nonrespiratory sarcopenia group. Probable respiratory sarcopenia was defined as the concurrent presence of respiratory muscle weakness (as less than the predicted value calculated from age, sex, and height) and low skeletal muscle mass (<7.0 kg/m2 in males and 5.7 kg/m2 in females). The following factors were measured: respiratory muscle strength, skeletal muscle mass index, muscle thickness and echo intensity of the rectus femoris, extracellular-to-intracellular water ratio, hand grip strength, 5 sit-to-stand, knee extension strength, bone mineral density, age, sex, body mass index, degree of frailty, presence or absence of medical history, presence or absence of habitual exercise, period of time since the start of exercise, and number of hours of exercise at a time. The association subjects with probable respiratory sarcopenia were analyzed using hierarchical logistic regression analysis. RESULTS: Twenty-six with probable respiratory sarcopenia and 54 with nonrespiratory sarcopenia were included. Hierarchical logistic regression analysis revealed that echo intensity was a significant predictor of probable respiratory sarcopenia. The odds ratio for echo intensity was 2.54 (95% confidence interval: 1.04-6.23). CONCLUSIONS: Our results suggest that a decrease in muscle quality in the lower extremity is associated with probable respiratory sarcopenia.

Asunto(s)

Sarcopenia , Humanos , Sarcopenia/fisiopatología , Sarcopenia/diagnóstico por imagen , Sarcopenia/etiología , Masculino , Femenino , Anciano , Músculo Esquelético/fisiopatología , Músculo Esquelético/diagnóstico por imagen , Fuerza Muscular , Músculos Respiratorios/fisiopatología , Anciano de 80 o más Años , Fuerza de la Mano

RESUMEN

Idiopathic pleuroparenchymal fibroelastosis (iPPFE) is a rare form of idiopathic interstitial pneumonia. We report a case of a patient with iPPFE in whom postural changes improved diaphragmatic excursion (DE) and exercise tolerance. Chest radiography showed a greater elevation of the diaphragm at maximum expiration in the supine position than the standing position. DE measured by ultrasonography was higher in the supine position than the standing position. The findings may suggest greater diaphragm movement in the supine position, leading to successful rehabilitation and improved exercise endurance. There is no effective treatment for iPPFE; therefore, an innovative treatment strategy is warranted.

RESUMEN

Systematic reviews support the benefits of inspiratory muscle training (IMT) for exercise performance. Recently, many health benefits from IMT have been reported in older adults. Therefore, this work reviewed the literature focusing on IMT effects beyond physical performance in older adults, such as cardiorespiratory, metabolic, and postural balance outcomes. Searches were conducted with the following terms: ("respiratory muscle training" OR "inspiratory muscle training") OR ("inspiratory muscle strength training") AND ("elderly" OR "older" OR "aging" OR "aging"), and using the databases: MEDLINE (PubMed), SCOPUS and EUROPE PMC. Of the 356 articles found, 13 matched the inclusion criteria after screening. Based on reviewed studies, four to eight weeks of IMT (Mostly from 50 % up to 75 % of MIP, 7 days/week) improve cardiac autonomic control at rest and post-exercise, cerebrovascular response to orthostatic stress, static and dynamic balance, blood pressure control, endothelial function, and oxidative stress in older adults. The benefits of IMT in cardiac autonomic and vascular functions are reversed after training cessation. It thus appears that IMT promotes broad physiological gains for the older population. It is necessary to carry out more randomized clinical trials on the subject to confirm the findings of this research.

Asunto(s)

Ejercicios Respiratorios , Músculos Respiratorios , Humanos , Ejercicios Respiratorios/métodos , Anciano , Músculos Respiratorios/fisiología , Equilibrio Postural/fisiología , Envejecimiento/fisiología

RESUMEN

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

RESUMEN

BACKGROUND: Progressive exercise intolerance is a hallmark of pulmonary hypertension (pH), severely impacting patients' independence and quality of life (QoL). Accumulating evidence over the last decade shows that combined abnormalities in peripheral reflexes and target organs contribute to disease progression and exercise intolerance. OBJECTIVE: The aim of this study was to review the literature of the last decade on the contribution of the cardiovascular, respiratory, and musculoskeletal systems to pathophysiology and exercise intolerance in pH. METHODS: A systematic literature search was conducted using specific terms in PubMed, SciELO, and the Cochrane Library databases for original pre-clinical or clinical studies published between 2013 and 2023. Studies followed randomized controlled/non-randomized controlled and pre-post designs. RESULTS: The systematic review identified 25 articles reporting functional or structural changes in the respiratory, cardiovascular, and musculoskeletal systems in pH. Moreover, altered biomarkers in these systems, lower cardiac baroreflex, and heightened peripheral chemoreflex activity seemed to contribute to functional changes associated with poor prognosis and exercise intolerance in pH. Potential therapeutic strategies acutely explored involved manipulating the baroreflex and peripheral chemoreflex, improving cardiovascular autonomic control via cardiac vagal control, and targeting specific pathways such as GPER1, GDF-15, miR-126, and the JMJD1C gene. CONCLUSION: Information published in the last 10 years advances the notion that pH pathophysiology involves functional and structural changes in the respiratory, cardiovascular, and musculoskeletal systems and their integration with peripheral reflexes. These findings suggest potential therapeutic targets, yet unexplored in clinical trials, that could assist in improving exercise tolerance and QoL in patients with pH.

RESUMEN

Prior studies of muscle blood flow and muscle-specific oxygen consumption have required invasive injection of dye and magnetic resonance imaging, respectively. Such measures have limited utility for continuous monitoring of the respiratory muscles. Frequency-domain near-infrared spectroscopy and diffuse correlation spectroscopy (FD-NIRS & DCS) can provide continuous surrogate measures of blood flow index (BFi) and metabolic rate of oxygen consumption (MRO2). This study aimed to validate sternocleidomastoid FD-NIRS & DCS outcomes against electromyography (EMG) and mouth pressure (Pm) during incremental inspiratory threshold loading (ITL). Six female and six male healthy adults (means ± SD; 30 ± 7 yr, maximum inspiratory pressure 118 ± 61 cmH2O) performed incremental ITL starting at low loads (8 ± 2 cmH2O) followed by 50-g increments every 2 min until task failure. FD-NIRS & DCS continuously measured sternocleidomastoid oxygenated and deoxygenated hemoglobin + myoglobin (oxy/deoxy[Hb + Mb]), tissue saturation of oxygen (StO2), BFi, and MRO2. Ventilatory parameters including inspiratory Pm were also evaluated. Pm increased during incremental ITL (P < 0.05), reaching -47[-74 to -34] cmH2O (median [IQR: 25%-75%]) at task failure. Ventilatory parameters were constant throughout ITL (all P > 0.05). Sternocleidomastoid BFi and MRO2 increased from the start of the ITL (both P < 0.05). Deoxy[Hb + Mb] increased close to task failure, concomitantly with a constant increase in MRO2, and decreased StO2. Sternocleidomastoid deoxy[Hb + Mb], BFi, StO2, and MRO2 obtained during ITL via FD-NIRS & DCS correlated with sternocleidomastoid EMG (all P < 0.05). In healthy adults, FD-NIRS & DCS can provide continuous surrogate measures of respiratory BFi and MRO2. Increasing sternocleidomastoid oxygen consumption near task failure was associated with increased oxygen extraction and reduced tissue saturation.NEW & NOTEWORTHY This study introduces a novel approach, frequency-domain near-infrared spectroscopy and diffuse correlation spectroscopy (FD-NIRS & DCS), for noninvasive continuous monitoring of respiratory muscle blood flow and metabolic rate of oxygen consumption. Unlike prior methods involving invasive dye injection and magnetic resonance imaging, FD-NIRS & DCS offers the advantage of continuous measurement without the need for invasive procedures. It holds promise for advancing muscle physiology understanding and opens avenues for real-time monitoring of respiratory muscles.

Asunto(s)

Consumo de Oxígeno , Flujo Sanguíneo Regional , Músculos Respiratorios , Espectroscopía Infrarroja Corta , Humanos , Masculino , Espectroscopía Infrarroja Corta/métodos , Adulto , Consumo de Oxígeno/fisiología , Femenino , Músculos Respiratorios/fisiología , Músculos Respiratorios/metabolismo , Flujo Sanguíneo Regional/fisiología , Electromiografía/métodos , Oxígeno/metabolismo , Adulto Joven , Saturación de Oxígeno/fisiología , Hemoglobinas/metabolismo

RESUMEN

RATIONALE: Endoscopic lung volume reduction improves lung function, quality of life and exercise capacity in severe emphysema patients. However, its effect on the diaphragm function is not well understood. We hypothesised that endoscopic lung volume reduction increases its strength by modifying its shape. OBJECTIVES: To investigate changes in both diaphragm shape and strength induced by the insertion of endobronchial valves. METHODS: In 19 patients, both the diaphragm shape and strength were investigated respectively by 3D Slicer software applied on CT scans acquired at functional residual capacity and by transdiaphragmatic pressure measurements by bilateral magnetic stimulation of the phrenic nerves before and 3 months after unilateral valves insertion. MEASUREMENTS AND MAIN RESULTS: After lung volume reduction (median (IQR), 434 mL (-597 to -156], p<0.0001), diaphragm strength increased (transdiaphragmatic pressure: 3 cmH2O (2.3 to 4.2), p<0.0001). On the treated side, this increase was associated with an increase in the coronal (16 mm (13 to 24), p<0.0001) and sagittal (26 mm (21 to 30), p<0.0001) lengths as well as in the area of the zone of apposition (62 cm2 (3 to 100), p<0.0001) with a decrease in the coronal (8 mm (-12 to -4), p<0.0001) and sagittal (9 mm (-18 to -2), p=0.0029) radii of curvature. CONCLUSIONS: Endoscopic lung volume reduction modifies the diaphragm shape by increasing its length and its zone of apposition and by decreasing its radius of curvature on the treated side, resulting in an increase in its strength. TRIAL REGISTRATION NUMBER: NCT05799352.

Asunto(s)

Diafragma , Neumonectomía , Enfisema Pulmonar , Tomografía Computarizada por Rayos X , Humanos , Diafragma/diagnóstico por imagen , Masculino , Neumonectomía/métodos , Femenino , Persona de Mediana Edad , Anciano , Enfisema Pulmonar/cirugía , Enfisema Pulmonar/fisiopatología , Enfisema Pulmonar/diagnóstico por imagen , Broncoscopía/métodos , Fuerza Muscular/fisiología , Capacidad Residual Funcional/fisiología

RESUMEN

BACKGROUND: 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. OBJECTIVE: 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. METHODS: 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. RESULTS: 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. CONCLUSION: 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. CLINICAL TRIAL REGISTRATION NUMBER: UMIN000046724; https://upload.umin.ac.jp/cgi-open-bin/ctr/index.cgi?ctrno=UMIN000046724.

Asunto(s)

Músculos Abdominales , Ejercicios Respiratorios , Deglución , Voluntarios Sanos , Fuerza Muscular , Músculos Respiratorios , Humanos , Masculino , Femenino , Ejercicios Respiratorios/métodos , Músculos Respiratorios/fisiología , Fuerza Muscular/fisiología , Deglución/fisiología , Adulto , Músculos Abdominales/fisiología , Inhalación/fisiología , Adulto Joven , Fuerza de la Mano/fisiología

RESUMEN

BACKGROUND: Singing for lung health (SLH) is an arts-based breathing control and movement intervention for people with long-term respiratory conditions, intended to improve symptoms and quality of life. Online, remotely delivered programmes might improve accessibility; however, no previous studies have assessed the effectiveness of this approach. METHODS: We conducted an assessor-blind randomised controlled trial comparing the impact of 12 weeks of once-weekly online SLH sessions against usual care on health-related quality of life, assessed using the RAND 36-Item Short Form Health Survey (SF-36) Mental Health Composite (MHC) and Physical Health Composite (PHC) scores. RESULTS: We enrolled 115 people with stable chronic obstructive pulmonary disease (COPD), median (IQR) age 69 (62-74), 56.5% females, 80% prior pulmonary rehabilitation, Medical Research Council dyspnoea scale 4 (3-4), forced expiratory volume in 1 s % predicted 49 (35-63). 50 participants in each arm completed the study. The intervention arm experienced improvements in physical but not mental health components of RAND SF-36; PHC (regression coefficient (95% CI): 1.77 (95% CI 0.11 to 3.44); p=0.037), but not MHC (0.86 (95% CI -1.68 to 3.40); p=0.504). A prespecified responder analysis based on achieving a 10% improvement from baseline demonstrated a response rate for PHC of 32% in the SLH arm and 12.7% for usual care (p=0.024). A between-group difference in responder rate was not found in relation to the MHC (19.3% vs 25.9%; p=0.403). DISCUSSION AND CONCLUSION: A 12-week online SLH programme can improve the physical component of quality of life for people with COPD, but the overall effect is relatively modest compared with the impact seen in research using face-to-face group sessions. Further work on the content, duration and dose of online interventions may be useful. TRIAL REGISTRATION NUMBER: NCT04034212.

Asunto(s)

Enfermedad Pulmonar Obstructiva Crónica , Calidad de Vida , Canto , Humanos , Enfermedad Pulmonar Obstructiva Crónica/terapia , Enfermedad Pulmonar Obstructiva Crónica/rehabilitación , Enfermedad Pulmonar Obstructiva Crónica/fisiopatología , Femenino , Masculino , Persona de Mediana Edad , Anciano , Resultado del Tratamiento , Pulmón/fisiopatología , Volumen Espiratorio Forzado , Ejercicios Respiratorios/métodos , Método Simple Ciego

RESUMEN

Doxorubicin (DOX) is a highly effective anthracycline antibiotic used to treat a wide variety of cancers including breast cancer, leukemia and lymphoma. Unfortunately, clinical use of DOX is limited due to adverse off-target effects resulting in fatigue, respiratory muscle weakness and dyspnea. The diaphragm is the primary muscle of inspiration and respiratory insufficiency is likely the result of both muscle weakness and neural impairment. However, the contribution of neuropathology to DOX-induced respiratory muscle dysfunction is unclear. We hypothesized that diaphragm weakness following acute DOX exposure is associated with neurotoxicity and that exercise preconditioning is sufficient to improve diaphragm muscle contractility by maintaining neuromuscular integrity. Adult female Sprague-Dawley rats were randomized into four experimental groups: 1) sedentary-saline, 2) sedentary-DOX, 3) exercise-saline or 4) exercise-DOX. Endurance exercise preconditioning consisted of treadmill running for 1 h/day at 30 m/min for 10 days. Twenty-four hours after the last bout of exercise, animals were treated with DOX (20 mg/kg, I.P.) or saline (equal volume). Our results demonstrate that 48-h following DOX administration diaphragm muscle specific force is reduced in sedentary-DOX rats in response to both phrenic nerve and direct diaphragm stimulation. Importantly, endurance exercise preconditioning in DOX-treated rats attenuated the decrease in diaphragm contractile function, reduced neuromuscular transmission failure and altered phrenic nerve morphology. These changes were associated with an exercise-induced reduction in circulating biomarkers of inflammation, nerve injury and reformation. Therefore, the results are consistent with exercise preconditioning as an effective way of reducing respiratory impairment via preservation of phrenic-diaphragm neuromuscular conduction.

Asunto(s)

Diafragma , Doxorrubicina , Condicionamiento Físico Animal , Ratas Sprague-Dawley , Animales , Diafragma/efectos de los fármacos , Diafragma/inervación , Doxorrubicina/toxicidad , Femenino , Ratas , Condicionamiento Físico Animal/fisiología , Antibióticos Antineoplásicos/toxicidad , Transmisión Sináptica/efectos de los fármacos , Transmisión Sináptica/fisiología , Nervio Frénico/efectos de los fármacos , Contracción Muscular/efectos de los fármacos , Contracción Muscular/fisiología , Unión Neuromuscular/efectos de los fármacos

Asunto(s)

Hipertensión , Reflejo , Músculos Respiratorios , Humanos , Hipertensión/fisiopatología , Hipertensión/metabolismo , Músculos Respiratorios/fisiopatología , Reflejo/fisiología , Masculino , Persona de Mediana Edad , Femenino , Inhalación/fisiología , Presión Arterial

RESUMEN

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

RESUMEN

BACKGROUND: The most common surgery for non-small cell lung cancer is lobectomy, which can be performed through either thoracotomy or video-assisted thoracic surgery (VATS). Insufficient research has examined respiratory muscle function and exercise capacity in lobectomy performed using conventional thoracotomy (CT), muscle-sparing thoracotomy (MST), or VATS. This study aimed to assess and compare respiratory muscle strength, diaphragm thickness, and exercise capacity in lobectomy using CT, MST, and VATS. METHODS: The primary outcomes were changes in respiratory muscle strength, diaphragm thickness, and exercise capacity. Maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP) were recorded for respiratory muscle strength. The 6-min walk test (6MWT) was used to assess functional exercise capacity. Diaphragm thickness was measured using B-mode ultrasound. RESULTS: The study included 42 individuals with lung cancer who underwent lobectomy via CT (n = 14), MST (n = 14), or VATS (n = 14). Assessments were performed on the day before surgery and on postoperative day 20 (range 17-25 days). The decrease in MIP (p < 0.001), MEP (p = 0.003), 6MWT (p < 0.001) values were lower in the VATS group than in the CT group. The decrease in 6MWT distance was lower in the MST group than in the CT group (p = 0.012). No significant differences were found among the groups in terms of diaphragmatic muscle thickness (p > 0.05). CONCLUSION: The VATS technique appears superior to the CT technique in terms of preserving respiratory muscle strength and functional exercise capacity. Thoracic surgeons should refer patients to physiotherapists before lobectomy, especially patients undergoing CT. If lobectomy with VATS will be technically difficult, MST may be an option preferable to CT because of its impact on exercise capacity.

Asunto(s)

Diafragma , Tolerancia al Ejercicio , Neoplasias Pulmonares , Fuerza Muscular , Neumonectomía , Músculos Respiratorios , Cirugía Torácica Asistida por Video , Toracotomía , Humanos , Neoplasias Pulmonares/cirugía , Neoplasias Pulmonares/patología , Neoplasias Pulmonares/diagnóstico por imagen , Masculino , Femenino , Fuerza Muscular/fisiología , Diafragma/fisiopatología , Diafragma/diagnóstico por imagen , Diafragma/cirugía , Neumonectomía/métodos , Persona de Mediana Edad , Cirugía Torácica Asistida por Video/métodos , Anciano , Músculos Respiratorios/fisiopatología , Toracotomía/métodos , Carcinoma de Pulmón de Células no Pequeñas/cirugía , Carcinoma de Pulmón de Células no Pequeñas/patología , Carcinoma de Pulmón de Células no Pequeñas/diagnóstico por imagen , Estudios de Seguimiento , Pronóstico

RESUMEN

OBJECTIVE: People living with chronic kidney disease (CKD) and receiving hemodialysis (HD) have impaired respiratory muscle strength and endurance. The objective of this study was to systematically review the effects of inspiratory muscle training (IMT) on respiratory muscle strength, functional capacity, lung function, quality of life, endothelial function, and oxidative stress in people living with CKD and receiving HD. METHODS: An electronic search was conducted from inception to June 2023. Randomized controlled trials that evaluated the effects of IMT on respiratory muscle strength, functional capacity, lung function, endothelial function, quality of life, or oxidative stress in adults living with CKD and receiving HD, compared with control, placebo IMT, or conventional physical therapy, were included. RESULTS: Eight studies were included, totaling 246 people. The meta-analysis showed that IMT increased the maximum inspiratory pressure (MIP) by 22.53 cm H2O, the maximum expiratory pressure (MEP) by 19.54 cm H2O, and the distance covered in the 6-minute walk test by 77.63 m. Changes in lung function and quality of life were not observed. It was not possible to quantitatively analyze data on endothelial function and oxidative stress. CONCLUSION: IMT improves MIP, MEP, and functional capacity in people living with CKD and receiving HD. IMT did not demonstrate significant results for lung function and quality of life. Effects on endothelial function and oxidative capacity remain uncertain. IMPACT: Inspiratory muscle training improves MIP, MEP, and functional capacity in people living with CKD and receiving HD, compared with conventional physical therapy or controls or placebo intervention. Increases in functional capacity in this population are extremely important because of the relationship with the survival of these people.

Asunto(s)

Ejercicios Respiratorios , Calidad de Vida , Ensayos Clínicos Controlados Aleatorios como Asunto , Diálisis Renal , Insuficiencia Renal Crónica , Músculos Respiratorios , Humanos , Ejercicios Respiratorios/métodos , Insuficiencia Renal Crónica/terapia , Insuficiencia Renal Crónica/fisiopatología , Músculos Respiratorios/fisiopatología , Fuerza Muscular/fisiología , Estrés Oxidativo/fisiología

RESUMEN

Respiratory function decreases with aging. The literature showed that non-ventilatory specific exercise could have a positive impact on respiratory muscles. A systematic literature review was conducted to assess the effects of non-ventilatory specific exercise on maximal inspiratory (MIP) and expiratory pressure (MEP) and peak expiratory flow (PEF) in older adults. The included 9 trials investigated the effects of resistance training, yoga, Pilates, physical activity based on walking, and whole-body vibration training. The meta-analysis showed no statistically significant differences in MIP, MEP, and PEF after implementation of a non-ventilatory specific exercise program in older individuals. Between-study heterogeneity was substantial for MIP and MEP outcomes but it was not statistically significant for PEF. Further RCTs will be necessary to determine the effects of physical exercise interventions. PROSPERO registry CRD42023478262.

Asunto(s)

Ejercicio Físico , Músculos Respiratorios , Humanos , Músculos Respiratorios/fisiología , Ejercicio Físico/fisiología , Anciano

RESUMEN

AIM: to investigate the effects of the whole body vibration (WBV) and inspiratory muscle training (IMT) on the inflammatory profile and in muscle mass and strength in pre-frail older women. METHODS: this study was a randomized double-blind trial. Forty two older women aged 60-80 years were randomly allocated to IMT + WBV (G1), IMTsham + WBV (G2) or Sham groups (G3). During 12 weeks G1 received both trainings, whereas G2 received WBV alone and G3 received IMT with a low fixed load and were positioned at the vibratory platform without therapeutic effect. Participants were evaluated before and after the intervention for the following outcomes: Brain-derived neurotrophic factor (BDNF) and inflammatory biomarkers (IB), respiratory (RT) and quadriceps thickness (QT) and diaphragmatic mobility (DM) using muscle ultrasound, body composition (BC) using a bioelectrical impedance scale and inspiratory muscle strength (IMS). RESULTS: after the training, G1 (114.93 ± 21.29) improved IMS (p<0.005) compared with G2 (91.29 ± 23.10) and G3 (85.21 ± 27.02). There was also a significant improve on time of the DM (p<0.001) and RT (p=0.006) for G1 (8.59 ± 3.55 and 11.11 ± 12.66) compared with G2 (1.05 ± 3.09 and 1.10 ± 10.60) and G3 (0.40 ± 2.29 and -1.85 ± 7.45). BDNF, IB, QT and BC were similar between groups. CONCLUSIONS: IMT associated with WBV is effective to improve in increasing IMS, RT and DM in pre-frail older women. However, these interventions do not modify BDNF, IB, QT or BC in this population.

Asunto(s)

Factor Neurotrófico Derivado del Encéfalo , Ejercicios Respiratorios , Músculos Respiratorios , Vibración , Humanos , Femenino , Factor Neurotrófico Derivado del Encéfalo/sangre , Anciano , Vibración/uso terapéutico , Método Doble Ciego , Ejercicios Respiratorios/métodos , Músculos Respiratorios/fisiología , Anciano de 80 o más Años , Fuerza Muscular/fisiología , Persona de Mediana Edad , Biomarcadores/sangre , Inflamación , Composición Corporal/fisiología

RESUMEN

BACKGROUND: Maximal respiratory pressure is used to assess the inspiratory and expiratory muscles strength by using maximal inspiratory pressure (PImax) and maximal expiratory pressure (PEmax). This study aimed to summarize and evaluate the reliability and validity of maximal respiratory pressure measurements. METHODS: This systematic review followed the Consensus-based Standards for the Selection of Health Measurement Instruments (COSMIN) recommendations and was reported by using the PRISMA checklist. Studies published before March 2023 were searched in PubMed and EMBASE databases. RESULTS: A total of 642 studies were identified by using the online search strategy and manual search (602 and 40, respectively). Twenty-three studies were included. The level of evidence for test-retest reliability was moderate for PImax and PEmax (intraclass correlation coefficient > 0.70 for both), inter-rater reliability was low for PImax and very low for PEmax (intraclass correlation coefficient > 0.70 for both), and the measurement error was very low for PImax and PEmax. In addition, concurrent validity presented a high level of evidence for PImax and PEmax (r > 0.80). CONCLUSIONS: Only concurrent validity of maximal respiratory pressure measured with the manometers evaluated in this review presented a high level of evidence. The quality of clinical studies by using maximal respiratory pressure would be improved if more high-quality studies on measurement properties, by following well established guidelines and the COSMIN initiative, were available.

Asunto(s)

Presiones Respiratorias Máximas , Músculos Respiratorios , Humanos , Reproducibilidad de los Resultados , Músculos Respiratorios/fisiología , Fuerza Muscular/fisiología , Manometría/métodos , Espiración/fisiología , Inhalación/fisiología

RESUMEN

INTRODUCTION: Protocols for obtaíníng the maxímum threshold pressure have been applied wíth límited precision to evaluate ínspiratory muscle endurance. In thís sense, new protocols are needed to allow more relíable measurements. The purpose of the present study was to compare a new incremental ramp load protocol for the evaluation of ínspíratory muscle endurance wíth the most used protocol in healthy indíviduals. METHODS: This was a prospective cross-sectional study carried out ín a síngle center. Nínety-two healthy indíviduals (43 men [22 ± 3 years] and 49 women [22 ± 3 years]) were randomly allocated to perform: (i) íncremental ramp load protocol and (íí) íncremental step loadíng protocol. The sustained pressure threshold (or maximum threshold pressure), maximum threshold pressure/dynamic strength índex ratío, time untíl task faílure, as well as dífference between the mean heart rate of the last five mínutes of baselíne and the peak heart rate of the last 30 seconds of each protocol were measured. RESULTS: Incremental ramp load protocol wíth small íncreases in the load and starting from mínímum values of strength index was able to evaluate the inspiratory muscle endurance through the maxímum threshold pressure of healthy indívíduals. CONCLUSION: The present study suggests that the íncremental ramp load protocol is able to measure maximum threshold pressure in a more thorough way, wíth less progression and greater accuracy in the load stratification compared to the límited incremental step loading protocol and with a safe and expected cardiovascular response in healthy individuals.

Asunto(s)

Prueba de Esfuerzo , Resistencia Física , Masculino , Humanos , Femenino , Resistencia Física/fisiología , Estudios Transversales , Estudios Prospectivos , Músculos Respiratorios/fisiología , Ensayos Clínicos Controlados Aleatorios como Asunto

RESUMEN

Objectives: The aim of this study was to investigate the effect of diaphragmatic breathing training with visual biofeedback on respiratory function in patients with multiple rib fractures. Patients and methods: Between June 2021 and October 2021, a total of 16 patients (15 males, 1 female; mean age: 49.50±11.85 years; range, 25 to 66 years) who were diagnosed with multiple rib fractures were randomly assigned into two groups as the control group (CG, n=8) and the visual biofeedback group (VBG, n=8). The effect of each diaphragmatic breathing training on respiratory function was evaluated before and after eight interventions. For respiratory function, pulmonary function test was used to measure pulmonary function and respiratory muscle strength, and the Pain, Inspiratory capacity, Cough (PIC) score was used to evaluated pain, inspiratory capacity, and cough ability. Results: In both groups, the pulmonary function representing the ratio of measurements to predicted values of both forced vital capacity (CG mean difference=25.37±4.58, p=0.002, VBG mean difference=24.25±3.96, p=0.007) and forced expiratory volume in 1 sec (CG mean difference=32.38±5.7, p=0.002, VBG mean difference=26.15±5.73, p <0.001) increased significantly. The maximal inspiratory (CG mean difference=14.00±0.35, p=0.002, VBG mean difference=20.5±6.26, p=0.009) and expiratory pressure (CG mean difference=43.72±29.44, p=0.034, VBG mean difference=25.76±6.78, p=0.015), the indicators of respiratory muscle strength, increased significantly in both groups. The PIC score, which evaluated pain, inspiratory capacity, and cough ability, also increased significantly in both groups (CG mean difference=1.63±0.26, p≤0.001, VBG mean difference=3.13±0.19, p <0.001). The change of PIC score after intervention did not significantly differ between the groups (F=1.439, p=0.250); however, there was a significant difference over time (F=38.476, p <0.001). The change of PIC scores differed over time between the groups (F=2.806 p=0.011). Conclusion: Diaphragmatic breathing training and diaphragmatic breathing training with visual biofeedback can improve pulmonary function, respiratory muscle strength, pain, inspiratory capacity, and cough ability in patients with multiple rib fractures.