Respiratory Muscle Training in Restrictive Thoracic Disease: A Randomized Controlled Trial
Abstract
Budweiser S, Moertl M, Jörres RA, Windisch W, Heinemann F, Pfeifer M. Respiratory muscle training in restrictive thoracic disease: a randomized controlled trial.
Objective
To investigate the effects of respiratory muscle training (RMT) in patients with restrictive thoracic disorders and intermittent noninvasive positive-pressure ventilation (NPPV).
Design
Prospective randomized controlled trial.
Setting
Home-based RMT, with assessment in a primary care pulmonary center.
Participants
Thirty patients with restrictive thoracic disorders; 28 patients completed the trial.
Intervention
Three months of RMT by isocapnic hyperpnea or sham training.
Main Outcome Measures
Respiratory muscle strength and endurance, lung function, exercise performance, and health-related quality of life (HRQOL).
Results
After RMT, maximal inspiratory mouth pressure was increased (27.6%±36.5%, P=.013). In patients who could perform cycle ergometer testing (n=17), peak oxygen consumption (2.24±3.39mL·kg−1·min−1 vs −1.71±2.54mL·kg−1·min−1, P=.014) and maximal work rate (9.4±14.8W vs −5.1±10.8W, P=.043) increased relative to a control group. Similar differences occurred regarding changes of HRQOL (physical performance, 3.3±11.4 score vs −6.6±9.0 score; P=.012) and time of ventilator use (−0.6±1.2h/d vs 0.4±0.5h/d, P=.010). Lung volumes, 12-second maximum voluntary ventilation, 6-minute walking distance, and blood gases were unchanged.
Conclusions
In patients with restrictive thoracic disorders and NPPV, RMT improved inspiratory muscle strength. Exercise performance and HRQOL were improved when the 2 groups were compared. RMT was practicable and safe despite severe respiratory impairment. Further evaluation, including different training intensities and modalities, seems warranted.
aCenter for Pneumology, Donaustauf Hospital, Donaustauf, Germany
bInstitute and Outpatient Clinic for Occupational and Environmental Medicine, Ludwig-Maximilians-University, Munich, Germany
cDepartment of Pneumology, University of Freiburg, Freiburg, Germany
dDepartment of Internal Medicine II, University of Regensburg, Regensburg, Germany.
Reprint requests to Stephan Budweiser, MD, Klinik Donaustauf, Ludwigstraße 68, D-93093 Donaustauf, Germany.
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