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High-Intensity Respiratory Muscle Training Improves Strength and Dyspnea Poststroke: A Double-Blind Randomized Trial

Published:October 12, 2018DOI:https://doi.org/10.1016/j.apmr.2018.09.115

      Abstract

      Objective

      To examine whether high-intensity home-based respiratory muscle training, that is, with higher loads, delivered more frequently and for longer duration, than previously applied, would increase the strength and endurance of the respiratory muscles, reduce dyspnea and respiratory complications, and improve walking capacity post-stroke.

      Design

      Randomized trial with concealed allocation, blinded participants and assessors, and intention-to-treat analysis.

      Setting

      Community-dwelling patients.

      Participants

      Patients with stroke, who had respiratory muscle weakness (N=38).

      Interventions

      The experimental group received 40-minute high-intensity home-based respiratory muscle training, 7 days per week, for 8 weeks, progressed weekly. The control group received a sham intervention of similar dose.

      Main Outcome Measures

      Primary outcome was inspiratory muscle strength (via maximal inspiratory pressure), whereas secondary outcomes were expiratory muscle strength (maximal expiratory pressure), inspiratory muscle endurance, dyspnea (Medical Research Council score), respiratory complications (hospitalizations), and walking capacity (6-minute walk test). Outcomes were measured at baseline, after intervention, and 1 month beyond intervention.

      Results

      Compared to the control, the experimental group increased inspiratory (27cmH2O; 95% confidence interval [95% CI], 15 to 40) and expiratory (42cmH2O; 95% CI, 25 to 59) strength, inspiratory endurance (33 breaths; 95% CI, 20 to 47), and reduced dyspnea (-1.3 out of 5.0; 95% CI, -2.1 to -0.6), and the benefits were maintained at 1 month beyond training. There was no significant between-group difference for walking capacity or respiratory complications.

      Conclusion

      High-intensity home-based respiratory muscle training was effective in increasing strength and endurance of the respiratory muscles and reducing dyspnea for people with respiratory muscle weakness post-stroke, and the magnitude of the effect was higher, than that previously reported in studies, which applied standard protocols.

      Keywords

      List of abbreviations:

      95% CI (95% confidence interval), MEP (maximal expiratory pressure), MIP (maximal inspiratory pressure)
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      Linked Article

      • Correction
        Archives of Physical Medicine and RehabilitationVol. 100Issue 8
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          The article by Kiefer Parreiras de Menezes et al, High-Intensity Respiratory Muscle Training Improves Strength and Dyspnea Poststroke, published in Archives of Physical Medicine and Rehabilitation 2019;100:205-212 ( https://doi.org/10.1016/j.apmr.2018.09.115 ), contained errors in Table 2. The interval of confidence in the between group difference for walking capacity is 38 (-22 to 98), and not 38 (-22 to -98); and 44 (-13 to 100) and not 44 (-13 to -100).
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