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)To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Archives of Physical Medicine and RehabilitationAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Heart disease and stroke statistics–2015 update: a report from the American Heart Association.Circulation. 2015; 131: e29-e322
- The global burden of stroke and need for a continuum of care.Neurology. 2013; 80: S5-S12
- Respiratory muscle strength and training in stroke and neurology: a systematic review.Int J Stroke. 2013; 8: 124-130
- Respiratory muscle training: theory and practice.Churchill Livingstone, Philadelphia2013
- Respiratory pressures and thoracoabdominal motion in community-dwelling chronic stroke survivors.Arch Phys Med Rehabil. 2005; 86: 1974-1978
- Inspiratory muscular weakness is most evident in chronic stroke survivors with lower walking speeds.Eur J Phys Rehabil Med. 2014; 50: 301-307
- Respiratory muscle training increases strength of respiratory muscles and reduces the occurrence of respiratory complications after stroke: a systematic review.J Physiother. 2016; 62: 138-144
- Inspiratory muscular training in chronic stroke survivors: a randomized controlled trial.Arch Phys Med Rehabil. 2011; 92: 184-190
- Inspiratory and expiratory muscle training in subacute stroke: a randomized clinical trial.Neurology. 2015; 85: 564-572
- Effects of respiratory muscle training on respiratory function, respiratory muscle strength and exercise tolerance in post-stroke patients: a systematic review with meta-analysis.Arch Phys Med Rehabil. 2016; 97: 1994-2001
- Inspiratory muscle training in patients with chronic obstructive pulmonary disease - structural adaptation and physiologic outcomes.Am J Respir Crit Care Med. 2002; 166: 1491-1497
- Effects of resistance training on muscle strength, endurance, and motor unit according to ciliary neurotrophic factor polymorphism in male college students.J Sports Sci Med. 2014; 13: 680-688
- Inspiratory muscle training with a pressure threshold breathing device in patients with chronic obstructive pulmonary disease.Am Rev Respir Dis. 1988; 138: 689-696
- Inspiratory muscle training for the recovery of function after stroke.Cochrane Database Syst Rev. 2012; 16: CD009360
- Reproducibility of twitch mouth pressure, sniff nasal inspiratory pressure, and maximal inspiratory pressure.Eur Respir J. 1998; 11: 901-905
- Test/retest reliability of maximum mouth pressure measurements with the MicroRPM in healthy volunteers.Respir Care. 2011; 56: 776-782
- High-intensity vs. sham inspiratory muscle training in patients with chronic heart failure: a prospective randomized trial.Eur J Heart Fail. 2013; 15: 892-901
- Predicting home and community walking activity in people with stroke.Arch Phys Med Rehabil. 2010; 91: 1582-1586
- CONSORT 2010 statement: updated guidelines for reporting parallel group randomized trials.J Clin Epidemiol. 2010; 63: 834-840
- Guidelines for the management of respiratory complications in patients with neuromuscular disease.Arch Bronconeumol. 2013; 49: 306-313
- Test-retest reliability and concurrent validity of a digital manovacuometer.Fisioter Pesqui. 2014; 21: 236-242
- Comparison of three protocols for measuring the maximal respiratory pressures.Fisioter Mov. 2015; 28: 31-39
- ATS/ERS statement on respiratory muscle testing.Am J Respir Care Med. 2002; 166: 518-624
- Inspiratory muscle training protocol for patients with chronic obstructive pulmonary disease (IMTCO study): a multicentre randomised controlled trial.BMJ Open. 2013; 3e003101
- Validation of the Modified Pulmonary Functional Status and Dyspnea Questionnaire and the Medical Research Council scale for use in Brazilian patients with chronic obstructive pulmonary disease.J Bras Pneumol. 2008; 34: 1008-1018
- The MRC breathlessness scale.Occup Med. 2008; 58: 226-227
- An official European Respiratory Society/American Thoracic Society technical standard: field walking tests in chronic respiratory disease.Eur Respir J. 2014; 44: 1428-1446
- An app with remote support achieves better adherence to home exercise programs than paper handouts in people with musculoskeletal conditions: a randomised trial.J Physiother. 2017; 63: 161-167
- Effect of high-intensity home-based respiratory muscle training on strength of respiratory muscles after stroke: a protocol for a randomised controlled trial.Braz J Phys Ther. 2017; 21: 372-377
- Interval estimation for the difference between independent proportions: comparison of eleven methods.Stat Med. 1998; 17: 873-890
- Effect size, confidence interval, and statistical significance: a practical guide for biologists.Biol Rev Camb Philos Soc. 2007; 82: 591-605
- Publishing code: an initiative to enhance transparency of data analyses reported in Journal of Physiotherapy.J Physiother. 2017; 63: 129-130
- Maximum inspiratory pressure as a clinically meaningful trial endpoint for neuromuscular diseases: a comprehensive review of the literature.Orphanet J Rare Dis. 2017; 12: 52
- Inspiratory muscle training in stroke patients with congestive heart failure: a CONSORT-compliant prospective randomized single-blinded controlled trial.Medicine (Baltimore). 2016; 95e4856
- Respiratory muscle strength training and neuromuscular electrical stimulation in subacute dysphagic stroke patients: a randomized controlled trial.Clin Rehabil. 2017; 31: 761-771
- Does respiratory muscle training improve cough flow in acute stroke? Pilot randomized controlled trial.Stroke. 2015; 46: 447-453
- Respiratory muscle training improves cardiopulmonary function and exercise tolerance in subjects with subacute stroke: a randomized controlled trial.Clin Rehabil. 2010; 24: 240-250
- Respiratory muscle function in patients with neuromuscular disorders and cardiopulmonary diseases.Int J Clin Pract. 1998; 52: 319-329
- 207th ENMC Workshop on chronic respiratory insufficiency in myotonic dystrophies: management and implications for research, 27-29 June 2014, Naarden, The Netherlands.Neuromuscul Disord. 2015; 25: 432-442
- Chronic respiratory care for neuromuscular diseases in adults.Eur Respir J. 2009; 34: 444-451
- Power of outcome measurements to detect clinically significant changes in pulmonary rehabilitation of patients with COPD.Chest. 2002; 121: 1092-1098
- Effects of respiratory muscle and endurance training using an individualized training device on the pulmonary function and exercise capacity in stroke patients.Med Sci Monit. 2014; 20: 2543-2549
- Dysphagia after stroke: incidence, diagnosis, and pulmonary complications.Stroke. 2005; 36: 2756-2763
- Walking training associated with virtual reality-based training increases walking speed of individuals with chronic stroke: systematic review with meta-analysis.Braz J Phys Ther. 2014; 18: 502-512
Article info
Publication history
Published online: October 12, 2018
Footnotes
Supported by Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES, grant code 001), Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq, grant no. 304434/2014-0), and Fundação de Amparo à Pesquisa de Minas Gerais (FAPEMIG, grant no. PPM 00082-16).
Clinical Trial Registration No.: NCT02400138.
Disclosures: none.
Identification
Copyright
© 2018 by the American Congress of Rehabilitation Medicine
ScienceDirect
Access this article on ScienceDirectLinked Article
- CorrectionArchives of Physical Medicine and RehabilitationVol. 100Issue 8
- PreviewThe 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).
- Full-Text
- Preview
