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Inspiratory Muscle Training In COPD
F. Lötters1, B. van Tol2, G. Kwakkel2 and R. Gosselink3
1 Dept of Public Health, Faculty of Medicine and Health Sciences, Erasmus University Rotterdam, Rotterdam, and 2 Dept of Physical Therapy and Research Institute for Fundamental and Clinical Human Movement Sciences, University Hospital Vrije Universteit, Amsterdam, the Netherlands. 3 Dept of Respiratory Rehabilitation, University Hospitals Leuven, Katholieke Universiteit, Leuven, Belgium
The purpose of this meta-analysis is to review studies investigating the efficacy of inspiratory muscle training (IMT) in chronic obstructive pulmonary disease (COPD) patients and to find out whether patient characteristics influence the efficacy of IMT.
A systematic literature search was performed using the Medline and Embase databases. On the basis of a methodological framework, a critical review was performed and summary effect-sizes were calculated by applying fixed and random effects models.
Both IMT alone and IMT as adjunct to general exercise reconditioning significantly increased inspiratory muscle strength and endurance. A significant effect was found for dyspnoea at rest and during exercise. Improved functional exercise capacity tended to be an additional effect of IMT alone and as an adjunct to general exercise reconditioning, but this trend did not reach statistical significance. No significant correlations were found for training effects with patient characteristics. However, subgroup analysis in IMT plus exercise training revealed that patients with inspiratory muscle weakness improved significantly more compared to patients without inspiratory muscle weakness.
Conclusions: From this review it is concluded that inspiratory muscle training is an important addition to a pulmonary rehabilitation programme directed at chronic obstructive pulmonary disease patients with inspiratory muscle weakness.
Expiratory Muscle Training in COPD
Paltiel Weiner, MD; Rasmi Magadle, MD; Marinella Beckerman, MD; Margalit Weiner, PhD and Noa Berar-Yanay, MD
*From the Department of Medicine A, Hillel Yaffe Medical Center, Hadera, Israel.
Background: There are several reports showing that expiratory muscle strength and endurance can be impaired in patients with COPD. This muscle weakness may have clinically relevant implications. Expiratory muscle training tended to improve cough and to reduce the sensation of respiratory effort during exercise in patients other than those with COPD.
Methods: Twenty-six patients with COPD (FEV1 38% predicted) were recruited for the study. The patients were randomized into two groups: group 1, 13 patients were assigned to receive specific expiratory muscle training (SEMT) daily, six times a week, each session consisting of 1/2 h of training, for 3 months; and group 2, 13 patients were assigned to be a control group and received training with very low load. Spirometry, respiratory muscle strength and endurance, 6-min walk test, Mahler baseline dyspnea index (before), and the transitional dyspnea index (after) were measured before and after training.
Results: The training-induced changes were significantly greater in the SEMT group than in the control group for the following variables: expiratory muscle strength (from 86 ± 4.1 to 104 ± 4.9 cm H2O, p < 0.005; mean difference from the control group, 24%; 95% confidence interval, 18 to 32%), expiratory muscle endurance (from 57 ± 2.9% to 76 ± 4.0%, p < 0.001; mean difference from the control group, 29%; 95% confidence interval, 21 to 39%), and in the distance walked in 6 min (from 262 ± 38 to 312 ± 47 m, p < 0.05; mean difference from the control group, 14%; 95% confidence interval, 9 to 20%). There was also a small but not significant increase (from 5.1 ± 0.9 to 5.6 ± 0.7, p = 0.14) in the dyspnea index.
Conclusions: The expiratory muscles can be specifically trained with improvement of both strength and endurance in patients with COPD.
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