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Exercise and Rehabilitation in Heart Failure
Published in Andreas P. Kalogeropoulos, Hal A. Skopicki, Javed Butler, Heart Failure, 2023
Audrey Borghi-Silva, Flávia Rossi Caruso, Renata Gonçalves Mendes
For ventilatory muscle training programs, a recent meta-analysis by Wu et al. demonstrated that a 6-week minimum of inspiratory muscle training led to improvements in HRQoL, maximum inspiratory pressure, and perceived dyspnea.17 The intervention group that received 40–60% of inspiratory pressure load showed improvement in maximal inspiratory pressure when compared with patients that received 10–15% of maximum inspiratory pressure.17 In this sense, a moderate training load of 40–60% of maximum inspiratory pressure may be ideal for patients with HFpEF. However, limited evidence exists regarding the optimal protocol for ventilatory muscle training. Thus, current recommendations of muscle training are based on the few studies that have been performed to date, especially in patients who have ventilatory muscle weakness.
Modern Rehabilitation Techniques for COVID-19
Published in Wenguang Xia, Xiaolin Huang, Rehabilitation from COVID-19, 2021
For some patients with acquired weakness in the intensive care unit (ICU), inspiratory muscle training (IMT) should be performed. This requires patients to use breathing training devices with an initial load of 30% of the maximum inspiratory pressure, inhaling five times in each group with an interval of not less than 6 seconds. Six groups should be performed for each training, with a 1-minute rest between groups. The frequency is once a day. During the training, if patients show obvious fatigue, polypnea, shortness of breath, wheezing, chest tightness, pain, etc., the treatment should be suspended in time, and the training intensity should be adjusted.
Respiratory muscle function in rehabilitation
Published in Claudio F. Donner, Nicolino Ambrosino, Roger S. Goldstein, Pulmonary Rehabilitation, 2020
Thierry Troosters, Michael I. Polkey, Rik Gosselink
A last factor influencing the pressure measured during maximal inspiratory or expiratory manoeuvres is the elastic recoil of the lungs and chest wall. These are depicted schematically in Figure 9.1. At functional residual capacity, the net result of the two components is zero. Consequently, at these lung volumes, pressures measured during inspiration or expiration are independent of the elastic recoil. At lower lung volumes, the maximal inspiratory pressure is the result of the pressure developed by the inspiratory muscles and the pressure developed by the thorax (which at this point is larger than the lung recoil). Conversely, when maximal expiratory pressure is measured at total lung capacity (TLC), the pressure obtained is the result of the elastic lung recoil, the recoil of the chest wall and the expiratory pressure developed by the expiratory muscles. Typically, however, in clinical practice measurement of maximal mouth pressures is preferred from extremes of lung volume (i.e. TLC for maximal expiratory pressure [MEP] and residual volume [RV] for maximal inspiratory pressure [MIP]) because the variability exhibited by patients is reduced at these volumes (9).
The effects of inspiratory muscle training on inspiratory muscle strength, lung function and quality of life in adults with spinal cord injuries: a systematic review and Meta-analysis
Published in Disability and Rehabilitation, 2023
Alyson Woods, Owen Gustafson, Mark Williams, Robyn Stiger
The aim of this systematic review was to determine if IMT is effective at improving respiratory muscle strength, lung function and quality of life, and whether any improvements in strength were enough to lower an individual with SCI’s risk of developing pneumonia. A secondary aim was to explore whether intervention, duration or type of device impacted on effectiveness. IMT was found to have a statistically significant effect on inspiratory muscle strength. However, there was a lack of sufficient evidence to reach a clear conclusion on quality of life, maximal expiratory pressure, or forced expiratory volume in 1 s. Therefore, maximal inspiratory pressure may be a better measure of improvement for respiratory muscle strength, especially in people with lesions where the inspiratory muscles innervate (C2-T11).
Relationship between kyphosis and cough strength and respiratory function of community-dwelling elderly
Published in Physiotherapy Theory and Practice, 2022
Hiromichi Takeda, Yoshihiro Yamashina, Kazuyuki Tabira
We used a spirometer (Pneumotrac, Vitalograph Ltd, Buckinghamshire, United Kingdom) to measure CPF and lung function. For CPF measurements, participants were asked to sit and wear a facemask that covered their nose and mouth. The facemask was coupled to the Pneumotrac, which would input differential pressure change to a digital spirometer. Voluntary cough airflow from the maximum inspiratory was performed at least twice to assess CPF. We did not evaluate reflex cough function. However, previous studies have reported that the CPF for voluntary cough rather than reflex cough is associated with a risk of pneumonia in patients with acute stroke and dysphagia (Kulnik et al., 2016). Spirometry was performed at least twice to assess forced expiratory volume in 1 second/forced vital capacity (FEV1/FVC) and VC, according to the Japanese Respiratory Society guidelines (Tojo, Suga, and Kambe, 2005). For further analysis, we used the best results of the CPF and pulmonary function tests. We measured the maximum expiratory pressure (PEmax) and maximum inspiratory pressure (PImax) using the intraoral pressure gauge (IOP-01, KOBATA GAUGE Mfg. Co., Ltd, Osaka, Japan). The PImax was determined on deep inspiration from the residual volume, and the PEmax was determined on deep expiration from the total lung capacity, following a previously described procedure (Black and Hyatt, 1969). Respiratory muscle strength was measured twice, and the best values were used for the analysis.
A randomized placebo-controlled study investigating the efficacy of inspiratory muscle training in the treatment of children with bronchial asthma
Published in Journal of Asthma, 2021
The strength of respiratory muscles was assessed through the maximal inspiratory pressure (IPmax) and maximal expiratory pressure (EPmax) during the maximal respiratory effort. An electronic respiratory pressure meter with a rigid mouthpiece (Micro RPM®, Micro Medical, UK) was used for assessment according to the standards set by the American Thoracic Society and European Respiratory Society (25). To measure the IPmax, children were asked to perform maximal inspiration, starting from residual lung volume to total lung capacity, following maximal expiration. To measure the EPmax, children were asked to make a maximal expiratory effort starting from total lung capacity to residual volume. The pressure thresholds sustained at least for 1-s were recorded. Each child performed 5 − 8 maneuvers to measure IPmax and EPmax. Then, three acceptable maneuvers including at least two reproducible maneuvers (i.e. the difference between values < 5%) were selected. The highest-pressure value of these maneuvers, expressed in cmH2O, was recorded (25,26). The percentage of the predicted value of IPmax and EPmax was calculated by an equation suggested earlier (27).