Respiratory Muscle Control in Patients with Parkinson's Disease

ABSTRACT Objective: To investigate parameters of lung function and respiratory muscle strength in different stages of Parkinson’s disease (PD), as well as to determine their correlation with motor function and quality of life. Methods: This was a cross-sectional study conducted at a referral center for PD in the city of Recife, Brazil. Respiratory muscle strength and lung function, as well as their relationship with motor function and quality of life, were evaluated in patients with PD, stratified by the level of severity, and were compared with the data obtained for a control group. After confirming the normality of data distribution, we performed one-way ANOVA with a post hoc t-test. Results: The sample comprised 66 individuals, in two groups: PD (n = 49) and control (n = 17). All of the parameters investigated showed inverse correlations with PD severity, and there were significant differences among the levels of severity, as well as between the PD and control groups, in terms of the MIP, MEP, FVC, FEV1, and FEF25-75%. The lung function parameters also showed moderate to weak inverse correlations with bradykinesia and rigidity. On a quality of life questionnaire, the total score and mobility domain score both presented a moderate inverse correlation with FVC, FEV1, PEF, and MEP. Conclusions: Respiratory muscle strength and some lung function parameters are impaired from the early stages of PD onward, bradykinesia and rigidity being the cardinal signs that correlate most strongly with impairment of those parameters. Such alterations negatively affect the quality of life of patients with PD.

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Detraining Effect on Pulmonary and Cardiovascular Autonomic Function and Functional Outcomes in Patients With Parkinson's Disease After Respiratory Muscle Training: An 18-Month Follow-Up Study

Frontiers in Neurology ◽

10.3389/fneur.2021.735847 ◽

2021 ◽

Vol 12 ◽

Author(s):

Chih-Cheng Huang ◽

Yun-Ru Lai ◽

Fu-An Wu ◽

Nai-Ying Kuo ◽

Ben-Chung Cheng ◽

...

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Pulmonary Function ◽

Functional Outcomes ◽

Respiratory Muscle ◽

Autonomic Function ◽

Clinical Severity ◽

Respiratory Muscle Training ◽

Muscle Training ◽

Cardiovascular Autonomic Function

Background: The effect of 3-month respiratory muscle training (RMT) on pulmonary and autonomic function and functional outcomes has been demonstrated in patients with Parkinson's disease (PD); however, there is a paucity of information on the durability of the training effect. In this study, we monitored the pulmonary and cardiovascular autonomic function and clinical severity scales until 18 months after the cessation of RMT to elucidate the detraining effect after RMT.Methods: All patients with PD receiving RMT were assessed with clinical severity scales as well as pulmonary and autonomic function tests at four different stages (baseline on enrollment, immediately after 3 months of RMT, and 6 and 18 months after cessation of RMT). A control group of PD patients who did not receive RMT was also recruited for comparison. Pulmonary function parameters, including forced vital capacity (FVC), forced expiratory volume in one second (FEV1), maximum inspiratory pressure (MIP), and maximum expiratory pressure (MEP), were assessed. Cardiovascular autonomic function was assessed using measures including heart rate response to deep breathing (HRDB), Valsalva ratio, and baroreflex sensitivity. Clinical severity scores were also measured using the Hoehn and Yahr staging and the Unified Parkinson's Disease Rating Scale (UPDRS).Results: The results showed significant improvements in MIP, MEP, HRDB, and UPDRS immediately after RMT. Despite some decay, the improvements in pulmonary function (MIP and MEP) and functional outcomes (UPDRS) remained significant until 6 months of detraining (9 months after enrollment). However, the improvement in cardiovascular autonomic function (HRDB) was reversed after 6 months of detraining.Conclusions: Based on these findings, we recommend that RMT may be repeated after at least 6 months after previous session (9 months after enrollment) for patients with PD to maintain optimal therapeutic effects.

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Defective corticomuscular connectivity during walking in patients with Parkinson’s disease

Journal of Neurophysiology ◽

10.1152/jn.00109.2020 ◽

2020 ◽

Vol 124 (5) ◽

pp. 1399-1414

Author(s):

Hikaru Yokoyama ◽

Takashi Yoshida ◽

Karl Zabjek ◽

Robert Chen ◽

Kei Masani

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

The Elderly ◽

Cortical Control ◽

Muscle Control ◽

Aging Effects

Mechanisms behind how Parkinson’s disease (PD) affects cortical control of muscles during walking remain unclear. As PD typically develops in the elderly, investigation of aging effects is important to examine deficits regarding PD. Here, we demonstrated that PD causes weak corticomuscular synchronization during walking, but aging does not. This lower-than-normal corticomuscular communication may cause impaired muscle control during walking.

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Respiratory muscle training in patients with Parkinson's disease

http://isrctn.com/ ◽

10.1186/isrctn10301406 ◽

2018 ◽

Author(s):

Alvaro Reyes

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Respiratory Muscle ◽

Respiratory Muscle Training ◽

Muscle Training

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Simultaneously Improved Pulmonary and Cardiovascular Autonomic Function and Short-Term Functional Outcomes in Patients with Parkinson’s Disease after Respiratory Muscle Training

Journal of Clinical Medicine ◽

10.3390/jcm9020316 ◽

2020 ◽

Vol 9 (2) ◽

pp. 316

Author(s):

Chih-Cheng Huang ◽

Yun-Ru Lai ◽

Fu-An Wu ◽

Nai-Ying Kuo ◽

Yuh-Chyn Tsai ◽

...

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Pulmonary Function ◽

Functional Outcomes ◽

Respiratory Muscle ◽

Autonomic Function ◽

Respiratory Muscle Training ◽

Muscle Training ◽

Short Term ◽

Cardiovascular Autonomic Function

Both pulmonary function and autonomic function are impaired in patients with Parkinson’s diseases (PD). This study tested the hypothesis that respiratory muscle training (RMT) can not only improve pulmonary function, but also simultaneously improve cardiovascular autonomic function and short-term functional outcomes in patients with PD. Pulmonary function was measured by the forced vital capacity (FVC), forced expiratory volume in one second (FEV1), maximum inspiratory pressures (MIP), and maximum expiratory pressures (MEP). Cardiovascular autonomic function was measured by the heart rate response to deep breathing (HRDB), Valsalva ratio, baroreflex sensitivity, and spectral analysis. The functional and severity scores were measured by the Hoehn and Yahr stage and Unified Parkinson’s Disease Rating Scale (UPDRS). These measures were evaluated in patients with PD before and after 3 months of RMT, compared with a control group of PD patients without RMT. The results showed significant improvement of clinical scores (total UPDRS and UPDRS I, II and III) after RMT (p < 0.0001). Concerning pulmonary function, the parameters of MIP and MEP improved significantly. The parameters of cardiovascular function also improved after RMT, although only HRDB reached statistical significance. Based on the results of our study, RMT can not only improve both pulmonary and cardiovascular autonomic function, but can also improve short-term functional outcomes in patients with PD.

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Respiratory Muscle Dysfunction in Parkinson's Disease

American Review of Respiratory Disease ◽

10.1164/ajrccm/138.2.266 ◽

1988 ◽

Vol 138 (2) ◽

pp. 266-271 ◽

Cited By ~ 64

Author(s):

George E. Tzelepis ◽

F. Dennis McCool ◽

Joseph H. Friedman ◽

Frederic G. Hoppin

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Respiratory Muscle ◽

Muscle Dysfunction

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Respiratory Muscle Performance and the Perception of Dyspnea in Parkinson's Disease

Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques ◽

10.1017/s031716710000175x ◽

2002 ◽

Vol 29 (1) ◽

pp. 68-72 ◽

Cited By ~ 37

Author(s):

Paltiel Weiner ◽

Rivka Inzelberg ◽

Avi Davidovich ◽

Puiu Nisipeanu ◽

Rasmi Magadle ◽

...

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Muscle Strength ◽

Respiratory Muscle ◽

Respiratory Muscles ◽

Normal Subjects ◽

Forced Expiratory Volume ◽

Muscle Performance ◽

Respiratory Muscle Strength ◽

Before And After

Background:Pulmonary and respiratory muscle function impairment are common in patients with Parkinson's disease (PD). However, dyspnea is not a frequent complaint among these patients, although it is well documented that the intensity of dyspnea is related to the activity and the strength of the respiratory muscles.Patients and Methods:We studied pulmonary function, respiratory muscle strength and endurance and the perception of dyspnea (POD) in 20 patients with PD (stage II and III Hoehn and Yahr scale) before and after their first daily L-dopa dose. Respiratory muscle strength was assessed by measuring the maximal inspiratory and expiratory mouth pressures (PImax and PEmax), at residual volume (RV) and total lung capacity (TLC) respectively. The POD was measured while the subject breathed against progressive load and dyspnea was rated using a visual analog scale.Results:Respiratory muscle strength and endurance were decreased and the POD was increased during the off medication period compared to normal subjects. There was a nonsignificant trend to an increase in PImax, PEmax and endurance after L-dopa intake. The POD of PD patients decreased (p<0.05) following medication, although, it remained increased (p<0.01) as compared to the normal subjects. Even if patients had spirometry data showing a mild restrictive pattern, before medication, both forced vital capacity (FVC) and forced expiratory volume (FEV)1 remained almost identical after L-dopa intake.Conclusions:Patients with PD have higher POD, compared to normal subjects and this increased perception is attenuated when the patients are on dopaminergic medication. The change in the POD is not related to changes in respiratory muscle performance or pulmonary functions. A central effect or a correction of uncoordinated respiratory movements by L-dopa may contribute to the decrease in POD following L-dopa treatment.

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Respiratory Disorders in Parkinson’s Disease

Journal of Parkinson s Disease ◽

10.3233/jpd-212565 ◽

2021 ◽

pp. 1-18

Author(s):

Evelyn M. Guilherme ◽

Roberta de Fátima C.M. Padovez ◽

Adriele de Oliveira ◽

Alyne Montero Ferro ◽

Valéria A. P. di Lorenzo ◽

...

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Muscle Strength ◽

Pulmonary Function ◽

Respiratory Muscle ◽

Physical Capacity ◽

Respiratory Muscle Strength ◽

Respiratory Impairment ◽

Respiratory Disorders ◽

Electronic Search

Background: Parkinson’s disease (PD) non motor symptoms may present early in the disease course and worsen with advancing disease. Respiratory changes can affect individuals to remain physically active, contributing to a reductionof functionality and quality of life. Objective: The aim of this systematic review is to synthesize evidence of respiratory disorders in patients with PD. Methods: An electronic search was performed up to November 2020 on PubMed-MEDLINE, Embase, Web of Science, Lilacs, Cinahl, and Cochrane using the following keyword combination: [(“Parkinson disease”) AND (“respiratory function tests” OR “evaluation”) AND (“respiratory system” OR “respiration disorders” OR “respiratory muscles”)]. Results: The electronic search resulted in 601 references in English or Portuguese. The selection process and data extraction were made by two independent reviewers. We selected 19 studies including cross-sectional studies that investigated the respiratory disorders in patients with PD through pulmonary function, respiratory muscle strength, or physical capacity evaluation. We excluded studies that considered patients with other diseases. Eighteen studies evaluated the pulmonary function in patients with PD, eleven studies verified the influence of PD on respiratory muscle strength, and three studies assessed the physical capacity through functional tests. Conclusion: The evidence showed that PD patients have higher chances to present a pulmonary dysfunction, either obstructive or restrictive, when compared to healthy subjects. In addition, these patients present lower respiratory muscle strength and a consequent decrease in physical capacity in endurance exercises. The respiratory impairment in PD seems to be directly related to the progression of the disease.

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