scholarly journals Respiratory Muscle Training Improves Functional Outcomes and Reduces Fatigue in Patients with Myasthenia Gravis: A Single-Center Hospital-Based Prospective Study

2020 ◽  
Vol 2020 ◽  
pp. 1-8 ◽  
Author(s):  
Che-Wei Hsu ◽  
Hui-Chen Lin ◽  
Wan-Chen Tsai ◽  
Yun-Ru Lai ◽  
Chih-Cheng Huang ◽  
...  
Keyword(s):  
Myasthenia Gravis ◽  
Functional Outcomes ◽  
Respiratory Muscle ◽  
Short Form ◽  
Outcome Measurement ◽  
Respiratory Muscle Training ◽  
Walking Distance ◽  
Control Group ◽  
Muscle Training ◽  
Home Based

Background. Myasthenia gravis (MG) is an immune-mediated disorder characterized by muscle fatigue and fluctuating weakness. Impairment in respiratory strength and endurance has been described in patients with generalized MG. We tested the hypothesis that respiratory muscle training (RMT) can improve functional outcomes and reduce fatigue in patients with MG. Methods. Eighteen patients with mild to moderate MG participated in this study. The training group underwent home-based RMT three times a week for 12 weeks. Sixteen patients with MG without RMT were enrolled as a disease control group. Lung function, autonomic testing, Multidimensional Fatigue Symptom Inventory-Short Form (MFSI-SF), and functional outcome measurement by using quantitative myasthenia gravis (QMG) score and myasthenia gravis composite (MGC) scale were measured before and after the 12-week RMT. Results. The 12-week RMT significantly increased forced vital capacity (FVC) from 77.9±12.6% to 83.8±17.7% (p=0.03), forced expiratory volume in one second (FEV1) from 75.2±18.3% to 83.3±19.0% (p=0.002), and 6-minute walking distance from 403.4±72.2 m to 466.1±68.5 m (p=0.003). The QMG score improved from 9.6±4.1 to 8.1±4.3 (p=0.04) and the MGC scale from 4.4±3.5 to 2.7±2.9 (p=0.02). The fatigue score (MFSI-SF) reduced from 17.1±14.7 to 13.5±16.9 (p=0.03). Conclusion. The home-based RMT is an effective pulmonary function training for MG patients. The RMT can not only improve short-term outcomes but also reduce fatigue in patients with mild to moderate generalized MG.

scholarly journals Integrative respiratory and skeletal musculature training in patients with functional class II–IV chronic heart failure and low or intermediate left ventricular ejection fraction: Design and rationale

2020 ◽  
Vol 35 (2) ◽  
pp. 123-130
Author(s):  
J. L. Begrambekova ◽  
N. A. Karanadze ◽  
V. Yu. Mareev ◽  
E. A. Kolesnikova ◽  
Ya. A. Orlova
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Respiratory Muscle ◽  
Aerobic Training ◽  
Respiratory Muscles ◽  
Treadmill Walking ◽  
Respiratory Muscle Training ◽  
Left Ventricular Ejection ◽  
Control Group ◽  
Muscle Training

Respiratory system remodeling plays an important role in the progression of congestive heart failure (CHF). Decreased oxygenation of the respiratory muscles during intense physical exertion in patients with CHF may aggravate respiratory failure and provoke hyperactivation of the inspiratory metaborefl ex, thereby aggravating exercise intolerance due to a decrease in muscular system perfusion. Respiratory muscle training can minimize the eff ects of inspiration metaborefl ex activation and prolong the duration of exercise.Trial design. This is a prospective randomized trial with a sham control. The trial will include 40 adult patients of both genders with NYHA II-III CHF and with ejection fraction (EF) ≤ 49%. Patients will be randomized in a 1:1 ratio to either Active or Control group. Active group will receive four-week guided respiratory muscles training followed by 12-week guided aerobic training (treadmill walking). Control group will receive four-week sham respiratory muscles training (THRESHOLD® IMT breathing trainer with level slightly above 0), followed by 12 weeks guided aerobic training (treadmill walking). The primary aim is to compare the eff ect of diff erent training modalities on functional capacity (peak VO2 ). Secondary outcome measures include changes in respiratory muscle strength, serum biomarkers (NT-proBNP and ST2) and Angiotensin II. Health-related quality of life (MLwHFQ.23) and psycho-emotional state of patients also will be assessed.The study also planned an additional analysis with a suitable group of patients who were screened but refused to participate in the study.Conclusion. Heart failure patients often give up exercise due to symptoms of shortness of breath and muscle weakness. We suggest that the training technique based on the inclusion of respiratory muscle training as the fi rst stage of cardiac rehabilitation will positively aff ect the eff ectiveness of subsequent aerobic training in patients with heart failure, by reducing the activity of RAAS and SAS and increasing respiratory effi ciency. 

scholarly journals Ventilatory support or respiratory muscle training as adjuncts to exercise in obese CPAP-treated patients with obstructive sleep apnoea: a randomised controlled trial

Thorax ◽  
2018 ◽  
Vol 73 (7) ◽  
pp. 634-643 ◽  
Author(s):  
Isabelle Vivodtzev ◽  
Renaud Tamisier ◽  
Marilie Croteau ◽  
Jean-Christian Borel ◽  
Angélique Grangier ◽  
...  
Keyword(s):  
Exercise Training ◽  
Functional Capacity ◽  
Respiratory Muscle ◽  
Sleep Apnoea ◽  
Respiratory Muscle Training ◽  
Walking Distance ◽  
Muscle Training ◽  
Cycling Exercise ◽  
Obstructive Sleep ◽  
Training Modalities

BackgroundObstructive sleep apnoea (OSA) and obesity are interdependent chronic diseases sharing reduced exercise tolerance and high cardiovascular risk.InterventionA 3-month intervention with innovative training modalities would further improve functional capacity and cardiovascular health than usual cycle exercise training in already continuous positive airway pressure (CPAP)-treated obese patients with OSA.MethodsFifty three patients (35<body mass index (BMI) <45 kg/m2) were randomly allocated to exercise training on a cycle ergometer, either alone (ERGO) or with respiratory muscle training (ERGO+RMT) or non-invasive ventilation (ERGO+NIV). Changes in 6 min walking distance (primary outcome), aerobic capacity (VO2peak), cardiovascular parameters, body composition and sleep quality were evaluated.Measurements and main resultsAll training modalities increased 6 min walking distance without differences between groups (P=0.97). ERGO+NIV and ERGO+RMT led to significantly higher improvement in VO2peak compared with ERGO (3.1 (95% CI 1.6 to 4.6) vs 2.3 (0.8 to 3.7) vs 0.5(−1.0 to 1.9) mL/min/kg, respectively, P=0.04) and ERGO+NIV significantly reduced self-measured blood pressure compared with ERGO+RMT and ERGO (systolic: −9.5 (95% CI −14.1 to −4.9) vs −13 (−5.8 to 3.1) vs −0.7 (−5.1 to 3.8) mm Hg, respectively, P=0.01). Waist and neck circumferences were reduced after ERGO+NIV compared with ERGO+RMT and ERGO (P=0.01).ConclusionsCombining RMT or NIV with cycling exercise training failed to provide further improvement in functional capacity as compared with cycling exercise training alone. However, the combination of NIV and exercise training demonstrated superiority for improving cardiometabolic risk factors in obese CPAP-treated patients with OAS.TRIAL REGISTRATION NUMBERResults, NCT01155271.

scholarly journals Effects of home-based respiratory muscle training in children and adolescents with chronic lung disease

2014 ◽  
Vol 40 (6) ◽  
pp. 626-633 ◽  
Author(s):  
Iván Rodríguez ◽  
Daniel Zenteno ◽  
Carlos Manterola
Keyword(s):  
Muscle Strength ◽  
Lung Disease ◽  
Children And Adolescents ◽  
Chronic Lung Disease ◽  
Respiratory Muscle ◽  
Respiratory Muscle Training ◽  
Respiratory Muscle Strength ◽  
Muscle Training ◽  
Home Based ◽  
Quasi Experimental

OBJECTIVE: Respiratory muscle weakness is a functional repercussion of chronic lung disease (CLD). The objective of this study was to assess the effects of home-based respiratory muscle training (RMT) in children and adolescents with CLD or neuromuscular disease (NMD). METHODS: This was a quasi-experimental study involving children and adolescents with CLD or NMD. Before and after 6 months of home-based RMT, we measured respiratory muscle strength (MIP and MEP), PEF, and peak cough flow (PCF). We made statistical comparisons between the pre-RMT and post-RMT values, as well as evaluating the correlation between the duration and effect of RMT. RESULTS: The study included 29 patients, with a mean age of 12 years (range, 5-17 years), of whom 18 (62.1%) were male. The CLD group comprised 11 patients (37.9%), and the NMD group comprised 18 (62.1%). The mean duration of the RMT was 60 weeks (range, 46-90 weeks) in the CLD group and 39 weeks (range, 24-89 weeks) in the NMD group. In comparison with the pre-RMT values, the post-RMT values for MIP and MEP were significantly higher in both groups, whereas those for PEF and PCF were significantly higher only in the NMD group. We found no correlation between the duration and the effect of RMT. CONCLUSIONS: Home-based RMT appears to be an effective strategy for increasing respiratory muscle strength in children and adolescents with CLD or NMD, although it increased the ability to cough effectively only in those with NMD.

scholarly journals 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

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.

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

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.

scholarly journals Respiratory Muscle Training in Patients With Moderate to Severe Myasthenia Gravis

1998 ◽  
Vol 25 (3) ◽  
pp. 236-241 ◽  
Author(s):  
Paltiel Weiner ◽  
Ditza Gross ◽  
Zeev Meiner ◽  
Rushrash Ganem ◽  
Margalit Weiner ◽  
...  
Keyword(s):  
Myasthenia Gravis ◽  
Respiratory Muscle ◽  
Respiratory Muscles ◽  
Complementary Therapy ◽  
Muscle Performance ◽  
Respiratory Muscle Training ◽  
Muscle Training ◽  
Group A ◽  
Group B ◽  
Respiratory Muscle Endurance

ABSTRACT:Background:Myasthenia gravis (MG) is a specific autoimmune disease characterized by weakness and fatigue. MG may affect also the respiratory muscles causing symptoms that may vary from dyspnea on severe exertion to dyspnea at rest. This study was undertaken in order to determine the effects of respiratory muscle training on respiratory muscle performance, spirometry data and the grade of dyspnea in patients with moderate to severe generalized MG.Methods:Eighteen patients with MG were studied and divided into 2 groups: Group A included 10 patients (3 males and 7 females aged 29-68) with moderate MG, and Group B that included 8 patients (5 males and 3 females aged 21-74) with severe MG. Patients in Group A received both inspiratory and expiratory muscle training for 1/2 h/day, 6 times a week, for 3 months, while patients in Group B followed the same protocol but had inspiratory muscle training only.Results:Mean PImax increased significantly from 56.6 ± 3.9 to 87.0 ± 5.8 cm H20 (p < 0.001) in Group A, and from 28.9 ± 5.9 to 45.5 ± 6.7 cm H20 (p < 0.005) in Group B. The mean PEmax also increased significantly in patients in Group A, but remained unchanged in the patients in Group B. The respiratory muscle endurance also increased significantly, from 47.9 ± 4.0 to 72.0 ± 4.2%, p < 0.001, in patients of Group A, and from 26.0 ± 2.9 to 43.4 ± 3.8, p < 0.001, in patients in Group B. The improved respiratory muscle performance was associated with a significant increase in the FEV, values, and in the FVC values, in patients of both groups. Mean dyspnea index score also increased significantly from 2.6 ± 0.8 to 3.6 ± 0.4 (p < 0.005) in Group A, and from 0.7 ± 0.2 to 2.0 ± 0.2 (p < 0.001) in Group B.Conclusions:Specific inspiratory threshold loading training alone, or combined with specific expiratory training, markedly improved respiratory muscle strength and endurance in patients with MG. This improvement in respiratory muscle performance was associated with improved lung function and decreased dyspnea. Respiratory muscle training may prove useful as a complementary therapy with the aim of reducing dyspnea symptoms, delay the breathing crisis and the need for mechanical ventilation in patients with MG.

scholarly journals Effect of Complete Respiratory Muscle Training (cRMT) on Dysphonia following Single CVA: A retrospective pilot study

2020 ◽  
Author(s):  
Robert J. Arnold ◽  
Christopher S Gaskill ◽  
Nina Bausek
Keyword(s):  
Pilot Study ◽  
Respiratory Muscle ◽  
Exercise Intervention ◽  
Intervention Group ◽  
Respiratory Muscle Training ◽  
Control Group ◽  
Muscle Training ◽  
Maximum Phonation Time ◽  
Perceptual Evaluation ◽  
Inspiratory Muscles

AbstractBackgroundAlthough dysphonia is less prevalent than dysphagia following cerebrovascular accidents, dysphonia does contribute to the burden of disease resulting from stroke. Strengthening muscles of the larynx and respiratory tract through respiratory muscle training (RMT) has proven effective in improving voice after neurological insult. However, approaches to strengthen only the expiratory muscle groups (EMST) dominate the clinical study literature, with variable outcomes. By focusing on exhalation, the contribution of inspiratory muscles to phonation may have been overlooked. This study investigated the effect of combined respiratory muscle training (cRMT) to improve voice function in stroke patients.MethodsRecorded data of twenty patients with dysphonia following stroke were allocated to an intervention (IG) or a control group (CG) based upon whether they chose cRMT or not while awaiting pro bono voice therapy services. The intervention group (N=10) was treated daily with three 5-minute sessions of complete resistive respiratory muscle training for 28 days, while the control group (N=10) received no cRMT or other exercise intervention. Perceptual and acoustic measurements as well as a pulmonary function test were assessed pre-and post-intervention.ResultsThe intervention group demonstrated significant improvements after 28 days of combined respiratory muscle training (cRMT) in peak flow (127%), patient self-perception of voice improvement (84.41%), as well as in five of the six categories of the Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V) overall severity (63.22%), breathiness (61.06%), strain (63.43%), pitch range (48.11%) and loudness (57.51%), compared to the control group who did not receive treatment. Furthermore, cRMT also led to significant improvements in maximum phonation time (212.5%) and acoustic parameters of vocal intensity and semitone range.ConclusionThis pilot study shows promise of the feasibility and effectiveness of cRMT to lessen the signs and symptoms of dysphonia while simultaneously improving breath support.

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