Unilateral diaphragmatic paralysis: inspiratory muscles, breathlessness and exercise capacity

BackgroundPatients with unilateral diaphragmatic paralysis (UDP) may present with dyspnoea without specific cause and limited ability to exercise. We aimed to investigate the diaphragm contraction mechanisms and nondiaphragmatic inspiratory muscle activation during exercise in patients with UDP, compared with healthy individuals.MethodsPulmonary function, as well as volitional and nonvolitional inspiratory muscle strength were evaluated in 35 patients and in 20 healthy subjects. Respiratory pressures and electromyography of scalene and sternocleidomastoid muscles were continuously recorded during incremental maximal cardiopulmonary exercise testing until symptom limitation. Dyspnoea was assessed at rest, every 2 min during exercise and at the end of exercise with a modified Borg scale.Main resultsInspiratory muscle strength measurements were significantly lower for patients in comparison to controls (all p<0.05). Patients achieved lower peak of exercise (lower oxygen consumption) compared to controls, with both gastric (−9.8±4.6 cmH2O versus 8.9±6.0 cmH2O) and transdiaphragmatic (6.5±5.5 cmH2O versus 26.9±10.9 cmH2O) pressures significantly lower, along with larger activation of both scalene (40±22% EMGmax versus 18±14% EMGmax) and sternocleidomastoid (34±22% EMGmax versus 14±8% EMGmax). In addition, the paralysis group presented significant differences in breathing pattern during exercise (lower tidal volume and higher respiratory rate) with more dyspnoea symptoms compared to the control group.ConclusionThe paralysis group presented with exercise limitation accompanied by impairment in transdiaphragmatic pressure generation and larger accessory inspiratory muscles activation compared to controls, thereby contributing to a neuromechanical dissociation and increased dyspnoea perception.

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Relation Between Inspiratory Muscle Strength and Recruitment Onset of Neck Inspiratory Muscles

Medicine & Science in Sports & Exercise ◽

10.1249/01.mss.0000519133.78979.a4 ◽

2017 ◽

Vol 49 (5S) ◽

pp. 798

Author(s):

Sohei Washino ◽

Hironori Watanabe ◽

Hiroaki Kanehisa ◽

Yasuhide Yoshitake

Keyword(s):

Muscle Strength ◽

Inspiratory Muscle ◽

Inspiratory Muscles ◽

Inspiratory Muscle Strength

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Effects of a Rehabilitation Programme with a Nasal Inspiratory Restriction Device on Exercise Capacity and Quality of Life in COPD

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17103669 ◽

2020 ◽

Vol 17 (10) ◽

pp. 3669 ◽

Cited By ~ 1

Author(s):

Aurelio Arnedillo ◽

Jose L. Gonzalez-Montesinos ◽

Jorge R. Fernandez-Santos ◽

Carmen Vaz-Pardal ◽

Carolina España-Domínguez ◽

...

Keyword(s):

Quality Of Life ◽

Muscle Strength ◽

Exercise Capacity ◽

Rehabilitation Program ◽

Inspiratory Muscle ◽

Control Group ◽

6Mwt Distance ◽

Before And After ◽

Inspiratory Muscle Strength

Objective: The objective was to assess the effects of a nasal restriction device for inspiratory muscle training, called Feelbreathe®, added to a rehabilitation program (RP) on exercise capacity, quality of life, dyspnea and inspiratory muscle strength in patients with stable COPD. Methods: Patients were randomized into three groups, one performed a supervised RP using the Feelbreathe® device (FB group), the second group developed the same RP with oronasal breathing without FB (ONB group) and the third was the control group (CG). We evaluated inspiratory muscle strength (PImax), dyspnea (mMRC), quality of life (CAT) and exercise capacity (6MWT) before and after 8-week of RP. Results: A total of 16 patients completed the study, seven in FB group, five in ONB group and four in the CG. After the RP, the FB group showed a significant increase in PImax (93.3 ± 19.1 vs. 123.0 ± 15.8 mmHg) and in the 6MWT distance (462.9 ± 71.8 m vs. 529.1 ± 50.1 m) and a decrease in the CAT score (9.7 ± 6.5 vs. 5.9 ± 6.0) and in the mMRC dyspnea score. FB provides greater improvement in PImax, dyspnea, quality of life and 6MWT than ONB. Conclusions: The Feelbreathe® device provides greater improvements in quality of life, dyspnea, exercise capacity and inspiratory muscle strength compared to patients that did not use it.

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Effects of inspiratory muscle strength and inspiratory resistance on neck inspiratory muscle activation during controlled inspirations

Experimental Physiology ◽

10.1113/ep087247 ◽

2019 ◽

Vol 104 (4) ◽

pp. 556-567 ◽

Cited By ~ 2

Author(s):

Sohei Washino ◽

Hirotoshi Mankyu ◽

Hiroaki Kanehisa ◽

Dean L. Mayfield ◽

Andrew G. Cresswell ◽

...

Keyword(s):

Muscle Strength ◽

Muscle Activation ◽

Inspiratory Muscle ◽

Inspiratory Resistance ◽

Inspiratory Muscle Strength

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Effect of inspiratory resistive training on diaphragm shear modulus and accessory inspiratory muscle activation

Applied Physiology Nutrition and Metabolism ◽

10.1139/apnm-2019-0906 ◽

2020 ◽

Vol 45 (8) ◽

pp. 851-856

Author(s):

Ryosuke Ando ◽

Toshiyuki Ohya ◽

Kenta Kusanagi ◽

Jun Koizumi ◽

Hayato Ohnuma ◽

...

Keyword(s):

Shear Modulus ◽

Muscle Activation ◽

Training Group ◽

Load Resistance ◽

Inspiratory Muscle ◽

Control Group ◽

Resistive Training ◽

Mouth Pressure ◽

Relative Change ◽

Inspiratory Muscle Strength

This study aimed to elucidate changes in diaphragm and accessory inspiratory muscle (sternocleidomastoid (SCM) muscle and intercostal muscle (IC)) function after a 6-week training program. Nineteen male elite collegiate swimmers were assigned to either a control group (n = 9) or training group (n = 10). The subjects in the training group performed 30 maximum inspirations at a load resistance of 50% of maximum inspiratory mouth pressure (PImax) using an inspiratory muscle training device. These were conducted twice per day and 6 days per week. At baseline and after 6 weeks, PImax, shear modulus of the diaphragm, and electromyograms (EMG) of the SCM and IC during a maximal inspiratory maneuver were evaluated. Relative change in PImax was greater in the training group than in controls. The shear modulus during a PImax maneuver had increased significantly in both groups after 6 weeks. EMG amplitudes of the SCM increased in the training group after 6 weeks, but not in the control group. EMG amplitudes of the IC did not change after 6 weeks in either group. These results suggest that 6-week inspiratory resistive training significantly improves the activation of the SCM, which could be one of the major mechanisms behind increases in inspiratory muscle strength after resistive training. Novelty Six-week inspiratory resistive training increased diaphragm stiffness during maximal inspiration maneuver. Six-week inspiratory resistive training increased electromyogram amplitudes of the sternocleidomastoid during maximal inspiration maneuver.

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The Relationship among the Inspiratory Muscle Strength, the Perception of Dyspnea and Inhaled Beta2-Agonists in Patients with Asthma

Canadian Respiratory Journal ◽

10.1155/2002/746808 ◽

2002 ◽

Vol 9 (5) ◽

pp. 307-312 ◽

Cited By ~ 23

Author(s):

Paltiel Weiner ◽

Rasmi Magadle ◽

Marinella Beckerman ◽

Noa Berar-Yanay

Keyword(s):

Muscle Strength ◽

Inspiratory Muscle ◽

Inspiratory Muscle Training ◽

Maximal Inspiratory Pressure ◽

Muscle Training ◽

Moderate Asthma ◽

Inspiratory Muscles ◽

The Mean ◽

The Relationship ◽

Inspiratory Muscle Strength

BACKGROUND: It is well documented that the perception of dyspnea (POD), subjectively reported by patients, is related to the activity and strength of the inspiratory muscles, and influences the use of 'as needed' beta2-agonists.STUDY OBJECTIVE: To investigate the relationship among the increase in inspiratory muscle strength after specific inspiratory muscle training, beta2-agonist consumption and the POD in patients with persistent, mild to moderate asthma.METHODS: Inspiratory muscle strength, daily beta2-agonist consumption and the POD were measured in 30 patients with mild to moderate asthma. Patients were then randomly assigned to two groups: one group received specific inspiratory muscle training until an increase of more than 20 cm H2O was reached, and one group was a control group and received sham training. Inspiratory muscle strength, the POD and daily beta2-agonist consumption were assessed during and after the training period.RESULTS: There was no good correlation between the baseline maximal inspiratory pressure and the POD, or between the baseline maximal inspiratory pressure and the mean daily beta2-agonist consumption. However, there was a significant correlation between the POD and the mean daily beta2-agonist consumption. The increase in inspiratory muscle strength after the inspiratory muscle training was closely correlated with the decrease in the POD (P<0.001) and the decrease in beta2-agonist consumption (P<0.001).CONCLUSIONS: The present study shows that, in patients with mild to moderate, persistent asthma, there is a correlation between the POD and the mean daily beta2-agonist consumption. When the inspiratory muscles are strengthened, there is a significant decrease in the POD and in beta2-agonist consumption.

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Sternocleidomastoid muscle activation following inspiratory muscle training in patients with chronic obstructive pulmonary disease: a randomized clinical trial

Fisioterapia e Pesquisa ◽

10.1590/1809-2950/19009727022020 ◽

2020 ◽

Vol 27 (2) ◽

pp. 133-139

Author(s):

Diogo Fanfa Bordin ◽

Dannuey Machado Cardoso ◽

Litiele Evelin Wagner ◽

Paula Regina Beckenkamp ◽

Andrea Lúcia Gonçalves da Silva ◽

...

Keyword(s):

Chronic Obstructive Pulmonary Disease ◽

Muscle Strength ◽

Pulmonary Disease ◽

Inspiratory Muscle ◽

Control Group ◽

Chronic Obstructive ◽

Electromyographic Activity ◽

Muscle Training ◽

Obstructive Pulmonary Disease ◽

Inspiratory Muscle Strength

ABSTRACT This study aims to assess the effect of short-time low frequency inspiratory muscle trainer (Threshold IMT) on inspiratory muscle strength and electromyographic activity of the sternocleidomastoid (SCM) muscle in people with chronic obstructive pulmonary disease (COPD). People with COPD participating in a lung rehabilitation program were allocated to a control or inspiratory muscle training (IMT) group. The control group participated in the usual rehabilitation, whereas the other group received IMT (performed with a load of 50% maximal inspiratory pressure (MIP) adjusted weekly). Both interventions lasted for 2 months. Outcomes included electromyographic analysis of the SCM and MIP. In total, ten participants were allocated to each group. The IMT group presented an increase in absolute (p<0.001) and predicted (p<0.001) values of MIP and also in pre- and post-intervention variation between groups (p=0.003 and p=0.008, respectively). Such differences were not found in the control group. The SCM muscle activity decreased in the IMT post intragroup evaluation (p=0.008). IMT provided a reduction of the electromyographic activity of SCM in COPD patients, also increasing inspiratory muscle strength in the study participants.

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The Type of Conservative Management Could Be Related to the Strength of the Inspiratory Muscles of Adolescents with Idiopathic Scoliosis—A Case Series

Children ◽

10.3390/children8111002 ◽

2021 ◽

Vol 8 (11) ◽

pp. 1002

Author(s):

Felipe León-Morillas ◽

Silvana Loana de Oliveira-Sousa ◽

Juan Alfonso Andrade-Ortega ◽

Alfonso Javier Ibáñez-Vera ◽

Rafael Lomas-Vega ◽

...

Keyword(s):

Muscle Strength ◽

Idiopathic Scoliosis ◽

Cobb Angle ◽

Respiratory Function ◽

Case Series ◽

Inspiratory Muscle ◽

Unknown Etiology ◽

Inspiratory Muscles ◽

Lateral Curvature ◽

Inspiratory Muscle Strength

Adolescent idiopathic scoliosis (AIS) is a lateral curvature of the spine with a Cobb angle of at least 10° with an unknown etiology. It is recognized that AIS may affect respiratory function. This study aims to describe and compare respiratory function in a case series of patients with scoliosis who underwent different types of therapeutic management: no intervention, orthotic brace, and global postural reeducation (GPR). Fifteen AIS patients were included in this study (seven no intervention, four orthotic brace and four GPR). Lung function and inspiratory muscle strength were measured and analyzed, as well as sociodemographic, clinical, and anthropometric variables. Significant correlations were observed between height (cm) and maximum inspiratory pressure (MIP) reference (cmH2O) and forced vital capacity (FVC) (liters) (r = 0.650 and r = 0.673, respectively; p < 0.01); weight (Kg) and MIP reference (cmH2O) (r = 0.727; p < 0.01); and Main curve degrees (Cobb angle) and FVC% (r = −0.648; p < 0.01). The AIS cases that underwent GPR treatment presented a greater MIP (% predictive) compared to the no intervention and brace cases (201.1% versus 126.1% and 78.4%, respectively; p < 0.05). The results of this case series show a possible relation whereby patients undergoing treatment with the GPR method have greater inspiratory muscle strength compared to the no intervention and brace cases. Studies with larger samples and prospective designs must be performed to corroborate these results.

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