Journal Information
Vol. 34. Issue 2.
Pages 64-70 (February 1998)
Share
Share
Download PDF
More article options
Vol. 34. Issue 2.
Pages 64-70 (February 1998)
Full text access
Entrenamiento de los músculos inspiratorios en la enfermedad pulmonar obstructiva crónica. Su impacto sobre las alteraciones funcionales y sobre la tolerancia al ejercicio
Inspiratory muscle training in chronic obstructive pulmonary disease. Impact lung functional and excesive tolerance
Visits
3851
P. de Lucas Ramos*, J.M. Rodríguez González-Moro, J. García de Pedro, A. Santacruz Siminiani, E. Tatay Martí, J.M. Cubillo Marcos
Servicio de Neumología. Hospital General Universitario Gregorio Marañón. Madrid
This item has received
Article information

El propósito de este estudio ha sido valorar el impacto del entrenamiento muscular inspiratorio en la enfermedad pulmonar obstructiva crónica (EPOC) tanto en las pruebas de función pulmonar como de capacidad de ejercicio. Se han estudiado 35 enfermos todos ellos con EPOC en situación clínica estable. Se les realizaba pruebas de función pulmonar (PFP), medida de presiones inspiratoria y espiratoria máximas (PIM, PEM), una prueba de ejercicio progresivo máximo y una prueba de ejercicio estable submáximo. Se formaron dos grupos de estudio, el grupo A (20 pacientes) y el grupo B (15 pacientes). Los sujetos del grupo A fueron incluidos en un programa de entrenamiento muscular de resistencia durante 4 meses y los del grupo B constituyeron el grupo control. Al final del período de estudio los 35 enfermos eran de nuevo sometidos a un estudio funcional similar al inicial. Todos los pacientes mostraban una obstrucción de grado moderado o severo sin diferencias significativas entre grupos (FEV1: grupo A 37,6±13%; grupo B 36,6±12%. FVC: grupo A 80,4±15%, grupo B: 80±12%). Tampoco existían diferencias iniciales entre grupos ni en las presiones respiratorias máximas ni en capacidad o tolerancia al ejercicio. No se objetivaron modificaciones en las PFP de ninguno de los grupos. La PIM del grupo A aumentó significativamente al término del estudio (In: 54±9 cmH2O, fin: 78±16; p<0,001), mientras que no hubo variaciones en el grupo B. No se objetivaron cambios ni en el VO2 máximo ni en la respuesta ventilatoria y/o gasométrica al ejercicio en ninguno de los grupos. Por el contrario, en el grupo entrenado se observó un descenso significativo en la sensación de disnea, valorada mediante escala de Borg, tanto con el esfuerzo máximo (5,7±1,1 frente a 4,7±1,2, p<0,005) como submáximo (5,9±0,9 frente a 4,9±1,3, p<0,005) y un incremento en el tiempo de tolerancia al ejercicio submáximo (5,5±2 min frente a 7±3, p<0,05), cambios que no se producían en los pacientes del grupo control. De acuerdo con estos resultados, aunque el entrenamiento de resistencia específico de los músculos inspiratorios no parece que mejore la función pulmonar de los pacientes con EPOC, sí se acompaña de una disminución de la sensación de disnea durante el ejercicio y de una mayor tolerancia al mismo.

Palabras clave:
EPOC
Entrenamiento muscular inspiratorio

The aim of this study was to evaluate the impact of inspiratory muscle training on lung function and exercise tolerance in patients with chronic obstructive pulmonary disease (COPD). Thirty-five patients with stable COPD were enrolled. We measured lung function variables and peak inspiratory and expiratory pressures (PImax and PEmax). Tests of Progressive maximal exercise tolerance and stable submaximal exercise tolerance were administered. Two study groups were formed. Group A patients (n=20) were enrolled in a respiratory muscle training program lasting four months. Group B (n=15) was the control group. At the end of the study period the patients underwent testing similar to the first battery of tests. All showed moderate to severe obstruction with no significant differences between groups (FEV1: group A 37.6±13%, group B 36.6±12%; FVC: group A 80.4±15%, group B 80±12%). Nor were there any significant differences between the two groups in initial results of either maximal respiratory pressures or exercise tolerance. No lung function changes were observed in either group. PImax in group A increased significantly at the end of the study (from 54±9 to 78±16 cmH2O; p<0.001); there were no changes in group B. No changes were seen in VO2max or ventilatory response and/or gasometry during exercise in any of the groups. The trained group, on the other hand, experienced a significant decrease in dyspnea evaluated on the Borg scale exercise in maximal (5.7±1.1 versus 4.7±1.2, p<0.005) and submaximal (5.9±0.9 versus 4.9±1.3, p<0.005) and an increase in time of submaximal exercise tolerance (5.5±2 versus 7±3 min, p<0.05), changes that were not observed in the control group. Based on these results, and although specific training of inspiratory muscles does not appear to improve lung function in patients with COPD, it is accompanied by a decreased sense of dyspnea during exercise and greater tolerance.

Key words:
COPD
Inspiratory muscle training
Full text is only aviable in PDF
Bibliografía
[1.]
D.F. Rochester.
The respiratory muscles in COPD.
State of the art. Chest, 85 (1984), pp. 47-50
[2.]
J.T. Sharp, J. Danon, W.S. Druz, et al.
Respiratory muscle function in patients with chronic obstructive pulmonary disease.
Am Rev Respir Dis, 110 (1974), pp. 154-167
[3.]
N.S. Arora, D.F. Rochester.
Effect of chronic obstructive pulmonary disease in diaphragm muscle dimensions.
Am Rev Respir Dis, 123 (1981), pp. 176-184
[4.]
T. Similowski, S. Yan, A.P. Gauthier, et al.
Contractile properties of. the human diaphragm during chronic hyperinflation.
N Engl J Med, 325 (1991), pp. 9l7-923l
[5.]
B. Aguilaniu.
Malnutrition and chronic obstructive bronchopaties.
Rev Mal Respir, 5 (1988), pp. 305-318
[6.]
J. Jardim, D. Farkas Cc Prefault, et al.
The failing inspiratory muscles under normoxic and hypoxic conditions.
Am Rev Respir Dis, 124 (1982), pp. 274-279
[7.]
D.F. Rochester, the diaphragm in COPD.
Better than expected, but not good enough.
N Engl J Med, 325 (1991), pp. 961-962
[8.]
D.E. Leith, M. Bradley.
Ventilatory muscle strength and endurance training.
J Appl Physiol, 41 (1976), pp. 508-516
[9.]
J.B. Andersen, L. Dragsted, T. Kann, et al.
Resistive breathing training in severe chronie obstructive pulmonary disease. A pilot study.
Scan J Respir Dis, 60 (1979), pp. 151-156
[10.]
D.F. Rochester.
Respiratory muscle weakness, pattern of breathing and CO2 retention in chronie obstructive pulmonary disease.
Am Rev RespirDis, 143 (1981), pp. 901-903
[11.]
P. Begin, A. Grassino.
Inspiratory muscle disfunction and chronie hypercapnia in chronie obstructive pulmonary disease.
Am Rev Respir Dis, 143 (1991), pp. 905-912
[12.]
R.L. Pardy, R.N. Rivington, P.J. Despas.
Inspiratory muscle training compared with physiotherapy in patients with chronie airflow limitation.
Am Rev Respir Dis, 123 (1981), pp. 421-425
[13.]
M. Belman, C. Mittman.
Ventilatory muscle training improves exercise capacity in chronie obstructive pulmonary disease patients.
Am Rev Respir Dis, 121 (1989), pp. 273-280
[14.]
G. Guyatt, J. Keller, J. Singer, et al.
Controlled trial of respiratory muscle training in chronie airflow limitation.
Thorax, 47 (1992), pp. 598-602
[15.]
T.L. Clanton, G. Dixon, J. Drake, et al.
Inspiratory muscle conditioning using a treshold loading device.
Chest, 87 (1985), pp. 62-66
[16.]
M.J. Belman, S.G. Thomas, M.I. Lewis.
Resistive breathing training in patients with chronie obstructive pulmonary disease.
Chest, 90 (1986), pp. 662-669
[17.]
M. Larson, M.J. Kim.
Respiratory muscle training with the incentive spirometer resistive breathing device.
Heart-Lung, 13 (1984), pp. 341-345
[18.]
K. Smith, D. Cook, H. Gordon, et al.
Respiratory muscle training in chronie airflow limitation: a meta-analysis.
Am Rev Respir Dis, 145 (1992), pp. 533-539
[19.]
Akabas Sr., A.R. Bazzy, S. DiMauro, et al.
Metabolic and functional adaptation of the diaphragman to training with resistive loads.
J Appl Physiol, 66 (1989), pp. 529-535
[20.]
J.L. McKeon, J. Turner, C. Kelly, et al.
The effect of inspiratory resistive training on exercise capacity in optimally treated patients with severe chronie airflow limitation.
Aust NZJ Med, 16 (1986), pp. 648-652
[21.]
R. Goldstein, J. De-Rosie, S. Long, et al.
Applicability of a treshold loading device for inspiratory muscle testing and training in patients with COPD.
Chest, 96 (1989), pp. 564-571
[22.]
A. Noseda, J.P. Carpiaux, W. Vandeput, et al.
Resistive inspiratory muscle training and exercise performance in COPD patients. A comparative study with conventional breathing retraining.
Bull Eur Physiopathol Respir, 23 (1987), pp. 457-463
[23.]
H. Chen, R. Dukes, B.J. Martin.
Inspiratory muscle training in patients with chronie obstructive pulmonary disease.
Am Rev Respir Dis, 131 (1985), pp. 251-255
[24.]
M.G. Flynn, C.E. Barter, J.C. Nosworthy, et al.
Threshold pressure training, breathing pattern, and exercise performance in chronic airflow obstruction.
Chest, 95 (1989), pp. 535-540
[25.]
A. Patessio, R. Casaburi, F. Ioli, et al.
Mechanisms of exercise limitation.
Eur Respir Rev, 1 (1991), pp. 482-485
[26.]
L.J. Sonne, J.A. Davis.
Increased exercise performance in patients with severe COPD following inspiratory resistive training.
Chest, 81 (1982), pp. 436-439
[27.]
S. Levine, P. Weiser, J. Gillen.
Evaluation of a ventilatory muscle endurance training program in the rehabilitation of patients with chronic obstructive pulmonary disease.
Am Rev Respir Dis, 33 (1986), pp. 400-406
[28.]
P. Falk, A.M. Eriksen, K. Kolliker, et al.
Relieving dyspnea with an inexpensive and simple method in patients with severe chronic airflow limitation.
Eur J Respir Dis, 66 (1985), pp. 181-186
[29.]
A. Flarver, Da. Mahler, J.A. Daubenspeck.
Targeted inspiratory muscle training improves respiratory muscle function and reduces dyspnea in patients with chronic obstructive pulmonary disease.
Ann lntern Med, 111 (1989), pp. 117-124
[30.]
D.A. Mahler, A. Harver.
A factor analysis of dyspnea ratings, respiratory muscle strength, and lung function in patients with chronic obstructive pulmonary disease.
Am Rev Respir Dis, 145 (1992), pp. 467-470
[31.]
A. Patessio, C. Rampulla, C. Frachia, et al.
Relationship between the perception of breathlessness and inspiratory resistive loading: report on a clinical trial.
Eur Resp J, 2 (1989), pp. 587-591
[32.]
C. Rampulla, S. Baiocchi, E. Dacosto, et al.
Dyspnea on exercise. Pathophysiologic mechanisms..
Chest, 101 (1992), pp. 248-252
[33.]
D.E. O’Donnell, K.A. Webb.
Breathlessness in patients with severe chronic airflow limitation. Physiologic correlations..
Chest, 102 (1992), pp. 824-831
[34.]
F. Madsen, N.H. Secher, L. Kay, et al.
Inspiratory resistance versus general physical training in patients with chronic obstructive pulmonary disease.
Eur J Respir Dis, 67 (1985), pp. 167-176
[35.]
M.J. Belman, R. Shadmehr.
Targeted resistive ventilatory muscle training in chronic obstructive pulmonary disease.
J Appl Physiol, 65 (1988), pp. 2.726-2.735
[36.]
P.R. Dekhuitjzen, H.T. Folgering, C.L. Van Herwaarden.
Target-flow inspiratory muscle training during pulmonary rehabilitation in patients with COPD.
Chest, 99 (1991), pp. 128-133
[37.]
J.L. Larson, M.J. Kim, J.T. Sharp, et al.
Inspiratory muscle training with a pressure threshold breathing device in patients with COPD.
Am Rev Respir Dis, 138 (1988), pp. 689-696
[38.]
P. Weiner, Y. Azgad, R. Ganam.
Inspiratory muscle training combined with general exercise reconditioning in patients with COPD.
Chest, 102 (1992), pp. 1.351-1.356
Copyright © 1998. Sociedad Española de Neumología y Cirugía Torácica
Archivos de Bronconeumología
Article options
Tools

Are you a health professional able to prescribe or dispense drugs?