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Vol. 34. Issue 2.
Pages 64-70 (February 1998)
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Vol. 34. Issue 2.
Pages 64-70 (February 1998)
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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
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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
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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
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Copyright © 1998. Sociedad Española de Neumología y Cirugía Torácica
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