Original article
Respiratory Muscle Training in Restrictive Thoracic Disease: A Randomized Controlled Trial

https://doi.org/10.1016/j.apmr.2006.08.340Get rights and content

Abstract

Budweiser S, Moertl M, Jörres RA, Windisch W, Heinemann F, Pfeifer M. Respiratory muscle training in restrictive thoracic disease: a randomized controlled trial.

Objective

To investigate the effects of respiratory muscle training (RMT) in patients with restrictive thoracic disorders and intermittent noninvasive positive-pressure ventilation (NPPV).

Design

Prospective randomized controlled trial.

Setting

Home-based RMT, with assessment in a primary care pulmonary center.

Participants

Thirty patients with restrictive thoracic disorders; 28 patients completed the trial.

Intervention

Three months of RMT by isocapnic hyperpnea or sham training.

Main Outcome Measures

Respiratory muscle strength and endurance, lung function, exercise performance, and health-related quality of life (HRQOL).

Results

After RMT, maximal inspiratory mouth pressure was increased (27.6%±36.5%, P=.013). In patients who could perform cycle ergometer testing (n=17), peak oxygen consumption (2.24±3.39mL·kg−1·min−1 vs −1.71±2.54mL·kg−1·min−1, P=.014) and maximal work rate (9.4±14.8W vs −5.1±10.8W, P=.043) increased relative to a control group. Similar differences occurred regarding changes of HRQOL (physical performance, 3.3±11.4 score vs −6.6±9.0 score; P=.012) and time of ventilator use (−0.6±1.2h/d vs 0.4±0.5h/d, P=.010). Lung volumes, 12-second maximum voluntary ventilation, 6-minute walking distance, and blood gases were unchanged.

Conclusions

In patients with restrictive thoracic disorders and NPPV, RMT improved inspiratory muscle strength. Exercise performance and HRQOL were improved when the 2 groups were compared. RMT was practicable and safe despite severe respiratory impairment. Further evaluation, including different training intensities and modalities, seems warranted.

Section snippets

Participants

Between October 2003 and October 2004, consecutive patients with restrictive thoracic disorders and current intermittent nocturnal NPPV who were regularly admitted for a 2-day follow-up visit at the Donaustauf Hospital, University of Regensburg, Germany, were screened for participation in our RCT. Inclusion criteria comprised impaired respiratory muscle function (Pimax <70% of predicted), arterial partial pressure of carbon dioxide (Paco2) less than 50mmHg, and arterial partial pressure of

Results

There were no significant differences in the baseline characteristics of the 28 patients who completed the trial (RMT, n=13; control, n=15) (see table 1). In the majority of patients (86%), lung restriction was due to kyphoscoliosis (idiopathic in 16 patients, congenital in 3 patients, postpoliomyelitis in 2 [1 in each group], post rachitis in 3 patients). Two subjects had a fibrothorax (1 in each group) and 2 patients (in the control group) had post-tuberculosis syndrome. The daily (total)

Discussion

The data from this study indicate that in patients with restrictive thoracic disorders who were treated with NPPV, inspiratory muscle strength as assessed by Pimax increased after 3 months of RMT compared with results in patients who performed a sham procedure. Improvements in exercise performance or HRQOL, however, were very small and significant only when compared with the slight deteriorations observed in the control group. Overall, RMT appears to be a safe and feasible treatment option in

Conclusions

The data of this randomized, controlled, double-blind trial provided some evidence that in severe restrictive thoracic disorders, RMT performed as isocapnic hyperpnea over 3 months can improve respiratory muscle function. It is probable that in patients with restrictive thoracic disorders and severe pulmonary impairment, even RMT that is primarily targeted on endurance necessarily includes a significant component of resistive training. This improvement, however, was not directly translated in

Acknowledgments

We thank Joerg Marienhagen, MD, and Peter Johannes Wild, MD, University of Regensburg, for their support in the statistical analysis; Rolf Suchy, MD, for valuable comments on cardiopulmonary exercise testing; and Uta Brückner and Günther Schilhabel for technical assistance.

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