Abstract

Research Article

Comparative efficacy of inspiratory, expiratory and combined respiratory muscle training on the pulmonary functions and chest expansion in acute stroke survivors

Adeogun Abiodun A* and Umar Dolapo K

Published: 16 July, 2021 | Volume 5 - Issue 2 | Pages: 010-018

Background: Respiratory muscle strength can be reduced in patients diagnosed with stroke, which reasonably justifies the use of respiratory muscle training in this population. This study determines the comparative efficacy of inspiratory, expiratory, and combined respiratory muscle training on the pulmonary functions and chest expansion in acute stroke survivors.

Method: Forty-five acute stroke survivors (15 in each group) completed all protocols of the study. Participants were randomly assigned to any one of three groups. In addition to the conventional exercise therapy, participants received any one of the three respiratory muscle training protocols (inspiratory muscle training, expiratory muscle training or combined respiratory muscle training). Chest expansion was assessed using tape measure and pulmonary function parameters were assessed using a spirometer.

Results: Paired t-test analysis showed significant improvements in the chest expansion and the pulmonary function parameters following training in each group. One-way ANOVA showed significant improvements in the pulmonary function parameters across the three groups but not in the chest expansion with p - value = 0.405. Least significant difference (LSD), post-hoc analysis shows that the significant difference for FEV1, FVC and FEV1/FVC lies between inspiratory muscle training group and expiratory muscle training group.

Conclusion: When the three training methods were compared, it was found that expiratory muscle training was the most beneficial in improving the pulmonary functions and chest expansion in acute stroke survivors.

Read Full Article HTML DOI: 10.29328/journal.jnpr.1001040 Cite this Article Read Full Article PDF

Keywords:

Acute stroke survivors; Respiratory muscle training; Chest expansion; Pulmonary functions

References

  1. Rabelo M, Nunes GS, da Costa Amante NM, de Noronha M, Fachin-Martins E. Reliability of muscle strength assessment in chronic poststroke hemiparesis: a systematic review and meta-analysis. Top Stroke Rehabil 2016; 23: 26-36. PubMed: https://pubmed.ncbi.nlm.nih.gov/26243549/
  2. Gomes-Neto M, Saquetto MB, Silva CM, Carvalho VO, Ribeiro N, et al. Effects of respiratory muscle training on respiratory function, respiratory muscle strength, and exercise tolerance in patients poststroke: a systematic review with meta-analysis. Arch Phy Med Rehabil 2016; 1: 1-8. PubMed: https://pubmed.ncbi.nlm.nih.gov/27216224/
  3. Harik-Khan RI, Wise RA, Fozard JL Determinants of maximal inspiratory pressure. The Baltimore Longitudinal Study of Aging. Am J Respir Crit Care Med. 1998; 158: 1459-1464. PubMed: https://pubmed.ncbi.nlm.nih.gov/9817693/
  4. Harraf F, Ward K, Man W, Rafferty G, Mills K, et al. Transcranial magnetic stimulation study of expiratory muscle weakness in acute ischaemic stroke. Neurology. 2008; 71: 2000 –2007. PubMed: https://pubmed.ncbi.nlm.nih.gov/19064882/
  5. Lanini B, Bianchi R, Romagnoli I. Chest wall kinematics in patients with hemiplegia. Am J Respir Criti Care Med. 2003; 168: 109–113. PubMed: https://pubmed.ncbi.nlm.nih.gov/12714347/
  6. Ward K, Seymour J, Steier J, Jolley CJ, Polkey MI, et al. Acute ischaemic hemispheric stroke is associated with impairment of reflex in addition to a voluntary cough. Eur Respir J. 2010; 36: 1383–1390. PubMed: https://pubmed.ncbi.nlm.nih.gov/20413536/
  7. Polese JC, Pinheiro MB, Faria CD, Britto RR, Parreira VF, et al. The strength of the respiratory and lower limb muscles and functional capacity in chronic stroke survivors with different physical activity levels. Braz J Phy Ther. 2013; 17: 487–493. PubMed: https://pubmed.ncbi.nlm.nih.gov/24173350/
  8. Xiao Y, Luo M, Wang J, Luo H. Inspiratory muscle training for the recovery of function after stroke (review). Cochrane Database Systema Rev. 2012; 5: 1-27. PubMed: https://pubmed.ncbi.nlm.nih.gov/22592740/
  9. Almeida IC, Clementino AC, Rocha EH, Branda˜o DC, Andrade AD. Effects of hemiplegy on pulmonary function and diaphragmatic dome displacement. Respir Physiol Neurobiolol. 2011; 178: 196-201. PubMed: https://pubmed.ncbi.nlm.nih.gov/21679778/
  10. Pollock RD, Rafferty GF, Moxham J, Kalra L. Respiratory muscle strength and training in stroke and neurology: a systematic review. Int J Stroke. 2013; 8: 124-130. PubMed: https://pubmed.ncbi.nlm.nih.gov/22568454/
  11. Jandt SR, Caballero RM, Ju´nior LA, Dias AS. Correlation between trunk control, respiratory muscle strength and spirometry in patients with stroke: an observational study. Physiother Res Int. 2011; 16: 218-224. PubMed: https://pubmed.ncbi.nlm.nih.gov/21157882/
  12. Khedr EM, El Shinawy O, Khedr T, Abdelazizali Y, Awad EM. Assessment of corticodiaphragmatic pathway and pulmonary function in acute ischaemic stroke patients. Eur J Neurol. 2000; 7: 323-330. PubMed: https://pubmed.ncbi.nlm.nih.gov/10886317/
  13. Tomczak CR, Jelani A, Haennel RG. Cardiac reserve and pulmonary gas exchange kinetics in patients with stroke. Stroke. 2008; 39: 3102-3106. PubMed: https://pubmed.ncbi.nlm.nih.gov/18703810/
  14. MacKay-Lyons MJ, Makrides L. Cardiovascular stress during a contemporary stroke rehabilitation program: is the intensity adequate to induce a training effect? Arch Phy Med Rehabil 2002; 83: 1378-1383. PubMed: https://pubmed.ncbi.nlm.nih.gov/12370872/
  15. Billinger SA, Taylor JM, Quaney BM. Cardiopulmonary response to exercise testing in people with chronic stroke: a retrospective study. Stroke Res Treatment. 2012; 20: 987637. PubMed: https://pubmed.ncbi.nlm.nih.gov/21961083/
  16. Hannawi Y, Hannawi B, Rao CPV, Suarez JI, Bershad EM. Stroke-associated pneumonia: major advances and obstacles. Cerebrovasc Dis. 2013; 35: 430-443. PubMed: https://pubmed.ncbi.nlm.nih.gov/23735757/
  17. Finlayson O, Kapral M, Hall R, Asllani E, Selchen D, et al. Risk factors, inpatient care, and outcomes of pneumonia after ischaemic stroke. Neurology. 2011; 77: 1338-1345. PubMed: https://pubmed.ncbi.nlm.nih.gov/21940613/
  18. Fontana GA, Lavorini F. Cough motor mechanisms. Respir Physiol Neurobiol J. 2006; 152: 266–281. PubMed: https://pubmed.ncbi.nlm.nih.gov/16600697/
  19. Widdicombe JG, Addington WR, Fontana GA, Stephens RE. A voluntary and reflex cough and the expiration reflex; implications for aspiration after stroke. Pulmon Pharmacol Therapeut. 2011; 24: 312-317. PubMed: https://pubmed.ncbi.nlm.nih.gov/21338708/
  20. Teixeira-Salmela LF, Parreira VF, Britto RR, Brant TC, Inacio EP, et al. Respiratory pressures and thoracoabdominal motion in community-dwelling chronic stroke survivors. Arch Phy Med Rehabil 2005; 86: 1974-1978. PubMed: https://pubmed.ncbi.nlm.nih.gov/16213241/
  21. Sutbeyaz ST, Koseoglu F, Inan L, Coskun O. Respiratory muscle training improves cardiopulmonary function and exercise tolerance in subjects with subacute stroke: a randomized controlled trial. Clin Rehabil 2010; 24: 240-250. PubMed: https://pubmed.ncbi.nlm.nih.gov/20156979/
  22. Pryor JA, Prasad AS. Physiotherapy for respiratory and cardiac problems: adults and paediatrics (5th Edition). Elsevier Health Sciences, USA. 2008.
  23. Kelly JO, Kilbreath SL, Davis GM. Cardiorespiratory fitness and walking ability in subacute stroke patients. Arch Phys Med Rehabil 2003; 84: 1780-1785. PubMed: https://pubmed.ncbi.nlm.nih.gov/14669183/
  24. Skinner JS. Exercise testing and exercise prescription for special cases: the­oretical basis and clinical application (3rd Edition). Lippincott Williams & Wilkins, Philadelphia, USA. 2005.
  25. Courbon A, Calmels P, Roche F, Ramas J, Rimaud D, et al. The relationship between maximal exercise capacity and walking capacity in adult hemiplegic stroke patients. Am J Phy Med Rehabil 2006; 85: 436-442. PubMed: https://pubmed.ncbi.nlm.nih.gov/16628151/
  26. Moodie LH, Reeve JC, Vermeulen N, Elkins MR. Inspiratory muscle training to facilitate weaning from mechanical ventilation: Protocol for a systematic review. Bri Med Res Notes. 2011; 4: 283. PubMed: https://pubmed.ncbi.nlm.nih.gov/21835031/
  27. Britto RR, Rezende NR, Marinho KC, Torres JL, Parreira VF, et al. Inspiratory muscular training in chronic stroke survivors: a randomized controlled trial. Arch Phy Med Rehabil 2011; 92: 184-190. PubMed: https://pubmed.ncbi.nlm.nih.gov/21272713/
  28. St Croix CM, Morgan BJ, Wetter TJ. Fatiguing inspiratory muscle work causes reflex sympathetic activation in humans. J Physiol. 2010; 529: 493-504. PubMed: https://pubmed.ncbi.nlm.nih.gov/11101657/
  29. Babcock MA, Pegelow DF, McClaran SR. The contribution of diaphragmatic power output to exercise-induced diaphragm fatigue. J Appl Physiol. 1995; 78: 1710-1719. PubMed: https://pubmed.ncbi.nlm.nih.gov/7649904/
  30. Beckerman M, Magadle R, Weiner M. The effects of 1 year of specif­ic inspiratory muscle training in patients with COPD. Chest. 2005; 128: 3177-3182. PubMed: https://pubmed.ncbi.nlm.nih.gov/16304259/
  31. Inzelberg R, Peleg N, Nisipeanu P, Magadle R, Carasso RL, et al. Inspiratory muscle training and the perception of dyspnoea in Parkinson’s disease. Can J Neurological Sci. 2005; 32: 213-217. PubMed: https://pubmed.ncbi.nlm.nih.gov/16018157/
  32. McConnell AK. Respiratory Muscle Training: Theory and Practice. Edinburgh, Churchill Livingstone/Elsevier. 2013.
  33. Kyo Chul S, Hyun Min L, Hyeon Ae K. The effects of the combination of inspiratory diaphragm exercise and expiratory Pursed-Lip breathing exercise on pulmonary functions of stroke patients. J Phy Ther Sci. 2013; 25: 241-244.
  34. Hsiao SF, Wu YT, Wu HD. Comparison of effectiveness of pressure threshold and targeted resistance devices for inspiratory muscle training in patients with the chronic obstructive pulmonary disease. J Formosan Med Associat. 2003; 102: 240-245. PubMed: https://pubmed.ncbi.nlm.nih.gov/12833187/
  35. Ray AD, Udhoji S, Mashtare TL. A combined inspiratory and expiratory muscle-training program improves respiratory muscle strength and fatigue in multiple sclerosis. Arch Phy Med Rehabil 2013; 94: 1964-1970. PubMed: https://pubmed.ncbi.nlm.nih.gov/23714277/
  36. Weiner P, Magadle R, Beckerman M. Comparison of specific expiratory, inspiratory, and combined muscle training programs in COPD. Chest. 2003; 124: 1357-1364. PubMed: https://pubmed.ncbi.nlm.nih.gov/14555566/
  37. Cohen J. Power primer. Psychological bulletin. 1992; 112: 155-159. PubMed: https://pubmed.ncbi.nlm.nih.gov/19565683/
  38. Kim K, Fell DW, Lee JH. Feedback respiratory training to enhance chest expansion and pulmonary function in chronic stroke: a double-blind randomized controlled study. J Phy Ther Sci. 2011; 23: 75-79.
  39. Viitanem JV, Kautiainen H, Suni J. The relative value of spinal and thoracic mobility measurement in ankylosing spondylitis. Scandinavian J Rheumatol. 1995; 24: 94-97. PubMed: https://pubmed.ncbi.nlm.nih.gov/7747150/
  40. Evans JA, Whitelaw WA. The assessment of maximal respiratory mouth pressures in adults. Respir Care. 2009; 54: 1348-1359. PubMed: https://pubmed.ncbi.nlm.nih.gov/19796415/
  41. Centers for Disease Control and Prevention. Growing stronger-strength training for the older adults. 2017; http://healthyliving.azcentral.com
  42. Kim JH, Park JH, Yim J. Respiratory exercise in stroke patients. Med Sci Monitor. 2014; 20: 2543-2549. PubMed: https://pubmed.ncbi.nlm.nih.gov/25488849/
  43. Kulnik ST, Rafferty GF, Birring SS, Moxham J, Kalra L. A pilot study of respiratory muscle training to improve the incidence of pneumonia in acute stroke: study protocol for a randomized controlled trial. Trials. 2014; 15: 123. PubMed: https://pubmed.ncbi.nlm.nih.gov/24725276/
  44. Messaggi-Sartor M, Guillen-Solà A, Depolo M, Duarte E, Rodríguez DA, et al. Inspiratory and expiratory muscle training in subacute stroke: A randomized clinical trial. Neurology. 2015; 85: 564-572. PubMed: https://pubmed.ncbi.nlm.nih.gov/26180145/
  45. Minoguchi H, Shibuya M, Miyagawa T. Cross-over comparison between respiratory muscle stretch gymnastics and inspiratory muscle training. Internal Med. 2002; 41: 805-812. PubMed: https://pubmed.ncbi.nlm.nih.gov/12413000/
  46. Fregonezi GA, Resqueti VR, Guell R, Prada J, Casan P. Effects of 8-week, interval-based inspiratory muscle training and breathing retraining in patients with generalized myasthenia gravis. Chest. 2005; 128: 1524-1530. PubMed: https://pubmed.ncbi.nlm.nih.gov/16162753/
  47. Sahin G, Calikoglu M, Ozge C. Respiratory muscle strength but not BASFI score relates to diminished chest expansion in ankylosing spondylitis. Clin Rheumatol. 2004; 23: 199-202. PubMed: https://pubmed.ncbi.nlm.nih.gov/15168144/
  48. De Groote A, Wantier M, Cheron G. Chest wall motion during tidal breathing. J Appl Physiol. 1997; 83: 1531-1537. PubMed: https://pubmed.ncbi.nlm.nih.gov/9375316/ 
  49. Lee LJ, Chang AT, Coppieters MW. Changes in sitting posture induce multiplanar changes in chest wall shape and motion with breathing. Respir Physiol Neurobiol. 2010; 170: 236-245. PubMed: https://pubmed.ncbi.nlm.nih.gov/20083236/
  50. Chiara T, Martin DA, Davenport PW, Bolser DC. Expiratory muscle strength training in persons with multiple sclerosis having mild to moderate disability: Effect on maximal expiratory pressure, pulmonary function, and maximal voluntary cough. Arch Phy Med Rehabil 2006; 87: 468-473. PubMed: https://pubmed.ncbi.nlm.nih.gov/16571384/
  51. McComas A. Human neuromuscular adaptations that accompany changes in activity. Med Sci Sports Exercise. 1994; 26: 1498-1509. PubMed: https://pubmed.ncbi.nlm.nih.gov/7869885/
  52. Duchateau J, Enoka R. Neural adaptations with chronic activity patterns in able-bodied humans. Am J Phy Med Rehabil 2002; 81: 17–27. PubMed: https://pubmed.ncbi.nlm.nih.gov/12409808/
  53. Olgiati R, Girr A, Hugi L, Haegi V. Respiratory muscle training in multiple sclerosis: a pilot study. Swiss Arch Neurol Psychiatry Psychother. 1989; 140: 46-50. PubMed: https://pubmed.ncbi.nlm.nih.gov/2467371/
  54. Biering-Sorensen F, Lehmann Knudsen J, Schmidt A, Bundgaard A, Christensen I. Effect of respiratory training with a mouth-nose-mask in tetraplegics. Paraplegia. 1991; 29: 113-139. PubMed: https://pubmed.ncbi.nlm.nih.gov/2023775/
  55. Weiner P, Gross D, Meiner Z. Respiratory muscle training in patients with moderate to severe myasthenia gravis. Canadian J Neurological Sci. 1998; 25: 236-241. PubMed: https://pubmed.ncbi.nlm.nih.gov/9706726/
  56. Liaw MY, Lin MC, Cheng PT, Wong M, Tang F. Resistive inspiratory muscle training: its effectiveness in patients with acute complete cervical cord injury. Arch Phy Med Rehabil 2000; 81: 752-756. PubMed: https://pubmed.ncbi.nlm.nih.gov/10857519/
  57. Wang T, Wang Y, Tang F, Lin K, Lien I. Resistive inspiratory muscle training in sleep-disordered breathing of traumatic tetraplegia. Arch Phy Med Rehabil 2002; 83:491-496. PubMed: https://pubmed.ncbi.nlm.nih.gov/11932850/
  58. Klefbeck B, Nedjad JH. Effect of inspiratory muscle training in patients with multiple sclerosis. Arch Phy Med Rehabil 2003; 84: 994-999. PubMed: https://pubmed.ncbi.nlm.nih.gov/12881823/
  59. Kuo YC, Chan J, Wu YP, Bernard JR, Liao YH. Effect of expiratory muscle strength training intervention on the maximum expiratory pressure and quality of life of patients with Parkinson’s disease. Neuro Rehabil 2017; 41: 219-226. PubMed: https://pubmed.ncbi.nlm.nih.gov/28527233/
  60. Jeonhyeong L. The effect of pulmonary function in the stroke patients af­ter feedback breathing exercise. Daegu University. 2008.
  61. Ehrlich M, Manns PJ, Poulin C. Respiratory training for a person with C3-C4 tetraplegia. Australian J Physiother. 1999; 45: 301-307. PubMed: https://pubmed.ncbi.nlm.nih.gov/11676779/
  62. Hyatt R. Expiratory flow limitation. J Appl Physiol. 1983; 55: 1-7. PubMed: https://pubmed.ncbi.nlm.nih.gov/6350246/
  63. Moon JH, Jung J, Won YS, Cho HY, Cho K. Effects of expiratory muscle strength training on swallowing function in acute stroke patients with dysphagia. J Phy Ther Sci. 2017; 29: 609-612. PubMed: https://pubmed.ncbi.nlm.nih.gov/28533594/

Figures:

Figure 1

Figure 1

Figure 1

Figure 2

Figure 1

Figure 3

Figure 1

Figure 4

Similar Articles

Recently Viewed

Read More

Most Viewed

Read More

Help ?