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Expiratory and expiratory plus inspiratory muscle training improves respiratory muscle strength in subjects with COPD: systematic review.

Abstract

BACKGROUND

Inspiratory muscle training (IMT) produces beneficial effects in COPD subjects, but the effects of expiratory muscle training (EMT) and EMT plus IMT in ventilatory training are still unclear. The aim of this study was to systematically review the effects of EMT and EMT plus IMT compared to control groups of COPD subjects.

METHODS

This study is a systematic review and meta-analysis. The search strategy included MEDLINE, Embase, LILACS, PEDro, and Cochrane CENTRAL and also manual search of references in published studies on the subject. Randomized trials comparing EMT and EMT plus IMT versus control groups of subjects with COPD were included. The outcomes analyzed were respiratory muscle strength and functional capacity. Two reviewers independently extracted the data.

RESULTS

The search retrieved 609 articles. Five studies were included. We observed that EMT provided higher gain in maximum expiratory pressure (P(E(max)) 21.49 cm H2O, 95% CI 13.39-29.59) and maximum inspiratory pressure (P(I(max)) 7.68 cm H2O, 95% CI 0.90-14.45) compared to control groups. There was no significant difference in the 6-min walk test distance (29.01 m, 95% CI -39.62 to 97.65) and dyspnea (0.15, 95% CI -0.77 to 1.08). In relation to EMT plus IMT, we observed that P(E(max)) (31.98 cm H2O, 95% CI 26.93-37.03) and P(I(max)) (27.98 cm H2O, 95% CI 20.10-35.85) presented higher values compared to control groups.

CONCLUSIONS

EMT and EMT plus IMT improve respiratory muscle strength and can be used as part of the treatment during pulmonary rehabilitation of subjects with severe to very severe COPD.

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  • Authors+Show Affiliations

    ,

    Instituto de Cardiologia do Rio Grande do Sul, Fundação Universitária de Cardiologia, Porto Alegre, Rio Grande do Sul, Brazil.

    ,

    Instituto de Cardiologia do Rio Grande do Sul, Fundação Universitária de Cardiologia, Porto Alegre, Rio Grande do Sul, Brazil.

    ,

    Instituto de Cardiologia do Rio Grande do Sul, Fundação Universitária de Cardiologia, Porto Alegre, Rio Grande do Sul, Brazil. Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil.

    ,

    Universidade Estadual de Santa Catarina, Florianópolis, Santa Catarina, Brazil.

    ,

    Instituto de Cardiologia do Rio Grande do Sul, Fundação Universitária de Cardiologia, Porto Alegre, Rio Grande do Sul, Brazil.

    Instituto de Cardiologia do Rio Grande do Sul, Fundação Universitária de Cardiologia, Porto Alegre, Rio Grande do Sul, Brazil. Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil. graciele.sbruzzi@ufrgs.br.

    Source

    Respiratory care 59:9 2014 Sep pg 1381-8

    MeSH

    Breathing Exercises
    Exercise Test
    Exercise Tolerance
    Exhalation
    Humans
    Inhalation
    Muscle Strength
    Pulmonary Disease, Chronic Obstructive
    Randomized Controlled Trials as Topic
    Respiratory Muscles
    Walking

    Pub Type(s)

    Journal Article
    Review
    Systematic Review

    Language

    eng

    PubMed ID

    24782553

    Citation

    Neves, Leonardo F., et al. "Expiratory and Expiratory Plus Inspiratory Muscle Training Improves Respiratory Muscle Strength in Subjects With COPD: Systematic Review." Respiratory Care, vol. 59, no. 9, 2014, pp. 1381-8.
    Neves LF, Reis MH, Plentz RD, et al. Expiratory and expiratory plus inspiratory muscle training improves respiratory muscle strength in subjects with COPD: systematic review. Respir Care. 2014;59(9):1381-8.
    Neves, L. F., Reis, M. H., Plentz, R. D., Matte, D. L., Coronel, C. C., & Sbruzzi, G. (2014). Expiratory and expiratory plus inspiratory muscle training improves respiratory muscle strength in subjects with COPD: systematic review. Respiratory Care, 59(9), pp. 1381-8. doi:10.4187/respcare.02793.
    Neves LF, et al. Expiratory and Expiratory Plus Inspiratory Muscle Training Improves Respiratory Muscle Strength in Subjects With COPD: Systematic Review. Respir Care. 2014;59(9):1381-8. PubMed PMID: 24782553.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Expiratory and expiratory plus inspiratory muscle training improves respiratory muscle strength in subjects with COPD: systematic review. AU - Neves,Leonardo F, AU - Reis,Manoela H, AU - Plentz,Rodrigo D M, AU - Matte,Darlan L, AU - Coronel,Christian C, AU - Sbruzzi,Graciele, Y1 - 2014/04/29/ PY - 2014/5/1/entrez PY - 2014/5/2/pubmed PY - 2015/9/22/medline KW - COPD KW - breathing exercise KW - chronic obstructive KW - expiratory muscle training KW - obstructive pulmonary disease KW - pulmonary diseases KW - respiratory muscle training SP - 1381 EP - 8 JF - Respiratory care JO - Respir Care VL - 59 IS - 9 N2 - BACKGROUND: Inspiratory muscle training (IMT) produces beneficial effects in COPD subjects, but the effects of expiratory muscle training (EMT) and EMT plus IMT in ventilatory training are still unclear. The aim of this study was to systematically review the effects of EMT and EMT plus IMT compared to control groups of COPD subjects. METHODS: This study is a systematic review and meta-analysis. The search strategy included MEDLINE, Embase, LILACS, PEDro, and Cochrane CENTRAL and also manual search of references in published studies on the subject. Randomized trials comparing EMT and EMT plus IMT versus control groups of subjects with COPD were included. The outcomes analyzed were respiratory muscle strength and functional capacity. Two reviewers independently extracted the data. RESULTS: The search retrieved 609 articles. Five studies were included. We observed that EMT provided higher gain in maximum expiratory pressure (P(E(max)) 21.49 cm H2O, 95% CI 13.39-29.59) and maximum inspiratory pressure (P(I(max)) 7.68 cm H2O, 95% CI 0.90-14.45) compared to control groups. There was no significant difference in the 6-min walk test distance (29.01 m, 95% CI -39.62 to 97.65) and dyspnea (0.15, 95% CI -0.77 to 1.08). In relation to EMT plus IMT, we observed that P(E(max)) (31.98 cm H2O, 95% CI 26.93-37.03) and P(I(max)) (27.98 cm H2O, 95% CI 20.10-35.85) presented higher values compared to control groups. CONCLUSIONS: EMT and EMT plus IMT improve respiratory muscle strength and can be used as part of the treatment during pulmonary rehabilitation of subjects with severe to very severe COPD. SN - 1943-3654 UR - https://www.unboundmedicine.com/medline/citation/24782553/Expiratory_and_expiratory_plus_inspiratory_muscle_training_improves_respiratory_muscle_strength_in_subjects_with_COPD:_systematic_review_ L2 - http://rc.rcjournal.com/cgi/pmidlookup?view=short&pmid=24782553 DB - PRIME DP - Unbound Medicine ER -