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Inspiratory Muscle Training Is Associated With Improved Inspiratory Muscle Strength, Resting Cardiac Output, and the Ventilatory Efficiency of Exercise in Patients With a Fontan Circulation.
J Am Heart Assoc 2017; 6(8)JA

Abstract

BACKGROUND

Patients with a Fontan circulation have reduced exercise capacity and respiratory muscle strength. Inspiratory muscle training (IMT) improves exercise capacity and quality of life in adults with heart failure. We assessed whether 6 weeks of a home-based program of IMT improves inspiratory muscle strength and the ventilatory efficiency of exercise in adolescent patients with a Fontan circulation.

METHODS AND RESULTS

Twenty-three adolescent participants (aged 16±2 years) with a Fontan circulation underwent 6 weeks of IMT for 30 minutes daily. Respiratory muscle strength (maximal inspiratory pressure and expiratory pressure), lung function, and exercise capacity (cardiopulmonary exercise testing) were assessed. Fourteen of 23 participants also underwent exercise cardiac magnetic resonance imaging to examine the effects of IMT on cardiac output and systemic and pulmonary blood flow. Six weeks of IMT improved maximal inspiratory pressure by 36±24 cm H2O (61±46%) with no change in maximal expiratory pressure. Ventilatory efficiency of exercise improved after 6 weeks of IMT (from 34.2±7.8 to 32.2±5.6, P=0.04). In those who underwent exercise cardiac magnetic resonance imaging, IMT increased resting cardiac output (from 4.2±1.2 to 4.5±1.0 L/min, P=0.03) and ejection fraction (from 50.1±4.3 to 52.8±6.1%, P=0.03).

CONCLUSIONS

Six weeks of IMT is associated with improved inspiratory muscle strength, ventilatory efficiency of exercise, and resting cardiac output in young Fontan patients. IMT may be a simple beneficial addition to the current management of Fontan patients, potentially reducing exercise intolerance and long-term morbidity and mortality.

Authors+Show Affiliations

The Children's Hospital at Westmead, Sydney, NSW, Australia klaohachai@gmail.com. The University of Sydney, Sydney, NSW, Australia.The Children's Hospital at Westmead, Sydney, NSW, Australia. The University of Sydney, Sydney, NSW, Australia.The Children's Hospital at Westmead, Sydney, NSW, Australia. The University of Sydney, Sydney, NSW, Australia.The Children's Hospital at Westmead, Sydney, NSW, Australia.The Royal Children's Hospital, Melbourne, Vic., Australia. Murdoch Children's Research Institute, Melbourne, Vic., Australia.The University of Sydney, Sydney, NSW, Australia. The Royal Prince Alfred Hospital, Sydney, NSW, Australia.The Children's Hospital at Westmead, Sydney, NSW, Australia. The University of Sydney, Sydney, NSW, Australia.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

28862962

Citation

Laohachai, Karina, et al. "Inspiratory Muscle Training Is Associated With Improved Inspiratory Muscle Strength, Resting Cardiac Output, and the Ventilatory Efficiency of Exercise in Patients With a Fontan Circulation." Journal of the American Heart Association, vol. 6, no. 8, 2017.
Laohachai K, Winlaw D, Selvadurai H, et al. Inspiratory Muscle Training Is Associated With Improved Inspiratory Muscle Strength, Resting Cardiac Output, and the Ventilatory Efficiency of Exercise in Patients With a Fontan Circulation. J Am Heart Assoc. 2017;6(8).
Laohachai, K., Winlaw, D., Selvadurai, H., Gnanappa, G. K., d'Udekem, Y., Celermajer, D., & Ayer, J. (2017). Inspiratory Muscle Training Is Associated With Improved Inspiratory Muscle Strength, Resting Cardiac Output, and the Ventilatory Efficiency of Exercise in Patients With a Fontan Circulation. Journal of the American Heart Association, 6(8), doi:10.1161/JAHA.117.005750.
Laohachai K, et al. Inspiratory Muscle Training Is Associated With Improved Inspiratory Muscle Strength, Resting Cardiac Output, and the Ventilatory Efficiency of Exercise in Patients With a Fontan Circulation. J Am Heart Assoc. 2017 Aug 21;6(8) PubMed PMID: 28862962.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Inspiratory Muscle Training Is Associated With Improved Inspiratory Muscle Strength, Resting Cardiac Output, and the Ventilatory Efficiency of Exercise in Patients With a Fontan Circulation. AU - Laohachai,Karina, AU - Winlaw,David, AU - Selvadurai,Hiran, AU - Gnanappa,Ganesh Kumar, AU - d'Udekem,Yves, AU - Celermajer,David, AU - Ayer,Julian, Y1 - 2017/08/21/ PY - 2017/9/2/entrez PY - 2017/9/2/pubmed PY - 2018/5/10/medline KW - Fontan procedure KW - exercise KW - exercise capacity KW - inspiratory muscle strength JF - Journal of the American Heart Association JO - J Am Heart Assoc VL - 6 IS - 8 N2 - BACKGROUND: Patients with a Fontan circulation have reduced exercise capacity and respiratory muscle strength. Inspiratory muscle training (IMT) improves exercise capacity and quality of life in adults with heart failure. We assessed whether 6 weeks of a home-based program of IMT improves inspiratory muscle strength and the ventilatory efficiency of exercise in adolescent patients with a Fontan circulation. METHODS AND RESULTS: Twenty-three adolescent participants (aged 16±2 years) with a Fontan circulation underwent 6 weeks of IMT for 30 minutes daily. Respiratory muscle strength (maximal inspiratory pressure and expiratory pressure), lung function, and exercise capacity (cardiopulmonary exercise testing) were assessed. Fourteen of 23 participants also underwent exercise cardiac magnetic resonance imaging to examine the effects of IMT on cardiac output and systemic and pulmonary blood flow. Six weeks of IMT improved maximal inspiratory pressure by 36±24 cm H2O (61±46%) with no change in maximal expiratory pressure. Ventilatory efficiency of exercise improved after 6 weeks of IMT (from 34.2±7.8 to 32.2±5.6, P=0.04). In those who underwent exercise cardiac magnetic resonance imaging, IMT increased resting cardiac output (from 4.2±1.2 to 4.5±1.0 L/min, P=0.03) and ejection fraction (from 50.1±4.3 to 52.8±6.1%, P=0.03). CONCLUSIONS: Six weeks of IMT is associated with improved inspiratory muscle strength, ventilatory efficiency of exercise, and resting cardiac output in young Fontan patients. IMT may be a simple beneficial addition to the current management of Fontan patients, potentially reducing exercise intolerance and long-term morbidity and mortality. SN - 2047-9980 UR - https://www.unboundmedicine.com/medline/citation/28862962/Inspiratory_Muscle_Training_Is_Associated_With_Improved_Inspiratory_Muscle_Strength_Resting_Cardiac_Output_and_the_Ventilatory_Efficiency_of_Exercise_in_Patients_With_a_Fontan_Circulation_ L2 - http://www.ahajournals.org/doi/full/10.1161/JAHA.117.005750?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -