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The impact of high-intensity inspiratory muscle training on exercise capacity and inspiratory muscle strength in heart failure with reduced ejection fraction: a systematic review and meta-analysis.
Clin Rehabil 2018; 32(11):1482-1492CR

Abstract

OBJECTIVE:

Inspiratory muscle training (IMT) improves prognostic clinical variables in patients with heart failure. However, the optimal intensity for increasing those outcomes remains unclear. Thus, we aimed to determine whether high-intensity inspiratory muscle training (HIIMT) improves exercise capacity and respiratory muscle strength in patients with heart failure with reduced ejection fraction (HFrEF).

METHODS:

We searched for randomized controlled clinical trials at MEDLINE, the Cochrane Central Register of Controlled Trials, the Physiotherapy Evidence Database, SciELO and CINAHL from the earliest date available to May 2018. Primary studies on HIIMT against low-intensity IMT or sham-IMT that evaluated exercise capacity and inspiratory muscle strength were included. Two independent reviewers evaluated the eligibility of studies retrieved from the databases. Disagreements were resolved by discussion or by a third reviewer. Weighted mean difference (WMD), standardized mean difference (SMD) and 95% confidence interval (CI) were estimated by random effect models.

RESULTS:

Five studies met the eligibility criteria (138 patients). HIIMT improved VO2peak (WMD 2.65 mL kg-1 min-1; 95% CI: 2.2 to 3.1 mL kg-1 min-1), walking tests (SMD 1.71; 95% CI: 0.83 to 2.59) and maximal inspiratory pressure (WMD 16.63 cmH2O; 95% CI: 10.34 to 22.91 cmH2O). The estimate for potential risks of adverse events was not performed because of the low prevalence of reports in primary studies.

CONCLUSION:

HIIMT seems to be a useful strategy for improving exercise capacity and inspiratory muscle strength in HFrEF patients.

Authors+Show Affiliations

1 Physical Therapy Department, Universidade Federal da Bahia (UFBA), Salvador, Brazil. 2 Graduate Program in Medicine and Health, Universidade Federal da Bahia (UFBA), Salvador, Brazil. 3 Physiotherapy Research Group, Universidade Federal da Bahia (UFBA), Salvador, Brazil.4 Graduate Program in Cardiology and Cardiovascular Sciences, Hospital de Clínicas de Porto Alegre (HCPA), Federal University of Rio Grande do Sul, Porto Alegre, Brazil. 5 Exercise Cardiology Research Group (CardioEx), HCPA/UFRGS, Porto Alegre, Brazil.4 Graduate Program in Cardiology and Cardiovascular Sciences, Hospital de Clínicas de Porto Alegre (HCPA), Federal University of Rio Grande do Sul, Porto Alegre, Brazil. 6 Exercise Pathophysiology Laboratory (LaFiEx), HCPA/UFRGS, Porto Alegre, Brazil.2 Graduate Program in Medicine and Health, Universidade Federal da Bahia (UFBA), Salvador, Brazil. 7 Diagnostic Support and Internal Medicine Department, School of Medicine, Universidade Federal da Bahia (UFBA), Salvador, Brazil.3 Physiotherapy Research Group, Universidade Federal da Bahia (UFBA), Salvador, Brazil. 8 Physical Therapy Department, Federal University of Sergipe (UFS), Aracaju, Brazil.4 Graduate Program in Cardiology and Cardiovascular Sciences, Hospital de Clínicas de Porto Alegre (HCPA), Federal University of Rio Grande do Sul, Porto Alegre, Brazil. 5 Exercise Cardiology Research Group (CardioEx), HCPA/UFRGS, Porto Alegre, Brazil. 9 School of Medicine, HCPA/UFRGS, Porto Alegre, Brazil.

Pub Type(s)

Journal Article
Meta-Analysis
Systematic Review

Language

eng

PubMed ID

29984598

Citation

Gomes Neto, Mansueto, et al. "The Impact of High-intensity Inspiratory Muscle Training On Exercise Capacity and Inspiratory Muscle Strength in Heart Failure With Reduced Ejection Fraction: a Systematic Review and Meta-analysis." Clinical Rehabilitation, vol. 32, no. 11, 2018, pp. 1482-1492.
Gomes Neto M, Ferrari F, Helal L, et al. The impact of high-intensity inspiratory muscle training on exercise capacity and inspiratory muscle strength in heart failure with reduced ejection fraction: a systematic review and meta-analysis. Clin Rehabil. 2018;32(11):1482-1492.
Gomes Neto, M., Ferrari, F., Helal, L., Lopes, A. A., Carvalho, V. O., & Stein, R. (2018). The impact of high-intensity inspiratory muscle training on exercise capacity and inspiratory muscle strength in heart failure with reduced ejection fraction: a systematic review and meta-analysis. Clinical Rehabilitation, 32(11), pp. 1482-1492. doi:10.1177/0269215518784345.
Gomes Neto M, et al. The Impact of High-intensity Inspiratory Muscle Training On Exercise Capacity and Inspiratory Muscle Strength in Heart Failure With Reduced Ejection Fraction: a Systematic Review and Meta-analysis. Clin Rehabil. 2018;32(11):1482-1492. PubMed PMID: 29984598.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The impact of high-intensity inspiratory muscle training on exercise capacity and inspiratory muscle strength in heart failure with reduced ejection fraction: a systematic review and meta-analysis. AU - Gomes Neto,Mansueto, AU - Ferrari,Filipe, AU - Helal,Lucas, AU - Lopes,Antônio Alberto, AU - Carvalho,Vitor Oliveira, AU - Stein,Ricardo, Y1 - 2018/07/09/ PY - 2018/7/10/pubmed PY - 2018/7/10/medline PY - 2018/7/10/entrez KW - Heart failure KW - high-intensity training KW - respiratory weakness SP - 1482 EP - 1492 JF - Clinical rehabilitation JO - Clin Rehabil VL - 32 IS - 11 N2 - OBJECTIVE:: Inspiratory muscle training (IMT) improves prognostic clinical variables in patients with heart failure. However, the optimal intensity for increasing those outcomes remains unclear. Thus, we aimed to determine whether high-intensity inspiratory muscle training (HIIMT) improves exercise capacity and respiratory muscle strength in patients with heart failure with reduced ejection fraction (HFrEF). METHODS:: We searched for randomized controlled clinical trials at MEDLINE, the Cochrane Central Register of Controlled Trials, the Physiotherapy Evidence Database, SciELO and CINAHL from the earliest date available to May 2018. Primary studies on HIIMT against low-intensity IMT or sham-IMT that evaluated exercise capacity and inspiratory muscle strength were included. Two independent reviewers evaluated the eligibility of studies retrieved from the databases. Disagreements were resolved by discussion or by a third reviewer. Weighted mean difference (WMD), standardized mean difference (SMD) and 95% confidence interval (CI) were estimated by random effect models. RESULTS:: Five studies met the eligibility criteria (138 patients). HIIMT improved VO2peak (WMD 2.65 mL kg-1 min-1; 95% CI: 2.2 to 3.1 mL kg-1 min-1), walking tests (SMD 1.71; 95% CI: 0.83 to 2.59) and maximal inspiratory pressure (WMD 16.63 cmH2O; 95% CI: 10.34 to 22.91 cmH2O). The estimate for potential risks of adverse events was not performed because of the low prevalence of reports in primary studies. CONCLUSION:: HIIMT seems to be a useful strategy for improving exercise capacity and inspiratory muscle strength in HFrEF patients. SN - 1477-0873 UR - https://www.unboundmedicine.com/medline/citation/29984598/The_impact_of_high_intensity_inspiratory_muscle_training_on_exercise_capacity_and_inspiratory_muscle_strength_in_heart_failure_with_reduced_ejection_fraction:_a_systematic_review_and_meta_analysis_ L2 - http://journals.sagepub.com/doi/full/10.1177/0269215518784345?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -