The effect of inspiratory muscle training on functional exercise capacity and quality of life in patients with pulmonary arterial hypertension: a systematic review

Year 2023, Volume: 28 Issue: 2, 242 - 247, 23.05.2023

Zeynep Betül Özcan Esra Pehlivan

https://doi.org/10.21673/anadoluklin.1071003

Abstract

Aim: Patients with pulmonary arterial hypertension, symptoms occur with exertion in the early stages of the disease, can also be observed at rest in the advanced stages of the disease. Although there is optimized medical treatment for patients with pulmonary arterial hypertension, most patients with pulmonary arterial hypertension complain of low exercise capacity and quality of life. One of the treatment parameters for pulmonary arterial hypertension is pulmonary rehabilitation. The most important component for pulmonary arterial hypertension is the physiotherapy program. Personalized physiotherapy programs consist of exercise training, respiratory muscle training and patient training components. Respiratory muscle strength training is more specifically applied as inspiratory muscle training. The number of studies investigating and discussing the general effects of inspiratory muscle training for patients with pulmonary arterial hypertension is scarce. For this reason, the application of inspiratory muscle training is recommended for patients with pulmonary arterial hypertension. The aim of this study was ‘Is inspiratory muscle training effective in increasing the functional exercise capacity and quality of life of patients with pulmonary arterial hypertension?’ is to answer the question.

Methods: Before January 2022, four main databases were searched: PubMed, Web of Science, Cochrane Library and Springer Link. The search was limited to randomized controlled prospective studies published in the last 5 years.

Results: Studies involving inspiratory muscle training in patients with pulmonary arterial hypertension were included. After reading the full texts, two studies were found that fulfil the inclusion criteria. These publications were all randomized controlled prospective studies.

Conclusion: It has been reported that inspiratory muscle training application increases functional exercise capacity and inspiratory muscle strength in patients with pulmonary arterial hypertension. However, its effectiveness in improving quality of life was unclear.

Keywords

Exercise test, pulmonary arterial hypertension, quality of life, rehabilitation, respiratory muscles

Pulmoner arteriyel hipertansiyonlu hastalarda inspiratuar kas eğitiminin fonksiyonel egzersiz kapasitesi ve yaşam kalitesi üzerine etkisi: sistematik bir derleme

Abstract

Amaç: Pulmoner arteriyel hipertansiyon hastalarında, hastalığın erken dönemlerinde semptomlar eforla ortaya çıkarken, hastalığın ileri evrelerinde dinlenme durumunda da gözlenebilir. Pulmoner arteriyel hipertansiyon hastaları için optimize edilmiş tıbbi tedavi bulunmasına rağmen, çoğu pulmoner arteriyel hipertansiyon hastası düşük egzersiz kapasitesi ve yaşam kalitesinden şikayetçidir. Pulmoner arteriyel hipertansiyon tedavi parametrelerinden biri pulmoner rehabilitasyondur. Pulmoner rehabilitasyon multidisipliner bir yaklaşımdır. Pulmoner arteriyel hipertansiyon için en önemli bileşeni fizyoterapi programıdır. Kişiye özel fizyoterapi programları egzersiz eğitimi, solunum kas eğitimi, hasta eğitimi bileşenlerinden oluşmaktadır. Solunum kas kuvveti eğitimi daha çok spesifik olarak inspiratuar kas eğitimi şeklinde uygulanmaktadır. Pulmoner arteriyel hipertansiyonlu hastalar için inspiratuar kas eğitimi uygulamasının genel etkilerini araştıran ve konu alan çalışma sayısı azdır. Bu çalışmanın amacı “Pulmoner arteriyel hipertansiyonlu hastalarda inspiratuar kas eğitimi hastanın fonksiyonel egzersiz kapasitesini ve yaşam kalitesini arttırmada etkili midir?” sorusunu cevaplamaktır.

Yöntemler: Ocak 2022 tarihinden önce PubMed, Web of Science, Cochrane Library, Springer Link olmak üzere dört ana veri tabanında arama yapıldı. Arama son 5 yılda yayınlanan randomize kontrollü prospektif çalışmalar olacak şekilde sınırlandırıldı.

Bulgular: Pulmoner arteriyel hipertansiyonlu hastalarda inspiratuar kas eğitimi uygulanan çalışmalar dahil edildi. Tam metinler okunduktan sonra dahil edilme kriterlerine uygun iki çalışma bulundu. Bu yayınların tümü randomize kontrollü prospektif çalışmalardı.

Sonuç: Çalışmalar incelendiğinde, pulmoner arteriyel hipertansiyonlu hastalarda inspiratuar kas eğitimi uygulamasının, fonksiyonel egzersiz kapasitesini ve inspiratuar kas kuvvetini arttırdığı ancak yaşam kalitesini arttırmadaki etkinliğinin belirsiz olduğu sonucuna varıldı.

Keywords

Egzersiz testi, pulmoner arteriyel hipertansiyon, rehabilitasyon, solunum kasları, yaşam kalitesi

References

• Kovacs G, Berghold A, Scheidl S, Olschewski H. Pulmonary arterial pressure during rest and exercise in healthy subjects: A systematic review. Eur Respir J. 2009;34(4):888-94.
• Galiè N, Humbert M, Vachiery JL, et al. 2015 ESC/ERS Guidelines for the Diagnosis and Treatment of Pulmonary Hypertension. Rev Esp Cardiol (Engl Ed). 2016;69(2):177.
• Milne ENC. Forgotten gold in diagnosing pulmonary hypertension: The plain chest radiograph. Radiographics. 2012;32(4):1085-7.
• Grünig E, Eichstaedt C, Barberà JA, et al. ERS statement on exercise training and rehabilitation in patients with severe chronic pulmonary hypertension. Eur Respir J. 2019;53(2):1800332.
• Panagiotou M, Peacock AJ, Johnson MK. Respiratory and limb muscle dysfunction in pulmonary arterial hypertension: A role for exercise training? Pulm Circ. 2015;5(3):424-34.
• Spruit MA, Singh SJ, Garvey C, et al. An official American Thoracic Society/European Respiratory Society statement: key concepts and advances in pulmonary rehabilitation. Am J Respir Crit Care Med. 2013;188(8):e13-e64.
• Cahalin LP, Arena R, Guazzi M, et al. Inspiratory muscle training in heart disease and heart failure: A review of the literature with a focus on method of training and outcomes. Expert Rev Cardiovasc Ther. 2013;11(2):161-77.
• Talwar A, Sahni S, Verma S, Khan SZ, Dhar S, Kohn N. Exercise tolerance improves after pulmonary rehabilitation in pulmonary hypertension patients. J Exerc Rehabil. 2017;13(2):214-7.
• Tran D, Munoz P, Lau EMT, et al. Inspiratory Muscle Training Improves Inspiratory Muscle Strength and Functional Exercise Capacity in Pulmonary Arterial Hypertension and Chronic Thromboembolic Pulmonary Hypertension: A Pilot Randomised Controlled Study. Heart Lung Circ. 2021;30(3):388-95.
• Aslan GK, Akıncı B, Yeldan I, Okumus G. A randomized controlled trial on inspiratory muscle training in pulmonary hypertension: Effects on respiratory functions, functional exercise capacity, physical activity, and quality of life. Heart Lung. 2020;49(4):381-7.
• Maron BA, Abman SH, Elliott CG, et al. Pulmonary arterial hypertension: Diagnosis, treatment, and novel advances. Am J Respir Crit Care Med. 2021;15;203(12):1472-87.
• Patel R, Aronow WS, Patel L, et al. Treatment of pulmonary hypertension. Med Sci Monit. 2012;18(4):31-9.
• Fox BD, Kassirer M, Weiss I, et al. Ambulatory rehabilitation improves exercise capacity in patients with pulmonary hypertension. J Card Fail. 2011;17(3):196-200.
• Humbert M, Sitbon O, Chaouat A, et al. Survival in patients with idiopathic, familial, and anorexigen-associated pulmonary arterial hypertension in the modern management era. Circulation. 2010;122(2):156-63.
• Boucly A, Weatherald J, Savale L, et al. Risk assessment, prognosis and guideline implementation in pulmonary arterial hypertension. Eur Respir J. 2017;50(2):1700889.
• Holland AE, Singh SJ, Casaburi R, et al. Defining modern pulmonary rehabilitation: An official American thoracic society workshop report. Ann Am Thorac Soc. 2021;18(5):12-e29.
• Naeije R. Breathing more with weaker respiratory muscles in pulmonary arterial hypertension. Eur Respir J. 2005;25(1):6-8.
• Mereles D, Ehlken N, Kreuscher S, et al. Exercise and respiratory training improve exercise capacity and quality of life in patients with severe chronic pulmonary hypertension. Circulation. 2006;114(14):1482-9.
• Grünig E, Ehlken N, Ghofrani A, et al. Effect of exercise and respiratory training on clinical progression and survival in patients with severe chronic pulmonary hypertension. Respiration. 2011;81(5):394-401.
• Morris NR, Kermeen FD, Holland AE. Exercise-based rehabilitation programmes for pulmonary hypertension. Cochrane Database Syst Rev. 2017;1(1):CD011285.
• Ehlken N, Lichtblau M, Klose H, et al. Exercise training improves peak oxygen consumption and haemodynamics in patients with severe pulmonary arterial hypertension and inoperable chronic thrombo-embolic pulmonary hypertension: A prospective, randomized, controlled trial. Eur Heart J. 2016;37(1):35-44.
• Mathai SC, Puhan MA, Lam D, Wise RA. The minimal important difference in the 6-minute walk test for patients with pulmonary arterial hypertension. Am J Respir Crit Care Med. 2012;86(5):428-33.
• Saglam M, Arikan H, Vardar-Yagli N, Calik-Kutukcu E, Inal-Ince D, Savci S, et al. Inspiratory Muscle Training in Pulmonary Arterial Hypertension. J Cardiopulm Rehabil Prev. 2015;12(2):699-705.
• Aslan GK, Akinci B, Yeldan I, Okumus G. Respiratory muscle strength in patients with pulmonary hypertension: The relationship with exercise capacity, physical activity level, and quality of life. Clin Respir J. 2018;12(2):699-705.
• Cenedese E, Speich R, Dorschner L, et al. Measurement of quality of life in pulmonary hypertension and its significance. Eur Respir J. 2006;28(4):808-15.