Combined effects of threshold inspiratory muscle training with outpatient phase cardiac rehabilitation after cardiac surgery: Randomized, double-blind, sham-controlled trial
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Abstract
Background: The median sternotomy approach in cardiac surgery can lead to a postoperative decrease in respiratory muscle strength, which in turn reduces patients' functional capacity. However, studies investigating the addition of inspiratory muscle training (IMT) to outpatient cardiac rehabilitation (CR) programs are limited. Objective: To evaluate the effects of threshold IMT combined with an outpatient CR program on inspiratory muscle strength and submaximal exercise capacity in post-cardiac surgery patients. Method: The present randomized, double-blind, sham-controlled trial included 16 eligible post-cardiac surgery patients with median sternotomy. Participants were randomized into two groups. The IMT group (n=7) received a 12-week program of moderate-intensity aerobic exercise-based cardiac rehabilitation combined with progressive threshold IMT. The sham group (n=9) participated in the same cardiac rehabilitation program but used an IMT device with a fixed, minimal resistance. The resistance settings of the IMT devices were blinded for both groups. The primary outcome, maximal inspiratory pressure (MIP), and the secondary outcome, six-minute walk distance (6MWD) as a measure of submaximal exercise capacity, were assessed at baseline, 6 weeks, and 12 weeks. Results: The mean change in MIP from baseline was significantly greater in the IMT group compared with the sham group at both 6 weeks (29.29 vs 6.67 cmH2O; p=0.003) and 12 weeks (37.00 vs 14.78 cmH2O; p=0.001). There was no statistically significant difference in the mean change in 6MWD between the two groups at 6 weeks (p=0.135) or 12 weeks (p=0.629). Conclusion: The addition of a 12-week threshold inspiratory muscle training to outpatient cardiac rehabilitation in post-cardiac surgery patients demonstrated a statistically significant increase in inspiratory muscle strength. Nevertheless, no significant enhancement in submaximal exercise capacity is observed when compared with the sham-device control group.
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References
Association of Thoracic Surgeons of Thailand. Statistics on heart surgery in Thailand (B.E.2566/2023) [Internet]. 2024 Feb 14 [cited 2024 Aug 5]. Available from: https://www.thaists.or.th/downloadcategory/statistics-on-heart-surgery-in-thailand/
Urell C, Westerdahl E, Hedenström H, Janson C, Emtner M. Lung function before and two days after open-heart surgery. Crit Care Res Pract. 2012;2012:291628. doi:10.1155/2012/291628
Gosselink R, De Vos J, van den Heuvel SP, Segers J, Decramer M, Kwakkel G. Impact of inspiratory muscle training in patients with COPD: what is the evidence? Eur Respir J. 2011;37(2):416-25. doi:10.1183/09031936.00045910
Labate V, Guazzi M. Past, present, and future rehabilitation practice patterns for patients with heart failure: the European perspective. Heart Fail Clin. 2015;11(1):105-15. doi:10.1016/j.hfc.2014.08.008
Cordeiro AL, Melo TA, Neves D, Luna J, Esquivel MS, Guimaraes AR, et al. Inspiratory muscle training and functional capacity in patients undergoing cardiac surgery. Braz J Cardiovasc Surg. 2016;31(2):140-4. doi:10.5935/1678-9741.20160035
Barros GF, Santos Cda S, Granado FB, Costa PT, Limaco RP, Gardenghi G. Respiratory muscle training in patients submitted to coronary arterial bypass graft. Rev Bras Cir Cardiovasc. 2010;25(4):483-90. doi:10.3109/14017431.2011.595820
Savci S, Degirmenci B, Saglam M, Arikan H, Inal-Ince D, Turan HN, et al. Short-term effects of inspiratory muscle training in coronary artery bypass graft surgery: a randomized controlled trial. Scand Cardiovasc J. 2011;45(5):286-93. doi:10.3109/14017431.2011.595820
Matheus GB, Dragosavac D, Trevisan P, Costa CE, Lopes MM, Ribeiro GC. Inspiratory muscle training improves tidal volume and vital capacity after CABG surgery. Rev Bras Cir Cardiovasc. 2012;27(3):362-9. doi:10.5935/1678-9741.20120055
Songsorn P. Effect of respiratory muscle training on lung function and respiratory muscle strength in patients undergoing open heart surgery. Thammasat Med J. 2015;15(2):220-30. [in Thai]
Gomes Neto M, Martinez BP, Reis HF, Carvalho VO. Pre- and postoperative inspiratory muscle training in patients undergoing cardiac surgery: systematic review and meta-analysis. Clin Rehabil. 2017;31(4):454-64. doi:10.1177/0269215516648754
Hermes BM, Cardoso DM, Gomes TJ, Santos TD, Vicente MS, Pereira SN, et al. Short-term inspiratory muscle training potentiates the benefits of aerobic and resistance training in patients undergoing CABG in phase II cardiac rehabilitation program. Rev Bras Cir Cardiovasc. 2015;30(4):474-81. doi:10.5935/1678-9741.20150062
Rosner B. Fundamentals of biostatistics. 5th ed. Duxbury: Thomson Learning; 2000. p. 308.
Pescatello LS, Arena R, Riebe D, Thompson PD, editors. ACSM's guidelines for exercise testing and prescription. 9th ed. Philadelphia: Wolters Kluwer/Lippincott Williams & Wilkins; 2014.
Beckerman M, Magadle R, Weiner M, Weiner P. The effects of 1 year of specific inspiratory muscle training in patients with COPD. Chest. 2005;128(5):3177-82. doi:10.1378/chest.128.5.3177
Dimitriadis Z, Kapreli E, Konstantinidou I, Oldham J, Strimpakos N. Test/retest reliability of maximal mouth pressure measurements with the MicroRPM in healthy volunteers. Respir Care. 2011;56(6):776-82. doi:10.4187/respcare.00783
Troosters T, Gosselink R, Decramer M. Respiratory muscle assessment. Eur Respir Monogr. 2005;31:57-71. doi: 10.1183/1025448x.00031004
American Thoracic Society/European Respiratory Society. ATS/ERS Statement on respiratory muscle testing. Am J Respir Crit Care Med. 2002 Aug 15;166(4):518-624. doi:10.1164/rccm.166.4.518
ATS Committee on Proficiency Standards for Clinical Pulmonary Function Laboratories. ATS statement: guidelines for the six-minute walk test. Am J Respir Crit Care Med. 2002 Jul 1;166(1):111-7. doi:10.1164/ajrccm.166.1.at1102
Hanphadungkit K. 6-Minute Walk Test. ASEAN J Rehabil Med. 2014;24(1):1-4.
Mills DE, Johnson MA, Barnett YA, Smith WH, Sharpe GR. The effects of inspiratory muscle training in older adults. Med Sci Sports Exerc. 2015;47(4):691-7. doi:10.1249/MSS.0000000000000474
Ramsook AH, Molgat-Seon Y, Schaeffer MR, Wilkie SS, Camp PG, Reid WD, et al. Effects of inspiratory muscle training on respiratory muscle electromyography and dyspnea during exercise in healthy men. J Appl Physiol (1985). 2017;122(5):1267-75. doi:10.1152/japplphysiol.00046.2017
Kisner C, Colby LA. Therapeutic exercise: foundations and techniques. 6th ed. Philadelphia: FA Davis Company; 2012. p. 157-98.
Ramirez-Sarmiento A, Orozco-Levi M, Guell R, Barreiro E, Hernandez N, Mota S, et al. Inspiratory muscle training in patients with chronic obstructive pulmonary disease: structural adaptation and physiologic outcomes. Am J Respir Crit Care Med. 2002;166(11):1491-7. doi:10.1164/rccm.200202-075OC
Taylor AW, Bachman L. The effects of endurance training on muscle fibre types and enzyme activities. Can J Appl Physiol. 1999;24(1):41-53. doi:10.1139/h99-005
Segizbaeva MO, Timofeev NN, Donina ZA, Kur'yanovich EN, Aleksandrova NP. Effects of inspiratory muscle training on resistance to fatigue of respiratory muscles during exhaustive exercise. Adv Exp Med Biol. 2015;840:35-43. doi:10.1007/5584_2014_20
Riedi C, Mora CT, Driessen T, Coutinho Mde C, Mayer DM, Moro FL, et al. Relation between respiratory muscle strength with respiratory complication on the heart surgery. Rev Bras Cir Cardiovasc. 2010;25(4):500-5. doi:10.1590/S0102-76382010000400013
Morsch KT, Leguisamo CP, Camargo MD, Coronel CC, Mattos W, Ortiz LD, et al. Ventilatory profile of patients undergoing CABG surgery. Rev Bras Cir Cardiovasc. 2009;24(2):180-7. doi:10.1590/S0102-76382009000200014
Urell C, Emtner M, Hedenström H, Westerdahl E. Respiratory muscle strength is not decreased in patients undergoing cardiac surgery. J Cardiothorac Surg. 2016 Mar 31;11:41. doi:10.1186/s13019-016-0433-z
Fiorina C, Vizzardi E, Lorusso R, Maggio M, De Cicco G, D'Aloia A, et al. The 6-min walking test early after cardiac surgery. Reference values and the effects of rehabilitation programme. Eur J Cardiothorac Surg. 2007;32(5):724-9. doi:10.1016/j.ejcts.2007.08.013
