Effectiveness and safety of inspiratory muscle training in patients with pulmonary hypertension: A systematic review and meta-analysis
BackgroundInspiratory muscle training (IMT) is a simple and well-tolerated physical therapy that increases respiratory muscle strength and relieving the degree of dyspnea and fatigue. Therefore, it may be used as a transitional modality before exercise training or as a specific physical therapy inte...
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Frontiers Media S.A.
2022-11-01
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| Series: | Frontiers in Cardiovascular Medicine |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fcvm.2022.999422/full |
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| author | Zeruxin Luo Hong Qian Xiu Zhang Yuqiang Wang Jing Wang Pengming Yu |
| author_facet | Zeruxin Luo Hong Qian Xiu Zhang Yuqiang Wang Jing Wang Pengming Yu |
| author_sort | Zeruxin Luo |
| collection | DOAJ |
| description | BackgroundInspiratory muscle training (IMT) is a simple and well-tolerated physical therapy that increases respiratory muscle strength and relieving the degree of dyspnea and fatigue. Therefore, it may be used as a transitional modality before exercise training or as a specific physical therapy intervention for those who are diagnosed with respiratory muscle weakness. However, the current evidence on IMT in pulmonary hypertension (PH) patients is inconclusive. The purpose of this systematic review and meta-analysis was to summarize the current role of IMT in this group of patients.MethodsPubMed, EMBASE, and Cochrane databases were searched through May 2022. Trials examining the feasibility and effectiveness of IMT in PH patients. Outcome measures included adverse events, training adherence and compliance, maximum inspiratory pressure (MIP), maximum expiratory pressure (MEP), forced vital capacity (FVC%), forced expiratory volume in 1 s (FEV1%), FEV1/FVC%, 6 min walk distance (6MWD), Peak VO2, dyspnea, and fatigue perception after the IMT training program. Only randomized controlled trials were included. The Cochrane Risk of Bias tool for controlled trials was adopted to assess study quality. Statistical heterogeneity was evaluated with the chi-square test and I2 statistic. Mean differences and 95% confidence intervals (CIs) were estimated.ResultsWe ultimately identified four studies that met the criteria. These studies comprised 80 patients with 16 males and 64 females. The mean age was 53.25. The main types of PH were group I (pulmonary arterial hypertension, 95%) and group IV (chronic thromboembolic PH, 5%). No severe adverse events were reported in the included studies. IMT had a significant effect on improving MIP (18.89 cmH2O; 95% CI: 9.43–28.35, P < 0.001) and MEP (8.06 cmH2O; 95% CI: 2.39–13.73; P = 0.005), increase in the 6MWD (30.16 m; 95% CI: 1.53–58.79; P = 0.04). No significant improvement was found in pulmonary function (P > 0.05), and uncertain effect on the quality of life (QoL) score.ConclusionBased on currently limited evidence, IMT is an effective physical therapy for increasing respiratory muscle function and exercise capacity, but still a lack of evidence on dyspnea and fatigue levels, pulmonary function, and QoL in PH patients. There are reasons to believe that IMT is a promising intervention in PH patients, enriching rehabilitation options and serving as a bridge before formal exercise training. It is expected that IMT will play an important role in the future clinical pathway of physical therapy for this group of patients.Systematic review registration[https://www.crd.york.ac.uk/PROSPERO/logout.php], identifier [CRD42022335972]. |
| first_indexed | 2024-04-11T07:42:34Z |
| format | Article |
| id | doaj.art-1c8d69de95c847c4bff9538f4ab11074 |
| institution | Directory Open Access Journal |
| issn | 2297-055X |
| language | English |
| last_indexed | 2024-04-11T07:42:34Z |
| publishDate | 2022-11-01 |
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| series | Frontiers in Cardiovascular Medicine |
| spelling | doaj.art-1c8d69de95c847c4bff9538f4ab110742022-12-22T04:36:25ZengFrontiers Media S.A.Frontiers in Cardiovascular Medicine2297-055X2022-11-01910.3389/fcvm.2022.999422999422Effectiveness and safety of inspiratory muscle training in patients with pulmonary hypertension: A systematic review and meta-analysisZeruxin Luo0Hong Qian1Xiu Zhang2Yuqiang Wang3Jing Wang4Pengming Yu5Department of Rehabilitation Medicine Center, West China Hospital, Sichuan University, Chengdu, Sichuan, ChinaDepartment of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, ChinaDepartment of Rehabilitation Medicine Center, West China Hospital, Sichuan University, Chengdu, Sichuan, ChinaDepartment of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, ChinaDepartment of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, ChinaDepartment of Rehabilitation Medicine Center, West China Hospital, Sichuan University, Chengdu, Sichuan, ChinaBackgroundInspiratory muscle training (IMT) is a simple and well-tolerated physical therapy that increases respiratory muscle strength and relieving the degree of dyspnea and fatigue. Therefore, it may be used as a transitional modality before exercise training or as a specific physical therapy intervention for those who are diagnosed with respiratory muscle weakness. However, the current evidence on IMT in pulmonary hypertension (PH) patients is inconclusive. The purpose of this systematic review and meta-analysis was to summarize the current role of IMT in this group of patients.MethodsPubMed, EMBASE, and Cochrane databases were searched through May 2022. Trials examining the feasibility and effectiveness of IMT in PH patients. Outcome measures included adverse events, training adherence and compliance, maximum inspiratory pressure (MIP), maximum expiratory pressure (MEP), forced vital capacity (FVC%), forced expiratory volume in 1 s (FEV1%), FEV1/FVC%, 6 min walk distance (6MWD), Peak VO2, dyspnea, and fatigue perception after the IMT training program. Only randomized controlled trials were included. The Cochrane Risk of Bias tool for controlled trials was adopted to assess study quality. Statistical heterogeneity was evaluated with the chi-square test and I2 statistic. Mean differences and 95% confidence intervals (CIs) were estimated.ResultsWe ultimately identified four studies that met the criteria. These studies comprised 80 patients with 16 males and 64 females. The mean age was 53.25. The main types of PH were group I (pulmonary arterial hypertension, 95%) and group IV (chronic thromboembolic PH, 5%). No severe adverse events were reported in the included studies. IMT had a significant effect on improving MIP (18.89 cmH2O; 95% CI: 9.43–28.35, P < 0.001) and MEP (8.06 cmH2O; 95% CI: 2.39–13.73; P = 0.005), increase in the 6MWD (30.16 m; 95% CI: 1.53–58.79; P = 0.04). No significant improvement was found in pulmonary function (P > 0.05), and uncertain effect on the quality of life (QoL) score.ConclusionBased on currently limited evidence, IMT is an effective physical therapy for increasing respiratory muscle function and exercise capacity, but still a lack of evidence on dyspnea and fatigue levels, pulmonary function, and QoL in PH patients. There are reasons to believe that IMT is a promising intervention in PH patients, enriching rehabilitation options and serving as a bridge before formal exercise training. It is expected that IMT will play an important role in the future clinical pathway of physical therapy for this group of patients.Systematic review registration[https://www.crd.york.ac.uk/PROSPERO/logout.php], identifier [CRD42022335972].https://www.frontiersin.org/articles/10.3389/fcvm.2022.999422/fullpulmonary hypertensioninspiratory muscle trainingmaximal inspiratory pressureexercise capacityquality of life |
| spellingShingle | Zeruxin Luo Hong Qian Xiu Zhang Yuqiang Wang Jing Wang Pengming Yu Effectiveness and safety of inspiratory muscle training in patients with pulmonary hypertension: A systematic review and meta-analysis Frontiers in Cardiovascular Medicine pulmonary hypertension inspiratory muscle training maximal inspiratory pressure exercise capacity quality of life |
| title | Effectiveness and safety of inspiratory muscle training in patients with pulmonary hypertension: A systematic review and meta-analysis |
| title_full | Effectiveness and safety of inspiratory muscle training in patients with pulmonary hypertension: A systematic review and meta-analysis |
| title_fullStr | Effectiveness and safety of inspiratory muscle training in patients with pulmonary hypertension: A systematic review and meta-analysis |
| title_full_unstemmed | Effectiveness and safety of inspiratory muscle training in patients with pulmonary hypertension: A systematic review and meta-analysis |
| title_short | Effectiveness and safety of inspiratory muscle training in patients with pulmonary hypertension: A systematic review and meta-analysis |
| title_sort | effectiveness and safety of inspiratory muscle training in patients with pulmonary hypertension a systematic review and meta analysis |
| topic | pulmonary hypertension inspiratory muscle training maximal inspiratory pressure exercise capacity quality of life |
| url | https://www.frontiersin.org/articles/10.3389/fcvm.2022.999422/full |
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