The short and largely home-based IMT protocol significantly improved inspiratory muscle function in both groups and is an alternative to traditional IMT protocols in this population. Participants in the TFRL group tolerated higher training loads and achieved larger improvements in inspiratory muscle function than those in the MTL group.

Objectives: To identify exercise tests that are suitable for home-based or remote administration in people with chronic lung disease. Methods: Rapid review of studies that reported home-based or remote administration of an exercise test in people with chronic lung disease, and studies reporting their clinimetric (measurement) properties. Results: 84 studies were included. Tests used at home were the 6-minute walk test (6MWT, two studies), sit-to-stand tests (STS, five studies), Timed Up and Go (TUG, 4 studies) and step tests (two studies). Exercise tests administered remotely were the 6MWT (two studies) and step test (one study). Compared to centre-based testing the 6MWT distance was similar when performed outdoors but shorter when performed at home (two studies). The STS, TUG and step tests were feasible, reliable (intra-class correlation coefficients >0.80), valid (concurrent and known groups validity) and moderately responsive to pulmonary rehabilitation (medium effect sizes). These tests elicited less desaturation than the 6MWT, and validated methods to prescribe exercise were not reported. Discussion: The STS, step and TUG tests can be performed at home, but do not accurately document desaturation with walking or allow exercise prescription. Patients at risk of desaturation should be prioritised for centre-based exercise testing when this is available.

ObjectivesThe aim of this systematic review of randomised controlled trials (RCTs), and quasi-experimental and retrospective studies is to investigate the effects of pulmonary rehabilitation (PR) in patients with advanced chronic disease on the waiting list for lung transplantation.SettingPR performed for inpatient or outpatient lung transplant candidates.InterventionPR programme including aerobic exercise training and/or resistance exercise training.Primary and secondary outcomesQuality of life and exercise capacity (primary outcomes). Survival rate after transplant surgery; pulmonary function; respiratory muscle strength; psychological aspects; upper and lower extremity muscle strength and adverse effects (secondary outcomes). Two review authors independently selected the studies, assessed study quality and extracted data. Studies in any language were included.ResultsThis was a systematic review and studies were searched on the Cochrane Library, MEDLINE, EMBASE, CINAHL and PEDro. Experimental and retrospective studies evaluating the effects of PR in candidates for lung transplantation (>18 years old) with any lung diseases were included. 2 RCTs, and two quasi-experimental and two retrospectives studies, involving 1305 participants were included in the review. 5 studies included an enhancement reported in quality of life using the Short Form 36 questionnaire and showed improvements in some domains. All studies included exercise capacity evaluated through 6 min walk test and in five of them, there were improvements in this outcome after PR. Owing to the different characteristics of the studies, it was not possible to perform a meta-analysis.ConclusionsStudies included in this review showed that PR is an effective treatment option for patients on the waiting list for lung transplantation and can improve quality of life and exercise capacity in those patients. Although individual studies reported positive effects of PR, this review shows that there is a need for more studies of a high methodological quality addressing PR effects in lung transplant candidates.Trial registration numberPROSPERO CDR42015025110.

Despite the increase in asynchrony, both breathing exercises were able to improve chest wall volumes without affecting dyspnea. The combination of exercises maintained the benefits but did not reduce the adverse effects of diaphragmatic breathing.

IntroductionRespiratory muscle dysfunction has been associated with failure to wean from mechanical ventilation. It has therefore been hypothesised that these patients might benefit from inspiratory muscle training (IMT). Evidence, however, is thus far limited to data from small, single-centre studies with heterogeneity in inclusion criteria, training modalities and outcomes. The aim of this study is to evaluate the effects of a novel IMT method on weaning outcomes in selected patients with weaning difficulties.MethodsThis study is designed as a double-blind, parallel-group, randomised controlled superiority trial with 1:1 allocation ratio. Patients with weaning difficulties will be randomly allocated into either an IMT group (intervention) or a sham-IMT group (control). Ninetypatients (45 in each group) will be needed to detect a 28% difference in the proportion of weaning success between groups (estimated difference in primary outcome based on previous studies) with a risk for type I error (α) of 5% and statistical power (1-β) of 80%. Patients will perform four sets of 6–10 breaths daily against an external load using a tapered flow resistive loading device (POWERbreathe KH2, HaB International, UK). Training intensity in the intervention group will be adjusted to the highest tolerable load. The control group will train against a low resistance that will not be modified during the training period. Training will becontinued until patients are successfully weaned or for a maximum duration of 28 days. Pulmonary and respiratory muscle function, weaning duration, duration of mechanical ventilation, ventilator-free days and length of stay in the intensive care unit will be evaluated as secondary outcomes. Χ2 tests and analysis of covariance with adjustments for baseline values of respective outcomesas covariates will be used to compare results after the intervention period between groups.Ethics and disseminationEthics approval was obtained from the local ethical committee (Ethische Commissie Onderzoek UZ/KU Leuven protocol ID: S60516). Results from this randomised controlled trial will be presented at scientific meetings as abstracts for poster or oral presentations and published in peerreviewed journals.Trial statusEnrolment into the study have started in August 2017. Data collection and data analysis are expected to be completed in September 2021.Trial registration numberNCT03240263.

Objective: To evaluate the efficacy of an inspiratory muscle training protocol on inspiratory muscle function, functional capacity, and quality of life in patients with asthma. Design: A single-blind, randomized controlled clinical trial. Setting: Community-based. Subjects: Patients with asthma, aged between 20 and 70 years old, non-smokers. Interventions: Participants were randomized into two groups: inspiratory muscle training group performed inspiratory muscle training 5 days a week for 8 weeks, consisting of six sets of 30 breaths per day with a training load ⩾50% of maximal inspiratory pressure, plus an educational program; the control group only received the educational program. Main measurements: Maximal inspiratory pressure, inspiratory muscle endurance, and the distance performed on the incremental shuttle walking test were assessed pre-intervention, post-intervention and at follow-up (3 months after the end of the intervention). The asthma quality of life questionnaire was applied pre and post-intervention. Results: Data from 39 participants were analyzed. Maximal inspiratory pressure in percentage of predicted and endurance test duration were significantly higher post-intervention in the inspiratory muscle training group (∆ post–pre: 50.8% vs 7.3% of predicted – P < 0.001 and ∆ post–pre: 207.9 seconds vs 2.7 seconds – P < 0.001, respectively). There was no significant difference in the incremental shuttle walking distance between groups (∆ post–pre: 30.9 m vs −8.1 m, P = 0.165). Quality of life was perceived as significantly better, without a difference between groups ( P > 0.05). Conclusions: About 8 weeks of inspiratory muscle training in patients with controlled asthma significantly increased inspiratory muscle strength and endurance.

There were improvements in breathlessness, daily activities, mobility, and communication, which positively affected the psychological and social aspects of the patients.

Optoelectronic plethysmography (OEP) has been used to measure changes in chest wall volume and its compartments. However, literature lacks research on its reliability. The purpose of this study was to evaluate the intra-rater and inter-rater reliability of OEP. Thirty-two healthy subjects were evaluated at rest and during submaximal exercise on a cycle ergometer. The following variables were assessed: chest wall volume (VCW); percentage contribution of the pulmonary rib cage (V(rcp)%), abdominal rib cage (V(rca)%), rib cage (V(rc)%) and abdomen (Vab%); chest wall end-expiratory volume (Vee(cw)); chest wall end-inspiratory volume (Vei(cw)); ratio of inspiratory time to total time of the respiratory cycle (Ti/T(tot)); respiratory rate (f) and mean inspiratory flow (V(cw)/Ti). Intraclass correlation coefficient (ICC) and coefficient of variation of Method Error (CV(ME)) were used to evaluate reliability. Results showed ICC values higher than 0.75 and CV(ME) values less than 10% for most variables at rest and during exercise indicating that OEP is a reliable instrument to assess chest wall volumes at rest and during exercise in healthy subjects.