Comprehensive Respiratory Muscle Training Improves Pulmonary Function and Respiratory Muscle Strength in Acute Stroke Patients

Abstract

To evaluate the effects of respiratory muscle training (RMT) on pulmonary function, respiratory complications, and stroke-related disabilities in patients with acute stroke. Methods: One hundred twenty-two subjects with stroke admitted to the stroke rehabilitation center of Inje Hospital between August 2016 and May 2018 were recruited. After the initial exclusion, the remaining patients were assigned to the RMT group (36 patients) or the standard rehabilitation (SR) group (28 patients who did not undergo RMT). A total of 44 patients completed the study, with 22 patients in each group. The RMT program consisted of air-stacking exercise, manually assisted coughing, inspiratory and expiratory muscle strengthening, cough exercises, and respiratory reeducation. Pulmonary function and respiratory muscle strength were evaluated before commencement and after 1 mo of RMT. The Functional Ambulation Category score, Korean version of the Modified Barthel Index, Shoulder Abduction and Finger Extension score, and handgrip power were assessed. The incidence of pneumonia was also evaluated. Results: Both pulmonary function and respiratory muscle strength significantly improved in both groups. However, differences (%) in the RMT group was greater for all parameters of pulmonary function and respiratory muscle strength. Respiratory complications at 1 yr were significantly lower in the RMT group (P = .016). Conclusion: Four weeks of comprehensive RMT in patients with acute stroke resulted in significantly greater improvements in both pulmonary function and respiratory muscle strength than SR. Therefore, RMT has the potential to reduce post-stroke respiratory complications.

Respiratory Muscle Training Reduces Respiratory Complications and Improves Swallowing Function After Stroke: A Systematic Review and Meta-Analysis

“…The 11 included trials 13,19,20,[35][36][37][38][39][40][41][42] involved 523 participants and investigated the effect of respiratory muscle training on respiratory complications (n=7), swallowing function (n=5), and cough function (n=4) after stroke. Ten studies performed respiratory muscle training with a threshold resistance trainer for inspiratory or expiratory muscle.…”

“…Seven trials were RCTs with a clear method of randomization, 13,19,20,37,38,40 and 4 trials were alleged RCTs but had unknown methodology and were thus defined as possible RCTs. 35,36,39,42…”

“…In all trials, the experimental intervention was respiratory muscle training delivered by a threshold resistance trainer or flow-oriented resistance trainer. The respiratory muscle training targeted the expiratory muscles, 20,35,39,40 a combination of inspiratory and expiratory muscles, 13,37,38,41,42 and inspiratory and expiratory muscles to separate participants. 19,36 Participants undertook training for 30 to 40 minutes (or 25 to 50 repetitions), 4 to 14 times per week for 3 to 13 weeks.…”

“…Occurrence of respiratory complications was measured in 7 trials 13,19,20,36,38,41,42 ; it was reported as number of participants with pneumonia in 5 trials 13,19,36,41,42 and as number of participants with lung infections in 1 trial 20 after the commencement of training. In Menezes et al's trial, 38 there was no specific information about respiratory complications.…”

“…Swallowing function was measured in 5 trials using the PAS (1-8 points) in 4 trials 13,35,39,40 and FOIS (1-7 points) in 3 trials. 13,37,40 Cough function was measured in 4 trials 19,36,37,42 using PECF-VC or PECF-RC.…”