Effect of respiratory muscle training in patients with chronic kidney disease: A systematic review and meta-analysis of randomized controlled trials

Abstract

Objective This systematic review and meta-analysis aimed to evaluate the effect of respiratory muscle training on respiratory muscle strength, lung function, cardiopulmonary fitness, and quality of life for chronic kidney disease patients. Methods PubMed, Embase, Web of Science Core Collection, and Cochrane Central Register of Controlled Trials published randomized controlled trials that evaluated the effect of respiratory muscle training for chronic kidney disease patients from inception to December 2021, and rerun on September 2022. The quality of included studies was evaluated according to the Cochrane Collaboration's risk of bias tool-2. The outcomes were analyzed as mean differences with a fixed/random effect model. The strength of evidence was evaluated with the Grading of Recommendation, Assessment, Development, and Evaluation approach. Results Eleven randomized controlled trials were included. All but two of the studies were in hemodialysis patients. The follow-up time range was 4 to 12 weeks. Compared to controls, respiratory muscle training significantly improved maximal expiratory pressure (mean difference = 17.36, p = 0.013), maximal inspiratory pressure (mean difference = 18.26, p = 0.002), forced expiratory volume at 1 second (mean difference = 0.20, p= 0.020), forced vital capacity (mean difference = 0.26, p = 0.008), but not for 6-minute walk test (mean difference = 39.85, p= 0.138). Conclusions As a non-pharmacological therapy, respiratory muscle training can effectively improve maximal expiratory pressure, maximal inspiratory pressure, forced expiratory volume at 1 second, and forced vital capacity in patients with chronic kidney disease and is safe for such populations.

Application of exercise therapy in patients with chronic kidney disease-induced muscle atrophy: a scoping review

“…The distribution of the studies by year and geographic location is presented in the supplementary figure. Among the 20 pieces of literature included in this study, 14 literatures described RCTs [ 12 – 27 ] and six literatures are quantitative non-random studies [ 10 , 11 , 13 , 19 , 22 , 29 ]. Table 1 lists the characteristics of the included literature and is discussed below.…”

“…The exercise intervention scheme mainly includes resistance exercise [ 12 – 28 ], aerobic exercise [ 23 , 29 ], and aerobic exercise combined with resistance exercise [ 13 , 15 , 22 , 24 ]. (1) Currently, resistance training is the most prevalent form of exercise intervention.…”

“…Furthermore, there are resistance exercises for the hip joint, such as leg compression and hip flexion. (2) The aerobic exercise intervention scheme primarily consists of several modalities, such as bicycle modalities [ 11 , 16 ], treadmill exercise [ 13 ], Baduanjin [ 29 ], and steady-state walking [ 23 ]. In this context, Luca et al [ 23 ] used steady-state walking as an intervention plan for aerobic exercise and examined the impact of this simple aerobic exercise on the subjects.…”

“…Two studies [ 21 , 27 ] assessed the exercise intensity of the subjects based on maximum repetitions (RM) and the percentage of maximum loading (1RM) of the exercise load. Four studies [ 13 , 15 , 16 , 19 ] set the exercise intensity based on the subjects' cardiopulmonary function indexes. This was achieved by measuring the heart rate of the patients during exercise as a reference, setting the appropriate exercise intensity after evaluating the heart rate at the maximum exercise intensity they could tolerate.…”

Comparison of the effects of two extraction methods on the alveolar ridge preservation of Maxillary Anterior Teeth

“…In traditional tooth extraction, it is inevitable that the soft and hard tissues around the affected tooth will be damaged. 12 , 13 In particular, the labial bone plate in the anterior teeth area is weak, and tooth extraction often leads to the destruction of the labial bone plate. 14 - 17 Therefore, it is of great significance for the retention of the labial bone plate in the maxillary anterior region.…”