Effectiveness of Respiratory Muscle Training for Pulmonary Function and Walking Ability in Patients with Stroke: A Systematic Review with Meta-Analysis

Abstract

Background: Neurological dysfunction due to stroke affects not only the extremities and trunk muscles but also the respiratory muscles. Aim: to synthesise the evidence available about the effectiveness of respiratory muscle training (RMT) to improve respiratory function parameters and functional capacity in poststroke patients. Methods: a systematic electronic search was performed in the MEDLINE, EMBASE, SPORTDiscus, PEDro and Web of Science databases, from inception to May 2020. Study selection and data extraction: randomised controlled trials (RCTs) that examined the effects of RMT versus non-RMT or sham RMT in poststroke patients. We extracted data about respiratory function, respiratory muscle strength and functional capacity (walking ability, dyspnea, balance, activities of daily life), characteristics of studies and features of RMT interventions (a type of RMT exercise, frequency, intensity and duration). Two reviewers performed study selection and data extraction independently. Results: nineteen RCTs met the study criteria. RMT improved the first second forced expiratory volume (FEV1), forced vital capacity (FVC), peak expiratory flow (PEF), maximal expiratory pressure (MEP), maximal inspiratory pressure (MIP) and walking ability (6 min walking test), but not Barthel index, Berg balance scale, and dyspnea. Conclusions: RMT interventions are effective to improve respiratory function and walking ability in poststroke patients.

Body composition and risk factors associated with sarcopenia in post-COVID patients after moderate or severe COVID-19 infections

“…Salem et al showed decreases in total lung capacity, forced vital capacity (FVC), forced expiratory volume (FEV 1 ), FEV 1 /FEV, and diffusing capacity for carbon monoxide [ 48 ]. Prior evidence in other populations as well as in COVID-19 patients has shown that pulmonary rehabilitation improves respiratory function and functional capacity [ 49 , 50 ].…”

Effects of Inspiratory Muscle Training on Respiration and Balance in Patients with Stroke: A Pilot Randomized Controlled Trial

“…IMT is one of the methods used to increase the respiratory muscle strength [30]. Pozuelo-Carrascosa et al [22] reported that respiratory muscle strengthening was effective in improving the lung function parameters, exhalation and inhalation muscle strength, and walking ability in patients after stroke.…”

“…IMT on postural stability and balance have been shown in a previous study [21]; if the respiratory muscle is strengthened, respiratory muscle fatigue is reduced, and exercise capacity is improved [14]. Since the respiratory muscles respond to training similarly to other skeletal muscles, the respiratory muscles must be trained just as the arm and leg muscles are trained in patients with stroke [22]. IMT is performed based on the principles of overload, specificity, and reversibility, which are the basic principles of skeletal muscle strengthening [23].…”

The use of respiratory muscle training in patients with pulmonary dysfunction, internal diseases or central nervous system disorders: a systematic review with meta-analysis

“…Respiratory muscle training (RMT) has long been used in many medical disciplines [ 8 ]. Respiratory muscles respond to training similarly to any other skeletal muscle [ 9 ]. In this regard, RMT consists of repetitive breathing exercises with hand-held respiratory trainer devices to provide pressure threshold or flow-dependent resistance against inhalation (inspiratory muscle training [IMT]) and/or exhalation (expiratory muscle training [EMT]) [ 10 ] to stimulate this musculature and to produce changes in the muscles’ structure.…”