Effects of the inspiratory muscle training and aerobic training on respiratory and functional parameters, inflammatory biomarkers, redox status and quality of life in hemodialysis patients: A randomized clinical trial

Abstract

ObjectiveEvaluate and compare the isolated and combined effects of Inspiratory Muscle Training (IMT) and Aerobic Training (AT) on respiratory and functional parameters, inflamatory biomarkers, redox status and health-related quality of life (HRQoL) in hemodialysis patients.MethodsA randomised controlled trial with factorial allocation and intention-to-treat analysis was performed in hemodialysis patients. Volunteers were randomly assigned to performe 8-weeks of IMT at 50% of maximal inspiratory pressure (MIP), low intensity AT or combined training (CT). Before the interventions, all the volunteers went 8-weeks through a control period (without training). Measures are taken at baseline, 8-week (after control period) and 16-week (after the interventions). Primary outcomes were functional capacity (incremental shuttle walk test), MIP and lower limbs strength (Sit-to-Stand test of 30 seconds). Plasma levels of interleukin-6 (IL-6), soluble tumor necrosis factor receptor 1 (sTNFR1) and 2 (sTNFR2), adiponectin, resistin and leptin, redox status parameters and HRQoL (KDQOL-SF questionnaire) were the scondary outcomes. Data analyses were performed by two-way repeated measurements ANOVA.Results37 hemodialysis patients aged 48.2 years old (IC95% 43.2–54.7) were randomized. Increase of MIP, functional capacity, lower limbs strength and resistin levels, and reduction of sTNFR2 levels in 16-week, compared to baseline and 8-week, were observed in all the groups (p<0.001). IMT improved functional capacity, MIP and lower limbs strength in 96.7m (IC95% 5.6–189.9), 34.5cmH2O (IC95% 22.4–46.7) and 2.2repetitions (IC95% 1.1–3.2) respectively. Increase in resistin leves and reduction in sTNFR2 leves after IMT was 0.8ng/dL (IC95% 0.5–1.1) and 0.8ng/dL (IC95% 0.3–1.3), respectively, without between-group differences. Compared to baseline and 8-week, adiponectin levels (p<0.001) and fatigue domain of the HRQoL (p<0.05) increased in 16-week only in CT.ConclusionIMT, AT and CT improved functional parameters and modulated inflammatory biomarkers, in addition, IMT provoked a similar response to low intensity AT in hemodialysis patients.Trial registrationRegistro Brasileiro de Ensaios clínicos RBR-4hv9rs.

Effectiveness of inspiratory muscle training on respiratory fitness and breathlessness in chronic renal failure: A randomized control trial

“…The major findings were that RM training by using threshold IM training device increased in only MIP and FVC values but not in the MEP, FEV 1 , and FEV 1 /FVC ratio among patients with CRF undergoing hemodialysis. These results are quite consistent with others studies (El‐Deen, Alanazi, & Ahmed, 2018; Figueiredo et al, 2012; Figueiredo et al, 2018; Pellizzaro et al, 2013). Moreover, a systematic review and meta‐analysis of IM training with randomized trials indicated the effects of IM training improved respiration muscles, when compared with a control or sham group (clinical important difference was 22 cmH 2 O; 95% CI 16–29) with two randomized control trials, FEV 1 values (mean difference was 0.24 L 95% CI 0.14–0.34), but not in FVC values (de Medeiros et al, 2017).…”

A novel respiratory device and the application of cardiorespiratory performance to hemodialysis patients

“…The study reported that use of respiratory prototype program could improve respiratory muscle strength, functional capacity and rate of dyspnea in hemodialysis patients. These results are in line with the previous studies 1, [5][6][7][8] .…”

Effect of inspiratory muscle training on respiratory muscle strength and functional capacity in patients with type 2 diabetes mellitus: A randomized clinical trial

“…Several studies on healthy and diseased populations have demonstrated an association between the findings of diaphragmatic electromyography and the severity of dyspnea 26‐28 . Consistent with our results, many studies on different healthy and diseased populations have shown that IMT reduces the severity of dyspnea and improves exercise and functional capacity 26,29‐33 …”