Can inspiratory muscle training benefit patients after stroke? A systematic review and meta-analysis of randomized controlled trials

Abstract

Objectives: The aim of this study was to investigate the effects of inspiratory muscle training in post-stroke patients and to explore the effective training protocol. Data sources: PubMed/Medline, Web of Science, Scopus, Embase, Cochrane database, China National Knowledge Infrastructure, and China Science Periodical Database were searched through April 2020. Review methods: Trials examining effects of inspiratory muscle training on pulmonary function, cardiopulmonary endurance, pulmonary infection incidence, and quality of life in post-stroke patients were included. Subgroup analysis was performed to compare different training programs. Mean differences and risk ratios with 95% confidence intervals were presented. Risk of bias was assessed with the Cochrane tool. Results: Thirteen randomized controlled trials involving a total of 373 participants were identified. Meta-analysis conducted in 8 out of 13 trials revealed evidence for beneficial effects of inspiratory muscle training on forced vital capacity (MD: 0.47, 95% CI: 0.28–0.66), forced expired volume in 1 second (MD: 0.26, 95% CI: 0.18–0.35), 6-minute walk test (MD: 52.61, 95% CI: 25.22–80.01), maximum inspiratory pressure (MD: 18.18, 95% CI: 5.58–30.78), inspiratory muscle endurance (MD: 19.99, 95% CI: 13.58–26.40), and pulmonary infection incidence (RR: 0.11, 95% CI: 0.03–0.40). Omitting individual trials from the meta-analysis did not significantly change the results. The effective inspiratory muscle training protocol was suggested by subgroup analysis with three repetitions per week and more than 20 minutes per day for three weeks. Conclusion: Inspiratory muscle training can be considered as an effective intervention for improving pulmonary function and cardiopulmonary endurance, and reducing pulmonary infection incidence in patients after stroke.

Effectiveness of Nonpharmacological Interventions in the Field of Ventilation: An Umbrella Review

“…Twelve systematic reviews were carried out on a population with DPOC [ 13 , 15 , 16 , 21 , 30 , 35 , 40 , 42 , 43 , 51 , 53 , 54 ]. Two systematic reviews were carried out on a population with asthma [ 47 , 49 ], two were carried out on a population with amyotrophic lateral sclerosis [ 19 , 34 ], two were carried out on a population with multiple sclerosis [ 44 , 55 ], two were carried out on a population with Parkinson’s disease [ 11 , 20 ], three were carried out on people who were poststroke [ 12 , 18 , 37 ], one was carried out on a population with pulmonary fibrosis [ 25 ], and three were carried out on a population with lung cancer [ 14 , 26 , 45 ]. Six reviews focused on preoperatory preparation [ 24 ] and postoperatory preparation [ 31 , 33 , 52 , 56 ], and three reviews focused on the respiratory exercises for abdominal surgeries [ 17 , 50 , 57 ].…”

“…Respiratory muscle training (inspiratory and expiratory muscle training) and incentive spirometry improves respiratory muscle strength, peak expiratory flow (PEF), and pulmonary function [ 11 , 18 , 25 , 28 , 37 , 38 , 40 , 44 , 46 , 48 , 58 ].…”

“…Inspiratory muscle training (normocapnic hyperpnea, inspiratory resistance training, and threshold load) was an effective intervention for improving pulmonary function and cardiopulmonary resistance and decreasing the incidence of pulmonary infections in poststroke patients [ 18 , 37 ].…”

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.…”

Immediate Effects of Diaphragmatic Breathing with Cervical Spine Mobilization on the Pulmonary Function and Craniovertebral Angle in Patients with Chronic Stroke

“…In the case of patients with stroke, respiratory rehabilitation is necessary for the inhalation muscles because the more difficult it is for a patient to walk, the worse the effect on inhalation muscles is [ 7 , 8 ]. Threshold inspiratory muscle training was used as a method to improve inspiratory function in stroke patients [ 9 ].…”