Effects of inspiratory muscle training on respiratory muscle strength, lung function, functional capacity and cardiac autonomic function in Parkinson's disease: Randomized controlled clinical trial protocol

Abstract

Background Individuals with Parkinson's disease (PD), in addition to motor impairment, may evolve with respiratory and autonomic nervous system disorders. Currently, there are few studies with emphasis on muscle and pulmonary dysfunction and that verify the benefits of inspiratory muscle training (IMT) in this population. Aim The aim of this study was to evaluate whether IMT is effective for the improvement of respiratory muscle strength, lung function, thoracic mobility, functional capacity and cardiac autonomic function in PD. Methods A randomized and controlled trial will be conducted with 26 participants with idiopathic PD, with aged between 50 and 65 years, in the Stages I to III by the Modified Hoehn and Yahr Scale. Respiratory muscle strength will be performed by manovacuometry and lung function by spirometry. Functional capacity will be evaluated by the 6‐min walk test and autonomic cardiac function by heart rate variability. In addition, thoracic mobility measurement will also be performed. After the evaluations, these participants will be randomly assigned to two groups: the IMT group with Powerbreathe®, which will perform the eight series of 2 min each, with 1 min of rest between them, totaling 30 min, at 60% of the maximum inspiratory pressure and the control group, who will perform the same training protocol but with the load maintained at 9 cmH2O. All participants will be submitted to the same motor training protocol. Conclusion It is expected that IMT increases the inspiratory muscle strength, contributing to the improved expiratory muscle strength, lung function, thoracic mobility, functional capacity and cardiac autonomic function in individuals with mild to moderate PD.

The Effects of Respiratory Training in Parkinson’s Disease: A Systematic Review

“…Pre-post intervention studies (that had been excluded from the analyses) showed similar positive effects for either strength training (EMST and IMST) and other respiratory training techniques like air stacking, or deep breathing exercises (plus upper extremity exercises) and (global) postural training to improve respiratory function tests, swallowing safety and phonatory aspects. [24,[26][27][28][31][32][33][34][35][36][37] This confirms that the positive results are robust, but also indicates that more high-quality studies for both respiratory strength training and volume-oriented training techniques remain needed. The included studies all showed positive effects, but the magnitude of the effects was different.…”

Relationships between respiratory muscle strength, chest wall expansion, and functional capacity in healthy nonsmokers

“…A randomized controlled trial in individuals with mild to moderate Parkinson disease suggested that increases in inspiratory muscle strength contribute to improved expiratory muscle strength, thoracic mobility, and functional capacity (Montero Ferro et al, 2019). As mentioned, it is likely that respiratory muscle strength is directly associated with chest wall expansion (Jung and Kim, 2018) and the latter directly correlates with lung volume (Ray et al, 2013).…”

Effects of Respiratory Muscle Strength Training on Respiratory-Related Impairments of Parkinson's Disease

“…Recently, some researchers have concentrated on the simultaneous effects of RMST on lung and cardiovascular autonomic nervous function. Alyne Montero Ferro designed the study protocol to investigate the impact of IMST on the cardiac autonomic nerve and pulmonary function in 26 PD patients (modified Hoehn Yahr scale, Stage I ~ III) (Montero Ferro et al, 2019 ). Huang et al recruited 75 individuals with PD.…”

“…Respiratory muscle strength training (RMST) can improve respiratory muscle strength and may prevent aspiration pneumonia (Troche et al, 2010 ; Kuo et al, 2017 ; Claus et al, 2021 ). Emerging applications using RMST, such as speech rehabilitation, have also been proposed (Montero Ferro et al, 2019 ; Huang et al, 2020a , 2021 ; Reyes et al, 2020a , b ; Cocks et al, 2022 ). 2014 European Physiotherapy Guideline for PD rehabilitation suggested that RMST can improve respiratory-related disorders of PD (Keus et al, 2014 ).…”