Expiratory and Expiratory Plus Inspiratory Muscle Training Improves Respiratory Muscle Strength in Subjects With COPD: Systematic Review

Abstract

BACKGROUND: Inspiratory muscle training (IMT) produces beneficial effects in COPD subjects, but the effects of expiratory muscle training (EMT) and EMT plus IMT in ventilatory training are still unclear. The aim of this study was to systematically review the effects of EMT and EMT plus IMT compared to control groups of COPD subjects. METHODS: This study is a systematic review and meta-analysis. The search strategy included MEDLINE, Embase, LILACS, PEDro, and Cochrane CENTRAL and also manual search of references in published studies on the subject. Randomized trials comparing EMT and EMT plus IMT versus control groups of subjects with COPD were included. The outcomes analyzed were respiratory muscle strength and functional capacity. Two reviewers independently extracted the data. RESULTS: The search retrieved 609 articles. Five studies were included. We observed that EMT provided higher gain in maximum expiratory pressure (P E max 21.49 cm H 2 O, 95% CI 13.39 -29.59) and maximum inspiratory pressure (P I max 7.68 cm H 2 O, 95% CI 0.90 -14.45) compared to control groups. There was no significant difference in the 6-min walk test distance (29.01 m, 95% CI ؊39.62 to 97.65) and dyspnea (0.15, 95% CI ؊0.77 to 1.08). In relation to EMT plus IMT, we observed that P E max (31.98 cm H 2 O, 95% CI 26.93-37.03) and P I max (27.98 cm H 2 O, 95% CI 20.10 -35.85) presented higher values compared to control groups. CONCLUSIONS: EMT and EMT plus IMT improve respiratory muscle strength and can be used as part of the treatment during pulmonary rehabilitation of subjects with severe to very severe COPD.

Home or community-based pulmonary rehabilitation for individuals with chronic obstructive pulmonary disease: a systematic review and meta-analysis

“…According to another systematic review, PR is effective when compared to control conditions for the same outcomes, even with different approaches in each physical exercise program 15 . A variety of physical training methods can be used during PR, including strength training, interval training, upper body training, inspiratory and expiratory muscle training, and transcutaneous electrical stimulation, in addition to aerobic training generally used in programs 9,16 .…”

Deviation in the recovery of the lower limb and respiratory muscles of patients with polymyositis: a preliminary clinical study

“…However, these studies did not evaluate the respiratory muscles. Notably, previous studies showed that the respiratory muscle strength of patients with chronic obstructive pulmonary disease was improved by physiotherapy, and that these improvements in inspiratory and expiratory muscle strength did not differ significantly17, 18 ) . Our results indicate there is a difference between inspiratory and expiratory muscle strength improvements among PM patients.…”

A Comparison between Two Types of Resistive Inspiratory Muscle Training Devices in Normal Subjects in Regards to Pulmonary Functions

“…Likewise, Enright and Unnithan [12] have conclude that using IMT with load of 60-80% of MIP on healthy subjects will increase their respiratory muscle strength which characterized by increase of both MIP and MEP. Not to forget to mention that other systematic review and meta-analysis Neves et al, [28] stated that IMT devices combined with EMT used with COPDs had a significant impact on both MIP and MEP which reflect muscle strength. This could be a strong indicator that improvement in muscle strength with COPDs might also reflect some improvements on healthy individuals with low activity level.…”