Inspiratory muscle training in neuromuscular patients: Assessing the benefits of a novel protocol

Abstract

BACKGROUND: Neuromuscular diseases are characterized by the compromise of respiratory muscles, thoracic ventilation, muscle strength and coughing capacity. Patients have low quality of life and increased morbidity and mortality mostly due to respiratory impairment. OBJECTIVE: To assess the benefits of adding inspiratory muscle training to neuromuscular patients’ treatment and their compliance to the approach. METHODS: We conducted a single-center prospective study with neuromuscular patients with decreased maximal inspiratory pressure. We developed an inspiratory muscle training protocol with three-month duration and once-daily training. The protocol had a progressive intensity that was individually tailored based on patients’ baseline characteristics and tolerance. We used Powerbreathe Medic Classic devices to perform the training. RESULTS: There were 21 patients who met the inclusion criteria and were enrolled in the study. Muscular dystrophy (n= 12, 57.3%) and amyotrophic lateral sclerosis (n= 4, 19%) were the most common diseases. After three months of training, patients increased their maximal inspiratory muscle pressure (p= 0.002) and peak cough flow (p= 0.011). Compliance to the protocol was 99 ± 5.5%. CONCLUSIONS: This protocol showed significant improvements on pulmonary muscles function and might be considered as an adjunct treatment to neuromuscular treatment. However, these positive results require larger further studies to validate the clinical benefits long-term.

The Implementation of Inspiratory Muscle Training to Enhance Weaning from Mechanical Ventilation: A Systematic Literature Review

“…This is related to the previous study that ventilation mechanics increase in strength within two weeks of IMT (Bissett et al, 2016). The increase in respiratory muscle strength can be caused by the effects of exercise such as IMT and the MIP (Maximal Inspiration Pressure) test manoeuvre (Cabrita et al, 2021;Han et al, 2020;Tanriverdi et al, 2021) However, atrophy may occur quickly in ICU patients, especially in skeletal muscle and respiratory muscles (Spiesshoefer et al, 2020), if the patient is attached to a mechanical ventilator for more than five days. With an adequate training stimulus, the possibility of atrophy in the respiratory muscles will decrease in a relatively short period of time, so that it will help the ventilator weaning process.…”

Respiratory therapies for Amyotrophic Lateral Sclerosis: A state of the art review

“…Inspiratory strength training has been well-tolerated by patients and preserved or improved maximal inspiratory pressure (MIP) outcomes. 101,102 However, unresisted diaphragmatic breathing alone does not appear to preserve inspiratory function. 103 An early clinical trial of inspiratory strength training compared 12 weeks of exercise to a usual care control, followed by 8 weeks of detraining.…”

“…Inspiratory strength training has been well-tolerated by patients and preserved or improved maximal inspiratory pressure (MIP) outcomes. 101,102 However, unresisted diaphragmatic breathing alone does not appear to preserve inspiratory function. 103…”