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Effect of respiratory muscle training in asthma: A systematic review and meta-analysis - 06/05/23

Doi : 10.1016/j.rehab.2022.101691 
Ana Lista-Paz a, b, , Lucía Bouza Cousillas a, Cristina Jácome c, Guilherme Fregonezi d, e, Noé Labata-Lezaun f, g, Luis Llurda-Almuzara f, g, Albert Pérez-Bellmunt f, g
a University of A Coruña, Faculty of Physiotherapy, A Coruña, Spain 
b Psychosocial and Functional Rehabilitation Intervention Research Group, The University of A Coruña, A Coruña, Spain 
c Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto (FMUP), Porto, Portugal 
d PneumoCardioVascular Lab/HUOL, Hospital Universitário Onofre Lopes, Empresa Brasileira de Serviços Hospitalares and Departamento de Fisioterapia Universidade Federal do Rio Grande do Norte, Natal, Brazil 
e Laboratório de Inovação Tecnológica em Reabilitação, Departamento de Fisioterapia, Universidade Federal do Rio Grande do Norte, Natal, Brazil 
f Faculty of Medicine and Health Sciences. Universitat Internacional de Catalunya (UIC-Barcelona), Spain 
g ACTIUM Functional Anatomy Group. Barcelona, Spain 

Corresponding author at: Faculty of Physiotherapy, The University of A Coruña, Campus Universitario de Oza, nº1, 15006, A Coruña, Spain.Faculty of PhysiotherapyThe University of A CoruñaCampus Universitario de Oza, nº1A Coruña15006Spain

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Abstract

Background

The last systematic review about respiratory muscle training (RMT) in people with asthma was published almost 10 years ago. Since then, several works have been published.

Objective

To review the effect of RMT in people with asthma.

Methods

We conducted a systematic review of research included up to September 2021 in PubMed/MEDLINE, PEDro, Scopus, Web of Science, CINAHL, LILACS, Cochrane Central Register of Controlled Trials and ClinicalTrials.gov. We included randomized controlled trials and quasi-experimental studies assessing the effect of RMT on respiratory muscle function, rescue medication, asthma-related symptoms, lung function, exercise capacity, healthcare use, health-related quality of life (HRQoL) and adverse effects in people with asthma. Risk of bias and methodological quality were assessed with the Cochrane Risk of Bias assessment tool and the PEDro scale. Meta-analysis was performed whenever possible; otherwise a qualitative approach was followed.

Results

Eleven studies (270 participants) were included, 10 with only adults and were included in the meta-analysis. Inspiratory muscle training (IMT) had beneficial effects on maximal inspiratory pressure (PImax: mean difference [MD] 21.95 cmH2O [95% confidence interval [CI] 15.05; 28.85]), with no changes in maximal expiratory pressure (MD 14.97 cmH2O [95%CI -5.65; 35.59]), lung function (forced expiratory volume in 1 sec: MD 0.06 [95%CI -0.14; 0.26] L; force vital capacity: MD 0.39 [95%CI -0.24; 1.02] L) and exercise capacity (standard mean difference [SMD] 1.73 [95%CI -0.61; 4.08]). Subgroup analysis revealed that IMT load >50% PImax and duration >6 weeks were beneficial for exercise capacity. The qualitative analysis suggested that IMT may have benefits on respiratory muscle endurance, rescue medication and exertional dyspnoea, with no adverse effects.

Conclusions

This systematic review and meta-analysis showed a significant increase in PImax after IMT in adults with asthma and reinforced the relevance of the dose–response principle of training. More evidence is needed to clarify the effect of IMT in respiratory muscle endurance, rescue medication, exercise capacity, healthcare use and HRQoL.

Trial Registration

PROSPERO International Prospective Register of Systematic Reviews CRD42020221939; display_record.php?RecordID=221939

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Keywords : Asthma, Breathing exercises, Physical therapy modalities, Maximal respiratory pressures, Systematic review


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Vol 66 - N° 3

Article 101691- avril 2023 Retour au numéro
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