High-intensity respiratory muscle training improves strength and dyspnea after stroke: a double-blind randomized trial

Publication date: Available online 12 October 2018

Source: Archives of Physical Medicine and Rehabilitation

Author(s): Kênia Kiefer Parreiras de Menezes, Lucas Rodrigues Nascimento, Louise Ada;, Patrick Roberto Avelino, Janaine Cunha Polese, Maria Tereza Mota Alvarenga, Mariana Hoffman Barbosa, Luci Fuscaldi Teixeira-Salmela

Abstract

Objective

To examine whether high-intensity home-based respiratory muscle training, ie, with higher loads, delivered more frequently and for longer duration, than previously applied, would increase the strength and endurance of the respiratory muscles, reduce dyspnea and respiratory complications, and improve walking capacity after stroke.

Design

Randomized trial with concealed allocation, blinded participants and assessors, and intention-to-treat analysis.

Setting

Community patients.

Participants

38 patients with stroke, who had respiratory muscle weakness.

Interventions

The experimental group received 40-min high-intensity home-based respiratory muscle training, seven days/week, for eight weeks, progressed weekly. The control group received a sham intervention of similar dose.

Main outcome measures

Primary outcome was inspiratory muscle strength (via maximal inspiratory pressure), while secondary outcomes were expiratory muscle strength (minimal expiratory pressure), inspiratory muscle endurance, dyspnea (Medical Research Council score), respiratory complications (hospitalizations), and walking capacity (six-minute walk test). Outcomes were measured at baseline, after intervention, and one month beyond intervention.

Results

Compared to the control, the experimental group increased inspiratory (27cmH₂O; 95%CI 15 to 40) and expiratory (42cmH₂O; 95%CI 25 to 59) strength, inspiratory endurance (33 breathes; 95%CI 20 to 47) and reduced dyspnea (1.3 out of 5.0; 95%CI 2.1 to 0.6) and the benefits were maintained at one-month beyond training. There was no significant between-group difference for walking capacity or respiratory complications.

Conclusion

High-intensity home-based respiratory muscle training was effective in increasing strength and endurance of the respiratory muscles and reducing dyspnea for people with respiratory muscle weakness after stroke, and the magnitude of the effect was higher, than that previously reported in studies, which applied standard protocols.

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