Article

PURPOSE: To evaluate the effectiveness of a home-based inspiratory muscle
training (IMT) programme using multiple inspiratory muscle tests. METHOD:
Sixty-eight patients (37 M) with moderate to severe chronic obstructive pulmonary
disease (COPD) (Mean [SD], FEV1 36.1 [13.6]% pred.; FEV1/FVC 35.7 [11.2]%) were
randomised into an experimental or control group and trained with a threshold
loading device at intensity >30% maximum inspiratory pressure (PImax) or <15%
PImax, respectively, for 7 weeks. Thirty-nine patients (23 M) completed the
study. The following measures were assessed pre- and post-IMT: PImax, sniff
inspiratory nasal pressure (SNIP), diaphragm contractility (Pdi,tw), incremental
shuttle walk test (ISWT), respiratory muscle endurance (RME), chronic respiratory
disease questionnaire (CRDQ), the hospital anxiety and depression scale (HADS)
and the SF-36. Between-group changes were assessed using one-way analysis of
variance (ANOVA). RESULTS: PImax and perception of well-being improved
significantly post-IMT [p = 0.04 and <0.05 in four domains, respectively]. This
was not reflected in SNIP [p = 0.7], Pdi,tw [p = 0.8], RME [p = 0.9] or ISWT [p =
0.5]. CONCLUSIONS: A seven-week, community-based IMT programme, with realistic
use of health-care resources, improves PImax and perception of well-being but a
different design may be required for improvement in other measures. Multiple
tests provide a more comprehensive evaluation of changes in muscle function
post-IMT. IMPLICATIONS FOR REHABILITATION: A seven-week, home-based inspiratory
muscle training programme improves maximal inspiratory pressure and perception of
well-being in patients with moderate to severe COPD but not sniff nasal
inspiratory pressure or diaphragm contractility, respiratory muscle endurance and
exercise capacity. Multiple tests are recommended for a more comprehensive
assessment of changes in muscle function following inspiratory muscle training
programmes. Therapists need to explore different community-based inspiratory
muscle training regimes for COPD patients and identify the optimal exercise
protocol that is likely to lead to improvements in diaphragm contractility and
exercise capacity.

Langue : ANGLAIS