Meral Bosnak-Guclu

Effects of inspiratory muscle training in patients with heart failure

AIM To investigate the effects of inspiratory muscle training (IMT) on functional capacity and balance, respiratory and peripheral muscle strength, pulmonary function, dyspnea, fatigue, depression, and quality of life in heart failure patients. METHODS A prospective, randomized controlled, double-blinded study. Thirty patients with heart failure (NYHA II-III, LVEF<40%) were included. Sixteen patients received IMT at 40% of maximal inspiratory pressure (MIP), and 14 patients received sham therapy (15% of MIP) for 6 weeks. Functional capacity and balance, respiratory muscle strength, quadriceps femoris muscle strength, pulmonary function, dyspnea, fatigue, quality of life, and depression were evaluated. RESULTS Functional capacity and balance, respiratory and peripheral muscle strength, dyspnea, depression were significantly improved in the treatment group compared with controls; quality of life and fatigue were similarly improved within groups (p < 0.05). Functional capacity (418.59 ± 123.32 to 478.56 ± 131.58 m, p < 0.001), respiratory (MIP = 62.00 ± 33.57 to 97.13 ± 32.63 cmH(2)O, p < 0.001) and quadriceps femoris muscle strength (240.91 ± 106.08 to 301.82 ± 111.86 N, p < 0.001), FEV(1)%, FVC% and PEF%, functional balance (52.73 ± 3.15 to 54.25 ± 2.34, p < 0.001), functional dyspnea (2.27 ± 0.88 to 1.07 ± 0.79, p < 0.001), depression (11.47 ± 7.50 to 3.20 ± 4.09, p < 0.001), quality of life, fatigue (42.73 ± 11.75 to 29.07 ± 13.96, p < 0.001) were significantly improved in the treatment group. Respiratory muscle strength (MIP = 78.64 ± 35.95 to 90.86 ± 30.23 cmH(2)O, p = 0.001), FVC%, depression (14.36 ± 9.04 to 9.50 ± 10.42, p = 0.011), quality of life and fatigue (42.86 ± 12.67 to 32.93 ± 15.87, p = 0.008) were significantly improved in the control group. CONCLUSION The IMT improves functional capacity and balance, respiratory and peripheral muscle strength; decreases depression and dyspnea perception in patients with heart failure. IMT should be included effectively in pulmonary rehabilitation programs.

International Physical Activity Questionnaire: Reliability and Validity of the Turkish Version:

Physical inactivity is a global problem which is related to many chronic health disorders. Physical activity scales which allow cross-cultural comparisons have been developed. The goal was to assess the reliability and validity of a Turkish version of the International Physical Activity Questionnaire (IPAQ). 1,097 university students (721 women, 376 men; ages 18–32) volunteered. Short and long forms of the IPAQ gave good agreement and comparable 1-wk. test-retest reliabilities. Caltrac accelerometer data were compared with IPAQ scores in 80 participants with good agreement for short and long forms. Turkish versions of the IPAQ short and long forms are reliable and valid in assessment of physical activity.

Comparison of functional exercise capacity, pulmonary function and respiratory muscle strength in patients with multiple sclerosis with different disability levels and healthy controls.

OBJECTIVE To compare functional exercise capacity, pulmonary function and respiratory muscle strength in fully ambulatory patients with multiple sclerosis with different disability levels and healthy controls, and to elucidate the determinant factors of functional exercise capacity. METHODS Forty-three fully ambulatory patients with multiple sclerosis and 30 healthy controls were included in the study. Patients were grouped according to Expanded Disability Status Scale (EDSS); Group I (EDSS 0-2), Group II (EDSS 2.5-4.5). Functional exercise capacity was evaluated using a six-minute walk test, and measurement of pulmonary function, and maximal inspiratory and expiratory pressures (MIP, MEP). The Pulmonary Index was used as a clinical predictor of respiratory dysfunction. RESULTS Respiratory muscle strength was lower in multiple sclerosis groups compared with controls, but the difference in MIP and %MIP did not reach statistical significance in Group I. The six-minute walk test distance was significantly shorter and peak expiratory flow was lower in multiple sclerosis groups (p < 0.05). Of the variance in the six-minute walk test distance, 75% was explained by EDSS (R2 = 0.55, p < 0.001), difference in heart rate (R2 = 0.06, p = 0.007), age (R2 = 0.05, p = 0.009) and gender (R2 = 0.09, p = 0.003). CONCLUSION Respiratory muscles are weakened, functional exercise capacity is reduced and pulmonary function is affected even in the early phase of multiple sclerosis. Ambulatory patients with multiple sclerosis who have a higher level of disability have lower pulmonary function, respiratory muscle strength and functional capacity than less disabled ones and controls. Neurological disability level, age, gender and heart rate difference on exertion are the determinants of functional exercise capacity.

Effects of scoliosis on respiratory muscle strength in patients with neuromuscular disorders

BACKGROUND CONTEXT Neuromuscular disorders (NMD) are characterized by loss of lung volume and respiratory muscle weakness, but the effects of scoliosis on lung function are unclear. PURPOSE To compare pulmonary function and respiratory muscle strength in patients with NMD with and without scoliosis as well as in healthy controls. STUDY DESIGN/SETTING Prospective comparison of pulmonary function testing and respiratory muscle strength were made at the pediatric pulmonology and cardiopulmonary rehabilitation units of a university hospital. PATIENT SAMPLE Twenty-two patients with NMD and scoliosis, 17 patients with NMD without scoliosis, and 24 age- and sex-matched healthy controls. Outcome measures were compared in patients with NMD with and without scoliosis and healthy subjects using Student t test, Mann-Whitney U test, chi-square test, one-way analysis of variance (ANOVA), Kruskal-Wallis one-way ANOVA, Pearson correlation coefficients, and Spearman rank correlation, as appropriate. OUTCOME MEASURES 1) Pulmonary function: forced vital capacity (FVC), forced expiratory volume in 1 second (FEV(1)), peak expiratory flow rate (PEF), forced expiratory flow between 25% and 75% of FVC (FEF(25-75%)), and maximum expiratory flows at 75%, 50%, and 25% of FVC (MEF(75), MEF(50), and MEF(25), respectively); 2) oxygen saturation: pulse oxymeter reading; and 3) respiratory muscle strength: maximal inspiratory mouth pressure (MIP) and maximal expiratory mouth pressure (MEP). METHODS Pulmonary function, oxygen saturation, MIP, and MEP were measured and compared in patients with NMD, patients with and without scoliosis, and in healthy subjects. RESULTS The patients with NMD, both with and without scoliosis, had significantly lower PEF, MIP, MEP, % predicted MIP (%MIP), and % predicted MEP (%MEP) than those of healthy subjects (p<.05). The patients with NMD and scoliosis had significantly lower values than those with NMD without scoliosis and controls (p<.05) for FVC, FEV(1), and FEF(25-75%). CONCLUSION Both inspiratory and expiratory muscle strength were diminished in patients with NMD compared with healthy controls. Significant differences were also noted in pulmonary function in patients with NMD with or without scoliosis. This suggests that NMD may impact respiratory function independently of the effects of scoliosis. Clinicians treating patients with NMD should be aware of the possibility of compromised respiratory function in these patients to address possible complications.

Extrapulmonary features of bronchiectasis: muscle function, exercise capacity, fatigue, and health status

BackgroundThere are limited number of studies investigating extrapulmonary manifestations of bronchiectasis. The purpose of this study was to compare peripheral muscle function, exercise capacity, fatigue, and health status between patients with bronchiectasis and healthy subjects in order to provide documented differences in these characteristics for individuals with and without bronchiectasis.MethodsTwenty patients with bronchiectasis (43.5 ± 14.1 years) and 20 healthy subjects (43.0 ± 10.9 years) participated in the study. Pulmonary function, respiratory muscle strength (maximal expiratory pressure – MIP - and maximal expiratory pressure - MEP), and dyspnea perception using the Modified Medical Research Council Dyspnea Scale (MMRC) were determined. A six-minute walk test (6MWT) was performed. Quadriceps muscle, shoulder abductor, and hand grip strength (QMS, SAS, and HGS, respectively) using a hand held dynamometer and peripheral muscle endurance by a squat test were measured. Fatigue perception and health status were determined using the Fatigue Severity Scale (FSS) and the Leicester Cough Questionnaire (LCQ), respectively.ResultsNumber of squats, 6MWT distance, and LCQ scores as well as lung function testing values and respiratory muscle strength were significantly lower and MMRC and FSS scores were significantly higher in patients with bronchiectasis than those of healthy subjects (p < 0.05). In bronchiectasis patients, QMS was significantly associated with HGS, MIP and MEP (p < 0.05). The 6MWT distance was significantly correlated to LCQ psychological score (p < 0.05). The FSS score was significantly associated with LCQ physical and total and MMRC scores (p < 0.05). The LCQ psychological score was significantly associated with MEP and 6MWT distance (p < 0.05).ConclusionsPeripheral muscle endurance, exercise capacity, fatigue and health status were adversely affected by the presence of bronchiectasis. Fatigue was associated with dyspnea and health status. Respiratory muscle strength was related to peripheral muscle strength and health status, but not to fatigue, peripheral muscle endurance or exercise capacity. These findings may provide insight for outcome measures for pulmonary rehabilitation programs for patients with bronchiectasis.

A comparison of muscle strength and endurance, exercise capacity, fatigue perception and quality of life in patients with chronic obstructive pulmonary disease and healthy subjects: a cross-sectional study

BackgroundChronic obstructive pulmonary disease (COPD) has significant systemic effects that substantially impact quality of life and survival. The purpose of this study was to assess and compare peripheral muscle strength and endurance, exercise capacity, fatigue perception and quality of life between patients with COPD and healthy subjects.MethodsTwenty COPD patients (mean FEV1 49.3 ± 19.2%) and 20 healthy subjects were included in the study. Pulmonary function testing and six-minute walk test (6MWT) were performed. Peripheral muscle strength was measured with a hand-held dynamometer, peripheral muscle endurance was evaluated with sit-ups, squats and modified push-ups tests. Fatigue perception was assessed using the Fatigue Impact Scale (FIS) and Fatigue Severity Scale (FSS). General quality of life was determined with the Nottingham Health Profile (NHP), and cough-specific quality of life was evaluated with the Leicester Cough Questionnaire (LCQ).ResultsPulmonary functions, strength of shoulder abductor and flexor muscles, numbers of sit-ups and squats, 6MWT distance and 6MWT% were significantly lower in COPD patients than in healthy subjects (p < 0.05). FIS psychosocial sub-dimension and total scores, NHP scores for all sub-dimensions except pain sub-dimension of the COPD group were significantly higher than those of healthy subjects (p < 0.05). The LCQ physical, psychological and social sub-dimensions and total scores were significantly lower in COPD patients than in healthy subjects (p < 0.05).ConclusionsPulmonary functions, peripheral muscle strength and endurance, exercise capacity and quality of life were adversely affected in patients with COPD. There are greater effect of fatigue on psychosocial functioning and general daily life activities and effect of cough on the quality of life in patients with COPD. This study supports the idea that COPD patients must be evaluated in a comprehensive manner for planning pulmonary rehabilitation programs.

Fatigue and multidimensional disease severity in chronic obstructive pulmonary disease

Background and aimsFatigue is associated with longitudinal ratings of health in patients with chronic obstructive pulmonary disease (COPD). Although the degree of airflow obstruction is often used to grade disease severity in patients with COPD, multidimensional grading systems have recently been developed. The aim of this study was to investigate the relationship between perceived and actual fatigue level and multidimensional disease severity in patients with COPD.Materials and methodsTwenty-two patients with COPD (aged 52-74 years) took part in the study. Multidimensional disease severity was measured using the SAFE and BODE indices. Perceived fatigue was assessed using the Fatigue Severity Scale (FSS) and the Fatigue Impact Scale (FIS). Peripheral muscle endurance was evaluated using the number of sit-ups, squats, and modified push-ups that each patient could do.ResultsThirteen patients (59%) had severe fatigue, and their St Georges Respiratory Questionnaire scores were significantly higher (p < 0.05). The SAFE index score was significantly correlated with the number of sit-ups, number of squats, FSS score and FIS score (p < 0.05). The BODE index was significantly associated with the numbers of sit-ups, squats and modified push-ups, and with the FSS and FIS scores (p < 0.05).ConclusionsPeripheral muscle endurance and fatigue perception in patients with COPD was related to multidimensional disease severity measured with both the SAFE and BODE indices. Improvements in perceived and actual fatigue levels may positively affect multidimensional disease severity and health status in COPD patients. Further research is needed to investigate the effects of fatigue perception and exercise training on patients with different stages of multidimensional COPD severity.RiassuntoRazionale e scopo dello studioLa sensazione di fatica si collega, nella valutazione longitudinale dello stato di salute, con la broncopneumopatia cronica ostruttiva (BPCO). Sebbene il livello di ostruzione del flusso delle vie aeree sia spesso utilizzato per stratificare la gravità di malattia nella BPCO, sono stati recentemente sviluppati sistemi di stadiazione multidimensionali. Scopo di questo studio è indagare il rapporto tra il livello di fatica percepito e reale con il livello di gravità multidimensionale nei pazienti con BPCO.Materiali e metodi22 pazienti con BPCO (età 52-74 anni) hanno preso parte allo studio. Gli indici SAFE e BODE sono stati utilizzati per valutare in modo multidimensionale la gravità di malattia. La fatica percepita è stata valutata con le scale FSS (Fatigue Severity Scale) e FIS (Fatigue Impact Scale). La resistenza dei muscoli periferici è stata indagata con il numero di ripetizioni degli esercizi seduto-in piedi, flessione sulle gambe e sollevamento modificato che ogni paziente era in grado di sostenere.Risultati13 pazienti (59%) hanno riferito grave fatica e il loro punteggio al St George’s Respiratory Questionnaire era significativamente più elevato (p < 0,05). Il punteggio dell’indice SAFE era correlato in modo significativo con il numero di ripetizioni degli esercizi seduto-in piedi, flessione sulle gambe e sollevamento modificato e con i punteggi FSS e FIS (p < 0,05).ConclusioniLa resistenza dei muscoli periferici e la percezione di fatica nei pazienti con BPCO è risultata correlata con il livello di gravità multidimensionale della patologia stimata sia con l’indice SAFE che col BODE. I miglioramenti nei livelli di fatica percepiti e reali possono perciò avere conseguenze positive sul quadro multidimensionale di gravità della malattia e sulla condizione di salute nei pazienti con BPCO. Ulteriori ricerche sono necessarie per valutare gli effetti della percezione di fatica e del riallenamento allo sforzo in pazienti con differenti stadi di gravità multidimensionale della BPCO.

Relationship between respiratory muscle strength, functional capacity and quality of life in pre-operative cardiac surgery patients

The aim of this study was to investigate the relationship between respiratory muscle strength, functional capacity, physical activity, and quality of life in preoperative cardiac surgery patients. Forty eight preoperative cardiac surgery patients (mean age 59.79±10.29 years, 40 M, 8 F, FEV1: 79.52±17.02%) participated in this study. Pulmonary function tests and respiratory muscle strength (MIP and MEP) were performed. Physical activity level was measured using International Physical Activity Questionnaire (IPAQ). Quality of life was determined using Nottingham Health Profile (NHP). Functional capacity was assessed using six-minute walk test (6MWT). The MIP was significantly correlated with 6MWT distance (r = 0.31, p<0.05). Respiratory muscle strength was not significantly correlated with quality of life and physical activity level (p>0.05). Total physical activity level was significantly related with NHP total score (r =  -0.35, p<0.05), NHP emotional stress dimension (r =  -0.32, p<0.05), NHP pain dimension (r =  -0.35, p<0.05), NHP energy dimension (r =  -0.29, p<0.05), NHP physical activity dimension (r =  -0.37, p<0.05). The NHP physical activity dimension was significantly correlated with 6MWT distance (r =  -0.29, p<0.05). Inspiratory muscle strength is related to functional capacity in preoperative cardiac surgery patients. Quality of life is related with physical activity level and functional capacity in these patients.

Effects of Inspiratory Muscle Training in Subjects With Sarcoidosis: A Randomized Controlled Clinical Trial

BACKGROUND: Respiratory muscle weakness occurs in sarcoidosis and is related to decreased exercise capacity, greater fatigue, dyspnea, and lower quality of life in sarcoidosis patients. The effects of inspiratory muscle training in this population have not been comprehensively investigated so far. This study was planned to investigate the effects of inspiratory muscle training on exercise capacity, respiratory and peripheral muscle strength, pulmonary function and diffusing capacity, fatigue, dyspnea, depression, and quality of life in subjects with sarcoidosis. METHODS: This was a prospective, randomized, controlled, and double blind study. Fifteen sarcoidosis subjects (treatment group) received inspiratory muscle training at 40% of maximal inspiratory pressure (PImax), and 15 subjects (control group) received sham therapy (5% of PImax) for 6 weeks. Functional and maximal exercise capacity, respiratory and peripheral muscle strength, pulmonary function and diffusing capacity, fatigue, dyspnea, depression, and quality of life were evaluated. RESULTS: Functional (P < .001) and maximal exercise capacity (P = .038), respiratory muscle strength (PImax [P < .001] and PEmax [P = .001]), severe fatigue (P = .002), and dyspnea perception (P = .02) were statistically significantly improved in the treatment group compared with controls; no significant improvements were observed in pulmonary function and diffusing capacity, peripheral muscle strength, fatigue, depression, and quality of life between groups after inspiratory muscle training. CONCLUSIONS: Inspiratory muscle training improves functional and maximal exercise capacity and respiratory muscle strength and decreases severe fatigue and dyspnea perception in subjects with early stages of sarcoidosis. Inspiratory muscle training can be safely and effectively included in rehabilitation programs. (ClinicalTrials.gov registration NCT02270333.)

Six minute walk test versus incremental shuttle walk test in cystic fibrosis

Although both self‐paced and externally paced field tests are widely used in cystic fibrosis (CF), it is still unclear whether they induce clinically relevant and similar cardiorespiratory responses. The aim of this study was therefore to compare the incremental shuttle walk test (ISWT) and 6 min walk test (6MWT), and to determine the factors influencing exercise capacity in CF.