Taciano Rocha

Effects of Inspiratory Muscle Training in Elderly Women on Respiratory Muscle Strength, Diaphragm Thickness and Mobility

BACKGROUND Aging results in a decline in the function of the respiratory muscles. Inspiratory muscle training is emerging as a possible intervention to attenuate the decline of respiratory muscles in the elderly. The aim of this study was to evaluate the efficacy of inspiratory muscle training on respiratory strength, diaphragm thickness, and diaphragmatic mobility in elderly women. METHODS This was a controlled, randomized, and double-blind clinical trial, performed on 22 elderly women distributed in two groups, training (TG) and control (CG). Over an 8-week period a moderate intensity inspiratory muscle training protocol was followed in the TG, while CG followed a sham protocol. In addition maximum expiratory and inspiratory pressure, mobility of the diaphragm and diaphragmatic thickness were evaluated by ultrasound. RESULTS After training, in TG maximal inspiratory pressure, maximal expiratory pressure, diaphragm thickness, and mobility increased by 37%, 13%, 11%, and 9% respectively, and their values were significantly higher than CG (p < .005, p = .013, p = .001, and p = .001). CONCLUSION Inspiratory muscle training of moderate intensity improves respiratory muscle strength, diaphragm thickness, and diaphragm mobility in elderly women and it should be considered to minimize changes associated with senescence.

The Manual Diaphragm Release Technique improves diaphragmatic mobility, inspiratory capacity and exercise capacity in people with chronic obstructive pulmonary disease: a randomised trial

QUESTIONS In people with chronic obstructive pulmonary disease, does the Manual Diaphragm Release Technique improve diaphragmatic mobility after a single treatment, or cumulatively? Does the technique also improve exercise capacity, maximal respiratory pressures, and kinematics of the chest wall and abdomen? DESIGN Randomised, controlled trial with concealed allocation, intention-to-treat analysis, and blinding of participants and assessors. PARTICIPANTS Twenty adults aged over 60 years with clinically stable chronic obstructive pulmonary disease. INTERVENTION The experimental group received six treatments with the Manual Diaphragm Release Technique on non-consecutive days within a 2-week period. The control group received sham treatments following the same regimen. OUTCOME MEASURES The primary outcome was diaphragmatic mobility, which was analysed using ultrasonography. The secondary outcomes were: the 6-minute walk test; maximal respiratory pressures; and abdominal and chest wall kinematics measured by optoelectronic plethysmography. Outcomes were measured before and after the first and sixth treatments. RESULTS The Manual Diaphragm Release Technique significantly improved diaphragmatic mobility over the course of treatments, with a between-group difference in cumulative improvement of 18mm (95% CI 8 to 28). The technique also significantly improved the 6-minute walk distance over the treatment course, with a between-group difference in improvement of 22 m (95% CI 11 to 32). Maximal expiratory pressure and sniff nasal inspiratory pressure both showed significant acute benefits from the technique during the first and sixth treatments, but no cumulative benefit. Inspiratory capacity estimated by optoelectronic plethysmography showed significant cumulative benefit of 330ml (95% CI 100 to 560). The effects on other outcomes were non-significant or small. CONCLUSION The Manual Diaphragm Release Technique improves diaphragmatic mobility, exercise capacity and inspiratory capacity in people with chronic obstructive pulmonary disease. This technique could be considered in the management of people with chronic obstructive pulmonary disease. TRIAL REGISTRATION NCT02212184.

Acute effects of different inspiratory efforts on ventilatory pattern and chest wall compartmental distribution in elderly women.

It is not completely described how aging affect ventilatory kinematics and what are the mechanisms adopted by the elderly population to overcome these structural modifications. Given this, the aim was to evaluate the acute effects of different inspiratory efforts on ventilatory pattern and chest wall compartmental distribution in elderly women. Variables assessed included: tidal volume (Vt), total chest wall volume (Vcw), pulmonary rib cage (Vrcp%), abdominal rib cage (Vrca%) and abdominal compartment (Vab%) relative contributions to tidal volume. These variables were assessed during quiet breathing, maximal inspiratory pressure maneuver (MIP), and moderate inspiratory resistance (MIR; i.e., 40% of MIP). 22 young women (age: 23.9 ± 2.5 years) and 22 elderly women (age: 68.2 ± 5.0 years) participated to this study. It was possible to show that during quiet breathing, Vab% was predominant in elderly (p<0.001), in young, however, Vab% was similar to Vrcp% (p=0.095). During MIR, Vrcp% was predominant in young (p<0.001) and comparable to Vab% in elderly (p=0.249). When MIP was imposed, both groups presented a predominance of Vrcp%. In conclusion, there are differences in abdominal kinematics between young and elderly women during different inspiratory efforts. In elderly, during moderate inspiratory resistance, the pattern is beneficial, deep, and slow. Although, during maximal inspiratory resistance, the ventilatory pattern seems to predict imminent muscle fatigue.

Upper limbs total occlusion pressure assessment: Doppler ultrasound reproducibility and determination of predictive variables.

Total occlusion pressure (TOP) is an important variable to ischaemic exercise training because the optimal pressure of flow restriction (OPR), applied during this exercise modality, is derived from it. Despite the common use of Doppler ultrasound (DU) to determine the TOP, the reproducibility of this assessment was not evaluated yet. Given this, the objective was to evaluate the reproducibility of DU for the measurement of TOP in upper limbs and determine the predictive variables. Thirteen male volunteers attended three times to the laboratory. On the 1st day, we assessed arm circumference (AC), systolic blood pressure (SBP) and diastolic (DBP), and brachial artery TOP. On 2nd and 3rd days, only TOP was assessed. We found a coefficient of variation of 5·6% and an intraclass correlation coefficient of 0·795 for the DU. In the analysis of TOP predictive variables, the Spearman coefficients (R) were 0·813 (SBP), 0·786 (DBP) and 0·388 (AC). Therefore, these results support that DU has good reproducibility for the TOP and that SBP and DBP should be considered to the determination of TOP in upper limbs.

Vibrating Platform Training Improves Respiratory Muscle Strength, Quality of Life, and Inspiratory Capacity in the Elderly Adults: A Randomized Controlled Trial

Background Aging affects respiratory strength that could cause reduction in functional capacity and quality of life, playing a fundamental role in healthy aging and survival. To prevent these declines, the whole body vibration (WBV) has been proposed to increase strength and functional capacity. The aim of the study was to evaluate the effects of WBV on respiratory muscle strength, thoracoabdominal ventilation, and quality of life in the elderly adults. Methods This study was a controlled, randomized double-blind clinical trial. The study included 28 elderly adults randomized into three groups: Resistance (n = 9), WBV (n = 9), or WBV + resistance exercises (n = 10), performing training, sham, or double training for 3 months, twice per week. The variables of the study were as follows: maximal inspiratory and expiratory pressures (MIP and MEP), distribution of thoracoabdominal volumes variation in optoelectronic plethysmography (pulmonary rib cage-VRCp, abdominal rib cage-VRCa, and abdomen-VAB), and quality of life. Results After training, WBV and WBV + resistance groups increased MIP and MEP (p < .001). During inspiratory capacity maneuver, WBV groups had incremental increases in chest wall total volume (p < .001), showing a rise in pulmonary rib cage (p = .03) and abdominal rib cage (p = .04). Furthermore, WBV groups improved SF-36 scores in functional capacity, physical aspects, energy, pain, and general heath domains. Conclusions The WBV is a training that could improve respiratory muscle strength and quality of life and promote different ventilatory strategies in chest wall and thoracoabdominal compartments in healthy elderly adults.