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Current insights of inspiratory muscle training on the cardiovascular system: a systematic review with meta-analysis
Background:
Cardiorespiratory limitation is a common hallmark of cardiovascular disease which is a key component of pharmacological and exercise treatments. More recently, inspiratory muscle training (IMT) is becoming an effective complementary treatment with positive effects on muscle strength and exercise capacity. We assessed the effectiveness of IMT on the cardiovascular system through autonomic function modulation via heart rate variability and arterial blood pressure.
Methods:
Randomized controlled trials (RCTs) were identified from searches of The Cochrane Library, MEDLINE and EMBASE to November 2018. Citations, conference proceedings and previous reviews were included without population restriction, comparing IMT intervention to no treatment, placebo or active control.
Results:
We identified 10 RCTs involving 267 subjects (mean age range 51–71 years). IMT programs targeted maximum inspiratory pressure (MIP) and cardiovascular outcomes, using low (
n
=6) and moderate to high intensity (
n
=4) protocols, but the protocols varied considerably (duration: 1–12 weeks, frequency: 3–14 times/week, time: 10–30 mins). An overall increase of the MIP (cmH
2
O) was observed (−27.57 95% CI −18.48, −37.45,
I
2
=64%), according to weighted mean difference (95%CI), and was accompanied by a reduction of the low to high frequency ratio (−0.72 95% CI−1.40, −0.05,
I
2
=50%). In a subgroup analysis, low- and moderate-intensity IMT treatment was associated with a reduction of the heart rate (HR) (−7.59 95% CI −13.96, −1.22 bpm,
I
2
=0%) and diastolic blood pressure (DBP) (−8.29 [−11.64, −4.94 mmHg],
I
2
=0%), respectively.
Conclusion:
IMT is an effective treatment for inspiratory muscle weakness in several populations and could be considered as a complementary treatment to improve the cardiovascular system, mainly HR and DBP. Further research is required to better understand the above findings
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Factors associated with inspiratory muscle weakness in patients with HIV-1
Background:the impact of human immunodeficiency virus type 1 (HIV-1) on lung function is well known and associated with a reduction in pulmonary ventilation. Moreover, the use of highly active antiretroviral therapy has been associated with mitochondrial dysfunction and decreased muscle strength. However, there is scarce information about the factors associated with inspiratory muscle weakness in these patients.Objective:the purpose of the present study was to investigate the factors associated with inspiratory muscle weakness in patients with HIV-1.Methods:two-hundred fifty seven patients with HIV-1 were screened and categorized into two groups: (1) IMW+ (n= 142) and (2) IMW-(n= 115). Lung function (FEV1, FVC and FEV1 /FVC), maximum inspiratory pressure, distance on the six-minute walk test and CD4 cell count were assessed.Results:the mean duration of HIV infection was similar in the two groups. The following variables were significantly different between groups: mean duration of highly active antiretroviral therapy (81 ± 12 in IMW+ versus 38 ± 13 months in IMW-; p= 0.01), and CD4 cell count (327 ± 88 in IMW+ versus 637 ± 97 cells/mm3 in IMW-; p= 0.02). IMW+ presented reduced lung function (FEV1, FVC, FEV1/FVC).Conclusion:patients with IMW+ had lower distance on the six-minute walk test in comparison to the IMW- group. The duration of highly active antiretroviral therapy, distance traveled on the 6MWT and CD4 count were determinants of IMW in patients with HIV