Search Results (66)

Background/Objectives: Shoulder pain in tennis players is usually interpreted from a local shoulder perspective, although kinetic-chain and trunk-control factors may also be relevant. The diaphragm contributes to breathing and trunk stabilization, but diaphragm-related measures have received limited attention in tennis players with shoulder pain. This study compared inspiratory muscle strength, diaphragm thickness, and diaphragm thickening fraction between tennis players with and without non-specific shoulder pain. Methods: This observational cross-sectional study included 64 tennis players: 32 with non-specific shoulder pain and 32 asymptomatic controls. Maximum inspiratory pressure (MIP), bilateral diaphragm thickness during relaxed inspiration and expiration, and diaphragm thickening fraction were assessed. Between-group differences were analyzed. Results: Tennis players with non-specific shoulder pain showed lower MIP than controls (p = 0.002). Diaphragm thickness during relaxed inspiration was lower in symptomatic players on the left (false discovery rate (FDR)-adjusted p = 0.033) and right sides (FDR-adjusted p = 0.012), and diaphragm thickening fraction was also lower bilaterally (left: FDR-adjusted p = 0.036; right: FDR-adjusted p = 0.039). Conclusions: Tennis players with non-specific shoulder pain showed lower inspiratory muscle strength, lower bilateral diaphragm thickness during relaxed inspiration, and lower bilateral diaphragm thickening fraction than asymptomatic players. These cross-sectional findings describe group-level differences but do not establish causality, diaphragm dysfunction, or clinical relevance. Full article

Background: Exercise intolerance is a common symptom in patients with chronic heart failure (CHF) and is often associated with reduced pulmonary function. Breathing exercise, including inspiratory muscle training (IMT) has been shown to alleviate respiratory symptoms in patients with pulmonary and cardiac disease. The purpose of this systematic review is to assess the impact of IMT on maximal inspiratory pressure (Pimax), diaphragm thickness, functional vital capacity (FVC), dyspnea and maximum oxygen uptake (VO_2peak) in patients with CHF. Methods: Database research was conducted (PubMed, EMBASE, Cochrane Library of Controlled Trials) by using an appropriate algorithm to indicate the IMT effect on pulmonary function studies. Eligibility criteria included pulmonary function measurements following IMT in patients with CHF. A continuous random effect model (PROSPERO-CRD420261360295) was used to calculate standard mean differences (Std.MD) in all outcomes (between an experimental and control group). Results: A total of 395 participants (13 randomized controlled trials) were identified. More studies indicate improvement in Pimax after IMT (Pimax: Std.MD: 1.07; 95%CI, 0.72–1.42; p < 0.00001). Functional vital capacity (Std.MD, 0.41; 95%CI, 0.03–0.79; p = 0.03) and dyspnea (Std.MD, 1.11; 95%CI, 0.57–1.66; p < 0.0001) were also improved. Moreover, VO_2peak assessed by cardiopulmonary exercise testing before and after IMT showed statistical significance (VO_2peak: Std.MD: 0.86; 95%CI, 0.06–1.66; p = 0.04) in trained patients with CHF compared to controls. Conclusions: The meta-analysis indicates that isolated IMT performed either as short- to medium-term intervention (4 to 8 weeks) with moderate to high intensity (40 to 90% Pimax) or long-term program (8 to 12 weeks) with low intensity (30% Pimax) promotes pulmonary function and metabolic responses. More studies are required to examine the impact of IMT on diaphragm thickness in patients with chronic heart failure. Full article

Background/Objectives: This study aimed to compare structural and functional parameters between chronic obstructive pulmonary disease (COPD) patients and healthy controls, assess associations with pulmonary function, and identify factors independently associated with COPD status. Methods: A cross-sectional study was conducted in 89 participants (COPD: n = 45; controls: n = 44). Structural parameters included forward shoulder posture (FSP), scapular rotation, scapular distance (SD), and pectoralis minor index, measured bilaterally. Functional parameters included maximum inspiratory and expiratory pressures (MIP/MEP), chest expansion at three thoracic levels, spinal angles, and spirometry (%FVC, %FEV1, FEV1/FVC, FEF_25–75%, PEFR). Univariate and stepwise multivariate logistic regression identified variables independently associated with COPD. Results: COPD patients were older and exhibited lower anthropometric measures. Scapular rotation was greater in COPD (p < 0.05 bilaterally), while SD was significantly reduced (p < 0.001 bilaterally). MIP, MEP, and chest expansion at all three levels were significantly impaired in COPD (p < 0.05). All spirometric parameters were markedly lower in COPD (all p < 0.001). SD was positively associated with spirometric indices on both sides (p < 0.01). FSP was inversely associated with MIP, MEP, and chest expansion (p < 0.05). In multivariate logistic regression, age (OR 1.280, p = 0.018), %FVC (OR 0.875, p = 0.029), and FEF_25–75% (OR 0.909, p < 0.001) were independently associated with COPD status. Conclusions: Patients with COPD demonstrated reduced SD and increased scapular rotation. SD was significantly associated with pulmonary function, whereas FEF_25–75% and %FVC emerged as independently associated variables of COPD status. Collectively, these findings underscore the clinical relevance of integrating targeted scapulothoracic and respiratory rehabilitation strategies to optimize functional outcomes and support overall respiratory health and well-being. Full article

Although poverty and tuberculosis are insidiously linked, knowledge of the relationship between social determinants of health (SDoHs) and post-tuberculosis lung disease (PTLD) is limited. This study aimed to analyze the association between physical function, pulmonary function, and SDoHs in individuals with PTLD (iwPTLD), considering the impact of social inequalities on physical performance. This cross-sectional study collected social data from 69 iwPTLDs using a standardized assessment form. The patients underwent pulmonary function testing via spirometry and body plethysmography, as well as respiratory muscle strength and quadriceps muscle strength (QMS) testing. They also completed the six-minute step test (6MST). The median value of steps climbed by participants on the 6MST was 88 (57–117), corresponding to 50.1% (34.9–73.2) of the predicted value. The mean QMS was 28.7 ± 11.9 kgf, with 11 participants (17.4%) showing QMS below the cutoff point. Spirometry revealed normal, obstructive, restrictive, and mixed patterns in 19 (27.5%), 20 (29%), 18 (26.1%), and 12 (17.4%) of the participants, respectively. Performance on the 6MST showed no statistically significant association with SDoHs. QMS showed a statistically significant association with treated sewage (W = 84, p = 0.026). Forced expiratory volume in one second showed significant correlations with education level (ρ = 0.248, p = 0.040), social protection (W = 207, p = 0.050, r = 0.238), and treated water (W = 24.5, p = 0.029, r = 0.264). Maximum inspiratory pressure showed significant correlations with education level (ρ = 0.246, p = 0.042) and treated water (W = 20, p = 0.021, r = 0.280). The regression model for 6MST and QMS performance showed that 12% and 45% of the variability was explained by the studied variables, respectively. In iwPTLD, impairments in physical function and damage to lung function are weakly associated with the deterioration of SDoHs. While this relationship is weak, it should not be ignored because it may operate through indirect pathways. Full article

Objectives: The aim of this study was to investigate the association between the effect of respiratory muscle strength parameters obtained from endurance athletes and their aerobic capacity levels. Methods: A total of 70 endurance athletes (23 women and 47 men) voluntarily participated in the study. Respiratory muscle strength was measured using a digital spirometer. Maximum VO2 was evaluated using the cardiopulmonary exercise test system (Cosmed K5). Results: As a result of the study, it was determined that in female endurance athletes, Maximum Inspiratory Pressure (MIP) and Maximum Expiratory Pressure (MEP) values were related to the End-Tidal Carbon Dioxide Pressure (PETCO2) value at maximum load. In male endurance athletes, it was determined that MEP values were related to PETCO2 values at maximum load, End-Tidal Oxygen Pressure (PETO2) values at maximum load, MaxVO2 values, VO2 values at RCP, and VO2 values at Ventilatory Threshold (VT). In addition, it was determined that in male endurance athletes, the MIP value was related to the VCO2 value at Ventilatory Threshold (RCP) and the VTidal value at maximum load. The other sub-parameters of maximum oxygen consumption (VO2) examined were not found to be related to respiratory muscle strength. Conclusions: The present findings indicate that respiratory muscle strength may be associated with selected cardiopulmonary exercise variables in endurance athletes. However, because this was a cross-sectional study, no causal inference can be made. Prospective and intervention studies are required to clarify these associations. Full article

Background: Regular aerobic exercise during childhood promotes critical physiological adaptations in the cardiovascular and respiratory system. Finswimming, a unique aquatic sport, requires high-intensity demands and specific breathing patterns. The present study aimed to compare respiratory function and cardiorespiratory responses between young male finswimmers and sedentary age-matched non-athletes. Methods: Thirty-two boys aged 8 to 12 years old were stratified into the finswimmers group (FSG, n = 16) and the non-athletes group (NAG, n = 16). Assessments included pulmonary function (spirometry) and respiratory muscle strength (Maximum Inspiratory Pressure, MIP/Maximum Expiratory Pressure, MEP). Exercise capacity was evaluated using the modified shuttle walk test (MSWT). Results: The FSG exhibited significantly higher pulmonary function (Forced Vital Capacity, Forced Expiratory Volume in 1 s, Maximum Voluntary Ventilation; p < 0.05) and superior MIP compared to the NAG (105.3 ± 24.8 versus 87.3 ± 24.7 cmH₂O; p = 0.022). During the MSWT, FSG covered substantially greater distances (746.6 ± 97.2 versus 591.1 ± 86.4 m; p < 0.001) with lower levels of leg fatigue (Borg 0–10) (0.53 ± 0.39 versus 2.13 ± 1.93; p = 0.004) and demonstrated lower heart rate recovery time (4.47 ± 0.68 versus 5.75 ± 0.68 min; p < 0.001) compared to NAG. At the iso-level (8th level of MSWT), FSG scored lower levels of leg fatigue (0.13 ± 0.12 versus 2.02 ± 2.0; p = 0.001) compared to NAG, indicating better peripheral oxygen % saturation (100 ± 0.0 versus 98.14 ± 1.16; p < 0.001). Conclusions: Systematic exercise training enhances profound cardiorespiratory and peripheral muscle adaptations in children. Enhanced cardiorespiratory function allows young athletes to achieve higher workloads and recover faster than sedentary peers, highlighting the sport’s role in establishing a robust cardiorespiratory fitness. Full article

Background: The aim of this prospective longitudinal observational study was to assess respiratory muscle function after surgical correction of scoliosis in individuals with spinal muscular atrophy (SMA). Material: The study included 20 patients (aged 7–19) with scoliosis in the course of neuromuscular disease, eligible for surgical treatment with diagnosed SMA Type 2 or 3. Methods: Measurements were taken of the maximal inspiratory pressure (MIP) [cmH₂O] and the maximal expiratory pressure (MEP) [cmH₂O] in all patients immediately before surgical correction of scoliosis (measurement I), 7 days after surgery (measurement II) and 3 months after surgery (measurement III). Results: The mean Cobb angle of spinal curvature measured before surgery in the entire group was 102.57 ± 17.96. The mean MEP values in the entire group of patients were 40.48 ± 11.76 cmH₂O before surgery, 36.74 ± 17.17 cmH₂O after 7 days, and 39.17 ± 16.18 cmH₂O 3 months after surgery. The MIP values for the entire group were 64.35 ± 28.40 cmH₂O before surgery, 53.96 ± 28.66 cmH₂O after 7 days, and 67.00 ± 31.27 cmH₂O after 3 months. Conclusions: Surgical correction of spinal curvature creates conditions for maintaining respiratory muscle strength in patients with SMA over a period of several months of observation. As a result of the surgical intervention, respiratory muscle strength did not deteriorate, but even slightly increased. Full article

Background/Objectives: To evaluate the prevalence, age at diagnosis, non-invasive ventilation pressures used in management, and clinical predictors for sleep disordered breathing (SDB) in pediatric patients with muscular dystrophies (MDs). Methods: A retrospective analysis of 195 polysomnography (PSG) studies conducted over 20 years for 98 children with different MDs was performed. Diagnosis of SDB was established if a child met the diagnostic criteria for one or more of the following conditions: obstructive sleep apnea (OSA), central apnea, nocturnal hypoxemia, or nocturnal hypoventilation. Outcomes were assessed and compared between MDs. Positive and negative predictive values (PPV, NPV), sensitivity, and specificity for detecting SDB were calculated for certain clinical parameters. Results: SDB was diagnosed in 73.6% of children with MDs, including OSA in 67%, followed by nocturnal hypoxemia (15.3%), nocturnal hypoventilation (7.7%), and central apnea (6.6%). The age at diagnosis and BiPAP pressures used varied between MDs. Patients with Congenital MD had the lowest mean age and required higher pressures (p < 0.05). PPV was high for maximum inspiratory or expiratory pressures (MIP, MEP) < 40% or <60%, forced vital capacity < 50% or <80%, total lung capacity < 60%, left ventricular ejection fraction < 50%, non-ambulation, and body mass index ≥ 95% for the presence of SDB. However, NPV, sensitivity, and specificity varied. Conclusions: SDB is common in pediatric patients with MDs, with OSA being the most prevalent disorder. The age at diagnosis and required BiPAP pressures for management differ among MD groups. Certain clinical measures may help identify some patients with the disease given the high PPV. Full article

Background/Objectives: Respiratory impairment is the leading cause of morbidity and mortality in participants with spinal cord injury (SCI). Cervical SCI (cSCI) severely compromises respiratory function due to paralysis and weakness of the respiratory muscles. Recent evidence suggests that transcutaneous electrical spinal cord stimulation (tSCS) may enhance motor strength and promote functional recovery. Therefore, cervical tSCS, applied at cervical segments, holds potential as a therapeutic strategy to improve respiratory function in participants with cervical SCI. Methods: This randomized controlled trial with a partial crossover design included participants with both complete and incomplete cSCI. Neurological assessments were used, as well as tests to evaluate pulmonary function maximum inspiratory pressure (MIP), maximum expiratory pressure (MEP), and spirometric measurements. These assessments were conducted at baseline and after the last session. The experimental group received tSCS at the C3–C4 and C6–C7 cervical spinal levels, delivered at a frequency of 30 Hz during occupational therapy. The control group underwent identical occupational therapy sessions without stimulation. Each session lasted 30 min and was conducted over eight days. Results: Fifteen participants with cSCI received tSCS, while 11 cSCI participants were included in the control group. Seven participants took part in both groups. Only the tSCS group showed significant improvements in MIP, MEP, and forced vital capacity (p < 0.05), while no significant changes were observed in the control group. Conclusions: tSCS applied at the cervical segments can promote respiratory function following cervical SCI. This approach may support neuroplasticity and help reduce long-term respiratory complications in participants with cervical SCI. However, to confirm these effects, long-term stimulation protocols and follow-up studies in larger SCI populations are required. Full article

Background and Objectives: Coronavirus disease 2019 (COVID-19) has affected multiple physiological systems, including respiratory function, which is critical for athletic performance. Although alterations in pulmonary dynamics have been observed in high-level athletes recovering from COVID-19, the effects on respiratory function remain unclear. In this context, the present study aimed to examine the impact of COVID-19 on the interrelationships among respiratory function parameters in high-level athletes. Materials and Methods: Sixty-eight high-level athletes participated in the present study, including 34 with a history of COVID-19 and 34 controls without prior infection. Respiratory function and respiratory muscle strength were assessed using a digital spirometer (Pony FX, Cosmed, Italy). Key variables included Forced Vital Capacity (FVC), Peak Expiratory Flow (PEF), Maximum Voluntary Ventilation (MVV), Forced Expiratory Volume in one second (FEV₁), and Maximum Inspiratory/Expiratory Pressure (MIP/MEP). Results: High-level athletes with prior COVID-19 infection exhibited significant differences in the correlations (p < 0.05) between FVC and PEF, FVC and MVV, FEV₁ and FEV₁/FVC, and MIP and MVV compared to controls. Conclusions: These findings suggest that COVID-19 can disrupt the interrelationships among respiratory function parameters in high-level athletes, highlighting the need for further longitudinal investigations. Full article

Objective: To investigate the effect of an 8-week inspiratory muscle training (IMT) intervention on respiratory muscle strength and cardiovascular autonomic regulation in obese young men. Methods: The study included 36 obese young men who met the inclusion and exclusion criteria. Participants were randomly divided into two groups: the IG (inspiratory muscle training group, n = 17), which underwent high-intensity IMT intervention for 8 weeks, 5 times a week, and the CG (control group, n = 18), which was not given any additional intervention. Assessed parameters included maximum inspiratory pressure (MIP), maximum expiratory pressure (MEP), systolic blood pressure (SBP), diastolic blood pressure (DBP), and heart rate (HR), as well as heart rate variability metrics such as the standard deviation of normal-to-normal intervals (SDNN), root mean square of successive differences (RMSSD), standard deviation of successive differences (SDSD), low-frequency power component (LF), high-frequency power component (HF), and LF/HF ratio. These measurements were taken both at baseline and following the completion of the 8-week intervention period. Results: After 8 weeks of IMT, the MIP and MEP of the IG increased by 31.8% and 26.5%, respectively (p < 0.01). In addition, SBP, DBP, and HR decreased by 2.2%, 3.2%, and 2.1%, respectively (p < 0.01). In the HRV time domain, SDNN and RMSSD increased by 54.1% and 33.5%, respectively (p < 0.01), and there was no significant improvement in SDSD (p > 0.05); in the HRV frequency domain, LF decreased by 40.5%, HF increased by 59.4% (p < 0.01), and the LF/HF ratio decreased by 58.2% (p < 0.05). Conclusion: An 8-week 80%MIP IMT intervention significantly improves respiratory muscle strength and cardiovascular autonomic regulation in obese young men, suggesting that IMT is a promising non-pharmacological strategy for mitigating obesity-related cardiovascular risk. Full article

Aim: This study aimed to evaluate the effects of inspiratory muscle training on inspiratory muscle strength and cardiorespiratory performance in patients undergoing open heart surgery. Method: This study was conducted as a randomized controlled trial with two groups. Fifty-eight patients who underwent open heart surgery were randomly assigned to either the intervention group or the control group 29 in the control group and 29 in the intervention group. Patients in the intervention group participated in a physical therapy program combined with inspiratory muscle training using the Thammasat University (TU) Breath Trainer. Patients in the control group received only the standard physical therapy program. The maximum inspiratory pressure, maximum expiratory pressure and 6 min walk test distance were assessed both before surgery and prior to hospital discharge. Results: The intervention group had a significant increase in maximum inspiratory pressure (p < 0.001), maximum expiratory pressure (p < 0.001) and 6 min walk test distance (p = 0.013). The control group had a significant decrease in maximum inspiratory pressure (p < 0.001), maximum expiratory pressure (p = 0.002) and 6 min walk test distance (p < 0.001). Conclusions: Inspiratory muscle training can be performed using maximum pressure resistors, such as the TU-Breath Trainer device. This training has been shown to effectively improve inspiratory muscle strength and cardiorespiratory performance in patients undergoing open heart surgery, as well as reduce pulmonary complications and shorten the length of hospital stay. Full article

Background/Objectives: The aim of this review was to evaluate the effectiveness of respiratory muscle strength training in patients with Parkinson’s disease (PD). Methods: A systematic review and meta-analysis of randomised controlled trials (RCTs) was performed on PubMed, Web of Science, and Scopus databases. We included RCTs that evaluated the effectiveness of respiratory muscle training in patients with PD versus no intervention, sham treatment, or a different type of intervention. Quality assessment and risk of bias were assessed using the Downs and Black scale and the ROB2 tool. Results: Finally, 10 studies were included. The methodological quality of the studies was “good” in most of the studies, with results ranging from 21 to 25. In terms of risk of bias, six of them indicated low risk and four of them showed unclear risk of bias. Data were pooled and a meta-analysis of maximum expiratory pressure (MEP), maximum inspiratory pressure (MIP), and voluntary peak expiratory flow rate (PEFR) was performed. Meta-analysis indicated a significant overall effect of respiratory muscle strength training on MEP (MD = 17.08; 95% CI = 2.32, 31.84; p = 0.02) and on voluntary PEFR (MD = 1.50; 95% CI = 0.51, 2.48; p = 0.003). However, results in the meta-analysis showed a non-significant overall effect of respiratory muscle strength training on MIP (MD = 1.69; 95% CI = −11.91, 16.29; p = 0.82). Conclusions: The synthesis of evidence presented in this systematic review and meta-analysis underscores the potential of respiratory muscle strength training as an effective means of increasing MEP and PEFR in patients with PD. Full article

Background/Objectives: A major importance is now accorded to respiratory muscle weakness resulting from exposure to invasive mechanical ventilation (IMV) in intensive care unit patients. Some authors suggested that Inspiratory Muscle Training (IMT) could increase the chances of weaning off IMV. This systematic review examined the efficacy of IMT on weaning success in mechanically ventilated patients. Methods: A literature search was conducted on PubMed, Cochrane, and PEDro until June 2023. Weaning success, maximum inspiratory pressure (MIP), and Rapid Shallow Breathing Index (RSBI) were the outcome measures included. Results: Seven randomized controlled trials, including 517 participants under IMV for at least 48 h, were included in the review. From a qualitative point of view, a significant increase in MIP and a significant decrease in RSBI were found in the intervention group during the analysis. However, weaning success was the same between the intervention and control groups. No significant association was found between weaning success and the increase of MIP or the decrease of RSBI. Furthermore, it could not be demonstrated that a positive change in MIP or RSBI would increase the weaning success rates. Conclusions: From a qualitative point of view, IMT is effective in increasing MIP and decreasing RSBI. However, IMT has no significant impact on weaning success. Further research is recommended to analyze the effect of IMT on weaning success. Full article

Background/Objective: Gastroesophageal reflux disease (GERD) is multifactorial and affects an increasing number of people. It is a common condition in which the stomach contents move up into the esophagus; thus, its main cause is found in the antireflux valve mechanism of the gastroesophageal junction. This consists of two sphincters, the lower oesophageal and the diaphragmatic. The disease has been related to diaphragm dysfunction, either due to the de-coordination of the diaphragms’ contractility or due to decreased strength. Breathing exercises seem to have a positive effect in this population. The aim of this study was to systematically examine the effects of inspiratory muscle training (IMT) on GERD characteristics. Methods: We conducted a systematic review of research up to April 2024 in Scopus, PubMed, and Science Direct. We included randomized controlled trials (RCTs) and clinical trials assessing the effects of IMT on GERD characteristics. Methodological quality was assessed with the PEDro scale (Physiotherapy Evidence Database) and the Newcastle Ottawa scale (NOC). Results: Among the 1984 studies identified from the search, only three studies (one study with a post-COVID-19 population and two with GERD and healthy subjects) were included in this study, as they presented a fair to high methodological quality. Significant improvements in maximal inspiratory pressure (p < 0.001) and diaphragmatic excursion (p < 0.001) were revealed in one study. No significant differences between groups were mentioned for the reflux symptoms and for LES–EGJ pressure in the studies included. Conclusions: IMT seems to provide promising effects in strengthening the antireflux valve mechanism, as it increases MIP and diaphragmatic excursion. This systematic review established a bibliographic gap for the contribution of IMT in the antireflux valve mechanism. More evidence is needed to support the importance of IMT as a non-pharmacological intervention for GERD patients. Full article