muscle strength and exercise capacity

Cardiovascular disease is often associated with cardiorespiratory limitation, which is a key component of pharmacological and exercise treatments. Recently, inspiratory muscle training (IMT) has been found to be an effective complementary treatment that improves muscle strength and exercise capacity.

The aim of this study was to evaluate the effectiveness of IMT on the cardiovascular system by assessing autonomic function modulation via heart rate variability and arterial blood pressure.

We conducted a search of The Cochrane Library, MEDLINE, and EMBASE to November 2023 to identify randomized controlled trials (RCTs) that examined a program of IMT (≥ one-week treatment) offered as a sole intervention or as an adjuvant to another form of exercise. We included citations, conference proceedings, and previous reviews without population restriction, comparing IMT intervention to no treatment, placebo, or active control.

We identified 20 RCTs involving 521 subjects with a mean age range of 21-71 years. The IMT programs targeted maximum inspiratory pressure (MIP) and cardiovascular outcomes, using low (n=11) and moderate to high intensity (n=9) protocols, but the protocols varied considerably (duration: 1-12 weeks, frequency: 3-14 times/week, time: 10-30 mins). We observed an overall increase in MIP (cmH2O) (23.66 95% CI 15.95 to 31.37, I2=77%), according to weighted mean difference (95%CI), accompanied by a reduction of the low to high-frequency ratio (-0.70 95% CI -1.34 to -0.05, I2=42%).

In a subgroup analysis, low- and moderate-intensity IMT treatment was associated with a reduction of the systolic blood pressure (SBP) (-5.08 95% CI -9.11 to -1.06 mmHg, I2=0%), heart rate (HR) (-3.58 95% CI -5.94 to -1.21 bpm, I2=63.4%), and diastolic blood pressure (DBP) (-11.25 95% CI -16.46 to -6.05 mmHg, I2=0%), respectively.

In conclusion, IMT is an effective treatment for inspiratory muscle weakness in several populations and could be considered a complementary treatment to improve the cardiovascular system, mainly SBP, HR, and DBP. However, further research is required to better understand the above findings. More studies are needed to determine the role of IMT as a component or alternative to regular exercise protocols for treating individuals with increased blood pressure response.

Author(s) Details:

Rafael Pena,
Graduate Program in Human Movement and Rehabilitation, Evangelical University of Goias, Brazil.

Francisco V. Santos,
Cancer Institute of São Paulo, Intensive Care Unit, São Paulo, Brazil.

Graziella F. B. Cipriano,
Physical Therapy Department, University of Brasilia, Brasilia, Brazil.

Gerson Cipriano Jr.,
Physical Therapy Department, University of Brasilia, Brasilia, Brazil.

Adriana M. Güntzel Chiappa,
Hospital de Clinicas de Porto Alegre, Porto Alegre, Brazil.

Lawrence Patrick Cahalin,
Department of Physical Therapy, University of Miami Miller School of Medicine, Coral Gables, Florida, USA.

Gaspar R. Chiappa,
Graduate Program in Human Movement and Rehabilitation, Evangelical University of Goias, Brazil.

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