Unit:
Faculty of MedicineLibrary of the School of Health Sciences
Author:
Katsoula Xristina
Dissertation committee:
Χριστίνα Ρούτση, Καθηγήτρια, Ιατρική Σχολή, ΕΚΠΑ
Ιωάννης Βασιλειάδης, Αναπληρωτής Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Ροβίνα Νικολέττα, Αναπληρώτρια Καθηγήτρια, Ιατρική Σχολή, ΕΚΠΑ
Σεραφείμ Νανάς, Ομότιμος Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Στυλιανός Ορφανός, Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Ελένη Μάγειρα, Αναπληρώτρια Καθηγήτρια, Ιατρική Σχολή, ΕΚΠΑ
Αλέξανδρος Μπριασούλης, Επίκουρος Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Original Title:
Άσκηση αναπνευστικών μυών και αποκατάσταση σε ασθενείς με καρδιακή ανεπάρκεια
Translated title:
Respiratory muscle training and rehabilitation in patients with heart failure
Summary:
Introduction: Patients with chronic heart failure (CHF) demonstrate impaired function of respiratory system and frequently experience dyspnea. A characteristic pathophysiological feature of the syndrome is the dysfunction of microcirculation and vascular function. Exercise training programs have been shown to improve the functional status of these patients, however there are insufficient data about the acute and longterm effects of inspiratory muscle training (IMT) on peripheral muscle microcirculation. The aim of the present study was to evaluate both the acute effect of IMT on the microcirculation of non-exercising muscles (systemic effect) as well as the longterm effects of IMT in combined programs involving aerobic exercise (AET) and muscle training (MT).
Methods: Thirty-four patients (30♂/4♀) with stable CHF, with a mean age of 61.4±9.2 years, ejection fraction (EF): 33.9±7.8%, maximal inspiratory pressure (MIP): 78.2±27.1 cmH2O, VO2 peak: 17.4±3.9 ml/kg/min and a New York Heart Association (NYHA)≥II participated in the study. Initially, microcirculatory assessment was performed at rest and immediately after the respiratory program (5 sets/10 repetitions, training load: 60% of MIP). The long-term effects of IMT (36 sessions) was evaluated in 25 patients (successfully complete the rehabilitation program) and were randomized by stratification based on predicted MIP and VO2 peak either to intervention group: IMT/AET/MT (n=12) either in the control group: sham-IMT/AET/MT (n=13). Before and after the intervention were assessed: basal tissue oxygen saturation (StO2), oxygen consumption rate (OCR) and reperfusion rate (RR) were measured by near-infrared spectroscopy (NIRS) at the thenar muscle combined with vascular occlusion test (VOT), as well as indicators of cardiopulmonary exercise test (CPET), pulmonary/respiratory function and peripheral muscle strength and endurance.
Results: RR(%/min), following the release of vascular occlusion, as well as OCR (%/min) increased significantly in acute phase after the respiratory exercise (p<0,05), while the corresponding basal StO2 values did not reach the level of statistical significance (p=0.065). Regarding the long-term effects of respiratory exercise, the intervention group improved the RR (%/min) compared to the control group (p<0.05), while OCR (%/min) and StO2 values did not change (p>0.05). The indicator heart rate recovery at 1 min [HRR_1 min (bpm)], MIP (cmH2O), predicted MIP (%), as well as FEV1/FVC showed a significant difference in comparison between groups with the intervention group being superior (p<0.05). No difference was observed regarding the severity of the patients in microcirculatory parameters (p>0.05).
Conclusions: A session of respiratory exercise appears to alter significantly the dynamic indices of microcirculation assessed by NIRS in peripheral non-exercising muscles. A cardiac rehabilitation program that includes respiratory exercise appears to affected significantly the parameters of microcirculation, as well as the respiratory and the pulmonary function. The benefits of exercise appear to be similar for patients with different severity of the syndrome.
Main subject category:
Health Sciences
Keywords:
Respiratory muscle training, Inspiratory muscle training, Microcirculation, Chronic heart failure, Rehabilitation
Number of references:
156
