Abstract
Inspiratory muscle weakness (IMW) is prevalent in patients with chronic heart failure (CHF) caused by left ventricular systolic dysfunction, which contributes to reduced exercise capacity and the presence of dyspnea during daily activities. Inspiratory muscle strength (estimated by maximal inspiratory pressure) has independent prognostic value in CHF. Overall, the results of trials with inspiratory muscle training (IMT) indicate that this intervention improves exercise capacity and quality of life, particularly in patients with CHF and IMW. Some benefit from IMT may be accounted for by the attenuation of the inspiratory muscle metaboreflex. Moreover, IMT results in improved cardiovascular responses to exercise and to those obtained with standard aerobic training. These findings suggest that routine screening for IMW is advisable in patients with CHF, and specific IMT and/or aerobic training are of practical value in the management of these patients.
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References and Recommended Reading
Dempsey JA, Amann M, Romer LM, Miller JD: Respiratory system determinants of peripheral fatigue and endurance performance. Med Sci Sports Exerc 2008, 40:457–461.
Tumminello G, Guazzi M, Lancellotti P, Piérard L: Exercise ventilation inefficiency in heart failure: pathophysiological and clinical significance. Eur Heart J 2007, 28:673–678.
De-Troyer A, Estenne M, Yernault JC: Disturbance of respiratory muscle function in patients with mitral valve disease. Am J Med 1980, 69:867–873.
Mancini DM, Lang CC: Alterations in pulmonary and diaphragmatic function in heart failure. In Heart Failure: A Companion to Braunwald’s Heart Diseases. Edited by Mann DL. Philadelphia: Saunders; 2004:303–314.
American Thoracic Society/European Respiratory Society: ATS/ERS Statement on respiratory muscle testing. Am J Respir Crit Care Med 2002, 166:518–624.
Hughes PD, Polkey MI, Harris ML, et al.: Diaphragm strength in chronic heart failure. Am J Resp Crit Care Med 1999, 160:529–534.
Neder JA, Andreoni S, Lerario MD, Nery LE: Reference values for lung function tests. II. Maximal respiratory pressures and voluntaty ventilation. Braz J Med Biol Res 1999, 32:719–727.
Dall’Ago P, Chiappa GR, Guths H, et al.: Inspiratory muscle training in patients with heart failure and inspiratory muscle weakness: a randomized trial. J Am Coll Cardiol 2006, 47:757–763.
Laoutaris I, Dritsas A, Brown MD, et al.: Inspiratory muscle training using an incremental endurance test alleviates dyspnea and improves functional status in patients with chronic heart failure. Eur J Cardiovasc Prev Rehabil 2004, 11:489–496.
Laoutaris ID, Dritsas A, Brown MD, et al.: Immune response to inspiratory muscle training in patients with chronic heart failure. Eur J Cardiovasc Prev Rehabil 2007, 14:679–685.
Laoutaris ID, Dritsas A, Brown MD, et al.: Effects of inspiratory muscle training on autonomic activity, endothelial vasodilator function, and N-terminal pro-brain natriuretic peptide levels in chronic heart failure. J Cardiopulm Rehabil Prev 2008, 28:99–106.
Hammond MD, Bauer KA, Sharp JT, Rocha RD: Respiratory muscle strength in congestive heart failure. Chest 1990, 98:1091–1094.
Mancini DM, Henson D, LaManca J, Levine S: Respiratory function and dyspnea in patients with chronic congestive heart failure. Circulation 1992, 86:909–918.
McParland C, Krishnan B, Wang Y, Gallagher CG: Inspiratory muscle weakness and dyspnea in chronic heart failure. Am Rev Respir Dis 1992, 146:467–472.
Meyer FJ, Borst MM, Zugck C, et al.: Respiratory muscle dysfunction in congestive heart failure: clinical correlation and prognostic significance. Circulation 2001, 103:2153–2158.
Lavietes MH, Gerula CM, Fless KG, et al.: Inspiratory muscle weakness in diastolic dysfunction. Chest 2004, 126:838–844.
Nishimura Y, Maeda H, Tanaka K, et al.: Respiratory muscle strength and hemodynamics in chronic heart failure. Chest 1994, 105:355–359.
Chua TP, Anker SD, Harrington D, Coats AJ: Inspiratory muscle strength is a determinant of maximum oxygen consumption in chronic heart failure. Brit Heart J 1995, 74:381–385.
Mangner N, Gielen S, Weikert B, et al.: Skeletal muscle alterations in chronic heart failure: differential effects of left ventricular dysfunction on catabolic activation in the quadriceps and the diaphragm [abstract]. Eur Heart J 2008, 29(Suppl):306.
Ribeiro JP, Stein R, Chiappa GR: Beyond peak oxygen uptake: new prognostic markers from gas exchange exercise tests in chronic heart failure. J Cardiopulm Rehabil 2006, 26:63–71.
Frankenstein L, Meyer FJ, Sigg C, et al.: Is serial determination of inspiratory muscle strength a useful prognostic marker in chronic heart failure? Eur J Cardiovasc Prevt Rehabil 2008, 15:156–161.
Frankenstein L, Nelles M, Meyer FJ, et al.: Validity, prognostic value and optimal cut-off of respiratory muscle strength in patients with chronic heart failure changes with beta-blocker treatment. Eur J Cardiovasc Prev Rehabil 2009 (in press).
Coirault C, Hagège A, Chemla D, et al.: Angiotensinconverting inhibitor therapy improves respiratory muscle strength in patients with heart failure. Chest 2001, 119:1755–1760.
Granton JT, Naughton MT, Bernard DC, et al.: CPAP improves inspiratory muscle strength in patients with heart failure and central sleep apnea. Am J Respir Crit Care Med 1996, 153:277–282.
Sapienza CM: Respiratory muscle strength training applications. Curr Opin Otolaryngol Head Neck Surg 2008, 16:216–220.
Mancini DM, Henson D, La Manca J, et al.: Benefit of selective inspiratory muscle training on exercise capacity in patients with chronic congestive heart failure. Circulation 1995, 91:320–329.
Cahalin LP, Semigran MJ, Dec GW: Inspiratory muscle training in patients with chronic heart failure awaiting cardiac transplantation: results from a pilot clinical trial. Phys Ther 1997, 77:830–838.
Johnson PH, Cowley AJ, Kinnear WJ: A randomized trial of inspiratory muscle training in stable chronic heart failure. Eur Hear J 1998, 19:1249–1253.
Weiner P, Waizman J, Magadle R, et al.: The effect of specific inspiratory muscle training on the sensation of dyspnea and exercise tolerance in patients with congestive heart failure. Clin Cardiol 1999, 22:727–732.
Martínez A, Lisboa C, Jalil J, et al.: Selective training of respiratory muscles in patients with chronic heart failure [in Spanish]. Rev Med Chil 2001, 129:133–139.
Stein R, Chiappa GR, Guths H, et al.: Inspiratory muscle training improves oxygen uptake efficiency slope in patients with heart failure and inspiratory muscle weakness. J Cardiopulm Rehabil Prev 2009 (in press).
Chiappa GR, Roseguini BT, Vieira PJ, et al.: Inspiratory muscle training improves blood flow to resting and exercising limbs in patients with chronic heart failure. J Am Coll Cardiol 2008, 51:1663–1671.
Fleg JL: Improving exercise tolerance in chronic heart failure: a tale of inspiration? J Am Coll Cardiol 2008, 51:1672–1674.
Beniaminovitz A, Lang CC, LaManca J, Mancini DM: Selective low-level leg muscle training alleviates dyspnea in patients with heart failure. J Am Coll Cardiol 2002, 40:1602–1608.
Vibarel N, Hayot M, Ledermann B, et al.: Effect of aerobic exercise training on inspiratory muscle performance and dyspnea in patients with chronic heart failure. Eur J Heart Fail 2002, 4:745–751.
Laoutaris ID, Dritsas A, Adamopoulos S, et al.: Effects of inspiratory muscle training in patients with chronic heart failure. J Am Coll Cardiol 2008, 52:1888–1889.
Ribeiro JP, Chiappa GR, Stein R: Effects of inspiratory muscle training in patients with chronic heart failure—author reply. J Am Coll Cardiol 2008, 52:1889.
Lindsay DC, Lovegrove CA, Dunn MJ, et al.: Histological abnormalities of muscle from limb, thorax and diaphragm in chronic heart failure. Eur Hear J 1996, 1239–1250.
Stassijns G, Lysens R, Decramer M: Peripheral and respiratory muscles in chronic heart failure. Eur Respir J 1996, 9:2161–2167.
Tikunov B, Levine S, Mancine D: Chronic congestive heart failure elicits adaptations of endurance exercise in diaphragmatic muscle. Circulation 1997, 95:910–916.
Lopes FS, Carvalho RF, Campos GE, et al.: Down regulation of MyoD gene expression in rat diaphragm muscle with heart failure. Int J Exp Pathol 2008, 89:216–222.
van Hees HW, van der Heijden HF, Hafmans T, et al.: Impaired isotonic contractility and structural abnormalities in the diaphragm of congestive heart failure rats. Int J Cardiol 2008, 128:326–335.
Dayer MJ, Hopkinson NS, Ross ET, et al.: Does symptom-limited cycle exercise cause low frequency diaphragm fatigue in patients with heart failure? Eur J Heart Fail 2006, 8:68–73.
Supinski JS, Callahan LA: Diaphragmatic free radical generation in an animal model of heart failure. J Appl Physiol 2005, 99:1078–1084.
Kelly MK, Wicker RJ, Barstow TJ, Harms CJ: Effects of N-acetylcysteine on respiratory muscle fatigue during heavy exercise. Resp Physiol Neurobiol 2009, 165:67–72.
Mancini DM, Ferraro N, Nazzaro D, et al.: Respiratory muscle deoxygenation during exercise in patients with heart failure using near-infrared spectroscopy. J Am Coll Cardiol 1991, 18:492–498.
Terakado S, Takeuchi T, Miura T, et al.: Early occurrence of respiratory muscle deoxygenation assessed by near-infrared spectroscopy during leg exercise in patients with chronic heart failure. Jpn Circ J 1999, 63:97–103.
Borghi-Silva A, Carrascosa C, Oliveira CC, et al.: Effects of respiratory muscle unloading on leg muscle oxygenation and blood volume during high-intensity exercise in chronic heart failure. Am J Physiol Heart Circ Physiol 2008, 294:H2465–H2472.
Ribeiro JP, Callegaro CC, Schneider FL, et al.: Exaggerated peripheral chemoreflex response in heart failure with inspiratory muscle weakness [abstract]. J Cardiovasc Prev Rehabil 2008, 15(Suppl 1):S113.
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Ribeiro, J.P., Chiappa, G.R., Neder, J.A. et al. Respiratory muscle function and exercise intolerance in heart failure. Curr Heart Fail Rep 6, 95–101 (2009). https://doi.org/10.1007/s11897-009-0015-7
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DOI: https://doi.org/10.1007/s11897-009-0015-7