Chest
Volume 143, Issue 5, May 2013, Pages 1386-1394
Journal home page for Chest

Original Research
Pulmonary Rehabilitation
Respiratory Muscle Training for Respiratory Deficits in Neurodegenerative Disorders: A Systematic Review

https://doi.org/10.1378/chest.12-1442Get rights and content

Background

Studies of the impact of respiratory muscle training (RMT) on central neurodegenerative pathologies have been aimed at improving pulmonary function. However, there is no certainty about the effectiveness of RMT in patients affected by these groups of disorders. The purpose of this review was to assess the evidence regarding the efficacy of inspiratory muscle training (IMT) and expiratory muscle training (EMT) on respiratory function in patients with neurodegenerative disorders of the CNS.

Methods

A comprehensive search from 1990 to September 2012 on MEDLINE, Physiotherapy Evidence Database (PEDro), PubMed, Cochrane Library, and Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases was made. Studies reporting on IMT and EMT in patients with neurodegenerative diseases were included. The selected studies were abstracted using a standardized data collection instrument and were assessed by a quality checklist created and adapted from CONSORT (Consolidated Standards for Reporting Trials) and TREND (Transparent Reporting of Evaluation with Nonrandomized Designs).

Results

Twenty-four studies were identified by the search strategy. Only 19 studies met the criteria for full review. Ten studies met all the inclusion criteria and were included in the final analysis. Of the 16 parameters present in the quality assessment checklist, only six were achieved for the studies analyzed.

Conclusions

There is some evidence that RMT improves a number of respiratory function parameters in patients with Parkinson disease and multiple sclerosis; however, the number of studies and their quality are not sufficient to conclude whether IMT or EMT is effective in improving respiratory function in patients with neurodegenerative disorders of the CNS.

Section snippets

Data Sources and Searches

This systematic review included studies that reported on IMT and/or EMT in patients with neurodegenerative diseases. To search databases, keywords were structured using the population, intervention, comparison, and outcome (PICO) approach. People with central neurodegenerative disorders were considered as the population. RMT by pressure threshold trainers was defined as the intervention. No comparisons were made with any other treatment. The outcomes were valid and reliable measurements of

Studies Included

Twenty-four studies were identified by the initial search strategy. Only 19 studies met the criteria for full review. Of these 19 studies, 10 met all the inclusion criteria and were included in the final analysis (Fig 1). Of the 16 parameters present in the quality assessment checklist, only six were achieved for the studies analyzed (Table 1). In total, six EMT and four IMT studies were analyzed. Diagnoses, number of participants, and sex distribution for EMT and IMT studies are shown in Table

Discussion

The results of this review show that the number and the quality of studies detailing IMT and EMT for improving pulmonary function are insufficient. Of the 24 studies initially selected, 14 were discarded for various reasons, as depicted in Figure 1. No studies that assessed respiratory training in patients with Huntington disease were found. According to the quality checklist (Table 1), most of the studies showed a lack of sample size determination, no description of the sampling method or the

Conclusions

There is some evidence that RMT, by using pressure threshold devices, improves a number of respiratory function parameters in patients with Parkinson disease and multiple sclerosis. However, the number of studies and their quality are insufficient to conclude whether IMT or EMT is effective in improving pulmonary function in patients with neurodegenerative disorders of the CNS. From the studies analyzed in the current review, it is possible, however, to identify training parameters that can be

Acknowledgments

Author contributions: Mr Reyes had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Mr Reyes: contributed to the concept of the study, development of the search strategy, analysis of the results, and writing of the paper.

Dr Ziman: contributed to the interpretation of results, critical revision of the article for important intellectual content, editing of the paper, and final approval of the version to be

References (54)

  • J Kim et al.

    Effect of expiratory muscle strength training on elderly cough function

    Arch Gerontol Geriatr

    (2009)
  • SC Smeltzer et al.

    Reliability of maximal respiratory pressures in multiple sclerosis

    Chest

    (1999)
  • K Tully et al.

    Maximal expiratory pressures in spinal cord injury using two mouthpieces

    Chest

    (1997)
  • G Trebbia et al.

    Cough determinants in patients with neuromuscular disease

    Respir Physiol Neurobiol

    (2005)
  • LS Aboussouan

    Respiratory disorders in neurologic diseases

    Cleve Clin J Med

    (2005)
  • FK Mutluay et al.

    Effects of multiple sclerosis on respiratory functions

    Clin Rehabil

    (2005)
  • O Hardiman

    Management of respiratory symptoms in ALS

    J Neurol

    (2011)
  • R Inzelberg et al.

    Inspiratory muscle training and the perception of dyspnea in Parkinson's disease

    Can J Neurol Sci

    (2005)
  • DK Fry et al.

    Randomized control trial of effects of a 10-week inspiratory muscle training program on measures of pulmonary function in persons with multiple sclerosis

    J Neurol Phys Ther

    (2007)
  • P Zinzi et al.

    Effects of an intensive rehabilitation programme on patients with Huntington's disease: a pilot study

    Clin Rehabil

    (2007)
  • RD Gross et al.

    The coordination of breathing and swallowing in Parkinson's disease

    Dysphagia

    (2008)
  • T Pitts et al.

    Voluntary cough production and swallow dysfunction in Parkinson's disease

    Dysphagia

    (2008)
  • SR Almeida et al.

    Amyotrophic lateral sclerosis: prospective study on respiratory parameters

    Arq Neuropsiquiatr

    (2010)
  • TN Sathyaprabha et al.

    Pulmonary functions in Parkinson's disease

    Indian J Chest Dis Allied Sci

    (2005)
  • M Polatli et al.

    Pulmonary function tests in Parkinson's disease

    Eur J Neurol

    (2001)
  • B Rassler et al.

    Long-term respiratory muscle endurance training in patients with myasthenia gravis: first results after four months of training

    Autoimmune Dis

    (2011)
  • M Bosnak-Guclu et al.

    Comparison of functional exercise capacity, pulmonary function and respiratory muscle strength in patients with multiple sclerosis with different disability levels and healthy controls

    J Rehabil Med

    (2012)
  • Cited by (42)

    • Effects of Dual-Task Group Training on Gait, Cognitive Executive Function, and Quality of Life in People With Parkinson Disease: Results of Randomized Controlled DUALGAIT Trial

      2020, Archives of Physical Medicine and Rehabilitation
      Citation Excerpt :

      Two different physiotherapists supervised the ST program sessions. The sessions for the 2 programs were similarly structured: (1) 10 minutes of warm-up exercises specific to PD (respiratory,12 dissociation of the shoulder and pelvic girdle, transfers and postural changes, joint mobility, balance and strengthening)13-15; (2) 45 minutes of gait training (ST or DT, depending on the therapy program), and; (3) 5 minutes cool-down with self-assisted stretching.16,17 Changes in levodopa doses were monitored in all sessions of both programs.

    • Exercise in Prevention and Treatment of Multiple Sclerosis

      2017, Nutrition and Lifestyle in Neurological Autoimmune Diseases: Multiple Sclerosis
    • Respiratory training improved ventilatory function and respiratory muscle strength in patients with multiple sclerosis and lateral amyotrophic sclerosis: systematic review and meta-analysis

      2016, Physiotherapy (United Kingdom)
      Citation Excerpt :

      However, based on the principle of the specificity, this effect was more evident in the inspiratory muscle strength (MIP) because most of the studies just used the threshold (IMT) as intervention. For this reason, it is possible that in this meta-analysis the MIP has improved almost two times compared to the MEP [1,29,30]. In this meta-analysis, ventilatory function improved with the increase in FEV1; however, FVC did not change.

    View all citing articles on Scopus

    Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.

    Funding/Support: The authors have reported to CHEST that no funding was received for this study.

    View full text