Fry Donna K, Pfalzer Lucinda A, Chokshi Anang R, Wagner Michelle T, Jackson Emily S
Physical Therapy Department, University of Michigan-Flint, Flint, Michigan 48502, USA.
J Neurol Phys Ther. 2007 Dec;31(4):162-72. doi: 10.1097/NPT.0b013e31815ce136.
Pulmonary impairments have long been recognized as major causes of morbidity and mortality in individuals with advanced multiple sclerosis (MS). This study was designed to determine if a 10-week home exercise inspiratory training program in community-dwelling persons with MS improves pulmonary muscle strength and endurance. Forty-six ambulatory individuals with clinically diagnosed MS [Expanded Disability Status Scale (EDSS) 2.0-6.5, intervention group mean = 3.96 and control group mean = 3.36] were randomly assigned to an intervention group that received 10 weeks of inspiratory muscle strength training (IMT) or a nontreatment control group. Twenty-one subjects in the control group and 20 subjects in the intervention group completed the study. The intervention group demonstrated significantly greater improvement than the control group in maximal inspiratory pressure (P < 0.001). When compared to the control group, no significant differences were noted for maximal expiratory pressure or maximal ventilation volume after training in the intervention group. Baseline and postexercise training comparison of secondary pulmonary expiratory outcomes were significant in the intervention group for forced expiratory volume at one second (FEV1) (P = 0.014), forced vital capacity (FVC) (P = 0.041), and midexpiratory flow rate(FEF(25-75%)) (P = 0.011). No significant changes were noted for the control group. Thus, IMT significantly increased inspiratory muscle strength and resulted in generalized improvements in expiratory pulmonary function in persons with MS who have minimal to moderate disability. Future studies are needed that focus on the long-term effects of IMT with increased resistance and the impact it has on increasing pulmonary function and functional performance.
长期以来，肺部功能损害一直被认为是晚期多发性硬化症（MS）患者发病和死亡的主要原因。本研究旨在确定，针对社区居住的MS患者开展为期10周的家庭吸气训练计划，是否能改善肺部肌肉力量和耐力。46名临床诊断为MS的能行走个体[扩展残疾状态量表（EDSS）2.0 - 6.5，干预组平均分为3.96，对照组平均分为3.36]被随机分配到接受10周吸气肌力量训练（IMT）的干预组或非治疗对照组。对照组的21名受试者和干预组的20名受试者完成了研究。干预组在最大吸气压力方面的改善明显大于对照组（P < 0.001）。与对照组相比，干预组训练后的最大呼气压力或最大通气量没有显著差异。干预组在一秒用力呼气量（FEV1）（P = 0.014）、用力肺活量（FVC）（P = 0.041）和呼气中期流速（FEF(25 - 75%)）（P = 0.011）这些次要肺呼气指标的基线和运动后训练比较中具有显著差异。对照组没有显著变化。因此，IMT显著提高了吸气肌力量，并使轻度至中度残疾的MS患者的呼气肺功能得到全面改善。未来需要开展研究，关注增加阻力的IMT的长期效果及其对改善肺功能和功能表现的影响。
