de Abreu Raphael Martins, Rehder-Santos Patrícia, Minatel Vinicius, Dos Santos Gabriela Lopes, Catai Aparecida Maria
Cardiovascular Physical Therapy Laboratory, Department of Physical Therapy, Federal University of São Carlos, São Carlos, São Paulo, Brazil.
Laboratory of Neurological Physiotherapy Research, Department of Physical Therapy, Federal University of São Carlos, São Carlos, São Paulo, Brazil.
Auton Neurosci. 2017 Dec;208:29-35. doi: 10.1016/j.autneu.2017.09.002. Epub 2017 Sep 7.
To carry out a systematic review to determine if inspiratory muscle training (IMT) promotes changes in cardiovascular autonomic responses in humans.
The methodology followed the PRISMA statement for reporting systematic review analysis. MEDLINE, PEDro, SCOPUS and PubMed electronic databases were searched from the inception to March 2017. The quality assessment was performed using a PEDro scale. The articles were included if: (1) primary objective was related to the effects of IMT on the cardiovascular autonomic nervous system, and (2) randomized clinical trials and quasi-experimental studies. Exclusion criteria were reviews, short communications, letters, case studies, guidelines, theses, dissertations, qualitative studies, scientific conference abstracts, studies on animals, non-English language articles and articles addressing other breathing techniques. Outcomes evaluated were measures of cardiovascular autonomic control, represented by heart rate variability (HRV) and blood pressure variability (BPV) indexes.
The search identified 729 citations and a total of 6 studies were included. The results demonstrated that IMT performed at low intensities can chronically promote an increase in the parasympathetic modulation and/or reduction of sympathetic cardiac modulation in patients with diabetes, hypertension, chronic heart failure and gastroesophageal reflux, when assessed by HRV spectral analysis. However, there was no study which evaluated the effects of IMT on cardiovascular autonomic control assessed by BPV.
IMT can promote benefits for cardiac autonomic control, however the heterogeneity of populations associated with different protocols, few studies reported in the literature and the lack of randomized controlled trials make the effects of IMT on cardiovascular autonomic control inconclusive.
进行一项系统评价，以确定吸气肌训练（IMT）是否能促进人体心血管自主神经反应的变化。
该方法遵循PRISMA声明以报告系统评价分析。从数据库建立至2017年3月，检索了MEDLINE、PEDro、SCOPUS和PubMed电子数据库。使用PEDro量表进行质量评估。纳入的文章需满足以下条件：（1）主要目的与IMT对心血管自主神经系统的影响相关；（2）随机临床试验和准实验研究。排除标准包括综述、简短通讯、信函、病例研究、指南、论文、学位论文、定性研究、科学会议摘要、动物研究、非英语文章以及涉及其他呼吸技术的文章。评估的结局指标为心血管自主神经控制指标，以心率变异性（HRV）和血压变异性（BPV）指数表示。
检索共识别出729篇文献，最终纳入6项研究。结果表明，通过HRV频谱分析评估时，低强度的IMT可长期促进糖尿病、高血压、慢性心力衰竭和胃食管反流患者副交感神经调节增加和/或交感神经对心脏调节的降低。然而，尚无研究评估IMT对通过BPV评估的心血管自主神经控制的影响。
IMT可对心脏自主神经控制产生有益作用，然而，与不同方案相关的人群异质性、文献报道的研究较少以及缺乏随机对照试验，使得IMT对心血管自主神经控制的影响尚无定论。
