University of Leipzig, Carl-Ludwig-Institute for Physiology, Leipzig, Germany.
Division of Neurology, Medical Care Center, Helios Hospitals, Markranstädt, Germany.
Respir Med. 2018 Nov;144:7-15. doi: 10.1016/j.rmed.2018.09.001. Epub 2018 Sep 4.
Myasthenia gravis (MG) is characterized by reduced muscle endurance and often leads to respiratory complications.
A long-term respiratory muscle endurance training (RMET) based on normocapnic hyperpnea was introduced for the first time in MG patients. We investigated RMET effects on respiratory endurance (RE), MG symptoms, lung function and physical fitness and compared the results with a control group (CG).
The training period consisted of four weeks intensive training (IT; five 30-min training sessions per week) followed by twelve months maintenance training (MT; five 30-min training sessions over two weeks). Eighteen patients with mild to moderate MG participated as the training group (TG), six patients served as CG. RE, lung function, MG score and physical fitness were tested before and after IT and after three to twelve months of MT.
Only 12 TG patients completed the entire training period. Thirteen months of training significantly increased RE measured as time until exhaustion (T) to 412% of baseline (P < 0.001). The MG score improved from 0.67±0.09 to 0.41 ± 0.1 (p = 0.004), and the number of squats per minute as a measure of physical fitness increased in the TG to 160% of baseline (p = 0.015). While lung function did not change during the training period, we observed a modulation in the breathing pattern at rest with prolonged expiration (122% of baseline, p = 0.028). In addition, TG reported subjective improvements in MG symptoms, respiratory symptoms and physical fitness by 49%, 58% and 64%, respectively (P < 0.001). No significant changes were observed in the CG.
This is the first controlled long-term RMET study in MG patients. The results demonstrated that this normocapnic hyperpnea training is feasible and beneficial for patients with mild to moderate MG and is a valuable supplement to conventional drug treatment.
重症肌无力（MG）的特征是肌肉耐力降低，常导致呼吸并发症。
首次在 MG 患者中引入基于常压高碳酸血症的长期呼吸肌耐力训练（RMET）。我们研究了 RMET 对呼吸耐力（RE）、MG 症状、肺功能和身体适应性的影响，并将结果与对照组（CG）进行了比较。
训练期包括四周强化训练（IT；每周五次 30 分钟训练），随后进行十二个月维持训练（MT；两周内五次 30 分钟训练）。18 名轻度至中度 MG 患者作为训练组（TG）参加，6 名患者作为 CG。在 IT 前后以及 MT 后三至十二个月测试了 RE、肺功能、MG 评分和身体适应性。
只有 12 名 TG 患者完成了整个训练期。13 个月的训练使衰竭时间（T）延长至基线的 412%（P<0.001），RE 显著增加。MG 评分从 0.67±0.09 降至 0.41±0.1（p=0.004），作为身体适应性的每分钟深蹲次数增加到基线的 160%（p=0.015）。虽然在训练期间肺功能没有变化，但我们观察到静息时呼吸模式的调节，呼气延长（122%的基线，p=0.028）。此外，TG 报告 MG 症状、呼吸症状和身体适应性分别改善了 49%、58%和 64%（P<0.001）。CG 无明显变化。
这是 MG 患者首次进行的对照长期 RMET 研究。结果表明，这种常压高碳酸血症训练对轻度至中度 MG 患者是可行且有益的，是传统药物治疗的有价值的补充。
