Frota Aline Xavier, Mendes Fernanda de Souza Nogueira Sardinha, Vieira Marcelo Carvalho, Saraiva Roberto Magalhães, Veloso Henrique Horta, da Silva Paula Simplício, Sperandio da Silva Gilberto Marcelo, de Sousa Andréa Silvestre, Mazzoli-Rocha Flavia, Costa Henrique Silveira, Rodrigues Junior Luiz Fernando, Mediano Mauro Felippe Felix
Evandro Chagas National Institute of Infectious Disease, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil.
Center for Cardiology and Exercise, Aloysio de Castro State Institute of Cardiology, Rio de Janeiro, Brazil.
Disabil Rehabil. 2022 Apr;44(8):1305-1312. doi: 10.1080/09638288.2020.1800837. Epub 2020 Aug 11.
This study aimed to evaluate acute and subacute hemodynamic responses and perception of effort in individuals with CCC submitted to different IMT protocols.
This was a randomized cross-over trial conducted on CCC subjects with systolic left ventricular dysfunction (<45% left ventricular ejection fraction) without or with heart failure (stages B2 and C, respectively). Twenty-one participants performed two IMT protocols, one targeting 60% maximal inspiratory pressure with 3 × 10 repetitions (MIP60) and the other targeting 30% maximal inspiratory pressure (MIP30) with 3 × 20 repetitions with a 2 min recovery between sets for both. MIP60 and MIP30 were performed on the same day with a 2 h washout period. Measurements were taken at baseline, during and 60 min after IMT.
No differences in hemodynamic variables were observed across protocols. The perception of effort increased in both protocols, with higher scores for the MIP30 protocol (β = +1.6, = 0.01; β = +1.1, = 0.02; β = +0.9, = 0.08 for the 1st, 2nd and 3rd sets, respectively).
There were no differences in hemodynamic responses comparing MIP60 and MIP30 protocols in subjects with CCC. Despite the higher perception of effort during endurance protocol, both protocols can be considered a safe therapeutic strategy.IMPLICATIONS FOR REHABILITATIONDespite inspiratory muscle training may result in functional capacity improvements, no previous study evaluated the hemodynamic acute and subacute responses to inspiratory muscle training in chronic Chagas cardiomyopathy.The two inspiratory muscle training protocols (30% and 60% of maximal inspiratory pressure) did not cause significant hemodynamic repercussions in subjects with chronic Chagas cardiomyopathy.Inspiratory muscle training seems to be an effective strategy to improve functional capacity and can be implemented in the rehabilitation programs for patients with Chagas cardiomyopathy.Since no significant adverse responses were observed in any of the hemodynamic parameters during the inspiratory muscle training sessions, these two protocols of inspiratory muscle training (30% and 60% of maximal inspiratory pressure) seems to be safe in subjects with Chagas cardiomyopathy.
本研究旨在评估接受不同吸气肌训练（IMT）方案的恰加斯病心肌病（CCC）患者的急性和亚急性血流动力学反应以及用力感知情况。
这是一项针对左心室收缩功能不全（左心室射血分数<45%）且无心力衰竭或伴有心力衰竭（分别为B2期和C期）的CCC患者进行的随机交叉试验。21名参与者进行了两种IMT方案，一种以60%最大吸气压为目标，进行3组，每组10次重复（MIP60），另一种以30%最大吸气压（MIP30）为目标，进行3组，每组20次重复，两组之间均有2分钟的恢复时间。MIP60和MIP30在同一天进行，洗脱期为2小时。在基线、IMT期间及IMT后60分钟进行测量。
各方案间血流动力学变量无差异。两种方案中用力感知均增加，MIP30方案得分更高（第1、2和3组的β分别为+1.6，P = 0.01；β = +1.1，P = 0.02；β = +0.9，P = 0.08）。
在CCC患者中，比较MIP60和MIP30方案，血流动力学反应无差异。尽管耐力方案中用力感知更高，但两种方案均可被视为安全的治疗策略。
对康复的启示
尽管吸气肌训练可能会改善功能能力，但此前尚无研究评估慢性恰加斯病心肌病患者对吸气肌训练的急性和亚急性血流动力学反应。
两种吸气肌训练方案（最大吸气压的30%和60%）在慢性恰加斯病心肌病患者中未引起显著的血流动力学影响。
吸气肌训练似乎是改善功能能力的有效策略，可在恰加斯病心肌病患者的康复计划中实施。
由于在吸气肌训练期间任何血流动力学参数均未观察到明显的不良反应，这两种吸气肌训练方案（最大吸气压的30%和60%）在恰加斯病心肌病患者中似乎是安全的。
