Cardiopulmonary Physiotherapy Rehabilitation Department, Institute of Health Sciences, Bezmialem Vakif University, Istanbul, Turkey; Division of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Halic University, Istanbul, Turkey.
Department of Cardiopulmonary Physiotherapy and Rehabilitation, Division of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Bezmialem Vakif University, Istanbul, Turkey.
Complement Ther Clin Pract. 2021 Aug;44:101418. doi: 10.1016/j.ctcp.2021.101418. Epub 2021 May 14.
The major symptom of chronic obstructive pulmonary disease (COPD) is dyspnea, which causes dyspnea-related kinesiophobia resulting in avoidance of activities associated with dyspnea or compensation by reducing the rate of activity. The aim of this study was to assess dyspnea-related kinesiophobia and determine the effect of inspiratory muscle training (IMT) on dyspnea-related kinesiophobia in COPD.
Forty COPD subjects were randomly allocated to either the IMT or sham group. Both groups' maximal inspiratory pressure (MIP) was assessed weekly. All patients were instructed to perform the training exercises for 15 min twice a day, 5 days a week for a total of 8 weeks. In the IMT group, intensity was set at 30% of MIP and adjusted according to weekly MIP value. In the sham group, intensity remained constant at 15% of initial MIP. Pulmonary function test (PFT), respiratory muscle strength, 6-min walk test (6 MWT), Breathlessness Beliefs Questionnaire (BBQ), Modified Medical Research Council scale (MMRC), modified Borg scale, Hospital Anxiety and Depression Scale (HADS), Saint George's Respiratory Questionnaire (SGRQ), and COPD Assessment Test (CAT) were assessed before and after the intervention.
BBQ scores ranged from 18 to 51, with mean values in the IMT and sham groups of 39.80 ± 7.62 and 43.00 ± 6.58, respectively. When between-group differences of all outcome scores were compared, there was a statistically significant improvement in the IMT group than in the sham group (p < 0.05). After IMT, statistically significant decreases in BBQ and modified Borg scores were observed in within groups (p ≤ 0.001). These decreases were significantly greater in the IMT group (p ≤ 0.001). MMRC decreased significantly only in the IMT group (p < 0.001). There was a statistically significant increase in PFT values in the IMT group (p = 0.007-0.045), but no difference in the sham group (p = 0.129-0.886). Both groups showed statistically significant improvement in respiratory muscle strength, 6 MWT distance, and CAT score after 8 weeks (p < 0.05). All HADS and SGRQ scores decreased significantly in the IMT group (p < 0.001), whereas only the SGRQ activity score decreased significantly in the sham group (p = 0.017).
Our study provides data on the presence and level of dyspnea-related kinesiophobia in COPD patients. All patients had BBQ scores higher than 11, indicating dyspnea-related kinesiophobia. IMT reduced BBQ score and improved respiratory function, and exercise capacity. Our results also support the other known benefits of IMT such as reduced dyspnea and symptom perception, decreased anxiety and depression, and improved quality of life.
慢性阻塞性肺疾病（COPD）的主要症状是呼吸困难，这导致了与呼吸困难相关的运动恐惧，从而导致与呼吸困难相关的活动回避或通过降低活动速度来代偿。本研究旨在评估与呼吸困难相关的运动恐惧，并确定吸气肌训练（IMT）对 COPD 患者与呼吸困难相关的运动恐惧的影响。
40 例 COPD 患者被随机分配到 IMT 组或假手术组。两组的最大吸气压力（MIP）每周评估一次。所有患者均被指示每天进行 2 次，每次 15 分钟的训练，每周 5 天，共 8 周。在 IMT 组中，强度设定为 MIP 的 30%，并根据每周 MIP 值进行调整。在假手术组中，强度保持在初始 MIP 的 15%。在干预前后评估了肺功能测试（PFT）、呼吸肌力量、6 分钟步行测试（6MWT）、呼吸困难信念问卷（BBQ）、改良医学研究委员会量表（MMRC）、改良 Borg 量表、医院焦虑和抑郁量表（HADS）、圣乔治呼吸问卷（SGRQ）和 COPD 评估测试（CAT）。
BBQ 评分范围为 18-51，IMT 组和假手术组的平均评分分别为 39.80±7.62 和 43.00±6.58。当比较所有结局评分的组间差异时，IMT 组的改善明显优于假手术组（p<0.05）。在 IMT 后，组内 BBQ 和改良 Borg 评分均显著下降（p≤0.001）。IMT 组的下降幅度明显大于假手术组（p≤0.001）。仅在 IMT 组中，MMRC 显著降低（p<0.001）。IMT 组的 PFT 值显著增加（p=0.007-0.045），但假手术组无差异（p=0.129-0.886）。两组在 8 周后呼吸肌力量、6MWT 距离和 CAT 评分均显著改善（p<0.05）。IMT 组所有 HADS 和 SGRQ 评分均显著降低（p<0.001），而假手术组仅 SGRQ 活动评分显著降低（p=0.017）。
我们的研究提供了 COPD 患者存在与呼吸困难相关的运动恐惧及其程度的数据。所有患者的 BBQ 评分均高于 11，表明存在与呼吸困难相关的运动恐惧。IMT 降低了 BBQ 评分并改善了呼吸功能和运动能力。我们的结果还支持 IMT 的其他已知益处，如减轻呼吸困难和症状感知、降低焦虑和抑郁以及改善生活质量。
