严重残疾的多发性硬化症患者在进行呼气肌力量训练后，可达到健康受试者的表现。

Severely disabled multiple sclerosis patients can achieve the performance of healthy subjects after expiratory muscle strength training.

机构信息

Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine and General University Hospital in Prague, Charles University, Katerinska 30, 128 21 Prague 2, Czech Republic.

出版信息

Mult Scler Relat Disord. 2021 Oct;55:103187. doi: 10.1016/j.msard.2021.103187. Epub 2021 Aug 5.

DOI:10.1016/j.msard.2021.103187

PMID:34388534

Abstract

BACKGROUND

The efficacy of expiratory muscle strength training (EMST) in patients with multiple sclerosis (MS) is controversial. The current study's primary objective was to test the effects of a progressive and intensive 12 week home based EMST program on expiratory muscle strength and voluntary cough strength. The secondary objective was to determine the retention of EMST benefits.

METHODS

Thirty-five severely disabled MS patients (relapsing-remitting MS, n = 15; primary progressive MS, n = 5; secondary progressive MS, n = 15) with Expanded Disability Status Scale (EDSS) 5.0 - 7.0 were included in the study. Within 36 weeks, patients completed 12 weeks of a non-training period, 12 weeks of EMST and 12 weeks of a detraining period. Maximal expiratory pressure (PEmax) and voluntary peak cough flow (vPCF) were assessed 4 times: at week 0 (baseline), week 12 (pre-training), week 24 (post-training), and week 36 (post-detraining). MS patients included in the study were compared to age- and sex-matched healthy subjects. In the healthy controls, the PEmax and vPCF were assessed once to obtain normative data.

RESULTS

Twenty-six patients completed the training period (mean age 52.7 ± 10.2, EDSS 5.9 ± 0.6) and were compared to 26 sex- and age-matched healthy subjects (mean age 53.5 ± 5.8). Patients with MS had a lower PEmax (p = 0.002) and vPCF (p = 0.022) at baseline than the healthy control group. In training period, the PEmax and vPCF increased (p = 0.0000; effect size: d = 0.94 and p = 0.0036; d = 0.57 respectively) in comparison with the non-training period (p = 0.0692; d = -0.36 and p = 0.5810; d = 0.11 respectively). Following the 12 weeks detraining period, the PEmax and vPCF declined but remained 16.7% and 5.5% respectively above the pre-training values. No differences were observed in the PEmax and vPCF between the MS group at the post-training and post-detraining timepoint and the healthy control group normative values.

CONCLUSIONS

EMST improves expiratory muscle strength and voluntary cough strength in severely disabled MS patients.

摘要

背景

呼气肌力量训练（EMST）在多发性硬化症（MS）患者中的疗效存在争议。本研究的主要目的是测试为期 12 周的强化家庭 EMST 方案对呼气肌力量和自主咳嗽强度的影响。次要目的是确定 EMST 益处的保留情况。

方法

35 名严重残疾的 MS 患者（复发缓解型 MS，n = 15；原发性进展型 MS，n = 5；继发性进展型 MS，n = 15），扩展残疾状态量表（EDSS）评分为 5.0-7.0，纳入本研究。在 36 周内，患者完成了 12 周的非训练期、12 周的 EMST 和 12 周的脱训期。在 4 个时间点评估最大呼气压力（PEmax）和自主最大咳嗽流量（vPCF）：第 0 周（基线）、第 12 周（预训练）、第 24 周（后训练）和第 36 周（后脱训）。纳入研究的 MS 患者与年龄和性别匹配的健康受试者进行比较。在健康对照组中，仅评估一次 PEmax 和 vPCF 以获得正常数据。

结果

26 名患者完成了训练期（平均年龄 52.7 ± 10.2，EDSS 5.9 ± 0.6），并与 26 名年龄和性别匹配的健康受试者（平均年龄 53.5 ± 5.8）进行比较。MS 患者的 PEmax（p = 0.002）和 vPCF（p = 0.022）在基线时均低于健康对照组。在训练期间，与非训练期相比，PEmax（p = 0.0000；效应量：d = 0.94 和 p = 0.0036；d = 0.57）和 vPCF（p = 0.0036；d = 0.57 和 p = 0.0036；d = 0.11）均增加。在 12 周脱训期后，PEmax 和 vPCF 下降，但仍分别高于预训练值 16.7%和 5.5%。在训练后和脱训后时间点，MS 组的 PEmax 和 vPCF 与健康对照组的正常数值之间无差异。