Fabero-Garrido Raúl, Del Corral Tamara, Plaza-Manzano Gustavo, Sanz-Ayan Paz, Izquierdo-García Juan, López-de-Uralde-Villanueva Ibai
Department of Radiology, Rehabilitation and Physiotherapy, Faculty of Nursing, Physiotherapy and Podiatry, Complutense University of Madrid, Madrid, Spain.
Grupo InPhysio, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain.
Phys Ther. 2024 Mar 1;104(3). doi: 10.1093/ptj/pzad164.
This systematic review and meta-analysis aimed to evaluate the effects of respiratory muscle training (RMT) on functional exercise capacity, health-related quality of life (HRQoL), respiratory muscle function, and pulmonary function in individuals with ischemic heart disease (IHD).
The MEDLINE, Web of Science, Scopus, PEDro, CINAHL, Science Direct, and CENTRAL electronic databases were searched in January 2023. Randomized controlled trials published in English, Spanish, or Portuguese that were conducted to determine the effect of RMT versus passive control and/or sham RMT on the target variables in individuals with IHD, irrespective of age or sex were included. Two reviewers performed the searches and extraction of the most relevant data. The quality and risk of bias for each included study were examined with the PEDro scale and Cochrane risk-of-bias tool.
Thirteen studies (849 participants) were included. The meta-analysis showed a significant increase in peak oxygen consumption (mean difference [MD] = 2.18 mL·kg-1·min-1 [95% CI = 0.54 to 3.83]), inspiratory muscle strength (MD = 16.62 cm H2O [95% CI = 12.48 to 20.77]), inspiratory muscle endurance (standardized mean difference = 0.39 [95% CI = 0.19 to 0.60]), and expiratory muscle strength (MD = 14.52 cm H2O [95% CI = 5.51 to 23.53]). There were no benefits in 6-minute walking distance (MD = 37.57 m [95% CI = -36.34 to 111.48]), HRQoL (standardized mean difference = 0.22 [95% CI = -0.16 to 0.60]), pulmonary function (forced vital capacity; MD = 2.07% of predicted value [95% CI = -0.90 to 5.03], or forced expiratory volume at the first second (MD = -0.75% of predicted value [95% CI = -5.45 to 3.95]).
This meta-analysis provided high- and moderate-quality evidence that inspiratory muscle training (IMT) improves inspiratory muscle strength and endurance, respectively; and very low-quality evidence for effects on peak oxygen consumption and expiratory muscle strength in individuals with IHD. No superior effects were found in the 6-minute walking test, HRQoL, or pulmonary function compared with the control group.
The results shown in this systematic review with meta-analysis will provide clinicians a better understanding of the effects of IMT in people with IHD. IMT could be integrated into the cardiac rehabilitation management, although more research is needed.
本系统评价和荟萃分析旨在评估呼吸肌训练（RMT）对缺血性心脏病（IHD）患者的功能运动能力、健康相关生活质量（HRQoL）、呼吸肌功能和肺功能的影响。
于2023年1月检索了MEDLINE、Web of Science、Scopus、PEDro、CINAHL、Science Direct和CENTRAL电子数据库。纳入了以英文、西班牙文或葡萄牙文发表的随机对照试验，这些试验旨在确定RMT与被动对照和/或假RMT对IHD患者目标变量的影响，年龄和性别不限。两名 reviewers 进行了检索并提取了最相关的数据。使用PEDro量表和Cochrane偏倚风险工具检查每项纳入研究的质量和偏倚风险。
纳入了13项研究（849名参与者）。荟萃分析显示，峰值耗氧量显著增加（平均差[MD]=2.18 mL·kg-1·min-1[95%CI=0.54至3.83]）、吸气肌力量（MD=16.6 cmH2O[95%CI=12.48至20.77]）、吸气肌耐力（标准化平均差=0.39[95%CI=0.19至0.60]）和呼气肌力量（MD=14.52 cmH2O[95%CI=5.51至23.53]）。6分钟步行距离（MD=37.57 m[95%CI=-36.34至111.48]）、HRQoL（标准化平均差=0.22[95%CI=-0.16至0.60]）、肺功能（用力肺活量；MD=预测值的2.07%[95%CI=-0.90至5.03]，或第1秒用力呼气量（MD=预测值的-0.75%[95%CI=-5.45至3.95]）无益处。
本荟萃分析提供了高质量和中等质量的证据，表明吸气肌训练（IMT）分别改善了吸气肌力量和耐力；以及关于对IHD患者峰值耗氧量和呼气肌力量影响的非常低质量的证据。与对照组相比，在6分钟步行试验、HRQoL或肺功能方面未发现更优效果。
本系统评价和荟萃分析的结果将使临床医生更好地了解IMT对IHD患者的影响。IMT可纳入心脏康复管理，尽管还需要更多研究。
