Shiraishi Masashi, Higashimoto Yuji, Sugiya Ryuji, Mizusawa Hiroki, Takeda Yu, Noguchi Masaya, Nishiyama Osamu, Yamazaki Ryo, Kudo Shintarou, Kimura Tamotsu, Matsumoto Hisako
Department of Rehabilitation Medicine, Kindai University School of Medicine, Osaka, Japan.
Department of Respiratory Medicine and Allergology, Kindai University School of Medicine, Osaka, Japan.
ERJ Open Res. 2024 Nov 25;10(6). doi: 10.1183/23120541.00035-2024. eCollection 2024 Nov.
Inspiratory muscle training (IMT) is used to improve inspiratory muscle strength in patients with COPD. However, the effect of IMT on diaphragmatic function has not yet been thoroughly evaluated. This study aimed to evaluate the effect of IMT on maximum diaphragmatic excursion (DE) using ultrasonography in patients with COPD.
This was a single-centre, randomised, prospective, parallel-group, unblinded controlled trial involving 38 participants with stable COPD. Participants underwent a standardised 12-week pulmonary rehabilitation (PR) programme followed by a 12-week IMT programme, consisting of home-based IMT and low-frequency outpatient PR sessions supervised by physiotherapists (once every 2 weeks), low-frequency outpatient PR alone as a control. The DE and exercise tolerance were measured.
Out of the 38 patients initially enrolled in the PR programme, 33 successfully completed it and were subsequently randomised to the IMT programme. Finally, 15 (94%) and 14 (88%) patients from the IMT and control groups, respectively, completed the study. Following the IMT programme, DE increased in the IMT group (mean±sd 50.1±7.6 mm to 60.6±8.0 mm, p<0.001), but not in the control group (47.4±7.9 mm to 46.9±8.3 mm, p=0.10). Changes in DE and exercise tolerance (peak oxygen uptake) were greater in the IMT group than in the control group (both p<0.01).
IMT following the PR programme improved DE and exercise tolerance. Therefore, DE may be an important outcome of IMT.
吸气肌训练（IMT）用于改善慢性阻塞性肺疾病（COPD）患者的吸气肌力量。然而，IMT对膈肌功能的影响尚未得到充分评估。本研究旨在通过超声评估IMT对COPD患者最大膈肌移动度（DE）的影响。
这是一项单中心、随机、前瞻性、平行组、非盲对照试验，纳入38例稳定期COPD患者。参与者接受为期12周的标准化肺康复（PR）计划，随后进行为期12周的IMT计划，包括家庭式IMT和由物理治疗师监督的低频门诊PR课程（每2周一次），单独的低频门诊PR作为对照。测量DE和运动耐力。
最初纳入PR计划的38例患者中，33例成功完成该计划，随后被随机分配到IMT计划。最后，IMT组和对照组分别有15例（94%）和14例（88%）患者完成研究。IMT计划后，IMT组的DE增加（均值±标准差从50.1±7.6 mm增至60.6±8.0 mm，p<0.001），而对照组未增加（从47.4±7.9 mm降至46.9±8.3 mm，p=0.10）。IMT组DE和运动耐力（峰值摄氧量）的变化大于对照组（均p<0.01）。
PR计划后的IMT改善了DE和运动耐力。因此，DE可能是IMT的一项重要结果。
