Respiratory muscle weakness occurs in sarcoidosis and is related to decreased exercise capacity, greater fatigue, dyspnea, and lower quality of life in sarcoidosis patients. The effects of inspiratory muscle training in this population have not been comprehensively investigated so far. This study was planned to investigate the effects of inspiratory muscle training on exercise capacity, respiratory and peripheral muscle strength, pulmonary function and diffusing capacity, fatigue, dyspnea, depression, and quality of life in subjects with sarcoidosis.
METHODS:
This was a prospective, randomized, controlled, and double blind study. Fifteen sarcoidosis subjects (treatment group) received inspiratory muscle training at 40% of maximal inspiratory pressure (PImax), and 15 subjects (control group) received sham therapy (5% of PImax) for 6 weeks. Functional and maximal exercise capacity, respiratory and peripheral muscle strength, pulmonary function and diffusing capacity, fatigue, dyspnea, depression, and quality of life were evaluated.
RESULTS:
Functional (P < .001) and maximal exercise capacity (P = .038), respiratory muscle strength (PImax [P < .001] and PEmax [P = .001]), severe fatigue (P = .002), and dyspnea perception (P = .02) were statistically significantly improved in the treatment group compared with controls; no significant improvements were observed in pulmonary function and diffusing capacity, peripheral muscle strength, fatigue, depression, and quality of life between groups after inspiratory muscle training.
CONCLUSIONS:
Inspiratory muscle training improves functional and maximal exercise capacity and respiratory muscle strength and decreases severe fatigue and dyspnea perception in subjects with early stages of sarcoidosis. Inspiratory muscle training can be safely and effectively included in rehabilitation programs. (ClinicalTrials.gov registration NCT02270333.)
HunninghakeGW, CostabelU, AndoM, BaughmanR, CordierJF, du BoisR, et al. ATS/ERS/WASOG statement on sarcoidosis. American Thoracic Society/European Respiratory Society/World Association of Sarcoidosis and other Granulomatous Disorders. Sarcoidosis Vasc Diffuse Lung Dis, 1999; 16(2):149–173.
2.
SpruitMA, ThomeerMJ, GosselinkR, TroostersT, KasranA, DebrockAJ, et al. Skeletal muscle weakness in patients with sarcoidosis and its relationship with exercise intolerance and reduced health status. Thorax, 2005; 60(1):32–38.
3.
BaughmanRP, SparkmanBK, LowerEE. Six-minute walk test and health status assessment in sarcoidosis. Chest, 2007; 132(1):207–213.
4.
KabitzHJ, LangF, WalterspacherS, SorichterS, Müller-QuernheimJ, WindischW. Impact of impaired inspiratory muscle strength on dyspnea and walking capacity in sarcoidosis. Chest, 2006; 130(5):1496–1502.
5.
BaydurA, AlsalekM, LouieSG, SharmaOP. Respiratory muscle strength, lung function, and dyspnea in patients with sarcoidosis. Chest, 2001; 120(1):102–108.
6.
WirnsbergerRM, DrentM, HekelaarN, BretelerMH, DrentS, WoutersEF, DekhuijzenPN. Relationship between respiratory muscle function and quality of life in sarcoidosis. Eur Respir J, 1997; 10(7):1450–1455.
De VriesJ, WirnsbergerRM. Fatigue, quality of life and health status in sarcoidosis. In: DrentM, CostabelU, editors. Sarcoidosis. European Respiratory Monograph, Vol 10. Wakefield, UK: Informa; 2005:92–104.
9.
DrentM, WirnsbergerRM, BretelerMH, KockLM, de VriesJ, WoutersEF. Quality of life and depressive symptoms in patients suffering from sarcoidosis. Sarcoidosis Vasc Diffuse Lung Dis, 1998; 15(1):59–66.
10.
GosselinkR, De VosJ, van den HeuvelSP, SegersJ, DecramerM, KwakkelG. Impact of inspiratory muscle training in patients with COPD: what is the evidence?. Eur Respir J, 2011; 37(2):416–425.
11.
GeddesEL, O'BrienK, ReidWD, BrooksD, CroweJ. Inspiratory muscle training in adults with chronic obstructive pulmonary disease: an update of a systematic review. Respir Med, 2008; 102(12):1715–1729.
12.
SilvaIS, FregoneziGA, DiasFA, RibeiroCT, GuerraRO, FerreiraGM. Inspiratory muscle training for asthma. Cochrane Database Syst Rev, 2013;(9):CD003792.
13.
LiawMY, WangYH, TsaiYC, HuangKT, ChangPW, ChenYC, LinMC. Inspiratory muscle training in bronchiectasis patients: a prospective randomized controlled study. Clin Rehabil, 2011; 25(6):524–536.
14.
HoustonBW, MillsN, Solis-MoyaA. Inspiratory muscle training for cystic fibrosis. Cochrane Database Syst Rev, 2013;(11):CD006112.
15.
MontemezzoD, FregoneziGA, PereiraDA, BrittoRR, ReidWD. Influence of inspiratory muscle weakness on inspiratory muscle training responses in chronic heart failure patients: a systematic review and meta-analysis. Arch Phys Med Rehabil, 2014; 95(7):1398–1407.
16.
ATS Committee on Proficiency Standards for Clinical Pulmonary Function Laboratories. ATS statement: guidelines for the six-minute walk test. Am J Respir Crit Care Med, 2002; 166(1):111–117.
17.
GibbonsWJ, FruchterN, SloanS, LevyRD. Reference values for a multiple repetition 6-minute walk test in healthy adults older than 20 years. J Cardiopulm Rehabil, 2001; 21(2):87–93.
18.
HollandAE, HillCJ, ConronM, MunroP, McDonaldCF. Small changes in six-minute walk distance are important in diffuse parenchymal lung disease. Respir Med, 2009; 103(10):1430–1435.
19.
BradleyJ, HowardJ, WallaceE, ElbornS. Validity of a modified shuttle walk test in adult cystic fibrosis. Thorax, 1999; 54(5):437–439.
20.
ProbstVS, HernandesNA, TeixeiraDC, FelcarJM, MesquitaRB, GonçalvesCG, et al. Reference values for the incremental shuttle walking test. Respir Med, 2012; 106(2):243–248.
21.
American Thoracic Society/European Respiratory Society. ATS/ERS Statement on respiratory muscle testing. Am J Respir Crit Care Med, 2002; 166(4):518–624.
22.
EvansJA, WhitelawWA. The assessment of maximal respiratory mouth pressures in adults. Respir Care, 2009; 54(10):1348–1359.
23.
BohannonRW. Reference values for extremity muscle strength obtained by hand-held dynamometry from adults aged 20 to 79 years. Arch Phys Med Rehabil, 1997; 78(1):26–32.
24.
American Thoracic Society. Lung function testing: selection of reference values and interpretative strategies (editorial). Am Rev Respir Dis, 1991; 144(5):1202–1218.
25.
QuanjerPH, TammelingGJ, CotesJE, PedersenOF, PeslinR, YernaultJC. Lung volumes and forced ventilatory flows: Report Working Party Standardization of Lung Function Tests, European Community for Steel and Coal: Official Statement of the European Respiratory Society. Eur Respir J Suppl, 1993; 16:5–40.
26.
American Thoracic Society. Single breath carbon monoxide diffusing capacity (transfer factor): recommendations for a standard technique-1995 update (editorial). Am J Respir Crit Care Med, 1995; 152(6):2185–2198.
27.
ArmutluK, KorkmazNC, KeserI, SumbulogluV, AkbiyikDI, GuneyZ, KarabudakR. The validity and reliability of Fatigue Severity Scale in Turkish multiple sclerosis patients. Int J Rehabil Res, 2007; 30(1):81–85.
28.
MahlerDA, WellsCK. Evaluation of clinical methods for rating dyspnea. Chest, 1988; 93(3):580–586.
29.
OzerSK, DemirB, TugalO, KabakciE, YaziciMK. Montgomery and Asberg Depression Rating Scale: interrater validity and reliability study. Turk Psikiyatri Derg, 2001; 12(3):185–194.
30.
PolatlıM, YorgancıoğluA, AydemirÖ, Yılmaz DemirciN, KırkılG, AtışNaycı S, et al. Validity and reliability of Turkish version of St. George's respiratory questionnaire. Tuberk Toraks, 2013; 61(2):81–87.
31.
McConnellA. Respiratory muscle training: theory and practice. Toronto: Elsevier; 2013:135–147.
32.
GosselinkR, WagenaarRC, DecramerM. Reliability of a commercially available threshold loading device in healthy subjects and in patients with chronic obstructive pulmonary disease. Thorax, 1996; 51(6):601–605.
33.
ErdfelderE, FaulF, BuncherA. GPOWER: a general power analysis program. Behavior Research Methods, Instruments, & Computers, 1996; 28(1):1–11.
34.
StuessiC, SpenglerCM, Knöpfli-LenzinC, MarkovG, BoutellierU. Respiratory muscle endurance training in humans increases cycling endurance without affecting blood gas concentrations. Eur J Appl Physiol, 2001; 84(6):582–586.
35.
Sánchez RieraH, Montemayor RubioT, Ortega RuizF, Cejudo RamosP, Del Castillo OteroD, Elias HernandezT, Castillo GomezJ. Inspiratory muscle training in patients with COPD: effect on dyspnea, exercise performance and quality of life. Chest, 2001; 120(3):748–756.
36.
Bosnak-GucluM, ArikanH, SavciS, Inal-InceD, TulumenE, AytemirK, TokgözogluL. Effects of inspiratory muscle training in patients with heart failure. Respir Med, 2011; 105(11):1671–1681.
37.
LaoutarisID, AdamopoulosS, ManginasA, PanagiotakosDB, KallistratosMS, DoulaptsisC, et al. Benefits of combined aerobic/resistance/inspiratory training in patients with chronic heart failure: a complete exercise model? a prospective randomised study. Int J Cardiol, 2013; 167(5):1967–1972.
38.
Santana-SosaE, Gonzalez-SaizL, GroeneveldIF, Villa-AsensiJR, Barrio Gómez de AgueroMI, FleckSJ, et al. Benefits of combining inspiratory muscle with “whole muscle” training in children with cystic fibrosis: a randomized controlled trial. Br J Sports Med, 2014; 48(20):1513–1517.
39.
EnrightS, ChathamK, IonescuAA, UnnithanVB, ShaleDJ. Inspiratory muscle training improves lung function and exercise capacity in adults with cystic fibrosis. Chest, 2004; 126(2):405–411.
40.
HillK, JenkinsSC, PhilippeDL, CecinsN, ShepherdKL, GreenDJ, et al. High-intensity inspiratory muscle training in COPD. Eur Respir J, 2006; 27(6):1119–1128.
