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      Effects of High-Intensity Inspiratory Muscle Training Associated with Aerobic Exercise in Patients Undergoing CABG: Randomized Clinical Trial

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          Abstract

          Objective

          Evaluate the interaction between high-intensity inspiratory muscle training (IMT) and aerobic exercise on physical capacity, respiratory muscle strength, peripheral muscle strength, and quality of life of patients who underwent coronary artery bypass grafting (CABG).

          Methods

          Twenty-four patients underwent CABG were randomized into two groups. During 36 sessions, one group received IMT associated with aerobic exercise and the other group received only aerobic exercise. Primary outcome was the distance in the six-minute walk distance (6MWD) test. Secondary outcomes included respiratory muscle strength, peripheral muscle strength, and quality of life. Measures were taken at the baseline, at the 12 th session, the 24 th session, and 36 th session.

          Results

          Baseline characteristics were similar between the groups. There was no statistically significant difference between the two groups in any outcome [6MWD - P=0.935; peak oxygen consumption (PeakVO 2) - P=0.853; maximal inspiratory pressure (MIP) - P=0.243; maximal expiratory pressure (MEP) - P=0.268; sitting-rising test (SRT) - P=0.212], but there was interaction in MIP ( P=0.000) and all outcomes improved in the two groups (6MWD - P=0.000; PeakVO 2 - P=0.000; MIP - P=0.000; MEP - P=0.000; SRT - P=0.000).

          Conclusion

          There was an improvement of all outcomes in both groups, but IMT was not able to provide additional benefits. The use of this combination should be used with caution to not generate higher costs in the rehabilitation process of these patients.

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          Most cited references20

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          Exercise training in heart failure: from theory to practice. A consensus document of the Heart Failure Association and the European Association for Cardiovascular Prevention and Rehabilitation.

          The European Society of Cardiology heart failure guidelines firmly recommend regular physical activity and structured exercise training (ET), but this recommendation is still poorly implemented in daily clinical practice outside specialized centres and in the real world of heart failure clinics. In reality, exercise intolerance can be successfully tackled by applying ET. We need to encourage the mindset that breathlessness may be evidence of signalling between the periphery and central haemodynamic performance and regular physical activity may ultimately bring about favourable changes in myocardial function, symptoms, functional capacity, and increased hospitalization-free life span and probably survival. In this position paper, we provide practical advice for the application of exercise in heart failure and how to overcome traditional barriers, based on the current scientific and clinical knowledge supporting the beneficial effect of this intervention.
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            Impact of inspiratory muscle training in patients with COPD: what is the evidence?

            A meta-analysis including 32 randomised controlled trials on the effects of inspiratory muscle training (IMT) in chronic obstructive pulmonary disease (COPD) patients was performed. Overall and subgroup analyses with respect to training modality (strength or endurance training, added to general exercise training) and patient characteristics were performed. Significant improvements were found in maximal inspiratory muscle strength (P(I,max); +13 cmH₂O), endurance time (+261 s), 6- or 12-min walking distance (+32 and +85 m respectively) and quality of life (+3.8 units). Dyspnoea was significantly reduced (Borg score -0.9 point; Transitional Dyspnoea Index +2.8 units). Endurance exercise capacity tended to improve, while no effects on maximal exercise capacity were found. Respiratory muscle endurance training revealed no significant effect on P(I,max), functional exercise capacity and dyspnoea. IMT added to a general exercise programme improved P(I,max) significantly, while functional exercise capacity tended to increase in patients with inspiratory muscle weakness (P(I,max) <60 cmH₂O). IMT improves inspiratory muscle strength and endurance, functional exercise capacity, dyspnoea and quality of life. Inspiratory muscle endurance training was shown to be less effective than respiratory muscle strength training. In patients with inspiratory muscle weakness, the addition of IMT to a general exercise training program improved P(I,max) and tended to improve exercise performance.
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              • Article: not found

              Cardiac rehabilitation for people with heart disease: an overview of Cochrane systematic reviews.

              Overviews are a new approach to summarising evidence and synthesising results from related systematic reviews.
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                Author and article information

                Contributors
                Role: PT
                Role: PT
                Role: PT
                Role: PT
                Role: PT
                Role: PT
                Role: PT
                Journal
                Braz J Cardiovasc Surg
                Braz J Cardiovasc Surg
                rbccv
                Brazilian Journal of Cardiovascular Surgery
                Sociedade Brasileira de Cirurgia Cardiovascular
                0102-7638
                1678-9741
                Jul-Aug 2018
                Jul-Aug 2018
                : 33
                : 4
                : 376-383
                Affiliations
                [1 ] Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, RS, Brazil.
                [2 ] Instituto de Cardiologia, Porto Alegre, RS, Brazil.
                Author notes
                Correspondence Address: Rodrigo Della Méa Plentz, Universidade Federal de Ciências da Saúde de Porto Alegre, Rua Sarmento Leite, 245 - Porto Alegre, RS, Brazil, Zip code: 90050-170
                Article
                10.21470/1678-9741-2018-0053
                6122761
                30184035
                77c6ccf4-bab4-428e-aff3-ddf00021361e

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 22 February 2018
                : 10 April 2018
                Categories
                Original Article

                coronary artery bypass,cardiac rehabilitation,quality of life,exercise therapy,physical therapy modalities,breathing exercises,muscle strength/physiology,oxygen consumption/physiology,respiratory muscles/physiopathology

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