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Respiratory muscle training in neuromuscular disease: long-term effects on strength and load perception
1Department of Pediatrics, Tulane University School of Medicine, New Orleans, LA 70112, USA. dgozal@tmcpop.tmc.tulane.edu
Insights
Respiratory muscle training (RMT) improved respiratory muscle strength and reduced respiratory load perception (RLP) in children with neuromuscular disorders (NMD). While strength gains were temporary, RLP improvements persisted, potentially easing respiratory symptoms.
Area of Science:
- Pediatric Pulmonology
- Neuromuscular Disorders
- Rehabilitation Medicine
Background:
- Respiratory muscle dysfunction significantly contributes to morbidity and mortality in pediatric neuromuscular disorders (NMD).
- Effective interventions are crucial for managing respiratory complications in these vulnerable patients.
Purpose of the Study:
- To evaluate the efficacy of respiratory muscle training (RMT) in improving respiratory muscle strength and respiratory load perception (RLP) in children with NMD.
- To assess the durability of these effects after training cessation.
Main Methods:
- A 6-month randomized controlled trial involving 21 children with NMD and 20 healthy controls undergoing incremental RMT.
- Measurements included maximal static inspiratory and expiratory pressures (Pi(max), Pe(max)) and RLP using a modified Borg scale.
- Assessments were conducted pre-training, monthly during training, and for 1 year post-training.
Main Results:
- RMT significantly improved Pi(max) and Pe(max) in children with NMD compared to controls (P < 0.02 and P < 0.004, respectively).
- Respiratory load perception (RLP) significantly decreased in the trained NMD group (P < 0.01).
- While strength improvements were transient, RLP improvements persisted for 12 months post-training.
Conclusions:
- Respiratory muscle training can enhance respiratory muscle strength and reduce RLP in children with NMD.
- Long-lasting improvements in RLP suggest a potential benefit for reducing respiratory symptoms, despite the reversibility of strength gains.
Purpose:
Deterioration of respiratory muscle function in patients with neuromuscular disorders is primarily responsible for the high morbidity and mortality associated with these diseases.
Methods:
The potential benefit of respiratory muscle training (RMT) on preservation of respiratory muscle strength and respiratory load perception (RLP) was examined in 21 children (mean age: 12.2 +/- 1.8 yr [SD], 16 male) with Duchenne's muscular dystrophy or spinal muscular atrophy type III, and in 20 age-, weight-, and sex-matched controls. Subjects were randomly allocated to undergo incremental RMT with resistive inspiratory and expiratory loads for a period of 6 months (trained group, TR) or to perform similar exercises with no load (NT). Maximal static inspiratory (Pi(max)) and expiratory (Pe(max)) pressures and RLP (modified Borg visual analog scale 0-10) were assessed on two separate occasions before beginning of the training protocol, monthly throughout RMT duration, and every 3-6 months upon cessation of RMT for 1 yr.
Results:
In controls, no significant changes in maximal static pressures or load perception occurred during RMT or thereafter. Training in neuromuscular disorder (NMD) patients was associated with improvements in Pi(max) (mean delta max: +19.8 +/- 3.8 cmH2O in TR vs +4.2 +/- 3.6 cmH2O in NT; P < 0.02) and in Pe(max) (mean delta max: +27.1 +/- 4.9 cmH2O in TR vs -1.8 +/- 3.4 cmH2O in NT; P < 0.004). Similarly, RLP significantly decreased during the RMT period in TR (mean delta: 1.9 +/- 0.3; P < 0.01) but did not change in NT (-0.2 +/- 0.2). In addition, with cessation of RMT, static pressures returned to pretraining values in TR within approximately 3 months. However, RLP was still improved after 12 months.
Conclusions:
We conclude that in children with NMD, although RMT-induced increases in expiratory muscle strength are rapidly reversible, long-lasting improvements in RLP occur and could be associated with decreased respiratory symptoms.