Introduction
Materials and methods
Study design
Recruitment of subjects
Study interventions
Endpoints
Respiratory muscle strength
Dyspnea
Breathing pattern
Spirometry
Exercise capacity
Quality of life, emotional status
Nutritional status
BODE index
Statistical analysis
Results
Baseline characteristics
Sham training (n=23) | IMT (n=23) | CTSC (n=23) | CTDC (n=23) |
F
|
P-value
| |
---|---|---|---|---|---|---|
Age(year) | 69.43±6.44 | 67.49±6.17 | 68.26±7.03 | 67.22±7.35 | 0.498 | 0.685 |
Smoking index | 513.04±559.47 | 356.52±389.44 | 380.87±448.49 | 355.22±446.89 | 0.603 | 0.614 |
BMI(kg/m2) | 20.86±4.41 | 22.09±3.37 | 21.86±3.03 | 22.99±2.28 | 1.662 | 0.188 |
FFMI(kg/m2) | 16.47±2.20 | 15.51±2.35 | 15.76±2.72 | 16.82±1.38 | 1.740 | 0.165 |
PImax>60cmH2O | 72.73±12.59(n=12) | 75.01±17.91(n=9) | 75.79±9.79(n=8) | 72.55±8.52(n=11) | 0.211 | 0.888 |
PImax≤60cmH2O | 46.12±11.03(n=11) | 44.6±10.87(n=14) | 43.83±10.41(n=15) | 52.29±8.21(n=12) | 1.795 | 0.161 |
PEmax (cmH2O) | 63.82±18.46 | 60.26±19.96 | 56.10±16.73 | 62.13±13.56 | 0.844 | 0.473 |
mMRC | 1.609±0.839 | 1.652±0.832 | 1.913±0.793 | 1.478±0.790 | 1.155 | 0.332 |
FVC(L) | 2.312±0.781 | 2.229±0.673 | 2.076±0.813 | 2.298±0.593 | 0.517 | 0.671 |
FEV1(L) | 1.137±0.462 | 1.161±0.325 | 0.967±0.292 | 1.120±0.339 | 1.375 | 0.256 |
FEV1%pred (%) | 48.217±15.030 | 46.652±13.506 | 42.565±12.033 | 47.248±12.404 | 0.806 | 0.494 |
FEV1/FVC | 0.501±0.123 | 0.534±0.108 | 0.505±0.172 | 0.495±0.112 | 0.554 | 0.648 |
6MWD(m) | 415.130±52.301 | 398.957±78.733 | 382.087±81.637 | 400.652±78.016 | 0.776 | 0.510 |
CAT | 10.478±5.846 | 10.696±4.106 | 12.609±4.131 | 10.348±5.149 | 1.094 | 0.356 |
SGRQ | 16.435±7.415 | 17.348±6.184 | 18.783±5.018 | 17.565±7.051 | 0.511 | 0.676 |
HADS | 5.870±3.293 | 5.174±2.125 | 5.696±2.835 | 5.000±3.568 | 0.436 | 0.727 |
BODE | 2.870±1.576 | 3.304±1.636 | 3.826±1.154 | 2.783±1.930 | 2.614 | 0.062 |
Respiratory muscle strength
Sham training (n=23) | IMT (n=23) | CTSC (n=23) | CTDC (n=23) |
F
|
P-value
| |
---|---|---|---|---|---|---|
Δ BMI (kg/m2) | -0.084±0.489 | -0.456±0.727 | -0.145±0.534 | -0.254±0.611 | 1.540 | 0.210 |
Δ FFMI (kg/m2) | -0.182±0.400 | -0.231±0.537 | 0.128±0.913 | -0.070±0.664 | 1.371 | 0.257 |
ΔPImax(cmH2O) | 2.150±4.30 | 9.830±6.857a | 8.722±6.052a | 8.130±6.548a | 7.347 | <0.001 |
ΔPEmax (cmH2O) | 2.160±5.107 | 4.544±4.119 | 8.844±8.155a,b | 8.313±6.635a,b | 5.710 | 0.001 |
Δ mMRC | 0.130±0.548 | -0.304±0.559a | -0.261±0.449a | -0.217±0.422 a | 3.558 | 0.018 |
Δ FVC(L) | -0.013±0.098 | -0.011±0.175 | 0.007±0.138 | -0.059±0.158 | 0.706 | 0.551 |
Δ FEV1(L) | -0.005±0.081 | -0.020±0.109 | 0.020±0.120 | -0.030±0.086 | 0.561 | 0.642 |
ΔFEV1%pred (%) | -0.261±3.427 | -0.826±4.549 | -0.174±5.789 | -2.030±5.358 | 0.688 | 0.562 |
Δ FEV1/FVC | -0.002±0.034 | -0.001±0.034 | 0.014±0.049 | 0.002±0.017 | 0.940 | 0.425 |
Δ 6MWD(m) | 8.478±20.784 | 24.174±18.364 | 19.087±26.787 | 19.739±12.941 | 2.175 | 0.097 |
Δ CAT | 0.304±2.098 | -2.304±2.787a | -1.435±1.903a | -1.739±1.484a | 6.575 | 0.0005 |
Δ SGRQ | -0.174±2.103 | -3.087±2.429a | -2.565±1.927a | -2.261±1.322a | 9.124 | <0.001 |
Δ HADS | -0.174±1.370 | -0.609±1.559 | -0.652±1.849 | -0.130±1.714 | 0.692 | 0.559 |
Δ BODE | -0.174±0.778 | -0.478±1.163 | -0.348±1.434 | -0.174±1.230 | 0.472 | 0.703 |
Dyspnea
Breathing pattern
Sham training (n=23) | IMT (n=23) | CTSC (n=23) | CTDC (n=23) |
P
2
| |
---|---|---|---|---|---|
RR(breaths/min) | |||||
Pre-test | 20.3 (18.6 to 21.9) | 20.3 (18.7 to 22) | 20.7 (19 to 22.3) | 20.0 (18.3 to 21.6) | |
Post-test | 20.1 (18.6 to 21.6) | 20.1 (18.6 to 21.6) | 18.7 (17.1 to 20.2) | 19.8 (18.3 to 21.3) | P2=0.949 |
P1 | 0.584 | 0.275 | <0.01 | 0.466 | |
Ti(S) | |||||
Pre-test | 1.489 (1.353 to 1.624) | 1.481 (1.346 to 1.617) | 1.435 (1.299 to 1.570) | 1.501 (1.366 to 1.637) | |
Post-test | 1.486 (1.354 to 1.617) | 1.435 (1.303 to 1.566) | 1.388 (1.257 to 1.520) | 1.457 (1.325 to 1.588) | P2=0.851 |
P1 | 0.691 | <0.01 | <0.01 | <0.01 | |
Te(S) | |||||
Pre-test | 1.751 (1.521 to 1.980) | 1.719 (1.489 to 1.948) | 1.687 (1.457 to 1.916) | 1.661 (1.431 to 1.890) | |
Post-test | 1.755 (1.527 to 1.984) | 1.757 (1.528 to 1.985) | 1.752 (1.524 to 1.981) | 1.723 (1.495 to 1.952) | P2=0.989 |
P1 | 0.571 | <0.01 | <0.01 | <0.01 | |
Ti/Ttot | |||||
Pre-test | 0.466 (0.434 to 0.497) | 0.474 (0.442 to 0.506) | 0.476 (0.444 to 0.508) | 0.488 (0.456 to 0.520) | |
Post-test | 0.466 (0.435 to 0.496) | 0.460 (0.430 to 0.490) | 0.457 (0.427 to 0.488) | 0.470 (0.439 to 0.500) | P2=0.922 |
P1 | 0.886 | <0.01 | <0.01 | <0.01 | |
Vt(L) | |||||
Pre-test | 0.469 (0.447 to 0.491) | 0.467 (0.444 to 0.489) | 0.463 (0.441 to 0.485) | 0.479 (0.457 to 0.501) | |
Post-test | 0.465 (0.444 to 0.485) | 0.471 (0.450 to 0.492) | 0.462 (0.441 to 0.482) | 0.477 (0.457 to 0.498) | P2=0.762 |
P1 | 0.127 | 0.127 | 0.645 | 0.539 | |
IC(L) | |||||
Pre-test | 1.613 (1.461 to 1.766) | 1.568 (1.416 to 1.720) | 1.541 (1.389 to 1.693) | 1.665 (1.513 to 1.818) | |
Post-test | 1.600 (1.456 to 1.744) | 1.575 (1.431 to 1.720) | 1.537 (1.393 to 1.682) | 1.652 (1.508 to 1.796) | P2=0.909 |
P1 | 0.068 | 0.313 | 0.634 | 0.077 |
Spirometry and exercise capacity
Quality of life, emotional status
BODE index and nutritional status
Subjects with vs. without respiratory muscle weakness
Subgroups | Sham training | IMT | CTSC | CTDC | ANOVA (interaction) |
---|---|---|---|---|---|
Number | 23 | 23 | 23 | 23 | |
PImax>60cmH2O | 12 | 9 | 8 | 11 | |
PImax≤60cmH2O | 11 | 14 | 15 | 12 | |
Δ BMI(kg/m2) | |||||
PImax>60cmH2O | -0.101±0.394 | -0.593±0.770 | -0.056±0.541 | -0.173±0.618 | |
PImax≤60cmH2O | -0.066±0.595 | -0.367±0.713 | -0.192±0.543 | -0.328±0.622 | P=0.702 |
p | 0.867 | 0.479 | 0.574 | 0.554 | |
ΔFFMI(kg/m2) | |||||
PImax>60cmH2O | -0.188±0.431 | -0.232±0.583 | 0.053±0.335 | 0.131±0.814 | |
PImax≤60cmH2O | -0.176±0.385 | -0.230±0.528 | 0.168±1.118 | -0.254±0.450 | P=0.605 |
p | 0.941 | 0.993 | 0.780 | 0.170 | |
ΔPImax(cmH2O) | |||||
PImax>60cmH2O | 1.758±4.911 | 5.367±5.558 | 5.738±5.218 | 5.218±6.244 | |
PImax≤60cmH2O | 2.576±3.710 | 12.700±6.155 | 10.313±6.011 | 10.800±5.835 | P=0.254 |
p | 0.659 | 0.009 | 0.084 | 0.038 | |
ΔPEmax(cmH2O) | |||||
PImax>60cmH2O | 1.808±5.852 | 4.700±3.482 | 8.275±11.023 | 4.600±6.340 | |
PImax≤60cmH2O | 2.544±4.404 | 4.443±4.606 | 9.147±6.593 | 11.717±5.007 | P=0.162 |
p | 0.739 | 0.888 | 0.814 | 0.007 | |
Δ mMRC | |||||
PImax>60cmH2O | 0.167±0.577 | -0.333±0.707 | -0.250±0.463 | -0.273±0.467 | |
PImax≤60cmH2O | 0.091±0.539 | -0.286±0.469 | -0.267±0.458 | -0.167±0.389 | P=0.938 |
p | 0.749 | 0.847 | 0.935 | 0.559 | |
Δ FVC(L) | |||||
PImax>60cmH2O | -0.033±0.114 | 0.004±0.208 | 0.051±0.184 | -0.059±0.210 | |
PImax≤60cmH2O | 0.009±0.078 | -0.021±0.159 | -0.016±0.107 | -0.059±0.100 | P=0.661 |
p | 0.312 | 0.745 | 0.277 | 0.999 | |
Δ FEV1(L) | |||||
PImax>60cmH2O | -0.015±0.072 | -0.053±0.134 | 0.095±0.123 | -0.021±0.104 | |
PImax≤60cmH2O | 0.006±0.092 | 0.001±0.089 | -0.021±0.101 | -0.039±0.068 | P=0.033 |
p | 0.405 | 0.749 | 0.097 | 0.687 | |
ΔFEV1%pred(%) | |||||
PImax>60cmH2O | -0.500±2.876 | -2.556±5.812 | 2.875±4.764 | -1.246±6.620 | |
PImax≤60cmH2O | 0.0±4.074 | 0.286±3.292 | -1.800±5.759 | -2.750±4.048 | P=0.074 |
p | 0.539 | 0.256 | 0.024 | 0.620 | |
Δ FEV1/FVC | |||||
PImax>60cmH2O | -0.003±0.033 | -0.014±0.030 | 0.040±0.051 | 0.005±0.020 | |
PImax≤60cmH2O | -0.002±0.037 | 0.007±0.035 | -0.001±0.044 | -0.001±0.014 | P=0.037 |
p
| 0.981 | 0.148 | 0.058 | 0.451 | |
Δ 6MWD(m) | |||||
PImax>60cmH2O | 3.667±25.850 | 25.556±25.793 | 15.750±17.958 | 15.909±7.687 | |
PImax≤60cmH2O | 13.727±12.539 | 23.286±12.615 | 20.867±30.928 | 23.250±15.910 | P=0.775 |
p | 0.255 | 0.780 | 0.673 | 0.180 | |
Δ CAT | |||||
PImax>60cmH2O | 0.583±2.193 | -2.333±2.121 | -1.125±2.532 | -1.636±1.433 | |
PImax≤60cmH2O | 0±2.049 | -2.286±3.221 | -1.600±1.549 | -1.833±1.586 | P=0.962 |
p | 0.518 | 0.969 | 0.581 | 0.759 | |
Δ SGRQ | |||||
PImax>60cmH2O | 0.167±2.588 | -3.333±1.732 | -2.250±2.493 | -2.182±1.537 | |
PImax≤60cmH2O | -0.546±1.440 | -2.929±2.841 | -2.733±1.624 | -2.333±1.155 | P=0.811 |
p | 0.430 | 0.706 | 0.579 | 0.791 | |
Δ HADS | |||||
PImax>60cmH2O | -0.250±1.138 | -0.556±1.333 | -1.000±1.927 | -0.364±1.963 | |
PImax≤60cmH2O | -0.091±1.640 | -0.643±1.737 | -0.467±1.846 | 0.083±1.505 | P=0.924 |
p | 0.788 | 0.899 | 0.523 | 0.545 | |
Δ BODE | |||||
PImax>60cmH2O | -0.167±0.937 | -0.556±1.014 | -0.125±0.991 | -0.364±1.286 | |
PImax≤60cmH2O | -0.182±0.603 | -0.429±1.284 | -0.467±1.642 | 0.000±1.206 | P=0.803 |
p | 0.964 | 0.805 | 0.598 | 0.492 |