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Erschienen in: Clinical Research in Cardiology 9/2017

02.03.2017 | Original Paper

Is there any benefit using low-intensity inspiratory and peripheral muscle training in heart failure? A randomized clinical trial

verfasst von: Tatiana Satie Kawauchi, Iracema Ioco Kikuchi Umeda, Lays Magalhães Braga, Antonio de Pádua Mansur, João Manoel Rossi-Neto, Amanda Guerra de Moraes Rego Sousa, Mário Hiroyuki Hirata, Lawrence P. Cahalin, Naomi Kondo Nakagawa, PT, PhD

Erschienen in: Clinical Research in Cardiology | Ausgabe 9/2017

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Abstract

Background

Inspiratory and peripheral muscle training improves muscle strength, exercise tolerance, and quality of life in patients with chronic heart failure (HF). However, studies investigating different workloads for these exercise modalities are still lacking.

Objective

To examine the effects of low and moderate intensities on muscle strength, functional capacity, and quality of life.

Design

A randomized controlled trial.

Methods

Thirty-five patients with stable HF (aged >18 years, NYHA II/III, LVEF <40%) were randomized to: non-exercise control group (n = 9), low-intensity training group (LIPRT, n = 13, 15% maximal inspiratory workload, and 0.5 kg of peripheral muscle workload) or moderate-intensity training group (MIPRT, n = 13, 30% maximal inspiratory workload and 50% of one maximum repetition of peripheral muscle workload). The outcomes were: respiratory and peripheral muscle strength, pulmonary function, exercise tolerance by the 6-minute walk test, symptoms based on the NYHA functional class, and quality of life using the Minnesota Living with Heart Failure Questionnaire.

Results

All groups showed similar quality-of-life improvements. Low and moderate intensities training programs improved inspiratory muscle strength, peripheral muscle strength, and walking distance. However, only moderate intensity improved expiratory muscle strength and NYHA functional class in HF patients.

Conclusions

The low-intensity inspiratory and peripheral resistance muscle training improved inspiratory and peripheral muscle strength and walking distance, demonstrating that LIPRT is an efficient rehabilitation method for debilitated HF patients. In addition, the moderate-intensity resistance training also improved expiratory muscle strength and NYHA functional class in HF patients.
Literatur
1.
Zurück zum Zitat Piepoli MF, Guazzi M, Boriani G, Cicoira M, Corrà U, Libera LD, Emdin M, Mele D, Passino C, Vescovo G, Vigorito C, Villani CQ, Agostoni P (2010) Exercise intolerance in chronic heart failure: mechanisms and therapies. Part I. Eur J Cardiovasc Prev Rehabil 17:637–642CrossRefPubMed Piepoli MF, Guazzi M, Boriani G, Cicoira M, Corrà U, Libera LD, Emdin M, Mele D, Passino C, Vescovo G, Vigorito C, Villani CQ, Agostoni P (2010) Exercise intolerance in chronic heart failure: mechanisms and therapies. Part I. Eur J Cardiovasc Prev Rehabil 17:637–642CrossRefPubMed
2.
Zurück zum Zitat Piña IL, Apstein CS, Balady GJ, Belardinelli R, Chaitman BR, Duscha BD, Fletcher BJ, Fleg TL, Sullivan MJ (2003) Exercise and heart failure: a statement from the American Heart Association Committee on exercise, rehabilitation, and prevention. Circulation 107:1210–1225. doi:10.1161/01.CIR.0000055013.92097.40 CrossRefPubMed Piña IL, Apstein CS, Balady GJ, Belardinelli R, Chaitman BR, Duscha BD, Fletcher BJ, Fleg TL, Sullivan MJ (2003) Exercise and heart failure: a statement from the American Heart Association Committee on exercise, rehabilitation, and prevention. Circulation 107:1210–1225. doi:10.​1161/​01.​CIR.​0000055013.​92097.​40 CrossRefPubMed
4.
Zurück zum Zitat Von Scheidt W, Zugck C, Pauschinger M, Hambrecht R, Bruder O, Hartmann A, Rauchhaus M, Zahn R, Brachmann J, Tebbe U, Neumann T, Strasser RH, Böhm M, Störk S, Hochadel M, Heidemann P, Senges J (2014) Characteristics, management modalities and outcome in chronic systolic heart failure patients treated in tertiary care centers: results from the EVIdence based TreAtment in Heart Failure (EVITA-HF). Clin Res Cardiol 103:1006–1014. doi:10.1007/s00392-014-0743-x CrossRef Von Scheidt W, Zugck C, Pauschinger M, Hambrecht R, Bruder O, Hartmann A, Rauchhaus M, Zahn R, Brachmann J, Tebbe U, Neumann T, Strasser RH, Böhm M, Störk S, Hochadel M, Heidemann P, Senges J (2014) Characteristics, management modalities and outcome in chronic systolic heart failure patients treated in tertiary care centers: results from the EVIdence based TreAtment in Heart Failure (EVITA-HF). Clin Res Cardiol 103:1006–1014. doi:10.​1007/​s00392-014-0743-x CrossRef
5.
Zurück zum Zitat Whellan DJ, Nigam A, Arnold M, Starr AZ, Hill J, Fletcher G, Ellis SJ, Cooper L, Omwanyi A, Chandeler B, Keyan SJ, Ewald G, Kao A, Gheoghiade M (2011) Benefit of exercise therapy for systolic heart failure in relation to disease severity and etiology-findings from the HF-ACTION study. Am Heart J 162:1003–1010. doi:10.1016/j.ahj.2011.09.017 CrossRefPubMedPubMedCentral Whellan DJ, Nigam A, Arnold M, Starr AZ, Hill J, Fletcher G, Ellis SJ, Cooper L, Omwanyi A, Chandeler B, Keyan SJ, Ewald G, Kao A, Gheoghiade M (2011) Benefit of exercise therapy for systolic heart failure in relation to disease severity and etiology-findings from the HF-ACTION study. Am Heart J 162:1003–1010. doi:10.​1016/​j.​ahj.​2011.​09.​017 CrossRefPubMedPubMedCentral
7.
Zurück zum Zitat Johnson PH, Cowley AJ, Kinnear WJM (1998) A randomized controlled trial of inspiratory muscle training in stable chronic heart failure. Eur Heart J 19:1249–1253CrossRefPubMed Johnson PH, Cowley AJ, Kinnear WJM (1998) A randomized controlled trial of inspiratory muscle training in stable chronic heart failure. Eur Heart J 19:1249–1253CrossRefPubMed
8.
Zurück zum Zitat Dall’Ago P, Chiappa G R S, Guths H, Stein R, Ribeiro JP (2006) Inspiratory muscle training in patients with heart failure and inspiratory muscle weakness. J Am Coll Cardiol 47:757–763CrossRefPubMed Dall’Ago P, Chiappa G R S, Guths H, Stein R, Ribeiro JP (2006) Inspiratory muscle training in patients with heart failure and inspiratory muscle weakness. J Am Coll Cardiol 47:757–763CrossRefPubMed
9.
Zurück zum Zitat Laoutaris I, Dritsas A, Brown MD, Manginas A, Alivizatos PA, Cokkinos DV (2004) Inspiratory muscle training using an incremental endurance test alleviates dyspnea and improves functional status in patients with chronic heart failure. Eur J Cardiovasc Prev Rehabil 11(6):489–496CrossRefPubMed Laoutaris I, Dritsas A, Brown MD, Manginas A, Alivizatos PA, Cokkinos DV (2004) Inspiratory muscle training using an incremental endurance test alleviates dyspnea and improves functional status in patients with chronic heart failure. Eur J Cardiovasc Prev Rehabil 11(6):489–496CrossRefPubMed
10.
Zurück zum Zitat Weiner P, Waizman J, Magadle R, Berar-Yanay N, Pelled B (1999) The effect of specific inspiratory muscle training on the sensation of dyspnea and exercise tolerance in patients with congestive heart failure. Clin Cardiol 22:727–732CrossRefPubMed Weiner P, Waizman J, Magadle R, Berar-Yanay N, Pelled B (1999) The effect of specific inspiratory muscle training on the sensation of dyspnea and exercise tolerance in patients with congestive heart failure. Clin Cardiol 22:727–732CrossRefPubMed
11.
Zurück zum Zitat Meyer K (2006) Resistance exercise in chronic heart failure—landmark studies and implications for practice. Clin Invest Med 29:166–169PubMed Meyer K (2006) Resistance exercise in chronic heart failure—landmark studies and implications for practice. Clin Invest Med 29:166–169PubMed
12.
Zurück zum Zitat Feiereisen P, Delagardelle C, Vaillant M, Lasar Y, Beissel J (2007) Is strength training the more efficient training modality in chronic heart failure? Med Sci Sports Exerc 39:1910–1917CrossRefPubMed Feiereisen P, Delagardelle C, Vaillant M, Lasar Y, Beissel J (2007) Is strength training the more efficient training modality in chronic heart failure? Med Sci Sports Exerc 39:1910–1917CrossRefPubMed
13.
Zurück zum Zitat Winkelmann ER, Chiappa GR, Lima COC, Viecili PRN, Stein R, Ribeiro JP (2009) Addition of inspiratory muscle training to aerobic training improves cardiorespiratory responses to exercise in patients with heart failure and inspiratory muscle weakness. Am Heart J 158(768):e1–e7. doi:10.1016/j.ahj.2009.09.005 Winkelmann ER, Chiappa GR, Lima COC, Viecili PRN, Stein R, Ribeiro JP (2009) Addition of inspiratory muscle training to aerobic training improves cardiorespiratory responses to exercise in patients with heart failure and inspiratory muscle weakness. Am Heart J 158(768):e1–e7. doi:10.​1016/​j.​ahj.​2009.​09.​005
14.
Zurück zum Zitat Adamopoulos S, Schmid JP, Dendale P, Poerschke D, Hansen D, Dritsas A, Kopuloubinis A, Aldrs T, Gkouziouta A, Reyckers I, Vartela V, Plessas N, Doulaptosis C, Saner H, Lauoutaris ID (2014) Combined aerobic/inspiratory muscle training vs. aerobic training in patients with chronic heart failure: the Vent-HeFT trial: a european prospective multicentre randomised trial. Eur J Heart Fail 16:574–582. doi:10.1002/ejhf.70 CrossRefPubMed Adamopoulos S, Schmid JP, Dendale P, Poerschke D, Hansen D, Dritsas A, Kopuloubinis A, Aldrs T, Gkouziouta A, Reyckers I, Vartela V, Plessas N, Doulaptosis C, Saner H, Lauoutaris ID (2014) Combined aerobic/inspiratory muscle training vs. aerobic training in patients with chronic heart failure: the Vent-HeFT trial: a european prospective multicentre randomised trial. Eur J Heart Fail 16:574–582. doi:10.​1002/​ejhf.​70 CrossRefPubMed
15.
Zurück zum Zitat Laoutaris ID, Adamopoulos S, Manginas A, Panagiotakos DB, Kallistratos MS, Doulaptsis C, Kouloubinis A, Voudris V, Pavilides G, Cokkins DV, Dritsos A (2013) Benefits of combined aerobic/resistance/inspiratory training in patients with chronic heart failure. A complete exercise model? A prospective randomised study. Int J Cardiol 167:1967–1972. doi:10.1016/j.ijcard.2012.05.019 CrossRefPubMed Laoutaris ID, Adamopoulos S, Manginas A, Panagiotakos DB, Kallistratos MS, Doulaptsis C, Kouloubinis A, Voudris V, Pavilides G, Cokkins DV, Dritsos A (2013) Benefits of combined aerobic/resistance/inspiratory training in patients with chronic heart failure. A complete exercise model? A prospective randomised study. Int J Cardiol 167:1967–1972. doi:10.​1016/​j.​ijcard.​2012.​05.​019 CrossRefPubMed
18.
Zurück zum Zitat American Thoracic Society (1995) Standardization of spirometry. Am J Respir Crit Care Med 152:1107–1136CrossRef American Thoracic Society (1995) Standardization of spirometry. Am J Respir Crit Care Med 152:1107–1136CrossRef
20.
Zurück zum Zitat ATS statement: guidelines for the six-minute walk test (2002) ATS Committee on Proficiency Standards for Clinical Pulmonary Function Laboratories. Am J Respir Crit Care Med 166:111–117CrossRef ATS statement: guidelines for the six-minute walk test (2002) ATS Committee on Proficiency Standards for Clinical Pulmonary Function Laboratories. Am J Respir Crit Care Med 166:111–117CrossRef
21.
Zurück zum Zitat Salzwedel A, Reibis R, Wegscheider K, Eichler S, Buhlert H, Kaminski S, Völler H (2016) Cardiopulmonary exercise testing is predictive of return to work in cardiac patients after multicomponent rehabilitation. Clin Res Cardiol 105(3):257–267. doi:10.1007/s00302-015-0917-1 CrossRefPubMed Salzwedel A, Reibis R, Wegscheider K, Eichler S, Buhlert H, Kaminski S, Völler H (2016) Cardiopulmonary exercise testing is predictive of return to work in cardiac patients after multicomponent rehabilitation. Clin Res Cardiol 105(3):257–267. doi:10.​1007/​s00302-015-0917-1 CrossRefPubMed
22.
Zurück zum Zitat Enright PL, Sherrill DL (1998) Reference equations for the six-minute walk in healthy adults. Am J Respir Crit Care Med 158:1384–1397CrossRefPubMed Enright PL, Sherrill DL (1998) Reference equations for the six-minute walk in healthy adults. Am J Respir Crit Care Med 158:1384–1397CrossRefPubMed
23.
Zurück zum Zitat Rector TS, Cohn JN (1992) Assessment of patient outcome with the Minnesota Living with Heart Failure questionnaire: reliability and validity during a randomized, double-blind, placebo-controlled trial of pimobendan. Pimobendan Multicenter Research Group. Am Heart J 124:1017–1025CrossRefPubMed Rector TS, Cohn JN (1992) Assessment of patient outcome with the Minnesota Living with Heart Failure questionnaire: reliability and validity during a randomized, double-blind, placebo-controlled trial of pimobendan. Pimobendan Multicenter Research Group. Am Heart J 124:1017–1025CrossRefPubMed
24.
Zurück zum Zitat Schowalter M, Gelbrich G, Stork S, Langguth JP, Morbach C, Earl G, Faller H, Angermann CE (2013) Generic and disease-specific health-related quality of life in patients with chronic systolic heart failure: impact of depression. Clin Res Cardiol 102:269–278. doi:10.1007/s00392-012-0531-4 CrossRefPubMed Schowalter M, Gelbrich G, Stork S, Langguth JP, Morbach C, Earl G, Faller H, Angermann CE (2013) Generic and disease-specific health-related quality of life in patients with chronic systolic heart failure: impact of depression. Clin Res Cardiol 102:269–278. doi:10.​1007/​s00392-012-0531-4 CrossRefPubMed
26.
Zurück zum Zitat Craig CL, Marshall AL, Söstöm M, Bauman AE, Booth ML, Ainsworth BE (2003) International Physical Activity Questionnaire: 12-country reliability and validity. Med Sci Sports Exerc 35(8):1381–1395CrossRefPubMed Craig CL, Marshall AL, Söstöm M, Bauman AE, Booth ML, Ainsworth BE (2003) International Physical Activity Questionnaire: 12-country reliability and validity. Med Sci Sports Exerc 35(8):1381–1395CrossRefPubMed
27.
Zurück zum Zitat Working Group on Cardiac Rehabilitation and Exercice Physiology and Working Group on Heart Failure of the European Society of Cardiology (2001) Recommendations for exercise training in chronic heart failure patients. Eur Heart J 22:125–135. doi:10.1053/euhj.2000.2440 CrossRef Working Group on Cardiac Rehabilitation and Exercice Physiology and Working Group on Heart Failure of the European Society of Cardiology (2001) Recommendations for exercise training in chronic heart failure patients. Eur Heart J 22:125–135. doi:10.​1053/​euhj.​2000.​2440 CrossRef
28.
Zurück zum Zitat Cahalin LP, Arena R, Guazzi M, Myers J, Cipriano G, Chiappa G, Lavie CJ, Forman DE (2013) Inspiratory muscle training in heart disease and heart failure: a review of the literature with a focus on method of training and outcomes. Exp Rev Cardiovasc Ther 11:161–177. doi:10.1586/erc.12.191 CrossRef Cahalin LP, Arena R, Guazzi M, Myers J, Cipriano G, Chiappa G, Lavie CJ, Forman DE (2013) Inspiratory muscle training in heart disease and heart failure: a review of the literature with a focus on method of training and outcomes. Exp Rev Cardiovasc Ther 11:161–177. doi:10.​1586/​erc.​12.​191 CrossRef
29.
Zurück zum Zitat Täger T, Schell M, Cebola R, Fröhlich H, Dösch A, Franke J, Katus HA, Wians FH, Frankenstein L (2015) Biological variation, reference change value (RCV) and minimal important difference v (MID) of inspiratory muscle strength (PImax) in patients with stable chronic heart failure. Clin Res Cardiol 104(10):822–830. doi:10.1007/s00392-015-0850-3 CrossRefPubMed Täger T, Schell M, Cebola R, Fröhlich H, Dösch A, Franke J, Katus HA, Wians FH, Frankenstein L (2015) Biological variation, reference change value (RCV) and minimal important difference v (MID) of inspiratory muscle strength (PImax) in patients with stable chronic heart failure. Clin Res Cardiol 104(10):822–830. doi:10.​1007/​s00392-015-0850-3 CrossRefPubMed
31.
Zurück zum Zitat Cahalin LP, Semigran MJ, Dec GW (1997) Inspiratory muscle training in patients with chronic heart failure awaiting cardiac transplantation: results of a pilot clinical trial. Phys Ther 77:830–838CrossRefPubMed Cahalin LP, Semigran MJ, Dec GW (1997) Inspiratory muscle training in patients with chronic heart failure awaiting cardiac transplantation: results of a pilot clinical trial. Phys Ther 77:830–838CrossRefPubMed
32.
Zurück zum Zitat Pu CT, Johnson MT, Forman DE, Hausdorff JM, Roubenoff R, Foldvari M, Fielding RA, Singh MA (2001) Randomized trial of progressive resistance training to counteract the myopathy of chronic heart failure. J Appl Physiol 90:2341–2350PubMed Pu CT, Johnson MT, Forman DE, Hausdorff JM, Roubenoff R, Foldvari M, Fielding RA, Singh MA (2001) Randomized trial of progressive resistance training to counteract the myopathy of chronic heart failure. J Appl Physiol 90:2341–2350PubMed
33.
Zurück zum Zitat Tyni-Lenné R, Dencker K, Gordon A, Jansson E, Sylvén C (2001) Comprehensive local muscle training increases aerobic working capacity and quality of life and decreases neurohormonal activation in patients with chronic heart failure. Eur J Heart Fail 3:47–52. doi:10.1016/S1388-9842(00)00087-8 CrossRefPubMed Tyni-Lenné R, Dencker K, Gordon A, Jansson E, Sylvén C (2001) Comprehensive local muscle training increases aerobic working capacity and quality of life and decreases neurohormonal activation in patients with chronic heart failure. Eur J Heart Fail 3:47–52. doi:10.​1016/​S1388-9842(00)00087-8 CrossRefPubMed
34.
Zurück zum Zitat Chiappa GR, Roseguini BT, Vieira PJ, Alves CN, Tavares A, Winkelmann ER, Ferlin EL, Stein R, Ribeiro JP (2008) Inspiratory muscle training improves blood flow to resting and exercising limbs in patients with chronic heart failure. J Am Coll Cardiol 51:1663–1671. doi:10.1016/j.jacc.2007.12.045 CrossRefPubMed Chiappa GR, Roseguini BT, Vieira PJ, Alves CN, Tavares A, Winkelmann ER, Ferlin EL, Stein R, Ribeiro JP (2008) Inspiratory muscle training improves blood flow to resting and exercising limbs in patients with chronic heart failure. J Am Coll Cardiol 51:1663–1671. doi:10.​1016/​j.​jacc.​2007.​12.​045 CrossRefPubMed
37.
Zurück zum Zitat Williams MA, Haskell WL, Ades PA, Amsterdam EA, Bittner V, Franklin BA, Gulanick M, Laing ST, Stewart KJ (2007) Resistance exercise in individuals with and without cardiovascular disease: 2007 update: a scientific statement from the American Heart Association Council on Clinical Cardiology and Council on Nutrition, Physical Activity, and Metabolism. Circulation 116:572–584. doi:10.1161/CIRCULATIONAHA.107.185214 CrossRefPubMed Williams MA, Haskell WL, Ades PA, Amsterdam EA, Bittner V, Franklin BA, Gulanick M, Laing ST, Stewart KJ (2007) Resistance exercise in individuals with and without cardiovascular disease: 2007 update: a scientific statement from the American Heart Association Council on Clinical Cardiology and Council on Nutrition, Physical Activity, and Metabolism. Circulation 116:572–584. doi:10.​1161/​CIRCULATIONAHA.​107.​185214 CrossRefPubMed
Metadaten
Titel
Is there any benefit using low-intensity inspiratory and peripheral muscle training in heart failure? A randomized clinical trial
verfasst von
Tatiana Satie Kawauchi
Iracema Ioco Kikuchi Umeda
Lays Magalhães Braga
Antonio de Pádua Mansur
João Manoel Rossi-Neto
Amanda Guerra de Moraes Rego Sousa
Mário Hiroyuki Hirata
Lawrence P. Cahalin
Naomi Kondo Nakagawa, PT, PhD
Publikationsdatum
02.03.2017
Verlag
Springer Berlin Heidelberg
Erschienen in
Clinical Research in Cardiology / Ausgabe 9/2017
Print ISSN: 1861-0684
Elektronische ISSN: 1861-0692
DOI
https://doi.org/10.1007/s00392-017-1089-y

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