Influence of Respiratory Muscle Training on Patients’ Recovery after Lung Resection

Abstract

This prospective experimental study aimed to compare effects of 3 different home-based postoperative respiratory muscle training protocols – inspiratory, expiratory and combined, in the patients’ postoperative recovery, regarding safety and respiratory muscle function, pulmonary function, physical fitness, physical activity (PA), dyspnoea and quality of life (QoL). Patients were divided in four groups Usual Care (UCare), inspiratory (IMT), expiratory (EMT) or combined muscle training (CombT) according to group allocation. Significant treatment*time interactions were found for maximal inspiratory pressure (MIP) (p=0.014), sedentary PA (SEDPA) (p=0.003), light PA (LIGPA) (p=0.045) and total PA (p=0.035). Improvements were observed for MIP in CombT (p=0.001), IMT (p=0.001), EMT (p=0.050). SEDPA reduced in EMT (p=0.001) and IMT (p=0.006), while LIGPA increased in both groups (p=0.001), as well as Total PA (p=0.005 and p=0.001, respectively). In UCare, CombT, and EMT, QoL improved only for Usual Activities. In conclusion, the addition of respiratory muscle training to physiotherapy usual care is safe and effective to increase MIP and contribute to improve physical activity. The CombT showed greater improvement on MIP, while IMT compared to EMT, was more effective to improve physical activity.

Key words

pulmonary surgery - respiratory muscle training - physiotherapy usual care - maximal inspiratory pressure - physical activity - quality of life

• References

• 1 Cukic V. Reduction of pulmonary function after surgical lung resections of different volume. Med Arch 2014; 68: 231-235
• 2 Brocki BC, Andreasen JJ, Langer D. et al. Postoperative inspiratory muscle training in addition to breathing exercises and early mobilization improves oxygenation in high-risk patients after lung cancer surgery: a randomized controlled trial. Eur J Cardiothorac Surg 2016; 49: 1483-1491
• 3 Kwon S, Symons R, Yukawa M. et al. Evaluating the association of preoperative functional status and postoperative functional decline in older patients undergoing major surgery. Am Surg 2012; 78: 1336-1344
• 4 Brunelli A. Risk assessment for pulmonary resection. Semin Thorac Cardiovasc Surg 2010; 22: 2-13
• 5 Kendall F, Abreu P, Pinho P. et al. The role of physiotherapy in patients undergoing pulmonary surgery for lung cancer. A literature review. Rev Port Pneumol (2006) 2017; 23: 343-351
• 6 Nomori H, Horio H, Fuyuno G. et al. Respiratory muscle strength after lung resection with special reference to age and procedures of thoracotomy. Eur J Cardiothorac Surg 1996; 10: 352-358
• 7 Qaseem A, Snow V, Fitterman N. et al. Risk assessment for and strategies to reduce perioperative pulmonary complications for patients undergoing noncardiothoracic surgery: A guideline from the American College of Physicians. Ann Intern Med 2006; 144: 575-580
• 8 Nomori H, Ohtsuka T, Horio H. et al. Difference in the impairment of vital capacity and 6-minute walking after a lobectomy performed by thoracoscopic surgery, an anterior limited thoracotomy, an anteroaxillary thoracotomy, and a posterolateral thoracotomy. Surg Today 2003; 33: 7-12
• 9 Gosselink R, De Vos J, van den Heuvel SP. et al. Impact of inspiratory muscle training in patients with COPD: What is the evidence?. Eur Respir J 2011; 37: 416-425
• 10 Charususin N, Gosselink R, McConnell A. et al. Inspiratory muscle training improves breathing pattern during exercise in COPD patients. Eur Respir J 2016; 47: 1261-1264
• 11 Weiner P, Man A, Weiner M. et al. The effect of incentive spirometry and inspiratory muscle training on pulmonary function after lung resection. J Thorac Cardiovasc Surg 1997; 113: 552-557
• 12 Mota S, Guell R, Barreiro E. et al. Clinical outcomes of expiratory muscle training in severe COPD patients. Respir Med 2007; 101: 516-524
• 13 Neves LF, Reis MH, Plentz RDM. et al. Expiratory and expiratory plus inspiratory muscle training improves respiratory muscle strength in subjects with COPD: Systematic review. Respir Care 2014; 59: 1381
• 14 Petrovic M, Reiter M, Zipko H. et al. Effects of inspiratory muscle training on dynamic hyperinflation in patients with COPD. Int J Chron Obstruct Pulmon Dis 2012; 7: 797-805
• 15 Harriss DJ, MacSween A, Atkinson G. Ethical standards in sport and exercise science research: 2020 update. Int J Sports Med 2019; 40: 813-817
• 16 Kovelis D, Segretti NO, Probst VS. et al. Validation of the Modified Pulmonary Functional Status and Dyspnea Questionnaire and the Medical Research Council scale for use in Brazilian patients with chronic obstructive pulmonary disease. J Bras Pneumol 2008; 34: 1008-1018
• 17 Bestall JC, Paul EA, Garrod R. et al. Usefulness of the Medical Research Council (MRC) dyspnoea scale as a measure of disability in patients with chronic obstructive pulmonary disease. Thorax 1999; 54: 581-586
• 18 Ferreira PL, Ferreira LN, Pereira LN. Contribution for the validation of the Portuguese version of EQ-5D. Acta Med Port 2013; 26: 664-675
• 19 Brooks R. EuroQol: The current state of play. Health Policy 1996; 37: 53
• 20 Rabin R, Gudex C, Selai C. et al. Preference-based assessments: From translation to version management: A history and review of methods for the cultural adaptation of the EuroQol five-dimensional questionnaire. 2014; 17: 70-76
• 21 Miller MR, Hankinson J, Brusasco V. et al. Standardisation of spirometry. Eur Respir J 2005; 26: 319-338
• 22 American Thoracic Society/European Respiratory S ATS/ERS Statement on respiratory muscle testing. Am J Respir Crit Care Med 2002; 166: 518-624
• 23 Laboratories ATSCoPSfCPF. ATS statement: guidelines for the six-minute walk test. Am J Respir Crit Care Med 2002; 166: 111-117
• 24 Trost SG, McIver KL, Pate RR. Conducting accelerometer-based activity assessments in field-based research. Med Sci Sports Exerc 2005; 37: S531-S543
• 25 Troiano RP, Berrigan D, Dodd KW. et al. Physical activity in the United States measured by accelerometer. Med Sci Sports Exerc 2008; 40: 181-188
• 26 Estellat C, Torgerson DJ, Ravaud P. How to perform a critical analysis of a randomised controlled trial. Best Pract Res Clin Rheumatol 2009; 23: 291-303
• 27 Rothwell PM. Treating individuals 2. Subgroup analysis in randomised controlled trials: Importance, indications, and interpretation. Lancet 2005; 365: 176-186
• 28 VanderWeele TJ, Knol MJ. Interpretation of subgroup analyses in randomized trials: heterogeneity versus secondary interventions. Ann Intern Med 2011; 154: 680-683
• 29 Mans CM, Reeve JC, Elkins MR. Postoperative outcomes following preoperative inspiratory muscle training in patients undergoing cardiothoracic or upper abdominal surgery: A systematic review and meta analysis. Clin Rehabil 2015; 29: 426-438
• 30 Mesquita Montes A, Crasto C, de Melo CA. et al. The effect of inspiratory and expiratory loads on abdominal muscle activity during breathing in subjects “at risk” for the development of chronic obstructive pulmonary disease and healthy. J Electromyogr Kinesiol 2017; 34: 50-57
• 31 Kendall F, Oliveira J, Peleteiro B. et al. Inspiratory muscle training is effective to reduce postoperative pulmonary complications and length of hospital stay: a systematic review and meta-analysis. Disabil Rehabil 2018; 40: 864-882
• 32 Janssen SM, Abbink JJ, Lindeboom R. et al. Outcomes of pulmonary rehabilitation after treatment for non-small cell lung cancer stages I to IIIa: An observational study. J Cardiopulm Rehabil Prev 2017; 37: 65-71
• 33 Granger CL, Parry SM, Edbrooke L. et al. Deterioration in physical activity and function differs according to treatment type in non-small cell lung cancer – future directions for physiotherapy management. Physiotherapy 2016; 102: 256-263
• 34 Novoa N, Varela G, Jimenez MF. et al. Influence of major pulmonary resection on postoperative daily ambulatory activity of the patients. Interact Cardiovasc Thorac Surg 2009; 9: 934-938
• 35 Nagamatsu Y, Maeshiro K, Kimura NY. et al. Long-term recovery of exercise capacity and pulmonary function after lobectomy. J Thorac Cardiovasc Surg 2007; 134: 1273-1278
• 36 Cavalheri V, Tahirah F, Nonoyama M. et al. Exercise training for people following lung resection for non-small cell lung cancer – a Cochrane systematic review. Cancer Treat Rev 2014; 40: 585-594
• 37 Ries AL, Bauldoff GS, Carlin BW. et al. Pulmonary Rehabilitation: Joint ACCP/AACVPR Evidence-Based Clinical Practice Guidelines. Chest 2007; 131: 4S-42S