Atemmuskeltraining: State-of-the-Art

Zusammenfassung

Spezifisches Atemmuskeltraining (IMT) ist in der Lage, die Funktion der Atemmuskulatur zu verbessern. Anhand der Studienlage und klinischen Praxis haben sich 3 Methoden etabliert: 1.) kontrollierte Stenoseatmung („resisitive load“), 2.) „threshold load“ und 3.) normokapnische Hyperpnoe. Die jeweiligen Methoden und zugehörigen Trainingsgeräte weisen spezifische Charakteristika auf. Die Einleitung eines IMT erfordert eine vorausgehende Diagnostik der Atemmuskelfunktion und eine detaillierte individualisierte Trainingseinweisung und -anleitung.

Ziel dieser Übersichtsarbeit ist es, anhand der aktuell verfügbaren Literatur die unterschiedlichen IMT-Methoden bei den wichtigsten Indikationsgebieten zu beleuchten und kritisch zu diskutieren. Bei den neuromuskulären Erkrankungen werden Muskeldystrophien, spinale Muskelatrophien, amyotrophe Lateralsklerose, Phrenicusparese und Verletzungen des Rückenmarks dargestellt. Zudem werden die Bereiche interstitielle Lungenerkrankungen, Sarkoidose, Linksherzinsuffizienz, pulmonal-arterielle Hypertonie, Kyphoskoliose und Adipositas beleuchtet. Bei den obstruktiven Atemwegs- und Lungenerkrankungen werden COPD, Asthma, Mukoviszidose und „Non-CF-Bronchiektasen“ aufgearbeitet. Abschließend finden sich Ausarbeitungen für den Bereich Weaning vom Respirator und im Zusammenhang mit körperlicher Aktivität.

Abstract

Specific respiratory muscle training (IMT) improves the function of the inspiratory muscles. According to literature and clinical experience, there are 3 established methods: 1.) resistive load 2.) threshold load and 3.) normocapnic hyperpnea. Each training method and the associated devices have specific characteristics. Setting up an IMT should start with specific diagnostics of respiratory muscle function and be followed by detailed individual introduction to training.

The aim of this review is to take a closer look at the different training methods for the most relevant indications and to discuss these results in the context of current literature.

The group of neuromuscular diseases includes muscular dystrophy, spinal muscular atrophy, amyotrophic lateral sclerosis, paralysis of the phrenic nerve, and injuries to the spinal cord. Furthermore, interstitial lung diseases, sarcoidosis, left ventricular heart failure, pulmonary arterial hypertension (PAH), kyphoscoliosis and obesity are also discussed in this context. COPD, asthma, cystic fibrosis (CF) and non-CF-bronchiectasis are among the group of obstructive lung diseases. Last but not least, we summarize current knowledge on weaning from respirator in the context of physical activity.

• Literatur

• 1 Kabitz HJ, Walterspacher S, Mellies U et al. [Recommendations for respiratory muscle testing]. Pneumologie 2014; 68: 307-314
• 2 Kabitz HJ, Windisch W. Diagnostik der Atemmuskelfunktion: state of the art. Pneumologie 2007; 61: 582-587
• 3 Thews G. Lungenatmung. In: Schmidt RF, Thews G, Hrsg. Physiologie des Menschen. Berlin, Heidelberg, New York, Tokio: Springer; 1997: 565-591
• 4 Leith DE, Bradley M. Ventilatory muscle strength and endurance training. J Appl Physiol 1976; 41: 508-516
• 5 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
• 6 Illi SK, Held U, Frank I et al. Effect of respiratory muscle training on exercise performance in healthy individuals: a systematic review and meta-analysis. Sports Med 2012; 42: 707-724
• 7 Geddes EL, O’Brien K, Reid WD et al. Inspiratory muscle training in adults with chronic obstructive pulmonary disease: an update of a systematic review. Respir Med 2008; 102: 1715-1729
• 8 Nici L, Donner C, Wouters E et al. American Thoracic Society/European Respiratory Society statement on pulmonary rehabilitation. Am J Respir Crit Care Med 2006; 173: 1390-1413
• 9 Belman MJ, Shadmehr R. Targeted resistive ventilatory muscle training in chronic obstructive pulmonary disease. J Appl Physiol (Bethesda, Md: 1985) 1988; 65: 2726-2735
• 10 Gosselink R, Wagenaar RC, Decramer M. Reliability of a commercially available threshold loading device in healthy subjects and in patients with chronic obstructive pulmonary disease. Thorax 1996; 51: 601-605
• 11 Caine MP, McConnell AK. Development and evaluation of a pressure threshold inspiratory muscle trainer for use in the context of sports performance. Sports Engineering 2000; 3: 149-159
• 12 McConnell AK, Romer LM. Dyspnoea in health and obstructive pulmonary disease: the role of respiratory muscle function and training. Sports Med 2004; 34: 117-132
• 13 Scherer TA, Spengler CM, Owassapian D et al. Respiratory muscle endurance training in chronic obstructive pulmonary disease: impact on exercise capacity, dyspnea, and quality of life. Am J Respir Crit Care Med 2000; 162: 1709-1714
• 14 Slavka G. Das motorische Nervensystem. Wien: (Grafik unpubliziert) 2015
• 15 Walton J. Clinical Examination, Differential Diagnosis and Classification. In: Walton J, Karpati G, Hilton DJ, eds. Disorders of voluntary muscle. 6. th ed. Edinburgh: Churchill Livingstone; 1994: 547
• 16 Mah JK, Korngut L, Dykeman J et al. A systematic review and meta-analysis on the epidemiology of Duchenne and Becker muscular dystrophy. Neuromuscul Disord 2014; 24: 482-491
• 17 DiMarco AF, Kelling JS, DiMarco MS et al. The effects of inspiratory resistive training on respiratory muscle function in patients with muscular dystrophy. Muscle Nerve 1985; 8: 284-290
• 18 Wanke T, Toifl K, Merkle M et al. Inspiratory muscle training in patients with Duchenne muscular dystrophy. Chest 1994; 105: 475-482
• 19 Winkler G, Zifko U, Nader A et al. Dose-dependent effects of inspiratory muscle training in neuromuscular disorders. Muscle Nerve 2000; 23: 1257-1260
• 20 Topin N, Matecki S, Le Bris S et al. Dose-dependent effect of individualized respiratory muscle training in children with Duchenne muscular dystrophy. Neuromuscul Disord 2002; 12: 576-583
• 21 Koessler W, Wanke T, Winkler G et al. 2 Years’ experience with inspiratory muscle training in patients with neuromuscular disorders. Chest 2001; 120: 765-769
• 22 Smith PE, Coakley JH, Edwards RH. Respiratory muscle training in Duchenne muscular dystrophy. Muscle Nerve 1988; 11: 784-785
• 23 Aslan GK, Gurses HN, Issever H et al. Effects of respiratory muscle training on pulmonary functions in patients with slowly progressive neuromuscular disease: a randomized controlled trial. Clin Rehabil 2013; 28: 573-581
• 24 Gozal D, Thiriet P. Respiratory muscle training in neuromuscular disease: long-term effects on strength and load perception. Med Sci Sports Exerc 1999; 31: 1522-1527
• 25 Pinto S, de Carvalho M. Can inspiratory muscle training increase survival in early-affected amyotrophic lateral sclerosis patients?. Amyotroph Lateral Scler Frontotemporal Degener 2013; 14: 124-126
• 26 Eidenberger M, Nowotny S. Inspiratory muscle training in patients with amyotrophic lateral sclerosis: A systematic review. NeuroRehabilitation 2014; 35: 349-361
• 27 Petrovic M, Lahrmann H, Pohl W et al. Idiopathic diaphragmatic paralysis – satisfactory improvement of inspiratory muscle function by inspiratory muscle training. Respir Physiol Neurobiol 2009; 165: 266-267
• 28 Mueller G, Perret C, Spengler CM. Optimal intensity for respiratory muscle endurance training in patients with spinal cord injury. J Rehabil Med 2006; 38: 381-386
• 29 Van Houtte S, Vanlandewijck Y, Kiekens C et al. Patients with acute spinal cord injury benefit from normocapnic hyperpnoea training. J Rehabil Med Medicine 2008; 40: 119-125
• 30 Berlowitz DJ, Tamplin J. Respiratory muscle training for cervical spinal cord injury. Cochrane Database Syst Rev 2013; 7 Cd008507
• 31 Watanabe F, Taniguchi H, Sakamoto K et al. Quadriceps weakness contributes to exercise capacity in nonspecific interstitial pneumonia. Respir Med 2013; 107: 622-628
• 32 Jastrzebski D, Kozielski J, Zebrowska A. [Pulmonary rehabilitation in patients with idiopathic pulmonary fibrosis with inspiratory muscle training]. Pneumonologia i alergologia polska 2008; 76: 131-141
• 33 Newman LS, Rose CS, Maier LA. Sarcoidosis. N Engl J Med 1997; 336: 1224-1234
• 34 Kabitz HJ, Lang F, Walterspacher S et al. Impact of impaired inspiratory muscle strength on dyspnea and walking capacity in sarcoidosis. Chest 2006; 130: 1496-1502
• 35 Murray J, Nadel J. Textbook of respiratory medicine. 3. rd ed. Philadelphia: Saunders; 2000
• 36 Hornstein S, Inman S, Ledsome JR. Ventilatory muscle training in kyphoscoliosis. Spine 1987; 12: 859-863
• 37 Kelly TM, Jensen RL, Elliott CG et al. Maximum respiratory pressures in morbidly obese subjects. Respirations 1988; 54: 73-77
• 38 Chlif M, Keochkerian D, Choquet D et al. Effects of obesity on breathing pattern, ventilatory neural drive and mechanics. Respir Physiol Neurobiol 2009; 168: 198-202
• 39 Villiot-Danger JC, Villiot-Danger E, Borel JC et al. Respiratory muscle endurance training in obese patients. Int J Obes (2005) 2011; 35: 692-699
• 40 Tenorio LH, Santos AC, Camara Neto JB et al. The influence of inspiratory muscle training on diaphragmatic mobility, pulmonary function and maximum respiratory pressures in morbidly obese individuals: a pilot study. Disabil Rehabil 2013; 35: 1915-1920
• 41 Barbalho-Moulim MC, Miguel GP, Forti EM et al. Effects of preoperative inspiratory muscle training in obese women undergoing open bariatric surgery: respiratory muscle strength, lung volumes, and diaphragmatic excursion. Clinics (Sao Paulo, Brazil) 2011; 66: 1721-1727
• 42 Casali CC, Pereira AP, Martinez JA et al. Effects of inspiratory muscle training on muscular and pulmonary function after bariatric surgery in obese patients. Obesity Surgery 2011; 21: 1389-1394
• 43 McParland C, Krishnan B, Wang Y et al. Inspiratory muscle weakness and dyspnea in chronic heart failure. Am Rev Respir Dis 1992; 146: 467-472
• 44 Nishimura Y, Maeda H, Tanaka K et al. Respiratory muscle strength and hemodynamics in chronic heart failure. Chest 1994; 105: 355-359
• 45 Weiner P, Waizman J, Magadle R et al. The effect of specific inspiratory muscle training on the sensation of dyspnea and exercise tolerance in patients with congestive heart failure. Clin Cardiol 1999; 22: 727-732
• 46 Marco E, Ramirez-Sarmiento AL, Coloma A et al. High-intensity vs. sham inspiratory muscle training in patients with chronic heart failure: a prospective randomized trial. Eur J Heart Fail 2013; 15: 892-901
• 47 Plentz RD, Sbruzzi G, Ribeiro RA et al. Inspiratory muscle training in patients with heart failure: meta-analysis of randomized trials. Arq Bras Cardiol 2012; 99: 762-771
• 48 Smart NA, Giallauria F, Dieberg G. Efficacy of inspiratory muscle training in chronic heart failure patients: a systematic review and meta-analysis. Int J Cardiol 2013; 167: 1502-1507
• 49 Kabitz HJ, Schwoerer A, Bremer HC et al. Impairment of respiratory muscle function in pulmonary hypertension. Clin Sci (Lond) 2008; 114: 165-171
• 50 Grunig E, Ehlken N, Ghofrani A et al. Effect of exercise and respiratory training on clinical progression and survival in patients with severe chronic pulmonary hypertension. Respiration 2011; 81: 394-401
• 51 Mereles D, Ehlken N, Kreuscher S et al. Exercise and respiratory training improve exercise capacity and quality of life in patients with severe chronic pulmonary hypertension. Circulation 2006; 114: 1482-1489
• 52 Shoemaker MJ, Donker S, Lapoe A. Inspiratory muscle training in patients with chronic obstructive pulmonary disease: the state of the evidence. Cardiopulm Phys Ther J 2009; 20: 5-15
• 53 Geddes EL, Reid WD, Crowe J et al. Inspiratory muscle training in adults with chronic obstructive pulmonary disease: a systematic review. Respir Med 2005; 99: 1440-1458
• 54 Ambrosino N. The case for inspiratory muscle training in COPD. For. Eur Respir J 2011; 37: 233-235
• 55 Polkey MI, Moxham J, Green M. The case against inspiratory muscle training in COPD. Against. Eur Respir J 2011; 37: 236-237
• 56 Ramirez-Sarmiento A, Orozco-Levi M, Guell R et al. Inspiratory muscle training in patients with chronic obstructive pulmonary disease: structural adaptation and physiologic outcomes. Am J Respir Crit Care Med 2002; 166: 1491-1497
• 57 Villafranca C, Borzone G, Leiva A et al. Effect of inspiratory muscle training with an intermediate load on inspiratory power output in COPD. Eur Respir J 1998; 11: 28-33
• 58 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
• 59 Charususin N, Langer D, Gosselink R. Does additional inspiratory muscle training alter breathing pattern during whole body exercise in COPD patients?. Eur Respir J 2014; 44: 3345
• 60 Macklem PT. Therapeutic implications of the pathophysiology of COPD. Eur Respir J 2010; 35: 676-680
• 61 Langer D, Ciavaglia C, Preston M et al. Inspiratory Muscle Training Reduces Respiratory Neural Drive In Patients With COPD. Eur Respir J 2014; 44: 1912
• 62 Perez T, Becquart LA, Stach B et al. Inspiratory muscle strength and endurance in steroid-dependent asthma. Am J Respir Crit Care Med 1996; 153: 610-615
• 63 Stell IM, Polkey MI, Rees PJ et al. Inspiratory muscle strength in acute asthma. Chest 2001; 120: 757-764
• 64 Lavietes MH, Grocela JA, Maniatis T et al. Inspiratory muscle strength in asthma. Chest 1988; 93: 1043-1048
• 65 McKenzie DK, Gandevia SC. Strength and endurance of inspiratory, expiratory, and limb muscles in asthma. Am Rev Respir Dis 1986; 134: 999-1004
• 66 Silva IS, Fregonezi GA, Dias FA et al. Inspiratory muscle training for asthma. Cochrane Database Syst Rev 2013; 9 CD003792
• 67 Pinet C, Cassart M, Scillia P et al. Function and bulk of respiratory and limb muscles in patients with cystic fibrosis. Am J Respir Crit Care Med 2003; 168: 989-994
• 68 Ionescu AA, Chatham K, Davies CA et al. Inspiratory muscle function and body composition in cystic fibrosis. Am J Respir Crit Care Med 1998; 158: 1271-1276
• 69 Reid WD, Geddes EL, O’Brien K et al. Effects of inspiratory muscle training in cystic fibrosis: a systematic review. Clin Rehabil 2008; 22: 1003-1013
• 70 Santana-Sosa E, Gonzalez-Saiz L, Groeneveld IF et al. Benefits of combining inspiratory muscle with 'whole muscle' training in children with cystic fibrosis: a randomised controlled trial. Br J Sports Med 2014; 48: 1513-1517
• 71 Enright S, Chatham K, Ionescu AA et al. Inspiratory muscle training improves lung function and exercise capacity in adults with cystic fibrosis. Chest 2004; 126: 405-411
• 72 de Jong W, van Aalderen WM, Kraan J et al. Inspiratory muscle training in patients with cystic fibrosis. Respir Med 2001; 95: 31-36
• 73 Rochester CL, Fairburn C, Crouch RH. Pulmonary rehabilitation for respiratory disorders other than chronic obstructive pulmonary disease. Clin Chest Med 2014; 35: 369-389
• 74 Newall C, Stockley RA, Hill SL. Exercise training and inspiratory muscle training in patients with bronchiectasis. Thorax 2005; 60: 943-948
• 75 Liaw MY, Wang YH, Tsai YC et al. Inspiratory muscle training in bronchiectasis patients: a prospective randomized controlled study. Clin Rehabil 2011; 25: 524-536
• 76 Levine S, Nguyen T, Taylor N et al. Rapid Disuse Atrophy of Diaphragm Fibers in Mechanically Ventilated Humans. N Engl J Med 2008; 358: 1327-1335
• 77 Esteban A, Anzueto A, Frutos F et al. Characteristics and outcomes in adult patients receiving mechanical ventilation: a 28-day international study. JAMA 2002; 287: 345-355
• 78 Funk GC, Anders S, Breyer MK et al. Incidence and outcome of weaning from mechanical ventilation according to new categories. Eur Respir J 2010; 35: 88-94
• 79 Carlucci A, Ceriana P, Prinianakis G et al. Determinants of weaning success in patients with prolonged mechanical ventilation. Crit Care 2009; 13: R97
• 80 Budweiser S, Moertl M, Jorres RA et al. Respiratory muscle training in restrictive thoracic disease: a randomized controlled trial. Arch Phys Med Rehabil 2006; 87: 1559-1565
• 81 Schonhofer B, Geiseler J, Dellweg D et al. [Prolonged weaning: S2k-guideline published by the German Respiratory Society]. Pneumologie 2014; 68: 19-75
• 82 Aldrich TK, Karpel JP, Uhrlass RM et al. Weaning from mechanical ventilation: adjunctive use of inspiratory muscle resistive training. Crit Care Med 1989; 17: 143-147
• 83 Martin AD, Davenport PD, Franceschi AC et al. Use of inspiratory muscle strength training to facilitate ventilator weaning: a series of 10 consecutive patients. Chest 2002; 122: 192-196
• 84 Sprague SS, Hopkins PD. Use of inspiratory strength training to wean six patients who were ventilator-dependent. Phys Ther 2003; 83: 171-181
• 85 Martin AD, Smith BK, Davenport PD et al. Inspiratory muscle strength training improves weaning outcome in failure to wean patients: a randomized trial. Crit Care (London, England) 2011; 15: R84
• 86 Condessa RL, Brauner JS, Saul AL et al. Inspiratory muscle training did not accelerate weaning from mechanical ventilation but did improve tidal volume and maximal respiratory pressures: a randomised trial. J Physiother 2013; 59: 101-107
• 87 HajGhanbari B, Yamabayashi C, Buna TR et al. Effects of respiratory muscle training on performance in athletes: a systematic review with meta-analyses. J Strength Cond Res 2013; 27: 1643-1663
• 88 Mador MJ, Magalang UJ, Rodis A et al. Diaphragmatic fatigue after exercise in healthy human subjects. Am Rev Respir Dis 1993; 148: 1571-1575
• 89 Johnson BD, Babcock MA, Suman OE et al. Exercise-induced diaphragmatic fatigue in healthy humans. J Physiol 1993; 460: 385-405
• 90 Verges S, Schulz C, Perret C et al. Impaired abdominal muscle contractility after high-intensity exhaustive exercise assessed by magnetic stimulation. Muscle Nerve 2006; 34: 423-430
• 91 Taylor BJ, How SC, Romer LM. Exercise-induced abdominal muscle fatigue in healthy humans. J Appl Physiol 2006; 100: 1554-1562
• 92 Romer LM, Polkey MI. Exercise-induced respiratory muscle fatigue: implications for performance. J Appl Physiol 2008; 104: 879-888
• 93 Wüthrich TU, Marty J, Kerherve H et al. Aspects of respiratory muscle fatigue in a mountain ultramarathon race. Med Sci Sports Exerc 2015; 47: 519-527
• 94 Choukroun ML, Kays C, Gioux M et al. Respiratory muscle function in trained and untrained adolescents during short-term high intensity exercise. Eur J Appl Physiol Occup Physiol 1993; 67: 14-19
• 95 Coast JR, Clifford PS, Henrich TW et al. Maximal inspiratory pressure following maximal exercise in trained and untrained subjects. Med Sci Sports Exerc 1990; 22: 811-815
• 96 Babcock MA, Pegelow DF, Johnson BD et al. Aerobic fitness effects on exercise-induced low-frequency diaphragm fatigue. J Appl Physiol 1996; 81: 2156-2164
• 97 Gandevia SC, Butler JE, Hodges PW et al. Balancing acts: respiratory sensations, motor control and human posture. Clin Exp Pharmacol Physiol 2002; 29: 118-121
• 98 Janssens L, Brumagne S, Polspoel K et al. The effect of inspiratory muscles fatigue on postural control in people with and without recurrent low back pain. Spine 2010; 35: 1088-1094
• 99 Verges S, Lenherr O, Haner AC et al. Increased fatigue resistance of respiratory muscles during exercise after respiratory muscle endurance training. Am J Physiol Regul Integr Comp Physiol 2007; 292: R1246-1253
• 100 Volianitis S, McConnell AK, Koutedakis Y et al. Inspiratory muscle training improves rowing performance. Med Sci Sports Exerc 2001; 33: 803-809
• 101 Romer LM, McConnell AK, Jones DA. Inspiratory muscle fatigue in trained cyclists: effects of inspiratory muscle training. Med Sci Sports Exerc 2002; 34: 785-792