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CLINICAL RESEARCH: HEART FAILURE

Inspiratory Muscle Training in Patients With Heart Failure and Inspiratory Muscle Weakness

A Randomized Trial

Pedro Dall’Ago, PT, ScD^_*,, Gaspar R.S. Chiappa, PT, MSc, Henrique Guths, PT, MSc, Ricardo Stein, MD, ScD and Jorge P. Ribeiro, MD, ScD^,,_*

^_* Department of Physiological Sciences, Fundação Faculdade Federal de Ciências Médicas de Porto Alegre, Porto Alegre, Brazil
School of Physical Therapy, UNILASALLE, Canoas, Brazil
Cardiology Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
Department of Medicine, Faculty of Medicine, UFRGS, Porto Alegre, Brazil.

Manuscript received May 24, 2005; revised manuscript received August 21, 2005, accepted September 26, 2005.

^_* Reprint requests and correspondence: Dr. Jorge P. Ribeiro, Cardiology Division, Hospital de Clínicas de Porto Alegre, Rua Ramiro Barcelos 2350, 90035-007, Porto Alegre, RS, Brazil. (Email: jpribeiro{at}cpovo.net).

OBJECTIVES: This study sought to evaluate the effects of inspiratory muscle training in inspiratory muscle strength, as well as in functional capacity, ventilatory responses to exercise, recovery oxygen uptake kinetics, and quality of life in patients with chronic heart failure (CHF) and inspiratory muscle weakness.

BACKGROUND: Patients with CHF may have reduced strength and endurance in inspiratory muscles, which may contribute to exercise intolerance and is associated with a poor prognosis.

METHODS: Thirty-two patients with CHF and weakness of inspiratory muscles (maximal inspiratory pressure [PI_max] <70% of predicted) were randomly assigned to a 12-week program of inspiratory muscle training (IMT, 16 patients) or to a placebo-inspiratory muscle training (P-IMT, 16 patients). The following measures were obtained before and after the program: PI_max at rest and 10 min after maximal exercise; peak oxygen uptake, circulatory power, ventilatory oscillations, and oxygen kinetics during early recovery (O₂/t–slope); 6-min walk test; and quality of life scores.

RESULTS: The IMT resulted in a 115% increment PI_max, 17% increase in peak oxygen uptake, and 19% increase in the 6-min walk distance. Likewise, circulatory power increased and ventilatory oscillations were reduced. The O₂/t–slope was improved during the recovery period, and quality of life scores improved.

CONCLUSIONS: In patients with CHF and inspiratory muscle weakness, IMT results in marked improvement in inspiratory muscle strength, as well as improvement in functional capacity, ventilatory response to exercise, recovery oxygen uptake kinetics, and quality of life.

Abbreviations and Acronyms    = relative amplitude of oscillations   CHF = chronic heart failure   CPET = cardiopulmonary exercise testing   IMT = inspiratory muscle training   P-IMT = placebo inspiratory muscle training   PImax = maximal static inspiratory pressure   Pthmax = maximal inspiratory pressure sustained for 1 min during incremental test   R = respiratory exchange ratio   /t slope = kinetics during recovery   T1/2 = time required for 50% from peak   CO2 = carbon dioxide output   E = minute ventilation   E/CO2–slope = relationship between change in E and CO2 during incremental exercise   O2 = oxygen uptake

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