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CLINICAL RESEARCH: HEART FAILURE

Inspiratory Muscle Training Improves Blood Flow to Resting and Exercising Limbs in Patients With Chronic Heart Failure

Gaspar R. Chiappa, PT, ScD^_*, Bruno T. Roseguini, PT, MSc^_*, Paulo J.C. Vieira, PT^_*, Cristiano N. Alves, PT^_*, Angela Tavares, MSc^_*, Eliane R. Winkelmann, PT, MSc^_*, Elton L. Ferlin, BsEE, Ricardo Stein, MD, ScD^_*, and Jorge P. Ribeiro, MD, ScD^_*,,,_*

^_* Exercise Pathophysiology Research Laboratory, Hospital de Clinicas de Porto Alegre, Porto Alegre, Brazil
Biomedical Engineering, Hospital de Clinicas de Porto Alegre, Porto Alegre, Brazil
Cardiology Division, Hospital de Clinicas de Porto Alegre, Porto Alegre, Brazil
Department of Medicine, Faculty of Medicine, Federal University of Rio Grande Sul, Porto Alegre, Brazil.

Manuscript received September 24, 2007; revised manuscript received December 12, 2007, accepted December 17, 2007.

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

Objectives: We tested the hypothesis that inspiratory muscle loading could result in exaggerated peripheral vasoconstriction in resting and exercising limbs and that inspiratory muscle training (IMT) could attenuate this effect in patients with chronic heart failure (CHF) and inspiratory muscle weakness.

Background: Inspiratory muscle training improves functional capacity of patients with CHF, but the mechanisms of this effect are unknown.

Methods: Eighteen patients with CHF and inspiratory muscle weakness (maximal inspiratory pressure <70% of predicted) and 10 healthy volunteers participated in the study. Inspiratory muscle loading was induced by the addition of inspiratory resistance of 60% of maximal inspiratory pressure, while blood flow to the resting calf (CBF) and exercising forearm (FBF) were measured by venous occlusion plethysmography. For the patients with CHF, blood flow measurements as well as ultrasound determination of diaphragm thickness were made before and after a 4-week program of IMT.

Results: With inspiratory muscle loading, CHF patients demonstrated a more marked reduction in resting CBF and showed an attenuated rise in exercising FBF when compared with control subjects. After 4 weeks of IMT, CHF patients presented hypertrophy of the diaphragm and improved resting CBF and exercise FBF with inspiratory muscle loading.

Conclusions: In patients with CHF and inspiratory muscle weakness, inspiratory muscle loading results in marked reduction of blood flow to resting and exercising limbs. Inspiratory muscle training improves limb blood flow under inspiratory loading in these patients.

Abbreviations and Acronyms   CBF = calf blood flow   CHF = chronic heart failure   CVR = calf vascular resistance   f b = breathing frequency   FBF = forearm blood flow   FVR = forearm vascular resistance   HR = heart rate   IMT = inspiratory muscle training   MAP = mean arterial pressure   PETCO 2 = resting end-tidal partial pressure of carbon dioxide   PImax = maximal static inspiratory pressure   SpO 2 = pulse % oxygen saturation

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