Inspiratory Muscle Training Based on Anaerobic Threshold on the Functional Capacity of Patients After Coronary Artery Bypass Grafting: Clinical Trial

André Luiz Lisboa Cordeiro, Hayssa de Cássia Mascarenhas, Lucas Landerson, Jaclene da Silva Araújo, Daniel Lago Borges, Thiago Araújo de Melo, André Guimarães, Jefferson Petto, André Luiz Lisboa Cordeiro, Hayssa de Cássia Mascarenhas, Lucas Landerson, Jaclene da Silva Araújo, Daniel Lago Borges, Thiago Araújo de Melo, André Guimarães, Jefferson Petto

Abstract

Introduction: Coronary artery bypass grafting (CABG) is associated with reduced ventilatory muscle strength and consequent worsening of functional capacity (FC). Inspiratory Muscle Training (IMT) can be indicated, but there is still a lack of knowledge about the use of the anaerobic threshold (AT) as a basis for prescription. The objective of this study is to evaluate if IMT based on AT modifies FC and inspiratory muscle strength of patients submitted to CABG.

Methods: This is a clinical trial. On the first postoperative day, the patients were divided into two groups: the conventional group (IMT-C), which performed IMT based on 40% of maximal inspiratory pressure (MIP), and the IMT-AT group, which performed IMT based on AT. All patients underwent preoperative and postoperative assessment of MIP and performed a six-minute walk test (6MWT).

Results: Forty-two patients were evaluated, 21 in each group. Their mean age was 61.4±10 years and 27 (64%) of them were male. There was a reduction of inspiratory muscle strength with a delta of 23±13 cmH2O in the IMT-C group vs. 11±10 cmH2O in the IMT-AT group (P<0.01) and of the walking distance with a delta of 94±34 meters in the IMT-C group vs. 57±30 meters in the IMT-AT group (P=0.04).

Conclusion: IMT based on AT minimized the loss of FC and inspiratory muscle strength of patients submitted to CABG.

Keywords: Muscular Strength; Myocardial Revascularization; Respiratory Muscles.

Conflict of interest statement

No conflict of interest.

Figures

Fig. 1
Fig. 1
Glycemic threshold assessment protocol. MIP=maximal inspiratory pressure; REP=repetitions
Fig. 2
Fig. 2
Study flowchart. IMT-AT=Inspiratory Muscle Training based on anaerobic threshold; IMT-C=conventional Inspiratory Muscle Training
Fig. 3
Fig. 3
Threshold and exhaustion values of patients undergoing muscle training based on glycemic threshold.

References

    1. Marques AMR, D’Alessandro WB, D’Alessandro AAB. Review study: the effectiveness of physiotherapy protocols in prevention of pulmonary dysfunction in the postoperative period of myocardial revascularization. Rev Am Sci Health. 2017;5(1):48–52. doi: 10.18606/2318-1419/amazonia.sci.health.v5n1p48-52. Portuguese.
    1. Souza HP, Werneck GL, Medeiros LT, Sabroza PC, Santos JPC. Spatial analysis of causes of death from cardiovascular disease and associated factors in a deployment area of a large development project. Hygeia. 2017;13(24):199–214. Portuguese.
    1. Cordeiro AL, de Melo TA, Neves D, Luna J, Esquivel MS, Guimarães AR, et al. Inspiratory muscle training and functional capacity in patients undergoing cardiac surgery. Braz J Cardiovasc Surg. 2016;31(2):140–144. doi: 10.5935/1678-9741.20160035.
    1. Ferreira PEG, Rodrigues AJ, Évora PRB. Effects of an inspiratory muscle rehabilitation program in the postoperative period of cardiac surgery. Arq Bras Cardiol. 2009;92(4):261–268. doi: 10.1590/S0066-782X2009000400005.
    1. Oliveira LD, Schneider J, Winkelmann ER. Acute effects in a inspiratory muscle training session: individuals with chronic kidney disease vs healthy. Rev Pesq Fisioter. 2017;7(1):13–19. doi: 10.17267/2238-2704rpf.v7i1.1173. Portuguese.
    1. Steffens E, Dallazen F, Sartori C, Chiapinotto S, Battisti IDE, Winkelmann ER. Physical and functional conditions and quality of life in patients in pre and post-operative cardiac Surgery. Rev Pesq Fisioter. 2016;6(4):422–429. doi: 10.17267/2238-2704rpf.v6i4.1149.
    1. Brandão DA, Almeida PAS, Barbosa ES, Morais DC, Ferreira GR, Silva SF. Comparison between the responses of blood glucose and lactate during progressive test in treadmill in physically active men. Fit Perf J. 2010;9(1):113–119. Portuguese.
    1. Oliveira JC, Baldissera V, Simões HG, Aguiar AP, Azevedo PHS, Poian PAF, et al. Identification of the lactate threshold and theblood glucose threshold in resistance exercise. Rev Bras Med Esporte. 2006;12(6):298e–302e. doi: 10.1590/S1517-86922006000600007.
    1. Shoemaker MJ, Curtis AB, Vangsnes E, Dickinson MG. Clinically meaningful change estimates for the six-minute walk test and daily activity in individuals with chronic heart failure. Cardiopulm Phys Ther J. 2013;24(3):21–29.
    1. Guedes DP, Lopes CC, Guedes JERP. Reproducibility and validity of the international physical activity questionnaire in adolescents. Rev Bras Med Esporte. 2005;11(2):147e–154e. doi: 10.1590/S1517-86922005000200011.
    1. Neder JA, Andreoni S, Lerario MC, Nery LE. Reference values for lung function tests. II. Maximal respiratory pressures and voluntary ventilation. Braz J Med Biol Res. 1999;32(6):719–727. doi: 10.1590/s0100879x1999000600007.
    1. American Thoracic Society/European Respiratory Society ATS/ERS Statement on respiratory muscle testing. Am J Respir Crit Care Med. 2002;166(4):518–624. doi: 10.1164/rccm.166.4.518.
    1. Riberto M, Miyazaki MH, Filho DJ, Sakamoto H, Battistella LR. Reprodutibilidade da versão brasileira da medida de independência funcional. Acta Fisiátrica. 2001;8(1):45–52. doi: 10.5935/01047795.20010002. Portuguese.
    1. Oliveira FTO, Petto J, Esquivel MS, Dias CMCC, Oliveira ACS, Aras R. Comparison of the strength and resistance of inspirational muscles between assets and sedentary. J Phys Res. 2018;8(2):223–229. doi: 10.17267/2238-2704rpf.v8i2.1926.
    1. Ge X, Wang W, Hou L, Yang K, Fa X. Inspiratory muscle training is associated with decreased postoperative pulmonary complications: evidence from randomized trials. J Thorac Cardiovasc Surg. 2018;156(3):1290–1300. doi: 10.1016/j.jtcvs.2018.02.105.
    1. Thybo Karanfil EO, Møller AM. Preoperative inspiratory muscle training prevents pulmonary complications after cardiac surgery - a systematic review. Dan Med J. 2018;65(3):A5450–A5450.
    1. Dot I, Pérez-Teran P, Samper MA, Masclans JR. Diaphragm dysfunction in mechanically ventilated patients. Arch Bronconeumol. 2017;53(3):150–156.
    1. Miozzo AP, Stein C, Marcolino MZ, Sisto IR, Hauck M, Coronel CC, et al. Effects of high-intensity inspiratory muscle training associated with aerobic exercise in patients undergoing CABG: randomized clinical trial. Braz J Cardiovasc Surg. 2018;33(4):376–383. doi: 10.21470/16789741-2018-0053.
    1. Ribeiro JP, Chiappa GR, Callegaro CC. The contribution of inspiratory muscles function to exercise limitation in heart failure: pathophysiological mechanisms. Rev Bras Fisioter. 2012;16(4):261–267. doi: 10.1590/s141335552012005000034.
    1. Crisafulli A, Salis E, Tocco F, Melis F, Milia R, Pittau G, et al. Impaired central hemodynamic response and exaggerated vasoconstriction during muscle metaboreflex activation in heart failure patients. Am J Physiol Heart Circ Physiol. 2007;292(6):H2988–H2996. doi: 10.1152/ajpheart.00008.2007.
    1. Sinoway LI, Li J. A perspective on the muscle reflex: implications for congestive heart failure. J Appl Physiol (1985) 2005;99(1):5–22. doi: 10.1152/japplphysiol.01405.2004.
    1. Gremeaux V, Troisgros O, Benaïm S, Hannequin A, Laurent Y, Casillas JM, et al. Determining the minimal clinically important difference for the six-minute walk test and the 200-meter fast-walk test during cardiac rehabilitation program in coronary artery disease patients after acute coronary syndrome. Arch Phys Med Rehabil. 2011;92(4):611–619. doi: 10.1016/j.apmr.2010.11.023.
    1. Stein R, Maia CP, Silveira AD, Chiappa GR, Myers J, Ribeiro JP. Inspiratory muscle strength as a determinant of functional capacity early after coronary artery bypass graft surgery. Arch Phys Med Rehabil. 2009;90(10):1685–1691. doi: 10.1016/j.apmr.2009.05.010.
    1. Savci S, Degirmenci B, Saglam M, Arikan H, Inal-Ince D, Turan HN, et al. Short-term effects of inspiratory muscle training in coronary artery bypass graft surgery: a randomized controlled trial. Scand Cardiovasc J. 2011;45(5):286–293. doi: 10.3109/14017431.2011.595820.
    1. Bohannon RW, Crouch R. Minimal clinically important difference for change in 6-minute walk test distance of adults with pathology: a systematic review. J Eval Clin Pract. 2017;23(2):377–381. doi: 10.1111/jep.12629.
    1. Wyrwich KW, Tierney WM, Babu AN, Kroenke K, Wolinsky FD. A comparison of clinically important differences in health-related quality of life for patients with chronic lung disease, asthma, or heart disease. Health Serv Res. 2005;40(2):577–591. doi: 10.1111/j.1475-6773.2005.00373.x.
    1. Kendall F, Oliveira J, Peleteiro B, Pinho P, Bastos PT. 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(8):864–882. doi: 10.1080/09638288.2016.1277396.
    1. Gomes Neto M, Martinez BP, Reis HF, Carvalho VO. Pre- and postoperative inspiratory muscle training in patients undergoing cardiac surgery: systematic review and meta-analysis. Clin Rehabil. 2017;31(4):454–464. doi: 10.1177/0269215516648754.

Source: PubMed

Sponzoři a spolupracovníci

Zdravotní podmínky

Drogové intervence

3
Předplatit