Respiratory Muscle Training Can Improve Cognition, Lung Function, and Diaphragmatic Thickness Fraction in Male and Non-Obese Patients with Chronic Obstructive Pulmonary Disease: A Prospective Study

Yuan-Yang Cheng, Shih-Yi Lin, Chiann-Yi Hsu, Pin-Kuei Fu, Yuan-Yang Cheng, Shih-Yi Lin, Chiann-Yi Hsu, Pin-Kuei Fu

Abstract

Patients with chronic obstructive pulmonary disease (COPD) are frequently comorbid with mild cognitive impairment (MCI). Whether respiratory muscle training (RMT) is helpful for patients with COPD comorbid MCI remains unclear. Inspiratory muscle training (IMT) with or without expiratory muscle training (EMT) was performed. Patients were randomly assigned to the full training group (EMT + IMT) or the simple training group (IMT only). A total of 49 patients completed the eight-week course of RMT training. RMT significantly improved the maximal inspiratory pressure (MIP), the diaphragmatic thickness fraction and excursion, lung function, scores in the COPD assessment test (CAT), modified Medical Research Council (mMRC) scale scores, and MMSE. The between-group difference in the full training and single training group was not significant. Subgroup analysis classified by the forced expiratory volume in one second (FEV1) level of patients showed no significant differences in MIP, lung function, cognitive function, and walking distance. However, a significant increase in diaphragmatic thickness was found in patients with FEV1 ≥ 30%. We suggest that patients with COPD should start RMT earlier in their disease course to improve physical activity.

Keywords: COPD; FEV1; cognitive impairment; diaphragmatic thickness fraction; expiratory muscle training; inspiratory muscle training; respiratory muscle training.

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Participant recruitment flowchart: BMI: body mass index; CPET: cardiopulmonary exercise test; IMT: inspiratory muscle training; EMT: expiratory muscle training; 6MWT: six-minute walking test.
Figure 2
Figure 2
Ultrasonographic evaluation of diaphragm. (A) Diaphragmatic thickness was measured below the intercostal muscles between the ribs. +: Markers of the anterior and posterior edges of diaphragm. (B) Amount of diaphragmatic excursion was measured using the M mode to trace the movement of the posterior edge of liver. +: Markers of the posterior edge of liver during respiration.
Figure 3
Figure 3
Difference of diaphragmatic thickness fraction before and after RMT. * p < 0.05.

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