Current insights of inspiratory muscle training on the cardiovascular system: a systematic review with meta-analysis

Graziella Fb Cipriano, Gerson Cipriano Jr, Francisco V Santos, Adriana M Güntzel Chiappa, Luigi Pires, Lawrence Patrick Cahalin, Gaspar R Chiappa, Graziella Fb Cipriano, Gerson Cipriano Jr, Francisco V Santos, Adriana M Güntzel Chiappa, Luigi Pires, Lawrence Patrick Cahalin, Gaspar R Chiappa

Abstract

Background: Cardiorespiratory limitation is a common hallmark of cardiovascular disease which is a key component of pharmacological and exercise treatments. More recently, inspiratory muscle training (IMT) is becoming an effective complementary treatment with positive effects on muscle strength and exercise capacity. We assessed the effectiveness of IMT on the cardiovascular system through autonomic function modulation via heart rate variability and arterial blood pressure. Methods: Randomized controlled trials (RCTs) were identified from searches of The Cochrane Library, MEDLINE and EMBASE to November 2018. Citations, conference proceedings and previous reviews were included without population restriction, comparing IMT intervention to no treatment, placebo or active control. Results: We identified 10 RCTs involving 267 subjects (mean age range 51-71 years). IMT programs targeted maximum inspiratory pressure (MIP) and cardiovascular outcomes, using low (n=6) and moderate to high intensity (n=4) protocols, but the protocols varied considerably (duration: 1-12 weeks, frequency: 3-14 times/week, time: 10-30 mins). An overall increase of the MIP (cmH2O) was observed (-27.57 95% CI -18.48, -37.45, I 2=64%), according to weighted mean difference (95%CI), and was accompanied by a reduction of the low to high frequency ratio (-0.72 95% CI-1.40, -0.05, I 2=50%). In a subgroup analysis, low- and moderate-intensity IMT treatment was associated with a reduction of the heart rate (HR) (-7.59 95% CI -13.96, -1.22 bpm, I 2=0%) and diastolic blood pressure (DBP) (-8.29 [-11.64, -4.94 mmHg], I 2=0%), respectively. Conclusion: IMT is an effective treatment for inspiratory muscle weakness in several populations and could be considered as a complementary treatment to improve the cardiovascular system, mainly HR and DBP. Further research is required to better understand the above findings.

Keywords: breathing exercises; cardiovascular system; respiratory muscle training.

Conflict of interest statement

The authors declare that there are no conflicts of interest in this work.

Figures

Figure 1
Figure 1
Study flow diagram.
Figure 2
Figure 2
Forest plot depicts of inspiratory muscle training on inspiratory muscle strength compared to low and moderate-high intensity.
Figure 3
Figure 3
Forest plot depicts of inspiratory muscle training on (A) systolic blood pressure, (B) diastolic blood pressure, and (C) heart rate compared to low and moderate-high intensity.
Figure 4
Figure 4
Forest plot depicts of inspiratory muscle training on (A) low-frequency heart rate variability, (B) high-frequency heart rate variability, and (C) low-to-high frequency ratio compared to low and moderate-high intensity.

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