Effectiveness of Respiratory Muscle Training for Pulmonary Function and Walking Ability in Patients with Stroke: A Systematic Review with Meta-Analysis

Diana P Pozuelo-Carrascosa, Juan Manuel Carmona-Torres, José Alberto Laredo-Aguilera, Pedro Ángel Latorre-Román, Juan Antonio Párraga-Montilla, Ana Isabel Cobo-Cuenca, Diana P Pozuelo-Carrascosa, Juan Manuel Carmona-Torres, José Alberto Laredo-Aguilera, Pedro Ángel Latorre-Román, Juan Antonio Párraga-Montilla, Ana Isabel Cobo-Cuenca

Abstract

Background: Neurological dysfunction due to stroke affects not only the extremities and trunk muscles but also the respiratory muscles. Aim: to synthesise the evidence available about the effectiveness of respiratory muscle training (RMT) to improve respiratory function parameters and functional capacity in poststroke patients. Methods: a systematic electronic search was performed in the MEDLINE, EMBASE, SPORTDiscus, PEDro and Web of Science databases, from inception to May 2020. Study selection and data extraction: randomised controlled trials (RCTs) that examined the effects of RMT versus non-RMT or sham RMT in poststroke patients. We extracted data about respiratory function, respiratory muscle strength and functional capacity (walking ability, dyspnea, balance, activities of daily life), characteristics of studies and features of RMT interventions (a type of RMT exercise, frequency, intensity and duration). Two reviewers performed study selection and data extraction independently. Results: nineteen RCTs met the study criteria. RMT improved the first second forced expiratory volume (FEV1), forced vital capacity (FVC), peak expiratory flow (PEF), maximal expiratory pressure (MEP), maximal inspiratory pressure (MIP) and walking ability (6 min walking test), but not Barthel index, Berg balance scale, and dyspnea. Conclusions: RMT interventions are effective to improve respiratory function and walking ability in poststroke patients.

Keywords: meta-analysis; pulmonary function; respiratory muscle training; stroke; walking ability.

Conflict of interest statement

The authors have declared no conflict of interest. The funders had no role in the design of the study, in the collection, analyses, or interpretation of data; in the writing of the manuscript, or in the decision to publish the results.

Figures

Figure 1
Figure 1
Literature search: Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) consort diagram. RMT, Respiratory muscle training; RCTs, randomized controlled trials.
Figure 2
Figure 2
Forest plot showing the effect size (ES) of respiratory muscle training (RMT) on first second forced expiratory volume (FEV1) between intervention and control groups for each study. IMT, inspiratory muscle training; EMT, expiratory muscle training.
Figure 3
Figure 3
Forest plot showing the effect size (ES) of respiratory muscle training (RMT) on forced vital capacity (FVC) between intervention and control groups for each study. IMT, inspiratory muscle training; EMT, expiratory muscle training.
Figure 4
Figure 4
Forest plot showing the effect size (ES) of respiratory muscle training (RMT) on peak expiratory flow (PEF) between intervention and control groups for each study. IMT, inspiratory muscle training; EMT, expiratory muscle training.
Figure 5
Figure 5
Forest plot showing the effect size (ES) of respiratory muscle training (RMT) on maximal expiratory pressure (MEP) between intervention and control groups for each study. IMT, inspiratory muscle training; EMT, expiratory muscle training.
Figure 6
Figure 6
Forest plot showing the effect size (ES) of respiratory muscle training (RMT) on maximal inspiratory pressure (MIP) between intervention and control groups for each study. IMT, inspiratory muscle training; EMT, expiratory muscle training.
Figure 7
Figure 7
Forest plot showing the effect size (ES) of respiratory muscle training (RMT) on 6 min walking test (6-MWT) between intervention and control groups for each study. IMT, inspiratory muscle training; EMT, expiratory muscle training.
Figure 8
Figure 8
Forest plot showing the effect size (ES) of respiratory muscle training (RMT) on dyspnea between intervention and control groups for each study. IMT, inspiratory muscle training; EMT, expiratory muscle training.

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