Efficacy of inspiratory muscle training in chronic heart failure patients: A systematic review and meta-analysis

• Published in: International journal of cardiology Vol. 167; no. 4; pp. 1502 - 1507
• Main Authors: Smart, Neil A, Giallauria, Francesco, Dieberg, Gudrun
• Format: Journal Article
• Language: English
• Published: Shannon Elsevier Ireland Ltd 20-08-2013; Elsevier
• Subjects: Biological and medical sciences; Breathing Exercises - methods; Cardiology. Vascular system; Cardiorespiratory fitness; Cardiovascular; Chronic Disease; Exercise training; Heart; Heart Failure - physiopathology; Heart Failure - therapy; Heart failure, cardiogenic pulmonary edema, cardiac enlargement; Humans; Inhalation - physiology; Inspiratory muscle training; Left ventricular dysfunction; Medical sciences; Quality of life; Randomized Controlled Trials as Topic - methods; Respiratory Muscles - physiology; Treatment Outcome; Left ventricular dysfunction; Cardiorespiratory fitness; Exercise training; Inspiratory muscle training; Quality of life; Heart; Physical exercise; Cardiovascular disease; Systematic review; Heart ventricle; Left ventricular failure; Respiratory system; Metaanalysis; Respiratory muscle; Efficiency; Heart disease; Exercise tolerance test; Cardiology; Left ventricle performance; Human; Heart failure; Patient; Chronic; Cardiovascular risk; Circulatory system
• ISSN: 0167-5273; 1874-1754
• DOI: 10.1016/j.ijcard.2012.04.029

Abstract Introduction Inspiratory muscle training (IMT) offers an alternative to exercise training (ExT) in the most severely deconditioned heart failure patients who are unable to exercise. We conducted a meta-analysis to determine magnitude of change in peak VO2 , six minute walk distance (6MWD), Quality of Life measured by the Minnesota Living with Heart Failure Questionnaire (MLWHFQ), maximal inspiratory pressure (PI max) and ventilatory equivalent for carbon dioxide (VE /VCO2 slope) with IMT. Methods A systematic search was conducted of randomized, controlled trials of IMT therapy in CHF patients using Medline (Ovid) (1950–February 2012), Embase.com (1974–February 2012), Cochrane Central Register of Controlled Trials and CINAHL (1981–February 2012). The search strategy included a mix of MeSH and free text terms for the key concepts heart failure, inspiratory or respiratory muscle training, exercise training Results The eleven included studies contained data on 287 participants: 148 IMT participants and 139 sham or sedentary control. Compared to control groups, CHF patients undergoing IMT showed a significant improvement in peak VO2 (+ 1.83 ml kg − 1 min − 1 , 95% C.I. 1.33 to 2.32 ml kg − 1 min − 1 , p < 0.00001); 6MWD (+ 34.35 m, 95% C.I. 22.45 to 46.24 m, p < 0.00001); MLWHFQ (− 12.25, 95% C.I. − 17.08 to − 7.43, p < 0.00001); PImax (+ 20.01, 95% C.I. 13.96 to 26.06, p < 0.00001); and VE /VCO2 slope (− 2.28, 95% C.I. − 3.25 to − 1.30, p < 0.00001). Conclusions IMT improves cardio-respiratory fitness and quality of life to a similar magnitude to conventional exercise training and may provide an initial alternative to the more severely de-conditioned CHF patients who may then transition to conventional ExT.