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Respiratory muscle training in neuromuscular disease: long-term effects on strength and load perception

GOZAL, DAVID; THIRIET, PATRICE

Medicine & Science in Sports & Exercise: November 1999 - Volume 31 - Issue 11 - p 1522
Clinical Sciences: Clinically Relevant

GOZAL, D., and P. THIRIET. Respiratory muscle training in neuromuscular disease: long-term effects on strength and load perception. Med. Sci. Sports Exerc., Vol. 31, No. 11, pp. 1522–1527, 1999.

Purpose: Deterioration of respiratory muscle function in patients with neuromuscular disorders is primarily responsible for the high morbidity and mortality associated with these diseases.

Methods: The potential benefit of respiratory muscle training (RMT) on preservation of respiratory muscle strength and respiratory load perception (RLP) was examined in 21 children (mean age: 12.2 ± 1.8 yr [SD], 16 male) with Duchenne’s muscular dystrophy or spinal muscular atrophy type III, and in 20 age-, weight-, and sex-matched controls. Subjects were randomly allocated to undergo incremental RMT with resistive inspiratory and expiratory loads for a period of 6 months (trained group, TR) or to perform similar exercises with no load (NT). Maximal static inspiratory (Pimax) and expiratory (Pemax) pressures and RLP (modified Borg visual analog scale 0–10) were assessed on two separate occasions before beginning of the training protocol, monthly throughout RMT duration, and every 3–6 months upon cessation of RMT for 1 yr.

Results: In controls, no significant changes in maximal static pressures or load perception occurred during RMT or thereafter. Training in neuromuscular disorder (NMD) patients was associated with improvements in Pimax (mean Δmax: +19.8 ± 3.8 cmH2O in TR vs +4.2 ± 3.6 cmH2O in NT;P < 0.02) and in Pemax (mean Δmax: +27.1 ± 4.9 cmH2O in TR vs −1.8 ± 3.4 cmH2O in NT;P < 0.004). Similarly, RLP significantly decreased during the RMT period in TR (mean Δ: 1.9 ± 0.3;P < 0.01) but did not change in NT (−0.2 ± 0.2). In addition, with cessation of RMT, static pressures returned to pretraining values in TR within ∼3 months. However, RLP was still improved after 12 months.

Conclusions: We conclude that in children with NMD, although RMT-induced increases in expiratory muscle strength are rapidly reversible, long-lasting improvements in RLP occur and could be associated with decreased respiratory symptoms.

Constance S. Kaufman Pediatric Pulmonary Research Laboratory, Section of Pediatric Pulmonology, Department of Pediatrics, Tulane University School of Medicine, New Orleans, LA 70112; and Centre de Recherche et d’Innovation sur le Sport, Unité de Formation et de Recherche en Activité Physique et Sportive, Université Claude Bernard, Lyon 1, Villeurbanne, FRANCE

Submitted for publication October 1998.

Accepted for publication March 1999.

Address for correspondence: David Gozal, M.D., Section of Pediatric Pulmonology, SL-37, Tulane University School of Medicine 1430 Tulane Avenue, New Orleans, LA 70112; E-mail: dgozal@tmcpop.tmc.tulane.edu.

© 1999 Lippincott Williams & Wilkins, Inc.