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Short-Term Effects of Normocapnic Hyperpnea and Exercise Training in Patients With Chronic Obstructive Pulmonary Disease

A Pilot Study

Paneroni, Mara, PT, MSc; Simonelli, Carla, PT; Saleri, Manuela, PT; Trainini, Debora, PT; Fokom, Georges, PT; Speltoni, Ilaria, PT; Piaggi, Giancarlo, PT; Ambrosino, Nicolino, MD, FERS; Vitacca, Michele, MD, FERS

American Journal of Physical Medicine & Rehabilitation: December 2018 - Volume 97 - Issue 12 - p 866–872
doi: 10.1097/PHM.0000000000000988
Original Research Articles

Objective The aim of the study was to evaluate the short-term physiologic effects of respiratory muscle training with normocapnic hyperpnea added to standard exercise training on respiratory muscle endurance/strength and exercise tolerance in patients with chronic obstructive pulmonary disease.

Design The study used a randomized controlled trial. Patients referred for rehabilitation were randomly assigned to 20 sessions (twice daily 5 d/wk) of either normocapnic hyperpnea (group 1, n = 12) or sham maneuvers (group 2, n = 10) in addition to individualized cycle training and abdominal, upper, and lower limb muscle exercise. At baseline and end of study, patients underwent evaluation of respiratory muscle endurance, maximum voluntary ventilation, maximal inspiratory, and expiratory pressures, and 6-min walking distance.

Results After training, a significant improvement was found only for group 1 in respiratory muscle endurance time (by 654 [481] secs versus 149 [216] secs for group 2, P = 0.0108) and maximal inspiratory (group 1: from 81.2 [21.9] cmH2O to 107.6 [23.0] cmH2O, P = 0.018 versus group 2: from 75.4 [13.8] cmH2O to 81.3 [18.9] cmH2O, P = 0.139). The difference between groups for 6-min walking distance, maximum voluntary ventilation, and expiratory pressures was not significant.

Conclusions Short-term normocapnic hyperpnea training added to standard exercise, compared with exercise training alone, improves respiratory muscle endurance and strength but not exercise tolerance in patients with chronic obstructive pulmonary disease.

From the Respiratory Rehabilitation Division, Istituti Clinici Scientifici Maugeri, IRCCS, Lumezzane, Italy (MP, MS, DT, GF, MV); Cardiac Rehabilitation Division, Istituti Clinici Scientifici Maugeri, IRCCS, Lumezzane, Italy (CS, IS); Respiratory Rehabilitation Division, Istituti Clinici Scientifici Maugeri, IRCCS, Pavia, Italy (MP, CS, MS, DT, GF, IS, GP, NA, MV); and Respiratory Rehabilitation Division, Istituti Clinici Scientifici Maugeri, IRCCS, Montescano, Italy (NA).

All correspondence should be addressed to: Mara Paneroni, PT, MSc, Istituti Clinici Scientifici Maugeri, IRCCS via Salvatore Maugeri 2, 27100 Pavia, Italy.

The Research was supported by institutional funding.

MP did data collection, data analysis, statistics, writing, and editing. CS did data collection, data analysis, writing, and editing. MS did data collection, data analysis, and writing. DT, GF, IS, and GP did data collection. NA did review and editing. MV did protocol and editing.

All the authors approved and critically revised the article.

Financial disclosure statements have been obtained, and no conflicts of interest have been reported by the authors or by any individuals in control of the content of this article.

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