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Effects of 8-week, interval-based inspiratory muscle training and breathing retraining in patients with generalized myasthenia gravis
de Freitas Fregonezi GA, Resqueti VR, Guell R, Pradas J, Casan P
Chest 2005 Sep;128(3):1524-1530
clinical trial
6/10 [Eligibility criteria: Yes; Random allocation: Yes; Concealed allocation: No; Baseline comparability: Yes; Blind subjects: No; Blind therapists: No; Blind assessors: Yes; Adequate follow-up: Yes; Intention-to-treat analysis: No; Between-group comparisons: Yes; Point estimates and variability: Yes. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed*

STUDY OBJECTIVE: To assess the effect of interval-based inspiratory muscle training (IMT) combined with breathing retraining (BR) in patients with generalized myasthenia gravis (MG) in a partial home program. DESIGN: A randomized controlled trial with blinding of outcome assessment. SETTING: A secondary-care respiratory clinic. PATIENTS: Twenty-seven patients with generalized MG were randomized to a control group or a training group. INTERVENTIONS: The training group underwent interval-based IMT associated with BR (diaphragmatic breathing (DB) and pursed-lips breathing (PLB)) three times a week for 8 weeks. The sessions included 10 min each of DB, interval-based IMT, and PLB. Interval-based IMT consisted of training series interspersed with recovery time. The threshold load was increased from 20 to 60% of maximal inspiratory pressure (PImax) over the 8 weeks. MEASUREMENTS AND RESULTS: Lung function, respiratory pattern, respiratory muscle strength, respiratory endurance, and thoracic mobility were measured before and after the 8 weeks. The training group improved significantly compared to control group in PImax (p = 0.001), maximal expiratory pressure (PEmax) (p = 0.01), respiratory rate (RR)/tidal volume (VT) ratio (p = 0.05), and upper chest wall expansion (p = 0.02) and reduction (p = 0.04). Significant differences were seen in the training group compared to baseline PImax (p = 0.001), PEmax (p = 0.01), maximal voluntary ventilation (p = 0.02), RR/VT ratio (p = 0.003), VT (p = 0.02), RR (p = 0.01), total time of RR (p = 0.01), and upper chest wall expansion (p = 0.005) and reduction (p = 0.005). No significant improvement was seen in lower chest wall or lung function. CONCLUSIONS: The partial home program of interval-based IMT associated with BR is feasible and effective in patients with generalized MG. Improvements in respiratory muscle strength, chest wall mobility, respiratory pattern, and respiratory endurance were observed.

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