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High-intensity respiratory muscle training improves strength and dyspnea after stroke: a double-blind randomized trial
Parreiras de Menezes KK, Nascimento LR, Ada L, Avelino PR, Polese JC, Mota Alvarenga MT, Hoffman Barbosa M, Teixeira-Salmela LF
Archives of Physical Medicine and Rehabilitation 2019 Feb;100(2):205-221
clinical trial
8/10 [Eligibility criteria: Yes; Random allocation: Yes; Concealed allocation: Yes; Baseline comparability: Yes; Blind subjects: Yes; Blind therapists: No; Blind assessors: No; Adequate follow-up: Yes; Intention-to-treat analysis: Yes; Between-group comparisons: Yes; Point estimates and variability: Yes. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed*

OBJECTIVE: To examine whether high-intensity home-based respiratory muscle training, ie, with higher loads, delivered more frequently and for longer duration, than previously applied, would increase the strength and endurance of the respiratory muscles, reduce dyspnea and respiratory complications, and improve walking capacity after stroke. DESIGN: Randomized trial with concealed allocation, blinded participants and assessors, and intention-to-treat analysis. SETTING: Community patients. PARTICIPANTS: 38 patients with stroke, who had respiratory muscle weakness. INTERVENTIONS: The experimental group received 40-min high-intensity home-based respiratory muscle training, seven days/week, for eight weeks, progressed weekly. The control group received a sham intervention of similar dose. MAIN OUTCOME MEASURES: Primary outcome was inspiratory muscle strength (via maximal inspiratory pressure), while secondary outcomes were expiratory muscle strength (minimal expiratory pressure), inspiratory muscle endurance, dyspnea (Medical Research Council score), respiratory complications (hospitalizations), and walking capacity (six-minute walk test). Outcomes were measured at baseline, after intervention, and one month beyond intervention. RESULTS: Compared to the control, the experimental group increased inspiratory (27cmH2O; 95% CI 15 to 40) and expiratory (42cmH2O; 95% CI 25 to 59) strength, inspiratory endurance (33 breathes; 95% CI 20 to 47) and reduced dyspnea (1.3 out of 5.0; 95% CI 2.1 to 0.6) and the benefits were maintained at one-month beyond training. There was no significant between-group difference for walking capacity or respiratory complications. CONCLUSION: High-intensity home-based respiratory muscle training was effective in increasing strength and endurance of the respiratory muscles and reducing dyspnea for people with respiratory muscle weakness after stroke, and the magnitude of the effect was higher, than that previously reported in studies, which applied standard protocols.

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