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Respiratory muscle training in neuromuscular disease: long-term effects on strength and load perception
Gozal D, Thiriet P
Medicine and Science in Sports and Exercise 1999 Nov;31(11):1522-1527
clinical trial
4/10 [Eligibility criteria: No; Random allocation: Yes; Concealed allocation: No; Baseline comparability: Yes; Blind subjects: No; Blind therapists: No; Blind assessors: No; Adequate follow-up: No; 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*

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 to 10) were assessed on two separate occasions before beginning of the training protocol, monthly throughout RMT duration, and every 3 to 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 delta max: +19.8 +/- 3.8 cmH2O in TR versus +4.2 +/- 3.6 cmH2O in NT; p < 0.02) and in PEmax (mean delta max: +27.1 +/- 4.9 cmH2O in TR versus -1.8 +/- 3.4 cmH2O in NT; p < 0.004). Similarly, RLP significantly decreased during the RMT period in TR (mean delta: 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 approximately 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.

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