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Purpose: To evaluate the potential of incorporating respiratory muscle strength, specifically maximal inspiratory pressure (MIP), and maximal expiratory pressure (MEP), along with traditional sarcopenia screening measures such as hand grip strength (HGS) and skeletal muscle mass index (SMI), to identify sarcopenia in older men. Materials and Methods: A retrospective analysis was conducted involving male patients aged 65 years and older who underwent measurements of respiratory muscle strength, HGS, and muscle mass at a general hospital in Korea from July 2016 to May 2022. Statistical analysis utilized independent t-tests and receiver operating characteristic (ROC) curves to assess the sensitivity and specificity of MIP, MEP, HGS, and SMI in sarcopenia screening. The cut-off values for sarcopenia screening were determined based on the area under the ROC curve (AUC). Results: The analysis of 282 study participants revealed the following cut-off values for sarcopenia based on the AUC: for MIP, the cut-off value was 65.50 cmH2O (AUC=0.70, sensitivity: 0.63, specificity: 0.61), while for MEP, it was 84.50 cmH2O (AUC=0.74, sensitivity: 0.66, specificity: 0.68). Conclusions: This study showed the utility of respiratory muscle strength in screening for sarcopenia among older men. We suggest the screening cut-off values as 65.50 cmH2O for MIP and 84.50 cmH2O for MEP. Even when HGS and SMI measurements are not feasible, sarcopenia can be reasonably predicted based on respiratory muscle strength. [ABSTRACT FROM AUTHOR]

OBJECTIVE: This study aimed to establish normative values for maximum inspiratory pressure and maximal expiratory pressure in the Turkish population while creating specific equations to calculate these values. MATERIAL AND METHODS: The study involved 219 healthy adults, with a minimum of 50 individuals in specific age ranges: 20-29, 30-39, 40-49, and 50-60 years. Each age group comprised at least 25 males and 25 females. Participants were required to be free from health conditions influencing respiratory muscle strength and non-smokers. Measurements of maximum inspiratory pressure and maximal expiratory pressure were recorded for all participants. RESULTS: As a result of the regression analysis performed for the maximum inspiratory pressure values, the model P value was < .001, and the R2 value was found to be 0.261. The equation obtained as a result of the model was: 82.583 - 3.218 × gender - 0.093 × age + 9.534 × height + 0.343 × weight. As a result of the regression analysis performed for maximal expiratory pressure values, the model P value was <.001, and the R2 value was found to be 0.285. The equation obtained as a result of the model was: 157.165 - 35.522 × gender - 0.271 × age-42.036 × height + 0.787 × weight. CONCLUSIONS: The newly developed equations offer valuable tools for evaluating respiratory muscle strength in the Turkish population. These results confirm the importance of using maximum inspiratory pressure and maximal expiratory pressure to monitor changes in each patient, while also emphasizing the necessity of reliable reference equations. [ABSTRACT FROM AUTHOR]

Abstract Background The relationship between sarcopenia and chronic obstructive pulmonary disease (COPD) has been increasingly reported, and there is some overlap regarding their clinical features and pulmonary rehabilitation (PR) strategies. No Korean study has reported the actual prevalence of sarcopenia in patients with stable COPD who are recommended for pulmonary rehabilitation. This study evaluated the prevalence and clinical features of sarcopenia in older adult outpatients with stable COPD and the changes after 6 months. Methods In this cross-sectional and 6-month follow-up study, we recruited 63 males aged ≥ 65 diagnosed with stable COPD. Sarcopenia was diagnosed using the AWGS 2019 criteria, which included hand grip strength testing, bioelectrical impedance analysis, Short Physical Performance Battery administration, and Strength, Assistance with walking, Rising from a chair, Climbing stairs, and Falling screening tool administration. A 6-minute walk test (6 MWT) was conducted, forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), maximal inspiratory and expiratory pressures (MIP and MEP, respectively) and peak expiratory flow (PEF) were assessed, and patient-reported questionnaires were administered. Results At baseline, 14 (22%) patients were diagnosed with possible sarcopenia, and eight (12.6%) were diagnosed with sarcopenia. There were significant differences in the age; body mass index; Body mass index, airflow Obstruction, Dyspnea, and Exercise index; modified Medical Research Council dyspnea scores; and International Physical Activity Questionnaire scores between the normal and sarcopenia groups. Whole-body phase angle, MIP, MEP, PEF, and 6-minute walk distance (6 MWD) also showed significant differences. Over 6 months, the proportion of patients with a reduced FEV1 increased; however, the proportion of patients with sarcopenia did not increase. Conclusion A relatively low prevalence of sarcopenia was observed in older adult outpatients with stable COPD. No significant change in the prevalence of sarcopenia was found during the 6-month follow-up period. Trial registration The study was registered with the Clinical Research Information Service (KCT0006720). Registration date: 30/07/2021.

The prolonged consequences of SARS‐CoV‐2 on young elite athletes recovering from primary and reinfection are unclear. This study aimed to assess inspiratory/expiratory muscle strength and respiratory function at the time of spontaneous recovery at 3, 6, and 9 months after SARS‐CoV‐2 primary and reinfection in elite athletes. The study enrolled 25 elite male judoists, including 11 primary infection cases, five reinfection cases, and nine controls from the Türkiye Olympic Preparation Center. Inspiratory/expiratory muscle strength and respiratory function were measured, including maximal inspiratory pressure (MIP), maximal expiratory pressure (MEP), forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC), FEV1/FVC, and peak expiratory flow (PEF) before and up to 9 months after SARS‐CoV‐2 infection in the early pre‐competition preparation phases. The most common symptoms reported by reinfection cases were fatigue (80%), dyspnea (60%), and muscle/joint pain (60%), while primary infection cases reported fatigue (73%), muscle/joint pain (45%), and headache (45%). MIP decreased by −14% and MEP decreased by −13% following the SARS‐CoV‐2 infection in reinfection cases. Likewise, FEV1 and FVC decreased by −5% and −8%, respectively; consequently, FEV1/FVC increased by 3%. Inspiratory/expiratory muscle strength and respiratory function improved rapidly after 9 months of SARS‐CoV‐2 infection in primary cases, whereas dysfunction persisted in reinfection cases. PEF was unaffected throughout the 9‐month follow‐up period. Reinfection may lead to further alterations in respiratory system relative to the primary infection, with a suspected restrictive pattern that remains dysfunctional in the third month; however, it improves significantly during a 9‐month follow‐up period. Highlights: In elite judo athletes, reinfection with SARS‐CoV‐2 cause more severe respiratory dysfunction compared to primary infection, with notable impairments in maximal inspiratory pressure (MIP) and MEP by −14% and −13%, respectively, at 3 months.FEV1 and FVC decreased by −5% and −8%, respectively, at 3 months post‐infection. Although respiratory function gradually improved over 9 months, some reinfected athletes have the potential to exhibit a suspected restrictive abnormality (FVC <80% of predicted) characterized by a greater decrease in FVC compared to FEV1, leading to an increased FEV1/FVC ratio.Reinfected athletes who have recovered from SARS‐CoV‐2 infection may require a longer recovery period before returning to training and competition. It seems warranted that they should be followed carefully in terms of clinical rehabilitation needs after a repeated infection and directed to specific care pathways aimed at reducing long‐term adverse effects. [ABSTRACT FROM AUTHOR]

• The median time until the first pneumonia event after spinal cord injury is 6 days. • Persons with traumatic AIS A, B, or C tetraplegia are at highest risk for pneumonia. • Elderly people are at increased risk for multiple pneumonia events. To describe the occurrence of pneumonia in individuals with acute spinal cord injury (SCI) and identify its key predictors. Multi-centric, longitudinal cohort study. 10 specialized SCI rehabilitation units in Europe and Australia. Eligible were 902 men and women with acute SCI, aged 18 years or older, with cervical or thoracic lesions and not dependent on 24-hour mechanical ventilation; 503 participated in the study (N=503). Not applicable. We assessed demographics and lesion related parameters at study entry, and any pneumonia events throughout inpatient rehabilitation. Respiratory function, decubitus, and urinary tract infections were assessed at 1, 3, and 6 months post injury as well as at discharge from inpatient rehabilitation. Time to event (pneumonia) analyses were done using the Kaplan-Meier method, and potential predictors for pneumonia were analyzed with multivariable survival models. Five hundred three patients with SCI were included, with 70 experiencing at least 1 pneumonia event. 11 participants experienced 2 or more events during inpatient rehabilitation. Most events occurred very early after injury, with a median of 6 days. Pneumonia risk was associated with tetraplegia (hazard ratio [HR]=1.78; 95% confidence interval [CI] 1.00-3.17) and traumatic etiology (HR=3.75; 95% CI 1.30-10.8) American Spinal Injury Impairment Scale (AIS) A (HR=5.30; 95% CI 2.28-12.31), B (HR=4.38; 95% CI 1.77-10.83), or C (HR=4.09; 95% CI 1.71-9.81) lesions. For every 10 cmH 2 O increase in inspiratory muscle strength, pneumonia risk was reduced by 13% (HR=0.87; 95% CI 0.78-0.97). Pneumonia is a major complication after SCI with the highest incidence very early after injury. Individuals with traumatic or AIS A, B, or C tetraplegia are at highest risk for pneumonia. [ABSTRACT FROM AUTHOR]

Background: The relationship between sarcopenia and chronic obstructive pulmonary disease (COPD) has been increasingly reported, and there is some overlap regarding their clinical features and pulmonary rehabilitation (PR) strategies. No Korean study has reported the actual prevalence of sarcopenia in patients with stable COPD who are recommended for pulmonary rehabilitation. This study evaluated the prevalence and clinical features of sarcopenia in older adult outpatients with stable COPD and the changes after 6 months. Methods: In this cross-sectional and 6-month follow-up study, we recruited 63 males aged ≥ 65 diagnosed with stable COPD. Sarcopenia was diagnosed using the AWGS 2019 criteria, which included hand grip strength testing, bioelectrical impedance analysis, Short Physical Performance Battery administration, and Strength, Assistance with walking, Rising from a chair, Climbing stairs, and Falling screening tool administration. A 6-minute walk test (6 MWT) was conducted, forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), maximal inspiratory and expiratory pressures (MIP and MEP, respectively) and peak expiratory flow (PEF) were assessed, and patient-reported questionnaires were administered. Results: At baseline, 14 (22%) patients were diagnosed with possible sarcopenia, and eight (12.6%) were diagnosed with sarcopenia. There were significant differences in the age; body mass index; Body mass index, airflow Obstruction, Dyspnea, and Exercise index; modified Medical Research Council dyspnea scores; and International Physical Activity Questionnaire scores between the normal and sarcopenia groups. Whole-body phase angle, MIP, MEP, PEF, and 6-minute walk distance (6 MWD) also showed significant differences. Over 6 months, the proportion of patients with a reduced FEV1 increased; however, the proportion of patients with sarcopenia did not increase. Conclusion: A relatively low prevalence of sarcopenia was observed in older adult outpatients with stable COPD. No significant change in the prevalence of sarcopenia was found during the 6-month follow-up period. Trial registration: The study was registered with the Clinical Research Information Service (KCT0006720). Registration date: 30/07/2021. [ABSTRACT FROM AUTHOR]

Introduction. Although Chagas disease causes high levels of morbidity, the muscle function and tolerance to physical activity in Chagas disease patients are still not completely understood. Objective. To compare health-related fitness of patient groups with acute Chagas disease versus chronic Chagas disease. Materials and methods. We conducted a cross-sectional study involving 18 patients. The data were obtained from patient´s records, and functional capacity was measured with the sixminute walk test, the peripheral muscle strength with handgrip strength, and respiratory muscle strength using the maximum inspiratory pressure and the maximum expiratory pressure. Results. The 18 patients were divided in two groups: acute Chagas disease (n=9) and chronic Chagas disease (n=9). The distance walked in the six-minute walk test was lower than the predicted distance walked in both groups (p < 0.0001). The maximum expiratory pressure was lower than the predicted one (p = 0.005), and statistically significant for chronic Chagas disease patients (p = 0.02). Heart rate increased faster in the chronic Chagas disease group within the first two minutes of the six-minute walk test (p = 0.04). The sixminute walk test in the acute Chagas disease group presented a strong correlation with peripheral muscle strength (p = 0.012) and maximum inspiratory pressure (p = 0.0142), while in the chronic Chagas disease group, only peripheral muscle strength and maximum inspiratory pressure were correlated (p = 0.0259). Conclusion. The results suggest lowered functional capacity and reduced respiratory and peripheral muscle strength in patients with Chagas disease, although no differences were observed between groups. The early increase in heart rate during exercise in the chronic Chagas disease group implies a greater myocardial overload.

Copyright of Biomédica: Revista del Instituto Nacional de Salud is the property of Instituto Nacional de Salud of Colombia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Revista Foco (Interdisciplinary Studies Journal) is the property of Revista Foco and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Stroke disrupts the functions carried out by the brain such as the control of movement, sensation, and cognition. Disruption of movement control results in hemiparesis that affects the function of the diaphragm. Impaired function of the diaphragmcan in turn affectmany outcomes such as respiratory, cognitive, and motor function. The aim of this study is to carry out a systematic review and meta-analysis to determine the efficacy of diaphragmatic breathing exercise on respiratory, cognitive, and motor outcomes after stroke. Method: The study was registered in PROSPERO (CRD42023422293). PubMED, Embase, Web of Science (WoS), PEDro, Scopus, and CENTRAL databases were searched until September 2023. Only randomized controlled trials comparing diaphragmatic breathing exercise with a control were included. Information on the study authors, time since stroke, mean age, height, weight, sex, and the protocols of the experimental and control interventions including intensity, mean scores on the outcomes such as respiratory, cognitive, andmotor functions were extracted. Cochrane risks of bias assessment tool and PEDro scale were used to assess the risks of bias and methodological quality of the studies. Narrative synthesis and meta-analysis were used to summarize the results, which were then presented in tables, risk-of-bias graph, and forest plots. The meta-analysis was carried out on respiratory function [forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), FEV1/FVC, peak expiratory flow (PEF)] and motor function (trunk impairment, and internal and external oblique muscles activity). Results: Six studies consisting of 151 participants were included. The results of themeta-analyses showed that diaphragmatic breathing exercise is only superior to the control at improving respiratory function, FVC (MD = 0.90, 95% CI = 0.76 to 1.04, P < 0.00001), FEV1 (MD = 0.32, 95% CI = 0.11 to 0.52, P = 0.002), and PEF (MD = 1.48, 95% CI = 1.15 to 1.81, P < 0.00001). Conclusion: There is limited evidence suggesting that diaphragmatic breathing exercise may help enhance respiratory function, which may help enhance recovery of function post stroke. [ABSTRACT FROM AUTHOR]

Introduction Chronic obstructive pulmonary disease is a systemic disease characterized not only by respiratory symptoms but also by physical deconditioning and muscle weakness. One prominent manifestation of this disease is the decline in respiratory muscle strength. Previous studies have linked the genotypes of insulin-like growth factor 1 and 2 (IGF-1 and IGF-2) to muscle weakness in other populations without this disease. However, there is a notable knowledge gap regarding the biological mechanisms underlying respiratory muscle weakness, particularly the role of IGF-1 and IGF-2 genotypes in this pulmonary disease. Therefore, this study aimed to investigate, for the first time, the association between IGF-1 and IGF-2 genotypes with respiratory muscle strength in individuals with chronic obstructive pulmonary disease. In addition, we analyzed the relationship between oxidative stress, chronic inflammation, and vitamin D with respiratory muscle strength. Methods A cross sectional study with 61 individuals with chronic obstructive pulmonary disease. Polymerase chain reaction of gene polymorphisms IGF-1 (rs35767) and IGF-2 (rs3213221) was analyzed. Other variables, related to oxidative stress, inflammation and Vitamin D were dosed from peripheral blood. Maximal inspiratory and expiratory pressure were measured. Results The genetic polymorphisms were associated with respiratory muscle strength ( 3.0 and 3.5; = 0.57). Specific genotypes of IGF-1 and IGF-2 presented lower maximal inspiratory and expiratory pressure (

Objective To evaluate the relationship between respiratory muscle strength, diaphragm thickness (DT), and indices of sarcopenia. Methods This study included 45 healthy elderly volunteers (21 male and 24 female) aged 65 years or older. Sarcopenia indices, including hand grip strength (HGS) and appendicular skeletal muscle mass/body mass index (ASM/BMI), were measured using a hand grip dynamometer and bioimpedance analysis, respectively. Calf circumference (CC) and gait speed were also measured. Maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP) were obtained using a spirometer, as a measure of respiratory muscle strength. DT was evaluated through ultrasonography. The association between indices of sarcopenia, respiratory muscle strength, and DT was evaluated using Spearman’s rank correlation test, and univariate and multiple regression analysis. Results ASM/BMI (r=0.609, p

summary: Purpose: Hemiparesis in stroke survivors has been reported to affect respiratory function. The relationship between trunk control and respiratory function, however, is not well understood. We aimed to map the state of the association between the trunk and respiratory function as well as evaluate the effect of a respiratory function training intervention on trunk control for stroke survivors. Methods: A scoping review and meta-analysis of observational and interventional studies were performed. Cochrane Library, CINAHL with Full Text (EBSCO), Medline (Ovid), and PubMed were searched using the terms stroke, respiratory, and trunk control. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) checklist was used to examine the sections of each report. Results: A total of 102 studies were identified, of which 12, published between 2011 and 2022, were included in the meta-analysis or narrative synthesis. Three studies were included in the meta-analysis of the correlation between trunk control and respiratory function parameters (forced vital capacity [FVC], forced expiratory volume during the first breath [FEV1], maximal inspiratory pressure [MIP], and maximal expiratory pressure [MEP]) with effect sizes (Fisher's z) for all outcomes, which ranged from small to intermediate (between 0.21 and 0.39). Furthermore, five studies were included in the meta-analysis of the effect of respiratory function training intervention on trunk control. An overall effect size (Cohen's d) of 1.47 corresponds to a large effect. We also found significant improvements in MIP and MEP but not in FVC and FEV1 for stroke survivors with the interventions. Conclusions: Respiratory training, use of diaphragmatic resistance exercise or abdominal breathing, use of a pressure threshold-loading device, and the performance of functional strengthening exercises for the trunk muscles were found to increase patients’ trunk control and improve their respiratory muscle strength.

BackgroundStroke disrupts the functions carried out by the brain such as the control of movement, sensation, and cognition. Disruption of movement control results in hemiparesis that affects the function of the diaphragm. Impaired function of the diaphragm can in turn affect many outcomes such as respiratory, cognitive, and motor function. The aim of this study is to carry out a systematic review and meta-analysis to determine the efficacy of diaphragmatic breathing exercise on respiratory, cognitive, and motor outcomes after stroke.MethodThe study was registered in PROSPERO (CRD42023422293). PubMED, Embase, Web of Science (WoS), PEDro, Scopus, and CENTRAL databases were searched until September 2023. Only randomized controlled trials comparing diaphragmatic breathing exercise with a control were included. Information on the study authors, time since stroke, mean age, height, weight, sex, and the protocols of the experimental and control interventions including intensity, mean scores on the outcomes such as respiratory, cognitive, and motor functions were extracted. Cochrane risks of bias assessment tool and PEDro scale were used to assess the risks of bias and methodological quality of the studies. Narrative synthesis and meta-analysis were used to summarize the results, which were then presented in tables, risk-of-bias graph, and forest plots. The meta-analysis was carried out on respiratory function [forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), FEV1/FVC, peak expiratory flow (PEF)] and motor function (trunk impairment, and internal and external oblique muscles activity).ResultsSix studies consisting of 151 participants were included. The results of the meta-analyses showed that diaphragmatic breathing exercise is only superior to the control at improving respiratory function, FVC (MD = 0.90, 95% CI = 0.76 to 1.04, P < 0.00001), FEV1 (MD = 0.32, 95% CI = 0.11 to 0.52, P = 0.002), and PEF (MD = 1.48, 95% CI = 1.15 to 1.81, P < 0.00001).ConclusionThere is limited evidence suggesting that diaphragmatic breathing exercise may help enhance respiratory function, which may help enhance recovery of function post stroke.Systematic Review RegistrationPROSPERO, identifier CRD42023422293.

Background. The assessment of cardiopulmonary problems, exercise capacity, and inspiratory and expiratory muscle strength all depend on body composition, which is a crucial factor in determining human health. Objectives. The present study aimed to examine the effect of body composition and functional exercise capacity on respiratory muscle strength in young healthy adults. Material and methods. In the prospective study, sixty individuals aged between 18–25 years of age who were non-obese were evaluated in terms of body composition by body mass index, respiratory muscle strength by mouth pressure threshold and functional exercise capacities by six minute walking test and sit to stand test. Also, sociodemographic characteristics such as age, gender, education level, height and weight of the participants were recorded. Results. The relationship between body density (BD) parameters and inspiratory muscle strength was found to be moderate (r = 0.394, p < 0.05), while the relationship between expiratory muscle strength was found to be minimal (r = 0.282, p < 0.05). When other measurements and respiratory muscle strength were compared, it was found that the parameters are unrelated to one another (p > 0.05). Conclusions. Present study showed a significant correlation between body density and inspiratory and expiratory respiratory muscle strength. However, no correlation was found between body composition and functional exercise capacity and respiratory muscle strength. Body density increment will affect respiratory muscle strength negatively. [ABSTRACT FROM AUTHOR]

Objective: This study investigates the feasibility of delivering inspiratory muscle training as part of the physical therapy treatment for patients with post-COVID dyspnoea. Design: Mixed-methods pilot study. Subjects/patients: Patients with complaints of dyspnoea after COVID-19 infection and their physical therapists. Methods: The Amsterdam University of Applied Sciences and the Amsterdam University Medical Centers conducted this study. Participants performed daily inspiratory muscle training at home for 6 weeks, consisting of 30 repetitions against a pre-set resistance. The primary outcome was feasibility assessed as acceptability, safety, adherence and patient- and professional experience obtained through diaries and semi-structured interviews. The secondary outcome was maximal inspiratory pressure. Results: Sixteen patients participated. Nine patients and 2 physical therapists partook in semi-structured interviews. Two patients dropped out before initiating the training. Adherence was 73.7%, and no adverse events occurred. Protocol deviations occurred in 29.7% of the sessions. Maximal inspiratory pressure changed from 84.7% of predicted at baseline to 111.3% at follow-up. Qualitative analysis identified barriers to training: ‘Getting acquainted with the training material’ and ‘Finding the right schedule’. Facilitators were: ‘Support from physical therapists’ and ‘Experiencing improvements’. Conclusion: Delivering inspiratory muscle training to patients with post-COVID dyspnoea seems feasible. Patients valued the simplicity of the intervention and reported perceived improvements. However, the intervention should be carefully supervised, and training parameters adjusted to individual needs and capacity. LAY ABSTRACT Many people who have recovered from a COVID-19 infection develop persistent shortness of breath, fatigue and difficulties with memories, learning new things or making decisions. This condition affects their daily life and is called post-COVID syndrome. Inspiratory muscle training is a technique that aims to help people to breathe more easily by strengthening and improving the coordination of breathing muscles. We undertook this study to determine if performing such training was possible for these patients. We interviewed 2 physiotherapists who provided the training and 9 of their patients. In addition, we looked into the diaries 16 patients kept about their training to learn about their experiences or unexpected (medical) problems they might have had with the training. We found that the training seemed reasonable since patients and their physiotherapists found it simple, and no negative experiences happened. However, patients said it helped if the physiotherapist supervised them during the training.

Copyright of Medicina (Buenos Aires) is the property of Medicina (Buenos Aires) and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Inspiratory muscle training may benefit respiratory function, cardiocirculatory parameters, quality of life and functionality in neuromuscular diseases. This pilot study aimed to demonstrate the POWERbreathe® inspiratory muscle training effects on maximum inspiratory pressure (PImax), heart rate (HR) and HR variability, as well as the quality of life impairment and functionality in patients with Amyotrophic Lateral Sclerosis (ALS). A pilot single-blinded, non-randomized controlled clinical trial was carried out. A total of 20T ALS patients were enrolled and divided into experimental (n = 10) and control (n = 10) groups. The experimental group received POWERbreathe® inspiratory muscle training in conjunction with usual care, and the control group received only usual care for 8 weeks. PImax (measured by POWERbreathe® KH1), HR and HR variability (evaluated by Polar H7), quality of life impairment [measured by the Amyotrophic Lateral Sclerosis Assessment Questionnaire—40 items (ALSAQ-40)] and functionality [assessed by the ALS Functional Rating Scale Revised (ALSFRS-R)] were collected at baseline and after 8 weeks of intervention. We detected statistically significant differences (p < 0.05) with an effect size ranging from medium to large (Cohen's d = 0.72–1.37); relative to the control group, the experimental group had an increased PImax (mean difference = 10.80 cm H2O; 95% CI = 3.42–18.17) and ALSFRS-R score (mean difference = 5.30 points; 95% CI = −0.03–10.63) and reduced HR (mean difference = −8.80 beats-per-minute; 95% CI = −20.27–2.67) and R-R interval (mean difference = 78.30 ms; 95% CI = 2.89–153.70). POWERbreathe® inspiratory muscle training, in addition to usual care, may improve inspiratory strength and heart rate in patients with ALS. These results encourage larger and longer trials investigating potential clinically relevant benefits of inspiratory muscle training to these patients over the disease course. [ABSTRACT FROM AUTHOR]

Background: The diaphragm is the primary muscle responsible for breathing. Weakness in the diaphragm will result in breathing difficulties. The micro-RPM (respiratory pressure meter) is a non-invasive testing device to measure respiratory muscle strength, which is not always feasible, while thoracic expansion measurements are easy to do. Aim: This study constructs a prediction formula for a maximal inspiratory pressure (MIP) value from thoracic expansion measurements. Methods: This study was quantitative with a cross-sectional design. Participants were healthy adults aged 20–40 years, with normal Mini-Mental State Examinations, body mass index, spirometry, and moderate activity levels. The tests performed were MIP and thoracic expansion measurements at three levels: axilla (L1), the fourth intercostal space (L2), and at processus xiphoideus (L3). The data were analyzed using an unpaired t-test and multivariate. Results: The mean MIP for males (81.51 ± 13.90 cmH2O) was significantly greater than females (63.17 ± 15.89 cmH2O) (P = 0.0001). These findings were not different with the Chinese, Indian, Mangalorean, and Malaysian populations because they are all of Asian ethnicity. Thoracic expansion L2 (r = 0.463, P = 0.0001) and L3 (r = 0.502, P = 0.0001) were moderately correlated with MIP, whereas thoracic expansion L2, L3 combined with gender had a weak effect on MIP. The prediction formula was: MIP = 56.802 + 2.387 + L2 + 13.904 + Gender * and MIP = 53.289+ 3.561 + L3 + 9.504 + Gender *, * 0 = female; 1 = male. Conclusions: A prediction formula for MIP can be made using the thoracic expansion variable with gender as a determinant factor. A quick and easy measurement of thoracic expansion can be used as a mean of screening respiratory muscle strength in patient care.

Purpose: To evaluate the potential of incorporating respiratory muscle strength, specifically maximal inspiratory pressure (MIP), and maximal expiratory pressure (MEP), along with traditional sarcopenia screening measures such as hand grip strength (HGS) and skeletal muscle mass index (SMI), to identify sarcopenia in older men., Materials and Methods: A retrospective analysis was conducted involving male patients aged 65 years and older who underwent measurements of respiratory muscle strength, HGS, and muscle mass at a general hospital in Korea from July 2016 to May 2022. Statistical analysis utilized independent t-tests and receiver operating characteristic (ROC) curves to assess the sensitivity and specificity of MIP, MEP, HGS, and SMI in sarcopenia screening. The cut-off values for sarcopenia screening were determined based on the area under the ROC curve (AUC)., Results: The analysis of 282 study participants revealed the following cut-off values for sarcopenia based on the AUC: for MIP, the cut-off value was 65.50 cmH 2 O (AUC=0.70, sensitivity: 0.63, specificity: 0.61), while for MEP, it was 84.50 cmH 2 O (AUC=0.74, sensitivity: 0.66, specificity: 0.68)., Conclusions: This study showed the utility of respiratory muscle strength in screening for sarcopenia among older men. We suggest the screening cut-off values as 65.50 cmH 2 O for MIP and 84.50 cmH 2 O for MEP. Even when HGS and SMI measurements are not feasible, sarcopenia can be reasonably predicted based on respiratory muscle strength., Competing Interests: The authors have nothing to disclose., (Copyright © 2024 Korean Society for Sexual Medicine and Andrology.)

Introduction: The stability of a new hyperbaric ventilator (Shangrila590, Beijing Aeonmed Company, Beijing, China) at different clinically relevant pressures in a hyperbaric chamber during pressure-controlled ventilation (PCV) was investigated., Methods: The ventilator was connected to a test lung in the multiplace hyperbaric chamber. The inspiratory pressure (PI) of the ventilator was set to 1.0, 1.5, 2.0, 2.5 and 3.0 kPa (approximately 10, 15, 20, 25 and 30 cmH₂O). The compliance and resistance of the test lung were set to 200 mL·kPa⁻¹ and 2 kPa·L⁻¹·s⁻¹, respectively. Experiments were conducted at 101, 203 and 284 kPa ambient pressure (1.0, 2.0 and 2.8 atmospheres absolute respectively). At each of the 5 PI values, the tidal volume (VT), peak inspiratory pressure (Ppeak) and peak inspiratory flow (Fpeak) displayed by the ventilator and the test lung were recorded for 20 cycles. Test lung data were considered the actual ventilation values. The ventilation data were compared among the three groups to evaluate the stability of the ventilator., Results: At every PI, the Ppeak detected by the ventilator decreased slightly with increasing ambient pressure. The Fpeak values measured by the test lung decreased substantially as the ambient pressure increased. Nevertheless, the reduction in VT at 284 kPa and PI 30 cmH₂O (compared to performance at 101 kPa) was comparatively small (approximately 60 ml)., Conclusions: In PCV mode this ventilator provided relatively stable VT across clinically relevant PI values to ambient pressures as high as 284 kPa. However, because Fpeak decreases at higher ambient pressure, some user adjustment might be necessary for precise VT maintenance during clinical use at higher PIs and ambient pressures., Competing Interests: The authors report no conflicts of interest in this work., (Copyright: This article is the copyright of the authors who grant Diving and Hyperbaric Medicine a non-exclusive licence to publish the article in electronic and other forms.)

Objective: The purpose of this study was to validate a maximum inspiratory pressure test protocol based on the principles of the one-repetition maximum test, assess its test-retest reliability, and establish minimal detectable change in individuals with chronic obstructive pulmonary disease (COPD)., Methods: Forty-nine individuals with COPD were included in the study, of whom 44 individuals attended 2 appointments separated by 7 to 10 days for test-retest reliability. The maximum inspiratory pressure test was performed using a threshold valve device (one-repetition maximum-based protocol) and the digital manometer (reference test). The one-repetition maximum-based protocol consisted of an incremental phase (inspiratory load increase [10 cmH2O] to achieve respiratory failure) and an approach phase (load halfway between the lowest failed attempt and the last valid attempt was prescribed)., Results: The concurrent validity of the one-repetition maximum-based protocol for the maximum inspiratory pressure test was good with respect to the reference test (day 1, ICC = 0.81; day 2, ICC = 0.85). The test-retest reliability was excellent (ICC = 0.92), with a standard error of measurement of 6.3 cmH2O and a minimal detectable change of 17.5 cmH2O., Conclusion: This study validated a new one-repetition maximum-based protocol for the maximum inspiratory pressure test using an inspiratory muscle training device in individuals with COPD, showing good concurrent validity compared with the reference test, as well as excellent test-retest reliability. The minimal detectable change reported can be interpreted and applied in the clinical setting., Impact: There was a need for developing new, inexpensive, simple, and feasible methods for the maximum inspiratory pressure test. The validation of the one-repetition maximum-based protocol addresses this issue, allowing for the appropriate prescription of inspiratory muscle training, favoring its widespread use in people with COPD and therefore improving their physical therapist care., (© 2024 American Physical Therapy Association. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

After COVID-19 long term respiratory symptoms and reduced lung function including maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP) have been reported. However, no studies have looked at MIP and MEP in all disease groups and the reference materials collection methods differ substantially. We aimed to determine MIP and MEP in individuals after COVID-19 infection with different disease severity using reference material of healthy control group obtained using the same standardized method. Patients with COVID-19 were included March 2020-March 2021 at Rigshospitalet, Denmark. MIP and MEP were measured using microRPM. Predicted MIP and MEP were calculated using reference material obtained from 298 healthy adults aged 18-97 years using the same method. In SECURe, 145 participants were measured median 5 months after COVID-19 diagnosis and of these 16% had reduced MIP and/or MEP. There was reduced spirometry and total lung capacity, but not reduced diffusion capacity in those with abnormal MIP and/or MEP compared with normal MIP and MEP. Of those with reduced MIP and/or MEP at 5 months, 80% still had reduced MIP and/or MEP at 12 months follow-up. In conclusion, few have reduced MIP and/or MEP 5 months after COVID-19 and little improvement was seen over time., (© 2024 The Author(s). Physiological Reports published by Wiley Periodicals LLC on behalf of The Physiological Society and the American Physiological Society.)

Introduction: Enhancing lung function can significantly improve daily life functionality for children with cerebral palsy, leading to increased interest in respiratory physiotherapy training devices in clinical practice. This study aims to evaluate the efficacy of devices (inspiratory muscle training and feedback devices) for improving pulmonary function through various respiratory parameters., Methods: A systematic review with meta-analysis of randomized clinical trials was conducted in seven databases up until May 2023. The included studies focused on training inspiratory muscle function using specific devices (inspiratory muscle training and feedback devices) in children with cerebral palsy. The main outcomes were maximum expiratory pressure and maximum inspiratory pressure. Secondary outcomes included forced vital capacity, forced expiratory volume in 1 s, peak expiratory flow, and the Tiffenau index. The effects of respiratory treatment were calculated through the estimation of the effect size and its 95% confidence intervals. The risk of bias in the included studies was assessed using the Cochrane Collaboration's tool for assessing the risk of bias (RoB2)., Results: Nine studies were included in the systematic review with meta-analysis, involving a total of 321 children aged between 6 and 18 years after secondary analyses were conducted. Feedback devices were found to be more effective in improving maximum expiratory pressure (effect size -0.604; confidence interval -1.368 to 0.161), peak expiratory flow, forced expiratory volume in 1 s, and forced vital capacity. Inspiratory muscle training devices yielded better effectiveness in improving maximum inspiratory pressure (effect size -0.500; confidence interval -1.259 to 0.259), the Tiffeneau index, and quality of life., Conclusion: Both devices showed potential in improving pulmonary function in children with cerebral palsy. Further high-quality clinical trials are needed to determine the optimal dosage and the most beneficial device type for each pulmonary function parameter., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Background: Mucopolysaccharidoses (MPS) are rare metabolic diseases that impair respiratory function leading to respiratory failure. This study aimed to compare maximal inspiratory and expiratory pressures (MIP and MEP) obtained in children with MPS and compare with predicted values from previous studies involving healthy children., Methods: This is a cross-sectional study, in which the chest deformity was evaluated; MIP, MEP through digital manometer, and lung function through spirometry. MIP and MEP were compared with five different predict equations and with a control group of healthy children. Agreement between respiratory muscle weakness regarding absolute values of MIP and MEP in relation to predictive values by the equations included in the study were assessed by Kappa coefficient., Results: MPS group was composed of 22 subjects. 45.5% had pectus carinatum, 36.4% pectus excavatum, and presented lower MIP (37.14±36.23 cmH2O) and MEP (60.09±22.3 cmH2O) compared with control group (22 healthy subjects) (MIP: 91.45±35.60; MEP: 95.73±22.38). Only the MEP equations proposed by Tomalak et al. were close to those found in our MPS children (P=0.09). In the MPS group it was observed a weak agreement between inspiratory weakness through absolute and predicted values in only two equations: Tomalak et al. and Domenèch-Clar et al. (for both: k=0.35, P value =0.03); and for MEP a moderate agreement was found using all predictive equations., Conclusions: In MPS children MRP data should not be normalized using the reference equations for healthy ones, is more coherent to longitudinally follow absolute pressures and lung volumes in this group.

Kalyana Chakravarthy Bairapareddy,1 Anulucia Augustine,2 Gopala Krishna Alaparthi,1 Fatma Hegazy,1 Tamer Mohamed Shousha,1,3 Sara Atef Ali,1 Ravishankar Nagaraja,4 Baskaran Chandrasekaran5 1Department of Physiotherapy, College of Health Sciences, University of Sharjah, Sharjah, United Arab Emirates; 2Department of Cardiovascular and Respiratory Physiotherapy, MGM College of Physiotherapy, Navi Mumbai, Maharashtra, India; 3Faculty of Physical Therapy, Cairo University, Cairo, Egypt; 4Department of Biostatistics, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi, 110007, India; 5Department of Exercise Sciences and Sports, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka, IndiaCorrespondence: Kalyana Chakravarthy BairapareddyDepartment of Physiotherapy, College of Health Sciences, University of Sharjah, Sharjah, United Arab EmiratesEmail kreddy@sharjah.ac.aeBackground: Maximum inspiratory pressure (MIP), maximum expiratory pressure (MEP) and maximum voluntary ventilation (MVV) measurements assist in determining the respiratory muscle strength and endurance. These determinants of respiratory muscles vary significantly by age, gender, height, and ethnic origin. Normative values for maximum respiratory pressures (MRPs) and MVV would aid in evaluating respiratory muscle function in athletes, estimating performance, and assisting in rehabilitation. In addition, the reference values may aid in determining the efficacy of therapeutic interventions in young people with chronic respiratory diseases. The purpose of this study was to see how respiratory muscle strength indices correlated with anthropometric and physical activity characteristics in young Arabs.Methodology: The study included 80 male volunteers and 85 female volunteers ranging in age from 18 to 30 years. MicroRPM was used to measure MIP and MEP, and pulmonary function test data, including MVV values, were recorded. All subjects completed the Global Physical Activity Questionnaire (GPAQ) and anthropometric measurements. Unpaired t-tests or Mann–Whitney U-tests were used to determine male-female differences. Using the Pearson correlation coefficient and Spearman Rho correlation coefficient tests, MIP and MEP values were correlated with body composition and physical activity. Using stepwise multiple linear regression analysis, the relationships between respiratory function (MVV, MIP, and MEP) and PFT values (FVC, FEV1, and FEV1/FVC), physical activity, and sedentary behavior were investigated.Results: MIP, MEP, and MVV values were significantly lower in females than in males. MIP, MEP, and MVV values had a moderate correlation with forced vital capacity, forced expiratory volume in 1 second, and height, but not with weight, BMI, or GPAQ. Age, gender, and body mass index were found to be significant predictors of maximal respiratory pressures in a young Arab population.Conclusion: Maximum respiratory pressures and maximal voluntary ventilation were significantly lower in young Arabs than in other ethnic groups; these values were influenced by gender and height but not by levels of physical activity.Keywords: maximal respiratory pressures, maximum voluntary ventilation, anthropometrics, physical activity, young Arabs

To examine the relationship between inspiratory muscle performance (IMP) and functional sitting balance (FSB) in persons with chronic spinal cord injury (SCI). We hypothesized that a moderate correlation would be found between IMP and FSB and that individuals with better balance would have better IMP. The SCI-specific modification of the Function in Sitting Test (FIST-SCI) measured FSB. The IMP measures included (1) maximal inspiratory pressure (MIP), (2) sustained MIP (SMIP), and (3) inspiratory duration. Upper extremity motor score (UEMS) and level of injury (LOI) were taken from International Standards for Neurological Classification of Spinal Cord Injury examinations. Spearman correlational analyses assessed relationships among these factors in the sample (N=37). Mann-Whitney U tests explored differences between 2 comparison group pairs (tetraplegia group [TG] vs paraplegia group [PG]; independent transfer group [ITG] vs assisted transfer group [ATG]). Regression analysis examined variables predictive of FSB in the TG. Research facility. Volunteers with tetraplegia (n=21, American Spinal Injury Association Impairment Scale (AIS) A=8, B=7, C=6) and paraplegia (n=16, AIS A=9, B=4, C=3) (N=37). Not applicable. IMP, LOI, UEMS, FIST-SCI. UEMS, MIP, SMIP, and LOI had moderate to high correlations with FIST-SCI scores (ρ=0.720 (P <.001), 0.480 (P =.003), 0.467 (P =.004), 0.527 (P =.001), respectively). UEMS, MIP, and FIST-SCI scores were higher in the PG and ITG than the TG and ATG, respectively (PG vs. TG P values=<.001,.008,.002, respectively, and ITG vs. ATG P values=<.001,.032, <.001, respectively). Further, SMIP and UEMS predicted FIST-SCI balance scores in the TG, accounting for 55% of total variance (P <.001) (FIST-SCI=11.88+0.03 [SMIP]+0.425 [UEMS]). The relationship between IMP and balance appears preserved after SCI. FSB was predicted, in part, via UEMS and SMIP in the TG. Future research should focus on the effect of SCI-based breathing interventions on FSB. [ABSTRACT FROM AUTHOR]

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CONTEXT: Type 2 diabetes is a systemic disorder that propagates several pathological processes leading to a plethora of complications including those on skeletal muscle strength and lung function. AIMS: This study aims to evaluate the association of glycemic control, duration of disease, and physical activity level on respiratory muscle strength (RMS). SETTINGS AND DESIGN: A cross-sectional study was conducted in the outpatient department setting after approval from the institutional ethics committee. SUBJECTS AND METHODS: The Hemoglobin A1c (HbA1c) level of recruited participants was recorded from a recent laboratory test and they were interviewed with the Rapid Assessment of Physical Activity (RAPA) tool to obtain their current physical activity levels. The evaluation of maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP) was performed using the MicroRespiratory Pressure Meter (MicroRPM) device. STATISTICAL ANALYSIS USED: Pearson's correlation coefficient (r) was calculated for the RMS variables (MIP and MEP) against HbA1c, duration of disease, and RAPA Score. RESULTS: Twenty-six participants were evaluated. Significant correlations were found HbA1c with MIP (r = −0.45, P = 0.02) and RAPA Score with MIP (r = 0.42, P = 0.03) at P < 0.05. CONCLUSIONS: Inspiratory muscle strength is well associated with glycemic control and physical activity of the individual. [ABSTRACT FROM AUTHOR]

BACKGROUND: Duchenne muscular dystrophy (DMD) is frequently complicated by development of a cardiomyopathy. Despite significant medical advances provided to DMD patients over the past 2 decades, there remains a group of DMD patients who die prematurely. The current study sought to identify a set of prognostic factors that portend a worse outcome among adult DMD patients. METHODS AND RESULTS: A retrospective cohort of 43 consecutive patients was followed in the adult UT Southwestern Neuromuscular Cardiomyopathy Clinic. Clinical data were abstracted from the electronic medical record to generate baseline characteristics. The population was stratified by survival to time of analysis and compared with characteristics associated with death. The DMD population was in the early 20s, with median follow-up times over 2 years. All the patients had developed a cardiomyopathy, with the majority of the patients on angiotensin-converting enzyme inhibitors (86%) and steroids (56%), but few other guideline-directed heart failure medications. Comparison between the nonsurviving and surviving cohorts found several poor prognostic factors, including lower body mass index (17.3 [14.8-19.3] versus 25.8 [20.8-29.1] kg/m2, P

ABSTRACT Introduction: surgical treatment of obesity causes important changes in respiratory mechanics. Aim: Comparatively analyze respiratory muscle strength in post bariatric patients underwent to gastric bypass by laparotomy and laparoscopy during hospital stay. Methods: observational study with a non-randomized longitudinal design, of a quantitative character. Data were collected from 60 patients with BMI 40Kg/m2, divided in laparotomy group (n=30) and laparoscopy group (n=30). Smokers, patients with previous lung diseases and those unable to perform the exam correctly were excluded. Both groups were evaluated at immediate postoperative, first and second postoperative days with manovacuometry for respiratory muscle strength and visual analogue pain scale. Results: the sample was homogeneous in age, sex and BMI. Reduction in maximal respiratory pressures was observed after surgery for those operated on by laparotomy, no return to baseline values on discharge day on the second postoperative day. This group had also more severe pain and longer operative time. There was no difference in respiratory pressure measurements after surgery in the laparoscopy group. Conclusion: conventional bariatric surgery reduces muscle strength in the postoperative period and leads to more intense pain during hospitalization when compared to the laparoscopy group.

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Abstract Introduction Inspiratory muscle weakness (IMW) is a potential cause of exertional dyspnea frequently under‐appreciated in clinical practice. Cardiopulmonary exercise testing (CPET) is usually requested as part of the work‐up for unexplained breathlessness, but the specific pattern of exercise responses ascribed to IMW is insufficiently characterized. Objectives To identify the physiological and sensorial responses to progressive exercise in dyspneic patients with IMW without concomitant cardiorespiratory or neuromuscular diseases. Methods Twenty‐three subjects (18 females, 55.2 ± 16.9 years) complaining of chronic daily life dyspnea (mMRC = 3 [2‐3]) plus maximal inspiratory pressure < the lower limit of normal and 12 matched controls performed incremental cycling CPET. FEV1/FVC

Objective: To compare maximum respiratory pressures and spirometric parameters among elderly individuals classified as having no sarcopenia, probable sarcopenia, and confirmed sarcopenia, and to test the ability of these variables to discriminate sarcopenia in a community-dwelling elderly population. Methods: This was a cross-sectional study involving 221 elderly (≥ 60 years of age) individuals of both sexes. Sarcopenia was diagnosed in accordance with the new consensus of the European Working Group on Sarcopenia in Older People. Maximum respiratory pressures and spirometry parameters were assessed. Results: The prevalences of probable sarcopenia and confirmed sarcopenia were 20.4% and 4.1%, respectively. Regardless of the sex, those with confirmed sarcopenia had significantly lower MEP than those with no sarcopenia and probable sarcopenia, whereas only males with confirmed sarcopenia presented with significantly lower MIP than did the other individuals. There was an inverse association of MIP and MEP with sarcopenia, indicating that the decrease by 1 cmH2O in these parameters increases the chance of sarcopenia by 8% and 7%, respectively. Spirometric parameters were not associated with sarcopenia. Cutoff points for MIP and MEP, respectively, were ≤ 46 cmH2O and ≤ 50 cmH2O for elderly women, whereas they were ≤ 63 cmH2O and ≤ 92 cmH2O for elderly men, and both were identified as predictors of sarcopenia (area under the ROC curve > 0.70). Conclusions: Sarcopenia was associated with lower maximum respiratory pressures, but not with spirometric parameters. Maximum respiratory pressures can be used as markers of sarcopenia in a community-dwelling elderly population regardless of the sex. [ABSTRACT FROM AUTHOR]

Background: The diaphragm is the primary muscle responsible for breathing. Weakness in the diaphragm will result in breathing difficulties. The micro- RPM (respiratory pressure meter) is a non-invasive testing device to measure respiratory muscle strength, which is not always feasible, while thoracic expansion measurements are easy to do. Aim: This study constructs a prediction formula for a maximal inspiratory pressure (MIP) value from thoracic expansion measurements. Methods: This study was quantitative with a cross-sectional design. Participants were healthy adults aged 20-40 years, with normal Mini-Mental State Examinations, body mass index, spirometry, and moderate activity levels. The tests performed were MIP and thoracic expansion measurements at three levels: axilla (L1), the fourth intercostal space (L2), and at processus xiphoideus (L3). The data were analyzed using an unpaired t-test and multivariate. Results: The mean MIP for males (81.51 ± 13.90 cmH2O) was significantly greater than females (63.17 ± 15.89 cmH2O) (P = 0.0001). These findings were not different with the Chinese, Indian, Mangalorean, and Malaysian populations because they are all of Asian ethnicity. Thoracic expansion L2 (r = 0.463, P = 0.0001) and L3 (r = 0.502, P = 0.0001) were moderately correlated with MIP, whereas thoracic expansion L2, L3 combined with gender had a weak effect on MIP. The prediction formula was: MIP = 56.802 + 2.387 + L2 + 13.904 + Gender * and MIP = 53.289+ 3.561 + L3 + 9.504 + Gender *, * 0 = female; 1 = male. Conclusions: A prediction formula for MIP can be made using the thoracic expansion variable with gender as a determinant factor. A quick and easy measurement of thoracic expansion can be used as a mean of screening respiratory muscle strength in patient care. [ABSTRACT FROM AUTHOR]

Abstract Objective: To verify the concurrent validity between the inspiratory muscle strength (IMS) values obtained in static (maximal inspiratory pressure [MIP]) and dynamic (S-Index) assessments. Methods: Healthy individuals were submitted to two periods of evaluation: i) MIP, static maneuver to obtain IMS, determined by the Mueller’s maneuver from residual volume (RV) until total lung capacity (TLC); ii) and S-Index, inspiration against open airway starting from RV until TLC. Both measures were performed by the same evaluator and the subjects received the same instructions. Isolated maneuvers with differences < 10% were considered as reproducible measures. Results: Data from 45 subjects (21 males) were analyzed and that showed statistical difference between MIP and S-Index values (133.5 ± 33.3 and 125.6 ± 32.2 in cmH2O, respectively), with P=0.014. Linear regression showed r2=0.54 and S-Index prediction formula = 39.8+(0.75×MIP). Pearson’s correlation demonstrated a strong and significant association between the measures with r=0.74. The measurements showed good concordance evidenced by the Bland-Altman test. Conclusion: S-Index and MIP do not present similar values since they are evaluations of different events of the muscular contraction. However, they have a strong correlation and good agreement, which indicate that both are able to evaluate the IMS of healthy individuals.

Background: In 2013, a new predictor of successful mechanical ventilation liberation named timed inspiratory effort (TIE) index was devised with the normalization of the maximum inspiratory pressure (obtained within 60 s of unidirectional airway occlusion) with the time at which the value was reached. The aim of this study was to verify whether the presence of a sequence of a certain number of inspiratory effort values between 30-60 s > 1.0 cm H 2 O/s could predict weaning success in a performance comparable to the TIE index., Methods: This was a retrospective observational study using 4 databases of previous studies on the TIE index. All patients receiving mechanical ventilation for ≤ 24 h were eligible. Liberation from mechanical ventilation-extubation decisions was made based on performance with spontaneous breathing trials. P < .05 was considered significant. The performance of the TIE index was evaluated by calculating the area under the receiver operating characteristics (AUROC) curve., Results: From 349 eligible patients, 165 subjects were selected for analysis. The AUROC for the TIE index in the studied sample was 0.92 (95% CI 0.87-0.97, P < .001). A sequence of ≤ 4 inspiratory efforts > 1.0 cm H 2 O/s was found in 51.5% of the subjects, with successful ventilatory liberation occurring in 95.3%. The highest specificity values belonged to the sequence of ≤ 4 and ≤ 5 inspiratory efforts > 1.0 cm H 2 O/s; the highest positive predictive value and positive likelihood ratio belonged to the sequence of ≤ 4 inspiratory efforts > 1.0 cm H 2 O/s. The mean time that could have been spared if the procedure were interrupted after the first sequence of 4 inspiratory efforts > 1.0 cm H 2 O/s was 23 ± 3 s., Conclusions: The presence of a sequence of ≤ 4 inspiratory efforts > 1.0 cm H 2 O/s during the TIE index measurement was a reliable predictor of weaning success, which could allow timely interruption of the procedure and entail a substantial reduction in airway occlusion time., Competing Interests: The authors have disclosed no conflicts of interest., (Copyright © 2024 by Daedalus Enterprises.)

Introduction: Lung transplant (LT) is one of the therapeutic options for patients with terminal respiratory diseases. It is highly important to incorporate the functional status and frailty assessment into the selection process of candidates for LT., Objectives: Identify the prevalence of frailty in the LT waiting list. Study the relationship between frailty, functional status, Lung Allocation Score (LAS) and muscular dysfunction., Methodology: Descriptive transversal study of patients on the waiting list for LT., Population: 74 patients with chronic respiratory diseases assessed by the lung transplant committee and accepted to be transplanted in a university hospital in Barcelona. The outcome variables were frailty status was evaluate for SPPB test, functional capacity was evaluate for the six-minute walking test (6MWT) and muscular dysfunction. The results were analyzed with the statistical package STATA 12., Results: Sample of 48 men and 26 women, with a median age of 56.55 years (SD 10.87. The prevalence of frailty assessed with the SPPB was 33.8% (8.1% are in frailty and 25.7% are in a state of pre-frailty). There is a relationship between the SPPB, 6MWT and maximal inspiratory pressure, but not with others force values. There is a relationship between the risk of frailty (scores below 9 in SPPB) and the meters walked in 6 but not with the LAS., Conclusions: The risk of frailty in patients with terminal chronic respiratory diseases is high. Frailty is related with functional capacity, but not with LAS., (Copyright © 2024 Sociedad Española de Rehabilitación y Medicina Física. Publicado por Elsevier España, S.L.U. All rights reserved.)

Background: Maximal respiratory pressure is used to assess the inspiratory and expiratory muscles strength by using maximal inspiratory pressure (P Imax ) and maximal expiratory pressure (P Emax ). This study aimed to summarize and evaluate the reliability and validity of maximal respiratory pressure measurements., Methods: This systematic review followed the Consensus-based Standards for the Selection of Health Measurement Instruments (COSMIN) recommendations and was reported by using the PRISMA checklist. Studies published before March 2023 were searched in PubMed and EMBASE databases., Results: A total of 642 studies were identified by using the online search strategy and manual search (602 and 40, respectively). Twenty-three studies were included. The level of evidence for test-retest reliability was moderate for P Imax and P Emax (intraclass correlation coefficient > 0.70 for both), inter-rater reliability was low for P Imax and very low for P Emax (intraclass correlation coefficient > 0.70 for both), and the measurement error was very low for P Imax and P Emax . In addition, concurrent validity presented a high level of evidence for P Imax and P Emax (r > 0.80)., Conclusions: Only concurrent validity of maximal respiratory pressure measured with the manometers evaluated in this review presented a high level of evidence. The quality of clinical studies by using maximal respiratory pressure would be improved if more high-quality studies on measurement properties, by following well established guidelines and the COSMIN initiative, were available., Competing Interests: The authors have disclosed no conflicts of interest., (Copyright © 2024 by Daedalus Enterprises.)

Background: During invasive ventilation, external flow jet nebulization results in increases in displayed exhaled tidal volumes (V T ). We hypothesized that the magnitude of the increase is inaccurate. An ASL 5000 simulator measured ventilatory parameters over a wide range of adult settings: actual V T , peak inspiratory pressure (PIP), and time to minimum pressure., Methods: Ventilators with internal and external flow sensors were tested by using a variety of volume and pressure control modes (the target V T was 420 mL). Patient conditions (normal, COPD, ARDS) defined on the ASL 5000 were assessed at baseline and with 3.5 or 8 L/min of added external flow. Patient-triggering was assessed by reducing muscle effort to the level that resulted in backup ventilation and by changing ventilator sensitivity to the point of auto-triggering., Results: Results are reported as percentage change from baseline after addition of 3.5 or 8 L/min external flow. For ventilators with internal flow sensors, changes in displayed exhaled V T ranged from 10% to 118%, however, when using volume control, actual increases in actual V T and PIP were only 4%-21% ( P = .063, .031) and 6%-24% ( P = .25, .031), respectively. Changes in actual V T correlated closely with changes in PIP ( P < .001; R 2 = 0.68). For pressure control, actual V T decreased by 3%-5% ( P = .031) and 4%-9% ( P = .031) with 3.5 and 8 L/min respectively, PIP was unchanged. With external flow sensors at the distal Y-piece junction, volume and pressure changes were statistically insignificant. The time to minimum pressure increased at most by 8% ( P = .02) across all modes and ventilators. The effects on muscle pressure were minimal (∼1 cm H 2 O), and ventilator sensitivity effects were nearly undetectable., Conclusions: External flow jet nebulization resulted in much smaller changes in volume than indicated by the ventilator display. Statistically significant effects were confined primarily to machines with internal flow sensors. Differences approached the manufacturer-reported variation in ventilator baseline performance. During nebulizer therapy, effects on V T can be estimated at the bedside by monitoring PIP., (Copyright © 2024 by Daedalus Enterprises.)

Inspiratory muscle training may benefit respiratory function, cardiocirculatory parameters, quality of life and functionality in neuromuscular diseases. This pilot study aimed to demonstrate the POWERbreathe® inspiratory muscle training effects on maximum inspiratory pressure (PImax), heart rate (HR) and HR variability, as well as the quality of life impairment and functionality in patients with Amyotrophic Lateral Sclerosis (ALS). A pilot single-blinded, non-randomized controlled clinical trial was carried out. A total of 20T ALS patients were enrolled and divided into experimental (n = 10) and control (n = 10) groups. The experimental group received POWERbreathe® inspiratory muscle training in conjunction with usual care, and the control group received only usual care for 8 weeks. PImax (measured by POWERbreathe® KH1), HR and HR variability (evaluated by Polar H7), quality of life impairment [measured by the Amyotrophic Lateral Sclerosis Assessment Questionnaire—40 items (ALSAQ-40)] and functionality [assessed by the ALS Functional Rating Scale Revised (ALSFRS-R)] were collected at baseline and after 8 weeks of intervention. We detected statistically significant differences (p < 0.05) with an effect size ranging from medium to large (Cohen’s d = 0.72–1.37); relative to the control group, the experimental group had an increased PImax (mean difference = 10.80 cm H2O; 95% CI = 3.42–18.17) and ALSFRS-R score (mean difference = 5.30 points; 95% CI = −0.03–10.63) and reduced HR (mean difference = −8.80 beats-per-minute; 95% CI = −20.27–2.67) and R-R interval (mean difference = 78.30 ms; 95% CI = 2.89–153.70). POWERbreathe® inspiratory muscle training, in addition to usual care, may improve inspiratory strength and heart rate in patients with ALS. These results encourage larger and longer trials investigating potential clinically relevant benefits of inspiratory muscle training to these patients over the disease course.

Purpose: To compare the effects of sustained abdominal exercises--pelvic tilt and twist curl-up--on the magnitude of abdominalmuscle activation andmaximal expiratory pressure (MEP) in healthymen andwomen. It was hypothesized that the activation would differ between men and women during these 3 exercisemaneuvers. Methods: Using a cross-sectional design, 10 healthy men and 10 women sustained pelvic tilt and twist curl-up exercises until task failure. Baseline MEP was compared with MEP immediately after both exercises. The root mean square of the internal oblique, rectus abdominis, external oblique, and transverse abdominis were evaluated during pelvic tilt, twist curl-up, andMEP. Results: Pelvic tilt and twist curl-upwere sustained for similar durations. Twist curl-up induced higher activations andmore shifts to lowermedian frequency inall 4 abdominals compared with pelvic tilt. Although internal oblique activation was highest during MEP and lowest during pelvic tilt in women, these comparisons did not differ in men. Maximal expiratory pressure tended to decrease after sustained pelvic tilt inwomen but did not change inmen. Conclusions: Twist curl-up activated abdominalmuscles more so than pelvic tilt. Some sex differences were shown that should be considered in future research of abdominal muscle exercise prescription. [ABSTRACT FROM AUTHOR]

Abstract Background: Reduced respiratory muscle strength leads to reduced pulmonary function, chest wall movements in the affected side, and increased chest infections, which thereby reduces oxygenation and ventilation. Respiratory muscle training can be used in acute stroke subjects to increase their pulmonary function. Purpose: To compare the short-term effects of diaphragmatic breathing exercise, flow, and volume-oriented incentive spirometry on respiratory function following stroke. Methods: A non-randomized hospital-based study was conducted at Kasturba Medical College Hospitals, Mangalore, India. Forty-two sub-acute subjects of either gender, with the first episode of stroke within six months, were assigned to three groups by the consultant, i.e., diaphragmatic breathing group (DBE), Flow oriented-incentive spirometry group (FIS), and volume oriented-incentive spirometry group (VIS; N = 14) each. All subjects received intervention thrice daily, along with conventional stroke rehabilitation protocols throughout the study period. Pre- and post-intervention values were taken on alternate days until day 5 for all the three groups. Results: The pulmonary function and maximal respiratory pressures were found to be significantly increased by the end of intervention in all three groups, but FIS and DBE groups had better results than VIS (FVC = FIS group, 13.71%; VIS group, 14.89%; DBE group, 21.27%, FEV1 = FIS group, 25.97%; VIS group, 22.52%; DBE group, 19.38%, PEFR = FIS group, 38.76%; VIS group,9.75%; DBE group, 33.16%, MIP = FIS group, 28.23%; VIS group, 19.36%; DBE group, 52.14%, MEP = FIS group, 43.00%; VIS group, 22.80%; DBE group, 28.68%). Conclusion: Even though all interventions had positive outcomes in all variables, flow incentive spirometry had better results across all outcomes (pulmonary function and maximal respiratory pressures) when compared to the other two interventions making it a valuable tool for stroke rehabilitation. [ABSTRACT FROM AUTHOR]

Objectives: Maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP) could be useful clinical parameters in monitoring many conditions including cystic fibrosis (CF). However, current protocols for undertaking the measurements lack standardization including the number of repeated attempts to achieve best values. We aimed to (a) determine the optimum number of attempts to achieve best MIP/MEP values, and (b) evaluate if the number of attempts is consistent across two different test days. Methods: We analyzed data of a previous randomized controlled trial involving the effect of singing on respiratory muscle strength in 35 children with CF. On two different days (T1, T2) children performed MIP/MEP with at least ten attempts each to achieve < 10% repeatability. Results: All children achieved repeatable MIP/MEP values within 10–11 attempts with 24 (68.6%) and 26 (74.3%) of these achieving best values of MIP and MEP, respectively, at attempts 6–11. Median values of the pressures by three, five, eight and all attempts significantly increased with more attempts (all p < 0.05). At T2, 56% required fewer attempts to achieve best values, but 32% required more attempts, indicating that the number of attempts required was inconsistent between test days. Conclusion: It is likely that at least ten attempts (best two within < 10% variability) is required to achieve best and reliable MIP/MEP in children with CF. A larger sample size in children with CF and various conditions is required to consolidate these findings. [ABSTRACT FROM AUTHOR]

IntroductionInspiratory muscle training (IMT) protocols are typically performed using pressure threshold loading with inspirations initiated from residual volume (RV). We aimed to compare effects of three different IMT protocols on maximal inspiratory pressures (PImax) and maximal inspiratory flow (V̇Imax) at three different lung volumes. We hypothesized that threshold loading performed from functional residual capacity (FRC) or tapered flow resistive loading (initiated from RV) would improve inspiratory muscle function over a larger range of lung volumes in comparison with the standard protocol.Methods48 healthy volunteers (42% male, age: 48 ± 9 years, PImax: 110 ± 28%pred, [mean ± SD]) were randomly assigned to perform three daily IMT sessions of pressure threshold loading (either initiated from RV or from FRC) or tapered flow resistive loading (initiated from RV) for 4 weeks. Sessions consisted of 30 breaths against the highest tolerable load. Before and after the training period, PImax was measured at RV, FRC, and midway between FRC and total lung capacity (1/2 IC). V̇Imax was measured at the same lung volumes against a range of external threshold loads.ResultsWhile PImax increased significantly at RV and at FRC in the group performing the standard training protocol (pressure threshold loading from RV), it increased significantly at all lung volumes in the two other training groups (all p < 0.05). No significant changes in V̇Imax were observed in the group performing the standard protocol. Increases of V̇Imax were significantly larger at all lung volumes after tapered flow resistive loading, and at higher lung volumes (i.e., FRC and 1/2 IC) after pressure threshold loading from FRC in comparison with the standard protocol (all p < 0.05).ConclusionOnly training with tapered flow resistive loading and pressure threshold loading from functional residual capacity resulted in consistent improvements in respiratory muscle function at higher lung volumes, whereas improvements after the standard protocol (pressure threshold loading from residual volume) were restricted to gains in PImax at lower lung volumes. Further research is warranted to investigate whether these results can be confirmed in larger samples of both healthy subjects and patients.

Introduction: Inspiratory muscle weakness (IMW) is a potential cause of exertional dyspnea frequently under‐appreciated in clinical practice. Cardiopulmonary exercise testing (CPET) is usually requested as part of the work‐up for unexplained breathlessness, but the specific pattern of exercise responses ascribed to IMW is insufficiently characterized. Objectives: To identify the physiological and sensorial responses to progressive exercise in dyspneic patients with IMW without concomitant cardiorespiratory or neuromuscular diseases. Methods: Twenty‐three subjects (18 females, 55.2 ± 16.9 years) complaining of chronic daily life dyspnea (mMRC = 3 [2‐3]) plus maximal inspiratory pressure < the lower limit of normal and 12 matched controls performed incremental cycling CPET. FEV1/FVC<0.7, significant abnormalities in chest CT or echocardiography, and/or an established diagnosis of neuromuscular disease were among the exclusion criteria. Results and Conclusion: Patients presented with reduced aerobic capacity (peak V̇O2: 79 ± 26 vs 116 ± 21 %predicted), a tachypneic breathing pattern (peak breathing frequency/tidal volume = 38.4 ± 22.7 vs 21.7 ± 14.2 breaths/min/L) and exercise‐induced inspiratory capacity reduction (‐0.17 ± 0.33 vs 0.10 ± 0.30 L) (all P <.05) compared to controls. In addition, higher ventilatory response (ΔV̇E/ΔV̇CO2 = 34.1 ± 6.7 vs 27.0 ± 2.3 L/L) and symptomatic burden (dyspnea and leg discomfort) to the imposed workload were observed in patients. Of note, pulse oximetry was similar between groups. Reduced aerobic capacity in the context of a tachypneic breathing pattern, inspiratory capacity reduction and preserved oxygen exchange during progressive exercise should raise the suspicion of inspiratory muscle weakness in subjects with otherwise unexplained breathlessness. [ABSTRACT FROM AUTHOR]

Introduction: Chronic obstructive pulmonary disease is a systemic disease characterized not only by respiratory symptoms but also by physical deconditioning and muscle weakness. One prominent manifestation of this disease is the decline in respiratory muscle strength. Previous studies have linked the genotypes of insulin-like growth factor 1 and 2 (IGF-1 and IGF-2) to muscle weakness in other populations without this disease. However, there is a notable knowledge gap regarding the biological mechanisms underlying respiratory muscle weakness, particularly the role of IGF-1 and IGF-2 genotypes in this pulmonary disease. Therefore, this study aimed to investigate, for the first time, the association between IGF-1 and IGF-2 genotypes with respiratory muscle strength in individuals with chronic obstructive pulmonary disease. In addition, we analyzed the relationship between oxidative stress, chronic inflammation, and vitamin D with respiratory muscle strength., Methods: A cross sectional study with 61 individuals with chronic obstructive pulmonary disease. Polymerase chain reaction of gene polymorphisms IGF-1 (rs35767) and IGF-2 (rs3213221) was analyzed. Other variables, related to oxidative stress, inflammation and Vitamin D were dosed from peripheral blood. Maximal inspiratory and expiratory pressure were measured., Results: The genetic polymorphisms were associated with respiratory muscle strength ( 3.0 and 3.5; = 0.57). Specific genotypes of IGF-1 and IGF-2 presented lower maximal inspiratory and expiratory pressure (<0.05 for all). Oxidative stress, inflammatory biomarkers, and vitamin D were not associated with respiratory muscle strength., Conclusion: The polymorphisms of IGF-1 and IGF-2 displayed stronger correlations with respiratory muscle strength compared to blood biomarkers in patients with chronic obstructive pulmonary disease. Specific genotypes of IGF-1 and IGF-2 were associated with reduced respiratory muscle strength in this population., Competing Interests: The authors declare no conflict of interest., (This work is licensed under a Creative Commons Attribution 4.0 International License.)