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Randomized Controlled Trial
. 2023 Feb 10;91(1):93-102.
doi: 10.3390/arm91010009.

Inspiratory-Expiratory Muscle Training Improved Respiratory Muscle Strength in Dialysis Patients: A Pilot Randomised Trial

Nicola Lamberti  1 , Giovanni Piva  2 , Yuri Battaglia  3 , Michele Franchi  4 , Matteo Pizzolato  4 , Antonio Argentoni  4 , Giorgio Gandolfi  4 , Giulia Gozzi  4 , Margherita Lembo  4 , Pietro Lavisci  4 , Alda Storari  5 , Natascia Rinaldo  1 , Fabio Manfredini  1   4   6 , Annalisa Cogo  1
Affiliations
Randomized Controlled Trial

Inspiratory-Expiratory Muscle Training Improved Respiratory Muscle Strength in Dialysis Patients: A Pilot Randomised Trial

Nicola Lamberti et al. Adv Respir Med. .

Abstract

End-stage kidney disease (ESKD) exposes patients to progressive physical deconditioning involving the respiratory muscles. The aim of this pilot randomized controlled trial was to determine the feasibility and effectiveness of low-intensity respiratory muscle training (RMT) learned at the hospital and performed at home. A group of ESKD patients (n = 22) were randomized into RMT or usual care (control group, CON) in a 1:1 ratio. The respiratory training was performed at home with an inspiratory-expiratory system for a total of 5 min of breathing exercises in a precise rhythm (8 breaths per minute) interspersed with 1 min of rest, two times per day on nondialysis days for a total of 4 weeks, with the air resistance progressively increasing. Outcome measures were carried out every 4 weeks for 3 consecutive months, with the training executed from the 5th to the 8th week. Primary outcomes were maximal inspiratory and expiratory pressure (MIP, MEP), while secondary outcomes were lung capacity (FEV1, FVC, MVV). Nineteen patients without baseline between-group differences completed the trial (T: n = 10; Age: 63 ± 10; Males: n = 12). Both MIP and MEP significantly improved at the end of training in the T group only, with a significant difference of MEP of 23 cmH2O in favor of the RMT group (p = 0.008). No significant variations were obtained for FVC, FEV1 or MVV in either group, but there was a greater decreasing trend over time for the CON group, particularly for FVC (t = -2.00; p = 0.046). Low-fatiguing home-based RMT, with a simple device involving both inspiratory and expiratory muscles, may significantly increase respiratory muscle strength.

Keywords: dialysis; end-stage kidney disease; exercise; rehabilitation; respiratory muscle training; respiratory muscles; strength.

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Conflict of interest statement

Annalisa Cogo and Fabio Manfredini previously received a grant from MEDINET. The other authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Study flow diagram.
Figure 2
Figure 2
Distribution overtime for MIP and MEP values in the RMT group (red) and CON group (blue). Legend: data are reported as mean (95% confidence interval).
See this image and copyright information in PMC

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