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. 2024 Nov 25;10(6):00035-2024.
doi: 10.1183/23120541.00035-2024. eCollection 2024 Nov.

Enhanced diaphragm excursion and exercise tolerance in COPD patients through inspiratory muscle training after standardised pulmonary rehabilitation: randomised controlled trial

Masashi Shiraishi  1 , Yuji Higashimoto  1 , Ryuji Sugiya  1 , Hiroki Mizusawa  1 , Yu Takeda  1 , Masaya Noguchi  1 , Osamu Nishiyama  2 , Ryo Yamazaki  2 , Shintarou Kudo  3 , Tamotsu Kimura  1 , Hisako Matsumoto  2
Affiliations

Enhanced diaphragm excursion and exercise tolerance in COPD patients through inspiratory muscle training after standardised pulmonary rehabilitation: randomised controlled trial

Masashi Shiraishi et al. ERJ Open Res. .

Abstract

Objective: Inspiratory muscle training (IMT) is used to improve inspiratory muscle strength in patients with COPD. However, the effect of IMT on diaphragmatic function has not yet been thoroughly evaluated. This study aimed to evaluate the effect of IMT on maximum diaphragmatic excursion (DEmax) using ultrasonography in patients with COPD.

Methods: This was a single-centre, randomised, prospective, parallel-group, unblinded controlled trial involving 38 participants with stable COPD. Participants underwent a standardised 12-week pulmonary rehabilitation (PR) programme followed by a 12-week IMT programme, consisting of home-based IMT and low-frequency outpatient PR sessions supervised by physiotherapists (once every 2 weeks), versus low-frequency outpatient PR alone as a control. The DEmax and exercise tolerance were measured.

Results: Out of the 38 patients initially enrolled in the PR programme, 33 successfully completed it and were subsequently randomised to the IMT programme. Finally, 15 (94%) and 14 (88%) patients from the IMT and control groups, respectively, completed the study. Following the IMT programme, DEmax increased in the IMT group (mean±sd 50.1±7.6 mm to 60.6±8.0 mm, p<0.001), but not in the control group (47.4±7.9 mm to 46.9±8.3 mm, p=0.10). Changes in DEmax and exercise tolerance (peak oxygen uptake) were greater in the IMT group than in the control group (both p<0.01).

Conclusions: IMT following the PR programme improved DEmax and exercise tolerance. Therefore, DEmax may be an important outcome of IMT.

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Conflict of interest statement

Conflict of interest: The authors have nothing to disclose.

Figures

FIGURE 1
FIGURE 1
The study protocols. After registration, a standardised pulmonary rehabilitation (PR) programme was implemented for all patients. Standardised initial PR included twice-weekly sessions of monitored exercise training and self-training at home for 12 weeks, followed by randomisation to the IMT or control group. After randomisation, all patients were instructed to continue self-training at home and attend outpatient maintenance PR supervised by physiotherapists (once every 2 weeks). The inspiratory muscle training (IMT) group underwent IMT at home for 12 weeks.
FIGURE 2
FIGURE 2
Flow chart of patient selection. IMT: inspiratory muscle training.
FIGURE 3
FIGURE 3
Change of maximum diaphragmatic excursion (DEmax) as measured by an ultrasonography at baseline and week 12. Error bars indicate the standard deviation. **: p<0.01.
FIGURE 4
FIGURE 4
Change of peak oxygen uptake (V˙O2) as measured by a cycle ergometer at baseline and week 12. Error bars indicate the standard deviation. *: p<0.05.
See this image and copyright information in PMC

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