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9TMR Non-Drug Therapy  2019, Vol. 2 Issue (4): 117-126    DOI: 10.12032/TMRND201902022
Review     
The impact of inspiratory muscle training on exercise capacity and inspiratory muscle strength in heart failure patients: a meta-analysis
Meng-Ya Jing1, Xiao-Yi Li1, Xue-Yun Hao1, Guo-Min Song2,*()
1Graduate College, Tianjin University of Traditional Chinese Medicine, Tianjin, 301617, P. R. China
2Department of Nursing, Tianjin Hospital, Tianjin, 300211, P. R. China
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Highlights

The evidence from a large number of trials with about 1,415 patients in total suggested that inspiratory muscle training in patients with heart failure improved cardiac functions, especially the 6-minute walking distance and maximum suction pressure.

Editor’s Summary

By searching PubMed, EMbase, the Cochrane Library, Web of Science, CBM, WanFang, VIP, and CNKI databases about the effects of inspiratory muscle training on cardiopulmonary function in patients with heart failure, this meta-analysis analyzed 20 randomized controlled trials with 1,415 patients and concluded that inspiratory muscle training seemed to be a useful strategy for improving exercise capacity and inspiratory muscle strength in heart failure patients, which could improve 6-minute walking distance and maximum inspiratory pressure, but not the peak oxygen uptake, first second forced expiratory volume, and forced vital capacity. The conclusion could provide some reference and consultation for clinical practice. However, the quality of included studies was low, new large-scale randomized controlled trials were needed to confirm the findings of this systematic review.

Abstract

Objective: To systematically evaluate the therapeutic effects of inspiratory muscle training (IMT) on cardiopulmonary functions in patients with heart failure. Methods: PubMed, EMbase, the Cochrane Library, Web of Science, CBM, WanFang Data, VIP, and CNKI databases were searched to collect randomized controlled trials about the effects of IMT on cardiopulmonary function in patients with heart failure. Meta-analysis was performed using RevMan 5.3 software after two researchers independently screened the literatures, extracted the data, and evaluated the risk of bias. Results: A total of 20 articles with 1,415 patients were included. Meta-analysis showed that IMT was able to increase the 6-minute walking distance (mean difference (MD) = 59.41, 95% confidence interval (CI) (51.02-67.80), P < 0.001) and maximum inspiratory pressure (MD = 15.59, 95% CI (12.96-18.21), P < 0.001) in patients with heart failure compared with the control group. But there was no statistical difference in peak oxygen uptake (MD = 1.37, 95% CI (-0.57-3.30), P = 0.17), first second forced expiratory volume (MD = -5.79, 95% CI (-12.23-0.65), P = 0.08) and forced vital capacity (MD = -0.45, 95% CI (-6.39-5.49), P = 0.88) between the control and the experimental group. Conclusion: Available evidence suggested that IMT seemed to be a useful strategy for improving exercise capacity and inspiratory muscle strength in heart failure patients. Limited by the quantity and quality of the included studies, the above conclusions need to be verified by more high-quality studies.



Key wordsInspiratory muscle training      Exercise capacity      Inspiratory muscle strength      Heart failure      Meta-analysis     
Received: 16 February 2019      Published: 06 December 2019
Corresponding Authors: Song Guo-Min   
E-mail: songguomin134@163.com
Cite this article:

Meng-Ya Jing, Xiao-Yi Li, Xue-Yun Hao, Guo-Min Song. The impact of inspiratory muscle training on exercise capacity and inspiratory muscle strength in heart failure patients: a meta-analysis. 9TMR Non-Drug Therapy, 2019, 2(4): 117-126. doi: 10.12032/TMRND201902022

URL:

https://www.tmrjournals.com/ndt/EN/10.12032/TMRND201902022     OR     https://www.tmrjournals.com/ndt/EN/Y2019/V2/I4/117

Figure 1 The specific search strategies of the meta-analyses
Figure 2 Eligibility and data-synthesis PRISMA flow diagram. *The number of databases retrieved and the number of documents detected are as follows: PubMed (n = 31), EMbase (n = 91), The Cochrane Library (n = 142), Web of Science (n = 323), CBM (n = 82), CNKI (n = 34), WanFang Data (n = 34) and VIP (n = 22).
Figure 3 Results of bias risk assessment included in the study
Bosnak-Guclu 2011 [12] Turkey 69.5 ± 7.9/65.7 ± 10.5 16/14 A B 1.5 ①③④⑤
Dall’Ago 2006[13] Brazil 54 ± 3/58 ± 2 16/16 A B 3 ①②④⑤
Johnson 1998 [14] US 70 ± 4.6/63.4 ± 4.5 8/8 A B 2
Padula 2009 [15] UA 51-89/32-95 15/17 A + F + G + H F + G + H 3
Palau 2014 [16] Spain 60-76/73-77 14/12 A + D D 3 ①②
Weiner 1999 [17] Israel 66.2 ± 14.5/63.8 ± 12.6 10/10 A B 3 ②③
Winkelmann 2009 [18] Brazil 54 ± 12/59 ± 9 12/12 A + E E 3 ①②
REN aifen 2018 [19] China 75.5 ± 6.5/75.0 ± 7.1 40/40 A + C C 3
SHI xunyu 2016 [20] China 61.14 ± 11.93/64.56 ± 9.54 42/39 A + C C 3
XIANG qian 2018 [21] China 63.43 ± 10.31/60.2 ± 10.61 44/44 A + C C -
YUANjiaming 2018 [22] China 64.21 ± 7.65/67.21 ± 4.21 17/17 A + E E 3
ZHAO wei 2017 [23] China 64.36 ± 6.2/66.53 ± 5.76 60/60 A + C C 3
Marco 2013 [24] Spain 68.5 ± 8.9/70.1 ± 10.8 11/11 A B 1
Adamopoulos 2014 [25] Greece 57.8 ± 11.7/58.3 ± 13.2 21/22 A + E E 3 ②③④⑤
Mello 2012 [26] Brazil 54.3 ± 2/53.3 ± 2 15/12 A C 3 ②③
XIA changda 2018 [27] China 64.26 ± 3.17/65.05 ± 4.12 45/44 A + C C 12
LIN na 2011 [28] China 56.8 ± 16.2/57.5 ± 16.2 32/35 A + C C -
YANG xiangyu 2018 [29] China - 100/100 A + C C 6
CHEN zefang 2015 [30] China 62.1 ± 4.1/62.9 ± 5.0 42/42 A + C C 2
YANG manmei 2015 [31] China 49.01 ± 11.91/48 ± 12.02 150/150 A + C C -
Table 1 Basic characteristics of the included studies
Figure 4 The effects of IMT on 6-MWD in patients with heart failure. IMT, inspiratory muscle training; 6-MWD, 6-minute walk distance; SD, standard deviation; CI, confidence interval.
Figure 5 The effects of IMT on peak VO2 in patients with heart failure. IMT, inspiratory muscle training; Peak VO2, peak oxygen uptake; SD, standard deviation; CI, confidence interval.
Figure 6 The effects of IMT on MIP in patients with heart failure. IMT, inspiratory muscle training; MIP, maximum inspiratory pressure; SD, standard deviation; CI, confidence interval.
Figure 7 The effects of IMT on FEV1 in patients with heart failure. IMT, inspiratory muscle training; FEV1, first second forced expiratory volume; SD, standard deviation; CI, confidence interval.
Figure 8 The effects of IMT on FVC in patients with heart failure. IMT, inspiratory muscle training; FVC, forced vital capacity; SD, standard deviation; CI, confidence interval.
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