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Effects of Pulmonary Rehabilitation Including Inspiratory Muscle Training in Patients with Chronic Obstructive Pulmonary Disease after Stratification by the Degree of Static Hyperinflation

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Abstract

Background

Inspiratory muscle training (IMT) improves inspiratory muscle strength, exercise capacity and health status in patients with chronic obstructive pulmonary disease (COPD). However, there is no additional effect on top of comprehensive pulmonary rehabilitation (PR). It is unclear whether patients with different baseline degrees of static hyperinflation respond differentially to IMT as part of a PR program. Therefore, the aim was to study the effects of IMT as an add-on on PR after stratification for baseline degrees of static hyperinflation.

Methods

In this single center retrospective study data were extracted between June 2013 and October 2020 of COPD patients who participated in a comprehensive PR program including IMT. IMT was performed twice daily, one session consisted of 3 series of 10 breaths and training intensity was set initially at a load of approximately 50% of patients’ maximal static inspiratory mouth pressure (MIP). The primary outcome measure was MIP. Secondary outcomes were the distance achieved on the 6-min walk test (6MWD), endurance cycling exercise capacity at 75% of the peak work rate (CWRT) and disease-specific health status using the COPD assessment test.

Results

754 patients with COPD were screened for eligibility and 328 were excluded because of repeated PR programs, missing data or baseline residual volume (RV) > 350%. In total, 426 COPD patients were categorized into RV categories 50–130% (n = 84), 131–165% (n = 86), 166–197% (n = 86), 198–234% (n = 85) and 235–349% (n = 85). In the whole sample, MIP, endurance exercise capacity and health status improved significantly. The change in 6MWD was higher in the lowest baseline degree of static hyperinflation [+ 39 (9–92) m] compared with the baseline highest degree of static hyperinflation [+ 11 (− 18–54) m] (p < 0.05).

Conclusions

IMT as part of a PR program in patients with COPD with different baseline degrees improved MIP irrespective of the degree of static lung hyperinflation. Improvement in functional exercise capacity was significantly higher in the group with the lowest degree of static hyperinflation compared with the patients with the highest degree of static hyperinflation.

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The authors have not disclosed any funding.

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Authors and Affiliations

  1. Department of Research and Development, CIRO+, Center of Expertise for Chronic Organ Failure, Hornerheide 1, Horn, The Netherlands

    Maurice J. H. Sillen, Anouk W. Vaes, Miriam T. J. Groenen, Frits M. E. Franssen & Martijn A. Spruit

  2. NUTRIM School of Nutrition and Translational Research in Metabolism, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands

    Frits M. E. Franssen & Martijn A. Spruit

  3. Department of Respiratory Medicine, Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands

    Frits M. E. Franssen & Martijn A. Spruit

Authors
  1. Maurice J. H. Sillen
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  2. Anouk W. Vaes
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  3. Miriam T. J. Groenen
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  4. Frits M. E. Franssen
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  5. Martijn A. Spruit
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Contributions

Trial concept and design: MJHS, and MAS; acquisition of data: MJHS, MTJG; analysis and interpretation of data: MJHS, AWV, MTJG, FMEF, and MAS; drafting the article: MJHS, AWV, FMEF, and MAS; revising it critically for important intellectual content: all authors; final approval of the version to be published: all authors. MJHS had full access to all trial data and takes responsibility for the integrity of the data and the accuracy of the data analysis.

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Correspondence to Maurice J. H. Sillen.

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Sillen, M.J.H., Vaes, A.W., Groenen, M.T.J. et al. Effects of Pulmonary Rehabilitation Including Inspiratory Muscle Training in Patients with Chronic Obstructive Pulmonary Disease after Stratification by the Degree of Static Hyperinflation. Lung 200, 487–494 (2022). https://doi.org/10.1007/s00408-022-00554-x

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  • DOI: https://doi.org/10.1007/s00408-022-00554-x

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