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“Inspiratory muscle weakness in acutely hospitalized patients 75 years and over”: a secondary analysis of a randomized controlled trial on the effectiveness of multicomponent exercise and inspiratory muscle training

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Key summary points

AbstractSection Aim

To evaluate inspiratory muscle function and the effect of a multicomponent exercise program including inspiratory muscle training during short-stay hospitalization.

AbstractSection Findings

Inspiratory muscle impairment is very prevalent in the hospitalized elderly. Analysis of maximal inhibitory pressure revealed that those patients with inspiratory muscle weakness on admission showed the greatest improvement in inspiratory muscle strength.

AbstractSection Message

These findings are especially relevant to identify those oldest-old patients who may benefit most from muscle inspiratory training during hospitalization for acute illness.

Abstract

Purpose

The impact of hospitalization for acute illness on inspiratory muscle strength in oldest-old patients is largely unknown, as are the potential benefits of exercise and inspiratory muscle training (IMT) during in-hospital stay.

Design and methods

This was a sub-study of a randomized clinical trial that evaluated the efficiency of a multicomponent exercise program in preventing hospitalization-associated disability. Patients were randomized into control (CG) and intervention (IG) groups. The intervention included two daily sessions of supervised walking, squat, balance, and IMT. Baseline and discharge maximal inspiratory pressure (MIP) and inspiratory muscle weakness (IMW) were determined. The effect of the intervention on inspiratory muscle strength was assessed by analyzing (1) the differences between groups in baseline and discharge MIP and IMW, (2) the association, patient by patient, between baseline and discharge MIP, and the improvement index (MIP discharge/baseline) in patients with or without IMW.

Results

In total, 174 patients were assessed (mean age of 87), 57 in CG and 117 in IG. Baseline MIP was lower than predicted in both sexes (women 29.7 vs 44.3; men 36.7 vs 62.5 cmH2O, P < 0.001, baseline vs predicted, respectively). More than 65% of patients showed IMW at admission. In women in IG, the mean MIP was higher at discharge than at admission (P = 0.003) and was the only variable that reached expected reference levels at discharge (Measured MIP 39.2 vs predicted MIP 45 cmH2O, P = 0.883). Patients with IMW on admission showed a statistically significant improvement in MIP after the intervention.

Conclusion

IMW is very prevalent in oldest-old hospitalized with acute illness. Patients might benefit from a multicomponent exercise program including IMT, even during short-stay hospitalization.

Clinical trial registration

ClinicalTrials.gov; No.: NTC03604640. May 3, 2018.

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Data availability

The data that support the findings of this study are available from the corresponding author.

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Acknowledgements

We thank the geriatric ward staff for their valuable help and their contribution to our results, especially the following professionals: J. Ortiz, MT. Vidán, E. Santana, I. Ariza, FJ. Gómez-Olano, JP. Vasquez, S. González, P. Lavandera, A. Grau, P. Aldama, R. Valdovinos, G. Hernández, J. Ballesteros, J. Lozano, JM. García de Viguera, G. Fajardo and A. Paredes. We also thank the participants and their families.

Funding

The research reported in this study was supported by the following grants: Instituto de la Salud Carlos III (PI17/02021), CIBERFES, Fondo Europeo de Desarrollo Regional (FEDER). The work of JMC is supported by a contract granted by Biomedical Research Networking Center on Frailty and Healthy Aging (CIBERFES, Spain).

Author information

Author notes

  1. José Antonio Serra Rexach and Jennifer Mayordomo-Cava have contributed equally to this work and share last authorship.

Authors and Affiliations

  1. Department of Geriatrics, Hospital General Universitario Gregorio Marañón, Madrid, Spain

    Teresa Zarralanga-Lasobras, Vicente Romero-Estarlich, Cristina Carrasco-Paniagua & José Antonio Serra-Rexach

  2. Gregorio Marañón Health Research Institute, C. Castillo de Alarcón, 49, 28692, Villafranca del Castillo, Madrid, Spain

    Teresa Zarralanga-Lasobras, José Antonio Serra-Rexach & Jennifer Mayordomo-Cava

  3. Biomedical Research Networking Center on Frailty and Healthy Aging, CIBERFES, Madrid, Spain

    José Antonio Serra-Rexach

  4. Department of Medicine, School of Medicine, Universidad Complutense, Madrid, Spain

    José Antonio Serra-Rexach

  5. Facultad HM Hospitales de Ciencias de la Salud de la Universidad Camilo José Cela, Madrid, Spain

    Jennifer Mayordomo-Cava

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  1. Teresa Zarralanga-Lasobras
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Contributions

All authors meet the criteria for authorship stated in the Uniform Requirements for Manuscripts Submitted to Biomedical Journals. Study concept and design: TZL, JASR, JMC. Acquisition of data: TZL, CCP, VRE. Analysis and interpretation of data: TZL, JASR, JMC. Drafting of the manuscript: TZL, JASR, JMC. Critical revision of the manuscript for important intellectual content: TZL, JASR, JMC.

Corresponding author

Correspondence to Jennifer Mayordomo-Cava.

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Conflict of interests

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.

Ethical approval

The Ethics Committee of the “Fundación para la Investigación Biomédica” from the “Hospital Universtario Gregorio Marañon, Madrid” approved the study (No. 07/2018). All the data were analyzed anonymously, and clinical investigations have been conducted according to the principles expressed in the Declaration of Helsinki.

Informed consent

Written informed consent for participation was obtained from all patients/relatives.

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The sponsors were not involved in the design of this study, the data analysis, or the preparation of the manuscript.

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Zarralanga-Lasobras, T., Romero-Estarlich, V., Carrasco-Paniagua, C. et al. “Inspiratory muscle weakness in acutely hospitalized patients 75 years and over”: a secondary analysis of a randomized controlled trial on the effectiveness of multicomponent exercise and inspiratory muscle training. Eur Geriatr Med 15, 83–94 (2024). https://doi.org/10.1007/s41999-023-00865-z

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