Effect of inspiratory muscle training on respiratory muscle strength and functional capacity in patients with type 2 diabetes mellitus: A randomized clinical trial.

Publisher: Blackwell Publishing Asia Country of Publication: Australia NLM ID: 101504326 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1753-0407 (Electronic) Linking ISSN: 17530407 NLM ISO Abbreviation: J Diabetes Subsets: MEDLINE

Original Publication: Richmond, Vic. : Blackwell Publishing Asia, 2009-

Breathing Exercises* ; Exercise Tolerance* ; Muscle Strength*; Diabetes Mellitus, Type 2/*therapy ; Diaphragm/*physiopathology; Adult ; Diabetes Mellitus, Type 2/diagnosis ; Diabetes Mellitus, Type 2/physiopathology ; Female ; Functional Status ; Humans ; Male ; Middle Aged ; Saudi Arabia ; Single-Blind Method ; Time Factors ; Treatment Outcome

Background: Type 2 diabetes mellitus (T2DM) is usually associated with respiratory manifestations including inspiratory muscle weakness which affects exercise capacity. The present study aimed to determine the effect of inspiratory muscle training (IMT) on inspiratory muscle strength and exercise capacity in patients with Type 2 diabetes mellitus (T2DM).
Methods: This was a randomized controlled trial in patients with type 2 diabetes mellitus with no previous cardiopulmonary or neuromuscular diseases. Patients had no back pain. Patients were randomized into interventional or placebo groups. Sniff nasal inspiratory pressure (SNIP), maximum inspiratory pressure (MIP), and six-minute walking test (6MWT) were measured at baseline and 8 weeks post incremental inspiratory muscle training.
Results: At baseline, interventional and placebo groups were similar in age, body mass index, sex inspiratory muscle strength, and exercise capacity. After 8 weeks of incremental inspiratory muscle training at 40% of MIP, the interventional group had a significant increase in the SNIP (mean difference: 18.5 ± 5.30 cm H2O vs 2.8 ± 4.8 cm H2O) and MIP (mean difference: 19.4 ± 4.3 Vs 5.4 ± 3.6 cm H2O) compared to the placebo group, respectively. The interventional group showed improvement in the 6MWT (mean difference: 70 ± 29 m vs 34 ± 24 m) compared to the placebo group, P < .05.
Conclusion: Incremental inspiratory muscle training increased the diaphragm strength in patients with T2DM and improved exercise capacity.
(© 2020 Ruijin Hospital, Shanghai JiaoTong University School of Medicine and John Wiley & Sons Australia, Ltd.)

Walter RE, Beiser A, Givelber RJ, O'Connor GT, Gottlieb DJ. Association between glycemic state and lung function: the Framingham heart study. Am J Respir Crit Care Med. 2003;167:911-916.
Andersen H, Nielsen S, Mogensen CE, Jakobsen J. Muscle strength in type 2 diabetes. Diabetes. 2004;53:1543-1548.
Fuso L, Pitocco D, Longobardi A, et al. Reduced respiratory muscle strength and endurance in type 2 diabetes mellitus. Diabetes Metab Res Rev. 2012;28:370-375.
Leenders M, Verdijk LB, van der Hoeven L, et al. Patients with type 2 diabetes show a greater decline in muscle mass, muscle strength, and functional capacity with aging. J Am Med Dir Assoc. 2013;14:585-592.
Cetinus E, Buyukbese MA, Uzel M, Ekerbicer H, Karaoguz A. Hand grip strength in patients with type 2 diabetes mellitus. Diabetes Res Clin Pract. 2005;70:278-286.
Yeh HC, Punjabi NM, Wang NY, et al. Cross-sectional and prospective study of lung function in adults with type 2 diabetes: the atherosclerosis risk in communities (ARIC) study. Diabetes Care. 2008;31:741-746.
Lawlor DA, Ebrahim S, Smith GD. Associations of measures of lung function with insulin resistance and type 2 diabetes: findings from the British Women's heart and health study. Diabetologia. 2004;47:195-203.
van den Borst B, Gosker HR, Zeegers MP, Schols AMWJ. Pulmonary function in diabetes: a metaanalysis. Chest. 2010;138:393-406.
Correa AP, Ribeiro JP, Balzan FM, et al. Inspiratory muscle training in type 2 diabetes with inspiratory muscle weakness. Med Sci Sports Exerc. 2011;43:1135-1141.
Kaminski DM, Schaan BD, da Silva AM, et al. Inspiratory muscle weakness is associated with autonomic cardiovascular dysfunction in patients with type 2 diabetes mellitus. Clin Auton Res. 2011;21:29-35.
Silva Mdos S, Martins AC, Cipriano G Jr, et al. Inspiratory training increases insulin sensitivity in elderly patients. Geriatr Gerontol Int. 2012;12:345-351.
Chamberlain JJ, Rhinehart AS, Shaefer CF Jr, Neuman A. Diagnosis and management of diabetes: synopsis of the 2016 American Diabetes Association standards of medical Care in Diabetes. Ann Intern Med. 2016;164:542-552.
ATS Committee on Proficiency Standards for Clinical Pulmonary Function Laboratories. ATS statement: guidelines for the six-minute walk test. Am J Respir Crit Care Med. 2002;166:111-117.
American Thoracic Society/European Respiratory Society. ATS/ERS statement on respiratory muscle testing. Am J Respir Crit Care Med. 2002;166:518-624.
Podsiadlo D, Richardson S. The timed "up & go": a test of basic functional mobility for frail elderly persons. J Am Geriatr Soc. 1991;39:142-148.
Roberts HC, Denison HJ, Martin HJ, et al. A review of the measurement of grip strength in clinical and epidemiological studies: towards a standardised approach. Age Ageing. 2011;40:423-429.
Casanova C, Celli BR, Barria P, et al. The 6-min walk distance in healthy subjects: reference standards from seven countries. Eur Respir J. 2011;37:150-156.
Mello PR, Guerra GM, Borile S, et al. Inspiratory muscle training reduces sympathetic nervous activity and improves inspiratory muscle weakness and quality of life in patients with chronic heart failure: a clinical trial. J Cardiopulm Rehabil Prev. 2012;32:255-261.
Bhandari A, Xia Y, Cortright R, et al. Effect of respiratory muscle training on GLUT-4 in the sheep diaphragm. Med Sci Sports Exerc. 2000;32:1406-1411.
Moreno AM, Toledo-Arruda AC, Lima JS, Duarte CS, Villacorta H, Nóbrega ACL. Inspiratory muscle training improves intercostal and forearm muscle oxygenation in patients with chronic heart failure: evidence of the origin of the respiratory metaboreflex. J Card Fail. 2017;23:672-679.
Chiappa GR, Roseguini BT, Vieira PJ, et al. Inspiratory muscle training improves blood flow to resting and exercising limbs in patients with chronic heart failure. J Am Coll Cardiol. 2008;51:1663-1671.
Enright S, Chatham K, Ionescu AA, Unnithan VB, Shale DJ. Inspiratory muscle training improves lung function and exercise capacity in adults with cystic fibrosis. Chest. 2004;126:405-411.
Lotters F, van Tol B, Kwakkel G, Gosselink R. Effects of controlled inspiratory muscle training in patients with COPD: a meta-analysis. Eur Respir J. 2002;20:570-576.
De Santi F, Zoppini G, Locatelli F, et al. Type 2 diabetes is associated with an increased prevalence of respiratory symptoms as compared to the general population. BMC Pulm Med. 2017;17:101.
Miller J, Edwards LD, Agusti A, et al. Comorbidity, systemic inflammation and outcomes in the ECLIPSE cohort. Respir Med. 2013;107:1376-1384.
Pehlivan E, Mutluay F, Balci A, et al. The effects of inspiratory muscle training on exercise capacity, dyspnea and respiratory functions in lung transplantation candidates: a randomized controlled trial. Clin Rehabil. 2018;32:1328-1339.
Faisal A, Alghamdi BJ, Ciavaglia CE, et al. Common mechanisms of dyspnea in chronic interstitial and obstructive lung disorders. Am J Respir Crit Care Med. 2016;193:299-309.
Mendonca CT, Schaeffer MR, Riley P, Jensen D. Physiological mechanisms of dyspnea during exercise with external thoracic restriction: role of increased neural respiratory drive. J Appl Physiol. 2014;116:570-581.
Huang MH, Fry D, Doyle L, et al. Effects of inspiratory muscle training in advanced multiple sclerosis. Mult Scler Relat Disord. 2020;37:101492.
Riganas C, Papadopoulou Z, Margaritelis NV, Christoulas K, Vrabas IS. Inspiratory muscle training effects on oxygen saturation and performance in hypoxemic rowers: effect of sex. J Sports Sci. 2019;37:2513-2521.
Chen X, Hou L, Zhang Y, et al. The effects of five days of intensive preoperative inspiratory muscle training on postoperative complications and outcome in patients having cardiac surgery: a randomized controlled trial. Clin Rehabil. 2019;33:913-922.
Cargnin C, Karsten M, Guaragna J, et al. Inspiratory muscle training after heart valve replacement surgery improves inspiratory muscle strength, lung function, and functional capacity: a randomized controlled trial. J Cardiopulm Rehabil Prev. 2019;39:E1-E7.
Figueiredo PHS, Lima MMO, Costa HS, et al. Effects of the inspiratory muscle training and aerobic training on respiratory and functional parameters, inflammatory biomarkers, redox status and quality of life in hemodialysis patients: a randomized clinical trial. PLoS One. 2018;13:e0200727.

Keywords: 2型糖尿病; functional capacity; inspiratory muscle training; randomized clinical trial; respiratory muscle strength; type 2 diabetes mellitus; 功能能力; 吸气肌训练; 呼吸肌力; 随机临床试验
Local Abstract: [Publisher, Chinese] 背景: 2型糖尿病(T2 DM)通常与呼吸道症状有关, 包括影响运动能力的吸气肌无力。本研究旨在探讨吸气肌训练(IMT)对T2 DM患者吸气肌力和运动能力的影响。 方法:这是一项随机对照试验, 研究对象为既往无心肺或神经肌肉疾病的T2DM患者。患者也没有背部疼痛。患者被随机分为干预组或安慰剂组。分别在基线和递增吸气肌训练后8周测定鼻腔吸气压(SNIP)、最大吸气压(MIP)和6分钟步行试验(6MWT)。 结果: 基线时, 干预组和安慰剂组在年龄、体重指数、性别、吸气肌力和运动量方面相似。经过8周40%MIP递增吸气肌训练后, 与安慰剂组相比, 干预组的SNIP(平均差值:18.5±5.30 cmH 2 O vs 2.8±4.8 cmH 2 O)和MIP(平均差值:19.4±4.3 cmH 2 O vs 5.4±3.6 cmH 2 O)明显增加。与安慰剂组相比, 干预组6MWT有明显改善(平均差值:70±29m vs 34±24m, P<0.05)。 结论: 递增吸气肌训练增加了T2DM患者的膈肌力量, 提高了运动能力。.

Date Created: 20210120 Date Completed: 20211118 Latest Revision: 20211118

20221213

10.1111/1753-0407.13106

33471439