Respiratory muscle training and resting in COPD
- Bartolome R Celli, MD
Bartolome R Celli, MD
- Professor of Medicine
- Harvard University School of Medicine
The respiratory muscles constitute a vital component of the respiratory pump. Their contraction during part of the breathing cycle changes the anatomic configuration of the thorax and displaces its components, so that air moves into and out of the gas exchanging portion of the lungs [1-3]. The importance of the respiratory musculature in chronic obstructive pulmonary disease (COPD) is underscored by diaphragmatic structural changes which render patients more resistant to fatigue, including an increased quantity of slow twitch fibers and slow isomers of myosin light chains, tropomyosin, and troponins [4,5].
The effect of training and resting the respiratory muscles in patients with COPD will be presented here. An overview of the management of stable COPD is discussed separately. (See "Management of stable chronic obstructive pulmonary disease".)
STRENGTH AND ENDURANCE TRAINING
A number of studies have demonstrated that respiratory muscle strength and endurance can be increased with specific training, similar to skeletal muscle training [6-9]. A sufficient stimulus, such as greater than 30 percent of maximal force, is needed for training to occur.
Since reduced inspiratory muscle strength is evident in patients with chronic obstructive pulmonary disease (COPD), considerable efforts have been made to define the role of respiratory muscle training in this setting. Theoretically, an increase in inspiratory muscle strength (and perhaps endurance) could result in improved respiratory muscle function. However, this may only be relevant when patients must handle inspiratory loads that are greater than baseline, such as during an acute exacerbation.
Inspiratory muscle training improved the six minute walk distance and reduced dyspnea in a study that compared expiratory, inspiratory, and combined training . In a systematic review and meta-analysis (32 trials), inspiratory muscle training improved inspiratory muscle strength, endurance time, 6 or 12 minute walk distance, and also reduced dyspnea . On the other hand, a systematic review indicates that expiratory muscle training will improve expiratory muscle forces, but not the six minute walk distance or dyspnea in patients with COPD . More data are needed to clarify the possible role of expiratory muscle training on clinical outcomes.
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- STRENGTH AND ENDURANCE TRAINING
- Strength training
- Endurance training
- - Flow resistive loading
- - Threshold loading
- - Voluntary isocapnic hyperpnea
- Novel training methods
- Potential deleterious effects
- RESPIRATORY MUSCLE RESTING
- Acute on chronic respiratory failure
- Chronic stable COPD
- SOCIETY GUIDELINE LINKS