title: Inspiratory and expiratory muscle training in subacute stroke: A randomized clinical trial.
abstract: OBJECTIVE
  To assess the effectiveness, feasibility, and safety of short-term inspiratory and expiratory muscle training (IEMT) in subacute stroke patients.
  
  
  METHODS
  Within 2 weeks of stroke onset, 109 patients with a first ischemic stroke event were randomly assigned to the IEMT (n = 56) or sham IEMT (n = 53) study group. The IEMT consisted of 5 sets of 10 repetitions, twice a day, 5 days per week for 3 weeks, at a training workload equivalent to 30% of maximal respiratory pressures. Patients and researchers assessing outcome variables were blinded to the assigned study group. The main outcome was respiratory muscle strength assessed by maximal inspiratory and expiratory pressures (PImax, PEmax). Respiratory complications at 6 months were also recorded.
  
  
  RESULTS
  Both groups improved respiratory muscle strength during the study. IEMT was associated with significantly improved %PImax and %PEmax: effect size d = 0.74 (95% confidence interval [CI] 0.28-1.20) and d = 0.56 (95% CI 0.11-1.02), respectively. No significant training effect was observed for peripheral muscle strength. Respiratory complications at 6 months occurred more frequently in the sham group (8 vs 2, p = 0.042), with an absolute risk reduction of 14%. The number needed to treat to prevent one lung infection event over a follow-up of 6 months was 7. No major adverse events or side effects were observed.
  
  
  CONCLUSIONS
  IEMT induces significant improvement in inspiratory and expiratory muscle strength and could potentially offer an additional therapeutic tool aimed to reduce respiratory complications at 6 months in stroke patients.
  
  
  METHODS
  This study provides Class II evidence that short-term training may have the potential to improve respiratory muscle strength in patients with subacute stroke.
authors.affiliation: From the Rehabilitation Research Group (M.M.-S., A.G.-S., E.D., M.-C.B., F.E., E.M.) and the Muscle and Respiratory System Research Unit (URMAR) (D.A.R., E.B.), Institut Hospital del Mar d'Investigacions Mèdiques (IMIM); the Physical Medicine and Rehabilitation Department (M.M.-S., A.G.-S., M.D., E.D., M.-C.B., F.E., E.M.), Parc de Salut Mar (Hospital del Mar, Hospital de l'Esperança); the School of Medicine (A.G.-S., E.D., D.A.R., F.E., E.M.), Universitat Autònoma de Barcelona; the Respiratory Medicine Department (D.A.R., E.B., M.O.-L.), Hospital del Mar; the Department of Health Sciences (CEXS) (D.A.R., E.B., M.O.-L.), Universitat Pompeu i Fabra, Barcelona; and the Centro de Investigación en Red de Enfermedades Respiratorias (CIBERES) (D.A.R., E.B.), Instituto de Salud Carlos III (ISCIII), Madrid, Spain.
authors.forename: Monique
authors.initials: M
authors.lastname: Messaggi-Sartor
authors.affiliation: From the Rehabilitation Research Group (M.M.-S., A.G.-S., E.D., M.-C.B., F.E., E.M.) and the Muscle and Respiratory System Research Unit (URMAR) (D.A.R., E.B.), Institut Hospital del Mar d'Investigacions Mèdiques (IMIM); the Physical Medicine and Rehabilitation Department (M.M.-S., A.G.-S., M.D., E.D., M.-C.B., F.E., E.M.), Parc de Salut Mar (Hospital del Mar, Hospital de l'Esperança); the School of Medicine (A.G.-S., E.D., D.A.R., F.E., E.M.), Universitat Autònoma de Barcelona; the Respiratory Medicine Department (D.A.R., E.B., M.O.-L.), Hospital del Mar; the Department of Health Sciences (CEXS) (D.A.R., E.B., M.O.-L.), Universitat Pompeu i Fabra, Barcelona; and the Centro de Investigación en Red de Enfermedades Respiratorias (CIBERES) (D.A.R., E.B.), Instituto de Salud Carlos III (ISCIII), Madrid, Spain.
authors.forename: Anna
authors.initials: A
authors.lastname: Guillen-Solà
authors.affiliation: From the Rehabilitation Research Group (M.M.-S., A.G.-S., E.D., M.-C.B., F.E., E.M.) and the Muscle and Respiratory System Research Unit (URMAR) (D.A.R., E.B.), Institut Hospital del Mar d'Investigacions Mèdiques (IMIM); the Physical Medicine and Rehabilitation Department (M.M.-S., A.G.-S., M.D., E.D., M.-C.B., F.E., E.M.), Parc de Salut Mar (Hospital del Mar, Hospital de l'Esperança); the School of Medicine (A.G.-S., E.D., D.A.R., F.E., E.M.), Universitat Autònoma de Barcelona; the Respiratory Medicine Department (D.A.R., E.B., M.O.-L.), Hospital del Mar; the Department of Health Sciences (CEXS) (D.A.R., E.B., M.O.-L.), Universitat Pompeu i Fabra, Barcelona; and the Centro de Investigación en Red de Enfermedades Respiratorias (CIBERES) (D.A.R., E.B.), Instituto de Salud Carlos III (ISCIII), Madrid, Spain.
authors.forename: Marina
authors.initials: M
authors.lastname: Depolo
authors.affiliation: From the Rehabilitation Research Group (M.M.-S., A.G.-S., E.D., M.-C.B., F.E., E.M.) and the Muscle and Respiratory System Research Unit (URMAR) (D.A.R., E.B.), Institut Hospital del Mar d'Investigacions Mèdiques (IMIM); the Physical Medicine and Rehabilitation Department (M.M.-S., A.G.-S., M.D., E.D., M.-C.B., F.E., E.M.), Parc de Salut Mar (Hospital del Mar, Hospital de l'Esperança); the School of Medicine (A.G.-S., E.D., D.A.R., F.E., E.M.), Universitat Autònoma de Barcelona; the Respiratory Medicine Department (D.A.R., E.B., M.O.-L.), Hospital del Mar; the Department of Health Sciences (CEXS) (D.A.R., E.B., M.O.-L.), Universitat Pompeu i Fabra, Barcelona; and the Centro de Investigación en Red de Enfermedades Respiratorias (CIBERES) (D.A.R., E.B.), Instituto de Salud Carlos III (ISCIII), Madrid, Spain.
authors.forename: Esther
authors.initials: E
authors.lastname: Duarte
authors.affiliation: From the Rehabilitation Research Group (M.M.-S., A.G.-S., E.D., M.-C.B., F.E., E.M.) and the Muscle and Respiratory System Research Unit (URMAR) (D.A.R., E.B.), Institut Hospital del Mar d'Investigacions Mèdiques (IMIM); the Physical Medicine and Rehabilitation Department (M.M.-S., A.G.-S., M.D., E.D., M.-C.B., F.E., E.M.), Parc de Salut Mar (Hospital del Mar, Hospital de l'Esperança); the School of Medicine (A.G.-S., E.D., D.A.R., F.E., E.M.), Universitat Autònoma de Barcelona; the Respiratory Medicine Department (D.A.R., E.B., M.O.-L.), Hospital del Mar; the Department of Health Sciences (CEXS) (D.A.R., E.B., M.O.-L.), Universitat Pompeu i Fabra, Barcelona; and the Centro de Investigación en Red de Enfermedades Respiratorias (CIBERES) (D.A.R., E.B.), Instituto de Salud Carlos III (ISCIII), Madrid, Spain.
authors.forename: Diego A
authors.initials: DA
authors.lastname: Rodríguez
authors.affiliation: From the Rehabilitation Research Group (M.M.-S., A.G.-S., E.D., M.-C.B., F.E., E.M.) and the Muscle and Respiratory System Research Unit (URMAR) (D.A.R., E.B.), Institut Hospital del Mar d'Investigacions Mèdiques (IMIM); the Physical Medicine and Rehabilitation Department (M.M.-S., A.G.-S., M.D., E.D., M.-C.B., F.E., E.M.), Parc de Salut Mar (Hospital del Mar, Hospital de l'Esperança); the School of Medicine (A.G.-S., E.D., D.A.R., F.E., E.M.), Universitat Autònoma de Barcelona; the Respiratory Medicine Department (D.A.R., E.B., M.O.-L.), Hospital del Mar; the Department of Health Sciences (CEXS) (D.A.R., E.B., M.O.-L.), Universitat Pompeu i Fabra, Barcelona; and the Centro de Investigación en Red de Enfermedades Respiratorias (CIBERES) (D.A.R., E.B.), Instituto de Salud Carlos III (ISCIII), Madrid, Spain.
authors.forename: Maria-Camelia
authors.initials: MC
authors.lastname: Barrera
authors.affiliation: From the Rehabilitation Research Group (M.M.-S., A.G.-S., E.D., M.-C.B., F.E., E.M.) and the Muscle and Respiratory System Research Unit (URMAR) (D.A.R., E.B.), Institut Hospital del Mar d'Investigacions Mèdiques (IMIM); the Physical Medicine and Rehabilitation Department (M.M.-S., A.G.-S., M.D., E.D., M.-C.B., F.E., E.M.), Parc de Salut Mar (Hospital del Mar, Hospital de l'Esperança); the School of Medicine (A.G.-S., E.D., D.A.R., F.E., E.M.), Universitat Autònoma de Barcelona; the Respiratory Medicine Department (D.A.R., E.B., M.O.-L.), Hospital del Mar; the Department of Health Sciences (CEXS) (D.A.R., E.B., M.O.-L.), Universitat Pompeu i Fabra, Barcelona; and the Centro de Investigación en Red de Enfermedades Respiratorias (CIBERES) (D.A.R., E.B.), Instituto de Salud Carlos III (ISCIII), Madrid, Spain.
authors.forename: Esther
authors.initials: E
authors.lastname: Barreiro
authors.affiliation: From the Rehabilitation Research Group (M.M.-S., A.G.-S., E.D., M.-C.B., F.E., E.M.) and the Muscle and Respiratory System Research Unit (URMAR) (D.A.R., E.B.), Institut Hospital del Mar d'Investigacions Mèdiques (IMIM); the Physical Medicine and Rehabilitation Department (M.M.-S., A.G.-S., M.D., E.D., M.-C.B., F.E., E.M.), Parc de Salut Mar (Hospital del Mar, Hospital de l'Esperança); the School of Medicine (A.G.-S., E.D., D.A.R., F.E., E.M.), Universitat Autònoma de Barcelona; the Respiratory Medicine Department (D.A.R., E.B., M.O.-L.), Hospital del Mar; the Department of Health Sciences (CEXS) (D.A.R., E.B., M.O.-L.), Universitat Pompeu i Fabra, Barcelona; and the Centro de Investigación en Red de Enfermedades Respiratorias (CIBERES) (D.A.R., E.B.), Instituto de Salud Carlos III (ISCIII), Madrid, Spain.
authors.forename: Ferran
authors.initials: F
authors.lastname: Escalada
authors.affiliation: From the Rehabilitation Research Group (M.M.-S., A.G.-S., E.D., M.-C.B., F.E., E.M.) and the Muscle and Respiratory System Research Unit (URMAR) (D.A.R., E.B.), Institut Hospital del Mar d'Investigacions Mèdiques (IMIM); the Physical Medicine and Rehabilitation Department (M.M.-S., A.G.-S., M.D., E.D., M.-C.B., F.E., E.M.), Parc de Salut Mar (Hospital del Mar, Hospital de l'Esperança); the School of Medicine (A.G.-S., E.D., D.A.R., F.E., E.M.), Universitat Autònoma de Barcelona; the Respiratory Medicine Department (D.A.R., E.B., M.O.-L.), Hospital del Mar; the Department of Health Sciences (CEXS) (D.A.R., E.B., M.O.-L.), Universitat Pompeu i Fabra, Barcelona; and the Centro de Investigación en Red de Enfermedades Respiratorias (CIBERES) (D.A.R., E.B.), Instituto de Salud Carlos III (ISCIII), Madrid, Spain.
authors.forename: Mauricio
authors.initials: M
authors.lastname: Orozco-Levi
authors.affiliation: From the Rehabilitation Research Group (M.M.-S., A.G.-S., E.D., M.-C.B., F.E., E.M.) and the Muscle and Respiratory System Research Unit (URMAR) (D.A.R., E.B.), Institut Hospital del Mar d'Investigacions Mèdiques (IMIM); the Physical Medicine and Rehabilitation Department (M.M.-S., A.G.-S., M.D., E.D., M.-C.B., F.E., E.M.), Parc de Salut Mar (Hospital del Mar, Hospital de l'Esperança); the School of Medicine (A.G.-S., E.D., D.A.R., F.E., E.M.), Universitat Autònoma de Barcelona; the Respiratory Medicine Department (D.A.R., E.B., M.O.-L.), Hospital del Mar; the Department of Health Sciences (CEXS) (D.A.R., E.B., M.O.-L.), Universitat Pompeu i Fabra, Barcelona; and the Centro de Investigación en Red de Enfermedades Respiratorias (CIBERES) (D.A.R., E.B.), Instituto de Salud Carlos III (ISCIII), Madrid, Spain. emarco@parcdesalutmar.cat.
authors.forename: Ester
authors.initials: E
authors.lastname: Marco
mesh_terms: D000368:Aged; D002545:Brain Ischemia / Q000150:complications; D004311:Double-Blind Method; D005081:Exercise Therapy / Q000009:adverse effects / Q000379:methods*; D045853:Exhalation / Q000502:physiology; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D001239:Inhalation / Q000502:physiology; D008297:Male; D008875:Middle Aged; D053580:Muscle Strength / Q000502:physiology*; D012132:Respiratory Muscles / Q000502:physiology*; D020521:Stroke / Q000209:etiology; D000071939:Stroke Rehabilitation; D016896:Treatment Outcome