title: Respiratory muscle training with normocapnic hyperpnea improves ventilatory pattern and thoracoabdominal coordination, and reduces oxygen desaturation during endurance exercise testing in COPD patients.
abstract: BACKGROUND
  Few data are available about the effects of respiratory muscle training with normocapnic hyperpnea (NH) in COPD. The aim is to evaluate the effects of 4 weeks of NH (Spirotiger(®)) on ventilatory pattern, exercise capacity, and quality of life (QoL) in COPD patients.
  
  
  METHODS
  Twenty-six COPD patients (three females), ages 49-82 years, were included in this study. Spirometry and maximal inspiratory pressure, St George Respiratory Questionnaire, 6-minute walk test, and symptom-limited endurance exercise test (endurance test to the limit of tolerance [tLim]) at 75%-80% of peak work rate up to a Borg Score of 8-9/10 were performed before and after NH. Patients were equipped with ambulatory inductive plethysmography (LifeShirt(®)) to evaluate ventilatory pattern and thoracoabdominal coordination (phase angle [PhA]) during tLim. After four supervised sessions, subjects trained at home for 4 weeks - 10 minutes twice a day at 50% of maximal voluntary ventilation. The workload was adjusted during the training period to maintain a Borg Score of 5-6/10.
  
  
  RESULTS
  Twenty subjects completed the study. After NH, maximal inspiratory pressure significantly increased (81.5±31.6 vs 91.8±30.6 cmH2O, P<0.01); exercise endurance time (+150 seconds, P=0.04), 6-minute walk test (+30 meters, P=0.03), and QoL (-8, P<0.01) all increased. During tLim, the ventilatory pattern changed significantly (lower ventilation, lower respiratory rate, higher tidal volume); oxygen desaturation, PhA, and dyspnea Borg Score were lower for the same work intensity (P<0.01, P=0.02, and P<0.01, respectively; one-way ANOVA). The improvement in tidal volume and oxygen saturation after NH were significantly related (R (2)=0.65, P<0.01).
  
  
  CONCLUSIONS
  As expected, NH improves inspiratory muscle performance, exercise capacity, and QoL. New results are significant change in ventilatory pattern, which improves oxygen saturation, and an improvement in thoracoabdominal coordination (lower PhA). These two facts could explain the reduced dyspnea during the endurance test. All these results together may play a role in improving exercise capacity after NH training.
authors.affiliation: Biomedical Sport Studies Center, University of Ferrara, Ferrara, Cona (FE), Italy.
authors.forename: Eva
authors.initials: E
authors.lastname: Bernardi
authors.affiliation: Biomedical Sport Studies Center, University of Ferrara, Ferrara, Cona (FE), Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Pomidori
authors.affiliation: Biomedical Sport Studies Center, University of Ferrara, Ferrara, Cona (FE), Italy.
authors.forename: Faisy
authors.initials: F
authors.lastname: Bassal
authors.affiliation: Respiratory Section, Department of Medical Sciences, University of Ferrara, Cona (FE), Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Contoli
authors.affiliation: Biomedical Sport Studies Center, University of Ferrara, Ferrara, Cona (FE), Italy.
authors.forename: Annalisa
authors.initials: A
authors.lastname: Cogo
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001945:Breathing Exercises / Q000379:methods*; D004417:Dyspnea / Q000534:rehabilitation*; D005080:Exercise Test / Q000379:methods*; D005081:Exercise Therapy / Q000379:methods*; D017079:Exercise Tolerance; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010100:Oxygen / Q000097:blood; D029424:Pulmonary Disease, Chronic Obstructive / Q000534:rehabilitation*; D011788:Quality of Life; D013147:Spirometry
chemical_list: D010100:Oxygen
keywords: COPD; exercise; inspiratory muscle; pulmonary rehabilitation