Respiratory muscle training increases respiratory muscle strength and reduces respiratory complications after stroke: a systematic review.
OBJECTIVE
After stroke, does respiratory muscle training increase respiratory muscle strength and/or endurance? Are any benefits carried over to activity and/or participation? Does it reduce respiratory complications?


METHODS
Systematic review of randomised or quasi-randomised trials.


METHODS
Adults with respiratory muscle weakness following stroke.


METHODS
Respiratory muscle training aimed at increasing inspiratory and/or expiratory muscle strength.


METHODS
Five outcomes were of interest: respiratory muscle strength, respiratory muscle endurance, activity, participation and respiratory complications.


RESULTS
Five trials involving 263 participants were included. The mean PEDro score was 6.4 (range 3 to 8), showing moderate methodological quality. Random-effects meta-analyses showed that respiratory muscle training increased maximal inspiratory pressure by 7 cmH2O (95% CI 1 to 14) and maximal expiratory pressure by 13 cmH2O (95% CI 1 to 25); it also decreased the risk of respiratory complications (RR 0.38, 95% CI 0.15 to 0.96) compared with no/sham respiratory intervention. Whether these effects carry over to activity and participation remains uncertain.


CONCLUSIONS
This systematic review provided evidence that respiratory muscle training is effective after stroke. Meta-analyses based on five trials indicated that 30minutes of respiratory muscle training, five times per week, for 5 weeks can be expected to increase respiratory muscle strength in very weak individuals after stroke. In addition, respiratory muscle training is expected to reduce the risk of respiratory complications after stroke. Further studies are warranted to investigate whether the benefits are carried over to activity and participation.


BACKGROUND
PROSPERO (CRD42015020683). [Menezes KKP, Nascimento LR, Ada L, Polese JC, Avelino PR, Teixeira-Salmela LF (2016) Respiratory muscle training increases respiratory muscle strength and reduces respiratory complications after stroke: a systematic review.Journal of Physiotherapy62: 138-144].
NeuroGroup, Discipline of Physiotherapy, Universidade Federal de Minas Gerais, Brazil.
Kênia Kp
KK
Menezes
NeuroGroup, Discipline of Physiotherapy, Universidade Federal de Minas Gerais, Brazil.
Lucas R
LR
Nascimento
Discipline of Physiotherapy, The University of Sydney, Sydney, Australia.
Louise
L
Ada
NeuroGroup, Discipline of Physiotherapy, Universidade Federal de Minas Gerais, Brazil.
Janaine C
JC
Polese
NeuroGroup, Discipline of Physiotherapy, Universidade Federal de Minas Gerais, Brazil.
Patrick R
PR
Avelino
NeuroGroup, Discipline of Physiotherapy, Universidade Federal de Minas Gerais, Brazil.
Luci F
LF
Teixeira-Salmela
D001945:Breathing Exercises; D006801:Humans; D053580:Muscle Strength / Q000502:physiology*; D010807:Physical Endurance / Q000502:physiology; D012129:Respiratory Function Tests; D012132:Respiratory Muscles / Q000503:physiopathology*; D020521:Stroke / Q000503:physiopathology*; D000071939:Stroke Rehabilitation / Q000379:methods*; D016896:Treatment Outcome
Physical therapy; Respiratory muscle training; Strength; Stroke; Systematic review