Treino de músculos inspiratórios em doentes com DPOC

 

Inspiratory muscle training in COPD patients

 

Susana Garcia¹

Margarida Rocha²

Paula Pinto³

António M. F. Lopes⁴

Cristina Bárbara⁵

 

Resumo

Objectivo: Pretendemos investigar os efeitos de um protocolo específico de treino dos músculos inspiratórios (TMI) no comportamento da dispneia, da função pulmonar, da força dos músculos respiratórios, da tolerância ao exercício e da qualidade de vida, num grupo de doentes com doença pulmonar obstrutiva crónica (DPOC).

Amostra: Constituída por treze doentes com DPOC moderada a muito grave distribuídos por um grupo de controlo (n=5) com um valor médio de FEV1 de 43,9 ± 10,1% do valor teórico e um grupo experimental (n=8) com um valor médio de FEV1 de 57,8 ± ± 12,1 % do valor teórico. O grupo experimental foi sujeito a TMI por cinco semanas consecutivas e o grupo de controlo não efectuou qualquer tipo de treino, sendo apenas aconselhado a continuar com as actividades diárias até então praticadas.

Resultados: A aplicação do protocolo específico de TMI melhorou significativamente a pressão máxima inspiratória (PImax) no grupo experimental (Pimax inicial - 83,3± 21,4 versus Pimax final- 98,4±17,8 cmH2O; p<0,01). O mesmo aconteceu com o score de sintomas do St. George Respiratory Questionnaire (SGRQ) no grupo experimental (score inicial 58±2,2 versus score final 50±2,1; p<0,05), não se tendo verificado qualquer alteração nas variáveis avaliadas no grupo de controlo.

Conclusões: A aplicação do treino de músculos inspiratórios em doentes com DPOC moderada a muito grave induziu melhoria da força dos músculos inspiratórios com repercussão na melhoria da qualidade de vida no que diz respeito aos sintomas.

Palavras-chave: DPOC, TMI.

 

Abstract

Aim: The aim of this study was to evaluate the impact a specific inspiratory muscle training (IMT) protocol had on dyspnoea, lung function, respiratory muscle pressure, tolerance to exercise and quality of life in a group of patients with ch ronic obstructive pulmonary disease (COPD).

Population: We studied 13 patients with moderate to very severe COPD divided into a control group (n=5) with an average FEV1 43.9 ± 10.1% of predicted value and an IMT group (n=8) with FEV1 57.8 ± 12.1 % of predicted value. While this study group underwent IMT for five consecutive weeks, the control group did not undergo any kind of training.

Results: Using a specific IMT protocol significantly improved maximal inspiratory pressure (MIP) in the study group (initial MIP – 83.3± 21.4 versus final MIP- 98.4±17.8 cmH2O; p<0.01). The same result was seen with the St. George Respiratory Questionnaire (SGRQ) score in the study group (initial score 58±2.2 versus final score 50±2.1; p<0.05). No changes were recorded in the variables studied in the control group.

Conclusions: The use of IMT in patients with moderate to very severe COPD induced an improvement in inspiratory muscle force with a consequent improvement in the quality of life in relation to symptoms.

Key-words: COPD, IMT.

 

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Full text only available in PDF format.

 

Bibliografia / Bibliography

1. Gosselink R, Decramer M. Inspiratory muscle training: where are we? Eur Respir J 1994;7,2103 -5.        [ Links ]

2. Leith DE, Bradley M. Ventilatory muscle strength and endurance training. J Appl Physiol 1976;41 (4):508 -16.

3. Kim MJ, Larson JM, Covey MK, Vitalo CA, Alex CG, Patel M. Inspiratory muscle training in patients with chronic obstructive pulmonary disease. Nursing Research 1993;42(6):356 -62.

4. Larson JM, Kim MJ, Sharp JT, Larson DA. Inspiratory muscle training with a pressure threshold breathing device in patients with chronic obstructive pulmonary disease. Am Rev Respir Dis 1988;138:689 -95.

5. Lisboa C, Villafranca C, Leiva A, Cruz E, Pertuzé J, Borzone G. Inspiratory muscle training in chronic airflow limitation: effect on exercise performance. Eur Respir J 1997;10:537 -42.

6. Ferreira JMR, Cardoso AP, Rodrigues F, Sá R. Provas de função pulmonar: Controlo de qualidade (2.ª parte). Rev Port Pneumol 2002;8(1),33 -63.

7. Belman MJ, Sieck GC. Clinical significance of pulmonary function tests: the ventilatory muscles – fatigue, endurance and training. Chest 1982;6:761 -66.

8. Karvonen J, Saarelainen S, Nieminem MM. Measurement of respiratory muscle forces based on maximal inspiratory and expiratory pressures. Respiration 1994; 61:28 -31.

9. Morgan DL, Singh SJ. Cardiopulmonary function testing. In Pryor JA, Webber BA (Eds.), Physiotherapy for respiratory and cardiac problems (pp. 51 -72). Edinburgh: Churchill Livingstone. (1996).

10. Rochester DF. Tests of respiratory muscle function. Clin Chest Med 1988;9(2),249 -61.

11. Bárbara C. Músculos respiratórios: Da normalidade à doença pulmonar obstrutiva crónica. Provas de aptidão pedagógica e capacidade científica – trabalho de síntese. Lisboa. (1997).

12. Singh SJ, Morgan MDL, Scott S, Walters D, Hardman AF. Development of a shuttle walking test of disability in patients with chronic airways obstruction. Thorax 1992;47,1019 -24.

13. Lisboa C, Munoz V, Leiva A, Cruz E. (1994). Inspiratory muscle training in chronic airflow limitation: comparison of two different training loads with a threshold device. Eur Respir J 1994;81,757 -63.

14. Rutchik A, Weissman AR, Almenoff PL, Spungen AM, Bauman WA, Grimm DR. (1998). Resistive inspiratory muscle training in subjects with chronic cervical spinal cord injury. Arch Physical Med Rehab 1998;79,293 -7.

15. Harver A, Mahler DA, Daubenspeck JA. Target inspiratory muscle training improves respiratory muscle function and reduces dyspnoea in patients with chronic obstructive pulmonary disease. Ann Int Med 1989; 111:117 -24.

16. Jones PW, Quirck FH, Baveystock CM, Johns PL. A self -complete measure for chronic airflow limitation – The St. George’s Respiratory Questionnaire. Am Rev Respir Dis 1992;145,1321 -7.

17. Mahler DA. Ventilatory muscle training. In Hodgkin JE, Celli BR, Connors GL (Eds.), Pulmonary rehabilitation guidelines to success (pp. 165 -172). Philadelphia: Lippincott Williams & Wilkins. (2000).

18. Ramírez -Sarmiento A, Orozco -Levi M, Guell R, Barreiro E, Hernandez N, Mota S, Sangenis M, Broquetas JM, Casan P, Gea J. Inspiratory muscle training in patients with chronic obstructive pulmonary disease: structural adaptation and physiologic outcomes. Am J Respir Crit Care Med 2002;166,1491 -7.

19. GOLD (Global Initiative for Chronic Obstructive Lung Disease) – www.goldcopd.com/ – última visita a 20.01.2007.

20. Cahalin LP, Semigran MJ, Dec GW. Inspiratory muscle training in patients with chronic heart failure awaiting cardiac transplantation: results of a pilot clinical trial. Physical Therapy 1997;77:830 -8.

21. Belman MJ, Botnick WC, Nathan SD, Chon KI. Ventilatory load characteristics during ventilatory muscle training. Am J Respir Crit Care Med 1994;149: 925 -9.

22. Smith K, Cook D, Guyatt GH, Madhavan J, Oxman A. Respiratory muscle training in chronic airflow limitation: a meta -analysis. Am Rev Respir Dis 1992;145:533 -9.

23. 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(3):570 -7.

24. Fitting JW. Respiratory muscle fatigue limiting physical exercise? Eur Respir J 1990;4:103 -8.

25. Perez T. Intérêt du threshold. Journées Internationales en Kinésithérapie Respiratoire Instrumentale. Lille: Hôpital Calmette. (2000).

 

¹ Fisioterapeuta da Unidade de Readaptação Funcional Respiratória do Hospital de Pulido Valente (HPV) / Physiotherapist, Respiratory Rehabilitation Unit, Hospital de Pulido Valente (HPV).

² Técnica de cardiopneumologia da Unidade de Fisiopatologia Respiratória do HPV / Cardiopulmonology technician, Respiratory Physiopathology Unit, HPV.

³ Mestre em Patologia Respiratória. Assistente Hospitalar do HPV. Assistente Convidada da Faculdade de Ciências Médicas de Lisboa (FCML). Investigadora do Centro de Estudos de Patologia Respiratória da FCML / MA in Respiratory Pathology. Consultant, HPV. Guest Consultant, Lisbon School of Medical Sciences (FCML). Researcher, FCML Centre for Respiratory Pathology Studies.

⁴ Mestre em Fisioterapia. Professor Auxiliar Convidado da Escola Superior de Saúde do Alcoitão / MA in Physiotherapy. Guest Assistant Professor, Alcoitão Escola Superior de Saúde.

⁵ Coordenadora da Unidade de Fisiopatologia Respiratória do HPV. Assistente Hospitalar Graduada do HPV. Professora Auxiliar Convidada da FCML. Investigadora do Centro de Estudos de Patologia Respiratória da FCML / Head, Respiratory Physiopathology Unit, HPV. Specialist Consultant, HPV. Guest Assistant Professor, FCML. Researcher, FCML Centre for Respiratory Pathology Studies.

 

Recebido para publicação/Received for publication: 07.01.25

Aceite para publicação/accepted for publication: 07.11.14