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  • 強直性脊椎炎患者における吸気筋トレーニングは有酸素能力と肺機能を改善する:無作為化対照試験

    Drăgoi RG, Amaricai E, Drăgoi M, Popoviciu H and Avram C
    OBJECTIVE: To evaluate the impact of inspiratory muscle training on aerobic capacity and pulmonary function in patients with ankylosing spondylitis.
    DESIGN: Randomized controlled study.
    SETTING: Rheumatic Rehabilitation Centre.
    SUBJECTS: A total of 54 ankylosing spondylitis patients, all males, were randomized to a conventional exercise training associated with an inspiratory muscle training group, or to a conventional exercise training group.
    INTERVENTIONS: Group 1 (27 patients) performed eight weeks of conventional exercise training (supervised weekly group sessions followed by a home-based exercise programme) associated with inspiratory muscle training sessions. Group 2 (27 patients) received eight weeks of conventional exercise training only.
    MAIN MEASURES: Resting pulmonary function (forced vital capacity - FVC, forced expiratory volume in one second - FEV1); effort ventilatory efficiency (lowest ventilatory equivalent ratio for oxygen and carbon dioxide - VE/VO2 and VE/VCO2) and aerobic capacity (peak oxygen uptake - VO2peak) were assessed at baseline and after eight weeks of exercise-based intervention.
    RESULTS: After eight weeks follow-up, patients in Group 1 had a significant increased chest expansion and VO2peak compared with Group 2 (3.6 ±0.8 cm vs. 3.2 ±0.5 cm, P = 0.032; 2.0 ±0.5 l/min vs. 1.8 ±0.3 l/min, P = 0.033). There were no significant differences of spirometric measurements, except FVC which significantly improved in patients who performed inspiratory muscle training (82.7 ±5.1% vs. 79.5 ±3.5%, P = 0.014). VE/VCO2 also improved significantly in Group 1 (26.6 ±3.6 vs. 29.2 ±4.7, P = 0.040).
    CONCLUSIONS: Ankylosing spondylitis patients who performed eight weeks of inspiratory muscle training associated to conventional exercise training had an increased chest expansion, a better aerobic capacity, resting pulmonary function and ventilatory efficiency than those who performed conventional exercise training only.
    © The Author(s) 2015.
    KEYWORDS: Ankylosing spondylitis; exercise training; pulmonary function; respiratory muscle training
    PMID: 25810425 DOI: 10.1177/0269215515578292
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  • 呼吸筋トレーニングは脳卒中後の呼吸筋力を増加させ呼吸器合併症を減少させる:系統的レビュー

    Menezes KK, Nascimento LR, Ada L, Polese JC, Avelino PR and Teixeira-Salmela LF
    QUESTION: 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?
    DESIGN: Systematic review of randomised or quasi-randomised trials.
    PARTICIPANTS: Adults with respiratory muscle weakness following stroke.
    INTERVENTION: Respiratory muscle training aimed at increasing inspiratory and/or expiratory muscle strength.
    OUTCOME MEASURES: 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.
    CONCLUSION: 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.
    REGISTRATION: 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].
    Copyright © 2016 Australian Physiotherapy Association. Published by Elsevier B.V. All rights reserved.
    KEYWORDS: Physical therapy; Respiratory muscle training; Strength; Stroke; Systematic review
    PMID: 27320833 DOI: 10.1016/j.jphys.2016.05.014
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  • 脳卒中後の患者における呼吸機能、呼吸筋力、および運動耐性に対する呼吸筋トレーニングの効果:メタアナリシスによる系統的レビュー

    Gomes-Neto M, Saquetto MB, Silva CM, Carvalho VO, Ribeiro N and Conceição CS.
    OBJECTIVE: To examine the effects of respiratory muscle training on respiratory function, respiratory muscle strength, and exercise tolerance in patients poststroke.
    DATA SOURCES: We searched MEDLINE, Cochrane Library, Embase, SciELO, Physiotherapy Evidence Database (PEDro), and CINAHL (from the earliest date available to November 2015) for trials.
    STUDY SELECTION: Randomized controlled trials (RCTs) that examined the effects of respiratory muscle training versus nonrespiratory muscle training in patients poststroke. Two reviewers selected studies independently.
    DATA EXTRACTION: Extracted data from the published RCTs. Study quality was evaluated using the PEDro Scale. Weighted mean differences (WMDs), standard mean differences (SMDs), and 95% confidence intervals (CIs) were calculated.
    DATA SYNTHESIS: Eight studies met the study criteria. Respiratory muscle training improved maximal inspiratory pressure WMDs (7.5; 95% CI, 2.7-12.4), forced vital capacity SMDs (2.0; 95% CI, 0.6-3.4), forced expiratory volume at 1 second SMDs (1.2; 95% CI, 0.6-1.9), and exercise tolerance SMDs (0.7; 95% CI, 0.2-1.2). No serious adverse events were reported.
    CONCLUSIONS: Respiratory muscle training should be considered an effective method of improving respiratory function, inspiratory muscle strength, and exercise tolerance in patients poststroke. Further research is needed to determine optimum dosages and duration of effect.
    KEYWORDS: Exercise; Rehabilitation; Stroke
    PMID: 27216224 DOI: 10.1016/j.apmr.2016.04.018
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  • 遅発性ポンペ病(LOPD)における呼吸筋トレーニング(RMT):トレーニングと脱トレーニングの効果

    Jones HN, Crisp KD, Robey RR, Case LE, Kravitz RM and Kishnani PS
    BACKGROUND: Determine the effects of a 12-week respiratory muscle training (RMT) program in late-onset Pompe disease (LOPD).
    METHODS: We investigated the effects of 12-weeks of RMT followed by 3-months detraining using a single-subject A-B-A experimental design replicated across 8 adults with LOPD. To assess maximal volitional respiratory strength, our primary outcomes were maximum inspiratory pressure (MIP) and maximum expiratory pressure (MEP). Effect sizes for changes in MIP and MEP were determined using Cohen's d statistic. Exploratory outcomes targeted motor function, and peak cough flow (PCF) was measured in the last 5 subjects.
    RESULTS: From pretest to posttest, all 8 subjects exhibited increases in MIP, and 7 of 8 showed increases in MEP. Effect size data reveal the magnitude of increases in MIP to be large in 4 (d≥1.0) and very large in 4 (d≥2.0), and effect sizes for increases in MEP were large in 1 (d≥1.0) and very large in 6 (d≥2.0). Across participants, pretest to posttest MIP and MEP increased by a mean of 19.6% (sd=9.9) and 16.1% (sd=17.3), respectively. Respiratory strength increases, particularly for the inspiratory muscles, were generally durable to 3-months detraining.
    CONCLUSIONS: These data suggest our 12-week RMT program results in large to very large increases in inspiratory and expiratory muscle strength in adults with LOPD. Additionally, increases in respiratory strength appeared to be relatively durable following 3-months detraining. Although additional research is needed, RMT appears to offer promise as an adjunctive treatment for respiratory weakness in LOPD.
    KEYWORDS: Breathing exercises; Exercise; Glycogen storage disease type II; Rehabilitation; Skeletal muscle
    PMID: 26381077 DOI: 10.1016/j.ymgme.2015.09.003
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