Current insights of inspiratory muscle training on the cardiovascular system: A systematic review with meta-analysis

Graziella F.B. Cipriano, Gerson Cipriano, Francisco V. Santos, Adriana M.Güntzel Chiappa, Luigi Pires, Lawrence P Cahalin, Gaspar R. Chiappa

Research output: Contribution to journalReview article

Abstract

Background: Cardiorespiratory limitation is a common hallmark of cardiovascular disease which is a key component of pharmacological and exercise treatments. More recently, inspiratory muscle training (IMT) is becoming an effective complementary treatment with positive effects on muscle strength and exercise capacity. We assessed the effectiveness of IMT on the cardiovascular system through autonomic function modulation via heart rate variability and arterial blood pressure. Methods: Randomized controlled trials (RCTs) were identified from searches of The Cochrane Library, MEDLINE and EMBASE to November 2018. Citations, conference proceedings and previous reviews were included without population restriction, comparing IMT intervention to no treatment, placebo or active control. Results: We identified 10 RCTs involving 267 subjects (mean age range 51–71 years). IMT programs targeted maximum inspiratory pressure (MIP) and cardiovascular outcomes, using low (n=6) and moderate to high intensity (n=4) protocols, but the protocols varied considerably (duration: 1–12 weeks, frequency: 3–14 times/week, time: 10–30 mins). An overall increase of the MIP (cmH2O) was observed (−27.57 95% CI −18.48, −37.45, I2=64%), according to weighted mean difference (95%CI), and was accompanied by a reduction of the low to high frequency ratio (−0.72 95% CI−1.40, −0.05, I2=50%). In a subgroup analysis, low-and moderate-intensity IMT treatment was associated with a reduction of the heart rate (HR) (−7.59 95% CI −13.96, −1.22 bpm, I2=0%) and diastolic blood pressure (DBP) (−8.29 [−11.64, −4.94 mmHg], I2=0%), respectively. Conclusion: IMT is an effective treatment for inspiratory muscle weakness in several populations and could be considered as a complementary treatment to improve the cardiovascular system, mainly HR and DBP. Further research is required to better understand the above findings.

Original languageEnglish (US)
Pages (from-to)1-11
Number of pages11
JournalIntegrated Blood Pressure Control
Volume12
DOIs
StatePublished - Jan 1 2019

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Cardiovascular System
Meta-Analysis
Muscles
Blood Pressure
Heart Rate
Therapeutics
Randomized Controlled Trials
Muscle Weakness
Muscle Strength
MEDLINE
Population
Libraries
Arterial Pressure
Cardiovascular Diseases
Placebos
Pharmacology
Education
Research

Keywords

  • Breathing exercises
  • Cardiovascular system
  • Respiratory muscle training

ASJC Scopus subject areas

  • Internal Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Current insights of inspiratory muscle training on the cardiovascular system : A systematic review with meta-analysis. / Cipriano, Graziella F.B.; Cipriano, Gerson; Santos, Francisco V.; Chiappa, Adriana M.Güntzel; Pires, Luigi; Cahalin, Lawrence P; Chiappa, Gaspar R.

In: Integrated Blood Pressure Control, Vol. 12, 01.01.2019, p. 1-11.

Research output: Contribution to journalReview article

Cipriano, Graziella F.B. ; Cipriano, Gerson ; Santos, Francisco V. ; Chiappa, Adriana M.Güntzel ; Pires, Luigi ; Cahalin, Lawrence P ; Chiappa, Gaspar R. / Current insights of inspiratory muscle training on the cardiovascular system : A systematic review with meta-analysis. In: Integrated Blood Pressure Control. 2019 ; Vol. 12. pp. 1-11.
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abstract = "Background: Cardiorespiratory limitation is a common hallmark of cardiovascular disease which is a key component of pharmacological and exercise treatments. More recently, inspiratory muscle training (IMT) is becoming an effective complementary treatment with positive effects on muscle strength and exercise capacity. We assessed the effectiveness of IMT on the cardiovascular system through autonomic function modulation via heart rate variability and arterial blood pressure. Methods: Randomized controlled trials (RCTs) were identified from searches of The Cochrane Library, MEDLINE and EMBASE to November 2018. Citations, conference proceedings and previous reviews were included without population restriction, comparing IMT intervention to no treatment, placebo or active control. Results: We identified 10 RCTs involving 267 subjects (mean age range 51–71 years). IMT programs targeted maximum inspiratory pressure (MIP) and cardiovascular outcomes, using low (n=6) and moderate to high intensity (n=4) protocols, but the protocols varied considerably (duration: 1–12 weeks, frequency: 3–14 times/week, time: 10–30 mins). An overall increase of the MIP (cmH2O) was observed (−27.57 95{\%} CI −18.48, −37.45, I2=64{\%}), according to weighted mean difference (95{\%}CI), and was accompanied by a reduction of the low to high frequency ratio (−0.72 95{\%} CI−1.40, −0.05, I2=50{\%}). In a subgroup analysis, low-and moderate-intensity IMT treatment was associated with a reduction of the heart rate (HR) (−7.59 95{\%} CI −13.96, −1.22 bpm, I2=0{\%}) and diastolic blood pressure (DBP) (−8.29 [−11.64, −4.94 mmHg], I2=0{\%}), respectively. Conclusion: IMT is an effective treatment for inspiratory muscle weakness in several populations and could be considered as a complementary treatment to improve the cardiovascular system, mainly HR and DBP. Further research is required to better understand the above findings.",
keywords = "Breathing exercises, Cardiovascular system, Respiratory muscle training",
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AU - Cipriano, Graziella F.B.

AU - Cipriano, Gerson

AU - Santos, Francisco V.

AU - Chiappa, Adriana M.Güntzel

AU - Pires, Luigi

AU - Cahalin, Lawrence P

AU - Chiappa, Gaspar R.

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N2 - Background: Cardiorespiratory limitation is a common hallmark of cardiovascular disease which is a key component of pharmacological and exercise treatments. More recently, inspiratory muscle training (IMT) is becoming an effective complementary treatment with positive effects on muscle strength and exercise capacity. We assessed the effectiveness of IMT on the cardiovascular system through autonomic function modulation via heart rate variability and arterial blood pressure. Methods: Randomized controlled trials (RCTs) were identified from searches of The Cochrane Library, MEDLINE and EMBASE to November 2018. Citations, conference proceedings and previous reviews were included without population restriction, comparing IMT intervention to no treatment, placebo or active control. Results: We identified 10 RCTs involving 267 subjects (mean age range 51–71 years). IMT programs targeted maximum inspiratory pressure (MIP) and cardiovascular outcomes, using low (n=6) and moderate to high intensity (n=4) protocols, but the protocols varied considerably (duration: 1–12 weeks, frequency: 3–14 times/week, time: 10–30 mins). An overall increase of the MIP (cmH2O) was observed (−27.57 95% CI −18.48, −37.45, I2=64%), according to weighted mean difference (95%CI), and was accompanied by a reduction of the low to high frequency ratio (−0.72 95% CI−1.40, −0.05, I2=50%). In a subgroup analysis, low-and moderate-intensity IMT treatment was associated with a reduction of the heart rate (HR) (−7.59 95% CI −13.96, −1.22 bpm, I2=0%) and diastolic blood pressure (DBP) (−8.29 [−11.64, −4.94 mmHg], I2=0%), respectively. Conclusion: IMT is an effective treatment for inspiratory muscle weakness in several populations and could be considered as a complementary treatment to improve the cardiovascular system, mainly HR and DBP. Further research is required to better understand the above findings.

AB - Background: Cardiorespiratory limitation is a common hallmark of cardiovascular disease which is a key component of pharmacological and exercise treatments. More recently, inspiratory muscle training (IMT) is becoming an effective complementary treatment with positive effects on muscle strength and exercise capacity. We assessed the effectiveness of IMT on the cardiovascular system through autonomic function modulation via heart rate variability and arterial blood pressure. Methods: Randomized controlled trials (RCTs) were identified from searches of The Cochrane Library, MEDLINE and EMBASE to November 2018. Citations, conference proceedings and previous reviews were included without population restriction, comparing IMT intervention to no treatment, placebo or active control. Results: We identified 10 RCTs involving 267 subjects (mean age range 51–71 years). IMT programs targeted maximum inspiratory pressure (MIP) and cardiovascular outcomes, using low (n=6) and moderate to high intensity (n=4) protocols, but the protocols varied considerably (duration: 1–12 weeks, frequency: 3–14 times/week, time: 10–30 mins). An overall increase of the MIP (cmH2O) was observed (−27.57 95% CI −18.48, −37.45, I2=64%), according to weighted mean difference (95%CI), and was accompanied by a reduction of the low to high frequency ratio (−0.72 95% CI−1.40, −0.05, I2=50%). In a subgroup analysis, low-and moderate-intensity IMT treatment was associated with a reduction of the heart rate (HR) (−7.59 95% CI −13.96, −1.22 bpm, I2=0%) and diastolic blood pressure (DBP) (−8.29 [−11.64, −4.94 mmHg], I2=0%), respectively. Conclusion: IMT is an effective treatment for inspiratory muscle weakness in several populations and could be considered as a complementary treatment to improve the cardiovascular system, mainly HR and DBP. Further research is required to better understand the above findings.

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