The Comparison Effect of Two Pulmonary Rehabilitation Protocols on spirometer indexes and physical performance in patients with COPD.

Document Type : Original Article


1 hhh

2 فوق تخصص ریه


Background and Objective: Respiratory exercise training based on pulmonary
Rehabilitation can lead to improvement of physical function and pulmonary function in COPD patients. The aim of this study was to compare the effects of different protocols of inspiratory pressure threshold loading on some spirometery indexes, physical function and dyspnea in COPD patients.
Subjects and Methods: In present semi-experimental research thirty patients with moderate to severe intensity of COPD were selected targetly, and divided randomly in three groups: control (n=10), moderate intensity of inspiratory resistive training (n=10), height intensity of inspiratory resistive training (n=10).
Spirometer indexes, dyspnea, and physical function base on 6MWD test were measured before and after pulmonary rehabilitation protocols. Two way ANOVA used for statistical analysis (p < 0.05).
Results: Following implementation of pulmonary rehabilitation protocols, a significant increase in Inspiratory maximal pressure and a significant decrease in leg fatigue after 6MWD, were found in comparison with control group (p < 0.05). But there were no significant differences between
Intervention groups (P>0.05). After pulmonary rehabilitation periods there were no significant differences between FEV1، MVV، FEV1/FVC، VT، 6MWD, and dyspnea levels among control and intervention groups (P>0.05).
Conclusion: pulmonary rehabilitation programs based on inspiratory pressure


1-Singh D, Agusti A, Anzueto A, Barnes PJ, Bourbeau J, Celli BR, Criner GJ, Frith P, Halpin DM, Han M, Varela MV. Global strategy for the diagnosis, management, and prevention of chronic obstructive lung disease: the GOLD science committee report 2019. European Respiratory Journal. 2019 May 1;53(5).
2-Mathers CD, Loncar D. Projections of global mortality and burden of disease from 2002 to 2030. PLoS medicine. 2006 Nov 28;3(11):e442.
3-Mohammadi F, Jowkar Z, Reza Khankeh H, Fallah Tafti S. Effect of home-based nursing pulmonary rehabilitation on patients with chronic obstructive pulmonary disease: a randomised clinical trial. British journal of community nursing. 2013 Aug;18(8):398-403.
4-Me'marian R, Mohammadi I, Mirbagheri N. The Effect of Planning Regular Walking as Rehabilitation in Chronic Obstructive Pulmonary Patients Clinical Status. Archives of Rehabilitation. 2009 Jul 10;10(2):0-0.
5-Elmorsi AS, Eldesoky ME, Mohsen MA, Shalaby NM, Abdalla DA. Effect of inspiratory muscle training on exercise performance and quality of life in patients with chronic obstructive pulmonary disease. Egyptian Journal of Chest Diseases and Tuberculosis. 2016 Jan 1;65(1):41-6.
6-Majewska-Pulsakowska M, Wytrychowski K, Rożek-Piechura K. The role of inspiratory muscle training in the process of rehabilitation of patients with chronic obstructive pulmonary disease. InRespirology 2015 (pp. 47-51). Springer, Cham.
7-Donaldson AV, Maddocks M, Martolini D, Polkey MI, Man WD. Muscle function in COPD: a complex interplay. International journal of chronic obstructive pulmonary disease. 2012;7:523.
8-O'Donnell DE, Webb KA. The major limitation to exercise performance in COPD is dynamic hyperinflation. Journal of Applied Physiology. 2008 Aug;105(2):753-5.
9-Charususin N, Gosselink R, Decramer M, Demeyer H, McConnell A, Saey D, Maltais F, Derom E, Vermeersch S, Heijdra YF, van Helvoort H. Randomised controlled trial of adjunctive inspiratory muscle training for patients with COPD. Thorax. 2018 Oct 1;73(10):942-50.
10-O’Donnell DE, Webb KA, Neder JA. Lung hyperinflation in COPD: applying physiology to clinical practice. COPD Research and Practice. 2015 Dec;1(1):1-2.
11-Barreiro E, Gea J, Matar G, Hussain SN. Expression and carbonylation of creatine kinase in the quadriceps femoris muscles of patients with chronic obstructive pulmonary disease. American journal of respiratory cell and molecular biology. 2005 Dec;33(6):636-42.
12-Decramer M, Stas KJ. Corticosteroid-induced myopathy involving respiratory muscles in patients with chronic obstructive pulmonary disease or asthma. American Review of Respiratory Disease. 1992 Sep 1;146:800-.
13-O’Donnell DE, Elbehairy AF, Webb KA, Neder JA. The link between reduced inspiratory capacity and exercise intolerance in chronic obstructive pulmonary disease. Annals of the American Thoracic Society. 2017 Jul;14(Supplement 1):S30-9.
14-McConnell A. Respiratory Muscle Training E-Book: Theory and Practice. Elsevier Health Sciences; 2013 Apr 18.
15-Hill K, Jenkins SC, Philippe DL, Cecins N, Shepherd KL, Green DJ, Hillman DR, Eastwood PR. High-intensity inspiratory muscle training in COPD. European Respiratory Journal. 2006 Jun 1;27(6):1119-28.
16-Vestbo J, Hurd SS, Agustí AG, Jones PW, Vogelmeier C, Anzueto A, Barnes PJ, Fabbri LM, Martinez FJ, Nishimura M, Stockley RA. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: GOLD executive summary. American journal of respiratory and critical care medicine. 2013 Feb 15;187(4):347-65.
17-Oliveira MF, Zanussi G, Sprovieri B, Lobo DM, Mastrocolla LE, Umeda II, Sperandio PA. Alternatives to aerobic exercise prescription in patients with chronic heart failure. Arquivos brasileiros de cardiologia. 2016 Feb;106(2):97-104.
18-Borg GA. Psychophysical bases of perceived exertion. Medicine & science in sports & exercise. 1982.
19-Liang G, Zhang Z. Positive end expiratory pressure titration guided by plateau pressure in chronic obstructive pulmonary disease patients. The clinical respiratory journal. 2018 Feb;12(2):674-80.
20-Gosselink R, De Vos J, Van Den Heuvel SP, Segers J, Decramer M, Kwakkel G. Impact of inspiratory muscle training in patients with COPD: what is the evidence?. European Respiratory Journal. 2011 Feb 1;37(2):416-25.
21-Beaumont M, Forget P, Couturaud F, Reychler G. Effects of inspiratory muscle training in COPD patients: A systematic review and meta‐analysis. The clinical respiratory journal. 2018 Jul;12(7):2178-88.
22-Gea J, Pascual S, Casadevall C, Orozco-Levi M, Barreiro E. Muscle dysfunction in chronic obstructive pulmonary disease: update on causes and biological findings. Journal of thoracic disease. 2015 Oct;7(10):E418.
23-O’Donnell DE, Milne KM, James MD, de Torres JP, Neder JA. Dyspnea in COPD: New Mechanistic Insights and Management Implications. Advances in therapy. 2020 Jan 1:1-20.
24-van der Pijl R, Strom J, Conijn S, Lindqvist J, Labeit S, Granzier H, Ottenheijm C. Titin‐based mechanosensing modulates muscle hypertrophy. Journal of cachexia, sarcopenia and muscle. 2018 Oct;9(5):947-61.
25-Beaumont M, Mialon P, Le Ber C, Le Mevel P, Péran L, Meurisse O, Morelot-Panzini C, Dion A, Couturaud F. Effects of inspiratory muscle training on dyspnoea in severe COPD patients during pulmonary rehabilitation: controlled randomised trial. European Respiratory Journal. 2018 Jan 1;51(1).
26-Schultz K, Jelusic D, Wittmann M, Krämer B, Huber V, Fuchs S, Lehbert N, Wingart S, Stojanovic D, Göhl O, Alma HJ. Inspiratory muscle training does not improve clinical outcomes in 3-week COPD rehabilitation: results from a randomised controlled trial. European Respiratory Journal. 2018 Jan 1;51(1):1702000.
27-Crisafulli E, Costi S, Fabbri LM, Clini EM. Respiratory muscles training in COPD patients. International Journal of Chronic Obstructive Pulmonary Disease. 2007 Mar;2(1):19.
28-Witt JD, Guenette JA, Rupert JL, McKenzie DC, Sheel AW. Inspiratory muscle training attenuates the human respiratory muscle metaboreflex. The Journal of physiology. 2007 Nov 1;584(3):1019-28.
29-Ferraro FV, Gavin JP, Wainwright T, McConnell A. The effects of 8 weeks of inspiratory muscle training on the balance of healthy older adults: a randomized, double‐blind, placebo‐controlled study. Physiological reports. 2019 May;7(9):e14076.
30-Jing MY, Li XY, Hao XY, Song GM. The impact of inspiratory muscle training on exercise capacity and inspiratory muscle strength in heart failure patients: a meta-analysis. TMR Non-drug Therapy. 2019 Dec 6;2(4):117-26.
31-Decramer M. Hyperinflation and respiratory muscle interaction. European Respiratory Journal. 1997 Apr 1;10(4):934-41.
32-Geddes EL, O'Brien K, Reid WD, Brooks D, Crowe J. Inspiratory muscle training in adults with chronic obstructive pulmonary disease: an update of a systematic review. Respiratory medicine. 2008 Dec 1;102(12):1715-29.
33-Johns DP, Walters JA, Walters EH. Diagnosis and early detection of COPD using spirometry. Journal of thoracic disease. 2014 Nov;6(11):1557.
34-Kostakou E, Barrett N, Camporota L. Electrical impedance tomography to determine optimal positive end-expiratory pressure in severe chronic obstructive pulmonary disease. Critical Care. 2016 Dec;20(1):1-2.
35-McKenzie, D.K., Butler, J.E., Gandevia, S.C. Respiratory muscle function and activation in chronic obstructive pulmonary disease. J. Appl. Physiol. 2009;107:621–629.
36-Kim NS, Seo JH, Ko MH, Park SH, Kang SW, Won YH. Respiratory muscle strength in patients with chronic obstructive pulmonary disease. Annals of rehabilitation medicine. 2017 Aug;41(4):659.
37-Enright SJ, Unnithan VB, Heward C, Withnall L, Davies DH. Effect of high-intensity inspiratory muscle training on lung volumes, diaphragm thickness, and exercise capacity in subjects who are healthy. Physical therapy. 2006 Mar 1;86(3):345-54.
38-Downey, A.E., Chenoweth, L.M., Townsend, D.K., et al. Effects of inspiratory muscle training on exercise responses in normoxia and hypoxia. Respir. Physiol. Neurobiol. 2007;156:137–146.