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(Circulation. 1995;91:320-329.)
© 1995 American Heart Association, Inc.
Articles |
Benefit of Selective Respiratory Muscle Training on Exercise Capacity in Patients With Chronic Congestive Heart Failure
From the Cardiovascular and Pulmonary Sections, Philadelphia Veterans Administration Medical Center, Philadelphia, Pa.
Background Diminished respiratory muscle strength and endurance have been demonstrated in patients with heart failure. This may contribute to exertional dyspnea and reduced exercise capacity in these patients. The purpose of this study was to investigate whether selective respiratory muscle training could alleviate dyspnea and improve exercise performance in patients with chronic congestive heart failure.
Methods and Results Fourteen patients with chronic heart failure
(left ventricular ejection fraction, 22±9%) were enrolled in a
supervised respiratory muscle training program. This consisted of three
weekly sessions of isocapnic hyperpnea at maximal sustainable
ventilatory capacity, resistive breathing, and strength training.
Maximum sustainable ventilatory capacity, maximum voluntary
ventilation, maximal inspiratory and expiratory pressures, peak
O2, and the 6-minute walk
test
were measured before (pre) and after (post) 3 months of training. Eight
patients completed the training program. Respiratory muscle
endurance was improved with training, as evidenced by increases in
maximal sustainable ventilatory capacity (pre, 48.6±10.7 versus post,
76.9±14.5 L/min; P<.05) and in maximal voluntary
ventilation (pre, 100±36 versus post, 115±39 L/min;
P<.05). Respiratory muscle strength was also increased with
training as maximal inspiratory (pre, 64±31 versus post, 78±33
cm
H2O; P<.01) and expiratory (pre, 94±30 versus
post, 133±53 cm H2O; P<.001) pressures rose.
Submaximal and maximal exercise capacity were significantly improved
with selective respiratory muscle training as the 6-minute walk (pre,
1101±351 versus post, 1421±328 ft; P<.001) and peak
exercise O2 (pre,
11.4±3.3 versus
post, 13.3±2.7
mL · kg-1 · min-1;
P<.05) both significantly increased. Dyspnea during
activities of daily living was subjectively improved in the majority of
trained patients. Dyspnea quantified by the Borg scale was
significantly reduced during progressive isocapnic hyperpnea but not
during bicycle exercise. No statistically significant improvement in
maximal sustainable ventilatory capacity, maximum voluntary
ventilation, maximal inspiratory or expiratory mouth pressures,
6-minute walk, or peak O2
was observed
in the 6 patients who did not complete the training program.
Conclusions Selective respiratory muscle training improves respiratory muscle endurance and strength, with an enhancement of submaximal and maximal exercise capacity in patients with heart failure. Dyspnea during activities of daily living was subjectively improved in the majority of trained patients.
Key Words: exercise • heart failure
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