Most cited article - PubMed ID 32982207
Novel versus Traditional Inspiratory Muscle Training Regimens as Home-Based, Stand-Alone Therapies in COPD: Protocol for a Randomized Controlled Trial
Background: Chronic obstructive pulmonary disease (COPD) is a progressive condition leading to declining lung function, dyspnea, and reduced quality of life. Pulmonary rehabilitation (PR) remains a cornerstone in COPD management; however, access remains limited, with less than 3% of eligible patients participating. Inspiratory muscle training (IMT), especially through novel methods like the Test of Incremental Respiratory Endurance (TIRE), offers a potential home-based alternative to traditional rehabilitation services. Despite growing interest, a key knowledge gap persists: few randomized trials have directly compared TIRE with threshold loading IMT over extended, largely unsupervised home-based periods while concurrently evaluating inspiratory muscle endurance and adherence. This randomized controlled trial aimed to evaluate the long-term efficacy of TIRE IMT compared to traditional threshold IMT and sham training in COPD patients. The study also assessed adherence to these home-based interventions, focusing on unsupervised periods without additional motivational support. Methods: A total of 52 COPD patients were randomly assigned to one of three groups: TIRE IMT, Threshold IMT, or Sham IMT. The study consisted of an 8-week supervised Phase I followed by a 24-week unsupervised Phase II. Training details: TIRE-session template set to 50% of the day's maximal sustained effort; 6 levels × 6 inspirations (total 36) with preset inter-breath recoveries decreasing from 60 s to 10 s. Threshold IMT-spring-loaded valve set to 50% MIP (re-set at week 4); 36 inspirations completed within ≤30 min. Sham-valve set to minimal resistance (9 cmH2O); 36 inspirations within ≤30 min. Primary outcomes included changes in maximal inspiratory pressure (MIP) and sustained maximal inspiratory pressure. Secondary outcomes focused on adherence rates and correlations with functional capacity. Results: Of the 52 participants, 36 completed the study. Participant details: TIRE n = 12 (mean age 60.9 ± 12.9 years), Threshold n = 12 (67.4 ± 6.9 years), Sham n = 12 (67.3 ± 8.7 years); overall 21/36 (58%) men; mean BMI 30.0 ± 7.5 kg/m2. The TIRE IMT group demonstrated significantly greater improvements in MIP (31.7%) and SMIP compared to both the Threshold and Sham groups at 24 weeks (p < 0.05). Despite a decline in adherence during the unsupervised phase, the TIRE group maintained superior outcomes. No adverse events were reported during the intervention period. Conclusions: In this randomized trial, TIRE IMT was associated with greater improvements in inspiratory muscle performance than threshold and sham IMT. While adherence was higher in the TIRE group, it declined during the unsupervised phase. The clinical interpretation of these findings should consider the relatively wide confidence intervals and modest sample size. Nevertheless, the mean change in MIP in the TIRE arm exceeded a recently proposed minimal important difference for COPD, suggesting potential clinical relevance; however, no universally accepted minimal important difference exists yet for SMIP. Further adequately powered trials are warranted.
OBJECTIVE: Chronic obstructive pulmonary disease (COPD) is one of the leading causes of death worldwide. Telehealth rehabilitation may offer new opportunities in patient therapy. This systematic review aimed to evaluate the effects of internet-mediated telerehabilitation and compare them with the outcomes of conventional pulmonary rehabilitation in COPD patients. METHODS: Electronic databases PubMed, Prospero, Scopus, and Cochrane were searched for randomized controlled trials from January 2005 to December 2021. Two investigators reviewed studies for relevance and extracted study population, methods, and results data. RESULTS: Ten studies were eligible for systematic review from the initial selection (n = 1492). There was considerable heterogeneity in telerehabilitation approaches. Functional exercise capacity and quality of life were assessed in all studies. None of the results were inferior to conventional care. High adherence and high levels of safety were observed. CONCLUSION: Telerehabilitation in COPD patients is a safe therapy approach that increases and maintains functional exercise capacity and quality of life, making it an equivalent option to conventional outpatient rehabilitation. However, there is currently a lack of a unified approach to the composition of therapy and the use of technology, which needs to be addressed in the future.
- Keywords
- exercise, pulmonary disease, pulmonary rehabilitation, telehealth, telerehabilitation,
- MeSH
- Pulmonary Disease, Chronic Obstructive * MeSH
- Exercise MeSH
- Quality of Life MeSH
- Humans MeSH
- Telerehabilitation * methods MeSH
- Exercise Tolerance MeSH
- Check Tag
- Humans MeSH
- Publication type
- Journal Article MeSH
- Systematic Review MeSH
