Investigation of respiratory muscle strength and its influence on exercise capacity and quality of life in patients with idiopathic pulmonary fibrosis IPF and Respiratory Muscle Strength
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Keywords
Idiopathic Pulmonary Fibrosis, Interstitial Lung Diseases, Physical Activity, Maximal Inspiratory Pressure, Six-minute Walking Test
Abstract
Background: Adequate respiratory muscle strength is required to meet the increased ventilatory demand during physical activities. However, it is not well known whether respiratory muscle strength is impaired in patients with idiopathic pulmonary fibrosis (IPF). Objectives: This study aimed to investigate the relationship between respiratory muscle strength and exercise capacity, quality of life, physical activity level, and fatigue in IPF patients. Methods: The study comprised 30 individuals with idiopathic pulmonary fibrosis (IPF) and 30 healthy controls. Maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP) were measured to assess respiratory muscle strength. The International Physical Activity Questionnaire-Short Form, 6-minute walk test distance (6MWD), St George Respiratory Questionnaire (SGRQ), and Fatigue Severity Scale (FSS) were employed to evaluate physical activity level, exercise capacity, quality of life, and fatigue severity, respectively. Results: MIP (81±29 vs.73±20 cmH2O) and MEP (93±31 vs. 93±34 cmH2O) did not differ significantly between IPF patients and controls (p>0.05). In patients with IPF, MIP was significantly correlated with 6MWD (r=0.533), SGRQ (r=-0.428), and FSS (r=-0.433). Multivariate models including MIP, MEP, FEV1, FVC, and PA level explained 74% of the variance in the 6MWD (p<0.001), and MIP, FEV1, and PA level were independent predictors of the 6MWD, with FEV1 being the strongest predictor (β=0.659). Multivariate models predicting SGRQ revealed none of MIP, FEV1 or PA level was directly influencing the SGRQ score. Conclusions: This study suggests that patients with IPF do not have respiratory muscle weakness. Inspiratory muscle strength has a direct influence on exercise capacity but an indirect effect on quality of life, probably by influencing exercise capacity.
References
2. Walterspacher S, Schlager D, Walker DJ, Muller-Quernheim J, Windisch W, Kabitz HJ. Respiratory muscle function in interstitial lung disease. The European respiratory journal 2013;42:211-9.
3. Panagiotou M, Polychronopoulos V, Strange C. Respiratory and lower limb muscle function in interstitial lung disease. Chronic respiratory disease 2016;13:162-72.
4. Nishimura Y, Hida W, Taguchi O, et al. Respiratory muscle strength and gas exchange in neuromuscular diseases: comparison with chronic pulmonary emphysema and idiopathic pulmonary fibrosis. The Tohoku journal of experimental medicine 1989;159:57-68.
5. Aslan GK, Akinci B, Yeldan I, Okumus G. Respiratory muscle strength in patients with pulmonary hypertension: The relationship with exercise capacity, physical activity level, and quality of life. The clinical respiratory journal 2018;12:699-705.
6. Kang SW, Shin JC, Park CI, Moon JH, Rha DW, Cho DH. Relationship between inspiratory muscle strength and cough capacity in cervical spinal cord injured patients. Spinal cord 2006;44:242-8.
7. Pehlivan E, Mutluay F, Balci A, Kilic L. The effects of inspiratory muscle training on exercise capacity, dyspnea and respiratory functions in lung transplantation candidates: a randomized controlled trial. Clinical rehabilitation 2018;32:1328-39.
8. Félix E, Gimenes AC, Costa-Carvalho BT. Effects of inspiratory muscle training on lung volumes, respiratory muscle strength, and quality of life in patients with ataxia telangiectasia. Pediatric pulmonology 2014;49:238-44.
9. Vainshelboim B. Exercise training in idiopathic pulmonary fibrosis: is it of benefit? Breathe 2016;12:130-8.
10. Swigris JJ, Kuschner WG, Jacobs SS, Wilson SR, Gould MK. Health-related quality of life in patients with idiopathic pulmonary fibrosis: a systematic review. Thorax 2005;60:588-94.
11. American Thoracic Society/European Respiratory S. ATS/ERS Statement on respiratory muscle testing. American journal of respiratory and critical care medicine 2002;166:518-624.
12. Wen AS, Woo MS, Keens TG. How many maneuvers are required to measure maximal inspiratory pressure accurately. Chest 1997;111:802-7.
13. ATS/ERS Statement on respiratory muscle testing. American journal of respiratory and critical care medicine 2002;166:518-624.
14. Miller MR, Crapo R, Hankinson J, et al. General considerations for lung function testing. The European respiratory journal 2005;26:153-61.
15. Brooks D, Solway S, Gibbons WJ. ATS statement on six-minute walk test. American journal of respiratory and critical care medicine 2003;167:1287.
16. Holland AE, Spruit MA, Troosters T, et al. An official European Respiratory Society/American Thoracic Society technical standard: field walking tests in chronic respiratory disease. The European respiratory journal 2014;44:1428-46.
17. Enright PL, Sherrill DL. Reference equations for the six-minute walk in healthy adults. American journal of respiratory and critical care medicine 1998;158:1384-7.
18. Bozkurt B BA, Saryal S, Uzun Ö, Tulumoğlu Ş, Akkoca Ö. Translation and validation of the Turkish version of the St. George's Respiratory Questionnaire in patients with chronic obstructive pulmonary disease. Tuberkuloz ve toraks 2012;60:138-47.
19. Craig CL, Marshall AL, Sjostrom M, et al. International physical activity questionnaire: 12-country reliability and validity. Med Sci Sports Exerc 2003;35:1381-95.
20. Krupp LB, LaRocca NG, Muir-Nash J, Steinberg AD. The fatigue severity scale. Application to patients with multiple sclerosis and systemic lupus erythematosus. Arch Neurol 1989;46:1121-3.
21. Pietro KM, Ricardo G, Rui G, et al. Relationship of pectoralis muscle area and skeletal muscle strength with exercise tolerance and dyspnea in interstitial lung disease. Sarcoidosis, vasculitis, and diffuse lung diseases : official journal of WASOG 2017;34:200-8.
22. Algina J, Olejnik S. Sample Size Tables for Correlation Analysis with Applications in Partial Correlation and Multiple Regression Analysis. Multivariate behavioral research 2003;38:309-23.
23. Casas JP, Abbona H, Robles A, López AM. [Normal lung volumes in patients with idiopathic pulmonary fibrosis and emphysema]. Medicina (B Aires) 2008;68:282-4.
24. Naranjo-Orellana J, Santalla A. Long-Term Combined Training in Idiopathic Pulmonary Fibrosis: A Case Study. International journal of environmental research and public health 2020;17.
25. Durdu H, Yurdalan SU, Ozmen I. Clinical significance of pectoralis muscle strength in elderly patients with idiopathic pulmonary fibrosis. Sarcoidosis, vasculitis, and diffuse lung diseases : official journal of WASOG 2022;39:e2022009.
26. Case AH, Hellkamp AS, Neely ML, et al. Associations between Patient-reported Outcomes and Death or Lung Transplant in Idiopathic Pulmonary Fibrosis. Data from the Idiopathic Pulmonary Fibrosis Prospective Outcomes Registry. Annals of the American Thoracic Society 2020;17:699-705.
27. Vainshelboim B, Oliveira J, Fox BD, Kramer MR. The Prognostic Role of Ventilatory Inefficiency and Exercise Capacity in Idiopathic Pulmonary Fibrosis. Respiratory care 2016;61:1100-9.
28. Singer J YE, Katz PP, Sanchez G, Iribarren C, Eisner MD, Blanc PD. Respiratory and skeletal muscle strength in chronic obstructive pulmonary disease: impact on exercise capacity and lower extremity function J Cardiopulm Rehabil Prev 2011;31:111-9.
29. Kim SH, Shin MJ, Shin YB, Kim KU. Sarcopenia Associated with Chronic Obstructive Pulmonary Disease. Journal of bone metabolism 2019;26:65-74.
30. Faverio P, Fumagalli A, Conti S, et al. Sarcopenia in idiopathic pulmonary fibrosis: a prospective study exploring prevalence, associated factors and diagnostic approach. Respiratory research 2022;23:228.
31. Cremers JP, Drent M, Elfferich MD, et al. Body composition profiling in a Dutch sarcoidosis population. Sarcoidosis, vasculitis, and diffuse lung diseases : official journal of WASOG 2013;30:289-99.
32. Antwi-Boasiako C, Kollie MF, Kyeremeh KA, et al. Associations between spirometric measures and exercise capacity in type 2 diabetes. Diabetes & metabolic syndrome 2023;17:102831.
33. Satia I, Farooqi MAM, Cusack R, et al. The contribution of FEV(1) and airflow limitation on the intensity of dyspnea and leg effort during exercise. Insights from a real-world cohort. Physiological reports 2020;8:e14415.
34. Hsia CC. Cardiopulmonary limitations to exercise in restrictive lung disease. Medicine and science in sports and exercise 1999;31:S28-32.
35. Moderno EV, Yamaguti WP, Schettino GP, et al. Effects of proportional assisted ventilation on exercise performance in idiopathic pulmonary fibrosis patients. Respiratory medicine 2010;104:134-41.
36. Chiu KL, Hsieh PC, Wu CW, Tzeng IS, Wu YK, Lan CC. Exercise training increases respiratory muscle strength and exercise capacity in patients with chronic obstructive pulmonary disease and respiratory muscle weakness. Heart & lung : the journal of critical care 2020;49:556-63.
37. Morino A, Takahashi H, Chiba H, Ishiai S. Daily physical activity affects exercise capacity in patients with idiopathic pulmonary fibrosis. Journal of physical therapy science 2017;29:1323-8.
38. Wallaert B, Monge E, Le Rouzic O, Wémeau-Stervinou L, Salleron J, Grosbois JM. Physical activity in daily life of patients with fibrotic idiopathic interstitial pneumonia. Chest 2013;144:1652-8.
39. Singh SJ, Puhan MA, Andrianopoulos V, et al. An official systematic review of the European Respiratory Society/American Thoracic Society: measurement properties of field walking tests in chronic respiratory disease. The European respiratory journal 2014;44:1447-78.
40. Warburton DER, Bredin SSD. Health benefits of physical activity: a systematic review of current systematic reviews. Current opinion in cardiology 2017;32:541-56.
41. Kreuter M, Swigris J, Pittrow D, et al. The clinical course of idiopathic pulmonary fibrosis and its association to quality of life over time: longitudinal data from the INSIGHTS-IPF registry. Respiratory research 2019;20:59.
42. Bourke SC, Tomlinson M, Williams TL, Bullock RE, Shaw PJ, Gibson GJ. Effects of non-invasive ventilation on survival and quality of life in patients with amyotrophic lateral sclerosis: a randomised controlled trial. The Lancet Neurology 2006;5:140-7.
43. Defi IR, Otafirda MV, Novitri N, Rachmi A. Feasibility of inspiratory muscle training as a rehabilitation program for chronic kidney disease patients in a developing country. European review for medical and pharmacological sciences 2023;27:8330-9.
44. Silva VG, Amaral C, Monteiro MB, Nascimento DM, Boschetti JR. Effects of inspiratory muscle training in hemodialysis patients. Jornal brasileiro de nefrologia 2011;33:62-8.
45. Figueiredo PHS, Lima MMO, Costa HS, et al. Effects of the inspiratory muscle training and aerobic training on respiratory and functional parameters, inflammatory biomarkers, redox status and quality of life in hemodialysis patients: A randomized clinical trial. 2018;13:e0200727.
46. Agrawal SR, Joshi R, Jain A. Correlation of severity of chronic obstructive pulmonary disease with health-related quality of life and six-minute walk test in a rural hospital of central India. Lung India : official organ of Indian Chest Society 2015;32:233-40.
47. Arena R, Myers J, Williams MA, et al. Assessment of functional capacity in clinical and research settings: a scientific statement from the American Heart Association Committee on Exercise, Rehabilitation, and Prevention of the Council on Clinical Cardiology and the Council on Cardiovascular Nursing. Circulation 2007;116:329-43.
48. Rasekaba T, Lee AL, Naughton MT, Williams TJ, Holland AE. The six-minute walk test: a useful metric for the cardiopulmonary patient. Internal medicine journal 2009;39:495-501.
49. Li J, Xu X, Sun J, et al. Activities of daily living, life orientation, and health-related quality of life among older people in nursing homes: a national cross-sectional study in China. 2020;29:2949-60.
50. Christiansen L, Sanmartin Berglund J. Health-related quality of life and related factors among a sample of older people with cognitive impairment. 2019;6:849-59.
51. Meilleur KG, Linton MM, Fontana J, et al. Comparison of sitting and supine forced vital capacity in collagen VI-related dystrophy and laminin alpha2-related dystrophy. Pediatric pulmonology 2017;52:524-32.
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