Respiratory Muscle Training in Institutionalized Elderly Population

University of Valencia

Status: Completed

Conditions: Other Diagnoses, Comorbidities, and Complications; Syndrome; Institutionalization; Muscle Weakness

Treatments: Device: Threshold® Inspiratory Muscle Trainer (Respironics® Health Scan Inc. Cedar Grove, NJ, USA).; Other: Yoga Pranayama breathing exercises

Study type: Interventional

Funder types: Other

Identifiers

NCT01624272

H1325072291220

Details and patient eligibility

About

The global loss of muscle mass and strength associated with aging is a cause of functional impairment and disability, particularly in the frail elderly. Respiratory function can be severely compromised if there is a decrease of respiratory (RM) strength complicated by the presence of comorbidities and physical immobility.

Previous studies have shown that the specific RM training is an effective method to increase RM strength, both in healthy people and patients. In this case, specific RM training may be regarded as a beneficial alternative to improve RM function, and thus prevent physical and clinical deterioration in this population.

The hypothesis is that specific RM training would improve RM strength and endurance in the experimental groups vs. control who do not participate in RM training.

Institutionalized elderly people with an inability to walk were randomly allocated to a control group, a Threshold group or a Pranayama group. Both experimental groups performed a supervised RM training, five days a week for six consecutive weeks. The maximum inspiratory and expiratory pressures (MIP and MEP) and the maximum voluntary ventilation (MVV) were assessed at four time points in each of three groups.

Full description

Studies have shown that general aerobic exercise training is accompanied by significant respiratory physiological benefits, including gains in RM strength and endurance (Larson, et al., 1999; Sheel, 2002; Watsford, et al., 2005; Lacasse et al., 2006). This benefit appears to be greater when general exercise conditioning is combined with specific RM training (Weiner, et al., 1992; Wanke, et al., 1994; Larson, et al., 1999; Hill y Eastwood, 2005; O'Brien, et al., 2008). However, many frail elderly are not able to perform general aerobic exercise, related or not to ADL, as it is mentioned above (e.g., institutionalized elderly with comorbidities, functional impairment and RM weakness). In this case, specific RM training may be used as a beneficial alternative to maintain or improve RM function (Watsford and Murphy, 2008), and thus prevent deterioration in this functionally impaired elderly.

The most commonly used techniques of specific RM training are: a) isocapnic hyperpnoea (Leith and Bradley, 1976; Belman and Mittman, 1980), b) respiratory resistive loading (Pardy, et al., 1981; Sonne and Davis, 1982; Belman, et al., 1986), and c) respiratory threshold loading (Clanton, et al., 1985; Chen, et al., 1985; Martyn, et al., 1987; Larson, et al., 1988). Apart from these three well-known techniques, other less studied types of exercise such as the controlled breathing exercises of Yoga, Pranayama, may also be added to this list (Kulpati, et al., 1982; Manocha, et al., 2002; Donesky-Cueco, et al., 2009).

Enrollment: 71 patients

Sex: All

Ages: 65+ years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• clinically stable residents, institutionalized at least 1 year;
• Barthel Index less than 95 points;
• inability to independently walk more than 10 meters or inability to effectively use a wheelchair;
• Mini-Mental Status Examination score of at least 20 points (i.e., subjects without moderate or severe cognitive deterioration).

Exclusion criteria

• significant chronic cardiorespiratory diagnoses (e.g. moderate-severe COPD);
• an acute cardiorespiratory episode during the last 2 months prior to the study;
• neurological, muscular, or neuromuscular problems interfering with the capacity to engage in the tests and training protocols;
• active smokers or former smokers who had stopped smoking less than 5 years ago;
• a terminal disease.

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Factorial Assignment

Masking: None (Open label)

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71 participants in 3 patient groups

Control

No Intervention group

Description:

Usual care

Threshold Inspiratory Muscle Training

Experimental group

Description:

Inspiratory muscle training regime

Treatment:

Device: Threshold® Inspiratory Muscle Trainer (Respironics® Health Scan Inc. Cedar Grove, NJ, USA).

Controlled breathing exercises

Experimental group

Description:

Yoga Pranayama breathing exercises

Treatment:

Other: Yoga Pranayama breathing exercises