Journal of Rehabilitation Medicine 51-8 | Page 80

J Rehabil Med 2019; 51: 616–620 SHORT COMMUNICATION RESPIRATORY MUSCLE ENDURANCE TRAINING WITH NORMOCAPNIC HYPERPNOEA FOR PATIENTS WITH CHRONIC SPINAL CORD INJURY: A PILOT SHORT-TERM RANDOMIZED CONTROLLED TRIAL Jianing XI, PhD 1 , Hongying JIANG, PhD 1 #, Na ZHANG, PhD 1 , Jianjun WANG, PhD 1 , Bin ZHANG, PhD 1 , Hongli CAO, PhD 1 , Bo YANG, PhD 1 , Inez FRERICHS, PhD 2 , Knut MÖLLER, PhD 4 and Zhanqi ZHAO, PhD 3,4 # From the 1 Department of Respiratory Rehabilitation Center, Beijing Rehabilitation Hospital of Capital Medical University, Beijing, China, 2 Department of Anaesthesiology and Intensive Care Medicine, University Medical Centre of Schleswig-Holstein Campus Kiel, Germany, 3 Department of Biomedical Engineering, Fourth Military Medical University, Xi’an, China and 4 Institute of Technical Medicine, Furtwangen University, Villingen-Schwenningen, Germany #These authors contributed equally to this publication. Objective: To investigate the effects of normocap- nic hyperpnoea training on pulmonary function and patient-reported outcomes in chronic spinal cord injury. Design: Single-centre randomized controlled trial. Patients: Eighteen patients with spinal cord injury > 24 months post-injury and without regular respi- ratory muscle training prior to the study were inclu- ded prospectively. Methods: Patients were randomly assigned to either normocapnic hyperpnoea or control groups. The normocapnic hyperpnoea group patients performed training 15–20 min per day, 5 times a week for 4 weeks. The patients hyperventilated through partial re-breathing of ventilated air. The control group re- ceived no respiratory muscle training. Other reha- bilitative programmes were performed identically in both groups. Lung function testing was performed in the sitting position prior to and after the study. Patient-reported outcomes were assessed using the Patient Health Questionnaire-9, St George’s Respira- tory Questionnaire, Chronic Obstructive Pulmonary Disease Assessment Test and Borg scores. Results: Significant differences were found in the improvement ratio between the normocapnic hy- perpnoea and control groups for all investigated pa- rameters, except total lung capacity and diffusing capacity of the lung for carbon monoxide. Conclusion: Normocapnic hyperpnoea training may reduce the incidence of respiratory symptoms, im- prove pulmonary function and quality of life, and re- duce depression in patients with chronic spinal cord injury, regardless of their neurological level of inju- ry, even at more than 24 months after injury. Key words: normocapnic hyperpnoea; chronic spinal cord injury; patient-reported outcomes; respiratory muscle train- ing; lung function. Accepted May 29, 2019; Epub ahead of print Jun 14, 2019 J Rehabil Med 2019; 51: 616–620 Correspondence address: Hongying Jiang, Department of Respiratory Rehabilitation Center, Beijing Rehabilitation Hospital of Capital Medical University, Xixiazhuang, Baduchu, Shijingshan, Beijing 100114, China. E-mail: [email protected]; and Zhanqi Zhao, Department of Biomedical Engineering, 169 Changle Xi Rd, Fourth Military Medical University, Xi’an, China. E-mail: [email protected] LAY ABSTRACT Respiratory muscle endurance training is beneficial for patients with chronic spinal cord injury. This study mea- sured the effects of respiratory muscle endurance train- ing on lung function and patient-reported outcomes. Eighteen patients with spinal cord injury who were > 24 months post-injury were randomly assigned to either a studied or a control group. The results showed that endurance training may reduce the incidence of respi- ratory symptoms, improve lung function and quality of life, and reduce depression in patients with chronic spi- nal cord injury, regardless of their neurological level of injury, even at more than 24 months after injury. S ignificant impairment of lung function is frequent in patients with spinal cord injury (SCI). Respiratory complications are the leading cause of death in this population. Regular physical exercise helps to improve lung function (1). Current general rehabilitative pro- grammes include passive range of movement, mattress exercise, sitting balance and upper limb functional training (2). Respiratory muscle training (RMT), on the other hand, focuses on training the inspiratory and/or expiratory muscles to improve muscle strength, muscle endurance and, at the same time, lung function (3). Early initiation of RMT after an SCI may have a positive effect on respiratory function and prevent respiratory complications (4). Patients may benefit from RMT even after several years of injury (5). The most widely used type of RMT facilitates flow resistive devices to add ad- ditional work on inspiration and/or expiration (3). Other types of RMT include pressure threshold, abdominal weights and glossopharyngeal breathing focussing on different breathing mechanisms. Only a few studies have evaluated the effects of RMT with normocapnic hyperpnoea (NH) in SCI (4, 6). NH may be an attractive training modality, since it trains inspiratory and expira- tory muscles within a single programme. As shown by Van Houtte et al., respiratory muscles usually work at low resistance; therefore, challenging respiratory mus- cles by forced hyperpnoea might be a more “natural” way to train these muscles (4). Only limited data have This is an open access article under the CC BY-NC license. www.medicaljournals.se/jrm doi: 10.2340/16501977-2572 Journal Compilation © 2019 Foundation of Rehabilitation Information. ISSN 1650-1977