Data_Sheet_1_Effectiveness and safety of inspiratory muscle training in patients with pulmonary hypertension: A systematic review and meta-analysis.docx

BackgroundInspiratory muscle training (IMT) is a simple and well-tolerated physical therapy that increases respiratory muscle strength and relieving the degree of dyspnea and fatigue. Therefore, it may be used as a transitional modality before exercise training or as a specific physical therapy intervention for those who are diagnosed with respiratory muscle weakness. However, the current evidence on IMT in pulmonary hypertension (PH) patients is inconclusive. The purpose of this systematic review and meta-analysis was to summarize the current role of IMT in this group of patients.MethodsPubMed, EMBASE, and Cochrane databases were searched through May 2022. Trials examining the feasibility and effectiveness of IMT in PH patients. Outcome measures included adverse events, training adherence and compliance, maximum inspiratory pressure (MIP), maximum expiratory pressure (MEP), forced vital capacity (FVC%), forced expiratory volume in 1 s (FEV1%), FEV1/FVC%, 6 min walk distance (6MWD), Peak VO2, dyspnea, and fatigue perception after the IMT training program. Only randomized controlled trials were included. The Cochrane Risk of Bias tool for controlled trials was adopted to assess study quality. Statistical heterogeneity was evaluated with the chi-square test and I2 statistic. Mean differences and 95% confidence intervals (CIs) were estimated.ResultsWe ultimately identified four studies that met the criteria. These studies comprised 80 patients with 16 males and 64 females. The mean age was 53.25. The main types of PH were group I (pulmonary arterial hypertension, 95%) and group IV (chronic thromboembolic PH, 5%). No severe adverse events were reported in the included studies. IMT had a significant effect on improving MIP (18.89 cmH2O; 95% CI: 9.43–28.35, P < 0.001) and MEP (8.06 cmH2O; 95% CI: 2.39–13.73; P = 0.005), increase in the 6MWD (30.16 m; 95% CI: 1.53–58.79; P = 0.04). No significant improvement was found in pulmonary function (P > 0.05), and uncertain effect on the quality of life (QoL) score.ConclusionBased on currently limited evidence, IMT is an effective physical therapy for increasing respiratory muscle function and exercise capacity, but still a lack of evidence on dyspnea and fatigue levels, pulmonary function, and QoL in PH patients. There are reasons to believe that IMT is a promising intervention in PH patients, enriching rehabilitation options and serving as a bridge before formal exercise training. It is expected that IMT will play an important role in the future clinical pathway of physical therapy for this group of patients.Systematic review registration[https://www.crd.york.ac.uk/PROSPERO/logout.php], identifier [CRD42022335972].

背景：呼吸肌训练（IMT）是一种简便且耐受性良好的物理治疗方法，能够增强呼吸肌力量，减轻呼吸困难及疲劳程度。因此，它可能被用作运动训练前的过渡模式，或作为呼吸肌无力患者的特定物理治疗方法。然而，关于IMT在肺高血压（PH）患者中的现有证据尚无定论。本系统性综述和荟萃分析的目的在于总结IMT在此类患者群体中的当前作用。
方法：通过2022年5月检索PubMed、EMBASE和Cochrane数据库。研究调查了IMT在PH患者中的可行性和有效性。结果指标包括不良事件、训练依从性和合规性、最大吸气压力（MIP）、最大呼气压力（MEP）、用力肺活量（FVC%）、1秒用力呼气量（FEV1%）、FEV1/FVC%、6分钟步行距离（6MWD）、峰值摄氧量（Peak VO2）、IMT训练计划后的呼吸困难及疲劳感知。仅纳入随机对照试验。采用Cochrane偏倚风险工具对受控试验进行质量评估。统计异质性通过卡方检验和I2统计量进行评估。计算均值差异和95%置信区间（CIs）。
结果：最终确定了符合标准的研究四项。这些研究包括80名患者，其中男性16名，女性64名。平均年龄为53.25岁。主要的PH类型为I组（肺动脉高压，95%）和IV组（慢性血栓栓塞性PH，5%）。所纳入的研究中未报告严重不良事件。IMT对提高MIP（18.89 cmH2O；95% CI: 9.43–28.35，P < 0.001）和MEP（8.06 cmH2O；95% CI: 2.39–13.73；P = 0.005）以及增加6MWD（30.16 m；95% CI: 1.53–58.79；P = 0.04）具有显著效果。肺功能（P > 0.05）未发现显著改善，对生活质量（QoL）评分的影响尚不确定。
结论：基于目前有限的证据，IMT是一种有效的物理治疗方法，可增强呼吸肌功能和运动能力，但在PH患者的呼吸困难、疲劳水平、肺功能和QoL方面仍缺乏证据。有理由相信，IMT在PH患者中是一种有潜力的干预措施，丰富了康复选择，并在正式运动训练之前起到桥梁作用。预计IMT将在未来该群体患者的物理治疗临床路径中发挥重要作用。系统性综述登记[https://www.crd.york.ac.uk/PROSPERO/logout.php]，标识符[CRD42022335972]。