Exercise training and inspiratory muscle training in patients with bronchiectasis

Clare Newall ^1*, Robert A Stockley ² and Susan L Hill ²

¹ Lung Investigation unit, Queen Elizabeth Hospital, United Kingdom
² Lung Investigation Unit, Queen Elizabeth Hospital, United Kingdom

^* To whom correspondence should be addressed. E-mail: clare.newall{at}uhb.nhs.uk.

Accepted 17 June 2005

Abstract

Background: Bronchiectasis (BE) is a chronic suppurative lung disease often characterised by airflow obstruction and hyperinflation, and leading to decreased exercise tolerance and reduced health status. To date, the role of pulmonary rehabilitation (PR) and inspiratory muscle training (IMT) has not been investigated in this group of patients.

Methods: Thirty-two patients with idiopathic BE were randomly allocated to one of 3 groups: PR plus sham IMT (PR-SHAM), PR plus targeted IMT (PR-IMT), or control (CTRL). All patients (except CTRL) underwent an 8 week training programme of either PR or PR plus targeted IMT. Exercise training during PR was performed 3 times weekly at 80% of the peak heart rate. IMT was performed at home for 15 minutes, twice daily over the 8 week period.

Results: PR-SHAM and PR-IMT demonstrated significant increases in the Incremental Shuttle Walking Test (ISWT) of 96.7 metres (95% confidence interval 59.6-133.7 metres) and 124.5 metres (95% confidence interval 63.2-185.9 metres) respectively and in endurance exercise capacity of 174.9% (95% confidence interval 34.7-426.1) and 205.7% (95% confidence interval 31.6-310.6). There were no statistically significant differences in the improvements in exercise between the two groups. Significant improvements in inspiratory muscle strength (Pi max) were also observed both in the PR-IMT group (21.4cm H₂O increase, 95% confidence interval 9.3 to 33.4; p=0.008) and the PR-SHAM group (12.0cm H₂O increase, 95% confidence interval 1.1 to 22.9; p=0.04), the magnitude of which were also similar (p=0.220). Improvements in exercise capacity were maintained in the PR-IMT at 3 months after training, but not in the PR-SHAM group.

Conclusions: PR is effective in improving exercise tolerance in BE but there is no additional advantage of simultaneous IMT. IMT may, however, be important in the longevity of the training effects.

Keywords: exercise training, health status, inspiratory muscle training, pulmonary rehabilitation

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