Limited chest expansion and asymmetry in the respiratory muscles after a stroke lead to poor ventilation and reduced physical performance.
Objectives
To determine the effect of chest expansion resistance exercise and respiratory muscle stretching on respiratory function and gait endurance in patients with stroke.
Methods
Thirty stroke patients were randomly assigned to a chest expansion resistance group (CERG), a respiratory muscle stretching group (RMSG), and a control group (CG). CERG and RMSG received chest expansion resistance and respiratory muscle stretching, respectively, 3 times a week for 8 weeks. Respiratory function, respiratory muscle strength, and gait endurance were measured before and after the intervention period.
Results
The experimental groups, CERG and RMSG, showed significant improvements in respiratory function variables (p < .05). For respiratory muscle strength variables, maximal inspiratory pressure (MIP) in the CERG and maximal expiratory pressure (MEP) in the RMSG showed significant changes compared to the CG (p < .05). Both CERG and RMSG also showed significant improvements in the 6MWT compared to the CG (p < .05).
Conclusion
Chest expansion resistance exercise would be a more effective method, while both chest expansion resistance exercise and respiratory muscle stretching are helpful in improving respiratory function and gait endurance.
AdlerD.HerbelinB.SimilowskiT.BlankeO. (2014). Breathing and sense of self: visuo-respiratory conflicts alter body self-consciousness. Respir Physiol Neurobiol, 203, 68–74. doi:10.1016/j.res2014.08.003
2.
AliM. S.TalwarD.JainS. K. (2014). The effect of a short-term pulmonary rehabilitation on exercise capacity and quality of life in patients hospitalised with acute exacerbation of chronic obstructive pulmonary disease. Indian J Chest Dis Allied Sci, 56(1), 13–19.
3.
AreasG. P.Borghi-SilvaA.LobatoA. N.SilvaA. A.FreireR. C.JrAreasF. Z. (2013). Effect of upper extremity proprioceptive neuromuscular facilitation combined with elastic resistance bands on respiratory muscle strength: a randomized controlled trial. Braz J Phys Ther, 17(6), 541–546. doi:10.1590/S1413-35552012005000131
4.
Aydogan ArslanS.UgurluK.Sakizli ErdalE.KeskinE. D.DemirgucA. (2022). Effects of Inspiratory Muscle Training on Respiratory Muscle Strength, Trunk Control, Balance and Functional Capacity in Stroke Patients: A single-blinded randomized controlled study. Top Stroke Rehabil, 29(1), 40–48. doi:10.1080/10749357.2020.1871282
5.
BologniniN.RussoC.Souza CarneiroM. I.NicotraA.OlgiatiE.SpandriV., ... VallarG. (2020). Bi-hemispheric transcranial direct current stimulation for upper-limb hemiparesis in acute stroke: a randomized, double-blind, sham-controlled trial. Eur J Neurol, 27(12), 2473–2482. doi:10.1111/ene.14451
6.
BrittoR. R.RezendeN. R.MarinhoK. C.TorresJ. L.ParreiraV. F.Teixeira-SalmelaL. F. (2011). Inspiratory muscular training in chronic stroke survivors: a randomized controlled trial. Arch Phys Med Rehabil, 92(2), 184–190. doi:10.1016/j.apmr.2010.09.029
7.
BrooksD.SottanaR.BellB.HannaM.LaframboiseL.SelvanayagarajahS.GoldsteinR. (2007). Characterization of pulmonary rehabilitation programs in Canada in 2005. Canadian Respiratory Journal, 14(2), 87–92.
8.
ChoJ. E.LeeH. J.KimM. K.LeeW. H. (2018). The improvement in respiratory function by inspiratory muscle training is due to structural muscle changes in patients with stroke: a randomized controlled pilot trial. Topics in Stroke Rehabilitation, 25(1), 37–43.
9.
de SaR. B.PessoaM. F.CavalcantiA. G. L.CamposS. L.AmorimC.Dornelas de AndradeA. (2017). Immediate effects of respiratory muscle stretching on chest wall kinematics and electromyography in COPD patients. Respir Physiol Neurobiol, 242, 1–7. doi:10.1016/j.res2017.03.002
10.
DeanE.FrownfelterD. (2014). Cardiovascular and pulmonary physical therapy-E-Book. Evidence and Practice.
11.
DemecoA.ZolaL.FrizzieroA.MartiniC.PalumboA.ForestiR., ... CostantinoC. (2023). Immersive Virtual Reality in Post-Stroke Rehabilitation: A Systematic Review. Sensors (Basel), 23(3), 1712. doi:10.3390/s23031712
12.
GeedS.FeitP.EdwardsD. F.DromerickA. W. (2021). Why Are Stroke Rehabilitation Trial Recruitment Rates in Single Digits?Front Neurol, 12, 674237. doi:10.3389/fneur.2021.674237
13.
HodgesP. W.SapsfordR.PengelL. H. (2007). Postural and respiratory functions of the pelvic floor muscles. Neurourology and urodynamics, 26(3), 362–371. https://doi.org/10.1002/nau.20232
14.
HsiaC. C. (1999). Cardiopulmonary limitations to exercise in restrictive lung disease. Med Sci Sports Exerc, 31(1 Suppl), S28–S32. doi:10.1097/00005768-199901001-00005
15.
ItoM.KakizakiF.TsuzuraY.YamadaM. (1999). Immediate effect of respiratory muscle stretch gymnastics and diaphragmatic breathing on respiratory pattern. Respiratory Muscle Conditioning Group. Intern Med, 38(2), 126–132. doi:10.2169/internalmedicine.38.126
16.
KellyJ. O.KilbreathS. L.DavisG. M.ZemanB.RaymondJ. (2003). Cardiorespiratory fitness and walking ability in subacute stroke patients. Arch Phys Med Rehabil, 84(12), 1780–1785. doi:10.1016/s0003-9993(03)00376-9
17.
KidoS.NakajimaY.MiyasakaT.MaedaY.TanakaT.YuW., ... TakayanagiK. (2013). Effects of combined training with breathing resistance and sustained physical exertion to improve endurance capacity and respiratory muscle function in healthy young adults. J Phys Ther Sci, 25(5), 605–610. doi:10.1589/jpts.25.605
18.
KimC. B.ShinJ. H.ChoiJ. D. (2015). The effect of chest expansion resistance exercise in chronic stroke patients: a randomized controlled trial. J Phys Ther Sci, 27(2), 451–453. doi:10.1589/jpts.27.451
19.
LaniniB.BianchiR.RomagnoliI.ColiC.BinazziB.GigliottiF., ... ScanoG. (2003). Chest wall kinematics in patients with hemiplegia. Am J Respir Crit Care Med, 168(1), 109–113. doi:10.1164/rccm.200207-745OC
20.
LeeD. K.KimS. H. (2018). The effect of respiratory exercise on trunk control, pulmonary function, and trunk muscle activity in chronic stroke patients. J Phys Ther Sci, 30(5), 700–703. doi:10.1589/jpts.30.700
21.
LeelarungrayubD.PothongsununP.YankaiA.PratanaphonS. (2009). Acute clinical benefits of chest wall-stretching exercise on expired tidal volume, dyspnea and chest expansion in a patient with chronic obstructive pulmonary disease: A single case study. J Bodyw Mov Ther, 13(4), 338–343. doi:10.1016/j.jbmt.2008.11.004
22.
Lista-PazA.Torres-CastroR.FregoneziG.Gonzalez DonizL. (2019). Respiratory Muscle Training in Patients With Stroke. Am J Phys Med Rehabil, 98(7), e75–e76. doi:10.1097/PHM.0000000000001088
23.
MarekS. M.CramerJ. T.FincherA. L.MasseyL. L.DangelmaierS. M.PurkayasthaS., ... CulbertsonJ. Y. (2005). Acute Effects of Static and Proprioceptive Neuromuscular Facilitation Stretching on Muscle Strength and Power Output. J Athl Train, 40(2), 94–103.
24.
MenezesK. K.NascimentoL. R.AdaL.PoleseJ. C.AvelinoP. R.Teixeira-SalmelaL. F. (2016). Respiratory muscle training increases respiratory muscle strength and reduces respiratory complications after stroke: a systematic review. J Physiother, 62(3), 138–144. doi:10.1016/j.jphys.2016.05.014
25.
MinoguchiH.ShibuyaM.MiyagawaT.KokubuF.YamadaM.TanakaH., ... HommaI. (2002). Cross-over comparison between respiratory muscle stretch gymnastics and inspiratory muscle training. Intern Med, 41(10), 805–812. doi:10.2169/internalmedicine.41.805
26.
MiyaharaN.EdaR.TakeyamaH.KunichikaN.MoriyamaM.AoeK., ... HaradaM. (2000). Effects of short-term pulmonary rehabilitation on exercise capacity and quality of life in patients with chronic obstructive pulmonary disease. Acta Med Okayama, 54(4), 179–184. doi:10.18926/AMO/32272
27.
MontemezzoD.FregoneziG. A.PereiraD. A.BrittoR. R.ReidW. D. (2014). Influence of inspiratory muscle weakness on inspiratory muscle training responses in chronic heart failure patients: A systematic review and meta-analysis. Arch Phys Med Rehabil, 95(7), 1398–1407. doi:10.1016/j.apmr.2014.02.022
28.
NairS. P.GardasS. S.MithaiwalaR. (2021). Efficacy of chest expansion resistance exercise on respiratory function, trunk control and dynamic balance in patients with chronic stroke: A Comparative study. Bulletin of Faculty of Physical Therapy, 26, 1–8.
RehmanA.GanaiJ.AggarwalR.AlghadirA. H.IqbalZ. A. (2020). Effect of Passive Stretching of Respiratory Muscles on Chest Expansion and 6-Minute Walk Distance in COPD Patients. Int J Environ Res Public Health, 17(18), 6480. doi:10.3390/ijerph17186480
31.
SongG. B.ParkE. C. (2015). Effects of chest resistance exercise and chest expansion exercise on stroke patients’ respiratory function and trunk control ability. J Phys Ther Sci, 27(6), 1655–1658. doi:10.1589/jpts.27.1655
32.
TaussigL. M.LandauL. I. (2008). Pediatric Respiratory Medicine E-Book: Elsevier Health Sciences.
33.
Teixeira-SalmelaL. F.ParreiraV. F.BrittoR. R.BrantT. C.InacioE. P.AlcantaraT. O.CarvalhoI. F. (2005). Respiratory pressures and thoracoabdominal motion in community-dwelling chronic stroke survivors. Arch Phys Med Rehabil, 86(10), 1974–1978. doi:10.1016/j.apmr.2005.03.035
34.
TsuiA. Y.ChauR. M.CheingG. L.MokT. Y.LingS. O.KwanC. H.TsangS. M. (2023). Effect of chest wall mobilization on respiratory muscle function in patients with severe chronic obstructive pulmonary disease (COPD): a randomized controlled trial. Respiratory Medicine, 220, 107436.
35.
VazL. O.AlmeidaJ. C.FroesK.DiasC.PintoE. B.Oliveira-FilhoJ. (2021). Effects of inspiratory muscle training on walking capacity of individuals after stroke: A double-blind randomized trial. Clin Rehabil, 35(9), 1247–1256. doi:10.1177/0269215521999591
36.
WadaJ. T.Borges-SantosE.PorrasD. C.PaisaniD. M.CukierA.LunardiA. C.CarvalhoC. R. (2016). Effects of aerobic training combined with respiratory muscle stretching on the functional exercise capacity and thoracoabdominal kinematics in patients with COPD: a randomized and controlled trial. Int J Chron Obstruct Pulmon Dis, 11, 2691–2700. doi:10.2147/COPD.S114548
37.
WeinerP.MagadleR.BeckermanM.WeinerM.Berar-YanayN. (2003). Comparison of specific expiratory, inspiratory, and combined muscle training programs in COPD. Chest, 124(4), 1357–1364. doi:10.1378/chest.124.4.1357
38.
WuF.LiuY.YeG.ZhangY. (2020). Respiratory Muscle Training Improves Strength and Decreases the Risk of Respiratory Complications in Stroke Survivors: A Systematic Review and Meta-analysis. Arch Phys Med Rehabil, 101(11), 1991–2001. doi:10.1016/j.apmr.2020.04.017
