Background
Patients with pulmonary hypertension (PH) may have impaired exercise capacity and
quality of life; this may possibly be due to the early onset of dyspnoea associated
with respiratory muscle weakness. Respiratory muscle training could improve the condition
of these patients, so this study aimed to determine, through a systematic review and
meta-analysis, the effectiveness of respiratory muscle training in adult patients
with PH.
Methods
Medline, Embase, CENTRAL, clinical trial registries databases, and grey literature
and reference lists of reviews related to the objective were searched up to March
2022. Controlled clinical trials comparing the effectiveness of respiratory muscle
training with sham or no intervention in adults with PH were included. Records were
independently screened by two authors. The primary outcomes were maximal and functional
exercise capacity, quality of life, and dyspnoea. The secondary outcomes were respiratory
muscle strength, physical activity, lung function, and adverse events. Two authors
independently extracted data and the study quality was assessed using the Cochrane
risk-of-bias tool 2 (RoB 2). The certainty of the evidence was assessed according
to the GRADE approach.
Results
A total of 5,524 records were screened, and seven randomised clinical trials (RCTs)
(257 participants) were included. It was uncertain whether inspiratory muscle training
(IMT), compared with sham IMT or no intervention, increased the distance walked in
the 6-minute walk test (6MWT) (MD, 39 m; 95% CI, 20.72–57.39; I2=27%; four RCTs; very low certainty of evidence) and slightly decreased the perceived
sensation of dyspnoea (MD, 0.5 points on the mMRC scale; 95% CI, –0.87 to –0.13; I2=0%; two RCTs; very low certainty of evidence). In addition, it was uncertain whether
IMT had no effect on the emotional (SMD, –0.34; 95% CI, –1.06 to 0.38; I2=64%; three RCTs; very low certainty of evidence) and physical (SMD, 0.06; 95% CI,
–0.41 to 0.52; I2=16%; three RCTs; very low certainty of evidence) component of quality of life.
Conclusions
It is uncertain whether IMT increases functional exercise capacity and slightly decreases
the sensation of dyspnoea. In addition, it is uncertain whether IMT does not affect
the quality of life. More RCTs and with a better methodological design are needed
to increase the certainty of the evidence and determine the real effect of this intervention.
Keywords
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Article info
Publication history
Published online: January 12, 2023
Accepted:
November 16,
2022
Received in revised form:
November 1,
2022
Received:
April 22,
2022
Identification
Copyright
© 2022 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.
