Treinamento muscular respiratório em indivíduos com doença de Parkinson

Abstract

Respiratory dysfunction is one of the leading causes of hospitalization and death in individuals with Parkinson's disease (PD). Individuals with PD commonly exhibit reduced respiratory muscle strength and inspiratory muscle endurance, which seem to be associated with increased disability and a lower quality of life. Respiratory muscle training (RMT) is widely used in various populations to improve respiratory muscle strength and other related outcomes. However, research on this intervention in individuals with PD remains limited. To reduce this gap, five studies were conducted to investigate the application of RMT in this population. The first two studies consist of the protocol and the systematic review investigating the measurement properties and clinical utility of measurement tools used in telerehabilitation in individuals with neurological conditions, among them the PD. A total of 47 studies were included, identifying 43 measurement tools. Only three of these studies were conducted with individuals with PD. Eight instruments were recommended for their adequatemeasurement properties and clinical utility, none of them for individuals with PD. The third and fourth studies consist of the protocol and the randomized clinical trial (RCT) that evaluated the efficacy of high-intensity home-based inspiratory and expiratory muscle training on inspiratory and expiratory muscle strength (primary outcomes), inspiratory muscle endurance, peak cough flow, dyspnea, fatigue, exercise capacity, and quality of life (secondary outcomes) of individuals with PD. Individuals were randomly assigned to either the experimental group (EG) or the control group (CG). The EG performed high-intensity RMT (60% of maximum inspiratory pressure (MIP) and 60% of maximum expiratory pressure (MEP)) for 40 minutes per day (2 sessions of 20 minutes per day), 7 days a week, for 8 weeks. The CG followed the same protocol but without any load. Thirty-four individuals (69.53±8.35 years) were included. Compared to the CG, the EG showed significant increases in MIP (19.56 cmH2O; 95% CI: 9.67-29.45), MEP (24.29 cmH2O; 95% CI: 9.87-38.71), inspiratory muscle endurance (1.21 minutes; 95% CI: 0.39-2.03), exercise capacity (39.35 meters; 95% CI: 0.58-78.12) and reduction in dyspnea (-0.71 points; 95% CI: 1.30- -0.12). The improvements in MIP, inspiratory muscle endurance and dyspnea were maintained at follow-up. Both groups showed improvements in peak cough flow and quality of life, which were also maintained at follow-up. The fifth study investigated the perspectives, self efficacy, barriers and facilitators of the intervention among RCT participants. Thirty-one individuals (69.68±8.31 years) were included. No significant differences between the groups were observed for any outcomes. On a scale of 0 to 100, the perceived importance of RMT was rated at 91.39 (IQR 20). Fifty-five percent (n=17) of participants preferred exercising at home. On a scale of 1 to 5, self-efficacy was 3.90±0.14. The main barriers identified were lack of equipment (n=29;93.5%), information (n=28;90.3%), support (n=28;90.3%) and knowledge on the part of health professionals (n=28;90.3%). The main facilitators were performing the exercises at home (n=4) and the perceived effects of the training (n=4). Therefore, there is a need for methodological studies that investigate the measurement properties and clinical applicability of instruments used to assess health and functional outcomes in individuals with PD. Additionally, it was highlighted that home-based high intensity combined inspiratory and expiratory muscle training is effective in improving key outcomes in this population. Finally, participants' perspectives, self-efficacy, as well as identified barriers and facilitators, can inform the development of effective strategies for implementing home-based RMT.