Magadle R, McConnell AK, Beckerman M, Weiner P
Respir Med. 2007;doi:10.1016/j.rmed.2007.01.010 (e-publication).
Summary
Most pulmonary rehabilitation (PR) programs do not currently incorporate IMT in their PR programs for COPD patients.
The aim of the present study was to assess the influence of adding IMT to the patients already involved in a rehabilitation program.
Thirty-four patients with significant COPD were recruited for the study. All patients participated in a general exercise reconditioning (GER) program for 12weeks. The patients were then randomized to receive IMT or sham IMT, in addition to GER for the next 6 months.
Following three months of GER training, there was a significant increase in the 6-min walk test (6MWT) (from mean +/- SEM 254 +/- 38 to 322 +/- 42 m, p < 0.01) and small but non-significant in the perception of dyspnea (POD) and in the St. George Respiratory Questionnaire score (SGRQ). Following the addition of IMT to the GER program, there was a significant increase in the PImax in the GER + IMT group (from 66 +/- 4.7 to 78 +/- 4.5 cm H2O, p < 0.01). This was accompanied by a significant improvement in the POD and a further significant improvement in the SGRQ score. IMT provides additional benefits to patients undergoing PR program and is worthwhile even in patients who have already undergone a GER program.
Editor's Comment.
Despite several studies supporting the use of IMT in PR, it seems that few programs actually incorporate this into practice. This study shows that IMT adds to the benefits already accrued from the exercise component of PR in the PImax, dyspnea perception, and St. George Respiratory Questionnaire score, but not in the 6-minute walk test. The authors' contention that the exercise program had already provided the maximum possible improvement in the 6-minute walk test is difficult to substantiate, and the alternate explanation may well be the small number of patients (already small at 34 to begin with, and with 3 dropouts at the exercise training stage and a further 4 in the IMT phase), which might have rendered a small but true increase difficult to identify (type 2 error). Pulmonary rehabilitation should include the IMT component before it can truly be called comprehensive.
SK