Effects of Training in Pulmonary Hypertension
Condition: Respiratory Muscle Strength
MeSH terms: Hypertension, Pulmonary; Hypertension
Study type: Interventional

Summary: 
      Pulmonary hypertension (HP) is a progressive pathological condition presents with vascular
      changes in the lung. Cardiopulmonary changes in PH are considered the main limiting factor,
      however, it is known that the muscular alterations potentiate the symptomatology. Several HP
      factors and mechanisms have an impact on peripheral and respiratory muscle changes, so,
      specifically, respiratory muscles are also altered in patients with PH.

      In the face of respiratory muscle weakness, inspiratory muscle training (IMT) has been shown
      to increase respiratory muscle strength and functional capacity in chronic conditions such as
      obstructive pulmonary disease (COPD) and heart failure (HF).

      The objective of this study is to test whether a 12-week TMI protocol is capable of impacting
      functional capacity, respiratory muscle strength, spirometric values and quality of life in
      patients with PH.
    

Detailed description: 
      Pulmonary hypertension (HP) is a progressive pathological condition that HP presents with
      vascular changes in the lung that cause proliferative and obstructive remodeling promoting
      vasoconstriction with a consequent increase in pulmonary vascular resistance (PVR).

      Cardiopulmonary changes in PH are considered the main limiting factor, however, it is known
      that the muscular alterations potentiate the symptomatology. Several HP factors and
      mechanisms have an impact on peripheral and respiratory muscle changes, such as: decreased
      cardiac output, hypoxemia, inflammation, increased insulin resistance, altered autonomic
      nervous system (ANS) response, and muscle disuse. These factors imply alteration of fiber
      type, atrophy, capillary vascular reduction, reduction of oxidative capacity, endothelial
      dysfunction and decreased muscle excitability by ANS.

      Specifically, respiratory muscles are also altered in patients with PH. For the treatment of
      PH, in addition to optimized drug therapy, studies have demonstrated the effects of physical
      exercise for this population. Although there is no consensus about the best exercise
      modality, duration, frequency or intensity, physical training promotes benefits in exercise
      capacity, maximal oxygen capacity (VO2peak) and quality of life. The most recent European
      guideline [3] recommends supervised exercise in patients with PH who are clinically stable
      with optimized drug therapy (evidence grade IIa, Level B), but patients often do not have
      access to supervised physical rehabilitation programs, which Practice a challenge.

      In the face of respiratory muscle weakness, inspiratory muscle training (IMT) has been shown
      to increase respiratory muscle strength and functional capacity in chronic conditions such as
      obstructive pulmonary disease (COPD) and heart failure (HF). At HP, the study by Saglam M et
      al., 2015 demonstrates improvement of respiratory muscle strength and functional capacity,
      resulting in decreased dyspnea and fatigue in PH patients who performed the IMT protocol
      during six weeks of outpatient training.

      The objective of this study is to test whether a 12-week TMI protocol is capable of impacting
      functional capacity, respiratory muscle strength, spirometric values and quality of life in
      patients with PH.
    

Intervention name(s): respiratory muscle training; sham muscle training
Intervention type(s): Other; Other
Intervention description(s): The TMI protocol will be performed with POWERbreathe Line Plus (POWERbreathe International Ltd. Warwickshire, England) linear loader with resistance load of 30% of maximal inspiratory pressure (PImax) value for a period of 12 weeks, 7 times at Week, 30 min / day, one of the times in the week with the supervision of the researcher and, on the other six days of the week, patients will perform IMT at their homes, having as a control a records record of the protocol that will be delivered to each patient To record the time and duration of the exercise. At the end of each week, patients will be reevaluated for MIP, so that the load values are regulated according to the possible increase in inspiratory muscle strength. The data collection will be performed by a single evaluator and the patients will be properly oriented on the procedures to be performed.; sham comparator
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Triple (Participant, Investigator, Outcomes Assessor)
Primary purpose: Treatment
Keywords: Respiratory muscle strength; Pulmonary hypertension; Respiratory muscle training