Respiratory Muscles Training in Patients With Dilated Cardiomyopathy
Condition: Dilated Cardiomyopathy
MeSH terms: Cardiomyopathies; Cardiomyopathy, Dilated
Study type: Interventional

Summary: 
      The aim of this study was to determine the effects of respiratory muscles training on
      cardiopulmonary parameters and quality of life in patients with dilated cardiomyopathy (DCM).
      It was a randomized control trial conducted on the calculated sample size of 22 patients
      divided into 2 groups. Study was conducted at Shifa International Hospital Islamabad.
      Clinically stable, diagnosed cases of DCM aged 30 to 60 years were included in the study.
      Outcomes of study were ejection fraction, Left ventricular (LV) End systolic dimensions, LV
      End diastolic dimension, lung volumes and capacities and quality of life. Data was analyzed
      on Statistical Package for the Social Sciences (SPSS) version 21.

      .
    

Detailed description: 
      Dilated cardiomyopathy is the most common type of heart failure and primary source of heart
      replacement globally. It is characterized by poor left ventricular function,enlargement of
      left ventricle and systolic dysfunction. The underlying cause of DCM in adults is usually
      coronary artery disease, but other causes include inflammatory heart disease, myocardial
      toxins, and genetic defects; approximately 30% to 35% of patients are reported to have a
      genetic form of dilated cardiomyopathy. Most common sign and symptoms of dilated
      cardiomyopathy are ankle swelling, dyspnea, fatigue, elevated jugular venous pressure
      elevated, pulmonary rales due to reduced cardiac function with low output and elevated intra
      cardiac pressures. Other sign and symptoms chest pain due to reduced coronary blood flow,
      palpitation, syncope and sudden cardiac death. There is reduced exercise tolerance with
      fatigue and dyspnea, contributing to poor prognosis and quality of life.

      Chronic heart failure (CHF) patients have limited capacity to exercise and have impairments
      in breathing function.Respiratory muscle weakness is a part of the underlying cause for
      exercise intolerance in patients with heart failure with reduced ejection fraction.

      Pharmacological and non pharmacological management is directed to reduce clinical sign and
      symptoms and control of disease progression and complications like sudden cardiac arrest.
      Physical rehabilitation is beneficial, effective and safe for functional limitation of DCM
      patients. A modified Bruce protocol is usually used to gradually increase exercise intensity
      in cardiac rehabilitation programs for patients with cardiomyopathy. Bruce protocol was used
      to observe fluctuations in heart rate through a quick increase of exercise intensity for a
      short period of time. Some patients are able to exercise with higher intensity safely, but
      many patients reported difficulties on treadmill exercise. This becomes even more difficult
      when the intensity of the treadmill exercise is increased.

      Various studies have demonstrated the effects of exercise as well as inspiratory muscle
      training for improvement in patients with CHF and have considered it an important component
      of cardiac rehabilitation. Respiratory muscles training is commonly performed using
      inspiratory resistance devices but studies have proven that incentive spirometry could be an
      interesting alternative for clinical use for the cases where there is difficult to acquire
      the devices. Slow breathing treatment is safe and induces favourable effects in
      cardiopulmonary parameters, decreases rate of dyspnea, improves exercise performance and
      increases respiratory muscles and function. Deeper and slow breathing involves the use of
      diaphragm that is activated during slow breathing and does not increase respiratory
      workload.Respiratory muscles training is safe and improves physiologic parameters including
      an increase in oxygen saturation and improved exercise capacity, leading to an improvement in
      health status.

      This study is intended to observed the overall effect of respiratory muscles training
      including slow breathing and incentive spirometry along with treadmill training according to
      bruce protocol for improvement in their ejection fraction, left ventricular dimensions ,
      pulmonary function and quality of life.
    

Intervention name(s): Treadmill training; Treadmill protocol and Respiratory training
Intervention type(s): Other; Other
Intervention description(s): 3 days per week, starting at shorter duration 5-20min and progressed to 30- 40mins.
Training% or Intensity was kept 40-70%,
Training Heart Rate (HR) was calculated through formula:
HR max HR rest*Ex intensity + HR rest Rate of Perceived Exertion (RPE) 9-14 ON 6 -20 RPE scale The session was terminated if sustained ventricular arrhythmia, symptomatic drop in blood pressure, ST elevation, or development of severe symptoms; Treadmill protocol
Spirometry:
Volumetric exercises, using incentive Spirometer 10-15 repetitions
Slow breathing training:
5 minutes: spontaneous breathing, 4 minutes: controlled breathing (15 breaths/min) 4 minutes of controlled breathing (6 breaths/min) Treatment provided for 3 days in a week for a period of 4 weeks
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment
Keywords: Bruce protocol; Congestive heart failure; Dilated cardiomyopathy; Incentive spirometry; Slow breathing training