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Clinical Investigations: Miscellaneous |

Effects of 8-Week, Interval-Based Inspiratory Muscle Training and Breathing Retraining in Patients With Generalized Myasthenia Gravis*

Guilherme Augusto de Freitas Fregonezi, PT, MSc; Vanessa Regiane Resqueti, PT, MSc; Rosa Güell, MD, PhD; Jesus Pradas, MD, PhD; Pere Casan, MD, PhD
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*From the Departments of Pneumology (Drs. Fregonezi, Resqueti, Güell and Casan) and Neurology (Dr. Pradas), Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.

Correspondence to: Guilherme Augusto de Freitas Fregonezi, PT, MSc, Departament de Pneumologia, Área de Rehabilitación Respiratoria, Hospital de la Santa Creu i de Sant Pau Av, Sant Antoni Maria Claret, 167 08025, Barcelona, Spain; e-mail: gfreitas@hsp.santpau.es



Chest. 2005;128(3):1524-1530. doi:10.1378/chest.128.3.1524
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Study objective: To assess the effect of interval-based inspiratory muscle training (IMT) combined with breathing retraining (BR) in patients with generalized myasthenia gravis (MG) in a partial home program.

Design: A randomized controlled trial with blinding of outcome assessment.

Setting: A secondary-care respiratory clinic.

Patients: Twenty-seven patients with generalized MG were randomized to a control group or a training group.

Interventions: The training group underwent interval-based IMT associated with BR (diaphragmatic breathing [DB] and pursed-lips breathing [PLB]) three times a week for 8 weeks. The sessions included 10 min each of DB, interval-based IMT, and PLB. Interval-based IMT consisted of training series interspersed with recovery time. The threshold load was increased from 20 to 60% of maximal inspiratory pressure (Pimax) over the 8 weeks.

Measurements and results: Lung function, respiratory pattern, respiratory muscle strength, respiratory endurance, and thoracic mobility were measured before and after the 8 weeks. The training group improved significantly compared to control group in Pimax (p = 0.001), maximal expiratory pressure (Pemax) [p = 0.01], respiratory rate (RR)/tidal volume (Vt) ratio (p = 0.05), and upper chest wall expansion (p = 0.02) and reduction (p = 0.04). Significant differences were seen in the training group compared to baseline Pimax (p = 0.001), Pemax (p = 0.01), maximal voluntary ventilation (p = 0.02), RR/Vt ratio (p = 0.003), Vt (p = 0.02), RR (p = 0.01), total time of RR (p = 0.01), and upper chest wall expansion (p = 0.005) and reduction (p = 0.005). No significant improvement was seen in lower chest wall or lung function.

Conclusions: The partial home program of interval-based IMT associated with BR is feasible and effective in patients with generalized MG. Improvements in respiratory muscle strength, chest wall mobility, respiratory pattern, and respiratory endurance were observed.

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