Meta-analysis of respiratory training on motor function, exercise endurance and activity of daily living in stroke patients_West China Medical Journal

Authors：

WANG Jianqiao , SU Guodong , SUN Yiwen , ZHANG Shilin , WANG Yue , Lü Xueqin , FAN Xiangde , FAN Hua ,  LIU Huilin

Department of Physiotherapy, Beijing Bo’ai Hospital, China Rehabilitation Research Centre, Beijing 100068, P. R. China;

Corresponding?author：

LIU Huilin, Email: liuhuilin2010@sina.com

Keywords：

Respiratory training; Stroke; Motor function; Exercise endurance; Activity of daily living

DOI：

10.7507/1002-0179.201902114

Video：

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Objective To evaluate whether respiratory training can improve motor function, exercise endurance, and activity of daily living (ADL) in stroke patients. Methods The randomized controlled trials of the effects of respiratory training on motor function, exercise endurance, and ADL in stroke patients were searched in PubMed, Embase, Google Scholar, China National Knowledge Infrastructure, Wanfang, and VIP Database. The search date was from the establishment of each database to December 2018. The control group received routine rehabilitation, medical treatment or other interventions, and the trial group added respiratory training on that basis. Outcome measures included the Fugl-Meyer Assessment (FMA), the 6-minute walk test (6MWT), and the modified Barthel Index (BI). The literature was independently screened by two investigators according to the inclusion and exclusion criteria, and the quality of the included articles was evaluated using the Physiotherapy Evidence Database scale and Cochrane Library systematic review criteria. Statistical analysis was performed using RevMan 5.3 software. Results A total of 11 articles with 741 stroke patients were included. Meta-analysis showed that in the trial group the exercise endurance [mean difference (MD)=41.50 m, 95% confidence interval (CI) (7.63, 75.37) m, P=0.02], ADL [MD=9.97, 95%CI (3.99, 15.96), P=0.001], and motor function [MD=8.00, 95%CI (1.29, 14.70), P=0.02] were improved compared with those in the control group. Subgroup analysis showed that after 8-10 weeks of intervention, BI of the trial group was higher than that of the control group [MD=25.37, 95%CI (16.49, 34.25), P<0.000 01]; after 8 weeks and 12 weeks to 3 months of intervention, FMA of the trial group was higher than that of the control group [ after 8 weeks: MD=20.40, 95%CI (9.72, 31.08), P=0.000 2; after 12 weeks to 3 months: MD=6.18, 95%CI (3.57, 8.79), P<0.000 01]. Conclusions The results of this study showed that respiratory training can improve exercise tolerance, ADL, and motor function in stroke patients. In consideration of the limited number of included articles as well as the heterogeneity among included articles in the current study, and the lack of long-term follow-up period, further studies could use more optimized respiratory training programs to conduct high-quality researches with bigger sample sizes.

Citation： WANG Jianqiao, SU Guodong, SUN Yiwen, ZHANG Shilin, WANG Yue, Lü Xueqin, FAN Xiangde, FAN Hua, LIU Huilin. Meta-analysis of respiratory training on motor function, exercise endurance and activity of daily living in stroke patients. West China Medical Journal, 2019, 34(5): 539-547. doi: 10.7507/1002-0179.201902114 Copy

1.	Thrift AG, Thayabaranathan T, Howard G, et al. Global stroke statistics. Int J Stroke, 2017, 12(1): 13-32.
2.	Hardwick RM, Rajan VA, Bastian AJ, et al. Motor learning in stroke: trained patients are not equal to untrained patients with less impairment. Neurorehabil Neural Repair, 2017, 31(2): 178-189.
3.	Han P, Zhang W, Kang L, et al. Clinical evidence of exercise benefits for stroke. Adv Exp Med Biol, 2017, 1000: 131-151.
4.	Ivey FM, Prior S, Hafer-Macko CE, et al. Strength training for skeletal muscle endurance after stroke. J Stroke Cerebrovasc Dis, 2017, 26(4): 787-794.
5.	Rochester CL, Vogiatzis I, Holland AE, et al. An official American Thoracic Society/European Respiratory Society policy statement: enhancing implementation, use, and delivery of pulmonary rehabilitation. Am J Respir Crit Care Med, 2015, 192(11): 1373-1386.
6.	陳彥, 吳霜. 肺康復訓練對腦卒中患者肺功能影響的Meta分析. 華西醫學, 2018, 33(10): 1277-1286.
7.	Pollock RD, Rafferty GF, Moxham J, et al. Respiratory muscle strength and training in stroke and neurology: a systematic review. Int J Stroke, 2013, 8(2): 124-130.
8.	Menezes KK, Nascimento LR, Avelino PR, et al. Efficacy of interventions to improve respiratory function after stroke. Respir Care, 2018, 63(7): 920-933.
9.	中華醫學會神經病學分會腦血管病學組急性缺血性腦卒中診治指南撰寫組. 中國急性缺血性腦卒中診治指南2010. 中國全科醫學, 2011, 14(12B): 4013-4017.
10.	Steiner T, Kaste M, Forsting M, et al. 腦出血治療指南. 王文娟, 劉艷芳, 趙性泉, 譯. 中國卒中雜志, 2006, 1(12): 888-899.
11.	de Morton NA. The PEDro scale is a valid measure of the methodological quality of clinical trials: a demographic study. Aust J Physiother, 2009, 55(2): 129-133.
12.	Higgins JP, Thompson SG, Deeks JJ, et al. Measuring inconsistency in meta-analyses. BMJ, 2003, 327(7414): 557-560.
13.	Higgins JP, Thompson SG. Quantifying heterogeneity in a meta-analysis. Stat Med, 2002, 21(11): 1539-1558.
14.	Chen PC, Liaw MY, Wang LY, et al. Inspiratory muscle training in stroke patients with congestive heart failure: a CONSORT-compliant prospective randomized single-blind controlled trial. Medicine (Baltimore), 2016, 95(37): e4856.
15.	Cho JE, Lee HJ, Kim MK, et al. The improvement in respiratory function by inspiratory muscle training is due to structural muscle changes in patients with stroke: a randomized controlled pilot trial. Top Stroke Rehabil, 2018, 25(1): 37-43.
16.	Jung KM, Bang DH. Effect of inspiratory muscle training on respiratory capacity and walking ability with subacute stroke patients: a randomized controlled pilot trial. J Phys Ther Sci, 2017, 29(2): 336-339.
17.	Kim J, Park JH, Yim J. Effects of respiratory muscle and endurance training using an individualized training device on the pulmonary function and exercise capacity in stroke patients. Med Sci Monit, 2014, 20: 2543-2549.
18.	Lee HJ, Kang TW, Kim BR. Effects of diaphragm and deep abdominal muscle exercise on walking and balance ability in patients with hemiplegia due to stroke. J Exerc Rehabil, 2018, 14(4): 648-653.
19.	馬頔, 王維. 呼吸訓練聯合常規康復訓練對偏癱患者功能康復的研究. 中國康復醫學雜志, 2016, 31(10): 1111-1116.
20.	宋征宇, 張鵬, 趙紅梅, 等. 不同呼吸訓練方式在腦卒中后疲勞治療中的效果及對患者膈肌功能的影響. 中國臨床醫生雜志, 2018, 46(12): 1450-1453.
21.	蘇國棟, 劉惠林, 黃夢潔, 等. 呼吸肌訓練對急性腦卒中患者運動功能的效果. 中國康復理論與實踐, 2016, 22(9): 1008-1010.
22.	吳紅琴, 張蘭香, 王速敏, 等. 呼吸訓練器對腦卒中患者肺功能及日常生活自理能力的影響. 江蘇醫藥, 2015, 41(19): 2328-2329.
23.	余旭芳, 吳李秀, 俞坤強, 等. Breathelink呼吸訓練器對腦卒中患者肺功能及日常生活活動能力的影響. 現代實用醫學, 2018, 30(9): 1180-1182.
24.	俞長君, 李雪萍, 林強, 等. 呼吸肌訓練對亞急性期腦卒中患者呼吸功能的影響. 中華物理醫學與康復雜志, 2016, 38(10): 735-739.
25.	Ezeugwu VE, Olaogun M, Mbada CE, et al. Comparative lung function performance of stroke survivors and age-matched and sex-matched controls. Physiother Res Int, 2013, 18(4): 212-219.
26.	Lista Paz A, González Doniz L, Ortigueira García S, et al. Respiratory muscle strength in chronic stroke survivors and its relation with the 6-minute walk test. Arch Phys Med Rehabil, 2016, 97(2): 266-272.
27.	Gladstone DJ, Danells CJ, Black SE. The Fugl-Meyer Assessment of motor recovery after stroke: a critical review of its measurement properties. Neurorehabil Neural Repair, 2002, 16(3): 232-240.
28.	Stinear CM. Prediction of motor recovery after stroke: advances in biomarkers. Lancet Neurol, 2017, 16(10): 826-836.
29.	Oh D, Kim G, Lee W, et al. Effects of inspiratory muscle training on balance ability and abdominal muscle thickness in chronic stroke patients. J Phys Ther Sci, 2016, 28(1): 107-111.
30.	Bellet RN, Adams L, Morris NR. The 6-minute walk test in outpatient cardiac rehabilitation: validity, reliability and responsiveness--a systematic review. Physiotherapy, 2012, 98(4): 277-286.
31.	中華醫學會神經病學分會, 中華醫學會神經病學分會神經康復學組, 中華醫學會神經病學分會腦血管病學組. 中國腦卒中早期康復治療指南. 中華神經科雜志, 2017, 50(6): 405-412.
32.	Matos-Garcia BC, Rocco IS, Maiorano LD, et al. A home-based walking program improves respiratory endurance in patients with acute myocardial infarction: a randomized controlled trial. Can J Cardiol, 2017, 33(6): 785-791.
33.	Aznar-Lain S, Webster AL, Ca?ete S, et al. Effects of inspiratory muscle training on exercise capacity and spontaneous physical activity in elderly subjects: a randomized controlled pilot trial. Int J Sports Med, 2007, 28(12): 1025-1029.
34.	Reyes A, Ziman M, Nosaka K. Respiratory muscle training for respiratory deficits in neurodegenerative disorders: a systematic review. Chest, 2013, 143(5): 1386-1394.
35.	Okada T, Huxel KC, Nesser TW. Relationship between core stability, functional movement, and performance. J Strength Cond Res, 2011, 25(1): 252-261.
36.	吳希希, 錢競光, 康延琳. 步態分析技術在偏癱康復中的應用研究. 南京體育學院學報(自然科學版), 2016, 15(3): 37-41, 81.
37.	Ohura T, Hase K, Nakajima Y, et al. Validity and reliability of a performance evaluation tool based on the modified Barthel Index for stroke patients. BMC Med Res Methodol, 2017, 17(1): 131.
38.	Sandhya KM, Sri KV, Madhavi K. Effectiveness of supervised fitness and mobility exercise program on fitness, mobility and muscle strength in young adults with stroke. Int J Physiother, 2014, 1(3): 158-168.
39.	Britto RR, Rezende NR, Marinho KC, et al. Inspiratory muscular training in chronic stroke survivors: a randomized controlled trial. Arch Phys Med Rehabil, 2011, 92(2): 184-190.
40.	Sutbeyaz ST, Koseoglu F, Inan L, et al. Respiratory muscle training improves cardiopulmonary function and exercise tolerance in subjects with subacute stroke: a randomized controlled trial. Clin Rehabil, 2010, 24(3): 240-250.

1. Thrift AG, Thayabaranathan T, Howard G, et al. Global stroke statistics. Int J Stroke, 2017, 12(1): 13-32.
2. Hardwick RM, Rajan VA, Bastian AJ, et al. Motor learning in stroke: trained patients are not equal to untrained patients with less impairment. Neurorehabil Neural Repair, 2017, 31(2): 178-189.
3. Han P, Zhang W, Kang L, et al. Clinical evidence of exercise benefits for stroke. Adv Exp Med Biol, 2017, 1000: 131-151.
4. Ivey FM, Prior S, Hafer-Macko CE, et al. Strength training for skeletal muscle endurance after stroke. J Stroke Cerebrovasc Dis, 2017, 26(4): 787-794.
5. Rochester CL, Vogiatzis I, Holland AE, et al. An official American Thoracic Society/European Respiratory Society policy statement: enhancing implementation, use, and delivery of pulmonary rehabilitation. Am J Respir Crit Care Med, 2015, 192(11): 1373-1386.
6. 陳彥, 吳霜. 肺康復訓練對腦卒中患者肺功能影響的Meta分析. 華西醫學, 2018, 33(10): 1277-1286.
7. Pollock RD, Rafferty GF, Moxham J, et al. Respiratory muscle strength and training in stroke and neurology: a systematic review. Int J Stroke, 2013, 8(2): 124-130.
8. Menezes KK, Nascimento LR, Avelino PR, et al. Efficacy of interventions to improve respiratory function after stroke. Respir Care, 2018, 63(7): 920-933.
9. 中華醫學會神經病學分會腦血管病學組急性缺血性腦卒中診治指南撰寫組. 中國急性缺血性腦卒中診治指南2010. 中國全科醫學, 2011, 14(12B): 4013-4017.
10. Steiner T, Kaste M, Forsting M, et al. 腦出血治療指南. 王文娟, 劉艷芳, 趙性泉, 譯. 中國卒中雜志, 2006, 1(12): 888-899.
11. de Morton NA. The PEDro scale is a valid measure of the methodological quality of clinical trials: a demographic study. Aust J Physiother, 2009, 55(2): 129-133.
12. Higgins JP, Thompson SG, Deeks JJ, et al. Measuring inconsistency in meta-analyses. BMJ, 2003, 327(7414): 557-560.
13. Higgins JP, Thompson SG. Quantifying heterogeneity in a meta-analysis. Stat Med, 2002, 21(11): 1539-1558.
14. Chen PC, Liaw MY, Wang LY, et al. Inspiratory muscle training in stroke patients with congestive heart failure: a CONSORT-compliant prospective randomized single-blind controlled trial. Medicine (Baltimore), 2016, 95(37): e4856.
15. Cho JE, Lee HJ, Kim MK, et al. The improvement in respiratory function by inspiratory muscle training is due to structural muscle changes in patients with stroke: a randomized controlled pilot trial. Top Stroke Rehabil, 2018, 25(1): 37-43.
16. Jung KM, Bang DH. Effect of inspiratory muscle training on respiratory capacity and walking ability with subacute stroke patients: a randomized controlled pilot trial. J Phys Ther Sci, 2017, 29(2): 336-339.
17. Kim J, Park JH, Yim J. Effects of respiratory muscle and endurance training using an individualized training device on the pulmonary function and exercise capacity in stroke patients. Med Sci Monit, 2014, 20: 2543-2549.
18. Lee HJ, Kang TW, Kim BR. Effects of diaphragm and deep abdominal muscle exercise on walking and balance ability in patients with hemiplegia due to stroke. J Exerc Rehabil, 2018, 14(4): 648-653.
19. 馬頔, 王維. 呼吸訓練聯合常規康復訓練對偏癱患者功能康復的研究. 中國康復醫學雜志, 2016, 31(10): 1111-1116.
20. 宋征宇, 張鵬, 趙紅梅, 等. 不同呼吸訓練方式在腦卒中后疲勞治療中的效果及對患者膈肌功能的影響. 中國臨床醫生雜志, 2018, 46(12): 1450-1453.
21. 蘇國棟, 劉惠林, 黃夢潔, 等. 呼吸肌訓練對急性腦卒中患者運動功能的效果. 中國康復理論與實踐, 2016, 22(9): 1008-1010.
22. 吳紅琴, 張蘭香, 王速敏, 等. 呼吸訓練器對腦卒中患者肺功能及日常生活自理能力的影響. 江蘇醫藥, 2015, 41(19): 2328-2329.
23. 余旭芳, 吳李秀, 俞坤強, 等. Breathelink呼吸訓練器對腦卒中患者肺功能及日常生活活動能力的影響. 現代實用醫學, 2018, 30(9): 1180-1182.
24. 俞長君, 李雪萍, 林強, 等. 呼吸肌訓練對亞急性期腦卒中患者呼吸功能的影響. 中華物理醫學與康復雜志, 2016, 38(10): 735-739.
25. Ezeugwu VE, Olaogun M, Mbada CE, et al. Comparative lung function performance of stroke survivors and age-matched and sex-matched controls. Physiother Res Int, 2013, 18(4): 212-219.
26. Lista Paz A, González Doniz L, Ortigueira García S, et al. Respiratory muscle strength in chronic stroke survivors and its relation with the 6-minute walk test. Arch Phys Med Rehabil, 2016, 97(2): 266-272.
27. Gladstone DJ, Danells CJ, Black SE. The Fugl-Meyer Assessment of motor recovery after stroke: a critical review of its measurement properties. Neurorehabil Neural Repair, 2002, 16(3): 232-240.
28. Stinear CM. Prediction of motor recovery after stroke: advances in biomarkers. Lancet Neurol, 2017, 16(10): 826-836.
29. Oh D, Kim G, Lee W, et al. Effects of inspiratory muscle training on balance ability and abdominal muscle thickness in chronic stroke patients. J Phys Ther Sci, 2016, 28(1): 107-111.
30. Bellet RN, Adams L, Morris NR. The 6-minute walk test in outpatient cardiac rehabilitation: validity, reliability and responsiveness--a systematic review. Physiotherapy, 2012, 98(4): 277-286.
31. 中華醫學會神經病學分會, 中華醫學會神經病學分會神經康復學組, 中華醫學會神經病學分會腦血管病學組. 中國腦卒中早期康復治療指南. 中華神經科雜志, 2017, 50(6): 405-412.
32. Matos-Garcia BC, Rocco IS, Maiorano LD, et al. A home-based walking program improves respiratory endurance in patients with acute myocardial infarction: a randomized controlled trial. Can J Cardiol, 2017, 33(6): 785-791.
33. Aznar-Lain S, Webster AL, Ca?ete S, et al. Effects of inspiratory muscle training on exercise capacity and spontaneous physical activity in elderly subjects: a randomized controlled pilot trial. Int J Sports Med, 2007, 28(12): 1025-1029.
34. Reyes A, Ziman M, Nosaka K. Respiratory muscle training for respiratory deficits in neurodegenerative disorders: a systematic review. Chest, 2013, 143(5): 1386-1394.
35. Okada T, Huxel KC, Nesser TW. Relationship between core stability, functional movement, and performance. J Strength Cond Res, 2011, 25(1): 252-261.
36. 吳希希, 錢競光, 康延琳. 步態分析技術在偏癱康復中的應用研究. 南京體育學院學報(自然科學版), 2016, 15(3): 37-41, 81.
37. Ohura T, Hase K, Nakajima Y, et al. Validity and reliability of a performance evaluation tool based on the modified Barthel Index for stroke patients. BMC Med Res Methodol, 2017, 17(1): 131.
38. Sandhya KM, Sri KV, Madhavi K. Effectiveness of supervised fitness and mobility exercise program on fitness, mobility and muscle strength in young adults with stroke. Int J Physiother, 2014, 1(3): 158-168.
39. Britto RR, Rezende NR, Marinho KC, et al. Inspiratory muscular training in chronic stroke survivors: a randomized controlled trial. Arch Phys Med Rehabil, 2011, 92(2): 184-190.
40. Sutbeyaz ST, Koseoglu F, Inan L, et al. Respiratory muscle training improves cardiopulmonary function and exercise tolerance in subjects with subacute stroke: a randomized controlled trial. Clin Rehabil, 2010, 24(3): 240-250.

West China Medical Journal

Meta-analysis of respiratory training on motor function, exercise endurance and activity of daily living in stroke patients

Abstract Full text Figures/Tables Video References Cited by

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