AUTHOR=Luo Zeruxin , Qian Hong , Zhang Xiu , Wang Yuqiang , Wang Jing , Yu Pengming 

TITLE=Effectiveness and safety of inspiratory muscle training in patients with pulmonary hypertension: A systematic review and meta-analysis

JOURNAL=Frontiers in Cardiovascular Medicine

VOLUME=Volume 9 - 2022

YEAR=2022

URL=https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2022.999422

DOI=10.3389/fcvm.2022.999422

ISSN=2297-055X

ABSTRACT=Background: Inspiratory muscle training (IMT) is a simple and well-tolerated physical therapy that increases respiratory muscle strength and relieving the degree of dyspnea and fatigue. Therefore, it may be used as a transitional modality before exercise training or as a specific physical therapy intervention for those who are diagnosed with respiratory muscle weakness. However, the current evidence on IMT in PH patients is inconclusive. The purpose of this systematic review and meta-analysis is to summarize the current role of inspiratory muscle training in this group of patients.
Methods: PubMed, EMBASE, and Cochrane databases were searched through May 2022. Trials examining the feasibility and effectiveness of IMT in pulmonary hypertension patients. Outcome measures included adverse events, training adherence and compliance, MIP, MEP, FVC%, FEV1%, FEV1/FVC%, 6-min walk distance, Peak VO2, dyspnea, and fatigue perception after the IMT training program. Only randomized controlled trials were included. The Cochrane Risk of Bias tool for controlled trials was adopted to assess study quality. Statistical heterogeneity was evaluated with the chi-square test and I2 statistic. Mean differences and 95% confidence intervals were estimated.
	
Results: We ultimately identified four studies that met the criteria. No severe adverse events were reported in the included studies. IMT had a significant effect on improving MIP(18.89 cmH2O; 95%CI: 9.43-28.35, P < 0.001) and MEP (8.06 cmH2O; 95%CI: 2.39-13.73; P = 0.005)，increase in the 6-minute walk distance (30.16m; 95%CI: 1.53-58.79; P = 0.04). No significant improvement was found in pulmonary function (P > 0.05), and uncertain effect on the quality of life score.

Conclusions: Based on currently limited evidence, IMT is an effective physical therapy for increasing respiratory muscle function and exercise capacity, but still a lack of evidence on dyspnea and fatigue levels, pulmonary function, and quality of life in pulmonary hypertension patients. There are reasons to believe that IMT is a promising intervention in PH patients, enriching rehabilitation options and serving as a bridge before formal exercise training. It is expected that IMT will play an important role in the future clinical pathway of physical therapy for this group of patients.