Cardiac surgery procedures are among the main treatments for people with cardiovascular disease, with physiotherapy playing a vital part. Respiratory complications are common and associated with prolonged Intensive Care Unit (ICU) and hospital stay, as well as increased mortality. Inspiratory muscle training has been found to be beneficial in improving respiratory muscle function in critically ill patients and patients with heart failure. The purpose of this review is to present the results of implementing inspiratory muscle training (IMT) programs in patients before and/or after cardiac surgery. The PubMed, Embase and Science Direct databases were searched from January 2012 to August 2023. In the present review, randomized controlled clinical trials (RCTs), clinical trials and quasi-experimental studies conducted in adult patients pre and/or post cardiac surgery were included. Fifteen studies were considered eligible for inclusion in the review. The results revealed that the IMT programs varied in intensity, repetitions, and duration in all included studies. Most studies implemented the IMT after the surgery. Statistical significance between groups was noted in Maximal Inspiratory Pressure and the 6-Minute Walk Distance Test. Preoperative and postoperative programs could improve inspiratory muscle strength, pulmonary function, and functional capacity as well as decrease the length of hospital stay in patients undergoing cardiac surgery. No clear evidence emerged favoring low or higher IMT intensities. The combination of IMT with other forms of exercise might be beneficial in patients undergoing cardiac surgery. However, further RCTs are required to provide confirming evidence.

Background/Objectives: The Nijmegen Questionnaire (NQ) has been a prevalent screening tool for dysfunctional breathing for the past 40 years. Until recently, the validity of the NQ has been established for the general population with hyperventilation syndrome (HVS) and for individuals with asthma, but not for people with COPD. The aim of the study was to examine the validity and reliability of the NQ in individuals with COPD. Methods: Construct, convergent, divergent and discriminant validity as well as internal consistency reliability were examined in a sample of 84 people with stable COPD. Results: A three-factor solution with 16 items and 74.70% of explained variability was extracted through principal component analysis. High internal consistency (Cronbach alpha = 0.94) of the 16 NQ items was found. Significant differences were found between COPD individuals with and without DB (p < 0.001) and among people of all COPD levels of severity (p < 0.001). The value “>23” was found to detect the presence of DB, with 95.92% sensitivity and 94.29% specificity. Significant correlations were found between the total NQ score with BODE index (r = 0.81), Borg dyspnea scale (r = 0.47) and CAT (r = 0.49). The prevalence of DB for the specific sample was found to be 58.3%. Conclusions: The present study provided the first validity and reliability evidence for the NQ for people with stable COPD.

Background: Exercise intolerance is a common symptom in patients with chronic heart failure (CHF) and is often associated with reduced pulmonary function. Breathing exercise, including inspiratory muscle training (IMT) has been shown to alleviate respiratory symptoms in patients with pulmonary and cardiac disease. The purpose of this systematic review is to assess the impact of IMT on maximal inspiratory pressure (Pimax), diaphragm thickness, functional vital capacity (FVC), dyspnea and maximum oxygen uptake (VO_2peak) in patients with CHF. Methods: Database research was conducted (PubMed, EMBASE, Cochrane Library of Controlled Trials) by using an appropriate algorithm to indicate the IMT effect on pulmonary function studies. Eligibility criteria included pulmonary function measurements following IMT in patients with CHF. A continuous random effect model (PROSPERO-CRD420261360295) was used to calculate standard mean differences (Std.MD) in all outcomes (between an experimental and control group). Results: A total of 395 participants (13 randomized controlled trials) were identified. More studies indicate improvement in Pimax after IMT (Pimax: Std.MD: 1.07; 95%CI, 0.72–1.42; p < 0.00001). Functional vital capacity (Std.MD, 0.41; 95%CI, 0.03–0.79; p = 0.03) and dyspnea (Std.MD, 1.11; 95%CI, 0.57–1.66; p < 0.0001) were also improved. Moreover, VO_2peak assessed by cardiopulmonary exercise testing before and after IMT showed statistical significance (VO_2peak: Std.MD: 0.86; 95%CI, 0.06–1.66; p = 0.04) in trained patients with CHF compared to controls. Conclusions: The meta-analysis indicates that isolated IMT performed either as short- to medium-term intervention (4 to 8 weeks) with moderate to high intensity (40 to 90% Pimax) or long-term program (8 to 12 weeks) with low intensity (30% Pimax) promotes pulmonary function and metabolic responses. More studies are required to examine the impact of IMT on diaphragm thickness in patients with chronic heart failure.

Background/Objective: Post-COVID survivors present significant respiratory deficiency that has been associated with ongoing shortness of breath and impaired lung function. Inspiratory muscle training (IMT) is increasingly used in survivors of COVID-19 rehabilitational programs as a means to facilitate recovery of the respiratory system. Yet, its home-based effectiveness across clinically relevant outcomes remains unclear. This systematic review aimed to present current evidence on home- or tele-delivered IMT in the post-COVID-19 population. Methods: PubMed, Scopus, Cochrane library and Science Direct were systematically searched for studies evaluating home-based (or telerehabilitation) IMT, alone or as part of a respiratory muscle training program, in adults with post-COVID-19 symptoms. The primary outcome was inspiratory muscle strength. Secondary outcomes included dyspnea, pulmonary function, exercise capacity and health-related quality of life. The methodological quality of the included studies was assessed via the PEDro scale. Owing to clinical and methodological heterogeneity, we performed only a qualitative synthesis. Results: Eight studies met the inclusion criteria. Two included both inspiratory and expiratory muscles training and three included physical training as well. The methodological quality was found to be good. IMT consistently increased inspiratory muscle strength across trials. Respiratory muscle training (RMT) programs that combined inspiratory and expiratory training also improved maximal expiratory pressure. IMT reduced dyspnea versus control/sham or baseline and several studies reported improvements in exercise capacity and physical function. Spirometry/DLCO changes were small or null in most cohorts. HRQoL gains were domain-specific in anxiety and depression. Adherence was generally good. No serious adverse events attributable to IMT were reported. Conclusions: Home-based IMT for adults with post-COVID-19 conditions is safe and seems to improve inspiratory muscle strength and dyspnea, with signs of benefit for exercise capacity, physical function, and selected HRQoL domains. Effects on ventilatory efficiency and conventional lung function appear limited. Future multicenter, sham-controlled RCTs should further explore the characteristics of IMT, employ core outcome sets, include longer follow-up, and predefine phenotype-based subgroups.

Background and Objectives: According to recent physiotherapy recommendations (WHO, WCPT, 2020) for patients with COVID-19, after discharge from an ICU, they are expected to experience respiratory, physical, cognitive, and psychological problems due to the duration and nature of the immobilization and sedation, ventilation duration, and underlying morbidity. Moreover, only patients with a limitation in physical capacity and/or physical activity have an indication for physiotherapy. However, little is known about the effect of physiotherapy treatment on the functional capacity of patients with COVID-19. Purpose: The aim of the present study was to provide information for the effectiveness of physiotherapy intervention on the respiratory and physical functional status of patients with COVID-19, since there will be a great demand for physiotherapy treatment for these people soon. Materials and Methods: The Ethics Committee of the AHEPA University Hospital, School of Medicine, Health Sciences Faculty, Aristotle University of Thessaloniki, Greece granted approval for this study. This pilot clinical study was conducted from March to June 2020. The sample consisted of 11 patients with COVID-19, discharged from an ICU and hospitalized in the COVID-19 clinic of AHEPA University Hospital. All participants had an indication for physiotherapy, according to the recommendations, and a medical referral as well. The duration of their hospitalization ranged from two to six weeks. Among participants, there were seven males and four females, aged from 44–75 yrs, five smokers and six nonsmokers, four obese and seven nonobese. According to the recommendations, physiotherapy intervention was tailored to the patients’ needs and goals. Breathing exercises, early mobilization, and self-management for daily living were performed once a day, for five days a week, as tolerated. Measurement tools: Pulse oximeter (SpO₂), respiratory rate (RR), the Borg scale (intensity of dyspnea), Medical Research Council scale for disability (MRCd), clinical evaluation for dysfunctional breathing (DB), Medical Research Council scale for muscle strength (MRCms), Berg balance scale, Sit to Stand test (leg strength and endurance), Time Up and Go test (TUG) (general mobility), 1 min walk test (1MWT) (aerobic capacity), and the Barthel Index (BI) (performance in daily activities). For the purposes of the study, two measurements were conducted: at admission and at discharge from the COVID-19 clinic. Results: Dependent sample tests showed a significant effect (p < 0.001) for the recommended physiotherapy treatment on respiratory variables: 6.9 (1.4)% for SpO₂, 3.4 (0.9) breaths for respiratory rate, and 5.0 (1.3) for the Borg scale score. Significant improvements (p < 0.001) were additionally noted for physical functioning: 25.3 (13.0) for the Berg balance scale, 18.5 (11.2) for the MRCms score, 3 (1.3) s for the Sit to Stand test, 40.4 (40.6) s for the TUG efforts, 44.1 (25.5) s for 1MWT, and 65.9 (20.2) for BI. All patients displayed DB at admission to the COVID-19 clinic, while nine of them adopted a diaphragmatic breathing pattern at discharge. At admission to the COVID-19 clinic, all patients were at level five disability (MRCd), whereas at discharge 10 out of 11 patients improved (three at level four, four at level three, and three at level two). Conclusions: The present pilot study provided first evidence for the effectiveness of the WHO and WCPT physiotherapy recommendations on the respiratory and physical functioning status of patients with COVID-19. Further studies are needed to support these early findings.