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Exercise training and inspiratory muscle training in patients with bronchiectasis

Department of Respiratory Medicine, Queen Elizabeth Hospital, Birmingham, UK

Correspondence to:
Correspondence to:
Dr C Newall
Department of Respiratory Medicine, Queen Elizabeth Hospital, Birmingham B15 2TH, UK; Clare.Newall{at}uhb.nhs.uk

Background: Bronchiectasis is a chronic suppurative lung disease often characterised by airflow obstruction and hyperinflation, and leading to decreased exercise tolerance and reduced health status. The role of pulmonary rehabilitation (PR) and inspiratory muscle training (IMT) has not been investigated in this group of patients.

Methods: Thirty two patients with idiopathic bronchiectasis were randomly allocated to one of three groups: PR plus sham IMT (PR-SHAM), PR plus targeted IMT (PR-IMT), or control. All patients (except the control group) underwent an 8 week training programme of either PR or PR plus targeted IMT. Exercise training during PR was performed three times weekly at 80% of the peak heart rate. IMT was performed at home for 15 minutes twice daily over the 8 week period.

Results: PR-SHAM and PR-IMT resulted in significant increases in the incremental shuttle walking test of 96.7 metres (95% confidence interval (CI) 59.6 to 133.7) and 124.5 metres (95% CI 63.2 to 185.9), respectively, and in endurance exercise capacity of 174.9% (95% CI 34.7 to 426.1) and 205.7% (95% CI 31.6 to 310.6). There were no statistically significant differences in the improvements in exercise between the two groups. Significant improvements in inspiratory muscle strength were also observed both in the PR-IMT group (21.4 cm H₂O increase, 95% CI 9.3 to 33.4; p = 0.008) and the PR-SHAM group (12.0 cm H₂O increase, 95% CI 1.1 to 22.9; p = 0.04), the magnitude of which were also similar (p = 0.220). Improvements in exercise capacity were maintained in the PR-IMT group 3 months after training, but not in the PR-SHAM group.

Conclusion: PR is effective in improving exercise tolerance in bronchiectasis but there is no additional advantage of simultaneous IMT. IMT may, however, be important in the longevity of the training effects.

Abbreviations: FEV₁, forced expiratory volume in 1 second; IMT, inspiratory muscle training; KCO, carbon monoxide transfer coefficient; PImax, PEmax, maximum inspiratory and expiratory pressures; PR, pulmonary rehabilitation; RV, residual volume; TLC, total lung capacity; TLCO, lung carbon monoxide transfer factor; VC, vital capacity; V^·O₂, oxygen consumption

Keywords: respiratory muscle training; exercise tolerance; pulmonary rehabilitation; bronchiectasis

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