Skip to main content
Thorax logoLink to Thorax
. 2005 Jun 30;60(11):943–948. doi: 10.1136/thx.2004.028928

Exercise training and inspiratory muscle training in patients with bronchiectasis

C Newall 1, R Stockley 1, S Hill 1
PMCID: PMC1747238  PMID: 15994254

Abstract

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.

Full Text

The Full Text of this article is available as a PDF (84.2 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Berry M. J., Adair N. E., Sevensky K. S., Quinby A., Lever H. M. Inspiratory muscle training and whole-body reconditioning in chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 1996 Jun;153(6 Pt 1):1812–1816. doi: 10.1164/ajrccm.153.6.8665039. [DOI] [PubMed] [Google Scholar]
  2. Black L. F., Hyatt R. E. Maximal respiratory pressures: normal values and relationship to age and sex. Am Rev Respir Dis. 1969 May;99(5):696–702. doi: 10.1164/arrd.1969.99.5.696. [DOI] [PubMed] [Google Scholar]
  3. Borg G. A. Psychophysical bases of perceived exertion. Med Sci Sports Exerc. 1982;14(5):377–381. [PubMed] [Google Scholar]
  4. Cerny F. J. Relative effects of bronchial drainage and exercise for in-hospital care of patients with cystic fibrosis. Phys Ther. 1989 Aug;69(8):633–639. doi: 10.1093/ptj/69.8.633. [DOI] [PubMed] [Google Scholar]
  5. Cochrane G. M., Webber B. A., Clarke S. W. Effects of sputum on pulmonary function. Br Med J. 1977 Nov 5;2(6096):1181–1183. doi: 10.1136/bmj.2.6096.1181. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Foster S., Thomas H. M., 3rd Pulmonary rehabilitation in lung disease other than chronic obstructive pulmonary disease. Am Rev Respir Dis. 1990 Mar;141(3):601–604. doi: 10.1164/ajrccm/141.3.601. [DOI] [PubMed] [Google Scholar]
  7. Griffiths T. L., Burr M. L., Campbell I. A., Lewis-Jenkins V., Mullins J., Shiels K., Turner-Lawlor P. J., Payne N., Newcombe R. G., Ionescu A. A. Results at 1 year of outpatient multidisciplinary pulmonary rehabilitation: a randomised controlled trial. Lancet. 2000 Jan 29;355(9201):362–368. doi: 10.1016/s0140-6736(99)07042-7. [DOI] [PubMed] [Google Scholar]
  8. Guidelines for the measurement of respiratory function. Recommendations of the British Thoracic Society and the Association of Respiratory Technicians and Physiologists. Respir Med. 1994 Mar;88(3):165–194. [PubMed] [Google Scholar]
  9. Hill S. L., Stockley R. A. Effect of short and long term antibiotic response on lung function in bronchiectasis. Thorax. 1986 Oct;41(10):798–800. doi: 10.1136/thx.41.10.798. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Jones P. W., Quirk F. H., Baveystock C. M., Littlejohns P. A self-complete measure of health status for chronic airflow limitation. The St. George's Respiratory Questionnaire. Am Rev Respir Dis. 1992 Jun;145(6):1321–1327. doi: 10.1164/ajrccm/145.6.1321. [DOI] [PubMed] [Google Scholar]
  11. Koulouris N. G., Retsou S., Kosmas E., Dimakou K., Malagari K., Mantzikopoulos G., Koutsoukou A., Milic-Emili J., Jordanoglou J. Tidal expiratory flow limitation, dyspnoea and exercise capacity in patients with bilateral bronchiectasis. Eur Respir J. 2003 May;21(5):743–748. doi: 10.1183/09031936.03.00301103. [DOI] [PubMed] [Google Scholar]
  12. Larson J. L., Covey M. K., Wirtz S. E., Berry J. K., Alex C. G., Langbein W. E., Edwards L. Cycle ergometer and inspiratory muscle training in chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 1999 Aug;160(2):500–507. doi: 10.1164/ajrccm.160.2.9804067. [DOI] [PubMed] [Google Scholar]
  13. Larson J. L., Kim M. J., Sharp J. T., Larson D. A. Inspiratory muscle training with a pressure threshold breathing device in patients with chronic obstructive pulmonary disease. Am Rev Respir Dis. 1988 Sep;138(3):689–696. doi: 10.1164/ajrccm/138.3.689. [DOI] [PubMed] [Google Scholar]
  14. Lisboa C., Muñoz V., Beroiza T., Leiva A., Cruz E. Inspiratory muscle training in chronic airflow limitation: comparison of two different training loads with a threshold device. Eur Respir J. 1994 Jul;7(7):1266–1274. doi: 10.1183/09031936.94.07071266. [DOI] [PubMed] [Google Scholar]
  15. Nagle F. J., Balke B., Naughton J. P. Gradational step tests for assessing work capacity. J Appl Physiol. 1965 Jul;20(4):745–748. doi: 10.1152/jappl.1965.20.4.745. [DOI] [PubMed] [Google Scholar]
  16. Orenstein D. M., Franklin B. A., Doershuk C. F., Hellerstein H. K., Germann K. J., Horowitz J. G., Stern R. C. Exercise conditioning and cardiopulmonary fitness in cystic fibrosis. The effects of a three-month supervised running program. Chest. 1981 Oct;80(4):392–398. doi: 10.1378/chest.80.4.392. [DOI] [PubMed] [Google Scholar]
  17. Quanjer P. H., Tammeling G. J., Cotes J. E., Pedersen O. F., Peslin R., Yernault J. C. Lung volumes and forced ventilatory flows. Report Working Party Standardization of Lung Function Tests, European Community for Steel and Coal. Official Statement of the European Respiratory Society. Eur Respir J Suppl. 1993 Mar;16:5–40. [PubMed] [Google Scholar]
  18. Salh W., Bilton D., Dodd M., Webb A. K. Effect of exercise and physiotherapy in aiding sputum expectoration in adults with cystic fibrosis. Thorax. 1989 Dec;44(12):1006–1008. doi: 10.1136/thx.44.12.1006. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. Singh S. J., Morgan M. D., Scott S., Walters D., Hardman A. E. Development of a shuttle walking test of disability in patients with chronic airways obstruction. Thorax. 1992 Dec;47(12):1019–1024. doi: 10.1136/thx.47.12.1019. [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. Vale F., Reardon J. Z., ZuWallack R. L. The long-term benefits of outpatient pulmonary rehabilitation on exercise endurance and quality of life. Chest. 1993 Jan;103(1):42–45. doi: 10.1378/chest.103.1.42. [DOI] [PubMed] [Google Scholar]
  21. Wanke T., Formanek D., Lahrmann H., Brath H., Wild M., Wagner C., Zwick H. Effects of combined inspiratory muscle and cycle ergometer training on exercise performance in patients with COPD. Eur Respir J. 1994 Dec;7(12):2205–2211. doi: 10.1183/09031936.94.07122205. [DOI] [PubMed] [Google Scholar]
  22. Weiner P., Azgad Y., Ganam R. Inspiratory muscle training combined with general exercise reconditioning in patients with COPD. Chest. 1992 Nov;102(5):1351–1356. doi: 10.1378/chest.102.5.1351. [DOI] [PubMed] [Google Scholar]
  23. Weiner P., Magadle R., Berar-Yanay N., Davidovich A., Weiner M. The cumulative effect of long-acting bronchodilators, exercise, and inspiratory muscle training on the perception of dyspnea in patients with advanced COPD. Chest. 2000 Sep;118(3):672–678. doi: 10.1378/chest.118.3.672. [DOI] [PubMed] [Google Scholar]
  24. Wilson M. J., Martin D. E. Quantitative sputum culture as a means of excluding false positive reports in the routine microbiology laboratory. J Clin Pathol. 1972 Aug;25(8):697–700. doi: 10.1136/jcp.25.8.697. [DOI] [PMC free article] [PubMed] [Google Scholar]

Articles from Thorax are provided here courtesy of BMJ Publishing Group

RESOURCES