Efeitos do treinamento muscular respiratório sobre a função pulmonar e a tolerância ao exercício em pacientes pós-AVC: uma revisão sistemática

Abstract

Ferreira Neto, F. Effects of respiratory muscle training on pulmonary function and exercise tolerance in post-stroke patients: a systematic review. 2021. 82f. (Thesis) Doctorate in Interactive Processes of Organs and Systems – Institute of Health Sciences, Federal University of Bahia. Introduction: Stroke (CVA) is a vascular lesion with structural and functional alterations in the central nervous system, which affects multiple aspects of the patient, from motor, sensory, linguistic, emotional, and cognitive functions. Besides these deficiencies, it is common for these patients to have reduced cardiorespiratory fitness, as a consequence of the peripheral muscle involvement added to the respiratory one. Thus, respiratory muscle training (RMT) appears as a treatment alternative to be added to the therapeutic plan. However, there is a lack of scientific evidence on the effects associated with the types of resistive load and intensity of RMT, associated or not with neuro-functional treatment, on pulmonary functions and exercise tolerance. Therefore, this study sought to systematize the most recent evidence on the effects of respiratory muscle training to improve respiratory function and exercise tolerance in post- stroke patients. Method: This study, in a first moment, investigates the effects of RMT on pulmonary ventilation in post-stroke patients (Article 1). In a second moment, a new investigation was carried out in the scientific literature, with the objective of evaluating the effects of RMT with linear load on the exercise tolerance of patients after sub-acute to chronic stroke (Article 2). Both studies met the PRISMA criteria. Articles were searched in the VHL (Scielo, Lilacs, IBECS, Medline) and PubMed databases between the period January 2019 to June 2020 (Article 1) and January to October 2021 (Article 2), with limitation on language and no limitation on the period in which the studies were published. Included were, randomized controlled trials that used some method of RMT independent of load type (article 1) and specifically with linear load (article 2), and that assessed exercise tolerance (article 2), age 18 years, and sub-acute to chronic post-stroke. Results: A total of 8341 studies were screened and analyzed, systematizing the results of 25 studies on the effects of RMT in post-stroke patients; the interval of years of publications ranged from 2010 to 2021. The sample size ranged from 12 to 82 participants of both genders, and in almost all of them, two groups were used, an experimental and a control group, and four studies included a third placebo group or with another therapeutic method. Conclusion: RMT has beneficial effects on both lung function and exercise tolerance. The improvement of ventilatory markers - volumes, capacities and flows - and the respiratory muscle strength markers PIMax and PEMax were the most cited benefits. As for exercise tolerance, RMT, when associated with neuro-functional physiotherapy treatment, showed a better response, especially when RMT was prescribed at higher intensities.