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Inspiratory Muscle Training Improves Intercostal and Forearm Muscle Oxygenation in Patients With Chronic Heart Failure: Evidence of the Origin of the Respiratory Metaboreflex

  • Author Footnotes
    1 Both authors contributed equally to this manuscript.
    Adalgiza M. Moreno
    Footnotes
    1 Both authors contributed equally to this manuscript.
    Affiliations
    Laboratory of Exercise Sciences, Department of Physiology and Pharmacology, Fluminense Federal University, Niteroi, Rio de Janeiro, Brazil
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  • Author Footnotes
    1 Both authors contributed equally to this manuscript.
    Alessandra C. Toledo-Arruda
    Footnotes
    1 Both authors contributed equally to this manuscript.
    Affiliations
    Laboratory of Exercise Sciences, Department of Physiology and Pharmacology, Fluminense Federal University, Niteroi, Rio de Janeiro, Brazil
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  • Jéssica S. Lima
    Affiliations
    Laboratory of Exercise Sciences, Department of Physiology and Pharmacology, Fluminense Federal University, Niteroi, Rio de Janeiro, Brazil
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  • Carolina S. Duarte
    Affiliations
    Laboratory of Exercise Sciences, Department of Physiology and Pharmacology, Fluminense Federal University, Niteroi, Rio de Janeiro, Brazil
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  • Humberto Villacorta
    Affiliations
    Laboratory of Exercise Sciences, Department of Physiology and Pharmacology, Fluminense Federal University, Niteroi, Rio de Janeiro, Brazil
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  • Antonio C.L. Nóbrega
    Correspondence
    Reprint requests: Antonio C.L. Nóbrega, MD, DSc, Laboratory of Exercise Sciences, Department of Physiology and Pharmacology, Fluminense Federal University, Prof Hernani Pires de Melo Street, 101, Room 106, Niteroi, Rio de Janeiro 24210-130, Brazil. Tel: +55 21 97551 0000; Fax: +55 21 2629 2404.
    Affiliations
    Laboratory of Exercise Sciences, Department of Physiology and Pharmacology, Fluminense Federal University, Niteroi, Rio de Janeiro, Brazil
    Search for articles by this author
  • Author Footnotes
    1 Both authors contributed equally to this manuscript.

      Highlights

      • Inspiratory muscle training (IMT) improved quality of life and ventilatory performance during a respiratory fatigue protocol in patients with chronic heart failure.
      • The reduction of oxygen saturation in intercostal and forearm muscles during respiratory fatigue was attenuated by IMT in patients with chronic heart failure.
      • IMT attenuated the increase in blood lactate during respiratory fatigue in patients with chronic heart failure.

      Abstract

      Background

      The impact of inspiratory muscle training (IMT) on respiratory and peripheral muscle oxygenation and perfusion during inspiratory muscle fatigue in patients with chronic heart failure (HF) has not been established.

      Methods and Results

      Twenty-six patients with chronic HF were randomly assigned to either 8 weeks of IMT or a control group. Inspiratory fatigue was induced by means of a progressive inspiratory resistive loading protocol until there was an inability to sustain inspiratory pressure, when the inspiratory muscle metaboreflex should be activated. The main outcomes were intercostal and forearm muscle oxygen saturation and deoxygenation as measured by means of near-infrared spectroscopy (NIRS) and blood lactate levels. Inspiratory muscle strength was increased by 78% (P <.001) after 8 weeks of participation in the IMT group. IMT attenuated the reduction of oxygen saturation in intercostal and forearm muscles and the increase in blood lactate during respiratory fatigue (P <.001 and P <.05, respectively). These changes were different from the control group (P <.01, P <.05, and P <.05, respectively). After 8 weeks, similar increases in oxygen consumption, mean arterial pressure, heart rate, stroke volume, and cardiac output were observed in both groups during respiratory fatigue.

      Conclusions

      This randomized controlled clinical trial demonstrates that IMT attenuates the respiratory muscle oxygen demand-delivery mismatch during respiratory fatigue in patients with chronic HF.

      Key Words

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