Chronic Obstructive Pulmonary Disease Clinical Trial
Official title:
Diaphragm and Sternocleidomastoid Muscle Activation Patterns During Different Loaded Inspiratory Muscle Performance in Patients With Chronic Obstructive Pulmonary Disease
Chronic obstructive pulmonary disease (COPD) is a chronic inflammatory lung disease that causes obstructed airflow from the lung, characterized by chronic cough, dyspnea, and sputum production. Inspiratory muscle weakness has been shown in patients with COPD, and inspiratory muscle training (IMT) is commonly applied to these patients. However, the optimal prescribed intensity of IMT for patients with COPD remains unclear. In healthy adults the accessory muscles would be recruited to assist ventilation with increasing ventilatory demand, but the activation pattern of accessory muscles has not been studied in patients with COPD during loaded condition such as IMT. Therefore, the purpose of this study is to exam diaphragm and sternocleidomastoid muscle activation using surface electromyography during loaded inspiratory muscle tests with intensity of 30% and 50% of maximal inspiratory pressure.
The prevalence of chronic obstructive pulmonary disease (COPD) is 11.7% around the world in
2010, and it is expected to rise over the next 30 years. COPD is a chronic inflammatory lung
disease that causes obstructed airflow from the lung, characterized by chronic cough,
dyspnea, and sputum production. Studies have found evidences of inspiratory muscle weakness
in patients with COPD which include a reduction in maximal inspiratory pressure (PImax), a
shift toward oxidative type I fibers and atrophy in all types of fibers in diaphragm muscle.
The shift of diaphragm muscle fiber toward oxidative type I fibers might result from
endurance training-like effect that served to counteract the negative effects of elevated
oxidative stress and systemic inflammation in patients with COPD.
Inspiratory muscle training (IMT) is commonly applied to patients with COPD during pulmonary
rehabilitation, but its clinical benefits remain inconclusive. Some studies showed that IMT
improves breathing pattern, dyspnea and the strength and endurance of diaphragm, while others
showed that IMT could not improve inspiratory muscle strength and functional exercise
capacity either applied alone or in addition to pulmonary rehabilitation in patients with
COPD. Evidence from animal study showed that overloading the diaphragm during resistive
breathing might induce acute diaphragm injury. Increases oxidative stress and systemic
inflammation, and exacerbating the apoptosis of the diaphragm fibers may also occur during
IMT in patients with COPD, which leads to the progression of diaphragm muscle fibers atrophy.
In human studies, the intensity used for IMT ranged from 10% to 70% of PImax, and the
training effect showed no clear dose-response pattern. The optimal intensity that would
induce positive physiological effect without eliciting overloading injury remains unclear. In
healthy adults, the accessory muscles, such as sternocleidomastoid (SCM), scalenes, and
intercostals muscle, would be recruited to assist ventilation with increasing ventilatory
demand. Thus the activation of accessory muscles could be an indicator for training overload.
However, the activation pattern of accessory muscle has not been studied in patients with
COPD during IMT. Whether the commonly prescribed intensity for IMT would lead to excessive
activation of diaphragm, and more accessory muscle recruitment in patients with COPD remains
to be determined. Therefore, the purpose of this study is to exam diaphragm and SCM muscle
activation using surface electromyography during loaded inspiratory muscle tests with 30% and
50% of PImax intensity.
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