Respiratory muscle training for cystic fibrosis
Information
- DOI:
- https://doi.org/10.1002/14651858.CD006112.pub5Copy DOI
- Database:
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- Cochrane Database of Systematic Reviews
- Version published:
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- 17 December 2020see what's new
- Type:
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- Intervention
- Stage:
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- Review
- Cochrane Editorial Group:
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Cochrane Cystic Fibrosis and Genetic Disorders Group
- Copyright:
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- Copyright © 2020 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
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Cited by:
Authors
Contributions of authors
Up to 2018
Brian Houston drafted the protocol with comments from Helen Handoll and Cees van der Schans.
Nicola Mills, Arturo Solis‐Moya and Brian Houston extracted data and assessed study quality. Brian Houston drafted the full review with comments from Nicola Mills and Arturo Solis‐Moya.
Brian Houston acts as guarantor of the review.
For the 2018 update
Nathan Hilton drafted the update with comments from Arturo Solis‐Moya.
Nathan Hilton and Arturo Solis‐Moya extracted data and assessed study quality.
For the 2020 update
Gemma Stanford drafted the update with comments from Harrigan Ryan and Arturo Solis‐Moya.
Gemma Stanford, Harrigan Ryan and Arturo Solis‐Moya extracted data and assessed study quality.
Sources of support
Internal sources
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No sources of support supplied
External sources
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National Institute for Health Research, UK
This systematic review was supported by the National Institute for Health Research, via Cochrane Infrastructure funding to the Cochrane Cystic Fibrosis and Genetic Disorders Group.
Declarations of interest
Gemma Stanford declares no potential conflicts of interest; she has received a HEE/NIHR Clinical Doctoral Fellowship grant (ref: CDRF‐2014‐05‐055) from the UK National Institute of Health Research.
Arturo Solis Moya declares no potential conflicts of interest.
Harrigan Ryan declares no potential conflicts of interest.
Acknowledgements
We acknowledge the valuable contribution to the protocol and previous reviews of the previous review authors (Professor Cees van der Schans, Brian Houston, Helen Handoll, Nicola Mills, Nathan Hilton).
We thank Nikki Jahnke for her help and advice at both the protocol and review stage.
This project was supported by the National Institute for Health Research, via Cochrane Infrastructure funding to the Cochrane Cystic Fibrosis and Genetic Disorders Group. The views and opinions expressed therein are those of the authors and do not necessarily reflect those of the Systematic Reviews Programme, NIHR, NHS or the Department of Health.
Version history
| Published | Title | Stage | Authors | Version |
| 2020 Dec 17 | Respiratory muscle training for cystic fibrosis | Review | Gemma Stanford, Harrigan Ryan, Arturo Solis-Moya | |
| 2018 May 24 | Respiratory muscle training for cystic fibrosis | Review | Nathan Hilton, Arturo Solis‐Moya | |
| 2013 Nov 21 | Inspiratory muscle training for cystic fibrosis | Review | Brian W Houston, Nicola Mills, Arturo Solis‐Moya | |
| 2008 Oct 08 | Inspiratory muscle training for cystic fibrosis | Review | Brian W Houston, Nicola Mills, Arturo Solis‐Moya | |
| 2006 Jul 19 | Inspiratory muscle training for cystic fibrosis | Protocol | Brian Houston, Cees P van der Schans | |
Differences between protocol and review
Update 2011
Due to Teesside University (location of the lead author) changing its search engine, some of the search strategies have been re‐written. The search strategies in Appendix 5 have superseded those in Appendix 1.
Update 2018
In line with current Cochrane guidance, summary of findings tables have been added. The title has been changed from 'Inspiratory muscle training for cystic fibrosis' to 'Respiratory muscle training for cystic fibrosis'.
The new author team has re‐ordered the outcomes to prioritise outcomes that are deemed more clinically meaningful to people with CF.
Update 2020
Two new secondary outcome measures have been included which we felt important: postural stability and oxygen saturations.
Posture is an important marker for people with CF as poor posture is common; sometimes a poor posture which looks unusual is the key to a disease that can be hidden. Treatments that help to improve posture may be important to people with CF.
Oxygen saturations are often used as an outcome of clinical interventions to ensure oxygen levels in the body remain stable or improve with the treatment. Desaturation can be detrimental and potentially dangerous to the individual, and so saturations are often checked to ensure safety of the intervention. An improvement in oxygen saturations could also indicate an improvement in ventilation.
Keywords
MeSH
Medical Subject Headings (MeSH) Keywords
Medical Subject Headings Check Words
Adult; Child; Humans;
PICOs
Comparison 1: RMT (80% of maximal effort) versus control, Outcome 1: FEV1 (L)
Comparison 1: RMT (80% of maximal effort) versus control, Outcome 2: FVC (L)
Comparison 1: RMT (80% of maximal effort) versus control, Outcome 3: Chronic Respiratory Disease Questionnaire (mastery)
Comparison 1: RMT (80% of maximal effort) versus control, Outcome 4: Chronic Respiratory Disease Questionnaire (emotion)
Comparison 2: RMT (60% of maximal effort) versus control, Outcome 1: FEV1 (L)
Comparison 2: RMT (60% of maximal effort) versus control, Outcome 2: PImax (cm H₂O)
Comparison 3: RMT (40% of maximal effort) versus control, Outcome 1: FEV1 (L)
Comparison 3: RMT (40% of maximal effort) versus control, Outcome 2: FEV1 (% predicted)
Comparison 3: RMT (40% of maximal effort) versus control, Outcome 3: FVC (L)
Comparison 3: RMT (40% of maximal effort) versus control, Outcome 4: FVC (% predicted)
Comparison 3: RMT (40% of maximal effort) versus control, Outcome 5: Inspiratory muscle endurance (% PImax)
Comparison 4: RMT (30% of maximal effort) versus control, Outcome 1: FEV1 (% predicted) absolute
Comparison 4: RMT (30% of maximal effort) versus control, Outcome 2: FEV1 (% predicted) change from baseline
Comparison 4: RMT (30% of maximal effort) versus control, Outcome 3: FVC (%) absolute
Comparison 4: RMT (30% of maximal effort) versus control, Outcome 4: FVC (%) change from baseline
Comparison 4: RMT (30% of maximal effort) versus control, Outcome 5: Peak expiratory flow (%) absolute
Comparison 4: RMT (30% of maximal effort) versus control, Outcome 6: Peak expiratory flow (%) change from baseline
Comparison 4: RMT (30% of maximal effort) versus control, Outcome 7: Six‐minute walk test absolute
Comparison 4: RMT (30% of maximal effort) versus control, Outcome 8: Six‐minute walk test change from baseline
Comparison 4: RMT (30% of maximal effort) versus control, Outcome 9: Maximal inspiratory pressure (PImax) absolute
Comparison 4: RMT (30% of maximal effort) versus control, Outcome 10: Maximal inspiratory pressure (PImax) change from baseline
Comparison 4: RMT (30% of maximal effort) versus control, Outcome 11: Maximal expiratory pressure (PEmax) absolute
Comparison 4: RMT (30% of maximal effort) versus control, Outcome 12: Maximal expiratory pressure (PEmax) change from baseline
Comparison 4: RMT (30% of maximal effort) versus control, Outcome 13: Adherence
Comparison 4: RMT (30% of maximal effort) versus control, Outcome 14: Resting oxygen saturations absolute
Comparison 4: RMT (30% of maximal effort) versus control, Outcome 15: Resting oxygen saturations change from baseline
Comparison 4: RMT (30% of maximal effort) versus control, Outcome 16: Oxygen saturation change during test (absolute)
Comparison 4: RMT (30% of maximal effort) versus control, Outcome 17: Oxygen saturation change during test (change from baseline)
Comparison 4: RMT (30% of maximal effort) versus control, Outcome 18: Postural stability test absolute values after treatment (8 weeks)
Comparison 4: RMT (30% of maximal effort) versus control, Outcome 19: Postural stability test change from baseline (8 weeks)
Comparison 4: RMT (30% of maximal effort) versus control, Outcome 20: Limits of stability test absolute values after treatment (8 weeks)
Comparison 4: RMT (30% of maximal effort) versus control, Outcome 21: Limits of stability test change from baseline (8 weeks)
Comparison 5: RMT (20% of maximal effort) versus control, Outcome 1: FEV1 (L)
Comparison 5: RMT (20% of maximal effort) versus control, Outcome 2: FVC (L)
| Respiratory muscle training compared with control for cystic fibrosis | ||||||
| Patient or population: adults and children with cystic fibrosis Settings: outpatients Intervention: respiratory muscle traininga Comparison: controla | ||||||
| Outcomes | Illustrative comparative risks* (95% CI) | Relative effect | No of participants | Quality of the evidence | Comments | |
|---|---|---|---|---|---|---|
| Assumed risk | Corresponding risk | |||||
| Control | Respiratory muscle training | |||||
| FEV1 % predicted Follow‐up: 1 ‐ 3 months | No study reported any differences between the respiratory muscle training group and the control group. | NA | 83 (4) | ⊕⊝⊝⊝ | 1 study reported data for FEV1 % predicted at 40% of maximal capacity (de Jong 2001). 2 studies reported FEV1 % predicted at 30% of maximal capacity (Amelina 2006; Zeren 2019). 1 study reported FEV1 % predicted, but did not specify the resistance used (Asher 1983). 3 studies reported FEV1 measured in L and 1 measured z score; 1 study did not report the units of measurement. Results were similar to those for FEV1 % predicted. | |
| FVC: % predicted Follow‐up: 1 ‐ 3 months | No study reported any differences between the respiratory muscle training group and the control group. | NA | 72 (3) | ⊕⊝⊝⊝ | 1 study reported data for analysis for FVC (% predicted) at 40% of maximal capacity (de Jong 2001) and two studies at 30% of maximal capacity (Amelina 2006; Zeren 2019). 2 studies reported FVC in L and 1 measured z score; 1 study did not report the units of measurement. Results were similar to those for FVC % predicted. | |
| Exercise capacity: VO2max (mL/kg/min) Follow‐up: 1 ‐ 3 months | No study reported any differences between the respiratory muscle training group and the control group. | NA | 54 (3 studies including 1 cross‐over study) | ⊕⊝⊝⊝ | One study with an unspecified level of resistance reported an improvement within the respiratory muscle training group. | |
| HRQoL: total score Follow‐up: 1 ‐ 3 months | 2 studies reported no differences between the respiratory muscle training group and the control group. 1 study reported improvements in the parameters of mastery and emotion in the respiratory muscle training group compared to the control group. | NA | 69 (3 studies including 1 cross‐over study) | ⊕⊝⊝⊝ | 2 studies used the Chronic Respiratory Disease Questionnaire (CRDQ) and 1 study used the cystic fibrosis questionnaire (CFQ). | |
| Respiratory muscle function: maximal inspiratory pressure (PImax) Follow‐up: 1 ‐ 3 months | There was a greater improvement in the respiratory muscle training groups in 2 of the 4 studies measuring this outcome: MD 26.00 (95% CI 8.63 to 43.47) (Sawyer 1993); and MD 14.63 (95% CI 5.63 to 23.63) (Zeren 2019). The remaining 2 studies reported no differences between the respiratory muscle training group and the control group (Amelina 2006; Asher 1983). | NA | 87 (4 studies including 1 cross‐over study) | ⊕⊝⊝⊝ | Of the studies reporting a difference, the Sawyer study measured at 60% of maximal effort (Sawyer 1993) and the Zeren study measured at 30% resistance (Zeren 2019). 1 of the remaining studies reported at 30% of maximal effort (Amelina 2006) and 1 did not specify the level of resistance (Asher 1983). | |
| Respiratory muscle function: inspiratory capacity Follow‐up: 1 ‐ 3 months | No studies reported this outcome. | NA | ||||
| *The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). | ||||||
| GRADE Working Group grades of evidence | ||||||
| a. The resistance level of the respiratory muscle training intervention was variable; three studies used 80% of maximal effort, one study used 60% of maximal effort, one study used 40% of maximal effort, one study used 30% of maximal effort and three studies did not specify the level of resistance. Control groups were also variable; cycle ergometer, H20, treatment as usual, standard chest physiotherapy, low resistance threshold loading device, no training or sham training. b. Downgraded twice due to serious risk of bias: the included studies lacked methodological detail relating to methods of randomisation, allocation concealment and blinding. Most of the studies were at high risk of bias due to lack of blinding, incomplete outcome data or selective reporting, or both. c. Downgraded due to imprecision: studies included a small number of participants and numerical results were not available for some of the studies. | ||||||
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 1.1 FEV1 (L) Show forest plot | 1 | Mean Difference (IV, Fixed, 95% CI) | Totals not selected | |
| 1.1.1 One to three months | 1 | Mean Difference (IV, Fixed, 95% CI) | Totals not selected | |
| 1.2 FVC (L) Show forest plot | 1 | Mean Difference (IV, Fixed, 95% CI) | Totals not selected | |
| 1.2.1 One to three months | 1 | Mean Difference (IV, Fixed, 95% CI) | Totals not selected | |
| 1.3 Chronic Respiratory Disease Questionnaire (mastery) Show forest plot | 1 | Mean Difference (IV, Fixed, 95% CI) | Totals not selected | |
| 1.3.1 One to three months | 1 | Mean Difference (IV, Fixed, 95% CI) | Totals not selected | |
| 1.4 Chronic Respiratory Disease Questionnaire (emotion) Show forest plot | 1 | Mean Difference (IV, Fixed, 95% CI) | Totals not selected | |
| 1.4.1 One to three months | 1 | Mean Difference (IV, Fixed, 95% CI) | Totals not selected | |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 2.1 FEV1 (L) Show forest plot | 1 | Mean Difference (IV, Fixed, 95% CI) | Totals not selected | |
| 2.1.1 One to three months | 1 | Mean Difference (IV, Fixed, 95% CI) | Totals not selected | |
| 2.2 PImax (cm H₂O) Show forest plot | 1 | Mean Difference (IV, Fixed, 95% CI) | Totals not selected | |
| 2.2.1 One to three months | 1 | Mean Difference (IV, Fixed, 95% CI) | Totals not selected | |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 3.1 FEV1 (L) Show forest plot | 1 | Mean Difference (IV, Fixed, 95% CI) | Totals not selected | |
| 3.1.1 One to three months | 1 | Mean Difference (IV, Fixed, 95% CI) | Totals not selected | |
| 3.2 FEV1 (% predicted) Show forest plot | 1 | Mean Difference (IV, Fixed, 95% CI) | Totals not selected | |
| 3.2.1 One to three months | 1 | Mean Difference (IV, Fixed, 95% CI) | Totals not selected | |
| 3.3 FVC (L) Show forest plot | 1 | Mean Difference (IV, Fixed, 95% CI) | Totals not selected | |
| 3.3.1 One to three months | 1 | Mean Difference (IV, Fixed, 95% CI) | Totals not selected | |
| 3.4 FVC (% predicted) Show forest plot | 1 | Mean Difference (IV, Fixed, 95% CI) | Totals not selected | |
| 3.4.1 One to three months | 1 | Mean Difference (IV, Fixed, 95% CI) | Totals not selected | |
| 3.5 Inspiratory muscle endurance (% PImax) Show forest plot | 1 | Mean Difference (IV, Fixed, 95% CI) | Totals not selected | |
| 3.5.1 One to three months | 1 | Mean Difference (IV, Fixed, 95% CI) | Totals not selected | |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 4.1 FEV1 (% predicted) absolute Show forest plot | 1 | Mean Difference (IV, Fixed, 95% CI) | Totals not selected | |
| 4.1.1 One to three months | 1 | Mean Difference (IV, Fixed, 95% CI) | Totals not selected | |
| 4.2 FEV1 (% predicted) change from baseline Show forest plot | 1 | Mean Difference (IV, Fixed, 95% CI) | Totals not selected | |
| 4.2.1 One to three months | 1 | Mean Difference (IV, Fixed, 95% CI) | Totals not selected | |
| 4.3 FVC (%) absolute Show forest plot | 1 | Mean Difference (IV, Fixed, 95% CI) | Totals not selected | |
| 4.3.1 One to three months | 1 | Mean Difference (IV, Fixed, 95% CI) | Totals not selected | |
| 4.4 FVC (%) change from baseline Show forest plot | 1 | Mean Difference (IV, Fixed, 95% CI) | Totals not selected | |
| 4.4.1 One to three months | 1 | Mean Difference (IV, Fixed, 95% CI) | Totals not selected | |
| 4.5 Peak expiratory flow (%) absolute Show forest plot | 1 | Mean Difference (IV, Fixed, 95% CI) | Totals not selected | |
| 4.5.1 One to three months | 1 | Mean Difference (IV, Fixed, 95% CI) | Totals not selected | |
| 4.6 Peak expiratory flow (%) change from baseline Show forest plot | 1 | Mean Difference (IV, Fixed, 95% CI) | Totals not selected | |
| 4.6.1 One to three months | 1 | Mean Difference (IV, Fixed, 95% CI) | Totals not selected | |
| 4.7 Six‐minute walk test absolute Show forest plot | 1 | Mean Difference (IV, Fixed, 95% CI) | Totals not selected | |
| 4.7.1 One to three months | 1 | Mean Difference (IV, Fixed, 95% CI) | Totals not selected | |
| 4.8 Six‐minute walk test change from baseline Show forest plot | 1 | Mean Difference (IV, Fixed, 95% CI) | Totals not selected | |
| 4.8.1 One to three months | 1 | Mean Difference (IV, Fixed, 95% CI) | Totals not selected | |
| 4.9 Maximal inspiratory pressure (PImax) absolute Show forest plot | 1 | Mean Difference (IV, Fixed, 95% CI) | Totals not selected | |
| 4.9.1 One to three months | 1 | Mean Difference (IV, Fixed, 95% CI) | Totals not selected | |
| 4.10 Maximal inspiratory pressure (PImax) change from baseline Show forest plot | 1 | Mean Difference (IV, Fixed, 95% CI) | Totals not selected | |
| 4.10.1 One to three months | 1 | Mean Difference (IV, Fixed, 95% CI) | Totals not selected | |
| 4.11 Maximal expiratory pressure (PEmax) absolute Show forest plot | 1 | Mean Difference (IV, Fixed, 95% CI) | Totals not selected | |
| 4.11.1 One to three months | 1 | Mean Difference (IV, Fixed, 95% CI) | Totals not selected | |
| 4.12 Maximal expiratory pressure (PEmax) change from baseline Show forest plot | 1 | Mean Difference (IV, Fixed, 95% CI) | Totals not selected | |
| 4.12.1 One to three months | 1 | Mean Difference (IV, Fixed, 95% CI) | Totals not selected | |
| 4.13 Adherence Show forest plot | 1 | Mean Difference (IV, Fixed, 95% CI) | Totals not selected | |
| 4.13.1 One to three months | 1 | Mean Difference (IV, Fixed, 95% CI) | Totals not selected | |
| 4.14 Resting oxygen saturations absolute Show forest plot | 1 | Mean Difference (IV, Fixed, 95% CI) | Totals not selected | |
| 4.14.1 One to three months | 1 | Mean Difference (IV, Fixed, 95% CI) | Totals not selected | |
| 4.15 Resting oxygen saturations change from baseline Show forest plot | 1 | Mean Difference (IV, Fixed, 95% CI) | Totals not selected | |
| 4.15.1 One to three months | 1 | Mean Difference (IV, Fixed, 95% CI) | Totals not selected | |
| 4.16 Oxygen saturation change during test (absolute) Show forest plot | 1 | Mean Difference (IV, Fixed, 95% CI) | Totals not selected | |
| 4.16.1 One to three months | 1 | Mean Difference (IV, Fixed, 95% CI) | Totals not selected | |
| 4.17 Oxygen saturation change during test (change from baseline) Show forest plot | 1 | Mean Difference (IV, Fixed, 95% CI) | Totals not selected | |
| 4.17.1 Two to six months | 1 | Mean Difference (IV, Fixed, 95% CI) | Totals not selected | |
| 4.18 Postural stability test absolute values after treatment (8 weeks) Show forest plot | 1 | Mean Difference (IV, Fixed, 95% CI) | Totals not selected | |
| 4.18.1 Overall score | 1 | Mean Difference (IV, Fixed, 95% CI) | Totals not selected | |
| 4.18.2 Anterior/posterior SI | 1 | Mean Difference (IV, Fixed, 95% CI) | Totals not selected | |
| 4.18.3 Medial/lateral SI | 1 | Mean Difference (IV, Fixed, 95% CI) | Totals not selected | |
| 4.19 Postural stability test change from baseline (8 weeks) Show forest plot | 1 | Mean Difference (IV, Fixed, 95% CI) | Totals not selected | |
| 4.19.1 Overall score | 1 | Mean Difference (IV, Fixed, 95% CI) | Totals not selected | |
| 4.19.2 Anterior/posterior SI | 1 | Mean Difference (IV, Fixed, 95% CI) | Totals not selected | |
| 4.19.3 Medial/lateral SI | 1 | Mean Difference (IV, Fixed, 95% CI) | Totals not selected | |
| 4.20 Limits of stability test absolute values after treatment (8 weeks) Show forest plot | 1 | Mean Difference (IV, Fixed, 95% CI) | Totals not selected | |
| 4.20.1 Overall score | 1 | Mean Difference (IV, Fixed, 95% CI) | Totals not selected | |
| 4.20.2 Forward DS | 1 | Mean Difference (IV, Fixed, 95% CI) | Totals not selected | |
| 4.20.3 Backward DS | 1 | Mean Difference (IV, Fixed, 95% CI) | Totals not selected | |
| 4.20.4 Left DS | 1 | Mean Difference (IV, Fixed, 95% CI) | Totals not selected | |
| 4.20.5 Right DS | 1 | Mean Difference (IV, Fixed, 95% CI) | Totals not selected | |
| 4.21 Limits of stability test change from baseline (8 weeks) Show forest plot | 1 | Mean Difference (IV, Fixed, 95% CI) | Totals not selected | |
| 4.21.1 Overall score | 1 | Mean Difference (IV, Fixed, 95% CI) | Totals not selected | |
| 4.21.2 Forward DS | 1 | Mean Difference (IV, Fixed, 95% CI) | Totals not selected | |
| 4.21.3 Backward DS | 1 | Mean Difference (IV, Fixed, 95% CI) | Totals not selected | |
| 4.21.4 Left DS | 1 | Mean Difference (IV, Fixed, 95% CI) | Totals not selected | |
| 4.21.5 Right DS | 1 | Mean Difference (IV, Fixed, 95% CI) | Totals not selected | |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 5.1 FEV1 (L) Show forest plot | 1 | Mean Difference (IV, Fixed, 95% CI) | Totals not selected | |
| 5.1.1 One to three months | 1 | Mean Difference (IV, Fixed, 95% CI) | Totals not selected | |
| 5.2 FVC (L) Show forest plot | 1 | Mean Difference (IV, Fixed, 95% CI) | Totals not selected | |
| 5.2.1 One to three months | 1 | Mean Difference (IV, Fixed, 95% CI) | Totals not selected | |
