Respiratory training improved ventilatory function and respiratory muscle strength in patients with multiple sclerosis and lateral amyotrophic sclerosis: systematic review and meta-analysis

Background Among neurodegenerative diseases, multiple sclerosis (MS) and amyotrophic lateral sclerosis (ALS) have a high rate of respiratory disability. Objectives To analyze the effects of respiratory muscle training (RMT) on ventilatory function, muscle strength and functional capacity in patients with MS or ALS. Data sources A systematic review and meta-analysis of randomized controlled trials (RCTs) was performed. The sources were MEDLINE, PEDro, Cochrane CENTRAL, EMBASE, and LILACS, from inception to January 2015. Study selection/eligibility criteria The following were included: RCTs of patients with neurodegenerative diseases (MS or lateral ALS) who used the intervention as RMT (inspiratory/expiratory), comparison with controls who had not received RMT full time or were receiving training without load, and evaluations of ventilatory function (forced vital capacity - FVC, forced expiratory volume in one second FEV1, maximum voluntary ventilation - MVV), respiratory muscle strength (maximal expiratory pressure/maximum inspiratory pressure - MEP/MIP) and functional capacity (6-minute walk test - 6MWT). Results The review included nine papers, and a total of 194 patients. It was observed that RMT significantly increased at MIP (23.50 cmH(2)O; 95% CI: 7.82 to 39.19), MEP (12.03 cmH(2)O; 95% CI: 5.50 to 18.57) and FEV1 (0.27 L; 95% CI: 0.12 to 0.42) compared to the control group, but did not differ in FVC (0.48 L; 95% CI: -0.15 to 1.10) and distance in 6MWT (17.95 m; 95% CI: -4.54 to 40.44). Conclusion RMT can be an adjunctive therapy in the rehabilitation of neurodegenerative diseases improving ventilatory function and respiratory strength. (C) 2016 Chartered Society of Physiotherapy. Published by Elsevier Ltd. All rights reserved.