Respiratory Muscles Training in Patients With Dilated Cardiomyopathy
Respiratory Muscles Training in Patients With Dilated Cardiomyopathy
The aim of this study was to determine the effects of respiratory muscles training on
 cardiopulmonary parameters and quality of life in patients with dilated cardiomyopathy (DCM).
 It was a randomized control trial conducted on the calculated sample size of 22 patients
 divided into 2 groups. Study was conducted at Shifa International Hospital Islamabad.
 Clinically stable, diagnosed cases of DCM aged 30 to 60 years were included in the study.
 Outcomes of study were ejection fraction, Left ventricular (LV) End systolic dimensions, LV
 End diastolic dimension, lung volumes and capacities and quality of life. Data was analyzed
 on Statistical Package for the Social Sciences (SPSS) version 21.

 .
Dilated cardiomyopathy is the most common type of heart failure and primary source of heart
 replacement globally. It is characterized by poor left ventricular function,enlargement of
 left ventricle and systolic dysfunction. The underlying cause of DCM in adults is usually
 coronary artery disease, but other causes include inflammatory heart disease, myocardial
 toxins, and genetic defects; approximately 30% to 35% of patients are reported to have a
 genetic form of dilated cardiomyopathy. Most common sign and symptoms of dilated
 cardiomyopathy are ankle swelling, dyspnea, fatigue, elevated jugular venous pressure
 elevated, pulmonary rales due to reduced cardiac function with low output and elevated intra
 cardiac pressures. Other sign and symptoms chest pain due to reduced coronary blood flow,
 palpitation, syncope and sudden cardiac death. There is reduced exercise tolerance with
 fatigue and dyspnea, contributing to poor prognosis and quality of life.

 Chronic heart failure (CHF) patients have limited capacity to exercise and have impairments
 in breathing function.Respiratory muscle weakness is a part of the underlying cause for
 exercise intolerance in patients with heart failure with reduced ejection fraction.

 Pharmacological and non pharmacological management is directed to reduce clinical sign and
 symptoms and control of disease progression and complications like sudden cardiac arrest.
 Physical rehabilitation is beneficial, effective and safe for functional limitation of DCM
 patients. A modified Bruce protocol is usually used to gradually increase exercise intensity
 in cardiac rehabilitation programs for patients with cardiomyopathy. Bruce protocol was used
 to observe fluctuations in heart rate through a quick increase of exercise intensity for a
 short period of time. Some patients are able to exercise with higher intensity safely, but
 many patients reported difficulties on treadmill exercise. This becomes even more difficult
 when the intensity of the treadmill exercise is increased.

 Various studies have demonstrated the effects of exercise as well as inspiratory muscle
 training for improvement in patients with CHF and have considered it an important component
 of cardiac rehabilitation. Respiratory muscles training is commonly performed using
 inspiratory resistance devices but studies have proven that incentive spirometry could be an
 interesting alternative for clinical use for the cases where there is difficult to acquire
 the devices. Slow breathing treatment is safe and induces favourable effects in
 cardiopulmonary parameters, decreases rate of dyspnea, improves exercise performance and
 increases respiratory muscles and function. Deeper and slow breathing involves the use of
 diaphragm that is activated during slow breathing and does not increase respiratory
 workload.Respiratory muscles training is safe and improves physiologic parameters including
 an increase in oxygen saturation and improved exercise capacity, leading to an improvement in
 health status.

 This study is intended to observed the overall effect of respiratory muscles training
 including slow breathing and incentive spirometry along with treadmill training according to
 bruce protocol for improvement in their ejection fraction, left ventricular dimensions ,
 pulmonary function and quality of life.
Inclusion Criteria:

 -  Diagnosed cases of DCM

 -  New York Heart Association class (II)

 -  Clinically stable patients for at least (3) months

 -  Ejection Fraction (25 - 40%)

 Exclusion Criteria:

 -  Recent myocardial infarction, exercise induced angina and Syncope,

 -  Atrioventricular valve disease, selected for heart transplant

 -  Uncontrolled hypertension.

 -  Uncontrolled diabetes.

 -  Significant pulmonary disease. Intellectual, neurological or musculoskeletal
 abnormalities.