6533b7dafe1ef96bd126de7d

RESEARCH PRODUCT

Entrenamiento respiratorio: cambios en la presión inspiratoria máxima y relación con la funcionalidad del adulto mayor sano

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description

Los programas multicomponente (MCTP) han demostrado su mejora sobre la capacidad funcional del adulto mayor, tanto en el ámbito cardiovascular (aptitud cardiorrespiratoria) como neuromuscular (fuerza de miembros superiores e inferiores). Sin embargo, estos programas no incluyen ni la evaluación, ni el entrenamiento de la musculatura respiratoria. Con el fin de analizar la relación entre la fuerza inspiratoria (MIP) y la función pulmonar (FVC, FEV1, FEV1/FVC, FEF25%-75%, PEF); y entre la MIP y la capacidad funcional en adultos mayores usuarios de uno de estos programas (EFAM-UV©), se han planteado tres estudios. Como criterios de inclusión: ser mayor de 60 años, sin enfermedad cardíaca, respiratoria, cognitiva, neuromuscular o de la caja torácica, no llevar prótesis dental y ser capaces de saltar sin dolor. Entre los resultados más relevantes, el Estudio 1 constata diferencias de género en la fuerza inspiratoria (mujeres n=55; 73,27±4,60 años; 45,47±14,46 cmH2O; hombres n=12; 71,84±4,25 años; 64,92±18,81 cmH2O; p=0,000). Estas diferencias explican que la asociación entre MIP y función pulmonar se reduzca significativamente al tener en cuenta la covariable género (rg para FVC=0,401, FEV1=0,396; FEF25-75%=0,327; PEF=0,436; p60 years, with no heart, respiratory, cognitive, neuromuscular or rib-cage disease; no dental prosthesis; and able to jump without pain. Among the most important results, Study 1 confirms gender differences in MIP (women, n=55; 73.27±4.60 years; 45.47±14.46 cmH2O; men n=12; 71.84±4.25 years; 64.92±18.81 cmH2O; p=0.000). These differences explain that the association between MIP and lung function reduces taking into account the gender covariate (rg for FVC=0.401, FEV1=0.396; FEF25-75%=0.327; PEF=0.436; p<0.010), more than the age covariate (re for FVC=0.439; FEV1=0.456; FEF25-75%=0.409). The same stands between MIP and functional capacity (rg for 6MWT=0.360; HG=0.270 and re for 6MWT=0.397; HG=0.404; 30”STS=0.276; p<0.05). Sit to stand test shows the lowest association for rg, probably because there are no gender differences in its execution (30”STS=0.260). In all cases the correlation is between moderate and low, which suggests considering the addition of respiratory training for healthy active elderly. Again, the effect of gender is confirmed in Study 2 (women, n=15; 72.41±4.21 years; 54.13±15.39 cmH2O; men n=9; 69.81±4.19 years; 84.78±16.33 cmH2O; p=0.000), where the association with CMJ speed is reduced to rg=0.432 (p=0.040) and disappears in relation to CMJ relative power and 5STS. Associations fall when considering the more neural actions. In both studies, dispersion diagram and standardized results (z-scores), confirm these ideas. Given the need to train the MIP, the longitudinal design of Study 3 (women, n=10; 68.70±3.93 years; 39.00±7.63 cmH2O), allows to confirm the viability and benefits of inspiratory training combined with MCTP EFAM-UV©. After seven weeks of training, MIP, 6MWT and blood pressure (SBP and DBP) were improved (in %, ΔMIP=31.02±42.53; Δ6MWT=6.33±5.89, ΔSBP=-12.51±8.58, ΔDBP=-9.29±10.93; p<0.05), with no changes in lung function. In addition, the association between MIPPRE and ΔMIP (r=-0.821; p<0.05) points out that women who started the intervention with lower values of MIP, improved more. On one hand, these results suggest the need to train the inspiratory musculature specifically, both in men and women, and on the other hand, to include MIP assessment in elderly´s training programs.