Dans le cadre d’un programme de réhabilitation respiratoire (PRR) chez les patients atteints de BPCO, les sociétés savantes recommandent d’inclure un entrainement des muscles inspiratoires (EMI) chez les patients présentant une diminution objective de la force des muscles inspiratoires. Cette recommandation fait suite à une méta-analyse qui suggère qu’un EMI serait bénéfique lorsque la pression inspiratoire (PI) maximale est inferieure a 60 cm H2O.L’entraînement des muscles améliore la force et l’endurance des muscles inspiratoires, la capacité d’exercice et la dyspnée. Dans la dernière méta-analyse, les auteurs précisent que, dans le cadre d’un PRR, il n’est pas certain que l’EMI améliore davantage la dyspnée par rapport à un PRR seul.La question de départ est la suivante : est-ce que l’EMI au cours d’un PRR permet de diminuer davantage la dyspnée qu’un PRR seul ?Dans la première étude contrôlée randomisée, nous montrons que dans le cadre d’un PRR, l’EMI n’améliore pas davantage la dyspnée, chez des patients avec une force des muscles inspiratoires normale. Cependant, une analyse en sous-groupe tend à montrer que chez les patients plus sévèrement atteints (VEMS<50% théorique), l’EMI permettrait une amélioration plus importante de la dyspnée.La deuxième étude est le plus important essai contrôle randomise à propos de l’effet de l’EMI sur la dyspnée dans le cadre d’un PRR. Dans cette étude trois outils différents sont utilisés afin d’évaluer la dyspnée des patients, dont le questionnaire multidimensionnel MDP. Nous montrons que l’EMI ajoute a un PRR n’apporte pas une amélioration significativement plus importante de la dyspnée en comparaison a un PRR seul. Ainsi l’intérêt clinique de l’EMI dans le cadre d’un PRR semble remis en cause. / During a pulmonary rehabilitation program (PRP) in COPD patients, French and international respiratory societies recommend to include inspiratory muscles training (IMT) in patients with an objective inspiratory muscles weakness. This recommendation follows upon a meta-analysis which suggests that IMT would be beneficial when the maximal Inspiratory pressure (PImax) is lower than 60 cm H2O. IMT improves the strength and the endurance of the inspiratory muscles, the exercise capacity and the dyspnea. In the last meta-analysis, the authors specifies that, when IMT is associated to a PRP, it is not certain that IMT improves more the dyspnea compared with a PRP alone.The initial question of this work is: does IMT during a PRP allow decreasing more the dyspnea than a PRP alone?In the first randomized controlled trial, we show that during a PRP, IMT in COPD patients with normal inspiratory muscles strength does not improve more the dyspnea, compared to a PRP alone. However, an analysis in sub-groups tends to show that in severe or very severe COPD patients (VEMS < 50 % of predictive value), IMT would allow a higher improvement of the dyspnea.The second study is the most important randomized controlled trial about the effect of IMT on the dyspnea during pulmonary rehabilitation. In this study we used three different tools to estimate the dyspnea of the patients, of which the multidimensional Dyspnea Profile questionnaire (MDP). We show that IMT added to a PRP does not improve significantly more dyspnea compared to a PRP alone. So the clinical interest of IMT during a PRP seems questionnable.

Made available in DSpace on 2014-12-17T15:16:06Z (GMT). No. of bitstreams: 1 ElieteMC.pdf: 377775 bytes, checksum: 74beb1b592f264e0f8e2f6f3f9d1bab8 (MD5) Previous issue date: 2009-07-22 / The objective was measured by surface electromyography (EMGs), the activity of inspiratory muscles during incremental test in subjects with hemiparesis and show its correlation with the Functional Independence Measure (FIM). Were included in the study 32 individuals hemiparetics and 14 healthy as control group. We performed an evaluation of lung function and anthropometric data. The EMGs were performed during the incremental test with Threshold ? (15, 30, 45 and 60% of MIP) and during maximal inspiratory pressure (MIP). The electromyographic findings were calculated by the signal amplitude (RMS). All data were initially analyzed by Kolmogorov-Smirnov, the anthropometric characteristics of both groups were tested with the Levene and then intra-subject analysis (hemiparetic hemithorax and healthy hemithorax) and inter-group analysis (experimental group and control group) by paired and non-paired Student t tests and Pearson correlation. In intra-subject comparison was observed less activation (p <0.01) of the sternocleidomastoid muscle, scalene and diaphragm paretic side in both sexes - for the Threshold ? incremental test (15, 30, 45 and 60% of the MIP) and during maximal inspiratory pressure (MIP). In inter-group comparison, there was reduced activity in the diaphragm and the scalene, in hemiparetics males and females, respectivelly, during the same test. Our results demonstrate the existence of reduced electromyographic activity of inspiratory muscles in hemiparetics, including changes between different genders and suggests the need of further studies to assess the effects of specific training of inspiratory muscles. / O objetivo do estudo foi avaliar atrav?s da eletromiografia de superf?cie a ativa??o dos m?sculos inspirat?rios durante o teste incremental em indiv?duos com sequela decorrente de acidente vascular encef?lico (hemiparesia) e correlacionar com a Medida de independ?ncia Funcional (MIF). Foram inclu?dos no estudo 32 indiv?duos hemipar?ticos e 14 saud?veis como grupo controle. Foi realizada uma avalia??o da fun??o pulmonar e dos dados antropometricos. A EMGs realizou-se durante o teste incremental com Threshold? (15, 30, 45 e 60% da PImax) e durante press?o inspirat?ria m?xima (PImax). Os achados eletromiogr?ficos foram calculados por meio da da amplitude do sinal (RMS). Todos os dados foram inicialmente analisados pelo teste de Kolmogorov-Smirnov, as caracter?sticas antropom?tricas dos dois grupos foram submetidas ao teste de Levene e em seguida realizadas an?lises intra-sujeitos (hemit?rax hemipar?tico e o contralateral) e an?lises inter-grupos (grupo experimental e grupo controle), utilizando os testes t de Student pareado e n?o pareado e correla??o de Pearson. Na compara??o intrasujeitos observou-se menor ativa??o (p<0,01) dos m?sculos esternocleidomastoid?o, escaleno e diafragma do lado par?tico em ambos os sexos durante o teste incremental com Threshold? (15, 30, 45 e 60% da PImax) e durante press?o inspirat?ria m?xima. Na compara??o inter-grupos, houve menor atividade do diafragma em hemipar?ticos e do escaleno em hemipar?ticas durante mesmo teste. Nossos resultados demonstram a exist?ncia de redu??o da atividade eletromiogr?fica dos m?sculos inspirat?rios em hemipar?ticos, apresentando inclusive altera??es distintas entre os sexos e sugere a necessidade de novos estudos que avaliem os efeitos do treinamento espec?ficos dos m?sculos inspirat?rios.