Safety and feasibility of inspiratory muscle training for hospitalized patients undergoing hematopoietic stem cell transplantation: a randomized controlled study

Abstract

Purpose

Patients undergoing hematopoietic stem cell transplantation (HSCT) usually experienced respiratory muscle weakness. Inspiratory muscle training (IMT) at HSCT has not been studied yet. Thus, it is important to evaluate the safety, feasibility, and preliminary effectiveness of IMT for hospitalized patients undergoing HSCT with an unstable and acute clinical condition.

Methods

This is a randomized controlled feasibility study. Thirty-one hospitalized patients undergoing HSCT were randomized to the conventional physical rehabilitation (CON) or to the IMT group (conventional physical rehabilitation + IMT). IMT was carried out at 40% of maximal inspiratory pressure (MIP), 5 sessions weekly, 10–20 min/session. Primary outcomes were safety and feasibility (recruitment, adherence, and attrition rates) of IMT. Secondary outcomes were respiratory strength, respiratory rate, oxygen saturation, and frequency of patients with oxygen desaturation, bleeding, dyspnea, and acute pulmonary edema.

Results

Patients were allocated to the IMT (N = 15; 43.6 years) or to the CON group (N = 16; 46.6 years). The recruitment rate was 100%, the adherence rate was 91%, and attrition was 13% to IMT. Two events were observed in 126 IMT sessions (1.5%). MIP increased in the IMT group (P < 0.01). No differences were observed in respiratory rate and oxygen saturation between groups. Trends to negative outcomes were observed in the CON in comparison to IMT group for a need of oxygen therapy (18% vs. 6%), bleeding (12% vs. 6%), dyspnea (25% vs. 13%), and acute pulmonary edema (6% vs. 0%).

Conclusions

IMT is safe, feasible, and improves the inspiratory muscle strength in hospitalized patients undergoing HSCT.

Trial registration

Clinical trial registration: NCT03373526

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Acknowledgments

The authors would like to thank the BMT team for their assistance.

Funding

This study was financed in part by the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - Brasil (CAPES) [Finance Code 001], Fundação de Amparo à Pesquisa do Estado de Minas Gerais (FAPEMIG) (8443327/2019), and Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) (425702/2018-9).

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All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by Leonardo Barbosa de Almeida and Daniel Godoy Martinez. The first draft of the manuscript was written by Leonardo Barbosa de Almeida and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Leonardo Barbosa de Almeida.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee (University Hospital of Federal University of Juiz de Fora, Brazil – 2.354.808) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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de Almeida, L.B., Trevizan, P.F., Laterza, M.C. et al. Safety and feasibility of inspiratory muscle training for hospitalized patients undergoing hematopoietic stem cell transplantation: a randomized controlled study. Support Care Cancer 28, 3627–3635 (2020). https://doi.org/10.1007/s00520-019-05209-x

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Keywords

  • Hematopoietic stem cell transplantation
  • Bone marrow transplantation
  • Rehabilitation
  • Breathing exercises