Investigation of the effects of functional respiratory muscle training with telerehabilitation on respiratory and peripheral muscle functions in patients with chronic kidney disease

Symptoms seen in patients with chronic kidney disease (CKD) may cause loss of respiratory functions, functional capacity, and muscle functions. In this study, it was aimed to investigate the effects of different inspiratory muscle training (IMT) modalities applied with telerehabilitation on respiratory, diaphragm, peripheral and trunk muscle function, functional capacity, balance, posture, quality of life, cognitive function, fatigue, physical activity, endothelial function, and aortic stiffness in CKD patients. Thirty-eight patients were included in the study. The patients were randomly divided into three groups as fundamental IMT (13 patients), functional IMT (13 patients) and control (12 patients). Respiratory functions (spirometer), respiratory muscle strength (mouth pressure device), respiratory muscle endurance (IMT device), diaphragm function (ultrasonography), peripheral muscle strength (dynamometer), trunk muscle endurance (partial sit-ups, prone bridge, side bridge, and pelvic bridge test), functional capacity (6-minute walk test), balance (timed up and go test and single leg stance test), posture (Corbin evaluation form), quality of life (Nottingham Health Profile), fatigue (Multidimensional Assessment of Fatigue scale), cognitive function (Standardized Mini Mental test), physical activity (International Physical Activity Questionnaire short form), endothelial function (echocardiography and vascular probe), and aortic stiffness (echocardiography) were evaluated. There was a statistically significant difference between fundamental IMT, functional IMT and control groups in maximal inspiratory and expiratory pressure, strength index, respiratory muscle endurance, peripheral muscle strength, trunk muscle endurance test times, 6 minutes walk test distance, standing time on one leg and diaphragmatic mobility (p<0.05). The increases in respiratory muscle endurance, peripheral and trunk muscle functions, balance, and diaphragmatic mobility were statistically significantly higher in the functional IMT group compared to the fundamental IMT group (p<0.017). In the functional IMT group, there was a statistically significant decrease in the posture score, and an increase in the International Physical Activity Questionnaire short form and Standardized Mini Mental test total scores (p<0.017) were seen. The fundamental and functional IMT program provided significant improvements in respiratory muscle strength, respiratory muscle endurance, diaphragmatic mobility, peripheral and trunk muscle functions, functional capacity and balance of the patients. With the functional IMT program, more improvement in respiratory muscle endurance, diaphragmatic mobility, peripheral and trunk muscle functions and balance, and significant improvements in posture, physical activity level and cognitive functions were observed. According to our results, it is recommended to include functional IMT in the rehabilitation program in CKD patients.