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Review Article

Cardiopulmonary rehabilitation

Effectiveness of Inspiratory Muscle Training on Respiratory Muscle Strength in Patients Undergoing Cardiac Surgeries: A Systematic Review With Meta-Analysis
Fiona Verdine Dsouza, Sampath Kumar Amaravadi, Stephen Rajan Samuel, Harish Raghavan, Nagaraja Ravishankar
Ann Rehabil Med 2021;45(4):264-273.   Published online August 30, 2021
DOI: https://doi.org/10.5535/arm.21027
To determine the effect of inspiratory muscle training (IMT) on pulmonary function, respiratory muscle strength (RMS), and functional capacity in patients undergoing cardiac surgery. The PubMed, PEDro, CINAHL, Web of Science, CENTRAL, and EMBASE databases were searched from inception to June 2020. Randomized controlled trials (RCTs) that evaluated patients who underwent cardiac surgery were included in this review. Meta-analysis performed using a random-effects model showed that the mean difference in forced vital capacity, forced expiratory volume in 1 second, 6-minute walk distance, and RMS was 3.47% (95% confidence interval [CI], 0.57 to 6.36), 5.80% (95% CI, 2.03 to 9.56), 78.05 m (95% CI, 60.92 to 95.18), and 4.8 cmH2O (95% CI, -4.00 to 13.4), respectively. There is strong evidence that IMT improves inspiratory muscle strength, pulmonary function, and functional capacity, and reduces the length of hospital stay in patients undergoing cardiac surgery.

Citations

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  • Nursing Care Across the Clinical Continuum of TAVI: A Systematic Review of Multidisciplinary Roles
    Anna Jendrzejczak, Jadwiga Klukow, Joanna Czerwik-Marcinkowska, Wojciech Styk, Szymon Zmorzynski
    Journal of Clinical Medicine.2025; 14(13): 4535.     CrossRef
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    Rasha Abdulhalim Alqadi, Azza Ibrahim Abdelkader Habiba, Hanaa Hamad Mohamed El Sayed Akl, Engy AbdelRhman Khamis, Daniel Joseph E. Berdida
    Nursing & Health Sciences.2025;[Epub]     CrossRef
  • Inspiratory Muscle Training Improved Cardiorespiratory Performance in Patients Undergoing Open Heart Surgery: A Randomized Controlled Trial
    Chitima Kulchanarat, Suphannee Choeirod, Supattra Thadatheerapat, Dusarkorn Piathip, Opas Satdhabudha, Kornanong Yuenyongchaiwat
    Advances in Respiratory Medicine.2025; 93(3): 10.     CrossRef
  • Benefits of Cardiac Rehabilitation: Mechanisms to Restore Function and Clinical Impact
    Abdulla A. Damluji, Corey R. Tomczak, Stephanie Hiser, Deirdre E. O’Neill, Parag Goyal, Quinn R. Pack, Stephen J. Foulkes, Todd M. Brown, Mark J. Haykowsky, Dale M. Needham, Daniel E. Forman
    Circulation Research.2025; 137(2): 255.     CrossRef
  • Effectiveness of Active Cycle of Breathing Technique in Improving Physiological and Functional Outcomes Following Coronary Artery Bypass Graft Surgery: A Narrative Review
    Arnengsih Nazir
    Journal of Multidisciplinary Healthcare.2025; Volume 18: 5431.     CrossRef
  • Effects of Respiratory Muscle Training in Patients with Cardiomyopathy: Systematic Review
    Hanifa Suleman, Zohaib Shahid, Muhammad Naveed Babur, Abdul Wadood, Khizar Abid, Muhammad Ali Khan, Asna Waseem
    The Healer Journal of Physiotherapy and Rehabilitation Sciences.2025; 5(1): 233.     CrossRef
  • Respiratory therapy with positive expiratory pressure in patients after left ventricle geometric reconstruction
    Maksim L. Mamalyga, Mikhail M. Alshibaya, Mark A. Zatenko, Sergey A. Danilov, Gela G. Getsadze, Sergey L. Babak
    RUDN Journal of Medicine.2025; 29(2): 162.     CrossRef
  • Respiratory Muscle Training Combinations in Amateur Runners: A Randomized Trial of Pulmonary Function, Respiratory Muscle Strength, and Exercise Capacity
    Eunho Lee, Jinseop Kim
    Bioengineering.2025; 13(1): 11.     CrossRef
  • Can resistance prehabilitation training bring additional benefits in valvular cardiac surgery? protocol for a randomized controlled trial
    Jorge Montero-Cámara, Francisco José Ferrer-Sargues, María José Segrera Rovira, Adrián Sarria Cabello, David Cuesta Peredo, Juan Antonio Margarit Calabuig, Noemí Valtueña-Gimeno, María Luz Sánchez-Sánchez, Robert Jeenchen Chen
    PLOS ONE.2024; 19(5): e0303163.     CrossRef
  • Effectiveness of improving coordination abilities after cardiac surgery: a review
    Natalya V. Arkhipova, Svetlana A. Pomeshkina, Evgeniy V. Bykov
    Bulletin of Rehabilitation Medicine.2024; 23(3): 52.     CrossRef
  • Inspiratory Muscle Training in Phase 1 and 2 Postoperative Cardiac Rehabilitation Following Coronary Artery Bypass Graft Surgery: Systematic Review With Meta-Analysis
    Clênia Oliveira Araújo, Carla Cristina Araújo Alves, Francisco R A dos Santos, Lawrence P Cahalin, Graziella França Bernardelli Cipriano, Gerson Cipriano
    Physical Therapy.2024;[Epub]     CrossRef
  • Effect of Inspiratory Muscle Training on Outcomes After Cardiac Surgery
    Linqi Fang, Anqi Cheng, Zhaohua Zhu, Mengming Shao, Guoai Wang
    Journal of Cardiopulmonary Rehabilitation and Prevention.2024; 44(5): 324.     CrossRef
  • Effects of preoperative respiratory muscle training for improvement of postoperative health related quality of life in mitral valve replacement patients
    Umama Umar, Ahad Hussain, Komal Tariq
    Physiotherapy Research International.2024;[Epub]     CrossRef
  • Benefits from Implementing Low- to High-Intensity Inspiratory Muscle Training in Patients Undergoing Cardiac Surgery: A Systematic Review
    Aphrodite Evangelodimou, Irini Patsaki, Alexandros Andrikopoulos, Foteini Chatzivasiloglou, Stavros Dimopoulos
    Journal of Cardiovascular Development and Disease.2024; 11(12): 380.     CrossRef
  • The impact of threshold-loaded inspiratory muscle training and respiratory biofeedback on preserving inspiratory muscle strength and vital capacity after CABG: a randomized clinical trial
    Bahareh Mehregan-Far
    American Journal of Cardiovascular Disease.2024; 14(6): 375.     CrossRef
  • Distinguishing science from pseudoscience in commercial respiratory interventions: an evidence-based guide for health and exercise professionals
    Camilla R. Illidi, Lee M. Romer, Michael A. Johnson, Neil C. Williams, Harry B. Rossiter, Richard Casaburi, Nicholas B. Tiller
    European Journal of Applied Physiology.2023; 123(8): 1599.     CrossRef
  • Inspiratory Muscle and Functional Performance of Patients Entering Cardiac Rehabilitation after Cardiac Valve Replacement
    Sabine Gempel, Meryl Cohen, Eryn Milian, Melany Vidret, Andrew Smith, Ian Jones, Yessenia Orozco, Neva Kirk-Sanchez, Lawrence P. Cahalin
    Journal of Cardiovascular Development and Disease.2023; 10(4): 142.     CrossRef
  • Comparison of Effects of Liuzijue Exercise and Conventional Respiratory Training on Patients after Cardiac Surgery: A Randomized Controlled Trial
    Qiao-li Zhang, Min Ge, Cheng Chen, Fu-dong Fan, Yan Jin, Ning Zhang, Lei Wang
    Chinese Journal of Integrative Medicine.2023; 29(7): 579.     CrossRef
  • Inspiratory muscle training to reduce risk of pulmonary complications after coronary artery bypass grafting: a systematic review and meta-analysis
    Yuping Xiang, Qin Zhao, Tinahui Luo, Ling Zeng
    Frontiers in Cardiovascular Medicine.2023;[Epub]     CrossRef
  • Impact of cardiac rehabilitation on pre- and post-operative transcatheter aortic valve replacement prognoses
    Jieru Zou, Jie Yuan, Jingjin Liu, Qingshan Geng
    Frontiers in Cardiovascular Medicine.2023;[Epub]     CrossRef
  • The Effects of Inspiratory Muscle Training (IMT) on Patients Undergoing Coronary Artery Bypass Graft (CABG) Surgery: A Systematic Review and Meta-Analysis
    Sisi Zhang, Bo Li, Xiaoping Meng, Houjuan Zuo, Dayi Hu
    Reviews in Cardiovascular Medicine.2023;[Epub]     CrossRef
  • Resistance exercise for cardiac rehabilitation
    Danielle L. Kirkman, Duck-chul Lee, Salvatore Carbone
    Progress in Cardiovascular Diseases.2022; 70: 66.     CrossRef
  • Respiratory Muscle Strength in Patients with Coronary Heart Disease and Different Musculoskeletal Disorders
    E. D. Bazdyrev, N. A. Terentyeva, N. A. Galimova, K. E. Krivoshapova, O. L. Barbarash
    Rational Pharmacotherapy in Cardiology.2022; 18(4): 393.     CrossRef
  • 16,485 View
  • 285 Download
  • 20 Web of Science
  • 23 Crossref
Original Articles
Characteristics and Clinical Course of Dysphagia Caused by Anterior Cervical Osteophyte
Hee Eun Choi, Geun Yeol Jo, Woo Jin Kim, Hwan Kwon Do, Jun Koo Kwon, Se Heum Park
Ann Rehabil Med 2019;43(1):27-37.   Published online February 28, 2019
DOI: https://doi.org/10.5535/arm.2019.43.1.27
Objective
To investigate swallowing characteristics of patients with dysphagia caused by anterior cervical osteophytes (ACOs) and compare clinical courses according to treatment options.
Methods
A retrospective analysis of 1,866 videofluoroscopic swallowing studies (VFSS) of patients with ACOs from electronic medical records was performed. Patients with other diseases that could explain the dysphagia were excluded. Dysphagia characteristics and severity and clinical and radiological characteristics of subjects with ACOs were evaluated. Dysphagia characteristics and clinical course were compared among three treatment groups: surgical treatment, swallowing rehabilitation, and conservative treatment.
Results
Subjects were 22 men and 1 woman with a mean age of 78.69±8.01 years. The mean osteophyte thickness was 9.07±3.84 mm. It was significantly thicker in the surgical group than that in other groups (p=0.01). ACOs were most frequently found at C5 level. This level also had the thickest osteophytes. However, videofluoroscopic dysphagia scales (VDS) were not significantly different among the three treatment groups. The pharyngeal phase score of the VDS was significantly higher in the surgical group (p=0.041). Dysphagia severity was decreased significantly in the surgical group at 3 months after the initial VFSS (p=0.004).
Conclusion
The main swallowing characteristics in patients with ACOs were dysphagia features of the pharyngeal phase, including inappropriate airway protection, decreased laryngeal elevation, and reduced epiglottis inversion. When determining treatment options, it may be helpful to consider dysphagia severity at pharyngeal phase and osteophyte thickness.

Citations

Citations to this article as recorded by  
  • Cervical osteophytes resulting in dysphagia: A case report with literature review
    Hoshmand R. Asaad, Sivan H. Salih, Dana T. Gharib, Shaho F. Ahmed, Karokh F. HamaHussein, Deari A. Ismaeil, Hezha A. Mohammed, Azad S. Hattam, Sarwat T. San Ahmed, Twana Omer Saeed, Berun A. Abdalla, Fahmi H. Kakamad
    Radiology Case Reports.2026; 21(2): 752.     CrossRef
  • Esophageal and Oropharyngeal Dysphagia: Clinical Recommendations From the United European Gastroenterology and European Society for Neurogastroenterology and Motility
    Amir Mari, Francesco Calabrese, Andrea Pasta, Greta Lorenzon, Bas Weusten, Jutta Keller, Pierfrancesco Visaggi, Sabine Roman, Elisa Marabotto, Ram Dickman, Jordi Serra, Nicola De Bortoli, Paola Iovino, Daniel Pohl, Dan Dumitrascu, Mentore Ribolsi, Claudia
    United European Gastroenterology Journal.2025; 13(6): 855.     CrossRef
  • Ventral osteophytes of the first two cervical vertebrae as a cause of dysphagia, surgical treatment (clinical case)
    A. S. Nikitin, R. M. Nanaev, O. B. Kulakov, O. V. Levchenko
    Russian journal of neurosurgery.2025; 27(2): 113.     CrossRef
  • Advancing modified barium swallow pre-sorting with deep learning: a new paradigm for the first step analysis in X-ray swallowing study
    Shitong Mao, Mohamed A. Naser, Sheila Buoy, Kristy K. Brock, Katherine A. Hutcheson
    International Journal of Computer Assisted Radiology and Surgery.2025;[Epub]     CrossRef
  • Cervical Diffuse Idiopathic Skeletal Hyperostosis (DISH) as an Underrecognized Cause of Dysphagia: A Case Series and Review of the Literature
    Emmanouela Dionysia Laskaratou, Ioannis Sperelakis, Nikolaos Trygonis, Rozalia Dimitriou, Georgios Kontakis
    Cureus.2025;[Epub]     CrossRef
  • Dysphagia as the main symptom in anterior cervical spine osteophytes (Forestier disease and cervical spondylosis deformans). Case reports and literature review
    A.V. Trashin, N.V. Vikherev, E.M. Belov, V.A. Shamanin, V.V. Stepanenko
    Burdenko's Journal of Neurosurgery.2024; 88(2): 69.     CrossRef
  • A Case of Dysphagia Due to Large Osteophytic Lesions in the Cervical Spine: A Conservative Approach
    Christos Lyrtzis, Alexandros Poutoglidis, Athina Stamati, Nikolaos Lazaridis, George Paraskevas
    Cureus.2024;[Epub]     CrossRef
  • Diagnosis and Management of Anatomical Causes of Dysphagia: From Hypopharynx to Upper Esophagus
    Min Woo Park
    Journal of the Korean Dysphagia Society.2023; 13(1): 8.     CrossRef
  • The Impact of Cervical Spinal Disease on Pharyngeal Swallowing Function
    Rameen K. Walters, Rachana Gudipudi, Kate Davidson, Melissa Cooke, Jenna Barengo, Drasti Smyre, Kendrea L. Garand, Bonnie Martin-Harris, Maria G. Matheus, Shaun A. Nguyen, Ashli K. O'Rourke
    American Journal of Speech-Language Pathology.2023; 32(2): 565.     CrossRef
  • Anterior Cervical Spine Surgery Complicated With Dysphagia
    Liu Wei, Li Sulian, Li Tonglian, Zhang Yan, Liu Zongchao
    Orthopaedic Nursing.2023; 42(5): 297.     CrossRef
  • Spinal Osteophytosis: An Uncommon Cause of Dysphagia
    Andreia De Matos, Cristiane Macedo, Patrícia Afonso Mendes
    GE - Portuguese Journal of Gastroenterology.2022; 29(3): 215.     CrossRef
  • Disfagia por osteofitose cervical anterior: relato de caso
    Mateus Morais Aires, Gabriela Marie Fukumoto, Sarah Lima Ribeiro, Leonardo Haddad, Eliézia Helena de Lima Alvarenga
    CoDAS.2022;[Epub]     CrossRef
  • Zero‐Profile Implant System for Treatment of Dysphagia Caused by Noncontiguous Anterior Cervical Osteophytes—A Case Report with Literature Review
    Zihan Peng, Hao Liu, Ying Hong, Yang Meng
    Orthopaedic Surgery.2022; 14(10): 2782.     CrossRef
  • Giant Anterior Cervical Osteophyte Causing Dysphagia
    Sang Joon Kang, Hoe Jong Jeong, Won Cheol Jeong, Sang-Won Ha, Seung Min Kim
    Journal of the Korean Neurological Association.2022; 40(3): 267.     CrossRef
  • Aggravation of dysphagia after surgical removal of anterior cervical osteophytes: a case report
    Young-In Go, Gi-Wook Kim, Yu-Hui Won, Sung-Hee Park, Myoung-Hwan Ko, Jeong-Hwan Seo, Da-Sol Kim
    Journal of International Medical Research.2022;[Epub]     CrossRef
  • Anterior Cervical Osteophyte Resection for Treatment of Dysphagia
    Joshua M. Kolz, Mohammed A. Alvi, Atiq R. Bhatti, Marko N. Tomov, Mohamad Bydon, Arjun S. Sebastian, Benjamin D. Elder, Ahmad N. Nassr, Jeremy L. Fogelson, Bradford L. Currier, Brett A. Freedman
    Global Spine Journal.2021; 11(4): 488.     CrossRef
  • Hypertrophic anterior cervical osteophyte
    Takaomi Kobayashi, Alan Kawarai Lefor, Tadatsugu Morimoto
    Reumatología Clínica.2021; 17(9): 552.     CrossRef
  • Hypertrophic anterior cervical osteophyte
    Takaomi Kobayashi, Alan Kawarai Lefor, Tadatsugu Morimoto
    Reumatología Clínica (English Edition).2021; 17(9): 552.     CrossRef
  • Impact of Osteophytectomy on Swallowing Function in a Patient with Chronic Dysphagia
    Melissa M Howard, Justin Phillips, Stefan Henley, Sarah E. Green, Emily R. Rosario
    OBM Geriatrics.2021; 05(03): 1.     CrossRef
  • Ostéophytes vertébraux : une cause rare de dysphagie chez le sujet jeune
    M. Le Guen, G. Lahlou, S. Le Burel, T. Chaara, H. Nielly, H. Vanquaethem, L. Gilardin
    La Revue de Médecine Interne.2019; 40: A112.     CrossRef
  • 9,621 View
  • 157 Download
  • 14 Web of Science
  • 20 Crossref
Effectiveness of Surgical Release in Patients With Neglected Congenital Muscular Torticollis According to Age at the Time of Surgery
Kyung-Jay Min, Ah-Reum Ahn, Eun-Ji Park, Shin-Young Yim
Ann Rehabil Med 2016;40(1):34-42.   Published online February 26, 2016
DOI: https://doi.org/10.5535/arm.2016.40.1.34
Objective

To identify the correlation between change in spinal deformities after surgical release and age at the time of surgery, and the effectiveness of surgical release in patients with neglected congenital muscular torticollis (CMT).

Methods

This was a retrospective study of 46 subjects with neglected CMT who had undergone surgical release at age ≥5 years at a tertiary medical center between January 2009 and January 2014. Spinal deformities were measured on anteroposterior plain radiographs of the cervical and whole spine, both preoperatively and postoperatively, to assess 3 parameters: cervicomandibular angle (CMA), lateral shift (LS), and Cobb angle (CA). We analyzed the change in spinal deformities after surgical release in consideration of age at the time of surgery.

Results

The median age at the time of surgery was 12.87 years. All 3 parameters showed significant improvement after surgical release (median values, pre- to post-surgery: CMA, 12.13° to 4.02°; LS, 18.13 mm to 13.55 mm; CA, 6.10° to 4.80°; all p<0.05). There was no significant correlation between age at the time of surgery and change in CMA (R=0.145, p=0.341) and LS (R=0.103, p=0.608). However, CA showed significant improvement with increasing age (R=0.150, p=0.046).

Conclusion

We assessed the correlation between change in spinal deformities after surgical release and age at the time of surgery. We found that that surgical release is effective for spinal deformities, even in older patients. These findings enhance our understanding of the effectiveness and timing of surgical release in patients with neglected CMT.

Citations

Citations to this article as recorded by  
  • Bilateral congenital muscular torticollis in infants, report of two cases
    Anna Öhman
    F1000Research.2025; 13: 211.     CrossRef
  • Totally transaxillary endoscopic surgical release for congenital muscular torticollis
    Junjie Sun, Hao Chen, Zhihai Zhong, Qigen Xie, Wenzong Gao, Hong Jiang, Yunjie Yang, Pengfei Gao
    Frontiers in Surgery.2025;[Epub]     CrossRef
  • Factors Influencing the Duration of Rehabilitation in Infants with Torticollis—A Pilot Study
    Daniela Parau, Anamaria Butila Todoran, Rodica Balasa
    Medicina.2024; 60(1): 165.     CrossRef
  • Age Group-Specific Improvement of Vertebral Scoliosis after the Surgical Release of Congenital Muscular Torticollis
    Jong Min Choi, Seong Hoon Seol, Jae Hyun Kim, Chan Min Chung, Myong Chul Park
    Archives of Plastic Surgery.2024; 51(01): 072.     CrossRef
  • One Step Tenotomy in Congenital Torticollis: A Case Report
    Azharuddin Azharuddin, Robby Sitohang
    Open Access Macedonian Journal of Medical Sciences.2023; 11(C): 45.     CrossRef
  • Experience with the management of 2599 cases of congenital muscular torticollis and a multicenter epidemiological investigation in 17 hospitals in China
    Zhenhui Zhao, Hansheng Deng, Yuanheng Li, Xinyu Wang, Gen Tang, Yueping Zeng, Hui Xu, Qisong Yang, Zhengyu Wu, Shicheng Li, Zhiwen Cui, Guoshuang Feng, Guibing Fu, Shengping Tang, Zhu Xiong, Xin Qiu, Jian Tian, Fei Song, Xin Xu, Mei Wu, Guosong Wang, Li L
    BMC Musculoskeletal Disorders.2023;[Epub]     CrossRef
  • A rare case of 9 years congenital muscular torticollis treated with complete unipolar sternocleidomastoid release: A case report and literature review
    Aryadi Kurniawan, Anissa Feby Canintika
    International Journal of Surgery Case Reports.2022; 96: 107298.     CrossRef
  • The Effectiveness and Safety of Botulinum Toxin Injections for the Treatment of Congenital Muscular Torticollis
    Xin Qiu, Zhiwen Cui, Gen Tang, Hansheng Deng, Zhu Xiong, Shuai Han, Shengping Tang
    Journal of Craniofacial Surgery.2020; 31(8): 2160.     CrossRef
  • 8,076 View
  • 81 Download
  • 8 Web of Science
  • 8 Crossref
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