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Peripheral microcirculation adaptations in response to the addition of Inspiratory Muscle Training in heart failure cardiac rehabilitation regimen

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Published: Jul 7, 2025
DOI: https://doi.org/10.12681/healthresj.40159
Keywords:
exercise training inspiratory muscle training microcirculation near infrared spectroscopy chronic heart failure
Soultana Kourtidou
Clinical Ergospirometry, Exercise and Rehabilitation Laboratory, 1st Critical Care Department, Evangelismos Hospital, School of Medicine, National & Kapodistrian University of Athens, Greece, Onassis Cardiac Surgery Center, Athens, Greece
Christina Katsoula
Clinical Ergospirometry, Exercise and Rehabilitation Laboratory, 1st Critical Care Department, Evangelismos Hospital, School of Medicine, National & Kapodistrian University of Athens, Greece
Dimitrios Vagionas
Department of Perioperative Medicine, St Bartholomew’s Hospital, Barts Heart Centre, London, United Kingdom
Alexandros Briasoulis
Department of Clinical Therapeutics, Alexandra Hospital, School of Medicine, National & Kapodistrian University of Athens, Greece
Ioannis Vasileiou
Clinical Ergospirometry, Exercise and Rehabilitation Laboratory, 1st Critical Care Department, Evangelismos Hospital, School of Medicine, National & Kapodistrian University of Athens, Greece
Nikoleta Rovina
Intensive Care Unit, 1st Department of Respiratory Medicine, Sotiria Hospital, School of Medicine, National & Kapodistrian University of Athens, Greece;
Elektra Papadopoulou
Clinical Ergospirometry, Exercise and Rehabilitation Laboratory, 1st Critical Care Department, Evangelismos Hospital, School of Medicine, National & Kapodistrian University of Athens, Greece
Christina Routsi
Clinical Ergospirometry, Exercise and Rehabilitation Laboratory, 1st Critical Care Department, Evangelismos Hospital, School of Medicine, National & Kapodistrian University of Athens, Greece
Serafeim Nanas
Clinical Ergospirometry, Exercise and Rehabilitation Laboratory, 1st Critical Care Department, Evangelismos Hospital, School of Medicine, National & Kapodistrian University of Athens, Greece
Ioannis Vasileiadis
Clinical Ergospirometry, Exercise and Rehabilitation Laboratory, 1st Critical Care Department, Evangelismos Hospital, School of Medicine, National & Kapodistrian University of Athens, Greece
Eleftherios Karatzanos
Clinical Ergospirometry, Exercise and Rehabilitation Laboratory, 1st Critical Care Department, Evangelismos Hospital, School of Medicine, National & Kapodistrian University of Athens, Greece
Abstract

Background: Exercise intolerance, dyspnea on exertion and respiratory muscle fatigue are predominant features of chronic heart failure adding to disease severity. Inspiratory Muscle Training (IMT) has been recently integrated into traditional exercise-based cardiac rehabilitation regimens. We opted to evaluate the effect of IMT on the peripheral muscle microcirculation of patients with stable chronic heart failure participating in cardiac rehabilitation. 


Method and Material: Twenty-five stable patients with chronic heart failure underwent cardiac rehabilitation with aerobic exercise and resistance training 3×/week for 12 weeks. Subjects were randomly assigned to the intervention group that performed IMT or the control group that performed Sham-IMT in addition to standard CR regimen. Systemic microcirculation was assessed via near-infrared spectroscopy (NIRS) and the 3-min vascular occlusion technique at the thenar muscle. Cardiorespiratory exercise testing, pulmonary function and muscle strength assessment were also performed, at baseline and following completion of the cardiac rehabilitation program.


Results: Both groups equally improved their cardiorespiratory fitness, left ventricular ejection fraction and muscle strength (p>0.05 for between-group comparisons). The intervention group showed higher NIRS-derived reperfusion rate, maximum inspiratory pressure and lung function as compared to the control group (p<0.05).


Conclusions: Reperfusion rate is a known surrogate for endothelial function. Therefore, the addition of structured IMT in targeted cardiac rehabilitation marked beneficial effects on systemic microcirculation.

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Author Biographies
Soultana Kourtidou, Clinical Ergospirometry, Exercise and Rehabilitation Laboratory, 1st Critical Care Department, Evangelismos Hospital, School of Medicine, National & Kapodistrian University of Athens, Greece, Onassis Cardiac Surgery Center, Athens, Greece

† These authors contributed equally to this work

Christina Katsoula, Clinical Ergospirometry, Exercise and Rehabilitation Laboratory, 1st Critical Care Department, Evangelismos Hospital, School of Medicine, National & Kapodistrian University of Athens, Greece

† These authors contributed equally to this work

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