World J Oncol

World Journal of Oncology, ISSN 1920-4531 print, 1920-454X online, Open Access

Article copyright, the authors; Journal compilation copyright, World J Oncol and Elmer Press Inc

Journal website https://www.wjon.org

Review

Volume 15, Number 3, June 2024, pages 337-347

Potential Therapeutic Role of Respiratory Muscle Training in Dyspnea Management of Cancer Survivors: A Narrative Review

Figure 2. Mechanisms of dyspnea in cancer and the potential therapeutic role of respiratory muscles training for dyspnea management.

**Table 1.** Studies on Respiratory Muscle Training in Cancer Survivors
Study	Cancer patients	Intervention	Outcomes
Ray et al, 2017 [10] Single arm intervention	Breast (n = 5) and lung (n = 5)	Respiratory muscle training including both inspiratory and expiratory muscles (once a week supervised session + twice a week home-based). Three sets of 15 repetitions, three times a week for 4 weeks.	Reduction in dyspnea Baseline Dyspnea Index (+1.2 units) Transitional Dyspnea Index (+5.1 units)
Dahhak et al, 2022 [11] Randomized controlled trial	Breast (n = 19)	Twelve-week exercise training + inspiratory muscle training versus exercise training alone.	Reduction in dyspnea Transitional Dyspnea Index (+2.9)
Stefanelli et al, 2013 [12] Randomized controlled trial	Non-small cell lung cancer (n = 40)	Three weeks 5 days a week preoperative pulmonary rehabilitation combined with breathing exercises but not specifically respiratory muscle training versus usual care.	Reduced dyspnea Borg Dyspnea Scale (-1.1 units)
Molassiotis et al, 2015 [13] Randomized controlled trial	Stable lung cancer (n = 46)	Inspiratory muscle training, 30 min a day, 5 days a week for 12 weeks.	Reduction in dyspnea Modified Borg Dyspnea Scale (-0.8 units)
Sakai et al, 2023 [17] Controlled trial	Hospitalized stable lung cancer (n = 66)	Inspiratory muscle training + exercise therapy, 30 breaths twice a day at 30-40% of maximal inspiratory pressure + 20 - 40 min exercise therapy, 5 days a week for 2 weeks.	Reduction in dyspnea on exertion Modified Borg Dyspnea Scale (-1 units)
Palmer et al, 2019 [16] Single arm intervention	Head and neck cancer (n = 6)	Expiratory muscle training for 4 weeks	Reduction in dyspnea by 38% in Dyspnea Index (-2.3 units)
Ha et al, 2023 [57] Randomized controlled trial	Lung cancer (n = 22)	Virtual telemedicine-based inspiratory muscle training + walking intervention, inspiratory muscle training 10 - 15 min twice daily 5 days a week + walking four times a week for a total 12 weeks. Video conferences were every 2 weeks (six in total).	No significant difference in dyspnea versus control group (education only)
de Almeida et al, 2020 [58] Randomized controlled trial	Hospitalized hematopoietic stem cell transplantation (n = 31)	Physical rehabilitation (aerobic exercise) + inspiratory muscle training (40% of maximal inspiratory pressure, 10 - 20 min, 5 days/week).	Trend towards lower dyspnea prevalence in the intervention group but did reach statistically significant difference versus control group (aerobic exercise only)
Bargi et al, 2016 [14] Randomized controlled trial	Allogenic hematopoietic stem cell transplantation (n = 38)	Inspiratory muscle training (40% of maximal inspiratory pressure, 30 min/day, 7 days/week for 6 weeks) vs. sham (5% of maximal inspiratory pressure, 30 min/day, 7 days/week for 6 weeks).	Reduction in dyspnea Modified Borg Dyspnea Scale (-0.11 units)
Bayram et al, 2023 [15] Randomized controlled trial	Hematopoietic stem cell transplantation (n = 30)	Pulmonary rehabilitation (resistance training) + inspiratory muscle training (30% of maximal inspiratory pressure, 8 - 10 diaphragmatic breathings, two session/day, 5 days/week) vs. aerobic exercise 10 - 30 min for upper body 5 days/week).	Reduction in dyspnea Modified Borg Dyspnea Scale (-0.9 units)

Table 1. Studies on Respiratory Muscle Training in Cancer Survivors

Study

Cancer patients

Intervention

Outcomes

Ray et al, 2017 [10]
Single arm intervention

Breast (n = 5) and lung (n = 5)

Respiratory muscle training including both inspiratory and expiratory muscles (once a week supervised session + twice a week home-based).
Three sets of 15 repetitions, three times a week for 4 weeks.

Reduction in dyspnea
Baseline Dyspnea Index (+1.2 units)
Transitional Dyspnea Index (+5.1 units)

Dahhak et al, 2022 [11]
Randomized controlled trial

Breast (n = 19)

Twelve-week exercise training + inspiratory muscle training versus exercise training alone.

Reduction in dyspnea
Transitional Dyspnea Index (+2.9)

Stefanelli et al, 2013 [12]
Randomized controlled trial

Non-small cell lung cancer (n = 40)

Three weeks 5 days a week preoperative pulmonary rehabilitation combined with breathing exercises but not specifically respiratory muscle training versus usual care.

Reduced dyspnea
Borg Dyspnea Scale (-1.1 units)

Molassiotis et al, 2015 [13]
Randomized controlled trial

Stable lung cancer (n = 46)

Inspiratory muscle training, 30 min a day, 5 days a week for 12 weeks.

Reduction in dyspnea
Modified Borg Dyspnea Scale (-0.8 units)

Sakai et al, 2023 [17]
Controlled trial

Hospitalized stable lung cancer (n = 66)

Inspiratory muscle training + exercise therapy, 30 breaths twice a day at 30-40% of maximal inspiratory pressure + 20 - 40 min exercise therapy, 5 days a week for 2 weeks.

Reduction in dyspnea on exertion
Modified Borg Dyspnea Scale (-1 units)

Palmer et al, 2019 [16]
Single arm intervention

Head and neck cancer
(n = 6)

Expiratory muscle training for 4 weeks

Reduction in dyspnea by 38% in Dyspnea Index (-2.3 units)

Ha et al, 2023 [57]
Randomized controlled trial

Lung cancer (n = 22)

Virtual telemedicine-based inspiratory muscle training + walking intervention, inspiratory muscle training 10 - 15 min twice daily 5 days a week + walking four times a week for a total 12 weeks. Video conferences were every 2 weeks (six in total).

No significant difference in dyspnea versus control group (education only)

de Almeida et al, 2020 [58]
Randomized controlled trial

Hospitalized hematopoietic stem cell transplantation (n = 31)

Physical rehabilitation (aerobic exercise) + inspiratory muscle training (40% of maximal inspiratory pressure, 10 - 20 min, 5 days/week).

Trend towards lower dyspnea prevalence in the intervention group but did reach statistically significant difference versus control group (aerobic exercise only)

Bargi et al, 2016 [14]
Randomized controlled trial

Allogenic hematopoietic stem cell transplantation (n = 38)

Inspiratory muscle training (40% of maximal inspiratory pressure, 30 min/day, 7 days/week for 6 weeks) vs. sham (5% of maximal inspiratory pressure, 30 min/day, 7 days/week for 6 weeks).

Reduction in dyspnea
Modified Borg Dyspnea Scale (-0.11 units)

Bayram et al, 2023 [15]
Randomized controlled trial

Hematopoietic stem cell transplantation (n = 30)

Pulmonary rehabilitation (resistance training) + inspiratory muscle training (30% of maximal inspiratory pressure, 8 - 10 diaphragmatic breathings, two session/day, 5 days/week) vs. aerobic exercise 10 - 30 min for upper body 5 days/week).

Reduction in dyspnea
Modified Borg Dyspnea Scale (-0.9 units)