Obesity has emerged as one of the major health challenges predisposing the population across the globe to circulatory and metabolic comorbidities. Indeed, various treatment modalities practiced by the healthcare professionals and practitioners in challenging the progression of obesity aim at influencing the quality of life and managing the basal metabolic rate, and body mass index for proportionately enhancing the levels of activity among the target population. The rehabilitation strategies employed to enhance the breathing patterns among the obese individuals include rendering training sessions for increasing the efficiency and stability of inspiratory muscles. The inspiration process is indeed, the result of the concerted effort by group of muscles including sternocleidomastoids, scalenes, external intercostals and diaphragm. McConnell (2013) describes the patterns of instability of the inspiratory muscles among the patients affected by obesity. In fact, due to additional body weight the inspiratory muscles fail to maintain optimal homeostasis between their physiological requirement and potential of effectively transferring oxygen to the body tissues. This incapacity leads to substantial deficit of oxygenated blood to the body tissues resulting in early fatigue of the inspiratory muscles.
The training strategies adopted to stabilize the inspiratory muscles focus on increasing the load on these muscles to achieve longer term endurance and strength, thereby affecting the respiratory capacity of the obese individuals. Hess et al (2012:p.947) present evidences from clinical studies indicating the influence of inspiratory muscle training in enhancing the vital capacity, inspiratory volume and pulmonary strength of obese people affected by respiratory dysfunction. These outcomes are achieved by practicing induction techniques including, assisted coughing and glossopharyngeal breathing on the obese patients. Ratjen & Deterding (2012:p. 637) describe the clinical relevance of assisted coughing technique in enhancing the pulmonary functionality among the patients with respiratory incapacity. The assisted coughing overloads the inspiratory muscle with positive pressure leading to sustained pulmonary dilation resulting in peak cough flow required to clear the pulmonary secretions and maintaining optimal oxygen saturation levels essential for the functional enhancement of lungs among the obese patients. Similarly, the frog breathing technique induces the inspiratory muscles to inhale the bulk of air into trachea to effectively increase the tidal volume and subsequently, the vital capacity and pulmonary circulation. The clinical trial conducted by Barbalho-Moulim et al (2011:p.1721-27) evaluated the impact of inspiratory muscle training on the pulmonary functionality of the obese women scheduled for open bariatric surgery. The outcomes of the inspiratory muscle training revealed the increase in strength and capacity of the inspiratory muscles leading to the enhancement of pulmonary functionality among the obese candidates of bariatric surgery.
The clinical literature reveals the authenticity of the tests including pulmonary function analysis, spirometry and pulse oxymetry utilized in evaluating the expiratory reserve volume, residual capacity and oxygen saturation levels of the obese individuals (Buchwald, 2007:p.103). These diagnostic tools indeed provide an overall estimate of the pulmonary enhancement achieved by rendering inspiratory muscle training to the individuals affected by obesity. The emerging new tests employed in research studies in evaluating the outcomes of inspiratory muscle training on the obese individuals include assessing the levels of plasma cytokines and C reactive protein. Kelley (1993:p.504) provides clinical evidences indicating the abnormal variation of the plasma cytokines levels in cases of pulmonary complications. Similarly, Arena (2015) describes the findings from clinical studies indicating the abnormal fluctuations of C reactive protein levels with the reduction in endurance and strength of inspiratory muscles. This clearly indicates the prospective utilization of these diagnostic tests in evaluating the effects in terms of positive or negative clinical outcomes of the respiratory muscle training on the pulmonary capacity of the obese individuals. Therefore, the normalization of plasma cytokines and C reactive protein levels following the inspiratory muscle training may prove to be a supportive outcome in context to the efficacy of this rehabilitative intervention in pulmonary enhancement of the obese population.
The scientific studies conducted regularly to evaluate the impact of pulmonary dysfunction on the quality of life among obese individuals. Moreover, the clinical literature supports the contention of sustained effects of the inspiratory muscle training modality in reducing the neural respiratory drive, resulting in pulmonary enhancement among the obese patients. The consequent increase in inspiratory muscles capacity indeed influences the intra-thoracic pressure and inspiratory volume resulting in improved cardiac output. Therefore, the evidence based literature provides valid conclusions in context to the implications of inspiratory muscle training in the cardiopulmonary enhancement of obese population. However, extended clinical trials warranted to further testify the validity of this evidence based contention for devising effective strategies to influence the quality of life and cardio-respiratory functionality of the target population.
Arena, R 2015, Heart Failure Clinics: Exercise and Rehabilitation in Heart Failure, Elsevier, USA
Barbalho-Moulim, Miguel, G, Forti, E, Campos, F & Costa, D 2011, ‘Effects of preoperative inspiratory muscle training in obese women undergoing open bariatric surgery: respiratory muscle strength, lung volumes, and diaphragmatic excursion’, Clinics, vol. 66, no. 10, pp.1721-27, doi: 10.1590/S1807-59322011001000009
Buchwald, H, Cowan, G & Pories, W 2007, Surgical Management of Obesity, Saunders, Philadelphia
Hess, D, MacIntyre, N, Mishoe, S & Galvin, W 2012, Respiratory Care: Principles and Practice, Jones & Bartlett, UK
Kelley, J 1993, Cytokines of the Lung, Marcel-Dekker, USA
McConnell, A 2013, Respiratory Muscle Training: Theory and Practice, Elsevier, UK
Ratjen, F & Deterding, R 2012, Kendig and Chernick's Disorders of the Respiratory Tract in Children, Elsevier, Philadelphia
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