{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T23:40:52Z","timestamp":1791502852175,"version":"4.3.4"},"reference-count":30,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2020,3,30]],"date-time":"2020-03-30T00:00:00Z","timestamp":1585526400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Japan Society for the Promotion of Science Grant-in-Aid","award":["JP19K1922"],"award-info":[{"award-number":["JP19K1922"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Respiratory muscle weakness, frequently observed in patients with heart failure (HF), is reported as a predictor for poor prognosis. Although increased respiratory muscle strength ameliorates exercise tolerance and quality of life in HF patients, the relationship between changes in respiratory muscle strength and patient prognosis remains unclear. A total of 456 patients with HF who continued a 5-month cardiac rehabilitation (CR) were studied. We measured maximal inspiratory pressure (PImax) at hospital discharge as the baseline and five months thereafter to assess the respiratory muscle strength. Changes in PImax during the 5-month observation period (\u22bfPImax) were examined. We investigated the composite multiple incidence of all-cause death or unplanned readmission after 5-month CR. The relationship between \u22bfPImax and the incidence of clinical events was analyzed. Over a median follow-up of 1.8 years, 221 deaths or readmissions occurred, and their rate of incidence was 4.3\/100 person-years. The higher \u22bfPImax was significantly associated with lower incidence of clinical event. In multivariate Poisson regression model after adjustment for clinical confounding factors, \u22bfPImax remained a significant and independent predictor for all-cause death\/readmission (adjusted incident rate ratio for \u22bfPImax increase of 10 cmH2O: 0.77, 95% confidence interval: 0.70\u20130.86). In conclusion, the changes in respiratory muscle strength independently predict the incidence of clinical events in patients with HF.<\/jats:p>","DOI":"10.3390\/jcm9040952","type":"journal-article","created":{"date-parts":[[2020,4,2]],"date-time":"2020-04-02T13:39:34Z","timestamp":1585834774000},"page":"952","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":23,"title":["Changes in Respiratory Muscle Strength Following Cardiac Rehabilitation for Prognosis in Patients with Heart Failure"],"prefix":"10.3390","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8338-2141","authenticated-orcid":false,"given":"Nobuaki","family":"Hamazaki","sequence":"first","affiliation":[{"name":"Department of Rehabilitation, Kitasato University Hospital, Sagamihara 252-0375, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kentaro","family":"Kamiya","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation, Kitasato University School of Allied Health Sciences, Sagamihara 252-0373, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6503-8577","authenticated-orcid":false,"given":"Shohei","family":"Yamamoto","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Sciences, Kitasato University Graduate School of Medical Sciences, Sagamihara 252-0373, Japan"},{"name":"Department of Epidemiology and Prevention, Center for Clinical Sciences, National Center for Global Health and Medicine, Tokyo 162-8655, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kohei","family":"Nozaki","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation, Kitasato University Hospital, Sagamihara 252-0375, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takafumi","family":"Ichikawa","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation, Kitasato University Hospital, Sagamihara 252-0375, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ryota","family":"Matsuzawa","sequence":"additional","affiliation":[{"name":"Department of Physiotherapy, School of Rehabilitation, Hyogo University of Health Sciences, Kobe 650-8530, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shinya","family":"Tanaka","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation, Nagoya University Medical School Hospital, Nagoya 466-8560, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5632-0271","authenticated-orcid":false,"given":"Takeshi","family":"Nakamura","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Sciences, Kitasato University Graduate School of Medical Sciences, Sagamihara 252-0373, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masashi","family":"Yamashita","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Sciences, Kitasato University Graduate School of Medical Sciences, Sagamihara 252-0373, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emi","family":"Maekawa","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara 252-0373, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kentaro","family":"Meguro","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara 252-0373, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chiharu","family":"Noda","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara 252-0373, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3890-3777","authenticated-orcid":false,"given":"Minako","family":"Yamaoka-Tojo","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation, Kitasato University School of Allied Health Sciences, Sagamihara 252-0373, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Atsuhiko","family":"Matsunaga","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation, Kitasato University School of Allied Health Sciences, Sagamihara 252-0373, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Junya","family":"Ako","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara 252-0373, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2020,3,30]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"2996","DOI":"10.1161\/hc4901.102568","article-title":"ACC\/AHA Guidelines for the Evaluation and Management of Chronic Heart Failure in the Adult: Executive Summary A Report of the American College of Cardiology\/American Heart Association Task Force on Practice Guidelines (Committee to Revise the 1995 Guidelines for the Evaluation and Management of Heart Failure): Developed in Collaboration With the International Society for Heart and Lung Transplantation; Endorsed by the Heart Failure Society of America","volume":"104","author":"Hunt","year":"2001","journal-title":"Circulation"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"191","DOI":"10.1007\/s10741-016-9549-4","article-title":"Diaphragm abnormalities in heart failure and aging: Mechanisms and integration of cardiovascular and respiratory pathophysiology","volume":"22","author":"Kelley","year":"2017","journal-title":"Heart Fail. Rev."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1963","DOI":"10.1164\/ajrccm.158.6.9710028","article-title":"Systolic ventricular dysfunction causes selective diaphragm atrophy in rats","volume":"158","author":"Stassijns","year":"1998","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1164\/rccm.2206020","article-title":"Disorders of the respiratory muscles","volume":"168","author":"Laghi","year":"2003","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"263","DOI":"10.1002\/ejhf.239","article-title":"Heart failure with preserved ejection fraction induces molecular, mitochondrial, histological, and functional alterations in rat respiratory and limb skeletal muscle","volume":"17","author":"Bowen","year":"2015","journal-title":"Eur. J. Heart Fail."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"154","DOI":"10.1111\/resp.13432","article-title":"Respiratory muscle weakness increases dead-space ventilation ratio aggravating ventilation-perfusion mismatch during exercise in patients with chronic heart failure","volume":"24","author":"Hamazaki","year":"2019","journal-title":"Respirology"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"105834","DOI":"10.1016\/j.rmed.2019.105834","article-title":"Prevalence and prognosis of respiratory muscle weakness in heart failure patients with preserved ejection fraction","volume":"161","author":"Hamazaki","year":"2019","journal-title":"Respir. Med."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"2129","DOI":"10.1093\/eurheartj\/ehw128","article-title":"2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC)Developed with the special contribution of the Heart Failure Association (HFA) of the ESC","volume":"37","author":"Ponikowski","year":"2016","journal-title":"Eur. Heart J."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1502","DOI":"10.1016\/j.ijcard.2012.04.029","article-title":"Efficacy of inspiratory muscle training in chronic heart failure patients: A systematic review and meta-analysis","volume":"167","author":"Smart","year":"2013","journal-title":"Int. J. Cardiol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"2315","DOI":"10.1093\/eurheartj\/ehw106","article-title":"2016 European Guidelines on cardiovascular disease prevention in clinical practice: The Sixth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of 10 societies and by invited experts)Developed with the special contribution of the European Association for Cardiovascular Prevention & Rehabilitation (EACPR)","volume":"37","author":"Piepoli","year":"2016","journal-title":"Eur. Heart J."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"277","DOI":"10.1007\/s13539-013-0109-7","article-title":"Relation of respiratory muscle strength, cachexia and survival in severe chronic heart failure","volume":"4","author":"Habedank","year":"2013","journal-title":"J. Cachexia Sarcopenia Muscle"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"2394","DOI":"10.1253\/circj.CJ-19-0670","article-title":"Standard Cardiac Rehabilitation Program for Heart Failure","volume":"83","author":"Izawa","year":"2019","journal-title":"Circ. J."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"e004297","DOI":"10.1161\/JAHA.116.004297","article-title":"Performance of AHEAD Score in an Asian Cohort of Acute Heart Failure With Either Preserved or Reduced Left Ventricular Systolic Function","volume":"6","author":"Chen","year":"2017","journal-title":"J. Am. Heart Assoc."},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"ATS Committee on Proficiency Standards for Clinical Pulmonary Function Laboratories (2002). ATS statement: Guidelines for the six-minute walk test. Am. J. Respir. Crit. Care Med., 166, 111\u2013117.","DOI":"10.1164\/ajrccm.166.1.at1102"},{"key":"ref_15","first-page":"77","article-title":"Lung function testing\u2014The Official Guideline of the Japanese Respiratory Society","volume":"53","author":"Tojo","year":"2005","journal-title":"Rinsho Byori"},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"American Thoracic Society, and European Respiratory Society (2002). ATS\/ERS Statement on respiratory muscle testing. Am. J. Respir. Crit. Care Med., 166, 518\u2013624.","DOI":"10.1164\/rccm.166.4.518"},{"key":"ref_17","first-page":"1305","article-title":"Age-related changes in static maximal inspiratory and expiratory pressures","volume":"35","author":"Suzuki","year":"1997","journal-title":"Nihon Kyobu Shikkan Gakkai Zasshi"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"529","DOI":"10.1164\/ajrccm.160.2.9810081","article-title":"Diaphragm strength in chronic heart failure","volume":"160","author":"Hughes","year":"1999","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Group JCSJW (2014). Guidelines for rehabilitation in patients with cardiovascular disease (JCS 2012). Circ. J., 78, 2022\u20132093.","DOI":"10.1253\/circj.CJ-66-0094"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"347","DOI":"10.1093\/eurjhf\/hfr017","article-title":"Exercise training in heart failure: From theory to practice. A consensus document of the Heart Failure Association and the European Association for Cardiovascular Prevention and Rehabilitation","volume":"13","author":"Piepoli","year":"2011","journal-title":"Eur. J. Heart Fail."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"2153","DOI":"10.1161\/01.CIR.103.17.2153","article-title":"Respiratory muscle dysfunction in congestive heart failure: Clinical correlation and prognostic significance","volume":"103","author":"Meyer","year":"2001","journal-title":"Circulation"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"685","DOI":"10.1093\/eurjhf\/hfq050","article-title":"The prognostic importance of lung function in patients admitted with heart failure","volume":"12","author":"Iversen","year":"2010","journal-title":"Eur. J. Heart Fail."},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Chuang, M.L., Lin, I.F., and Hsieh, M.J. (2019). More Impaired Dynamic Ventilatory Muscle Oxygenation in Congestive Heart Failure than in Chronic Obstructive Pulmonary Disease. J. Clin. Med., 8.","DOI":"10.3390\/jcm8101641"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"672","DOI":"10.1016\/j.cardfail.2017.05.003","article-title":"Inspiratory Muscle Training Improves Intercostal and Forearm Muscle Oxygenation in Patients With Chronic Heart Failure: Evidence of the Origin of the Respiratory Metaboreflex","volume":"23","author":"Moreno","year":"2017","journal-title":"J. Card. Fail."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1663","DOI":"10.1016\/j.jacc.2007.12.045","article-title":"Inspiratory muscle training improves blood flow to resting and exercising limbs in patients with chronic heart failure","volume":"51","author":"Chiappa","year":"2008","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"2209","DOI":"10.1016\/j.jacc.2019.01.072","article-title":"Exercise Intolerance in Patients With Heart Failure: JACC State-of-the-Art Review","volume":"73","author":"Arena","year":"2019","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1664","DOI":"10.1152\/japplphysiol.01245.2010","article-title":"Respiratory muscle training improves hemodynamics, autonomic function, baroreceptor sensitivity, and respiratory mechanics in rats with heart failure","volume":"111","author":"Jaenisch","year":"2011","journal-title":"J. Appl. Physiol. (1985)"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"94","DOI":"10.1016\/j.ijcard.2014.06.035","article-title":"Minimal importance for 6-minute walk test distances among patients with chronic heart failure","volume":"176","author":"Tager","year":"2014","journal-title":"Int. J. Cardiol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"904","DOI":"10.1136\/heartjnl-2018-314158","article-title":"Change in renal function associated with drug treatment in heart failure: National guidance","volume":"105","author":"Clark","year":"2019","journal-title":"Heart"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"757","DOI":"10.1016\/j.jacc.2005.09.052","article-title":"Inspiratory muscle training in patients with heart failure and inspiratory muscle weakness: A randomized trial","volume":"47","author":"Chiappa","year":"2006","journal-title":"J. Am. Coll. Cardiol."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/9\/4\/952\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T09:13:19Z","timestamp":1760173999000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/9\/4\/952"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,3,30]]},"references-count":30,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2020,4]]}},"alternative-id":["jcm9040952"],"URL":"https:\/\/doi.org\/10.3390\/jcm9040952","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,3,30]]}}}