Effect of Respiratory Muscle Training on Lung Function on Quarry Workers in Minia Governorate Egypt

doi:10.21203/rs.3.rs-4503795/v1

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Effect of Respiratory Muscle Training on Lung Function on Quarry Workers in Minia Governorate Egypt

https://doi.org/10.21203/rs.3.rs-4503795/v1

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Objective To find the effect of aerobic exercises versus respiratory muscle training program on lung function among Quarry workers.

Design: Randomized controlled trial.

Subjects/Patients: Forty Quarry workers participated in the study

Methods: Patients were randomly allocated to two groups. (Group A) were given aerobic exercises by engaging in a 30-minute session of walking on a treadmill, for eight weeks, three times a week. (Group B) were given a respiratory muscle training program using incentive spirometer in addition to aerobic exercise for eightweeks. A spirometer was used to do a pulmonary function test, which evaluated lung function by measuring Forced Vital Capacity (FVC), Forced Expiratory Volume in one second (FEV1), and the ratio of FEV1 to FVC.

Results: Finding of this study indicated substantial improvement of FVC, FEV1 and FEV1/FVC after treatment in both groups values (P value= < 0.00001). there was significant difference between both groups after treatment regarding to FVC, FEV1, and FEV1/FVC with favored result in (Group B).

Conclusion: Both groups showed a significant improved on lung function in favor to group B. So, this study proven that respiratory muscle training is an essential supplement to aerobic exercise for pulmonary rehabilitation to improve pulmonary functions in Quarry workers.

Health sciences/Diseases

Health sciences/Health occupations

Quarry workers

Aerobic exercises

Incentive spirometer

pulmonary functions

Quarrying art is a longstanding commercial practice in regions rich in natural resources like marble, limestone, and gypsum. An individual employed in a quarry is exposed to numerous risks arising from the inhalation of airborne particulates, which significantly affects their health and safety. Airborne particles are the most hazardous chemical that may be inhaled, and they can potentially cause health problems for quarry workers such as respiratory, dermal, along with optical irritation as well as damage ⁽¹⁾.

Extended inhalation of particulate matter generated from the crushing of granite rocks harms lung function and leads to various respiratory symptoms and other health issues in quarry workers ⁽²⁾.

One specific issue in certain quarries is the inhalation of dust that contains silica. This can cause silicosis, a permanent lung disease characterized by lung inflammation and breathing problems. The condition continues to worsen long after exposure to silica dust has stopped ⁽³⁾.

Reports from both the United States as well as China have indicated that a significant number of individuals are exposed to silica dust, leading to the development of silicosis. This condition has proven to be fatal, particularly among older workers ⁽⁴⁾.

Developing nations, particularly those in Africa, often lack well-established health and safety policies, which are a methodical approach to controlling all potential dangers that could cause harmful working conditions for industry employees (5).

Research studies have shown that the stone's chemical composition, particularly silica, is likely the primary factor contributing to respiratory diseases, including obstructive and restrictive lung diseases (6). Prolonged exposure to dust has been demonstrated to lead to a decline in pulmonary function among several occupational groups ⁽⁶⁾. Lung irritation, inflammation, and fibrosis can result from inhaled dust particles, which in turn induce impaired oxygen diffusion and other aberrant lung functions ⁽⁷⁾. The alteration in the elasticity in addition viscosity of mucous affects its removal and leads to the formation of a luminal mucous plug, which causes blockage in the airflow, leading in a reduction in FVC, FEV1, as well as FEV1/FVC ratio. ⁽⁸⁾. Lower values of lung function indicators typically suggest the potential presence of chronic respiratory and lung diseases ⁽⁹⁾.

The diagnosis of lung disease involves assessing the efficiency as well as the functional capacity of the lungs by measuring various lung volumes, known as ventilator function. The key factors in ventilatory function are the FEV1 and FVC ⁽¹⁰⁾.

Smoking cessation, medication treatment, long-term oxygen therapy, surgery, rehabilitation, and physical therapy, particularly chest physical therapy (CPT), are all components of an exercise program whose intensity is mostly determined by the severity of the condition ⁽¹¹⁾.

The enhancement in pulmonary function may be attributed to the enhanced strength of respiratory muscles, enhanced thoracic movement, and the establishment of balance among lungs along with chest elasticity through regular exercise. The beneficial impact of aerobics on enhancing respiratory functions in individuals without health issues demonstrates that exercise can be regarded as a crucial element of pulmonary rehabilitation among patients suffering from lung disorders ⁽¹²⁾.

Study setting and Population:

The study was conducted in Minia; Egyptian Governorate located 234 km south of Cairo City, the capital of Egypt. As there is a lot of Quarry near to Deraya University, we did this study of community service at our university. This study focused on a mountainous region that is abundant in large amounts of rocks as well as mineral stones. This area is ideal for extracting, quarrying, and mining various types of stones. The quarries covered a large portion of the community and consisted of mountainous rocks. The people in this study were quarry workers who worked in both factories and offices. The factories were where the real work of mining, milling, blasting, breaking, bagging, as well as loading stones happened, while the offices were where office work was done.

Subjects:

The study included forty quarry workers ranging in age from (35 -55 years), the BMI ranges from 25 to 34.9 kg/m2, which indicates being overweight or obese in class 1 were randomly selected from Deraya University Outpatients Clinic and Hospital of Cardiothoracic at Minia University in the period from October 2023 to April 2024. The Ethical Committee (No: P.T. REC/012/004295) gave their approval before the trial began from Cairo University, Egypt, Physical Therapy Faculty and also Clinical Trials.gov (NCT06070584) was recorded first registration at 24/9/2024. Signed written informed consent forms from all patients were required before to their participation in our trial. This study was a randomized study every individual took part in the study by randomly selecting from two groups: (Group A) were given aerobic exercises with moderate intensity by engaging in a 30-minute session of walking on an electronic treadmill, for eight weeks, three times a week. (Group B) were given inspiratory muscle training by incentive spirometer for eight weeks, with three fifteen-minute sessions held weekly. Spirometry was used to measure pulmonary function before and following the study was conducted.

Inclusion criteria included quarry employees who had been working in the quarries for at least 5 years prior to the onset of chest diseases. Only men were included in the study as the nature of the quarries needs men. age between 35 and 55 years old, BMI varied from 25 to 34.9 kg/cm2.

Exclusion Criteria: Patients with chest infections, mental instability, chest cancer, musculoskeletal diseases, and other disorders that could potentially impact the study's findings were excluded from the trial.

Instrumentation

The weight and height scale were used to measure BMI (Model MC. Health scale (RTZ-120A, made in China) prior to commencing the study across both groups. Also, we used a mercury sphygmomanometer (Model Riester, Germany) and stethoscope (Model, Littman, USA) to measure systolic blood pressure (SBP) as well as diastolic blood pressure (DBP) of each woman before in addition after the study.

Aerobic exercise:

By increasing aerobic capacity and improving lung function, aerobic exercises are believed to be beneficial.

Treadmill used Kettler Treadmill made in UK have good maximum user weights 120-150kg. This study set out to find out the impact of such aerobic exercise for eight weeks, especially continuous walking on treadmill continuous walking on treadmill, on lung function (FVC, FEV1, and ratio of FEV1/FVC) in quarry workers in Minia, Egypt.

Spirometer:

Spirometry is an essential technique for detecting lung disease, monitoring patients' pulmonary function, and evaluating their suitability for different procedures. ⁽¹³⁾ Lung function was assessed by Geratherm Respiratory Blue Cherry spirometer; the participant is in an upright position and is wearing nasal clips while holding a handheld mouthpiece and instructed to close his lips on it to avoid escaping of air from sides of mouth piece and ensure complete volume of air be evaluated. before starting test, personal data obtained and recorded in his file as name, age, sex, weight, height as well as BMI then the test started and the participant followed the instruction appear on the screen as, tidal inspiration, deep inspiration, forced expiration and other parameters. the result of the test collected and appear in a report by the Blue Cherry spirometer automatically and the examiner save it on the devise. During previous examinations, three spirometry maneuvers were conducted, then FVC& FEV1 from the maneuver with the greatest FVC that satisfied the criteria were selected for analysis, Additionally, the highest values of FVC& FEV1 from all acceptable maneuvers were used, following current guidelines.⁽¹⁴⁾

Inspiratory Muscle trainer (incentive spirometer):

The incentive spirometer device is extensively utilized in physical, speech, as well as respiratory therapy to motivate the patient to engage in slow and deep inhalation by providing visual feedback. It is crucial to inhale gently when using a spirometer, as this enables the lungs to expand and the airways to open. The incentive spirometer employs visual feedback to evaluate a patient's inspiratory exertion by quantifying the volume of inhalation. The incentive spirometer is a cost-effective and easily manageable equipment that can be utilized in rehabilitation without any reported adverse effects. Once a patient learns how to use it correctly, it is easy to train and they won't need assistance anymore. Further, patients are more likely to comply with treatment plans when they receive visual feedback. ⁽¹⁵⁾

The procedure of exercises for group A:

For every patient, the training procedures are outlined.
Every subject in Both groups participated in an eight-week walking regimen on a treadmill machine, with the following criteria applied: -

Mode of exercise: aerobic exercise.
Intensity: moderate intensity, as measured by heart rate (60-75% of maximum heart rate) MHR=220-age. (Karvonan method)⁽¹⁶⁾

Heart rate: as measured by the sensor of the treadmill and the pulse oximeter.
Duration: Every session lasts 30 minutes. A five-minute warm-up and cool-down phase were incorporated into each session, during which the subject performed treadmill exercises at a constant speed and intensity. The conditioning regimen consisted of a 20-minute interval in which the speed of the treadmill was increased until the subject's MHR was reached (60-75 %).

Frequency: Three times weekly for a duration of eight weeks.

The procedure of exercises for Group (B): in addition to aerobic exercise patients used inspiratory muscle training for 15 minutes with an incentive spirometer. every patient was asked to take maximum inspiration as much as possible to raise the balls of the instrument five times then the patient rest, repeat the procedure followed by rest then repeat the same procedure followed by rest.

Evaluation procedures:

Each patient in both groups will undergo the following evaluation procedures conducted by their respective physicians and PTs. Compare the parameters recorded before and following eight weeks.

2- Anthropometric measurements:

To measure weight and height to calculate BMI (BMI=weight(kg)/ height(m2) for patient selection. Model: MC. Health Scale (RTZ-120A.Made in China). Evaluation carried out according to the specified anthropometric protocol as outlined in: BMI = weight (kg) / (height (m)² ^{(17 -18)}. "All methods were performed in accordance with the relevant guidelines and regulations".

Statistical analysis

To contrast the subject characteristics between the groups, an unpaired t-test was used. The Shapiro-Wilk test was used to ensure that the data followed a normal distribution. A Levene's test was conducted to assess the homogeneity of variances among the different groups. A Mixed MANOVA was conducted to investigate the impact of the treatment on FVC, FEV1, in addition to the ratio of FVC to FEV1. To conduct multiple comparisons, post hoc tests have been carried out utilizing the Bonferroni correction. The significance level for all statistical tests was set at p < 0.05. For this study, we used SPSS 25 for Windows (IBM SPSS, Chicago, IL, USA) to carry out all of our statistical analysis.

- Subject characteristics:

Table (1) shows the subject characteristics of groups A& B. There was no substantial difference among groups regarding age as well as BMI (p > 0.05).

Table 1. Comparison of subject characteristics among the group A &B:

	Group A	Group B
	Mean ±SD	Mean ±SD	MD	t- value	p-value
Age (years)	44.35 ± 4.75	43.70 ± 5.49	0.65	0.33	0.74
BMI (kg/m²)	29.25 ± 2.51	28.38 ± 2.36	0.87	1.13	0.27

SD, Standard deviation; MD, mean difference; p value, Probability value

Effect of treatment on FVC, FEV1 and FVC/FEV1:

Mixed MANOVA revealed a substantial interaction effect of treatment as well as time (F = 849.87, p = 0.001, Partial eta squared = 0.98). There was a substantial main effect of treatment (F = 7.45, p = 0.001, Partial eta squared = 0.38). There was a substantial main effect time (F = 10306.82, p = 0.001, Partial eta squared = 0.99).

Within group comparison

There was a substantial improvement in FVC, FEV1 as well as FVC/FEV1 post treatment in comparison to that pretreatment in both groups (p > 0.001). The percentage of change of FVC, FEV1, as well as FVC/FEV1 of group A, was 8.68, 10.86, and 2.53%, and that in group B was 12.20, 19.48, and 5.99%. (Table 2).

Between group comparison

Following treatment, group B's FVC, FEV1, as well as FVC/FEV1 improved substantially when compared to group A. (p < 0.05). (Table 2).& (figure 1)

Table 2. Mean FVC, FEV1 and FVC/FEV1 pre and post treatment of group A and B:

	Pre treatment	Post treatment
	Mean ±SD	Mean ±SD	MD (95% CI)	% of change	p value
FVC (L)
Group A	4.03 ± 0.14	4.38 ± 0.15	-0.35 (-0.37, -0.32)	8.68	0.001
Group B	4.10 ± 0.17	4.60 ± 0.18	-0.5 (-0.53, -0.48)	12.20	0.001
MD (95% CI)	-0.07 (-0.16, 0.03)	-0.22 (-0.33, -0.12)
	*p = 0.19*	*p = 0.001*
FEV1 (L)
Group A	3.04 ± 0.14	3.37 ± 0.14	-0.33 (-0.34, -0.33)	10.86	0.001
Group B	3.08 ± 0.12	3.68 ± 0.13	-0.6 (-0.61, -0.59)	19.48	0.001
MD (95% CI)	-0.04 (-0.13, 0.05)	-0.31(-0.40, -0.22)
	*p = 0.35*	*p = 0.001*
FVC/FEV1 (%)
Group A	75.18 ± 4.07	77.08 ± 3.57	-1.9 (-2.68, -1.13)	2.53	0.001
Group B	75.32 ± 4.34	79.83 ± 3.82	-4.51 (-5.29, -3.74)	5.99	0.001
MD (95% CI)	-0.14 (-2.84, 2.55)	-2.75 (-5.12, -0.38)
	*p = 0.91*	*p = 0.02*

SD, Standard deviation; MD, Mean difference; CI, Confidence interval; p value, Probability

Figure 1. Mean FVC and FEV1 pre and post treatment of group A and B

-The datasets used and/or analyzed during the current study available from the corresponding author on reasonable request.

This study showed that the incidence of respiratory diseases was higher among quarry workers, this may be due to high exposure to quarry dust.

The study's main objective was to assess whether IMT and/or aerobic exercise provides additional benefits in Quarry workers to improve lung function.

Workers with greater than 5 years of work experience exhibited a higher prevalence of respiratory symptoms compared to the reference group. This is corroborated by additional research, which demonstrates that an extended period of work experience is linked to a greater proportion of respiratory symptoms related to one's occupation ^(19,20,21). This could be attributed to the fact that as the duration of working experience increases, the amount of time exposed to dust also increases. Prolonged exposure to particles of dust or chemicals results in an increased accumulation of dust in the respiratory system and chronic inflammation, which exacerbates breathing difficulties and is characterized by various respiratory symptoms ⁽²²⁾.

The findings of our study indicated a statistical significance distinction (p < 0.05) between groups. Group A also improved in FVC, FEV1, in addition FEV1/FVC ratio in the eight weeks of treatment, but it was significantly less than group B.

The study demonstrated that the use of an incentive spirometer (IS) significantly improved both respiratory muscle strength as well as pulmonary functions, specifically in terms of FVC and FEV1. The findings align with a prior investigation carried out by (Amal et al., in 2023), that analyzed the influence of IS on ABG, spirometry, and diaphragmatic function among COPD patients. This study further demonstrated that IS had a stronger impact on improving ABG, certain pulmonary function parameters (FEV1/FVC), as well as diaphragmatic function in individuals with COPD.

Also, (Arwa et al, 2018)⁽²⁴⁾ They found that aerobic exercise had significant improvement in FEV1, MVV, and FEV1/FVC. After engaging in high-intensity aerobic exercise, there was a substantial improvement in FEV1 and MVV. However, changes in FVC were not statistically significant. The increase in FEV1 indicates that engaging in high-intensity aerobic exercise enhances the flow of air in the respiratory tract. The findings indicate that engaging in aerobic exercise on the treadmill has a beneficial impact on the respiratory function of sedentary individuals. It follows that (Kumar et al.,2016)⁽²⁶⁾ who looked into the incentive spirometry to determine its effectiveness in inducing sighing or yawning and promoting deep breaths in patients with inactive atelectasis and a tendency for shallow breathing. Additionally, the study examined the impact of inspiratory incentive spirometry on the recovery of pulmonary function as well as diaphragm movement in patients who had undergone laparoscopic abdominal surgery. The results showed that the technique led to early recovery in both aspects. Also, our result matched with ( Qaseem et al., 2011)⁽²⁷⁾, who found pulmonary rehabilitation programs could improve FEV1, FVC, and FEV1/ FVC, which leads to reduced air entrapment, enhanced respiratory function, and increased survival rates among those with COPD. Updated guidelines and research indicate that pulmonary rehabilitation is the most effective non-pharmacological treatment for COPD ⁽²⁷⁾.

Limitations of the study

This study investigated a small sample size; so, future investigations will necessitate a

larger sample size and not all parameters of pulmonary functions had been studied.

The current study investigates that respiratory muscle training and aerobic exercise lead to an improvement in lung function in Quarry workers. Both groups showed a significant improved on lung function in FEV1, FVC, FEV1/FVC in Quarry workers in favor to group B. So, this study investigates that respiratory muscle training is an essential supplement to aerobic exercise for pulmonary rehabilitation to increase pulmonary function in Quarry workers.

Acknowledgments

We would like to thank all individuals who contributed to the completion of this work, especially the study participants and every participant wear here personal protective equipment during the study.

Declaration of conflicting interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship and/or publication of this article.

Funding/ financial support: None

Authors’ contribution

THM, MAS, HAA and WEH. prepared the protocol for registration; conceptualized the study; and was involved in database searching, data abstraction, statistical analysis, report writing, and manuscript drafting. SMA, THM, MSA, and SS involved in the screening of primary studies, resolution of conflicts during data extraction, statistical analysis, and manuscript write-up. All authors read and approved the final manuscript before submission. All authors reviewed and approved the final manuscript.

Ethical approval

The study was approved by ethical committee of Cairo University, Egypt with the following reference number No:P.T.REC/012/004295.

Trial details

This clinical trial was registered at ClinicalTrials.gov (NCT06070584).

ORCID ID

Tarek H. Mahmoud https://orcid.org/ 0000-0001-9549-0206.

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No competing interests reported.

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Effect of Respiratory Muscle Training on Lung Function on Quarry Workers in Minia Governorate Egypt

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Abstract

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Introduction

Material and Methods

Results

Discussion

Limitations of the study

Conclusion

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