Effects of motor imagery and action observation on respiratory function in mild smokers: a randomized single-blind controlled pilot trial
Background: Motor imagery (MI) and action observation (AO) training can activate brain areas involved in planning, adjusting, and automating voluntary movement in a manner similar to that when these activities are being performed.
Aim: The main objective of this study was to assess the effects of MI and AO training on respiratory function in mild smokers.
Methods: A single-blind placebo-controlled pilot trial was designed. A total of 27 mild smokers were randomized into three groups: MI (n = 9), AO (n = 9), and sham observation (SO; n = 9) groups. The MI and AO groups performed mental training of breathing exercises while the SO group observed a landscape without a human agent. The primary outcomes were pulmonary function parameters (forced expiratory volume during the 1st s [FEV1], forced vital capacity [FVC], FEV1/FVC ratio, maximum voluntary ventilation [MVV], and peak expiratory flow [PEF]), and the secondary outcomes were maximal inspiratory/expiratory pressures (MIP/MEP) and perceived fatigue. All outcome measures were assessed at baseline and post-intervention.
Results: Regarding the pulmonary function parameters, only the AO group showed significant within-group differences in FEV1 (mean differences [MD] = 0.37 L (0.17 – 0.56), P = 0.001), FVC (MD = 0.1 L (0.02 – 0.16), P = 0.008), and PEF (MD = 0.74 L/s (0.29 – 1.18), P = 0.002) with a small-to-moderate effect size. No differences were found in FEV1/FVC ratio and MVV. With regard to the maximal static pressures, only the AO group showed significant within-group differences in MEP with a small effect size (MD = 11.22 cm H2O (0.19 – 22.2), P = 0.046). Finally, both AO and MI groups showed significantly greater perceived fatigue with regard to SO group with a large effect size (P < 0.05).
Conclusion: AO training has a slight impact on some pulmonary function parameters, such as FEV1, FVC, or PEF, as well as on MEP when applied in isolation and in a single session.
Relevance for Patients: Although it is still early to draw some solid conclusions, AO training could be used in combination with respiratory exercises to see if the effect is greater than exercises in isolation. The study of movement representation strategies on pulmonary function is a field that has been sparingly explored so far. This paper offers some interesting data to be considered for further research.
[1] Decety J. The Neurophysiological Basis of Motor Imagery. Behav Brain Res 1996;77:45-52.
[2] Buccino G. Action Observation Treatment: A Novel Tool in Neurorehabilitation. Philos Trans R Soc B Biol Sci 2014;369:20130185. doi: 10.1098/rstb.2013.0185
[3] Wright DJ, Williams J, Holmes PS. Combined Action Observation and Imagery Facilitates Corticospinal Excitability. Front Hum Neurosci 2014;8:951. doi: 10.3389/fnhum.2014.00951
[4] Hardwick RM, Caspers S, Eickhoff SB, Swinnen SP. Neural Correlates of Action: Comparing Meta-analyses of Imagery, Observation, and Execution. Neurosci Biobehav Rev 2018;94:31-44. doi: 10.1016/j.neubiorev.2018.08.003
[5] Calmels C, Holmes P, Lopez E, Naman V. Chronometric Comparison of Actual and Imaged Complex Movement Patterns. J Mot Behav 2006;38:339-48. doi: 10.3200/JMBR.38.5.339-348
[6] Wright CJ, Smith D. The Effect of PETTLEP Imagery on Strength Performance. Int J Sport Exerc Psychol 2009;7:18-31. doi: 10.1080/1612197X.2009.9671890
[7] Brady N, Maguinness C, Ní Choisdealbha A. My Hand or Yours? Markedly Different Sensitivity to Egocentric and Allocentric Views in the Hand Laterality Task. PLoS One 2011;6:e23316. doi: 10.1371/journal.pone.0023316
[8] Schuster C, Hilfiker R, Amft O, Scheidhauer A, Andrews B, Butler J, et al. Ettlin, Best Practice for Motor Imagery: A Systematic Literature Review on Motor Imagery Training Elements in Five Different Disciplines. BMC Med 2011;9:75. doi: 10.1186/1741-7015-9-75
[9] Montuori S, Curcio G, Sorrentino P, Belloni L, Sorrentino G, Foti F, et al. Functional Role of Internal and External Visual Imagery: Preliminary Evidences from Pilates. Neural Plast 2018;2018:7235872. doi: 10.1155/2018/7235872
[10] Ge S, Liu H, Lin P, Gao J, Xiao C, Li Z. Neural Basis of Action Observation and Understanding From First- and Third-Person Perspectives: An fMRI Study. Front Behav Neurosci 2018;12:283. doi: 10.3389/fnbeh.2018.00283
[11] Vingerhoets G, Stevens L, Meesdom M, Honoré P, Vandemaele P, Achten E. Influence of Perspective on the Neural Correlates of Motor Resonance During Natural Action Observation. Neuropsychol Rehabil 2012;22: 752-67. doi: 10.1080/09602011.2012.686885
[12] Filgueiras A, Quintas Conde EF, Hall CR. The Neural Basis of Kinesthetic and Visual Imagery in Sports: An ALE Meta - analysis. Brain Imaging Behav 2017;12:1513-23. doi: 10.1007/s11682-017-9813-9
[13] Mount J. Effectiveness of Visual vs Kinesthetic Instruction for Learning a Gross Motor Skill. Percept Mot Skills 1987;65:715-20. doi: 10.2466/pms.1987.65.3.715
[14] Solodkin A, Hlustik P, Chen E, Small SL. Fine Modulation in Network Activation during Motor Execution and Motor Imagery. Cereb Cortex 2004;14:1246-55. doi: 10.1093/CERCOR
[15] Fadiga L, Buccino G, Craighero L, Fogassi L, Gallese V, Pavesi G. Corticospinal Excitability is Specifically Modulated by Motor Imagery: A Magnetic Stimulation Study. Neuropsychologia 1998;37:147-58. doi: 10.1016/S0028-3932(98)00089-X
[16] Hashimoto R, Rothwell JC. Dynamic Changes in Corticospinal Excitability during Motor Imagery. Exp Brain Res 1999;125:75-81. doi: 10.1007/s002210050660
[17] Oishi K, Kasai T, Maeshima T. Autonomic Response Specificity during Motor Imagery. J Physiol Anthropol Appl Human Sci 2000;19:255-61.
[18] Decety J, Jeannerod M, Germain M, Pastene J. Vegetative Response during Imagined Movement is Proportional to Mental Effort. Behav Brain Res 1991;42:1-5.
[19] Cuenca-Martínez F, Angulo-Díaz-Parreño S, FeijóoRubio X, Fernández-Solís MM, León-Hernández JV, La Touche R, et al. Motor Effects of Movement Representation Techniques and Cross-education: A Systematic Review and Meta-analysis. Eur J Phys Rehabil Med 2022;58: 94-107. doi: 10.23736/S1973-9087.21.06893-3
[20] Ferrer-Peña R, Cuenca-Martínez F, Romero-Palau M, Flores-Román LM, Arce-Vázquez P, Varangot-Reille C, et al. Effects of Motor Imagery on Strength, Range of Motion, Physical Function, and Pain Intensity in Patients with Total Knee Arthroplasty: A Sydoi: 10.1016/J.BJPT.2021.11.001
[21] Cuenca-Martínez F, Suso-Martí L, León-Hernández JV, La Touche R. Effects of Movement Representation Techniques on Motor Learning of Thumb-opposition Tasks. Sci Rep 2020;10:12267. doi: 10.1038/s41598-020-67905-7
[22] Cuenca-Martínez F, La Touche R, León-Hernández JV, Suso-Martí L. Mental Practice in Isolation Improves Cervical Joint Position Sense in Patients with Chronic Neck Pain: A Randomized Single-blind Placebo Trial. PeerJ 2019;7:e7681. doi: 10.7717/peerj.7681
[23] Cuenca-Martínez F, Suso-Martí L, Sánchez-Martín D, Soria-Soria C, Serrano-Santos J, Paris-Alemany A, et al. Effects of Motor Imagery and Action Observation on Lumbo-pelvic Motor Control, Trunk Muscles Strength and Level of Perceived Fatigue: A Randomized Controlled Trial. Res Q Exerc Sport 2020;91:34-46. doi: 10.1080/02701367.2019.1645941
[24] Losana-Ferrer A, Manzanas-López S, CuencaMartínez F, Paris-Alemany A, La Touche R. Effects of Motor Imagery and Action Observation on Hand Grip Strength, Electromyographic Activity and Intramuscular Oxygenation in the Hand Gripping Gesture: A Randomized Controlled Trial. Hum Mov Sci 2018;58:119-31. doi: 10.1016/j.humov.2018.01.011
[25] Scott M, Taylor S, Chesterton P, Vogt S, Eaves DL. Motor Imagery during Action Observation Increases Eccentric Hamstring Force: An Acute Non-physical Intervention. Disabil Rehabil 2017; 40:1443-51 doi: 10.1080/09638288.2017.1300333
[26] Beaumont M, Forget P, Couturaud F, Reychler G. Effects of Inspiratory Muscle Training in COPD Patients: A Systematic Review and Meta-analysis. Clin Respir J 2018;12:2178-88. doi: 10.1111/CRJ.12905
[27] Tórtola-Navarro A, Gallardo-Gómez D, Álvarez-Barbosa F, Salazar-Martínez E. Cancer Survivor Inspiratory Muscle Training: Systematic Review and Bayesian Meta-analysis. BMJ Support Palliat Care 2023;13:e561-e569. doi: 10.1136/SPCARE-2022-003861
[28] Silva IS, Fregonezi GA, Dias FA, Ribeiro CT, Guerra RO, Ferreira GM. Inspiratory Muscle Training for Asthma. Cochrane Database Syst Rev 2013;2013:CD003792. doi: 10.1002/14651858.CD003792.PUB2
[29] Torres-Castro R, Solis-Navarro L, Puppo H, AlcarazSerrano V, Vasconcello-Castillo L, Vilaró J, et al. Respiratory Muscle Training in Patients with Obstructive Sleep Apnoea: A Systematic Review and Meta-Analysis. Clocks Sleep 2022;4:219-29. doi: 10.3390/CLOCKSSLEEP4020020
[30] Bostanci O, Mayda H, Yılmaz C, Kabadayı M, Yılmaz AK, Özdal M. Inspiratory Muscle Training Improves Pulmonary Functions and Respiratory Muscle Strength in Healthy Male Smokers. Respir Physiol Neurobiol 2019;264:28-32. doi: 10.1016/J.RESP.2019.04.001
[31] Galvan CC, Cataneo AJ. Effect of Respiratory Muscle Training on Pulmonary Function in Preoperative Preparation of Tobacco Smokers. Acta Cir Bras 2007;22:98-104. doi: 10.1590/S0102-86502007000200004
[32] Ferreira Dias Kanthack T, Guillot A, Saboul D, Debarnot U, Di Rienzo F. Breathing with the Mind: Effects of Motor Imagery on Breath-hold Performance. Physiol Behav 2019;208:112583. doi: 10.1016/j.physbeh.2019.112583
[33] Di Rienzo F, Hoyek N, Collet C, Guillot A. Physiological Changes in Response to Apnea Impact the Timing of Motor Representations: A Preliminary Study. Behav Brain Funct 2014;10:15. doi: 10.1186/1744-9081-10-15
[34] Bang DH, Shin WS, Kim SY, Choi JD. The Effects of Action Observational Training on Walking Ability in Chronic Stroke Patients: A Double-blind Randomized Controlled Trial. Clin Rehabil 2013;27:1118-25. doi: 10.1177/0269215513501528
[35] Buccino G, Arisi D, Gough P, Aprile D, Ferri C, Serotti L, et al. Improving Upper Limb Motor Functions through Action Observation Treatment: A Pilot Study in Children with Cerebral Palsy. Dev Med Child Neurol 2012;54:822-8. doi: 10.1111/j.1469-8749.2012.04334.x
[36] Ramos A, Mayayo M. Manual SEPAR de Procedimientos. Barcelona: Abordaje del Tabaquismo; 2007.
[37] Roman-Viñas B, Serra-Majem L, Hagströmer M, RibasBarba L, Sjöström M, Segura-Cardona R. International Physical Activity Questionnaire: Reliability and validity in a Spanish population. Eur J Sport Sci 2010;10:297-304. doi: 10.1080/17461390903426667
[38] Mantilla Toloza SC, Gómez-Conesa A. El Cuestionario Internacional de Actividad Física. Un Instrumento Adecuado en el Seguimiento de la Actividad Física Poblacional. Rev Iberoam Fisioter Kinesiol 2007;10:48-52. doi: 10.1016/S1138-6045(07)73665-1
[39] Campos A, González MA. Spanish Version of the Revised Movement Image Questionnaire (MIQ-R): Psychometric Properties and Validation. Revista de Psicología del Deporte 2010;19:265-75.
[40] Crapo O, Hankinson JL, Irvin C, MacIntyre NR, Voter KZ, Wise RA, et al. Standardization of Spirometry, 1994 Update. Am Thorac Soc 2012;152:1107-36. doi: 10.1164/AJRCCM.152.3.7663792
[41] Gibson GJ, Whitelaw W, Siafakas N. ATS/ERS Statement on Respiratory Muscle Testing. Am J Respir Crit Care Med2002;166:518-624. doi: 10.15063/RIGAKU.KJ00006203368
[42] Lee KA, Hicks G, Nino-Murcia G. Validity and Reliability of a Scale to Assess Fatigue. Psychiatry Res 1991;36:291-8.
[43] Cohen J. Statistical Power Analysis for the Behavioral Sciences. Statistical Power Analysis for the Behavioral Sciences. 2nd ed. Hillsdale, NJ: Lawrence Erlbaum Associates; 1988. P. 567. doi: 10.1234/12345678
[44] Faul F, Erdfelder E, Lang AG, Buchner A. GPower: A Flexible Statistical Power Analysis Program for the Social, Behavioral, and Biomedical Sciences. Behav Res Methods 2007;39:175-91. doi: 10.3758/BF03193146
[45] Cuenca-Martínez F, Suso-Martí L, León-Hernández JV, La Touche R. The Role of Movement Representation Techniques in the Motor Learning Process: A Neurophysiological Hypothesis and a Narrative Review. Brain Sci 2020;10:27-48. doi: 10.3390/brainsci10010027
[46] Rizzolatti G, Fadiga L, Gallese V, Fogassi L. Premotor Cortex and the Recognition of Motor Actions. Brain Res Cogn Brain Res 1996;3:131-41.
[47] Suso-Martí L, León-Hernández JV, La Touche R, ParisAlemany A, Cuenca-Martínez F. Motor Imagery and Action Observation of Specific Neck Therapeutic Exercises Induced Hypoalgesia in Patients with Chronic Neck Pain: A Randomized Single-Blind Placebo Trial. J Clin Med 2019;8:1019. doi: 10.3390/jcm8071019
[48] Park HD, Piton T, Kannape OA, Duncan NW, Lee KY, Lane TJ, et al. Breathing is Coupled with Voluntary Initiation of Mental Imagery. Neuroimage 2022;264:119685. doi: 10.1016/J.NEUROIMAGE.2022.119685
[49] Roure R, Collet C, Deschaumes-Molinaro C, Delhomme G, Dittmar A, Vernet-Maury E. Imagery Quality Estimated by Autonomic Response is Correlated to Sporting Performance Enhancement. Physiol Behav 1999;66:63-72.
[50] Dai Y, Huang F, Zhu Y. Clinical Efficacy of Motor Imagery Therapy Based on fNIRs Technology in Rehabilitation of Upper Limb Function After Acute Cerebral Infarction. Pak J Med Sci 2022;38:1980-5. doi: 10.12669/PJMS.38.7.5344