Eficácia do dilatador nasal na corrida: uma revisão sistemática e metanálise

Abstract

Introduction: The nasal valve is responsible for approximately 50 to 60% of total airway resistance in the respiratory tract and tends to collapse during inspiration. Nasal dilators were created to expand the nasal valve area and ensure better nasal patency in a nonpharmacological manner. Objective: To verify the effectiveness of using nasal dilators during running. Methods: This is a systematic literature review and meta-analysis that followed the recommendations PRISMA-P, PRISMA 2020 and registered in PROSPERO (CRD42021225795). According to the PICOS strategy studies were included: Population: healthy subjects without sex and age restrictions; Intervention: nasal dilators; Comparison: control group, placebo, minimal intervention, health education or other intervention; Outcomes: cardiorespiratory parameters and subjective perceptions of nasal obstruction and patency, effort, fatigue and dyspnea; Study: randomized clinical trials, randomized clinical trials of repeated measures or within-subjects design, published in full and peer-reviewed. The databases searched were MEDLINE/OVID, EMBASE, CENTRAL The Cochrane Library, CINAHL, SPORTDiscus, Web of Science, PEDro and Scopus. The descriptors “Running”, “Nasal Dilator” and “Randomized Controlled Trial” and synonyms were combined using the boolean operator “AND”. The selection and extraction of data, as well as the assessment of the risk of bias using the PEDro scale, were performed by independent researchers. Meta-analysis was conducted when at least two studies were comparable and reported as a standardized mean of difference (effect size) and 95% confidence interval. The Der Simonian and Laird random effects model was used and heterogeneity was evaluated using the I² statistic. The assessment of the certainty of the evidence was carried out using the GRADE approach. Results: 3748 articles were found, of which 11 were included in the qualitative analysis and seven in the quantitative analysis. The results showed a significant difference in favor of the nasal dilator compared to placebo for the outcomes VO2max [effect size, 95% CI: 0.34 (0.12 - 0.56), p: 0.00, I²: 0%, and N: 154] and RPE [effect size, 95% CI: - 0.27 (-0.51 - -0.03), p: 0.03, I²: 0%, and N: 136]. There was no significant difference between the use of nasal dilators when compared to the control for the outcomes VO2max [effect size, 95% CI: 0.16 (-0.39 - 0.72), p: 0. 57, I²: 0%, and N: 23], RPE [effect size, 95% CI: -0.34 (- 0.69 - 0.02), p: 0.06, I²: 0%, and N: 59], HR [effect size, CI 95%: 0.15 (-0.26 - 0.57), p: 0.47, I²: 0%, and N: 42], RER [effect size, CI 95%: -0.06 (-0.62 - 0.5), p: 0.83, I²: 0%, and N: 23] and exercise time [effect size, CI 95%: 0.08 (-0.34 - 0.49), p: 0.71, I²: 0%, and N: 42]. The certainty of the evidence ranged from low to very low. Conclusion: Data on the topic are incipient, and future studies will probably have an impact on estimation of the effect.