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58 Cuenca-Martínez et al. | Journal of Clinical and Translational Research 2024; 10(1): 52-61
impact on maximal strength variables and pulmonary volumes program alone as assessed with functional near-infrared
and flows. Several research studies indicate that both mental spectroscopy (fNIRs) technology [50]. In addition, in patients
practice techniques (MI and AO) provoke a neurophysiological where actual therapeutic exercise is not possible (e.g., bedridden,
activation of the areas related to the planning and adjustment of or after surgery), mental practice training could be performed with
voluntary movement in a way very similar to when the execution the aim of minimizing the impact of immobilization. However,
is carried out [3,4,45]. This is due to the activity of mirror neurons, research studies should be carried out to determine these effects
discovered by Rizzolatti et al. in the 1990s [46]. This mirror neuron in different clinical populations with ventilatory disorders, such as
system seems to function more efficiently through AO training chronic obstructive pulmonary disease, asthma, and lung cancer,
than through MI, as it is less demanding, in terms of cognitive and also to evaluate the medium- and long-term impact.
load, to maintain an image than to create and also maintain it [45]. The present study has some limitations that should be taken
This could be a justification for why AO training elicits greater into consideration. First, the main limitation is the small sample
changes than MI when both are applied in isolation. In previous size. Probably, a larger sample would give slightly different
research, we found that AO elicits greater and longer-lasting results although this is only an assumption. This pilot study was
motor learning than MI [21], as well as a better sense of short- used to make an estimate of the sample size and we found that
term cervical joint repositioning [22]. With respect to the other the final study should contain at least 15 participants for each
variables, AO training appears to lead to greater pain modulation, group. Second, this study has a theoretical perspective with the
as well as greater heart rate response in patients with cervical aim of looking at the impact of mental practice in isolation. To
pain, as compared with MI [47]. In addition, Cuenca- Martínez have a more clinical perspective, future studies should evaluate
et al. [45] commented that some variables could influence the whether the combination of movement representation techniques
process of building a movement image, such as motor experience. with actual respiratory training would lead to an improvement of
The musculature involved in breathing seems difficult to train, exercise capacity or assess the impact of airway disease on health
and therefore, visual input could be more effective than direct status and perceived wellbeing, as compared to actual exercise in
imagination when a motor gesture is complex to perform, as could isolation. Finally, the results were derived from the analysis of the
be the training of the respiratory musculature, both at tidal volume very short-term data. Future studies should include a follow-up to
and in a forced manner. This could also partly justify why the see if the changes generated by the intervention are sustained over
MI group did not show intra-group differences. Movement is a time. For all these reasons, the results should be interpreted with
cortical expression because it is planned before it is executed. The caution as this is a preliminary study.
voluntary initiation of both imagined/observed and actual action
is linked to breathing. It is suggested that the respiratory system 5. Conclusions
is involved in these processes of voluntary movement planning
regardless of whether it culminates in overt movements [48]. AO training has a slight impact on some pulmonary function
Perceived fatigue was also assessed, with the aim of confirming parameters, such as FEV , FVC, or PEF, as well as on MEP
1
that the participants undergoing mental practice training, specifically when applied in isolation and in a single session. The impact
the MI group, were actually performing the MI protocol. It has been of MI seems almost non-existent, at least in isolation and in a
widely reported that mental fatigue could be the main determinant single session. At the clinical level, it seems that AO training has
of MI [45,49], because the person would stop imagining in an effect on the activity of the expiratory musculature, resulting
conditions of high mental fatigue, especially in motor gestures with in a slight improvement in maximal strength that also appears to
great difficulty, or if the time of the imagining task is maintained in translate into small improvements in some pulmonary function
a sustained manner. This was also argued earlier by Buccino [2], parameters. Future studies should combine AO with breathing
who advocates that MI has some intrinsic limits that AO training exercises to assess whether the effects are more pronounced than
does not exhibit because MI is a more demanding tool, in terms those stemming from breathing exercises in isolation.
of attention and concentration, compared with AO training. The Acknowledgments
loss of attention, as well as the difficulty of the breathing training
exercises, could explain the poor effect of MI in this study. None.
At the clinical level, it appears that AO training has an impact
on the activity of the expiratory musculature that results in a slight Funding
improvement in maximal strength that also appears to translate Not applicable.
into small improvements in some pulmonary function parameters.
Although it is still early to draw solid conclusions, AO training Conflict of Interest
could be used in combination with respiratory exercise to see if
the effect is greater than exercise alone. For example, in other None declared.
populations such as patients with acute cerebral infarction, mental Ethics Approval and Consent to Participate
practice in combination with a conventional rehabilitation program
has been shown to elicit a greater clinical effect, including improved This study was approved by the Ethics Committee of Research
blood oxygen to brain tissue, than the conventional rehabilitation in Humans of the Ethics Commission in Experimental Research of
DOI: http://doi.org/10.36922/jctr.00117