Respiratory Muscle Training: Theory and Practice
Abstract
Respiratory Muscle Training: theory and practice is the world’s first book to provide an "everything-you-need-to-know" guide to respiratory muscle training (RMT). Authored by an internationally-acclaimed leading expert, it is an evidence-based resource, built upon current scientific knowledge, as well as clinical experience at the cutting-edge of respiratory training in a wide range of settings. The aim of the book is to give readers: 1) an introduction to respiratory physiology and exercise physiology, as well as training theory; 2) an understanding of how disease affects the respiratory muscles and the mechanics of breathing; 3) an insight into the disease-specific, evidence-based benefits of RMT; 4) advice on the application of RMT as a standalone treatment, and as part of a rehabilitation programme; and finally, 5) guidance on the application of functional training techniques to RMT.
The book is divided into two parts - theory and practice. Part I provides readers with access to the theoretical building blocks that support practice. It explores the evidence base for RMT as well as the different methods of training respiratory muscles and their respective efficacy. Part II guides the reader through the practical implementation of the most widely validated form of RMT, namely inspiratory muscle resistance training. Finally, over 100 "Functional" IMT exercises are described, which incorporate a stability and/or postural challenge, including exercises that address specific "dyspnoeagenic" movements.
Respiratory Muscle Training: theory and practice is supported by a dedicated website (www.physiobreathe.com), which provides access to the latest information on RMT, as well as video clips of all exercises described in the book. Purchasers will also receive a three-month free trial of the Physiotec software platform, which allows clinicians to create bespoke training programmes (including video clips) that can be printed or emailed to patients.
Supplementary resource (1)
... IMT protocols vary and depend on the respiratory device used, the characteristics of the exerciser and the desired effects. In general, a minimum of four weeks of regular IMT, usually performed twice daily for at least 5 days per week at 50-70% of the maximum inspiratory pressure (MIP), is required for improvement in respiratory muscle strength (McConnell, 2013). Moderate-to high-intensity IMT (∼60% MIP) can increase maximal contraction velocity and inspiratory muscle strength. ...
... Each measurement was taken five times. The minimum and maximum values were excluded and the average of the remaining three measurements was calculated (McConnell, 2013). The respiratory muscle fatigue was determined from the difference (∆) between the MIP and MEP values obtained before (pretest) and immediately after (posttest) the 60-minute walking test. ...
... The advantage of suprathreshold loading is that the increase in inspiratory resistance does not affect the actual airflow through the unit. Furthermore, the load resistance can be assessed objectively (McConnell 2011;McConnell, 2013). ...
Purpose: Restricting chest movement when carrying a loaded backpack reduces efficiency and increases the work of the respiratory muscles. The aim of the present study was to investigate the effects of six weeks of inspiratory muscle training (IMT) on respiratory muscle strength and endurance and on physical performance when carrying a load.
Methods: Twenty male (age: 32.2 ± 3.4 years) members of the Special Operations Unit of the Slovenian Army volunteered to participate. The experimental group (n=10) trained their respiratory muscles for six weeks against an incremental inspiratory resistance with a breathing apparatus. The placebo group (n=10) performed the same IMT protocol but with a sham inspiratory resistance. Assessment of the subjects before and after IMT included measurements of the maximal inspiratory and expiratory pressures, heart rate measurements, and ratings of perceived physical and respiratory exertion before and after a 60-min walk test with a 25-kg backpack.
Results: After six weeks of IMT, the maximum inspiratory pressure measured before and after the 60-minute walk test increased significantly (p < 0.001) in the experimental group by 47 ± 13% and 58 ± 20%, respectively. Inspiratory fatigue was also significantly lower in the experimental group. No changes were observed in the heart rate and the rating of perceived exertion during the walking test. In the placebo group, no significant changes were observed in the measured parameters after IMT.
Conclusion: Six weeks of IMT with progressive breathing resistance improves strength and reduces fatigue of the respiratory muscles. Individuals who perform tasks that require them to carry a heavy backpack for extended periods of time may benefit from IMT.
... IMT increases inspiratory muscle strength and reduces respiratory weakness, improving physical fitness and quality of life (QoL) in patients [13]. Cancer treatment has a large number of effects that can be counteracted by IMT, for example, improvement in lung function, sarcopenia of the respiratory muscles [14], loss of thoracic mobility derived from surgery [15], or pulmonary fibrosis induced by radiotherapy applied to the chest [16]. Although numerous studies have demonstrated the benefits of IMT in cancer survivors [17,18], there is wide heterogeneity in the way IMT is administered in terms of dose (frequency, volume, intensity), duration of interventions, when IMT is applied (before or after surgery), and their combination with other therapies. ...
... Not all studies of IMT as a stand-alone therapy in COPD patients obtained significant improvements in pulmonary function [50]. The low response on spirometric parameters with this type of intervention is not atypical, and the observed benefits of IMT in this population are related to improvements in respiratory strength and efficiency [14]. ...
... The present analysis suggests that performing IMT before surgery leads to a greater degree of improvement in pulmonary function, even considering the number of analyzed articles. This issue is in line with McConnell statement [14] which points out that pre-operative IMT could be applied for the improvement or maintenance of MIP after cancer treatment. In this sense, the timing of the IMT intervention may facilitate the recovery process if the treatment has damaged the respiratory system. ...
Background The long-term impact of cancer treatment is associated with respiratory dysfunction and physical fitness impairment. Although inspiratory muscle training (IMT) has been shown as an effective exercise therapy in cancer survivors, there is no evidence on the optimal dose, application moment nor specific population effects of this intervention. The main objective of this meta-analysis is to analyse the effects of IMT on pulmonary function, physical fitness and quality of life (QoL) in cancer survivors.
Methods This systematic review and meta-analysis was preregistered in the International Prospective Register of Systematic Reviews (PROSPERO) register and conducted according to the Preferred Reporting for Systematic Reviews and Meta-analysis statement. We used a Bayesian multilevel random-effects meta-analysis model to pool the data. Multilevel metaregression models were used to examine the conditional effects of our covariates. Convergence and model fit were evaluated through specific model parameters. Sensitivity analyses removing influential cases and using a frequentist approach were carried out.
Results Pooled data showed that IMT intervention is effective to improve pulmonary function (standardised mean difference=0.53, 95% credible interval 0.13 to 0.94, SE=0.19). However, IMT did not present statistically significant results on physical fitness and QoL. Metaregression analyses found that the type of cancer, the moment of application and the evaluation tool used had significant moderation effects on pulmonary function.
Conclusion IMT could be an important part in the management of side effects suffered by cancer survivors. Considering the current evidence, this intervention is highly recommended in patients diagnosed with oesophageal and lung cancers. IMT may provide superior benefits before the biological treatment and after the surgery.
PROSPERO registration number 304909.
... In human athletes there is a training-induced adaptation of the respiratory muscles 1,2 with an increase in the inspiratory muscle strength following both non-specific strength training and specific inspiratory muscle training (IMT). [1][2][3] IMT has been used as an ergogenic aid in healthy human subjects, with investigations demonstrating an improvement in athletic performance 4 and a change in a range of physiological parameters 5,6 but most importantly attenuation of inspiratory muscle fatigue. 7 In addition, there is a correlation between diaphragm thickness and inspiratory muscle strength in people, [8][9][10] with an increase in diaphragm thickness and inspiratory muscle strength (measured by maximal inspiratory pressure) following IMT. ...
... The application of IMT is used in human athletes to strengthen the respiratory muscles, delaying the activation of the respiratory muscle metaboreflex, 3 and optimising athletic performance in sports where diaphragm fatigue is performance limitating. 3,4,24 In addition, in human subjects, IMT reduces the perception of respiratory and limb effort. ...
... The application of IMT is used in human athletes to strengthen the respiratory muscles, delaying the activation of the respiratory muscle metaboreflex, 3 and optimising athletic performance in sports where diaphragm fatigue is performance limitating. 3,4,24 In addition, in human subjects, IMT reduces the perception of respiratory and limb effort. 3,24 The horses' respiratory system is thought to be the limiting factor which determines athletic performance. ...
Background
Little is known about the response of the equine respiratory muscles to training.
Objectives
To measure an index of inspiratory muscle strength (IMSi) before and after a period of conventional exercise training ( phase 1 ) and inspiratory muscle training (IMT), comparing high‐load (treatment) and low‐load (control) groups ( phase 2 ).
Study design
Prospective randomised controlled trial.
Methods
Phase 1 : Twenty National Hunt Thoroughbred racehorses performed an inspiratory muscle strength test (IMST) twice on two occasions; when unfit at timepoint A (July), and when race fit at timepoint B (October). Phase 2 : Thirty‐five Thoroughbred racehorses at race fitness were randomly assigned into a high‐load (treatment, n = 20) or low‐load (control, n = 15) IMT group. The high‐load group followed an IMT protocol that gradually increased the inspiratory pressure applied every 4 days. The low‐load group underwent sham IMT with a low training load. The IMT was performed 5 days/week for 10 weeks. The IMST was performed twice on two occasions, timepoint B (October) and timepoint C (January). Conventional exercise training and racing continued during the study period. The peak IMSi values obtained from the different groups at timepoints A, B and C were compared using a Wilcoxon Signed Rank Test.
Results
Phase 1 : There was a significant increase in IMSi from timepoint A: 22.5 cmH 2 O (21–25) to timepoint B: 26 cmH 2 O (24–30) ( p = 0.015). Phase 2 : From timepoint B to C there was a significant increase in IMSi for the high‐load group 34 cmH 2 O (28–36) ( p = 0.001) but not the low‐load group 26 cmH 2 O (24–30) ( p = 0.929). The peak IMSi at timepoint C was significantly higher for the high‐load than low‐load group ( p = 0.019).
Main limitations
Single centre study with only National Hunt horses undergoing race‐training included.
Conclusions
In horses undergoing race training there is a significant increase in IMSi in response to conventional exercise training and high‐load IMT.
... 7 According to the principle of specificity, high-intensity (50% of MIP), low-repetition training is provided for strength training; and low-intensity (30% of MIP), high-repetition is provided for endurance training. 9 It was stated that as the training intensity increases, better improvement is obtained in inspiratory muscle strength, functional exercise capacity, and quality of life. 10 Moreover, it has recently been concluded that the best mode of IMT training intensity at 60% MIP six times per week for 12 weeks is the best protocol to improve inspiratory muscle strength, walking distance, and dyspnea in patients with HF. ...
... The training was performed using a pressure threshold-loading device (POWERbreathe Ò Classic Low Resistance). The ISTG received IMT at 50% of MIP, 8,9 measured at supervised sessions each week, and 50% of the measured MIP value was the new training workload. Patients were instructed to maintain diaphragmatic breathing and try to maintain 10À15 breaths and 5À10s resting following each set. ...
... Patients were instructed to maintain 20À25 diaphragmatic breathing and 5À10s resting. The groups were trained for 30 min/day, 7 days/week, for 8 weeks, 8,9 six sessions at home and one under supervision. Vital signs were monitored during sessions. ...
Background
Studies have widely investigated the effects of inspiratory muscle strength training in patients with heart failure (HF). The effects of inspiratory muscle strength or endurance training on outcomes in patients with pacemakers have not been adequately studied.
Objectives
The aim was to compare the effects of inspiratory muscle strength and endurance training on exercise capacity, quality of life (QoL), peripheral and respiratory muscle strength, respiratory muscle endurance, pulmonary function, dyspnea, fatigue, and physical activity levels in pacemaker patients with HF.
Methods
A randomized, controlled, double-blind study was conducted. Fourteen pacemaker patients with HF received inspiratory muscle strength training (IMST) at 50% of maximal inspiratory pressure (MIP), and 18 patients received endurance training (IMET) at 30% of MIP 7 days/8 weeks. Exercise capacity [6 min. walking test (6MWT) and the Incremental Shuttle Walking Test (ISWT)], pulmonary function, respiratory muscle strength [MIP, maximal expiratory pressure (MEP)], endurance, peripheral muscle strength, dyspnea, fatigue, QoL, and physical activity level were evaluated before and after.
Results
Demographic characteristics were similar in IMST (3F/11M, 56.92 ± 7.61y, EF: 25%, ICD/CRT:11/3) and IMET (4F/14M, 56 ± 10.77y, EF: 30%, ICD/CRT:16/2) groups (p > 0.05). Significant improvements were present in MIP, MEP, respiratory muscle endurance, peripheral muscle strength, 6MWT and ISWT walking distances, dyspnea, QoL, physical activity level, fatigue scores within groups (p ≤ 0.05). However, there were no significant differences between the groups (p > 0.05). There were no significant improvements in FEV1%, FVC%, FEV1/FVC%, and FEF25-75 within and between the groups (p > 0.05).
Conclusions
Inspiratory muscle strength and endurance training similarly improves respiratory and peripheral muscle strength, exercise capacity, QoL, physical activity level, and decreases dyspnea and fatigue and are safe and effective in pacemaker patients with HF.
Trial registration
www.ClinicalTrials.gov; study number: NCT03501355.
... In human athletes, inspiratory muscle training (IMT) has been shown to activate, and induce a training response of the muscles of the upper airway (How et al., 2007) and diaphragm (Cardenas et al., 2018). Due to the resultant increase in the strength of the upper airway muscles, IMT has been applied successfully as a non-surgical treatment for exercise-induced laryngeal obstructions (McConnell, 2013;Clemm et al., 2017;Sandnes et al., 2019). Preliminary investigations confirm that IMT can be undertaken in horses and can result in an increase in an index of inspiratory muscle strength, measured during a continuous incremental inspiratory pressure loading protocol (Allen et al., 2020), which is thought to reflect an increase in diaphragmatic strength (L. ...
... Understanding how to strengthen the upper airway muscles has become a key research goal. The current IMT protocol was developed based on the established training principles applied in human athletes (McConnell, 2013), as well as preliminary investigations in horses (Allen et al., 2020). Firm conclusions regarding the benefit of IMT on dynamic upper airway function cannot be drawn from a case series of this nature, however, the results indicate that the technique is feasible and achievable in horses diagnosed with certain types of UAC, with no adverse effects identified. ...
... Vocal fold collapse is frequently observed in conjunction with LACC in horses with RLN but can also be seen in horses with good arytenoid abduction ; in these cases, VFC may be associated with dysfunction of the cricothyroid muscle (Holcombe et al., 2006). In human athletes, IMT has been applied successfully for the treatment of vocal cord dysfunction (Baker et al., 2003;McConnell, 2013;Sandnes et al., 2019). In the present study, it was intriguing to note that the grade of VFC decreased post-IMT in six horses. ...
Exercise-induced upper airway collapse (UAC) probably occurs when the stabilising muscles of the upper airway are unable to withstand the dramatic changes in airflow and pressure that occurs during exercise. In racehorses, the mainstay of treatment is surgical intervention. In human athletes, exercise-induced laryngeal obstruction has been treated successfully with inspiratory muscle training (IMT). The aims of this study were: (1) to assess the feasibility of IMT in racehorses; and (2) describe the exercising endoscopy findings pre- and post-IMT in racehorses diagnosed with dynamic UAC. Horses undergoing IMT wore a mask with an attached threshold-valve to apply an additional load during inspiration, creating a training stimulus with the purpose of increasing upper airway muscle strength. Each horse underwent IMT once daily, while standing in the stable, 5-6 days/week for 10 weeks. Endoscopy recordings were analysed in a blinded manner using an objective grading scheme and subjective pairwise analysis.
Seventeen horses successfully completed the IMT protocol, with full information available for 10 horses. Objective grading analysis showed a lower grade of vocal fold collapse (6/9 horses), palatal instability (7/10 horses) and intermittent dorsal displacement of the soft palate (5/7 horses) post-IMT. Pairwise subjective analysis suggested better overall airway function post-IMT in 3/10 horses. The main limitations of this preliminary investigation were the low number of horses examined and lack of a control population. Further research is required to investigate the effects of IMT on upper airway muscle strength and to evaluate its efficacy for prevention and treatment of UAC.
... 4) Similar to other skeletal muscles, respiratory muscles can also be trained based on the principles of exercise. 5) Inspiratory muscle training (IMT) is an exercise method used for both patients with COPD and the older adult population, with positive effects in both populations. [6][7][8] However, in these studies, the IMT (also known as "foundation or conventional IMT") focused only on the respiratory task of respiratory muscles. ...
... 10,11) The idea of a newly integrated exercise program that includes functional IMT, which includes all inspiratory muscle functions, was first proposed by McConnell. 5) This program aims to increase the gains by applying exercises addressing all muscle functions, 5) whereas foundation IMT mainly targets respiration. However, the contributions of the respiratory muscles to postural control and core stabilization have not been directly addressed in a rehabilitation context. ...
... 10,11) The idea of a newly integrated exercise program that includes functional IMT, which includes all inspiratory muscle functions, was first proposed by McConnell. 5) This program aims to increase the gains by applying exercises addressing all muscle functions, 5) whereas foundation IMT mainly targets respiration. However, the contributions of the respiratory muscles to postural control and core stabilization have not been directly addressed in a rehabilitation context. ...
Background:
Inspiratory muscle training (IMT) is a commonly used exercise method for both patients with chronic obstructive pulmonary disease (COPD) and the older adult population. In addition to their primary function, respiratory muscles play an active role in core stabilization. However, no IMT program includes both of these functions (i.e., core stabilization and postural control functions as well as respiration). This study investigated the effects of a newly integrated exercise program, termed "functional IMT," in geriatric individuals with and without COPD.
Methods:
This prospective and experimental study included 45 geriatric individuals with COPD (n=22) and without COPD (n=23). The training program consisted of 4 weeks of conventional IMT followed by 4 weeks of functional IMT. Respiratory muscle strength, symptoms, exercise capacity, balance, postural control, physical activity, and quality of life were evaluated.
Results:
After training, respiratory muscle strength, symptoms, exercise capacity, balance, postural control, and quality of life improved in both groups (p<0.05). In addition, physical activity was increased in the COPD group (p<0.05). We observed no statistically significant difference in outcomes between the two groups before and after treatment (p>0.05).
Conclusion:
The gains were similar in both groups. Functional IMT, which is an integrated approach that includes all respiratory muscle functions, is a safe, effective, and innovative method for use in geriatric individuals with and without COPD.
... Resistance training is a versatile form of exercise training with a large range of adaptations occurring including improved muscular strength, power, shortening velocity and endurance a1111111111 a1111111111 a1111111111 a1111111111 a1111111111 [1]. Respiratory muscle training (RMT) is a resistance training technique aimed towards improving the strength and function of the respiratory muscles using the general training principals of overload. ...
... Respiratory muscle training (RMT) is a resistance training technique aimed towards improving the strength and function of the respiratory muscles using the general training principals of overload. It is claimed to be the most efficient way of improving respiratory muscle function in human athletes [1]. ...
... RMT involves breathing against an increasing amount of resistance for a short period of time to overload the respiratory muscles, requiring them to work at a higher intensity and/or longer duration than normal [1]. RMT was first developed to assist people with breathing difficulties and alleviate symptoms of respiratory diseases such as chronic obstructive pulmonary disease (COPD) and asthma [2,3]. ...
Although inspiratory muscle training (IMT) is reported to improve inspiratory muscle strength in humans little has been reported for horses. We tested the hypothesis that IMT would maintain and/or improve inspiratory muscle strength variables measured in Thoroughbreds during detraining. Thoroughbreds from one training yard were placed into a control (Con, n = 3 males n = 7 females; median age 2.2±0.4 years) or treatment group (Tr, n = 5 males, n = 5 females; median age 2.1±0.3 years) as they entered a detraining period at the end of the racing/training season. The Tr group underwent eight weeks of IMT twice a day, five days per week using custom-made training masks with resistance valves and an incremental threshold of breath-loading protocol. An inspiratory muscle strength test to fatigue using an incremental threshold of breath-loading was performed in duplicate before (T0) and after four (T1) and eight weeks (T2) of IMT/no IMT using a custom-made testing mask and a commercial testing device. Inspiratory measurements included the total number of breaths achieved during the test, average load, peak power, peak volume, peak flow, energy and the mean peak inspiratory muscle strength index (IMSi). Data were analysed using a linear mixed effects model, P≤0.05 significant. There were no differences for inspiratory measurements between groups at T0. Compared to T0, the total number of breaths achieved (P = 0.02), load (P = 0.003) and IMSi (P = 0.01) at T2 had decreased for the Con group while the total number of breaths achieved (P
... Inspiratory muscle training has been used in humans for the management/treatment of a range of medical conditions, including exercise-induced laryngeal obstruction (EILO) and in the treatment of breathlessness for patients with chronic lung and/or heart disease [4]. It has also gained popularity amongst athletes as an ergogenic aid, by improving respiratory muscle performance. ...
... The use of inspiratory muscle training in human athletes has been shown to improve athletic performance [4,7,8] by delaying the onset of the RMF and postponing activation of the respiratory muscle metaboreflex. Existence of the respiratory muscle metaboreflex has been confirmed in dogs [9], but it is unknown whether RMF occurs in horses nor whether the respiratory muscle metaboreflex is active during race/competition conditions. ...
... Inspiratory muscle training has been shown to activate the upper airway muscles and has been used to treat EILO in human athletes [4,12]. The high prevalence of upper airway obstructions in racehorses poses significant performance, health and welfare concerns to the Thoroughbred industry. ...
Background:
Inspiratory muscle training applies a training stimulus directly to the inspiratory muscles and is distinct from whole-body training. The potential benefits of inspiratory muscle training have yet to be explored in horses.
Objectives:
The objectives were as follows: (a) to develop an equine-specific method of testing and training inspiratory muscles; (b) to assess tolerance and feasibility in a pilot study in a commercial Thoroughbred training establishment.
Study design:
Field study.
Methods:
A mask was used to interface commercial human inspiratory muscle training equipment. Ten horses undertook inspiratory muscle training once daily while stood in the stable approximately 5 days/wk over a 9-week period. Inspiratory muscle strength testing employed a continuous incremental inspiratory loading protocol alternating two loaded and two minimally loaded breaths until failure to tolerate the load occurred or the maximum 60 breaths were completed. The inspiratory muscle strength testing was undertaken twice; firstly, in 10 horses with minimal acclimatisation and secondly, in eight horses experienced with the inspiratory muscle training programme.
Results:
The 10 horses undertook inspiratory muscle training for a median of 42 days, reaching a median peak training load of 32.5 cm H2 O. One horse did not tolerate the mask with repeated snorting and was replaced. All horses completed the inspiratory muscle strength testing. The median peak value in inspiratory muscle strength testing protocol 1 was 27 cm H2 O and in inspiratory muscle strength testing protocol 2 was 41 cm H2 O. Two of 10 horses reached the maximum possible value in inspiratory muscle strength testing protocol 1; therefore, the test was adapted to permit a higher maximum value, despite this 3/8 horses reached the maximum possible value in inspiratory muscle strength testing protocol 2.
Main limitations:
A small number of horses were assessed. The inspiratory muscle strength testing protocol was refined during the study and requires additional refinement.
Conclusion:
Inspiratory muscle testing and training were feasible and tolerated in horses. Further research is required to understand whether the inspiratory muscle strength testing values obtained correlate with other physiological/performance outcomes. The potential benefits and/or adverse effects of inspiratory muscle training warrant further investigation.
... Resistance training is a versatile form of exercise training with a large range of adaptations 47 occurring including improved muscular strength, power, shortening velocity and endurance 48 [1]. Respiratory muscle training (RMT) is a resistance training technique aimed towards 49 improving the strength and function of the respiratory muscles using the general training 50 principals of overload. ...
... Respiratory muscle training (RMT) is a resistance training technique aimed towards 49 improving the strength and function of the respiratory muscles using the general training 50 principals of overload. It is claimed to be the most efficient way of improving respiratory 51 muscle function [1]. 52 ...
... RMT involves breathing against an increasing amount of resistance for a short period of time 54 to overload the respiratory muscles, requiring them to work at a higher intensity and/or longer 55 duration than normal [1]. RMT was first developed to assist people with breathing difficulties 56 and alleviate symptoms of respiratory diseases such as chronic obstructive pulmonary disease 57 (COPD) and asthma [2,3]. ...
Although inspiratory muscle training (IMT) is reported to improve inspiratory muscle strength in humans little has been reported for horses. We tested the hypothesis that IMT would maintain and/or improve inspiratory muscle strength variables measured in Thoroughbreds during detraining. Thoroughbreds from one training yard were placed into a control (Con, n=3 males n=7 females; median age 2.2±0.4 years) or treatment group (Tr, n=5 males, n=5 females; median age 2.1±0.3 years) as they entered a detraining period at the end of the racing/training season. The Tr group underwent eight weeks of IMT twice a day, five days per week using custom-made training masks with resistance valves and an incremental threshold of breath-loading protocol. An inspiratory muscle strength test to fatigue using an incremental threshold of breath-loading was performed in duplicate before (T0) and after four (T1) and eight weeks (T2) of IMT/no IMT using a custom-made testing mask and a commercial testing device. Inspiratory measurements included the total number of breaths achieved during the test, average load, peak power, peak volume, peak flow, energy and the mean peak inspiratory muscle strength index (IMSi). Data was analysed using a linear mixed effects model, P≤0.05 significant. There were no differences for inspiratory measurements between groups at T0. Compared to T0, the total number of breaths achieved (P=0.02), load (P=0.003) and IMSi (P=0.01) at T2 had decreased for the Con group while the total number of breaths achieved (P<0.001), load (P=0.03), volume (P=0.004), flow (P=0.006), energy (P=0.01) and IMSi (P=0.002) had increased for the Tr group. At T2 the total number of breaths achieved (P<0.0001), load (P<0.0001), volume (P=0.02), energy (P=0.03) and IMSi (P<0.0001) were greater for the Tr than Con group. In conclusion, our results support that IMT can maintain and/or increase aspects of inspiratory muscle strength for horses in a detraining programme.
... The so call multicomponent training programs (MCTPs), including strength, balance and gait training, combined or not with aerobic or cognitive demands, improve physical fitness and executive function (Blasco-Lafarga et al., 2016). But in addition to physical activity, respiratory muscle training (RMT) also improves the endurance and strength of the respiratory musculature with an expected impact on improving functional capacity (McConnell, 2013). Some of these RMT programs, which are classified in (a) voluntary isocapnic hyperpnea, (b) flow-resistive loading, and (c) pressure threshold loading, according to training devices and protocols (McConnell, 2013), are easy to conduct and have shown to be feasible for elderly (Mills, Johnson, Barnett, Smith, & Sharpe, 2014). ...
... But in addition to physical activity, respiratory muscle training (RMT) also improves the endurance and strength of the respiratory musculature with an expected impact on improving functional capacity (McConnell, 2013). Some of these RMT programs, which are classified in (a) voluntary isocapnic hyperpnea, (b) flow-resistive loading, and (c) pressure threshold loading, according to training devices and protocols (McConnell, 2013), are easy to conduct and have shown to be feasible for elderly (Mills, Johnson, Barnett, Smith, & Sharpe, 2014). Notwithstanding, to our knowledge, this is the first study to combine both MCTP and RMT, or more specifically inspiratory muscle training (IMT), in a sample of already fit elderly women. ...
... In order to evaluate cardiorespiratory fitness and functional capacity, women performed first the 6-min walk test (6MWT) (Rikli & Jones, 1999, 2013. All of them were familiar with this test, where they were encouraged to walk following a rectangular circuit of 20 m long and 5-m wide, with indicator cones every 5 m. ...
Purpose: This study aims to analyze changes in Maximum Inspiratory Pressure (MIP), lung function, cardiorespiratory fitness, and blood pressure, in 10 healthy active elderly women, following 7 weeks of inspiratory muscle training (IMT) combined with a multicomponent training program (MCTP). The association among these health parameters, their changes after training (deltas), and the influence of MIP at baseline (MIPpre) are also considered. Methods: IMT involved 30 inspirations at 50% of the MIP, twice daily, 7 days a week, while MCTP was 1 hr, twice a week. MIP, lung function (FVC, FEV1, FEV1/FVC, FEF25-75%, PEF), 6MWT, and blood pressure (SBP, DBP), jointly with body composition, were assessed before and after the intervention. Results: Seven weeks were enough to improved MIP (p = .019; d = 1.397), 6MWT (p = .012; d = .832), SBP (p = .003; d = 1.035) and DBP (p = .024; d = .848). Despite the high physical fitness (VO2 peak: M = 23.38, SD = 3.39 ml·min·Kg⁻¹), MIPpre was low (M = 39.00, SD = 7.63 cmH2O) and displayed a significant negative correlation with ΔMIPpre-post (r = −.821; p < .004), showing that women who started the intervention with lower MIP achieved higher improvements in inspiratory muscle strength after training. Conclusions: No significant changes in spirometric parameters may signal that lung function is independent of early improvements in inspiratory muscles and cardiorespiratory fitness. Absence of correlation between physical fitness and respiratory outcomes suggests that being fit does not ensure cardiorespiratory health in active elderly women, so IMT might be beneficial and should supplement the MCTP in this population.
... Training was performed using a pressure threshold-loading device (POWERbreathe® Classic, IMT Technologies Ltd., Birmingham, UK) used to inhale against the same pressure load in every inhalation for strengthening primarily diaphragm and rib cage muscles [37]. The device pressure is adjusted according to MIP [37] and reliability/ reproducibility has been demonstrated [38]. ...
... Training was performed using a pressure threshold-loading device (POWERbreathe® Classic, IMT Technologies Ltd., Birmingham, UK) used to inhale against the same pressure load in every inhalation for strengthening primarily diaphragm and rib cage muscles [37]. The device pressure is adjusted according to MIP [37] and reliability/ reproducibility has been demonstrated [38]. Recipients were taken into 1-week familiarization period and instructed to learn breathing adequately before training. ...
... Treatment group received IMT at 40 % of MIP, was measured at supervised sessions each week, and 40 % of measured MIP value was the new training workload. Control group received sham IMT at fixed workload, 5 % of baseline MIP [37,39]. Recipients were instructed to maintain a breathing set which consisted of consecutive 10-15 diaphragmatic breathing and 5-10-s resting following the set. ...
Abstract
PURPOSE:
Respiratory muscles are known to be weakened and are a cause of reduced exercise capacity in both recipients and candidates of allogeneic hematopoietic stem cell transplantation (allo-HSCT). Effects of inspiratory muscle training (IMT) in this patient population have not been comprehensively investigated so far. The current study was planned to investigate the effects of IMT during allo-HSCT on early transplantation-related outcomes.
METHODS:
This is a prospective, randomized controlled, double-blinded study. Thirty-eight allo-HSCT recipients, 20 of whom were allocated to the treatment group (40 % of maximal inspiratory pressure (MIP)) and 18 to the control group (5 % of MIP), received IMT for 6 weeks. Pulmonary functions, dyspnea, respiratory (MIP, maximal expiratory pressure (MEP)) and peripheral muscle strength, maximal exercise capacity using modified incremental shuttle walking test (MISWT) and submaximal exercise capacity using 6-min walking test (6-MWT), fatigue, depression, and quality of life were evaluated before and after IMT.
RESULTS:
The distance covered during MISWT (61.94 m) and 6-MWT (29.30 m), respiratory muscle strength (MIP 34.99 cmH2O, MEP 12.69 cmH2O), depression (-0.95), and modified Borg dyspnea scores (-0.11) showed a significant improvement in the treatment group compared to controls (p ≤ 0.05).
CONCLUSIONS:
Inspiratory muscle training is a safe and effective intervention which improves respiratory muscle strength and exercise capacity and decreases depression and dyspnea in allo-HSCT recipients. These positive changes might be further enhanced by prolonging the duration of training or inclusion of more recipients with inspiratory muscle weakness.
CLINICAL TRIAL REGISTRATION NUMBER:
NCT02270346.
... 11,12 Respiratory function is related to the breathing process, in which the lungs perform their function of ventilation and perfusion, and, thus, properly oxygenate all body tissues. 13 However, this process depends on proper functioning of all the involved structures, such as suitable strength and endurance of the respiratory muscles, as well as lung volumes and flows. 13 These variables have been commonly used to reflect respiratory function and evaluate the effectiveness of various types of interventions in people with stroke. ...
... 13 However, this process depends on proper functioning of all the involved structures, such as suitable strength and endurance of the respiratory muscles, as well as lung volumes and flows. 13 These variables have been commonly used to reflect respiratory function and evaluate the effectiveness of various types of interventions in people with stroke. [14][15][16] Neuromuscular electrical stimulation, 14 transcranial magnetic stimulation, 15 breathing exercises (breathing/chest expansion/diaphragmatic exercises), 16 and respiratory muscle training 6 are examples of applied interventions, which have the potential to improve respiratory function. ...
... 43 Because the lungs are positioned inside the rib cage, normal or optimal thoracic spine, rib, and scapular positioning are needed for normal breathing and full lung capacity. 13 A recent study that investigated the effects of specific motor control exercises of the lumbar-pelvic musculature on respiratory function in 20 obese men reported significant improvement in respiratory function, concluding that positive respiratory effects can be obtained by prescribing these exercises. 44 However, similar to the results related to aerobic exercises, these results were based on only a single study of moderate methodological quality, so further studies to investigate the effects of postural exercises on respiratory function are required. ...
Background:
The aim of this study was to systematically review all current interventions that have been utilized to improve respiratory function and activity after stroke.
Methods:
Specific searches were conducted. The experimental intervention had to be planned, structured, repetitive, purposive, and delivered with the aim of improving respiratory function. Outcomes included respiratory strength (maximum inspiratory pressure [PImax], maximum expiratory pressure [PEmax]) and endurance, lung function (FVC, FEV1, and peak expiratory flow [PEF]), dyspnea, and activity. The quality of the randomized trials was assessed by the PEDro scale using scores from the Physiotherapy Evidence Database (www.pedro.org.au), and risk of bias was assessed in accordance with the Cochrane Handbook for Systematic Reviews of Interventions.
Results:
The 17 included trials had a mean PEDro score of 5.7 (range 4 - 8) and involved 616 participants. Meta-analyses showed that respiratory muscle training significantly improved all outcomes of interest: PImax (weighted mean difference 11 cm H2O, 95% CI 7-15, I2 = 0%), PEmax (8 cm H2O, 95% CI 2-15, I2 = 65%), FVC (0.25 L, 95% CI 0.12-0.37, I2 = 29%), FEV1 (0.24 L, 95% CI 0.17-0.30, I2 = 0%), PEF (0.51 L/s, 95% CI 0.10-0.92, I2 = 0%), dyspnea (standardized mean difference -1.6 points, 95% CI -2.2 to -0.9; I2 = 0%), and activity (standardized mean difference 0.78, 95% CI 0.22-1.35, I2 = 0%). Meta-analyses found no significant results for the effects of breathing exercises on lung function. For the remaining interventions (ie, aerobic and postural exercises) and the addition of electrical stimulation, meta-analyses could not be performed.
Conclusions:
This systematic review reports 5 possible interventions used to improve respiratory function after stroke. Respiratory muscle training proved to be effective for improving inspiratory and expiratory strength, lung function, and dyspnea, and benefits were carried over to activity. However, there is still no evidence to accept or refute the efficacy of aerobic, breathing, and postural exercises, or the addition of electrical stimulation in respiratory function.
... Additional studies have demonstrated that RMT results in improvements of quality of life, respiratory symptoms, activity tolerance and the ability to carry out activities of daily living [54]. The efficiency of RMT in improving such clinical outcomes has been demonstrated in several clinical populations with RM weakness including but not limited to asthma, heart failure, chronic obstructive pulmonary disease (COPD) and patients with neuromuscular disorders [55]. It is then possible to consider the potential use of RMT in COVID-19 rehabilitation. ...
... RM deconditioning leads to an increased incidence of RM fatigue and elevated perceptual responses including dyspnoea and whole-body exertion during light exercise and activities of daily living [60,61]. RMT approaches have been continuously demonstrated to be well tolerated and acceptable to clinical populations [55]. RMT is well documented to reduce perceptions of exertion, limb discomfort and dyspnoea responses [62]. ...
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection results in multiorgan damage primarily mediated by viral infiltration via angiotensin-converting enzyme-2 receptors on the surface of cells. A primary symptom for many patients is exertional dyspnoea which may persist even beyond recovery from the viral infection. Respiratory muscle (RM) performance was hypothesised as a contributing factor to the severity of coronavirus disease 2019 (COVID-19) symptoms, such as dyspnoea, and outcomes. This was attributed to similarities between patient populations at elevated risk for severe COVID-19 symptoms and those with a greater likelihood of baseline RM weakness and the effects of prolonged mechanical ventilation. More recent evidence suggests that SARS-CoV-2 infection itself may cause damage to the RM, and many patients who have recovered report persistent dyspnoea despite having mild cases, normal lung function or undamaged lung parenchyma. These more recent findings suggest that the role of RM in the persistent dyspnoea due to COVID-19 may be more substantial than originally hypothesised. Therefore, screening for RM weakness and providing interventions to improve RM performance appears to be important for patients with COVID-19. This article will review the impact of SARS-CoV-2 infection on RM performance and provide clinical recommendations for screening RM performance and treatment interventions.
... Solunum kas eğitimi diye de adlandırılabilen inspiratuar kas eğitimi, kuvvet ve endurans eğitimi olarak ikiye ayrılır. Özelleşme prensibi esas alınarak kuvvet eğitimi için yüksek şiddette, az tekrar içeren programlar, solunum kaslarının endurans artışı içinse düşük şiddette, çok tekrar içeren programları düzenlenmelidir (McConnell, 2013). Periferik kaslara benzer şekilde dışarıdan yüklerle uygulanan eğitim direnç eğitimi olarak sınıflandırılırken, inspirasyon/ekspirasyon esnasında kaslara binen yük, solunum sisteminin akış direncini etkilediğinden bu tarz eğitimler dayanıklılık eğitimi olarak belirtilmektedir. ...
... Solunum fizyoterapisinde kullanılan solunum egzersizi eğitim cihazlarının ekonomik sebeplerden ötürü dünyada yaygın kullanımı olmadığından rahat ve kolay yapılabilen, cihazsız solunum egzersizleri tercih edilebilmektedir. Fakat ekonomik açıdan daha uygun olan insentif/volümetrik solunum cihazları da akciğer hacimleri ve ventilasyonu arttırmak için kullanılabilmektedir (McConnell., 2013, Menzes ve ark., 2018. Cerrahi sonrası görülebilen pulmoner atelektazi, uzun süreli yatak istirahati veya kısıtlayıcı akciğer defekti durumunda insentif spirometre uygulaması önerilmektedir. ...
Yakın zamanda yayınlanan çalışmalar, solunum kaslarının inspiratuar akıma dirençli solunumu takiben sistemik oksidatif strese katkıda bulunup bulunmadığını, oksidatif stres miktarının direnç yükü seviyesinden etkilenip etkilenmediğini ve oksidatif stres miktarının bununla ilişkili olup olmadığını, meydana gelen diyafragma yorgunluğunun derecesini incelemiştir. Ayrıca inspiratuar akışa dirençli solunumun (transdiagramatik basıncın %70’inde verilen) sistemik oksidatif strese yol açtığı fakat bunun diyafragma yorgunluğuyla ilgili olmadığı vurgulanmıştır. Solunum yolu hastalıklarında solunum kas kuvvetini arttıran inspiratuar kas eğitimi cihazlarının oksidatif stres üzerine etkisini değerlendiren çalışmaların kısıtlı olduğu ve sonuçlarının kanıtlarının net olmadığı görülmektedir. Solunum kas eğitiminin farklı hastalık gruplarında ise oksidatif stres
üzerine etkisini inceleyen çalışmalar mevcuttur. Hemodiyaliz hastalarında solunum kas eğitiminin endotel / glikokaliks, oksidatif stres biyobelirteçleri ve solunum fonksiyon testi üzerindeki etkilerini değerlendiren bir çalışmada solunum kas eğitiminin sindekan-1 ve anjiyopoietin-2 gibi oksidatif stres biyobelirteç seviyelerini azalttığı saptanmıştır. Kardiyak cerrahi sonrası farklı şiddetlerde uygulanan solunum kas eğitiminin inspiratuar oksidatif stres üzerine olumlu etki ettiği ve egzersiz kapasitesini arttırdığı bulunmuştur. Solunum kas eğitimi şeklinde uygulanan solunum fizyoterapisi egzersizlerinin oksidatif stres üzerine etkisini değerlendiren çalışmaların sonuçları farklılık göstermektedir ve kanıta dayalı çalışmaların azlığı dikkati çekmektedir. Bu nedenle solunum kas eğitiminin oksidatif stres üzerin etkisini değerlendiren daha fazla kanıta dayalı çalışmaya ihtiyaç vardır.
... The inspiratory muscles are also weakened functionally by hyperinflation (McConnell 2013) and affected by sarcopenia (Watsford et al. 2005), Figure 1-3. Indeed, inspiratory muscle strength was found predictive for decline in mobility with older adults (Buchman et al. 2008). ...
... Participants followed an established training protocol known to improve inspiratory muscle function, consisting of 30 quick breaths twice daily at an adjustable resistance (equivalent to ~50% of [baseline] MIP). In addition, participants in this group were able to increase the inspiratory resistance when they felt that 30 breaths were achievable with ease or if they could reach 35 consecutive breathes(McConnell 2013). ...
Accidental falls are the leading cause of fatal and non-fatal injuries amongst older adults in the Western world. Around 30% of people over 65 years will fall at least once a year in the UK, whereas 50% of people over 80 years will fall annually (NICE 2013). Recently, falls prevention programmes have begun to incorporate multidimensional movements with controlled breathing techniques (e.g. yoga, Tai chi and Pilates). Based on the research of Hodges, the diaphragm muscle may contribute to balance maintenance in two ways. Firstly, the diaphragm is activated during upper limb movements, which indicates that diaphragm co-activation may assist in the mechanical stabilisation of the spine. Secondly, the diaphragm plays a key role in the development of intra-abdominal pressure that helps to stabilise the lumbar spine during balance perturbations (e.g. shoulder abduction and adduction). This doctoral project investigates whether the effects of structured inspiratory muscle training (IMT) on respiratory function can improve indices of balance and physical performance with older adults. The project comprises three studies, each involved IMT delivered over 8 weeks, at home, and unsupervised. The IMT included: workload progression (increased according to each participant’s weekly improvement), twice-daily sessions (morning and evening) and training diaries (to monitor progression, adherence and attrition). Outcomes included: respiratory muscle function (e.g. maximal inspiratory pressure), physical performance (e.g. timed up and go), static and dynamic balance (e.g. mini-BEST) and trunk muscle strength (e.g. isometric flexion and extension) for a sample of older adults (n =129; age 72 ± 5 years). In study 1 IMT was found to be both feasible and safe, as an unsupervised home-based intervention with healthy older adults. In study 2 IMT proved to also be effective in improving respiratory muscle function, physical performance, dynamic balance and trunk muscle endurance. The final study (3) involved a comparison of community- dwellers performing IMT, and care home residents performing the Otago exercise programme (an established falls prevention intervention). Results showed that IMT produced similar balance improvements as the Otago exercise programme over 8 weeks, but with additional benefit to inspiratory muscle function and walking speed. In combination, these findings support the possibility of introducing IMT as a novel intervention for falls prevention for older adults in isolation, or together with established falls prevention intervention.
... Aerobic and resistance exercises have many beneficial effects on health although the rates of these exercises are gradually decreasing [9]. Engaging in inspiratory muscle training (IMT) is a time-efficient, well-tolerated, and safe approach both for people who are healthy and for those with chronic diseases [10]. Long-term IMT has been shown to increase inspiratory muscle strength, improve exercise capacity, and reduce blood pressure and vascular resistance in healthy people [11,12]. ...
... Participants were asked to select four sealed envelopes in which the intensities of IMT were written so that each participant had her or his own order in which to carry out the four IMT sessions. The different intensities of the IMT were selected from the most commonly used loads in clinical settings (10% as sham or light intensity, 30% as moderate intensity, and 60% as high intensity) [10,17]. In addition, DBE, which is described as breathing predominantly with the diaphragm while minimizing the action of accessory muscles, was chosen as the unloaded inspiratory muscle training [18]. ...
Background
Understanding the acute effects of inspiratory muscle training (IMT) at different intensities on the autonomic nervous system, arterial stiffness, and blood pressure in healthy young people will be important in the constitution of appropriate IMT prescriptions.AimsTo investigate the acute effects of IMT at different intensities on autonomic function, arterial stiffness, and blood pressure in healthy young peopleMethods
Thirty-six healthy participants were enrolled in this crossover study. All participants randomly performed IMT sessions, which consisted of diaphragmatic breathing exercise (DBE), 10%, 30%, and 60% of maximal inspiratory pressure (MIP) on consecutive days. Autonomic function and arterial stiffness were assessed by measuring heart rate variability (HRV) and aortic pulse wave velocity (AoPWV), respectively. HRV, AoPWV, and blood pressure were recorded before and immediately after each IMT session.ResultsThere was no significant difference in the baseline measurements between IMT sessions (p > 0.05). Heart rate (HR) significantly decreased after DBE and IMT at 10% of MIP (p < 0.05). All time domain parameters of HRV significantly improved after DBE compared with the baseline (p < 0.05). There was no difference in the frequency domain of HRV after the IMT sessions (p > 0.05). AoPWV significantly increased after IMT at 60% of MIP (p < 0.05). Mean arterial pressure significantly changed after DBE and IMT at 60% of MIP (p < 0.05).ConclusionsA single session of DBE positively affects autonomic function and blood pressure, while IMT at 60% of MIP increases arterial stiffness. The different intensities of IMT have various impacts on autonomic function, arterial stiffness, and blood pressure.Trial registrationNCT03788356
... Dyspnea is a significant common complaint in patients who have generalized muscle weakness (Parshall et al., 2012). During breathing, inspiration, which is an active process, depends on adequate strength of the inspiratory muscles, to allow for the expansion of the rib cage and, consequently, the entrance of air into the airways (McConnell, 2013). In weak patients, this musculature may not produce adequate expansion of the rib cage and, in turn, generate an unsatisfactory inspiration, which is the main descriptor of dyspnea (McConnell, 2013). ...
... During breathing, inspiration, which is an active process, depends on adequate strength of the inspiratory muscles, to allow for the expansion of the rib cage and, consequently, the entrance of air into the airways (McConnell, 2013). In weak patients, this musculature may not produce adequate expansion of the rib cage and, in turn, generate an unsatisfactory inspiration, which is the main descriptor of dyspnea (McConnell, 2013). The findings of the present study corroborate this theoretical rationale, by showing a significant association between inspiratory muscle weakness and dyspnea in individuals with stroke. ...
The objective of the present study was to investigate if different levels of inspiratory muscle strength would be associated with dyspnea, walking capacity, and quality of life after stroke. For this exploratory study, the dependent outcome was strength of the inspiratory muscles, measured by maximal inspiratory pressure. Individuals with maximal inspiratory pressure ≥80 cmH2O were classified as non-weak, those with maximal inspiratory pressure between 45 and 80 cmH2O were classified as weak, and those with maximal inspiratory pressure ≤45 cmH2O were classified as very weak. Related outcomes included dyspnea, measured by the modified Medical Research Council scale; walking capacity, measured by the 6-minute walk test; and quality of life, measured by the Stroke-Specific Quality of Life scale. Fifty-three participants, who had a mean age of 62 years (SD 12) and a mean time since the onset of the stroke of 20 (SD 17) months were included. Significant differences were found only between the weak/very weak and non-weak groups. The mean differences between the non-weak and weak/very weak participants were -1.8 points (95% confidence interval -2.7 to -0.9) for dyspnea and 55 points (95% confidence interval 22-88) for quality of life. Significant correlations were found between measures of inspiratory strength and dyspnea (r = -0.54; P < 0.01) and quality of life (r = 0.56; P < 0.01). There were not found any significant differences or correlations regarding walking capacity. The findings demonstrated that individuals with stroke, who had weakness of the inspiratory muscles, reported greater dyspnea and worse quality of life, compared with those, who did not have weakness. The results regarding walking capacity remain unclear.
... Moderate-to-high intensity IMT (<"60% of maximal inspiratory pressure) will increase muscle strength, maximal shortening velocity and maximal power of the inspiratory muscles. In addition, inspiratory muscle strength training will also improve muscle endurance and delay diaphragm fatigue, thus increasing exercise tolerance and performance [17]. Inspiratory pressure threshold loading requires individuals to produce a negative pressure sufficient to overcome a threshold load and thereby initiates inspiration. ...
... There are three training principles that are well established for skeletal muscles namely 'overload', 'specificity' and 'reversibility' [33]. Romer & McConnell studied on specificity and reversibility of inspiratory muscle training which stated that respiratory muscles respond to these principles in the same manner as other muscles [17]. Therefore there is possibility that the present study shows improvement in MIP in Group A when treated with Threshold IMT considering the above studies. ...
... WC and BP were the components evaluated in the current research and presented an inverse relation with forced vital capacity predicted. The existence of pulmonary alterations in the presence of metabolic syndrome and its components may be triggered by obesity, and also leads to restrictive breathing patterns through the conformational and morphological changes occurring in the individual's thoracic cavity with local losses in the pulmonary parenchyma [25]. ...
... Multiple linear regression coefficients of the metabolic syndrome and individual components according to the percentage of predicted FVC and FEV 1 (n ¼ 121 diaphragm amplitude during respiration. decrease in the amount of fibers recruited and respiratory muscle strength [25]. In addition, changes in the ventilation/perfusion ratio (V/Q), increased ventilation in the upper zones (areas of higher ventilation and reduced perfusion) and reduction in the inferior ones, culminating in a decrease in lung base volume predisposing to alveolar collapse, response inflammatory and tissue oxygenation reduction [9] may reduce the functional residual capacity (FRC) of these women. ...
Background
The presence of metabolic syndrome (MetS) and its components may induce structural and physiological changes that exacerbate the impairment of the respiratory function. The aim of the study is to evaluate the impact of metabolic syndrome and its components on lung function in women.
Methods
This is cross-sectional study. A total of 121 women aged 20–75 years were assisted in two primary health centers of Brazil. These women were divided into two groups according to the presence of metabolic syndrome. Waist circumference and blood pressure measurements, high density low-cholesterol (HDL-c) and triglycerides analysis and pulmonary function tests by spirometry were performed.
Results
Metabolic syndrome prevalence was 46.3%. Systemic arterial pressure (BP) and waist circumference (WC) were identified with higher eigenvalues in the main components explaining 26.78% of the variance. The multiple regression analysis showed an inverse relationship between forced expiratory volume in the first second predicted (FEV1%) (β = −6.0, p = 0.03) and predicted forced vital capacity (FVC%) (β = −7, 02, p = 0.004) with the presence of MetS. PA (β = −8.50, p = 0.003) and WC (β = −0.24, p = 0.001) it presented an inverse relationship with FVC% when was adjusted for age, smoking history, menopausal BMI.
Conclusions
WC and PA were considered the parameters most related to MetS by principals components analysis. The diagnosis of MetS presented an inverse relation with the spirometrics parameters. Elevation of BP and WC were the predictors of the CFV% reduction
... In order for the amount of inhaled O2 to be more efficient, these muscles that help breathing must be strong (Santos et al., 2012). A deterioration in the respiratory muscles reduces the respiratory capacity and negatively affects daily work by preventing the transport of oxygen (De Troyer, 2012;McConnell, 2013;Tiller et al., 2019). For this reason, respiratory capacities both affect the quality of life and are accepted as an important indicator of physical fitness (Schunemann et al., 2000;Verges, et al., 2009). ...
... (9) A systematic review by Elsevier Health Sciences suggests that respiratory muscle training is an effective post-operative treatment tool for patients undergoing thoracotomy and there is strong evidence that this training improves respiratory muscle strength, pulmonary function, and functional capacity and reduces patients' hospital stay. (10) ...
Introduction: Thoracotomy is a surgical procedure to gain access into the pleural space of the chest. It includes: Median sternotomy, Posterolateral thoracotomy & Anterolateral thoracotomy. The risk of post-operative pulmonary complications is relatively high following thoracic surgery; rates have been recorded at between 19% and 59%. Deep breathing exercises induce sustained increase in trans-pulmonary pressure, which increases lung volume, improves ventilation, oxygenation, prevents basal atelectasis, re-inflates collapsed lung regions, and reverses minimal postoperative atelectasis. Respiratory Muscle Training especially has been shown to improve respiratory muscle function and helps to reduce dyspnoea on exertion. Improvements in strength, speed, power and endurance leads to improvement in the performance of MIP & MEP, which in turn leads to increase in strength and endurance of the diaphragm and accessory muscles during respiration. Aim And Objective: To study the immediate effect of respiratory muscle training on peak expiratory flow rate in post thoracotomy individuals. Method: Participants were divided into two groups by random allocation. The intervention group received RMT of 2*30 repetition with standard breathing exercises whereas the control group were given only standard breathing exercises. Immediate post-test outcomes were measured on peak flow meter and Rate Perceived Exertion (RPE) as well. Result: Analysis was done in SPSS 20 Mean Age (61.93±11)). Data was not normally distributed, so non parametric test was used. According to the data there was significant statistical improvement of PEFR in thoracotomy individuals. (P≤0.002). Conclusion: There is significant statistical difference of PEFR after Respiratory Muscle Training in post thoracotomy individuals. Key words: Peak expiratory flow rate, Respiratory muscle training, Thoracotomy.
... However, MIP and MEP are less often measured in clinic. Regardless, respiratory muscle strength is crucial in many categories of subjects, as in chronic obstructive pulmonary disease, neuromuscular diseases, and heart failure [42]. It seems like MIP and MEP are very important to measure also in subjects with Long COVID with respiratory symptoms. ...
Background
The aim of this study was to describe and analyse the variety of respiratory appearances in Long COVID subjects who were not hospitalised during the acute phase of the infection.
Methods
A consecutive series of 60 subjects participated x¯10.8 months (SD 4.5) after the acute phase of the infection. Respiratory function was tested concerning lung volumes, expiratory flow, muscle strength, physical capacity including concurrent oxygen saturation, chest expansion, lung sounds, pain and breathing pattern. Differences between those with or without positive test and duration of symptoms more or less than 6 months were analysed with T-test, Chi-square test and Fisher’s exact test.
Results
Decreased forced vital capacity was found in 6/60 (10%), and forced expiratory volume in 1 s and 7/60 (12%), low maximal inspiratory pressure in 38/58 (54%) and low maximal expiratory pressure in 10/58 (17%). Decreased physical capacity was registered in 36/52 (69%), and thoracic expansion in 26/46 (56%). Pathologic lung sounds had 15/58 (26%) and six patients desaturated during the test of physical capacity. A majority (36/58, 67%) presented pain in the ribcage. All but three patients (95%) showed a dysfunctional breathing pattern in sitting and standing. Only poor and fair correlations were found between age, duration and level of physical capacity compared to spirometry, respiratory muscle strength and thoracic expansion.
Conclusion
Abnormal breathing pattern and respiratory movements as well as pain, and reduced lung volumes, flow, respiratory muscle strength, physical capacity and thoracic expansion may be involved in Long COVID. The breathing symptoms should therefore be looked for in a wider picture beyond spirometry and oximetry.
... 4,6,8 RMT is performed based on the argument that respiratory muscles respond to training stimuli by undergoing adaptations to their structure in the same manner as any other skeletal muscles. 9 Nevertheless, to the extent of the authors' knowledge, there is a dearth of conclusive studies which evaluated the effectiveness of RMT on muscle strength, pulmonary function, and respiratory complications in individuals after stroke. Therefore, the purpose of this systematic review was to establish its effects on respiratory functions of individuals poststroke. ...
Background:
Stroke is the most common leading cause of mortality and related morbidities worldwide. After stroke, the motor function of extremities and spinal muscles is significantly impairment, but not only this, it also has attributable factors leading to respiratory dysfunction. Nevertheless, to the extent of the authors' knowledge, there is a dearth of conclusive studies which examined the effectiveness of RMT on muscle strength, pulmonary function, and respiratory complications of individuals after stroke.
Objective:
The purpose of this systematic review was to evaluate the effectiveness of respiratory muscle training on respiratory muscle strength, pulmonary function, and respiratory complications in patients after stroke.
Methods:
An electronic database search of HINARI, PEDro, PubMed, Cochrane Library and Google scholar was used to identify randomized controlled trials that evaluated the effectiveness of respiratory muscle training in patients with stroke. Articles published from 2010 to 2019 were included. The quality of the articles was assessed using PEDro scale. Articles with abstract only, PEDro scores less than 5, published in non-English language, not freely available articles, and quasi experimental studies were excluded from this study.
Results:
The literature search yielded a total of 7 articles (6 randomized controlled trials with 1 pilot randomized controlled trial) which met inclusion criteria despite their heterogeneity. The methodological quality of all studies ranged from 6 to 8 in Pedro score. Most of the articles reported a significant increase in respiratory muscle strength, respiratory muscle function, and reduced risk of complications with a p value <0.05.
Conclusion:
Respiratory muscle training could potentially improve muscle strength and pulmonary functions of subjects after stroke. Thus, it may reduce stroke-related respiratory complications in subjects after stroke. However, further study is warranted with high quality RCTs and pooled synthesis of results.
... Romer & McConnell studied on specificity and reversibility of inspiratory muscle training which stated that respiratory muscles respond to these principles in the same manner as of the muscles [17]. ...
Background: Surgical care plays a crucial role in the treatment of a wide spectrum of ailments, as well as in the relief of human suffering. Gastrectomy, pancreatectomy, hepatic resection, cholecystectomy, and splenectomy were among the upper abdominal surgeries performed. The maximum inspiratory pressure (PImax) is an important metric for assessing the strength of the inspiratory muscles. Respiratory muscle training device increase the capacity for activity, strength, and endurance of respiratory muscles. Pressure Threshold IMT devices are typically spring-loaded handheld devices that is obstructed at various intensities. As a result, the current study aims to show the effect of Inspiratory Muscle Training in patients undergoing Upper Abdominal Surgery. Materials and Methods: On Day 1, maximal inspiratory pressure (PI Max) was measured by a Hand held pressure manometer before intervention. Threshold Inspiratory Muscle Training device was administered on Day 1, and continued for one week two sessions per day. Post treatment maximum inspiratory pressure. (PImax) was measured. Each session lasted 15 minutes, including breaks. Conclusion: The study concluded that Threshold inspiratory muscle training device shows improvement in Maximal Inspiratory Pressure in upper abdominal surgery patient.
... EMT elicits similar responses to IMT in the expiratory muscle system, and similar to IMT, improvement of the maximal expiratory pressure is the hallmark parameter of effective EMT. Interestingly, EMT leads to improved maximal inspiratory pressure, indicating involvement of the inspiratory muscles in the process of expiration, whereas IMT does not improve maximal expiratory pressure (McConnell, 2013). ...
Inspiratory muscle training (IMT) has been studied as a rehabilitation tool and ergogenic aid in clinical, athletic, and healthy populations. This technique aims to improve respiratory muscle strength and endurance, which has been seen to enhance respiratory pressure generation, respiratory muscle weakness, exercise capacity, and quality of life. However, the effects of IMT have been discrepant between populations, with some studies showing improvements with IMT and others not. This may be due to the use of standardized IMT protocols which are uniformly applied to all study participants without considering individual characteristics and training needs. As such, we suggest that research on IMT veer away from a standardized, one-size-fits-all intervention, and instead utilize specific IMT training protocols. In particular, a more personalized approach to an individual's training prescription based upon goals, needs, and desired outcomes of the patient or athlete. In order for the coach or practitioner to adjust and personalize a given IMT prescription for an individual, factors, such as frequency, duration, and modality will be influenced, thus inevitably affecting overall training load and adaptations for a projected outcome. Therefore, by integrating specific methods based on optimization, periodization, and personalization, further studies may overcome previous discrepancies within IMT research.
... For respiratory muscles of a healthy individual, the training should be takes place daily or at least three times per week, and once or twice per day. The suggested intensity is 50-70% (typically yields failure within 30 breaths), or 2-3 minutes and durations are 30 breaths or 2 to 3 minutes per session [6]. Therefore, in this study, the parameters were standardized to minimize error: Instructions for All Fours Belly Breathing: i. ...
... For those who received IMT, their inspiratory muscle strength was assessed at the first consultation using a validated Powerbreathe KH2 to measure their maximal inspiratory pressure (MIP) [34]. The patients' received a personal, handheld Powerbreathe medic device as seen in Fig. 2. The participants were instructed to complete a six-week program of recognised IMT protocol involving 30 breaths twice daily of 40% of their MIP, and to increase the inspiratory load every time 30 breathes was easily achievable [35]. Each participant kept a training diary which was discussed during consultations. ...
Objective
To determine the feasibility of physiotherapy led remote cardiac rehabilitation (RCR) for Adult Congenital Heart Disease (ACHD) patients and quantify the impact on physical activity levels and well-being.
Method
ACHD cardiologists referred sedentary complex ACHD patients over 3 months, for 12-week physiotherapy-led RCR. RCR provided individualised exercise program and coaching via telephone clinics and apps. Outcomes in Self Efficacy for Exercise (SEE) and Satisfaction with Life Score (SWLC) were assessed by comparing patients' responses upon program completion to baseline.
Results
23 patients were referred, 11 completed the programme, 3 had learning difficulties. Participants were mainly female (9); age range 18–61 (median 24). Reasons for not completing RCR included; failure to attend initial appointments (7), lack of interest (1), too unwell (1), lost at follow up (1) and a death unrelated to RCR.
Initially no patients were achieving the UK Physical Activity Guidelines; all 11 became more active fulfilling the guidelines. Improvements were seen in SEE with a mean increase of 23 (SD 12) and a mean improvement of 10 (SD 4) in SWLC. Participants (9) responded well to apps. Reasons for not using apps included limited phone storage capacity to download the app (1) or lack of device (2). Patients found RCR acceptable and a personalised approach was essential to improving efficacy.
Conclusion
RCR is feasible, allowing patients to access specialised, personalised exercise advice and prescription and become more active, improving quality of life (QOL). Future work is required to improve uptake and extend to larger patient numbers.
... This involved 30 breaths, twice daily: once in the morning (between 7:00 and 12:00), and once in the evening (between 16:00 and 21:00) at an adjustable resistance (equivalent to 50% of participants' [baseline] maximal inspiratory pressure). To maintain the training stimulus, all participants were instructed to increase their inspiratory resistance when they felt that 30 breaths were achievable with ease, or if they could reach 35 consecutive breaths (McConnell, 2013). Training adherence (i.e., number of sessions, number of breaths per session, and training stimulus) was monitored using self-reported training diaries and with objective measurement (i.e., maximal inspiratory pressure) at baseline (Week 1) and postintervention (Week 8). ...
Inspiratory muscle training (IMT) improved balance ability and respiratory muscle function in healthy older adults. The current study is a retrospective analysis to explore the relationship between inspiratory muscle function, balance ability, and adaptation to IMT. All participants (total = 129; IMT = 60; age range = 65–85 years) performed inspiratory and balance assessments, including the mini-balance evaluation system test, maximal inspiratory pressure, and peak inspiratory flow tests. Baseline inspiratory muscle function was positively related to balance ability (p < .05), and IMT-induced improvements in inspiratory function (23.3% in maximal inspiratory pressure, 8.0% in peak inspiratory flow rate, 14.9% in maximal peak inspiratory power) were related to improvements in balance (10.6% in mini-balance evaluation system test), with the greatest improvements (17.0%) observed in the oldest participants (76–85 years old, p < .05). In conclusion, with or without IMT, positive associations between inspiratory function and balance ability exist, with greater improvements in inspiratory muscle function related to greater improvements in balance ability.
... Akin to inspiratory muscle training, improvement of the maximal expiratory pressure (MEP) is the hallmark parameter of successful EMT. Interestingly, EMT alone also leads to improved maximal inspiratory pressure, demonstrating the involvement of the inspiratory muscles in the process of expiration, whereas IMT does not improve maximal expiratory pressure [32]. Due to the importance of expiratory muscles in speech and swallow functions, EMT is of particular interest for patients with dysphonia, dysphagia, and reduced ability for airway clearance, such as those with Parkinson's disease or other neuromuscular diseases (NMDs). ...
Background: Respiratory muscle strength can be reduced in patients diagnosed with stroke, which reasonably justifies the use of respiratory muscle training in this population. This study determines the comparative efficacy of inspiratory, expiratory, and combined respiratory muscle training on the pulmonary functions and chest expansion in acute stroke survivors. Method: Forty-five acute stroke survivors (15 in each group) completed all protocols of the study. Participants were randomly assigned to any one of three groups. In addition to the conventional exercise therapy, participants received any one of the three respiratory muscle training protocols (inspiratory muscle training, expiratory muscle training or combined respiratory muscle training). Chest expansion was assessed using tape measure and pulmonary function parameters were assessed using a spirometer. Results: Paired t-test analysis showed significant improvements in the chest expansion and the pulmonary function parameters following training in each group. One-way ANOVA showed significant improvements in the pulmonary function parameters across the three groups but not in the chest expansion with p - value = 0.405. Least significant difference (LSD), post-hoc analysis shows that the significant difference for FEV1, FVC and FEV1/FVC lies between inspiratory muscle training group and expiratory muscle training group. Conclusion: When the three training methods were compared, it was found that expiratory muscle training was the most beneficial in improving the pulmonary functions and chest expansion in acute stroke survivors.
... The validity of MIP, MEP, and SNIP measurements as indicators of respiratory muscle function (or impairment) has been established in detailed physiological studies of acute stroke patients and matched healthy control participants (Harraf et al., 2008;Ward et al., 2010) and in observational studies of chronic stroke survivors with differing levels of physical ability (e.g., Pinheiro et al., 2014). Longitudinal MIP and MEP measurements are often required to adjust the intensity of respiratory muscle training to individuals' baseline levels and any incremental improvements during the training period (McConnell, 2013). In stroke trials, MIP, MEP, and SNIP data are often collected longitudinally as indicators of change in respiratory muscle strength over time, or even as the primary outcome (e.g., Parreiras de Menezes et al., 2019). ...
Background and Purpose
Many stroke trials include maximal inspiratory pressure (MIP), maximal expiratory pressure (MEP), and sniff nasal inspiratory pressure (SNIP) outcome measurements. However, data on agreement and reliability of repeated MIP, MEP, and SNIP measurements in acute and subacute stroke patients are scarce.
Methods
This study employed a test–retest design. Eighteen patients (seven female) with mean (SD) age 59 (14.5) years were recruited from neurological wards. Median (range) time since first stroke was 50.5 (21–128) days. MIP, MEP, and SNIP were measured repeatedly in three testing sessions (S1–3) conducted within 24 h and following international standards. Intra‐rater agreement between testing sessions was analyzed using the Bland–Altman method. Test–retest reliability was analyzed using intra‐class correlation coefficient (ICC). Association between individual measurement variability, time poststroke, and level of stroke impairment was analyzed using Spearman's rho.
Results
Mean difference and 95% limits of agreement for MIP were −0.40 (−23.02, 22.22) cmH2O between S1 and S2, and 2.14 (−12.79, 16.99) cmH2O between S2 and S3; for MEP, −4.56 (−29.01, 19.90) cmH2O between S1 and S2, and 0.29 (−24.28, 24.87) cmH2O between S2 and S3; and for SNIP, −10.56 (−38.48, 17.37) cmH2O between S1 and S2, and −6.06 (−27.32, 15.20) cmH2O between S2 and S3. ICCs for MIP, MEP, and SNIP were ≥0.9 throughout. There were no strong correlations between individual measurement variability and time poststroke or level of stroke impairment.
Discussion
MIP, MEP, and SNIP in acute and subacute stroke patients show good test–retest reliability for group averages; however, absolute agreement can vary considerably for some individuals.
... Galen, 38 and that has inspired the development of systematic training of the respiratory muscles. 39 Regular workload by training against resistance triggers respiratory muscle hypertrophy, fiber formation, and improved function. This improves the adaptability of respiratory muscles to increased ventilatory demand, and/or the functionality of laryngeal and pharyngeal muscles used for speech and swallow. ...
Background
Dysphagia is prevalent with cerebrovascular accidents and contributes to the burden of disease and mortality. Strengthening dysfunctional swallow muscles through respiratory muscle training (RMT) has proven effective in improving swallow effectiveness and safety. However, approaches to strengthen only the expiratory muscle groups (EMST) dominate the clinical study literature, with variable outcomes. This study investigated the effect of simultaneous inspiratory‐expiratory muscle strengthening to improve swallowing function in stroke patients.
Methods
Recorded data of 20 patients receiving pro bono medical care for dysphagia following stroke were allocated to intervention (IG) or control group (CG) based upon whether they chose combined RMT (cRMT) or not while awaiting swallow therapy services. The intervention group was treated with three 5‐minute sessions of resistive respiratory muscle training for 28 days, while the control group received no RMT or other exercise intervention. Respiratory and swallow outcomes were assessed pre‐ and post‐intervention and included Mann Assessment of Swallowing Ability (MASA), fiberoptic endoscopic evaluation of swallowing (FEES) with penetration‐aspiration scale (PAS), functional oral intake scale (FOIS), patient visual analogue scale (VAS), and peak expiratory flow (PEF).
Results
After 28 days, the intervention group demonstrated greater improvements (P value < 0.05) in PEF (IG: 168.03% vs CG: 17.47%), VAS (IG: 103.85% vs CG: 27.54%), MASA (IG: 37.28% vs CG: 6.92%), PAS (IG: 69.84% vs CG: 12.12%), and FOIS (IG: 93.75% vs CG: 21.21%).
Conclusion
cRMT is a feasible and effective method to improve signs and symptoms of dysphagia while improving airway protection.
Level of Evidence
3
... Evidence that IMT is an effective asthma treatment has been controversial. Some studies showed that static and dynamic lung volumes have improved in patients with asthma (12,29,30) and other patient populations (15,31,32), as FEV 1 and FVC increased significantly following IMT application. Contrarily, other studies noted no changes in either the FEV 1 or FVC (33)(34)(35). ...
Objective:
To investigate the efficacy of inspiratory muscle training (IMT) on respiratory functions, respiratory muscle strength, and asthma symptoms in asthmatic children.
Methods:
In a randomized placebo-controlled assessor-blinded study, 34 children with asthma were randomized to receive either the IMT at 40% of the maximal inspiratory pressure (IPmax) for 20 min/session, thrice/week, over 12 consecutive weeks (IMT group; n = 17) or placebo IMT at 5% of IPmax (placebo group; n = 17). Additionally, both groups received the conventional respiratory rehabilitation (CRR) program. Outcome measurements performed pre- and post-treatment, included respiratory functions [forced expiratory volume at the first second (FEV1), forced vital capacity (FEV), and FEV1/FVC], respiratory muscle strength [represented by IPmax and maximal expiratory pressure (EPmax), and asthma control test (ACT).
Results:
At a significance level adjusted to P<.008, there were significant post-treatment differences between the IMT and placebo groups in FEV1 (P=.003), FVC (P=.001), FEV1/FVC (P=.004), IPmax (P=.002), EPmax (P=.004), and ACT (P=.001) adjusted to the pretreatment values, in favor of the IMT group.
Conclusion:
Incorporation of IMT in the CRR program for children with asthma can improve respiratory function, enhance respiratory muscle strength, and improve children's perception of asthma symptoms.
... 8 Exercise-induced diaphragmatic fatigue in humans is associated with a respiratory muscle metaboreflex, 9 whereby systemic blood flow is redistributed away from the locomotor muscles and redistributed to the diaphragm, 8,9 which hastens the development of locomotor fatigue and contributes to reduced performance. 2,9 The application of specific inspiratory muscle training (IMT) has been shown to delay the onset of this respiratory muscle metaboreflex. 10 Currently it is unknown whether this exercise-induced diaphragmatic fatigue and respiratory muscle metaboreflex occur in horses. ...
The diaphragm is an important respiratory muscle, playing a key role during exercise. In humans, diaphragm thickness increases in response to training and is correlated with inspiratory strength. In order to assess respiratory strength in the horse, new evaluation techniques are required and measurement of diaphragm thickness, in a non‐invasive and repeatable manner, is a possible approach. The purposes of this four‐part, prospective, pilot study were to develop and describe a repeatable method to measure the diaphragm thickness, using ultrasonography, in Thoroughbred racehorses. A standardized technique was developed whereby the ultrasound transducer was positioned 1 cm below a line between the cranioventral aspect of the tuber coxae and olecranon. The diaphragm thickness was measured on three occasions 1 week apart, by a single observer to determine the intraobserver repeatability, and by a second observer on one occasion to assess interobserver reproducibility. The diaphragm was observed in all intercostal spaces (ICS) from 7 to 17 on the left side, and 6 to 17 on the right side in a single horse. The thickest measurement (1.42 cm), obtained from 11 horses, was at ICS 11 on the left‐side during inspiration. The narrowest measurement (0.56 cm) was obtained at ICS 16 on the right‐side during expiration. There was no significant difference between the measurements obtained by a single observer on three occasions (P < .05). This is the first study to provide a detailed description of ultrasonographic imaging and measurement of the equine diaphragm. The novel technique developed to position the ultrasound transducer in a standardized location allowed examination and measurement of the diaphragm with good repeatability.
... [80][81][82][83] IMT has been shown to increase inspiratory muscle strength and endurance. 84,85 In chronic obstructive pulmonary disease population, IMT significantly increased the proportion of type I and the size of type II muscle fibers, which are related to muscle endurance and muscle strength, respectively. 85 However, their methods had some controversial points, including the position of muscle biopsy at the end of the experiment was collected at the contralateral site, and using semiquantitative imaging techniques for evaluating muscle structural changes after training. ...
Objective
To compare the effectiveness and rank order of physical therapy interventions, including conventional physical therapy (CPT), inspiratory muscle training (IMT), and early mobilisation (EM) on the mechanical ventilation (MV) duration and weaning duration.
Data sources
PubMed, The Cochrane Library, Scopus, and CINAHL Complete electronic databases were searched through August 2019.
Study selection
Randomised controlled trials (RCTs) investigating the effect of IMT, EM, or CPT on MV duration and the weaning duration in patients with mechanical ventilation were included. Studies that were determined to meet the eligibility criteria by two independent authors were included. A total of 6,498 relevant studies were identified in the search, and 18 RCTs (934 participants) were included in the final analysis.
Data extraction
Data were extracted independently by two authors and assessed the study quality by Cochrane risk-of-bias tool. The primary outcomes were MV duration and weaning duration.
Data synthesis
Various interventions of physical therapy were identified in the eligible studies, including IMT, IMT+CPT, EM, EM+CPT, and CPT. The data analysis demonstrated that compared with CPT, IMT+CPT significantly reduced the weaning duration (mean difference; 95% confidence interval) (-2.60; -4.76 to -0.45) and EM significantly reduced the MV duration (-2.01; -3.81 to -0.22). IMT + CPT and EM had the highest effectiveness in reducing the weaning duration and MV duration, respectively.
Conclusion
IMT or EM should be recommended for improving the weaning outcomes in mechanically ventilated patients. However, an interpretation with caution is required due to the heterogeneity.
... These changes improved muscle capacity in extracting oxygen from the blood for metabolism. 18,19 The capillarization that occurs in respiratory muscles facilitates local oxygen transport and removal of local metabolites in respiratory muscles. 20 Improvement on the fatigue threshold and shortness of breath scale showed a postponing of metaboreflex, consequently the extremities blood supply was adequate and the accumulation of metabolites was delayed. ...
Background: Running is a new trend of recreational sports in Indonesia. About 70% of recreational runners have difficulty in improving exercise capacity due to exercise-related transient abdominal pain (ETAP), caused by fatigue of the diaphragmatic muscles. Previous studies have shown that various training methods may increase diaphragmatic muscle strength and endurance, for example, inspiratory muscle training (IMT). Unfortunately, improvement of inspiratory muscle strength and endurance after exercise and IMT are still varies. Therefore, other methods are needed to optimize the effect of IMT. Application of the elastic taping on thoracic wall during exercise allows the inspiratory muscles to contract optimally which might improve functional capacity.Aim: To assess the effect of elastic taping on inspiratory muscle training using the pressure threshold IMT, in increasing the functional exercise capacity of recreational runners. Functional capacity was measured based on VO2max value, rating of perceived breathlessness (RPB) and rating of perceived exertion (RPE).Methods: an experimental study involved 14 nonsmoker recreational runners, ages 20-40 years, at Outpatient Clinic of Physical Medicine and Rehabilitation Department of Dr. Soetomo Hospital Surabaya. Subjects were divided into two groups (pressure threshold IMT with and without elastic taping groups), which were observed for four weeks. IMT was done five times a week, twice a day, with 30 repetitions, and 60% resistance 30 RM using Respironics®. Elastic taping Leukotape® was applied on the first until fifth day in each IMT sessions. The running exercises were done three times a week with EnMill® Treadmill ETB-03195 with a speed of 4.5 mph and 0% inclination. RBP, RPE and VO2max were measured using Borg Dyspneu scale, Borg Scale, and Bruce Treadmill Protocol test, respectively, before the first exercise and after 4 weeks of exercise.Results: There were an improvement of functional exercise capacity in both groups which were marked with a decline of RPB and RPE and increase of VO2max (p values < 0.05). However, there were no significant differences in the decrease of RPB and RPE and an increase of VO2max between groups (p values of were 0.31, 0.83, and 0.13, respectively). The effect of the elastic taping (r2 = 0.99) was not reflected in the differences of RPB, RPE and increasing VO2max.Conclusion: Inspiratory muscle training using pressure threshold IMT with or without the elastic taping for four weeks can improve exercise capacity of recreational runners.
... These changes improved muscle capacity in extracting oxygen from the blood for metabolism. 18,19 The capillarization that occurs in respiratory muscles facilitates local oxygen transport and removal of local metabolites in respiratory muscles. 20 Improvement on the fatigue threshold and shortness of breath scale showed a postponing of metaboreflex, consequently the extremities blood supply was adequate and the accumulation of metabolites was delayed. ...
Background: Running is a new trend of recreational sports in Indonesia. About 70% of recreational runners have difficulty in improving exercise capacity due to exercise-related transient abdominal pain (ETAP), caused by fatigue of the diaphragmatic muscles. Previous studies have shown that various training methods may increase diaphragmatic muscle strength and endurance, for example, inspiratory muscle training (IMT). Unfortunately, improvement of inspiratory muscle strength and endurance after exercise and IMT are still varies. Therefore, other methods are needed to optimize the effect of IMT. Application of the elastic taping on thoracic wall during exercise allows the inspiratory muscles to contract optimally which might improve functional capacity.
Aim: To assess the effect of elastic taping on inspiratory muscle training using the pressure threshold IMT, in increasing the functional exercise capacity of recreational runners. Functional capacity was measured based on VO2max value, rating of perceived breathlessness (RPB) and rating of perceived exertion (RPE).
Methods: an experimental study involved 14 nonsmoker recreational runners, ages 20-40 years, at Outpatient Clinic of Physical Medicine and Rehabilitation Department of Dr. Soetomo Hospital Surabaya. Subjects were divided into two groups (pressure threshold IMT with and without elastic taping groups), which were observed for four weeks. IMT was done five times a week, twice a day, with 30 repetitions, and 60% resistance 30 RM using Respironics®. Elastic taping Leukotape® was applied on the first until fifth day in each IMT sessions. The running exercises were done three times a week with EnMill® Treadmill ETB-03195 with a speed of 4.5 mph and 0% inclination. RBP, RPE and VO2max were measured using Borg Dyspneu scale, Borg Scale, and Bruce Treadmill Protocol test, respectively, before the first exercise and after 4 weeks of exercise.
Results: There were an improvement of functional exercise capacity in both groups which were marked with a decline of RPB and RPE and increase of VO2max (p values < 0.05). However, there were no significant differences in the decrease of RPB and RPE and an increase of VO2max between groups (p values of were 0.31, 0.83, and 0.13, respectively). The effect of the elastic taping (r2 = 0.99) was not reflected in the differences of RPB, RPE and increasing VO2max.
Conclusion: Inspiratory muscle training using pressure threshold IMT with or without the elastic taping for four weeks can improve exercise capacity of recreational runners.
... Automatic control of the cardiovascular system, the respiratory system is under direct voluntary control, which is essential for a wide range of everyday activities, e.g., speaking, blowing, snif ng, straining, lifting, etc. The respiratory control center resides within the brainstem, receiving a myriad of inputs from somatic receptors, as well as from other parts of thebrain [11]. ...
Introduction: Chronic obstructive pulmonary disease is characterized by persistent airflow limitation that is usually progressive and associated with an enhanced chronic inflammatory response in the airways to noxious particles or gases. Exacerbations and co morbidities contribute to the overall severity in individual patients [1]. In India, according to National Commission on Macroeconomics and Health background paper by Murthy et al., the annual treatment costs for COPD had been estimated to be greater than Rs. 35,000 crores in 2011 and Rs. 48,000 crores in 2016 [3]. COPD produces obstruction to the airflow which affects both the mechanical function and gas exchange of the lung. Respiratory muscles must work harder to overcome this resistance and therefore it leads to weakness of the respiratorymuscles. Drug therapy is the main treatment in patients with COPD which includes bronchodilators, mucolytics, appropriate antibiotics and corticosteroids. Following drug therapy, physical rehabilitation is the only management which reduce dyspnea [4]. Resistive Inspiratory Devices are hand-held devices of varying diameter. The resistance is increased by decreasing the diameter of the devices and resistance is decreased by increasing the diameter of the devices airway [7].
... Participants followed an established training protocol known to improve inspiratory muscle function, which consisted of 30 breaths, twice-daily (once in the morning [between 7:00 and 12:00] and once in the evening [between 16:00 and 21:00]) at an adjustable resistance (equivalent to 50% of MIP). The IMT group's participants were instructed to increase the inspiratory resistance when they felt that 30 breaths were achievable with ease, or if they could reach 35 consecutive breaths [27]. ...
The inspiratory muscles contribute to balance via diaphragmatic contraction and by increasing intra-abdominal pressure. We have shown inspiratory muscle training (IMT) improves dynamic balance significantly with healthy community-dwellers. However, it is not known how the magnitude of balance improvements following IMT compares to that of an established balance program. This study compared the effects of 8-week of IMT for community-dwellers, to 8-week of the Otago exercise program (OEP) for care-residents, on balance and physical performance outcomes. Nineteen healthy community-dwellers (74 ± 4 years) were assigned to self-administered IMT. Eighteen, healthy care-residents (82 ± 4 years) were assigned to instructor-led OEP. The IMT involved 30 breaths twice-daily at ~50% of maximal inspiratory pressure (MIP). The OEP group undertook resistance and mobility exercises for ~60 minutes, twice-weekly. Balance and physical performance were assessed using the mini Balance Evaluation System Test (mini-BEST) and time up and go (TUG). After 8-week, both groups improved balance ability significantly (mini-BEST: IMT by 24 ± 34%; OEP by 34 ± 28%), with no between-group difference. Dynamic balance sub-tasks improved significantly more for the IMT group (P < 0.01), than the OEP group and vice versa for static balance sub-tasks (P = 0.01). The IMT group also improved MIP (by 66 ± 97%), peak inspiratory power (by 31 ± 12%) and TUG (by -11 ± 27%); whereas the OEP did not. IMT and OEP improved balance ability similarly, with IMT eliciting greater improvement in dynamic balance, whilst OEP improved static balance more than IMT. Unlike IMT, the OEP did not provide additional benefits in inspiratory muscle function and TUG performance. Our findings suggest that IMT offers a novel method of improving dynamic balance in older adults, which may be more relevant to function than static balance and potentially a useful adjunct to the OEP in frailty prevention.
... [9][10][11][12][13] In this type of training, patients perform repetitive breathing exercises against an external load, with a flow-dependent resistance or pressure threshold. 4 Results are achieved when higher training loads (>30%) are applied. 13 A recent randomized clinical trial found that a program of high-intensity home-based respiratory muscle training was more effective in increasing respiratory muscle strength and reducing dyspnea than the standard protocols used in previous studies. ...
Background:
Although the significance of respiratory muscle training has been established in the literature, there is a need to understand the participants' perceptions of the benefits of this intervention.
Objective:
To understand how individuals who had a stroke perceive changes in their body functions and structures, activities, and participation after a high-intensity respiratory muscle training intervention and to understand their perceptions of the benefits and limitations of a home-based intervention.
Design:
Qualitative study.
Setting:
Community-dwelling patients.
Patients:
Fifteen individuals who had a stroke.
Methods:
For this qualitative study, interviews were conducted using a semistructured questionnaire about topics related to participation in a home-based respiratory muscle training intervention. The interviews were transcribed and analyzed using thematic content analysis.
Results:
Fifteen participants were interviewed. Most of the participants reported positive perceptions of body functions and structures, grouped into two thematic categories (breathing and speech); activity, also grouped into two thematic categories (walking and domestic activities); and participation, grouped into one thematic category (community-leisure activities). Answers about the benefits of a home-based intervention were grouped into three thematic categories (no need to leave home, commitment to training, and comfort). All participants reported that they would recommend the intervention to other stroke patients and that they were either satisfied or very satisfied with the intervention. Most (80%) participants did not consider the intervention difficult to perform.
Conclusion:
Individuals who had experienced a stroke perceived the benefits of high-intensity home-based respiratory muscle training in all components of function.
... Participants followed an established training protocol known to improve inspiratory muscle function, consisting of 30 quick breaths twice a daily at an adjustable resistance (equivalent to ~50% of baseline MIP). In addition, participants in this group were able to increase the inspiratory resistance when they felt that 30 breaths were achievable with ease or if they could reach 35 consecutive breathes (McConnell 2013). ...
To examine the effects of 8‐week unsupervised, home‐based inspiratory muscle training (IMT) on the balance and physical performance of healthy older adults.
Fifty‐nine participants (74 ± 6 years) were assigned randomly in a double‐blinded fashion to either IMT or sham‐IMT, using a pressure threshold loading device. The IMT group performed 30‐breath twice daily at ~50% of maximal inspiratory pressure (MIP). The sham‐IMT group performed 60‐breaths once daily at ~15% MIP; training was home‐based and unsupervised, with adherence self‐reported through training diaries. Respiratory outcomes were assessed pre‐ and post-intervention, including forced vital capacity, forced expiratory volume, peak inspiratory flow rate (PIFR), MIP, and inspiratory peak power. Balance and physical performance outcomes were measured using the shortened version of the Balance Evaluation System test (mini‐BEST), Biodex® postural stability test, timed up and go, five sit‐to‐stand, isometric “sit‐up” and Biering–Sørensen tests. Between‐group effects were examined using two‐way repeated measures ANOVA, with Bonferroni correction.
After 8‐week, the IMT group demonstrated greater improvements (P ≤ 0.05) in: PIFR (IMT = 0.9 ± 0.3 L sec−1; sham‐IMT = 0.3 L sec−1); mini‐BEST (IMT = 3.7 ± 1.3; sham‐IMT = 0.5 ± 0.9) and Biering–Sørensen (IMT = 62.9 ± 6.4 sec; sham‐IMT = 24.3 ± 1.4 sec) tests.
The authors concluded that twice daily unsupervised, home‐based IMT is feasible and enhances inspiratory muscle function and balance for community‐dwelling older adults.
... Post-operative respiratory physical therapy promotes benefits in obese people such as the restoration of pulmonary volumes and capacities and in diaphragmatic mobility [14], thus contributing to the prevention of pulmonary complications [13]. Several resources are used for this procedure such as inspiratory resistive load equipment, involving resistors, orifices, springs and resistive electronic devices [15][16][17], which can help in preventing pulmonary complications by increasing respiratory muscle strength and resistance [18,19], contributing to the early recovery of the flows and volumes in morbidly obesity patients submitted to bariatric surgery [20] and in the reduction of atelectasis and pneumonia and hospitalization time [21]. ...
Introduction: The gastroplasty post-operative period can alter respiratory mechanics and predispose patients to respiratory complications. Objective: The objective was to evaluate the effects of exercises with inspiratory load on respiratory muscle function and on the prevalence of atelectasis after gastroplasty. Method: 40 participants were randomly allocated into two groups: Control Group (CG), its members underwent conventional respiratory physical therapy (CRP) and the Inspiratory Load Group (ILG), its members performed exercises with linear inspiratory pressure load, with 40% of the maximum inspiratory pressure (MIP), associated with CRP. Therapy procedures were conducted twice during the immediate post-operative period and thrice on the first post-operative day. In addition to evaluating the MIP, the nasal inspiratory pressure (NIP) and the sustained maximum inspiratory pressure (SMIP) were evaluated before and after treatment. Analysis of variance followed by the Bonferroni correction were applied considering a 5% significance level (p < 0.05). Results: There was no significant difference in NIP and SMIP values when the pre- and post-operative periods were compared for the ILG; however, these values were significantly lower for the CG, also with intergroup differences in NIP values. Atelectasis prevalence was 5% for ILG and 15% for CG, with no intergroup difference. Conclusion: The inspiratory muscle strength and resistance of the respiratory muscles were maintained in the group that performed exercises with inspiratory load associated with CRP, with a low rate of atelectasis after gastroplasty.
... Breathing against resistance increases the workload of the respiratory muscles, triggering growth of muscle fibers and increase in muscle power output. Improved respiratory muscle strength decreases the work of breathing and improves capacity to respond to higher breathing demands during exercise and ADL (Activities of Daily Living) [17] . These physiological adaptations to RMT convert to an extensive list of benefits of RMT observed across a wide range of patients, including reduced dyspnea, increased exercise tolerance and quality of life. ...
Clinical Context and Key Findings
Home-based COPD managment, as provided by certified home-health providers, represents a cornerstone of patient care.
Resporatory muscle trainig (RMT) reduces symptoms of COPD and improves underlying respiratory muscle weakness, and may be a beneficial adjunct of standard of care treatment plans.
This 4 Week pilot study shows that RMT in combination with a standard of care home-based COPD management program can improve pulmonary and speech functions.
The electrohysterogram (EHG) is the uterine muscle electromyogram recorded at the abdominal surface of pregnant or non-pregnant woman. The maternal respiration electromyographic signal (MR-EMG) is one of the most relevant interferences present in an EHG. Alvarez (Alv) waves are components of the EHG that have been indicated as having the potential for preterm and term birth prediction. The MR-EMG component in the EHG represents an issue, regarding Alv wave application for pregnancy monitoring, for instance, in preterm birth prediction, a subject of great research interest. Therefore, the Alv waves denoising method should be designed to include the interference MR-EMG attenuation, without compromising the original waves. Adaptive filter properties make them suitable for this task. However, selecting the optimal adaptive filter and its parameters is an important task for the success of the filtering operation. In this work, an algorithm is presented for the automatic adaptive filter and parameter selection using synthetic data. The filter selection pool comprised sixteen candidates, from which, the Wiener, recursive least squares (RLS), householder recursive least squares (HRLS), and QR-decomposition recursive least squares (QRD-RLS) were the best performers. The optimized parameters were L = 2 (filter length) for all of them and λ = 1 (forgetting factor) for the last three. The developed optimization algorithm may be of interest to other applications. The optimized filters were applied to real data. The result was the attenuation of the MR-EMG in Alv waves power. For the Wiener filter, power reductions for quartile 1, median, and quartile 3 were found to be −16.74%, −20.32%, and −15.78%, respectively (p-value = 1.31 × 10 −12).
No studies have directly measured ventilatory and metabolic responses while wearing a respiratory training mask (RTM) at rest and during exercise. Eleven aerobically fit adults (age: 21 ± 1 years) completed a randomized cross-over study while wearing an RTM or control mask during cycling at 50% Wmax. An RTM was retrofitted with a gas collection tube and set to the manufacturer's “altitude resistance” setting of 6,000 ft (1,800 m). Metabolic gas analysis, ratings of perceived exertion, and oxygen saturation (SpO 2 ) were measured during rest and cycling exercise. The RTM did not affect metabolic, ventilation, and SpO 2 at rest compared to the control mask (all, effect of condition: P > 0.05). During exercise, the RTM blunted respiratory rate and minute ventilation (effect of condition: P < 0.05) compared to control. Similar increases in VO 2 and VCO 2 were observed in both conditions (both, effect of condition: P > 0.05). However, the RTM led to decreased fractional expired O 2 and increased fractional expired CO 2 (effect of condition: P < 0.05) compared to the control mask. In addition, the RTM decreased SpO 2 and increased RPE (both, effect of condition: P < 0.05) during exercise. Despite limited influence on ventilation and metabolism at rest, the RTM reduces ventilation and disrupts gas concentrations during exercise leading to modest hypoxemia.
Objectives This study investigated responses of cardiorespiratory parameters of healthy subjects from respiratory muscle training using a NU_spiroBreathe device. Methods Nine healthy female subjects with sedentary lifestyles were asked to perform respiratory muscle training using a NU_spiroBreathe device with 10 cmH2O resistance (10 repetitions/set, 3 sets). Cardiorespiratory parameters (blood pressure; pulse rate; oxygen saturation) were assessed before and during respiratory muscle training sessions and after a 30-minute recovery period. The data were analyzed using the k-related sample Friedman test. Results There were no significant changes in cardiorespiratory parameters before, during or after a 30-minutes recovery period from respiratory muscle training using NU_spiroBreathe device (p > 0.05). Conclusions Respiratory muscle training using an NU_spiroBreathe device does not change cardio-respiratory parameters and is safe for use by healthy subjects. Chiang Mai Medical Journal 2021; 60(1):53-62. doi 10.12982/CMUMEDJ.2021.05
Objective: Aim of the study was to examine the effects of inspiratory muscle training (IMT) on respiratory function, respiratory muscle strength, trunk control, balance, and functional capacity in stroke patients.
Methods: 21 stroke individuals were randomly divided into two groups as control group and treatment group. Maximal Inspiratory Pressure (MIP) and Maximal Expiratory Pressure (MEP) were evaluated. Also, Trunk Impairment Scale (TIS), Timed Up and Go Test (TUG) and Berg Balance Scale (BBS), and Six-Minute Walk Test (6MWT) were performed. Neurodevelopmental treatment program was performed in both groups for 5 days a week for 6 weeks, and IMT was given to the treatment group. IMT was started from 40% of MIP.
Results: After treatment, respiratory functions, respiratory muscle strength, and trunk control and balance improved in the treatment group. In the control group; however, only the balance level was improved. When the changes in the evaluation parameters between the groups were compared, there were only statistically significant differences in the TIS, PEF and MIP in the treatment group (p˂0.05), the change amounts in other evaluation parameters were similar (p˃0.05). When the effect size of the groups was compared, the effect size of the variables in the treatment group was found to be higher.
Conclusions: As a conclusion, the IMT, which was given in addition to the neurological physiotherapy and rehabilitation program to our patients, improved inspiratory muscle strength and trunk control. We believe that this result will raise awareness for physiotherapists working in the field of neurological rehabilitation about including respiratory muscle training in the rehabilitation program of stroke patients.
La implementación del entrenamiento respiratorio aislado en la rehabilitación y el entrenamiento de la voz es una práctica común en los países de habla hispana. Actualmente, no existe ningún manuscrito en español que revise la información teórica y empírica del entrenamiento respiratorio en este contexto. El propósito de la presente revisión es entregar la evidencia actualizada del efecto del entrenamiento respiratorio aislado en la voz. El entrenamiento de la fuerza respiratoria ha demostrado tener consecuencias positivas en los parámetros medidos; no obstante, los datos disponibles hasta ahora no reporta efectos significativos en la voz, exceptuando los casos de personas con trastornos neurológicos de base y presbifonía. Si el entrenamiento respiratorio con el uso de dispositivos no ha demostrado impactar favorablemente sobre otras disfonías (no neurológicas ni presbifonía) ni en sujetos sanos profesionales de la voz, no existiría razón para esperar que los ejercicios respiratorios aislados que se suelen incluir en las rutinas de entrenadores vocales, fonoaudiólogos, logopedas y foniatras tengan un efecto positivo. Considerando que el entrenamiento de la fuerza muscular respiratoria parece actuar sobre algunos parámetros vocales en personas con alteraciones neurológicas y presbifonía, futuras investigaciones deberían considerar la exploración del posible efecto positivo en otros parámetros vocales no medidos aún en este tipo de población.
Purpose:
There is little evidence of the ergogenic effect of flow-resistive masks worn during exercise. We compared a flow-resistive face mask (MASK) worn during high-intensity interval training (HIIT) against pressure threshold loading inspiratory muscle training (IMT).
Methods:
23 participants (13 males) completed a 5 km time trial and six weeks of HIIT (3 sessions weekly). HIIT (n = 8) consisted of repeated work (2 min) at the speed equivalent to 95% [Formula: see text]O2 peak with equal rest. Repetitions were incremental (six in weeks 1, 2 and 6, eight in weeks 3 and 4 and ten in week 5). Participants were allocated to one of three training groups. MASK (n = 8) wore a flow-resistive mask during all sessions. The IMT group (n = 8) completed 2 × 30 breaths daily at 50% maximum inspiratory pressure (PImax). A control group (CON, n = 7) completed HIIT only. Following HIIT, participants completed two 5 km time trials, the first matched identically to pre-intervention trial (ISO time), and a self-paced effort.
Results:
Time trial performance was improved in all groups (MASK 3.1 ± 1.7%, IMT, 5.7 ± 1.5% and CON 2.6 ± 1.0%, p < 0.05). IMT improved greater than MASK and CON (p = 0.004). Post intervention, PImax and diaphragm thickness were improved in IMT only (32% and 9.5%, respectively, p = 0.003 and 0.024).
Conclusion:
A flow-resistive mask worn during HIIT provides no benefit to 5 km performance when compared to HIIT only. Supplementing HIIT with IMT improves respiratory muscle strength, morphology and performance greater than HIIT alone.
Respiratory muscle weakness in patients with Chronic Obstructive Pulmonary Disease (COPD) was a problem that can affect the patient's ability to conduct daily activities. The aim of this study to see the difference between the intervention group given the pursed-lip breathing exercises, diaphragmatic breathing, and upper limb stretching with the control group which not given therapy. 38 COPD patients were grouped into intervention groups (n = 18) and control group (n = 18) randomly. The intervention group was given pursed-lip breathing, diaphragmatic breathing, and upper limb stretching for 4 weeks as much as two times for each week, while the control group was not given exercise. The dyspnea scale was measured using the MRC Dyspnea Scale questionnaire and was categorized as Mild (scale 1), Medium (2-3 scale), and Severe (scale 4-5). The result showed there was a difference in dyspnea (p-value 0.008) for intervention group and there is no difference in the dyspnea for control group that was not given exercise (0.655). In conclusion, pursed lip breathing, diaphragmatic breathing, and upper limb stretching can give more significant benefits when done sustainably, especially for COPD patients.
The purpose of this study was to assess the influence of the work history of the inspiratory
muscles upon the fatigue characteristics of the plantar flexors (PF).We hypothesized that under
conditions where the inspiratory muscle metaboreflex has been elicited, PF fatigue would be
hastened due to peripheral vasoconstriction. Eight volunteers undertook seven test conditions,
two ofwhichfollowed4 week of inspiratorymuscle training(IMT). The inspiratorymetaboreflex
was induced by inspiring against a calibrated flowresistor.We measured torque andEMGduring
isometric PF exercise at 85% of maximal voluntary contraction (MVC) torque. Supramaximal
twitches were superimposed uponMVC efforts at 1 min intervals (MVCTI); twitch interpolation
assessed the level of central activation. PF was terminated (Tlim) when MVCTI was<50% of
baseline MVC. PF Tlim was significantly shorter than control (9.93±1.95 min) in the presence
of a leg cuff inflated to 140 mmHg(4.89±1.78 min; P =0.006), as well aswhen PF was preceded
immediately by fatiguing inspiratory muscle work (6.28±2.24 min; P =0.009). Resting the
inspiratory muscles for 30 min restored the PF Tlim to control. After 4 weeks, IMT, inspiratory
muscle work at the same absolute intensity did not influence PF Tlim, but Tlim was significantly
shorter at thesamerelative intensity.Thedata are the first toprovide evidence that the inspiratory
muscle metaboreflex accelerates the rate of calf fatigue during PF, and that IMT attenuates this
effect.
Background: The variability of maximal inspiratory pressure (PImax) in response to repeated measurement affects its reliability; published studies have used between three and twenty PImax measurements on a single occasion. Objective: This study investigated the influence of a specific respiratory ‘warm-up’ upon the repeated measurement of inspiratory muscle strength and attempts to establish a procedure by which PImax can be assessed with maximum reliability using the smallest number of manoeuvres. Methods: Fourteen healthy subjects, familiar with the Mueller manoeuvre, were studied. The influence of repeated testing on a single occasion was assessed using an 18-measurement protocol. Using a randomised cross-over design, subjects performed the protocol, preceded by a specific respiratory warm-up (RWU) and on another occasion, without any preliminary activity (control). Comparisons were made amongst ‘baseline’ (best of the first 3 measurements), ‘short’ series (best of 7th to 9th measurement) and ‘long’ series (best of the last 3 measurements). Results: Under control conditions, the mean increase (‘baseline’ vs. ‘long’ series) was 11.4 (5.8)%; following the RWU, the increase (post RWU ‘baseline’ vs. ‘long’ series) was 3.2 (10.0)%. There were statistically significant differences between measurements made at all 3 protocol stages (‘baseline’, ‘short’ and ‘long’ series) under control conditions, but none following the RWU. Conclusions: The present data suggest that a specific RWU may attenuate the ‘learning effect’ during repeated PImax measurements, which is one of the main contributors of the test variability. The use of a RWU may provide a means of obtaining reliable values of PImax following just 3 measurements.
Background
In this study, we analyzed maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP) values in a stable COPD population compared with normal subjects. We evaluated the possible correlation between functional maximal respiratory static pressures and functional and anthropometric parameters at different stages of COPD. Furthermore, we considered the possible correlation between airway obstruction and MIP and MEP values.
Subject and methods
110 patients with stable COPD and 21 age-matched healthy subjects were enrolled in this study. Patients were subdivided according to GOLD guidelines: 31 mild, 39 moderate and 28 severe.
Results
Both MIP and MEP were lower in patients with severe airway impairment than in normal subjects. Moreover, we found a correlation between respiratory muscle function and some functional and anthropometric parameters: FEV1 (forced expiratory volume in one second), FVC (forced vital capacity), PEF (peak expiratory flow), TLC (total lung capacity) and height. MIP and MEP values were lower in patients with severe impairment than in patients with a slight reduction of FEV1.
Conclusion
The measurement of MIP and MEP indicates the state of respiratory muscles, thus providing clinicians with a further and helpful tool in monitoring the evolution of COPD.
In this study, we examined the time course of changes in the blood volume and oxygenation of accessory respiratory (RM) and locomotor (LM) muscles, and the interrelationships of changes in these parameters during maximal incremental intermittent exercise in 15 non-endurance-trained active men. Blood volume and oxygenation of the serratus anterior and of vastus lateralis were measured simultaneously by near-infrared spectroscopy. The respiratory compensation point, and the breakpoints where abrupt changes were apparent in RM and LM blood volume and oxygenation versus time were identified. During exercise, the decreases in RM and LM oxygenation were accentuated in the vicinity of the respiratory compensation point. This was concomitant with a reduction in LM, but not RM, blood volume. The time at which the respiratory compensation point and the breakpoints in RM and LM blood volume and oxygenation were detected (70.2-75.0% exercise time) did not differ, and were inter-correlated (r = 0.56 to 0.95). Moreover, the rate of the accelerated fall of oxygenation in the locomotor muscles was correlated with that of the decline in blood volume in that area (r = 0.73), and with that of the accelerated fall of oxygenation in the respiratory muscles (r = 0.71). The results suggest that the high ventilatory demand, which occurs naturally during intense intermittent exercise in non-endurance-trained individuals, may precipitate an accelerated fall in RM oxygenation, concomitant with a reduction in LM blood volume and an accentuated decline in LM oxygenation. Such responses are likely to occur above the respiratory compensation point during intermittent exercise.
Background:
After cardiac surgery, physical therapy is a routine procedure delivered with the aim of preventing postoperative pulmonary complications.
Objectives:
To determine if preoperative physical therapy with an exercise component can prevent postoperative pulmonary complications in cardiac surgery patients, and to evaluate which type of patient benefits and which type of physical therapy is most effective.
Search methods:
Searches were run on the Cochrane Central Register of Controlled Trials (CENTRAL) on the Cochrane Library (2011, Issue 12 ); MEDLINE (1966 to 12 December 2011); EMBASE (1980 to week 49, 2011); the Physical Therapy Evidence Database (PEDro) (to 12 December 2011) and CINAHL (1982 to 12 December 2011).
Selection criteria:
Randomised controlled trials or quasi-randomised trials comparing preoperative physical therapy with no preoperative physical therapy or sham therapy in adult patients undergoing elective cardiac surgery.
Data collection and analysis:
Data were collected on the type of study, participants, treatments used, primary outcomes (postoperative pulmonary complications grade 2 to 4: atelectasis, pneumonia, pneumothorax, mechanical ventilation > 48 hours, all-cause death, adverse events) and secondary outcomes (length of hospital stay, physical function measures, health-related quality of life, respiratory death, costs). Data were extracted by one review author and checked by a second review author. Review Manager 5.1 software was used for the analysis.
Main results:
Eight randomised controlled trials with 856 patients were included. Three studies used a mixed intervention (including either aerobic exercises or breathing exercises); five studies used inspiratory muscle training. Only one study used sham training in the controls. Patients that received preoperative physical therapy had a reduced risk of postoperative atelectasis (four studies including 379 participants, relative risk (RR) 0.52; 95% CI 0.32 to 0.87; P = 0.01) and pneumonia (five studies including 448 participants, RR 0.45; 95% CI 0.24 to 0.83; P = 0.01) but not of pneumothorax (one study with 45 participants, RR 0.12; 95% CI 0.01 to 2.11; P = 0.15) or mechanical ventilation for > 48 hours after surgery (two studies with 306 participants, RR 0.55; 95% CI 0.03 to 9.20; P = 0.68). Postoperative death from all causes did not differ between groups (three studies with 552 participants, RR 0.66; 95% CI 0.02 to 18.48; P = 0.81). Adverse events were not detected in the three studies that reported on them. The length of postoperative hospital stay was significantly shorter in experimental patients versus controls (three studies with 347 participants, mean difference -3.21 days; 95% CI -5.73 to -0.69; P = 0.01). One study reported a reduced physical function measure on the six-minute walking test in experimental patients compared to controls. One other study reported a better health-related quality of life in experimental patients compared to controls. Postoperative death from respiratory causes did not differ between groups (one study with 276 participants, RR 0.14; 95% CI 0.01 to 2.70; P = 0.19). Cost data were not reported on.
Authors' conclusions:
Evidence derived from small trials suggests that preoperative physical therapy reduces postoperative pulmonary complications (atelectasis and pneumonia) and length of hospital stay in patients undergoing elective cardiac surgery. There is a lack of evidence that preoperative physical therapy reduces postoperative pneumothorax, prolonged mechanical ventilation or all-cause deaths.
The purpose of this review was to assess the quality of evidence on inspiratory muscle training (IMT) in patients with heart failure and to provide an overview on subject selection, training protocols, and outcome achieved with IMT.
Literature search was first performed via the PubMed database, and additional references were identified from the Scopus citation index. Articles of the review type and of clinical trials published in English were included. Quality of the articles was assessed using Sackett's levels of evidence and rigor of methodology was assessed using PEDro (Physiotherapy Evidence Database) criteria for randomized controlled trials and the Downs & Black tool for cohort studies.
Twelve articles of clinical trials were included. Typical training protocols involved daily training with intensity greater than 30% of maximal inspiratory pressure (PImax), duration of 20 to 30 minutes (continuous or incremental) and using a pressure threshold muscle trainer. The effect sizes of PImax, walk test distance, and dyspnea were moderate to large across these studies. Effects on quality of life scores were inconsistent.
Inspiratory muscle training is beneficial for improving respiratory muscle strength, functional capacity, and dyspnea in patients with stable heart failure and respiratory muscle weakness.
Patients with chronic heart failure (CHF) may have lower inspiratory muscle strength and endurance, which may contribute to exercise intolerance. Inspiratory muscle training (IMT) can have beneficial effects on these patients. Thus, the aim of this study was to systematically review the effects of IMT compared to control groups (placebo-IMT or another intervention) in patients with CHF. A search of databases (MEDLINE, Cochrane CENTRAL and PEDro) and references of published studies, from 1960 to 2011, was conducted. Randomized trials comparing IMT to control groups in the treatment of patients with CHF were included. The GRADE approach was used to determine the quality of evidence for each outcome. Of 119 articles identified, 7 studies were included. IMT increased the distance walked in the six-minute walk test [69 m (95% CI: 7.21 to 130.79)] (very low evidence) and maximal static inspiratory pressure [23.36 cmH20 (95% CI: 11.71 to 35.02)] (low evidence) compared to control groups. However, IMT provides a significant improvement in peak oxygen consumption only in the studies that performed IMT for 12 weeks against no inspiratory load in patients with inspiratory muscle weakness [3.02 ml/kg/min-1 (95% CI: 0.43 to 5.61)]. IMT improves functional capacity and inspiratory muscle strength thereby deserving consideration as an additional intervention in patients with CHF. Larger and better-designed studies, however, are needed to clarify the potential benefit of IMT in this patient population.
Heart failure induces histological, metabolic and functional adaptations in the inspiratory muscles. This inspiratory muscle weakness, which occurs in 30% to 50% of the heart failure patients, is associated with reduction in the functional capacity, reduction in the quality of life and with a poor prognosis in these individuals.
The objective of this review was to discuss the pathophysiological mechanisms that may explain the role of the inspiratory muscles in the exercise limitation with focus in the reflexes that control the ventilation and the circulation during the exercise.
We performed searches in the PUBMED database using the terms "inspiratory muscles", "inspiratory muscle training", "metaboreflex" and chemoreflex" and including studies published since 1980.
Inspiratory muscle weakness is associated with exercise intolerance and with an exaggerated inspiratory chemoreflex and metaboreflex in heart failure. The inspiratory metaboreflex may be attenuated by the inspiratory muscle training or by the aerobic exercise training improving the exercise performance.
Patients with heart failure may present changes in the inspiratory muscle function associated with inspiratory chemoreflex and metaboreflex hyperactivity, which exacerbate the exercise intolerance.
Objective. To examine whether a programme of inspiratory muscle training (IMT) improves accumulative distance of self-paced walking in overweight and obese adults.
Methods. A total of 15 overweight and obese adults were randomized into experimental (EXP: n = 8) and placebo (PLA: n = 7) groups. Lung function, inspiratory muscle performance, 6-minute walking test, and predicted V˙O2 max were assessed prior to and following the 4-week IMT intervention. Both groups performed 30 inspiratory breaths, twice daily using a proprietary inspiratory resistance device set to 55% of baseline maximal effort (EXP), or performing the same inspiratory training procedure at the minimum resistive setting (PLA).
Results. Lung function was unchanged in both groups after-training; however inspiratory muscle strength was significantly improved in EXP (19 ± 25.2 cm H2O gain; P < 0.01) but did not significantly change in PLA. Additionally, the posttraining distance covered in the 6-minute walking test was significantly extended for EXP (62.5 ± 37.7 m gain; P < 0.01), but not for PLA. A positive association was observed between the change (%) of performance gain in the 6-minute walking test and body mass index (r = 0.736; P < 0.05) for EXP. Conclusion. The present study suggests that IMT provides a practical, minimally intrusive intervention to significantly augment both inspiratory muscle performance and walking distance covered by overweight and obese adults in a clinically relevant 6-minute walk test. This indicates that IMT may provide a useful priming (preparatory) strategy prior to entry in a physical training programme for overweight and obese adults.
To evaluate the effect of inspiratory muscle training (IMT) on cardiac autonomic modulation and on peripheral nerve sympathetic activity in patients with chronic heart failure (CHF).
Functional capacity, low-frequency (LF) and high-frequency (HF) components of heart rate variability, muscle sympathetic nerve activity inferred by microneurography, and quality of life were determined in 27 patients with CHF who had been sequentially allocated to 1 of 2 groups: (1) control group (with no intervention) and (2) IMT group. Inspiratory muscle training consisted of respiratory exercises, with inspiratory threshold loading of seven 30-minute sessions per week for a period of 12 weeks, with a monthly increase of 30% in maximal inspiratory pressure (PI(max)) at rest. Multivariate analysis was applied to detect differences between baseline and followup period.
Inspiratory muscle training significantly increased PI(max) (59.2 ± 4.9 vs 87.5 ± 6.5 cmH(2)O, P = .001) and peak oxygen uptake (14.4 ± 0.7 vs 18.9 ± 0.8 mL·kg(-1)·min(-1), P = .002); decreased the peak ventilation (VE)/carbon dioxide production (VCO(2)) ratio (35.8 ± 0.8 vs 32.5 ± 0.4, P = .001) and the VE/VCO(2) slope (37.3 ± 1.1 vs 31.3 ± 1.1, P = .004); increased the HF component (49.3 ± 4.1 vs 58.4 ± 4.2 normalized units, P = .004) and decreased the LF component (50.7 ± 4.1 vs 41.6 ± 4.2 normalized units, P = .001) of heart rate variability; decreased muscle sympathetic nerve activity (37.1 ± 3 vs 29.5 ± 2.3 bursts per minute, P = .001); and improved quality of life. No significant changes were observed in the control group.
Home-based IMT represents an important strategy to improve cardiac and peripheral autonomic controls, functional capacity, and quality of life in patients with CHF.
Inspiratory muscle training (IMT) became widespread, particularly in a clinical context, following the work of Delhez et al.[(1966 ) Modifications du diagramme pression-Volume maximum de l’appereil thoraco-pulmonaire aprés entrainement des muscles respiratoires par des exercises statiques. Arch. Internat. De Physiol. Et de Biochimie., 74, 335–336], who demonstrated that the breathing muscles could be strengthened by specific training. Numerous technologies have been described since then; however, to date, pressure threshold loading has proved to be the most effective technology, offering a versatile yet robust means of improving the strength, power and endurance of the inspiratory muscles in clinical populations. Unfortunately, at present, a pressure threshold training device suitable for training the inspiratory muscles of healthy humans does not exist. Thus, the potential for widespread implementation of IMT in athletic populations is severely constrained. The purpose of the present paper is to document the design and development of such a device.
The device described provides true threshold, near flow-independent, loading between −5 and −150 cm H2O. Whilst flow-independent loading was not accomplished, the degree of flow dependency achieved was substantially lower than that reported for previous (clinical) devices. Furthermore, the degree of flow dependency observed at anything other than low loads is of limited functional relevance.
The device is now commercially available and has been shown to increase exercise capacity in a number of intervention studies. The product is registered with the Medical Devices Agency as a class I medical device. In complying with the Medical Devices Regulations, 1994, the product is authorised to carry the CE mark. It is covered by an active patent no. 2278545 and is trademarked Powerbreathe® (IMT Technologies Ltd, Birmingham, UK).
Recently, we have shown that an untrained respiratory system does limit the endurance of submaximal exercise (64% peak oxygen consumption) in normal sedentary subjects. These subjects were able to increase breathing endurance by almost 300% and cycle endurance by 50% after isolated respiratory training. The aim of the present study was to find out if normal, endurance trained subjects would also benefit from respiratory training. Breathing and cycle endurance as well as maximal oxygen consumption (
[(V)\dot]O2 max\dot VO_{2 max}
) and anaerobic threshold were measured in eight subjects. Subsequently, the subjects trained their respiratory muscles for 4 weeks by breathing 85-1601 min–1 for 30 min daily. Otherwise they continued their habitual endurance training. After respiratory training, the performance tests made at the beginning of the study were repeated. Respiratory training increased breathing endurance from 6.1 (SD 1.8) min to about 40 min. Cycle endurance at the anaerobic threshold [77 (SD 6) %
[(V)\dot]O2 max\dot VO_{2 max}
] was improved from 22.8 (SD 8.3) min to 31.5 (SD 12.6) min while
[(V)\dot]O2 max\dot VO_{2 max}
and the anaerobic threshold remained essentially the same. Therefore, the endurance of respiratory muscles can be improved remarkably even in trained subjects. Respiratory muscle fatigue induced hyperventilation which limited cycle performance at the anaerobic threshold. After respiratory training, minute ventilation for a given exercise intensity was reduced and cycle performance at the anaerobic threshold was prolonged. These results would indicate the respiratory system to be an exercise limiting factor in normal, endurance trained subjects.
Obstructive sleep apnea (OSA) is caused by a collapse of the upper airway. Respiratory muscle training with a wind instrument (didgeridoo) in patients with moderate OSA has been previously shown to improve OSA symptomology. However, a survey of orchestra members did not indicate a difference in OSA risk between wind and non-wind instrumentalist. The present study examines whether playing of different wind instrument types may affect the risk of OSA.
A national sample of active musicians (n = 906) was surveyed through the internet. Participants' risk for OSA was determined by the Berlin Questionnaire. Additional survey items included questions about general health and musical experience.
A binary logistic regression was conducted to determine if OSA risk was predicted by gender, age, number of years playing instrument, number of hours per week playing instrument, and instrument type. Musicians who played a double reed instrument had a lower risk of OSA (p = 0.047) than non-wind instrumentalists. Additionally, in double reed instrumentalists, the number of hours spent playing the instrument predicted lower OSA risk (p = 0.020). The risk for OSA in other wind instruments (i.e., single reed, high brass, and low brass) was not significantly different from non-wind musicians.
Playing a double reed musical instrument was associated with a lower risk of OSA.
During the rowing stroke, the respiratory muscles are responsible for postural control, trunk stabilisation, generation/transmission of propulsive forces and ventilation (Bierstacker et al. in Int J Sports Med 7:73–79, 1986; Mahler et al. in Med Sci Sports Exerc 23:186–193, 1991). The challenge of these potentially competing requirements is exacerbated in certain parts of the rowing stroke due to flexed (stroke ‘catch’) and extended postures (stroke ‘finish’). The purpose of this study was to assess the influence of the postural role of the trunk muscles upon pressure and flow generating capacity, by measuring maximal respiratory pressures, flows, and volumes in various seated postures relevant to rowing. Eleven male and five female participants took part in the study. Participants performed two separate testing sessions using two different testing protocols. Participants performed either maximal inspiratory or expiratory mouth pressure manoeuvres (Protocol 1), or maximal flow volume loops (MFVLs) (Protocol 2), whilst maintaining a variety of specified supported or unsupported static rowing-related postures. Starting lung volume was controlled by initiating the test breath in the upright position. Respiratory mouth pressures tended to be lower with recumbency, with a significant decrease in P
Emax in unsupported recumbent postures (3–9 % compared to upright seated; P = 0.036). There was a significant decrease in function during dynamic manoeuvres, including PIF (5–9 %), FVC (4–7 %) and FEV1 (4–6 %), in unsupported recumbent postures (p < 0.0125; Bonferroni corrected). Thus, respiratory pressure and flow generating capacity tended to decrease with recumbency; since lung volumes were standardised, this may have been, at least in part, influenced by the postural co-contraction of the trunk muscles.
The purpose of this study was to elucidate the influence of inspiratory muscle fatigue on muscle sympathetic nerve activity (MSNA) and blood pressure (BP) response during submaximal exercise. We hypothesized that inspiratory muscle fatigue would elicit increases in sympathetic vasoconstrictor outflow and BP during dynamic leg exercise. The subjects carried out four submaximal exercise tests: two were maximal inspiratory pressure (PI(max)) tests and two were MSNA tests. In the PI(max) tests, the subjects performed two 10-min exercises at 40% peak oxygen uptake using a cycle ergometer in a semirecumbent position [spontaneous breathing for 5 min and with or without inspiratory resistive breathing for 5 min (breathing frequency: 60 breaths/min, inspiratory and expiratory times were each set at 0.5 s)]. Before and immediately after exercise, PI(max) was estimated. In MSNA tests, the subjects performed two 15-min exercises (spontaneous breathing for 5 min, with or without inspiratory resistive breathing for 5 min, and spontaneous breathing for 5 min). MSNA was recorded via microneurography of the right median nerve at the elbow. PI(max) decreased following exercise with resistive breathing, whereas no change was found without resistance. The time-dependent increase in MSNA burst frequency (BF) appeared during exercise with inspiratory resistive breathing, accompanied by an augmentation of diastolic BP (DBP) (with resistance: MSNA, BF +83.4%; DBP, +23.8%; without resistance: MSNA BF, +19.2%; DBP, -0.4%, from spontaneous breathing during exercise). These results suggest that inspiratory muscle fatigue induces increases in muscle sympathetic vasomotor outflow and BP during dynamic leg exercise at mild intensity.
Respiratory muscle training (RMT) has been extensively investigated over the past two decades. To date no method of ventilatory muscle training has fixed load throughout range in a manner consistent with the general principles of skeletal muscle training. The purpose of this study was to assess the use of computer-generated fixed-load incremental RMT produced by the performance of repeated sustained sub-maximal inspiratory efforts (80% of maximum, generated from RV to TLC; a full range of contraction/muscle shortening) with progressively reduced recovery times in healthy volunteers.
Respiratory muscle dysfunction is associated with prolonged and difficult weaning from mechanical ventilation. This dysfunction in ventilator-dependent patients is multifactorial: there is evidence that inspiratory muscle weakness is partially explained by disuse atrophy secondary to ventilation, and positive end-expiratory pressure can further reduce muscle strength by negatively shifting the length-tension curve of the diaphragm. Polyneuropathy is also likely to contribute to apparent muscle weakness in critically ill patients, and nutritional and pharmaceutical effects may further compound muscle weakness. Moreover, psychological influences, including anxiety, may contribute to difficulty in weaning. There is recent evidence that inspiratory muscle training is safe and feasible in selected ventilator-dependent patients, and that this training can reduce the weaning period and improve overall weaning success rates. Extrapolating from evidence in sports medicine, as well as the known effects of inspiratory muscle training in chronic lung disease, a theoretical model is proposed to describe how inspiratory muscle training enhances weaning and recovery from mechanical ventilation. Possible mechanisms include increased protein synthesis (both Type 1 and Type 2 muscle fibres), enhanced limb perfusion via dampening of a sympathetically-mediated metaboreflex, reduced lactate levels and modulation of the perception of exertion, resulting in less dyspnoea and enhanced exercise capacity.
The purpose of this study was to investigate the effect on muscular strength after a 3-week training with the bench-press at a fixed pushing of 80-100% maximal speed (FPS) and self-selected pushing speed (SPS). 20 resistance-trained subjects were divided at random in 2 groups differing only regarding the pushing speed: in the FPS group (n=10) it was equal to 80-100% of the maximal speed while in the SPS group (n=10) the pushing speed was self-selected. Both groups were trained twice a week for 3 weeks with a load equal to 85% of 1RM and monitored with the encoder. Before and after the training we measured pushing speed and maximum load. Significant differences between and within the 2 groups were pointed out using a 2-way ANOVA for repeated measures. After 3 weeks a significant improvement was shown especially in the FPS group: the maximum load improved by 10.20% and the maximal speed by 2.22%, while in the SPS group the effect was <1%. This study shows that a high velocity training is required to increase the muscle strength further in subjects with a long training experience and this is possible by measuring the individual performance speed for each load.
A key but little understood function of the cardiovascular system is to exchange heat between the internal body tissues, organs and the skin to maintain internal temperature within a narrow range in a variety of conditions that produce vast changes in external (exogenous) and/or internal (endogenous) thermal loads. Heat transfer via the flowing blood (i.e. vascular convective heat transfer) is the most important heat-exchange pathway inside the body. This pathway is particularly important when metabolic heat production increases many-fold during exercise. During exercise typical of many recreational and Olympic events, heat is transferred from the heat-producing contracting muscles to the skin surrounding the exercising limbs and to the normally less mobile body trunk and head via the circulating blood. Strikingly, a significant amount of heat produced by the contracting muscles is liberated from the skin of the exercising limbs. The local and central mechanisms regulating tissue temperature in the exercising limbs, body trunk and head are essential to avoid the deleterious consequences on human performance of either hyperthermia or hypothermia. This brief review focuses on recent literature addressing the following topics: (i) the dynamics of heat production in contracting skeletal muscle; (ii) the influence of exercise and environmental heat and cold stress on limb and systemic haemodynamics; and (iii) the impact of changes in muscle blood flow on heat exchange in human limbs. The paper highlights the need to investigate the responses and mechanisms of vascular convective heat exchange in exercising limbs to advance our understanding of local tissue temperature regulation during exercise and environmental stress.
We have evaluated the potential role of respiratory exercise by implementing specific inspiratory muscle training in a selected population of early-affected amyotrophic lateral sclerosis (ALS) patients. We studied 26 patients with ALS with normal respiratory function using two groups of patients in a parallel, control-group, randomized, delayed-start design. Patients in the first group (G1) started the active inspiratory exercise programme at entry and were followed for eight months, while the second group (G2) of patients followed a placebo exercise programme for the first four months and then active exercise for the second four-month period. The primary outcome measure was the ALSFRS. Respiratory tests, neurophysiological measurements, fatigue and quality of life scales were secondary outcomes. Analysis of covariance was used to compare changes between and within groups. Results showed that there was no significant difference between the two patient groups. Within-group analysis suggested that inspiratory exercise promotes a transient improvement in the respiratory subscore and in the maximal voluntary ventilation, peak expiratory flow, and sniff inspiratory pressure. In conclusion, there was no clear positive or negative outcome of the respiratory exercise protocol we have proposed, but we cannot rule out a minor positive effect. Exercise regimes merit more detailed clinical evaluation in ALS.
Does inspiratory muscle training improve inspiratory muscle strength and endurance, facilitate weaning, improve survival, and reduce the rate of reintubation and tracheostomy in adults receiving mechanical ventilation?
Systematic review of randomised or quasi-randomised controlled trials.
Adults over 16 years of age receiving mechanical ventilation.
Inspiratory muscle training versus sham or no inspiratory muscle training.
Data were extracted regarding inspiratory muscle strength and endurance, the duration of unassisted breathing periods, weaning success and duration, reintubation and tracheostomy, survival, adverse effects, and length of stay.
Three studies involving 150 participants were included in the review. The studies varied in time to commencement of the training, the device used, the training protocol, and the outcomes measured. Inspiratory muscle training significantly increased inspiratory muscle strength over sham or no training (weighted mean difference 8 cmH(2)O, 95% CI 6 to 9). There were no statistically significant differences between the groups in weaning success or duration, survival, reintubation, or tracheostomy.
Inspiratory muscle training was found to significantly increase inspiratory muscle strength in adults undergoing mechanical ventilation. Despite data from a substantial pooled cohort, it is not yet clear whether the increase in inspiratory muscle strength leads to a shorter duration of mechanical ventilation, improved weaning success, or improved survival. Further large randomised studies are required to clarify the impact of inspiratory muscle training on patients receiving mechanical ventilation. REVIEW REGISTRATION: PROSPERO CRD42011001132.