Inspiratory Muscle Training Device Research Articles

Effect of Inspiratory Muscle Training on Cough Strength in Older People With Frailty: A Single-Blind Randomized Controlled Trial

ObjectiveTo investigate the effect of inspiratory muscle training (IMT) on cough strength in older people with frailty. DesignSingle-blind randomized controlled trial. SettingDay health care centers at 2 sites. ParticipantsOlder people with frailty (N=60). InterventionsEligible people were randomly assigned to receive IMT program in addition to general exercise training (IMT group), or general exercise training alone (control group). The IMT group performed training using a threshold IMT device with the load set at 30% of maximum inspiratory mouth pressure in addition to the general exercise training program throughout the 8 weeks. The IMT took place twice a day and each session consisted of 30 breaths. Main Outcome MeasuresPrimary outcome was cough strength, measured as the cough peak flow (CPF), at the beginning and the end of the program. ResultsData from 52 participants (26 in each group) were available for the analysis. The mean age was 82.6 years; 33% were men. The change in CPF at the end of the program was 28.7±44.4 L/min in the IMT group and −7.4±26.6 L/min in the control group. A linear regression model showed that the presence or absence of IMT was associated with changes in CPF (mean difference between groups, 36.3; 95% confidence interval, 16.7-55.9; effect size, 0.99). ConclusionsIMT may be a useful intervention to improve cough strength in frail older people.

3D-printed magnetic-based air pressure sensor for continuous respiration monitoring and breathing rehabilitation

The rapid development of point-of-care testing has made prompt diagnosis, monitoring and treatment possible for many patients suffering from chronic respiratory diseases. Currently, the biggest challenge is further optimizing testing devices to facilitate more functionalities with higher efficiency and performance, along with specificity toward patient needs. By understanding that patients with chronic respiratory diseases may have difficulty breathing within a normal range, a respiration sensor is developed focusing on sensitivities in the lower air pressure range. In contrast to the simpler airflow data, the sensor can provide respiratory air pressure as an output using a magnetic-based pressure sensor. This unconventional but highly reliable approach, combined with the rest of the simple 3D-printed design of the sensor, offers a wide range of tunability and functionalities. Due to the detachable components of the respiration sensor, the device can be easily transformed into other respiratory uses such as an inspiratory muscle training device or modified to cater for higher-ranged deep breathing. Therefore, not only does it reach very low air pressure measurement (0.1 cmH2O) for normal, tidal breathing, but the sensor can also be manipulated to detect high levels of air pressure (up to 35 cmH2O for exhalation and 45 cmH2O for inhalation). With its excellent sensitivities (0.0456 mV/cmH2O for inhalation, -0.0940 mV/cmH2O for exhalation), impressive distinction between inhalation and exhalation, and fully reproducible and convenient design, we believe that this respiration sensor will pave the way for developing multimodal and multifunctional respiration sensors within the biomedical field.

The Effect of Threshold Inspiratory Muscle Training Device and Incentive Spirometry Device for Dyspnoea among Third-Trimester Antenatal Women

Background: During pregnancy, the progesterone hormone causes the respiratory system to increase oxygenconsumption. Maternal hyperventilation causes the partial pressure of oxygen to increase and partial pressure ofcarbon-dioxide to decrease. During the third trimester, the compression of the diaphragm in the lower base of thelungs, which causes dyspnoea.Purpose: The purpose of the study to find the prevalence and to evaluate the effect of threshold inspiratory muscletraining device and incentive spirometry device for dyspnoea among third- trimester antenatal women usingmodified borg dyspnoea and dyspnea-12 questionnaire.Materials and Methods: The study analysed prevalence of dyspnoea in third-trimester antenatal women fromDecember 2022 to April 2023 using the dyspnea-12 questionnaire. Out of 77 participants, 15 subjects were excludeddue to improper follow-up, lack of participation, and withdrawal from the study. In phase 2, in May 2023, 62participants were divided into two groups: 31 antenatal women underwent threshold inspiratory muscle trainingalong with diaphragmatic breathing exercises, and 31 underwent incentive spirometry along with diaphragmaticbreathing exercises.Result: Statistically significant differences between the two devices were evaluated by post-values of 13.80 ± 23.20;and the P value is < 0.0001. These values were considered to be extremely statistically significant.Conclusion: Threshold inspiratory muscle training device is more effective than Incentive Spirometry device fordyspnoea among third-trimester antenatal women.

Effects of inspiratory muscle training on respiratory muscle strength, respiratory function and functional capacity in adolescents with idiopathic scoliosis : Arandomized, controlled trial.

Adolescent Idiopathic Scoliosis (AIS) may impair respiratory dynamics and affect the performance of inspiratory and expiratory muscles. The benefit of inspiratory muscle training (IMT) is not well investigated in AIS. We aimed to investigate the effects of IMT on respiratory muscle strength, respiratory function and functional capacity in adolescents with mild to moderate AIS. Thirty-six adolescents were randomized into control or IMT groups. Forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1) and peak expiratory flow (PEF) were measured by spirometry; respiratory muscle strength by maximum inspiratory pressure (MIP) and maximum expiratory pressure (MEP); and functional capacity by 6-min walk test (6MWT) before and after the 8-week-long home-based exercise program. Both groups received conventional exercise program including diaphragmatic breathing exercises, resistive local expansion exercise on the collapsed areas in concave sides of scoliosis, spinal stabilization, strengthening of interscapular muscles and stretching exercises. IMT group also trained with Threshold IMT device for 15 minutes, twice a day for 8 weeks at the intensity of 30% of initial MIP value in addition to conventional exercise program. FEV1, PEF, MIP, MEP and 6MWT distance significantly improved in both groups. IMT group also showed significant improvement in FVC. The increases in FVC, MIP, MEP and 6MWT distance of IMT group were significantly higher compared to control group. IMT is found to be beneficial for patients with AIS for achieving further improvements in respiratory function, respiratory muscle strength and functional capacity compared to conventional exercise program alone.

Evaluation and Management of Dyspnea in Hypermobile Ehlers-Danlos Syndrome and Generalized Hypermobility Spectrum Disorder: Protocol for a Pilot and Feasibility Randomized Controlled Trial

Dyspnea is a prevalent symptom in individuals with hypermobile Ehlers-Danlos Syndrome (hEDS) and generalized hypermobility spectrum disorder (G-HSD), yet its contributors have not been identified. One known contributor to dyspnea is respiratory muscle weakness. The feasibility and effectiveness of inspiratory muscle training (IMT) in combination with standard-of-care rehabilitation (aerobic, resistance, neuromuscular stabilization, and balance and proprioception exercises) in improving respiratory muscle strength and patient-reported outcomes in patients with hEDS or G-HSD have not been evaluated. This study aims to evaluate dyspnea, respiratory muscle strength, and patient-reported outcome measures (PROMs) in hEDS or G-HSD compared with healthy controls and to assess the feasibility of a randomized controlled trial of IMT and standard-of-care rehabilitation for improving respiratory muscle strength, exercise capacity, and PROMs compared with standard-of-care rehabilitation in hEDS and G-HSD. The study will include 34 participants with hEDS or G-HSD and 17 healthy, age- and sex-matched controls to compare respiratory muscle structure and function and PROMs. After baseline assessments, participants with hEDS or G-HSD will be randomized into the intervention group and provided IMT combined with Ehlers-Danlos Syndrome standard-of-care rehabilitation or into the usual care group, and provided only standard-of-care rehabilitation for 8 weeks. The intervention group will be prescribed IMT in their home environment using the POWERbreathe K5 IMT device (POWERbreathe International Ltd). IMT will comprise 2 daily sessions of 30 breaths for 5 days per week, with IMT progressing from 20% to 60% of the baseline maximal inspiratory pressure (MIP) over an 8-week period. Feasibility will be assessed through rates of recruitment, attrition, adherence, adverse events, and participant satisfaction. The primary pilot outcome is MIP change over an 8-week period in hEDS or G-HSD. Secondary outcomes will include the evaluation of dyspnea using Medical Research Council Scale and 18-point qualitative dyspnea descriptors; diaphragmatic thickening fraction using ultrasound; respiratory muscle endurance; pulmonary function; prefrontal cortical activity using functional near-infrared spectroscopy; aerobic capacity during cardiopulmonary exercise testing; quality of life using Short Form-36; and scores from the Depression, Anxiety, and Stress scale-21. These measures will also be performed once in healthy controls to compare normative values. Multivariable regression will be used to assess the contributors to dyspnea. Paired 2-tailed t tests will be used to assess the changes in MIP and secondary measures after 8 weeks of IMT. Study recruitment began in August 2021 and, with several disruptions owing to COVID-19, is expected to be completed by December 2023. This study will provide a better understanding of the factors associated with dyspnea and the feasibility and effectiveness of IMT combined with standard-of-care rehabilitation. IMT may be a novel therapeutic strategy for improving respiratory muscle function and patient-reported outcomes in individuals with hEDS or G-HSD. ClinicalTrials.gov NCT04972565; https://clinicaltrials.gov/ct2/show/NCT04972565. DERR1-10.2196/44832.

Efficacy of Power Breathe Device versus Threshold Inspiratory Muscle Training Device on Inspiratory Muscle Strength in Upper Abdominal Surgery Patients: A Research Protocol

Introduction: Surgery care is important in the treatment of a variety of disorders as well as the alleviation of human suffering. Surgery is essential for meeting basic healthcare needs all across the world, although to varying degrees depending on disease subtypes and epidemiological regions. Laparoscopic surgery is now widely established. Benefits of laparoscopic surgery include improved cosmetic results, reduced postoperative pain, and reduced length of hospital stay with patient satisfaction. Upper abdominal surgery initiates a series of physiological events that result in postoperative pulmonary complications such as increased morbidity, mortality, and hospitalisation. Preoperatively in abdominal surgeries, Inspiratory Muscle Training (IMT) devices have been used to reduce postoperative pulmonary complications as well as improve the quality of life of the patients. Need of the study: Surgery is a crucial part of the healthcare system, and it has a direct impact on the respiratory system. With changes in postoperative pulmonary functions, there are limitations in lung volume and capacities such as total lung capacity, vital capacity, and tidal volume. Power breathe devices have been utilised preoperatively in abdominal procedures for inspiratory muscle training and to prevent postpulmonary complications. As a result, the purpose of this study is to see how the power breath device and the threshold IMT device affect inspiratory muscle strength in upper abdominal operations. Aim: To compare the effect of a power breathe device versus a threshold inspiratory muscle training device on inspiratory muscle strength in patients who had upper abdominal surgery. Methodology: The present comparative research protocol is planned to be conducted on 60 patients with upper abdominal surgery with reduced inspiratory muscle strength. The expected study duration is of one year from 2022 to 2023.Total subjects will be randomly divided into two groups, Group-A will receive power breathe plus conventional physiotherapy five days per week and Group-B will receive threshold IMT plus conventional physiotherapy five days per week for period of two weeks. Before initiating the intervention, patients will have their PImax (maximal inspiratory pressure) evaluated using hand-held pressure manometer equipment. After two weeks, patients will be reviewed again using the same outcome measures. Expected Results/Outcomes: Threshold IMT device along with conventional physiotherapy incorporated preoperatively for the patients is expected to give better results postoperatively

Efetividade de diferentes protocolos e cargas utilizadas no treinamento muscular inspiratório de indivíduos com DPOC: uma revisão sistemática

ABSTRACT Chronic obstructive pulmonary disease (COPD) changes the musculoskeletal system, including the respiratory muscles, which are responsible for increasing dyspnea and reducing functional capacity. Several studies have already showed the effectiveness of inspiratory muscle training (IMT); therefore, it should be part of the pulmonary rehabilitation program. However, assessing the best way to do it is still necessary. Thus, this study aimed to evaluate, by a systematic review, the effectiveness of different IMT protocols and loads on the outcomes of inspiratory muscle strength and endurance, functional capacity, and dyspnea reduction. This systematic review was performed in accordance with the PRISMA protocol. Studies were searched in February 2021 in the PubMed, SciELO, PEDro. For the search, the following keywords were used: “COPD” and “breathing exercises, resistive training, respiratory muscle training.” A total of 398 individuals previously diagnosed with COPD were included in the 10 selected studies. Different IMT devices were used and protocols varied in relation to loads and progression. Threshold was the most used IMT device. Its load was established according to the percentage of maximal inspiratory pressure (MIP) (30-80%) and readjusted according to new measurements taken every one or two weeks. Respiratory muscle training with both low loads and high loads presented positive results, however, establishing which is the best IMT protocol for individuals with COPD is not possible yet. Inspiratory muscle strength, functional capacity, and dyspnea get better with IMT.

Influence of Inspiratory Muscle Training on Respiratory Functions among Uncontrolled Asthmatics

Background: Specific breathing exercises are reported to improve quality of life and reduce symptoms; although no significant benefit on lung function or reduction of exacerbation risk. Additionally, inspiratory muscle training (IMT) aims to increase diaphragm and inspiratory muscle endurance. In this regard, IMT has been studied in uncontrolled asthma patients to investigate its effect on respiratory symptoms and pulmonary functions. Methods: Twenty-one uncontrolled and partially controlled asthmatic patients were included in the study. Asthma control test (ACT), asthma quality of life questionnaire (AQLQ), and spirometric evaluations were performed. The study population was randomized into two groups. The standard care group (n=10) received standard medical treatment while the intervention (n=11) group practiced a portable threshold IMT device following standard medical treatment. Results: The study was completed by 15 patients due to 6 lost follow up (one intervention group and 5 standard care) and one asthma exacerbation. We have found that the intervention group tended to have increased pulmonary function test parameters and AQLQ scores, moreover; MIP values and ACT scores have statistically significant increases after IMT(p=0.01, p=0.02 respectively). Conclusion: Add-on IMT to standard medical treatment could improve asthma control by strengthening inspiratory muscles in uncontrolled asthmatic patients. IMT could be considered in the non-pharmacological treatments of uncontrolled asthmatic patients. Despite the limited number of patients, this study revealed that IMT might have positive outcomes for uncontrolled asthma patients.

EFFECTS OF INSPIRATORY MUSCLE TRAINING ON FUNCTIONAL CAPACITY AND QUALITY OF LIFE IN PULMONARY HYPERTENSIVE PATIENT

Background: Exercise intolerance is present even in the early stages of pulmonary arterial hypertension (PAH) and is associated with poor prognosis. Respiratory muscle dysfunction is common and may contribute to exercise limitation. Objective: To determine the effects of inspiratory muscle training (IMT) in pulmonary hypertensive patient. Methodology: A randomized control trial was conducted at Services Hospital Lahore after approval from Medical Superintendent. A total of n=18 subjects were randomly allocated into two groups, both group received deep breathing exercise (DBE) and 2nd group received additionally Inspiratory muscle training (IMT) with pressure threshold Inspiratory muscle training device. All participants received 12 sessions in two weeks; the duration of each session was of 20 minutes. The outcome variables were functional capacity and quality of life (SF-36). In functional capacity, of the blood pressure (BP), heart rate (HR), partial pressure of oxygen (SpO2), distance walk (6min walk test) and level of dyspnea were recorded The data was evaluated at baseline and after 12th session. Results: The mean age of patients was 58.11±7.11 years, with 9 male and 9 female. After 2 weeks, the general health, social activities and energy were significantly (p<0.05) improved in experimental group. But no significant difference (p≥0.05) was observed between the group regarding activity limitation, physical and emotional health items of quality of life (SF-36). When comparing the Blood pressure and heart rate, no significant difference was observed between the groups, after 2 weeks of intervention (p≥0.05). While SpO2,6 MWT and dyspnea score was significantly (p<0.05) improved in experimental group as compare to control group. Conclusion: The Deep breathing and inspiratory muscle training both are equally effective with respect to improving the quality of life but IMT is more efficient as compared to Deep breathing for improving dyspnea and it also improves the pulmonary functional and exercise capacity. Key words: breathing exercises, dyspnea, inspiratory muscle training, pulmonary hypertension, quality of life.

Effect of Threshold Inspiratory Muscle Training Device on Inspiratory Muscle Strength in Upper Abdominal Surgery Patient: A Case Report

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.

The feasibility and tolerability of using inspiratory muscle training with adults discharged from the hospital with community-acquired pneumonia.

Patients experience substantial morbidity following discharge from hospital and during recovery from communi-ty-acquired pneumonia (CAP). Inspiratory muscle training (IMT) has demonstrated improved functional capacity and reduced patient-reported symptoms. To date the safety and tolerability of these methods have not been determined in CAP patients recovering following hospitalization. Accordingly, this study aimed to assess the safety and tolerability of IMT in adults discharged from hospital with CAP. Participants received an IMT device (POWERbreathe KHP2) and completed 9-weeks IMT training with weekly follow-up. Frequency (twice daily) and load (50% PImax) were fixed throughout, but training volume increased incrementally (2-week habituation phase, 7-week training phase). Primary outcomes of interest included IMT safety and tolerability. Twenty-two participants were recruited; 16 were male, mean age 55.2 years (range 27.9-77.3). From 1183 possible training days, side effects were reported on 15 occasions by 10 individual participants. All reported side-effects were assessed as grade 1 and did not prevent further training. Participant-reported IMT acceptability was 99.4%. Inspiratory muscle training is safe and tolerable in patients following hospitalisation for CAP. Patient satisfaction with IMT is high and it is viewed by patients as being helpful in their recovery. Distinguishing CAP-related symptoms and device-related side effects is challenging. Symptom prevalence declined during follow-up with concurrent improvements in spirometry observed. Further research is required to determine the efficacy of IMT interventions following CAP and other acute respiratory infections.

Influence of Inspiratory Muscle Training of Various Intensities on the Physical Performance of Long-Distance Runners.

The aim of this study was to assess the efficacy of inspiratory muscle training (IMT) at different intensities on the pulmonary function and physiological adaptations of long-distance runners undergoing sports training. This study involved 25 long-distance runners. The subjects were randomly divided into three groups depending on the type of IMT applied: POWERbreathe device (group 1), Threshold IMT device (group 2), and a control group. The following lung variables were evaluated: vital capacity (VC), forced vital capacity (FVC), forced expiratory volume in one second (FEV1) and peak expiratory flow (PEF). Respiratory muscle strength was assessed by maximum inspiratory pressure (PImax) and maximum expiratory pressure (PEmax). Spiroergometric measures included: heart rate (HR), oxygen uptake (VO2max), carbon dioxide production (VCO2max), maximum ventilation (VE) and respiratory exchange rate (RER), which were measured breath by breath using a gas analyser (VYNTUS CPX). Group 1, which used the POWERbreathe device, showed significant increases in all assessed physiological and physical performance variables. In group 2, which used the Threshold device, only VO2max, VE and tRER ventilation were significantly increased to a similar level as that observed in group 1. In the control group, we only observed a significant reduction in saturation. The use of IMT with a higher intensity resulted in significant improvements in all tested variables of lung ventilation and respiratory muscle strength. Also, after training, lactate accumulation was significantly decreased. Physiological characteristics (VO2max/kg) and muscle respiratory strength variables were significantly improved in the group that used the POWERbreathe device after 8 weeks of training.

Effect of inspiratory resistive training on diaphragm shear modulus and accessory inspiratory muscle activation.

This study aimed to elucidate changes in diaphragm and accessory inspiratory muscle (sternocleidomastoid (SCM) muscle and intercostal muscle (IC)) function after a 6-week training program. Nineteen male elite collegiate swimmers were assigned to either a control group (n = 9) or training group (n = 10). The subjects in the training group performed 30 maximum inspirations at a load resistance of 50% of maximum inspiratory mouth pressure (PImax) using an inspiratory muscle training device. These were conducted twice per day and 6 days per week. At baseline and after 6 weeks, PImax, shear modulus of the diaphragm, and electromyograms (EMG) of the SCM and IC during a maximal inspiratory maneuver were evaluated. Relative change in PImax was greater in the training group than in controls. The shear modulus during a PImax maneuver had increased significantly in both groups after 6 weeks. EMG amplitudes of the SCM increased in the training group after 6 weeks, but not in the control group. EMG amplitudes of the IC did not change after 6 weeks in either group. These results suggest that 6-week inspiratory resistive training significantly improves the activation of the SCM, which could be one of the major mechanisms behind increases in inspiratory muscle strength after resistive training. Novelty Six-week inspiratory resistive training increased diaphragm stiffness during maximal inspiration maneuver. Six-week inspiratory resistive training increased electromyogram amplitudes of the sternocleidomastoid during maximal inspiration maneuver.

Inspiratory muscle training improves pulmonary functions and respiratory muscle strength in healthy male smokers

The aim of the present study is to investigate the effects of inspiratory muscle training (IMT) on pulmonary function and respiratory muscle strength of both healthy smokers and nonsmokers. Forty-two healthy males (16 in the IMT smokers group [IMTS], 16 in the IMT nonsmokers group [IMTN], and 10 in the placebo group) participated in the present study. Using a randomized, double-blind, placebo-controlled design, IMTS and IMTN underwent 4 weeks of 30 breaths twice daily at 50% (+5% increase each week) of maximum inspiratory pressure (MIP), while the placebo group maintained 30 breaths twice daily at 15% MIP using an IMT device. The data were analyzed with repeated measures for one-way analysis of variance, 3 × 2 mixed factor analysis of variance, and least significant difference tests. Respiratory muscle strength (MIP and maximal expiratory pressure [MEP]) and pulmonary functions significantly improved after a 4-week period (between the pre and posttests) in the IMTN and IMTS groups (p < 0.05). The mean difference and percentage differences showed significant alterations in the respiratory muscle strength, forced and slow pulmonary capacities, and pulmonary volume between the IMTN and IMTS groups (p < 0.05). There were significant changes in the expiratory muscle strength (MEP), slow vital capacity (SVC), and forced pulmonary measurements (forced expiratory volume after 1 s and maximal voluntary ventilation) between IMTN and IMTS groups in favor of smokers (p < 0.05). These results show that greater improvements occurred in smokers after IMT. Increased respiratory muscle strength may be the underlying mechanism responsible for this improvement. Additionally, the benefits of IMT were greater in smokers than nonsmokers. This difference between smokers and nonsmokers may potentially be explained by higher influence of exercise on smokers’ lung microbiome, resulting in greater reversal of negative effects.

Exercise-induced laryngeal obstruction in athletes treated with inspiratory muscle training

BackgroundExercise-induced laryngeal obstruction (EILO) is common in athletes and presents with dyspnoea, chest tightness, inspiratory stridor and sometimes panic reactions. The evidence for conservative treatment is weak, but case reports...

Differential Effects of Inspiratory Muscle Training Between Athletes and Performing Artists

The purpose of this study was to examine whether inspiratory muscle training (IMT) had differential effects between athletes and performing artist's diaphragm performance. It was hypothesized that the performing artists would experience greater improvements in diaphragm performance than the athletes following an IMT program. The two groups underwent IMT by breathing through an IMT device 2 times every day for 9–11 weeks at 50% of their maximal inspiratory pressure (IP) for 30 seconds. Following IMT there was a significant increase (p&lt;0.05) in maximal IP for athletes (2.7 mmHg or a 24% increase) and performing artists (5.8 mmHg or a 28.5% increase) compared to the control group (1.8 mmHg or a 13.1% increase). No significant difference in maximal expiratory flow rate (EFR) was observed between the groups or compared to controls. While athletes and performing artists both experienced significant improvements in diaphragm performance following the IMT program compared to the control group, no significant difference was observed between the groups for their percent change in IP or EFR. These results show that the magnitude of the effect of the IMT program between athletes and performing artists was equal. The data suggests that performing artists' diaphragm performance responds similarly to athletes' following a IMT program, which is likely due to regular use of their respiratory muscles when practicing for performancesThis abstract is from the Experimental Biology 2018 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

The effects of threshold inspiratory muscle training in patients with chronic obstructive pulmonary disease: Arandomised experimental study.

To investigate the effects of threshold inspiratory muscle training in patients with stages II through IV chronic obstructive pulmonary disease using maximum inspiratory pressure, baseline dyspnoea index, 6-minute walk test and quality of life. A threshold inspiratory muscle training device provides pressure for inspiratory muscle strength, but there is limited information on the effects of threshold inspiratory muscle training starting at low pressure training. Randomised experimental design. A total of 55 patients completed this study between September 2013-April 2014. The experimental group (n=27) was provided medical treatment and routine care, along with five sessions of threshold inspiratory muscle training per week (21-30min per session), accompanied by a progressive increase in the pressure threshold over a period of 8weeks. The control group (n=28) was provided medical treatment and routine care only, without intervention. In the inferential analysis, p values <.05 were considered to indicate statistical significance. After 8weeks in the experimental group, mean maximum inspiratory pressure improved by -17.6±0.18cmH2 O, mean 6-minute walk test improved by 47.8±1.46m, and the baseline dyspnoea index increased from 4.48±2.12 points to 9.0±2.27 points. These data and quality of life were statistically different between the experimental and the control groups (p<.05). The threshold inspiratory muscle training can reduce patients' difficulties with respect to daily activities, thereby reducing the burden on the family, and improving prognosis in patients with moderate-to-very severe chronic obstructive pulmonary disease.

Transdiaphragmatic pressure and neural respiratory drive measured during inspiratory muscle training in stable patients with chronic obstructive pulmonary disease.

PurposeInspiratory muscle training (IMT) is a rehabilitation therapy for stable patients with COPD. However, its therapeutic effect remains undefined due to the unclear nature of diaphragmatic mobilization during IMT. Diaphragmatic mobilization, represented by transdiaphragmatic pressure (Pdi), and neural respiratory drive, expressed as the corrected root mean square (RMS) of the diaphragmatic electromyogram (EMGdi), both provide vital information to select the proper IMT device and loads in COPD, therefore contributing to the curative effect of IMT. Pdi and RMS of EMGdi (RMSdi%) were measured and compared during inspiratory resistive training and threshold load training in stable patients with COPD.Patients and methodsPdi and neural respiratory drive were measured continuously during inspiratory resistive training and threshold load training in 12 stable patients with COPD (forced expiratory volume in 1 s ± SD was 26.1%±10.2% predicted).ResultsPdi was significantly higher during high-intensity threshold load training (91.46±17.24 cmH2O) than during inspiratory resistive training (27.24±6.13 cmH2O) in stable patients with COPD, with P<0.01 for each. Significant difference was also found in RMSdi% between high-intensity threshold load training and inspiratory resistive training (69.98%±16.78% vs 17.26%±14.65%, P<0.01).ConclusionWe concluded that threshold load training shows greater mobilization of Pdi and neural respiratory drive than inspiratory resistive training in stable patients with COPD.

Comparação entre a pressão inspiratória máxima aferida pelo manovacuômetro digital e pelo dispositivo eletrônico de treinamento muscular inspiratório

Aims: To compare maximum inspiratory pressure (MIP) measured by a digital manometer and by an inspiratory muscle training (IMT) device and to evaluate hemodynamic changes after measurements.Methods: The sample included male and female individuals older than 18 years admitted to an intensive care unit who were hemodynamically stable, not being treated with vasoactive drugs or sedated, intubated or tracheostomized, and who were in the process of being weaned from mechanical ventilation. MIP was measured by both devices on three different occasions, with an occlusion time of 20 seconds and a 5-minute interval between measurements. The following parameters were assessed: respiratory rate, mean arterial pressure, and respiratory rate before and after each measurement by each device. The statistical analysis was made in the Statistical Analysis System and the R Project for Statistical Computing V. 3.1.2 softwares, using the ANOVA and the Wilcoxon tests.Results: Fifty-eight patients were included in the study. The mean value obtained for MIP was -46.22 centimeters of water (cmH2O) in the digital manometer and -13.15 cmH2O (p<0.001) in the IMT device. Heart rate showed a significant increase (p<0.0001) both before and after all measurements in both devices. Mean arterial pressure showed a statistically significant difference only before and after the first measurement by the digital manometer and before and after the second measurement by the IMT device (p<0.001). The respiratory rate oscillated significantly before and after the three measurements by both devices (p<0.0001). The hemodynamic parameters remained within reference values after MIP measurements.Conclusions: The digital manometer recorded a higher MIP than that measured by the IMT device. The hemodynamic parameter values oscillated in both devices, but they remained within the normal range and were not clinically significant.

Brief Research Report: The Feasibility of Expiratory Resistive Loading Using the Threshold Inspiratory Muscle Training Device

Brief Research Report: The Feasibility of Expiratory Resistive Loading Using the Threshold Inspiratory Muscle Training Device