Inspiratory Muscle Training Group Research Articles

Inspiratory Muscle Training: Improvement of Exercise Performance With Acute Hypoxic Exposure.

To determine whether chronic IMT improves submaximal-exercise performance with acute hypoxic exposure. A total of 14 endurance-trained men completed a 20-km cycling time trial (TT) in normobaric hypoxia (fraction of inspired oxygen [FiO2] = 0.16) before and after either 6 wk of an IMT protocol consisting of inspiratory loads equivalent to 80% of sustained maximal inspiratory pressure (n = 9) or a SHAM protocol (30% of sustained maximal inspiratory pressure; n = 5). In the IMT group, 20-km TT performance significantly improved by 1.45 (2.0%), P = .03, after the 6-wk intervention. The significantly faster TT times were accompanied by a higher average V˙E (pre vs post: 99.3 [14.5] vs 109.9 [18.0]L·min-1, P = .01) and absolute oxygen uptake (pre vs post: 3.39 [0.52] vs 3.60 [0.58]L·min-1, P = .010), with no change in ratings of perceived exertion or dyspnea (P > .06). There were no changes in TT performance in the SHAM group (P = .45). These data suggest that performing 6 wk of IMT may benefit hypoxic endurance exercise performance lasting 30-40min.

The effect of inspiratory muscle training on fatigue and dyspnea in patients with heart failure: A randomized, controlled trial.

Fatigue and dyspnea are debilitating symptoms in patients with heart failure (HF). The purpose of this study was to evaluate the effects of inspiratory muscle training (IMT) on dyspnea, fatigue and the New York Heart Association (NYHA) functional classification in patients with HF. In this prospective, randomized, controlled trial, 84 patients with HF (NYHA classes II-III/IV) with a mean age of 56.62 ± 9.56 years were randomly assigned to a 6-week IMT (n = 42) or a sham IMT (n = 42) program. The IMT was performed at 40% of the maximal inspiratory pressure (MIP) in the IMT group and at 10% in the sham group. The main outcomes were assessed at baseline and after the intervention and included dyspnea severity scale (Modified Medical Research Council [MMRC], Fatigue Severity Scale [FSS] and the NYHA functional classification (based on the presenting symptoms). The between-group analysis showed significant improvements in dyspnea, fatigue and the NYHA functional classification in the IMT group compared to the sham group (P < .05). The within-group analysis showed significant improvements in dyspnea (from 2.63 ± 0.79 to 1.38 ± 0.66, P < .001), fatigue (from 43.36 ± 8.5 to 28.95 ± 9.11, P < .001) and the NYHA functional classification (from 2.73 ± 0.5 to 2.1 ± 0.6, P = .001) in the IMT group, while fatigue and dyspnea increased significantly in the sham group. The 6-week home-based IMT was found to be an effective and safe tool for reducing dyspnea and fatigue and improving the NYHA functional classification.

Association between serum amyloid A and carotid intima-media thickness in patients with type 2 diabetes

Objective To explore the association between serum amyloid A (SAA) and carotid intima-media thickness (CIMT) in patients with type 2 diabetes mellitus(T2DM). Methods A total of 148 diabetic subjects were divided into three groups according to CIMT: normal IMT group, IMT incrassation group and arteriosclerosis group. Levels of SAA, 25-hydroxyvitamin D [25(OH)D], brachial-ankle artery pulse wave velocity (baPWV), high density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), fasting plasma glucose (FPG), glycosylated hemoglobin (HbA1c), triglyceride (TG), total cholesterol (TC), body mass index (BMI) and blood presure were measured in all groups. The relationship between SAA, CIMT, 25(OH)D, baPWV and other factors was also analyzed. Results Compared to the normal IMT group, levels of FPG, HbA1c, TC, BMI, SAA and ba-PWV were significantly higher in IMT incrassation group and arteriosclerosis group, while HDL-C and 25(OH)D were lower. In arteriosclerosis group, levels of BMI, FPG, HbA1c, SAA and ba-PWV were higher than those in IMT incrassation group, while 25(OH)D was lower. Pearson correlation analysis showed that the level of SAA was positively correlated with baPWV, BMI , TC, course of disease and IMT, while it was negatively correlated with HDL-C and 25(OH)D . Logistic regression analysis of IMT showed that smoking, obesity, high levels of HbA1c, FPG, TC, SAA, low levels of HDL-C and 25(OH)D may contribute to higher levels of IMT. Conclusions SAA was closely related to carotid atherosclerosis. Further prospective studies will be helpful to explore the influence of SAA on diabetic macroangiopathy. Key words: Serum amyloid a protein; Diabetes mellitus, type 2; Carotid intima-media thickness

CHRONIC EFFECT OF INSPIRATORY MUSCLE TRAINING TO MAXIMAL EXPIRATORY PRESSURE IN SEDENTARY HEALTHY BOYS

The aim of this study was to investigate the effect of inspiratory muscle training on maximal expiratory pressure (MEP) in healthy sedentary boys. For this purpose, 20 healthy sedentary boys aged 12 years were randomly assigned to two groups as inspiratory muscle training group (IMT, n = 10) and control group (CG, n = 10) who did not perform any training. 30x2 breath exercises were performed as inspiratory muscle training for 4 weeks and 3 days a week for 40% maximal inspiratory pressure (MIP). The MEP test was applied to all subjects 1 day before and after 4 weeks. The data were analyzed in SPSS 22.0 program. The mean of the percentage change with 2x2 mixed factor ANOVA and LSD correction tests were investigated with Mann Whitney U test. As a result of the statistical analysis, a significant difference was found between the IMT pre-and post-test results at the MEP value (p <0.05). In addition, it was observed that IMT showed a significant increase when compared to CG (p <0.05). In conclusion, it can be said that inspiratory muscle training affects the maximal expiratory pressure positively in healthy sedentary boys. Article visualizations:

The effects of 8weeks of inspiratory muscle training on the balance of healthy older adults: a randomized, double-blind, placebo-controlled study.

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 postintervention, 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.

The effect of inspiratory muscle training on the quality of life, immune response, inspiratory and lower limb muscle strength of older adults: a randomized controlled trial

Abstract Objective: To evaluate the impact of inspiratory muscle training (IMT) on the quality of life, immune response, inspiratory and lower limb muscle strength of older adults. Method: A randomized clinical trial was conducted with 30 institutionalized older adults. They were allocated into two groups: the IMT group (n=15), which underwent IMT with PowerBreathe Classic, using a load of 60% of maximal inspiratory pressure (MIP). This was performed using a 30 repetition protocol, three times a week, for six weeks. The second group was the control group (n=15) which did not perform any type of therapeutic intervention. In both groups, MIP, lower limb strength by sit-up test, quality of life by the SF-36 questionnaire and C-reactive protein (CRP) were evaluated. Results: The results demonstrated the homogeneity between the groups regarding the demographic and clinical variables. The IMT group showed an increase in the variation of MIP (9.20±7.36 cmH2O) compared to the control (0.93±8.79 cmH2O). Improvement was also observed in the sitting and standing test (p&lt;0.05) (Tukey Test) in the difference between the values before and after the IMT. In terms of quality of life, two of the eight SF-36 domains were influenced by the IMT, namely: functional capacity and limitations due to physical factors. There were no changes in CRP in either group. Conclusion: IMT improved the inspiratory muscle strength, lower limb strength and quality of life of institutionalized older adults. These findings reinforce the contribution of this therapy to reducing the deleterious effects of aging.

Maximum inspiratory pressure of the patients after open-heart surgery following physiotherapy

Background: After open-heart surgery, various complications require specific care, especially in the respiratory system. To reestablish it, several strategies should be used, such as respiratory muscle training, which aims to improve respiratory muscle strength, leading to a reduction in post-operative pulmonary complications in patients undergoing cardiac surgery. Aims and Objectives: The objective of the study was to measure and compare maximum inspiratory pressure (MIP) in open-heart surgery patients following conventional physiotherapy group and conventional physiotherapy plus inspiratory muscle training (IMT) group. Materials and Methods: The study was an experimental design and it was a prospective randomized control study where participants were taken from cardiac hospital using balance block computer-generated randomization method. Fifty participants were divided into two groups of 25 each. Group A received conventional physiotherapy and Group B received conventional plus inspiratory muscle exercise (B) by pressure threshold IMT instrument. Physiotherapy treatment was delivered by qualified physiotherapy, twice a day preoperatively and after extubation, 4–5 sessions per day were given until they discharged. The pre-operative, at discharge, and at the 1st follow-up, patient MIP was measured. Results: There was no statistically significant change in inspiratory muscle strength in patients exposed to an IMT program compared to the control group (P > 0.05). Conclusion: There was no difference in MIP in conventional physiotherapy and conventional plus inspiratory muscle trainer group in “pre-operative,” “discharged,” and “1st follow-up” in open-heart surgery patient.

Comparative Assessment of Two Robot-Assisted Therapies for the Upper Extremity in People With Chronic Stroke.

We investigated the effects on motor and daily function of robot-assisted therapies in people with chronic stroke using the Bi-Manu-Track (BMT) and InMotion 3.0 (IMT) compared with control treatment (CT). In this comparative efficacy trial, 30 participants were randomized to receive BMT, IMT, or CT. Outcome measures included the Fugl-Meyer Assessment (FMA), Modified Ashworth Scale (MAS), Motor Activity Log (MAL), and Medical Research Council (MRC) scale. The IMT group improved more in FMA and proximal MAS scores than the BMT group (both ps < .01) and the CT group (p < .01 and p = .03, respectively). The IMT and BMT groups showed clinically relevant improvements after treatment on the MRC rather than the MAL. The results indicate that the IMT might improve motor function. The IMT and BMT groups showed similar benefits for muscle power but limited improvements in self-perceived use of the affected arm.

Effect of preoperative inspiratory muscle training on physical functioning following esophagectomy.

This study aims to examine the effect of preoperative inspiratory muscle training (IMT) on pre- and postoperative functional exercise performance in patients undergoing esophagectomy. A subcohort of patients recruited to the PREPARE randomized control trial were studied. Following evaluation of respiratory muscle function (spirometry, maximum inspiratory pressure (MIP), and inspiratory muscle endurance), postoperative mobilization (accelerometry) and postoperative physical functioning (6-minute walk test (6MWT)), participants scheduled for esophagectomy were randomly assigned to either 2 weeks of preoperative IMT or a control group. Measures were repeated on the day before surgery and postoperatively. Sixty participants (mean (standard deviation) age 64.13 (7.8) years; n=42 male; n=43 transthoracic esophagectomy; n=17 transhiatial esophagectomy) were included in the final analysis (n=28 IMT; n=32 control). There was a significant improvement in preoperative MIP (P=0.03) and inspiratory muscle endurance (P=0.04); however preoperative 6MWT distance did not change. Postoperatively, control participants were more active on postoperative day (POD)1, and from POD1-POD5 (P=0.04). Predischarge, 6MWT distance was significantly lower in the IMT group (305.61 (116.3) m) compared to controls (380.2 (47.1) m, P=0.03). Despite an increase in preoperative respiratory muscle function, preoperative IMT does not improve pre- or postoperative physical functioning or postoperative mobilization following esophagectomy.

Effects of daily inspiratory muscle training on respiratory muscle strength and chest wall regional volumes in haemodialysis patients: a randomised clinical trial

Purpose: Evaluating the effects of interdialytic daily inspiratory muscle training (IMT) on respiratory muscle strength, chest wall regional volumes, diaphragmatic mobility and thickness, pulmonary function, functional capacity, and quality of life (QoL) in haemodialysis (HD) patients.Method: A randomised, and double-blind clinical trial composed of 24 chronic kidney disease patients undergoing HD. Patients were allocated into the IMT group (n = 12) or sham group (n = 12) and performed daily IMT twice per day with a load of 50% inspiratory muscle strength for the IMT group and 5 cmH2O for the sham group during 8 weeks. Respiratory muscle strength, diaphragm thickness and mobility, chest wall regional volumes, functional capacity, and QoL were measured.Results: At the end of the study, an increase in inspiratory and expiratory muscle strength was observed for both groups, but no significant difference was found between them. Changed volume distribution was also observed in the IMT group, with significantly increased inspiratory capacity in the pulmonary compartment compared to the sham group.Conclusions: Daily interdialytic IMT promoted a change in chest wall regional volumes, with an increase in the inspiratory capacity of the pulmonary rib cage. Both groups had increased inspiratory and expiratory muscle strength with daily respiratory exercise.Trial registration: www.ClinicalTrials.gov; study number: NCT02599987; name of trial registry: IMT in Patients with End-stage Renal Disease.Implications for rehabilitationMuscular impairment in chronic kidney disease patients results from a series of common alterations, affecting respiratory muscles.Patients with chronic kidney disease have low values of diaphragmatic thickness.The daily inspiratory muscle training (IMT) or breathing exercise over a period of 8 weeks provided increased respiratory muscle strength.The daily inspiratory muscle training presented a change in tri-compartment distribution of lung volume compared to the sham group, with increased inspiratory capacity of the pulmonary rib cage.

Impact of inspiratory muscle training on obstructive sleep apnea in coronary patients. The Ricaos Study: Preliminary results

Obstructive sleep apnea (OSA) syndrome affects 5% of the adult population and its prevalence is 13 times higher in coronary patients. However, OSA in coronary patients is less suggestive, leading to under diagnosis and lower adherence to continuous positive airway pressure (CPAP) treatment. While oropharyngeal exercises showed significant decrease in Apnea-Hypopnea Index (AHI) in patients with moderate OSA, there were no studies on specific inspiratory muscle training (IMT). The aim of our study was to assess the effectiveness of IMT on AHI reduction in coronary patients with moderate OSA and already engaged in a cardiac rehabilitation program post-infarction. We included coronary patients involving in a cardiac rehabilitation program after infarction, presenting an AHI between 15 and 30, and without clinical symptoms requiring CPAP. Patients were randomized in a 1:1 allocation in a control group (CTL - classic training) or in an IMT group (classic training + IMT). IMT consisted in a prolonged inspiration into a device allowing the air to pass during the inspiration only according to the force developed. The resistance applied was 70% of the maximum inspiratory pressure (Pi max ). Patients in the IMT group perform 2 sets of 30 breaths per day, 6 days a week for 2 months. We included 19 patients (59 ± 10 years; BMI = 27 ± 3 kg/m 2 ). All the patients showed a significant decrease in AHI after rehabilitation (21.5 ± 5.1 to 16.3 ± 7.8, P < 0.009). The IMT group ( n = 10) significantly improved Pi max ( P < 0.05) and had a significant decrease of AHI by 25% (−8.7, P = 0.02). In the CTL group ( n = 9), the AHI decreased by 23% (−5.2; P = 0.1). No significant differences were observed in anthropometric data. A specific IMT during a cardiac rehabilitation contributes to reduce significantly AHI in coronary patients with moderate OSA. Further research is needed to determine which patients benefit more of this alternative therapy.

Can inspiratory muscle training improve weaning outcomes in difficult to wean patients? A protocol for a randomised controlled trial (IMweanT study)

IntroductionRespiratory muscle dysfunction has been associated with failure to wean from mechanical ventilation. It has therefore been hypothesised that these patients might benefit from inspiratory muscle training (IMT). Evidence, however,...

The effects of inspiratory muscle training on exercise capacity, dyspnea and respiratory functions in lung transplantation candidates: a randomized controlled trial

Objective: To investigate whether inspiratory muscle training would contribute to the improvement of exercise capacity, dyspnea perception and respiratory functions in lung transplantation candidates. Design: Prospective randomized controlled trial. Setting: Pulmonary Rehabilitation center. Subjects: A total of 34 patients with severe lung disease requiring lung transplantation were randomly allocated to either pulmonary rehabilitation plus inspiratory muscle training group (PR + IMT group, n = 17) or pulmonary rehabilitation group (PR group, n = 17) before any lung transplantation operation. Methods: All patients underwent supervised pulmonary rehabilitation program on two days per week for three months. The PR + IMT group received inspiratory muscle training in addition to the standard pulmonary rehabilitation program. The 6-minute walk test, maximal inspiratory pressure, modified Medical Research Concile dyspnea scores and spirometric parameters were measured for each patient. Results: The PR + IMT group had statistically significantly increased in walking distance (100 m, P = 0.03), maximum inspiratory pressure (26 cmH2O, P = 0.001) and alveolar volume ratio of carbonmonoxide diffusion capacity (9%, P = 0.02) than PR group. Although both groups demonstrated a statistically significant decrease in the dyspnea score, no significant differences were found between the groups (P = 0.075). There was no change in spirometric variables in both groups. Conclusion: A greater increase in exercise capacity was observed in the PR + IMT group. Our study showed that inspiratory muscle training improved exercise capacity even further and increased the benefits provided by pulmonary rehabilitation.

EFFECTS OF HIGH-INTENSITY INSPIRATORY MUSCLE TRAINING IN RUGBY PLAYERS

ABSTRACT Introduction: Rugby is a sport characterized by high and low intensity motor action. Therefore, the respiratory muscles need adequate work to maintain sustained effective breathing. Objective: To analyze the effects of high-intensity inspiratory muscle training (IMT) in amateur rugby players from the city of Uberaba, Minas Gerais, Brazil. Methods: This is a clinical study in which 20 amateur players underwent a pulmonary function test, respiratory muscle strength and physical capacity assessment. The participants were divided into two groups: 10 volunteers in the IMT group (G1) and 10 in the control group (G2). All the assessments were carried out before and after 12 weeks of IMT. Results: No significant changes were observed in the pulmonary function test. However, maximal voluntary ventilation, maximal inspiratory pressure, maximal expiratory pressure and distance increased significantly after IMT. Conclusion: IMT had beneficial effects on amateur rugby players. Level of evidence I; Therapeutic studies - Investigation of treatment results.

Corticotherapy vs. corticotherapy plus immunosuppressive therapy in acute Vogt-Koyanagi-Harada disease

Abstract Introduction Vogt-Koyanagi-Harada disease is a multisystem disorder characterized by a bilateral granulomatous panuveitis. Multiple therapeutic regimens have been used to control inflammation in acute uveitic stage to prevent irreversible visual loss. The purpose of this paper is to compare the effect, on functional and anatomic outcomes, of early treatment with standard corticotherapy vs. corticotherapy plus immunosuppressive (IMT) therapy in acute Vogt-Koyanagi-Harada disease (Group A vs. Group B). Methods A retrospective chart review of patients with Vogt-Koyanagi-Harada disease, with an evolution time of 2 weeks or less, who attended the Inflammatory Eye Disease Clinic, from 2001 to 2015. Data collected included demographic information, presenting features, treatment and improvement in visual acuity (VA). Results Sixteen charts were reviewed; 15 females (93.75%). Mean age: 30.81 ± 10.53 years, follow-up time (months): 54.94 ± 43.43. Ten patients (66.6%) had IMT, azathioprine, methotrexate and cyclophosphamide. In group A, initial VA Anterior chamber recurrences occurred in both groups and posterior pole recurrences were observed in group A. Time to first recurrence was similar (P Frequency of recurrence was 2.33 ± 1.80 vs. 1.5 ± 0.79 (P Conclusions Adding IMT as first line therapy to corticosteroids, do not matter significantly in terms of final VA or development of visually significant complications. In the IMT plus corticosteroids group number of recurrences was significantly lower, and a steroid sparing effect was evident.

Effect of Inspiratory Muscle Training in the Management of Patients With Asthma: A RANDOMIZED CONTROLLED TRIAL.

The aim of this study was to investigate the effects of inspiratory muscle training (IMT) on respiratory muscle strength, exercise capacity, dyspnea, fatigue, quality of life, and daily living activities of asthmatic patients. Thirty-eight asthmatic patients, between 18 and 65 years of age, were enrolled in the study and randomly divided into 2 groups; IMT (n = 20) or control (n = 18). Participants in the IMT group performed 30 breaths using a patient-specific threshold pressure device, twice daily for 6 wk at 50% maximal inspiratory pressure (MIP), in addition to "breathing training" during this period. Participants in the control group performed only the "breathing training" (sham or no threshold pressure device). Outcome measurements, performed before and after the intervention, included pulmonary function test, respiratory muscle strength, 6-min walk test, modified Medical Research Council dyspnea scale, St George's Respiratory Questionnaire, Fatigue Severity Scale, and London Chest Activity of Daily Living scale. Among the outcomes in the study, changes to key variables including MIP (P < .01); MIP, percent predicted (P < .01); maximal expiratory pressure (MEP), percent predicted (P < .01); 6-min walk test walking distance (P = .001); modified Medical Research Council scale (P =<.001); Fatigue Severity Scale (P = .03); St George's Respiratory Questionnaire symptoms (P = .03); London Chest Activity of Daily Living domestic (P = .03); and London Chest Activity of Daily Living leisure (P = .01) were significantly different in favor of IMT versus control. These findings suggest that IMT may be an effective modality to enhance respiratory muscle strength, exercise capacity, quality of life, daily living activities, reduced perception of dyspnea, and fatigue in asthmatic patients.

Effect of inspiratory muscle training (IMT) on aerobic capacity, respiratory muscle strength and rate of perceived exertion in paraplegics

Objectives: The purpose is to study the effect of inspiratory muscle training on aerobic capacity, respiratory muscle strength and rate of perceived exertion in paraplegics.Study Design: Randomized controlled trial.Settings: Rehabilitation department in Indian Spinal Injuries Centre, New Delhi.Participants: A sample of 30 paraplegics (T1-T12) were randomly allocated into two groups: inspiratory muscle training (IMT) group and control group.Interventions: The IMT group received inspiratory muscle training for 15 minutes 5 times a week for 4 weeks whereas the control group was given breathing exercises.Outcome measures: Maximal inspiratory pressure(MIP), maximal expiratory pressure (MEP), modified Borg’s scale (MBS), 12 minute wheelchair aerobic test (12MWAT), multistage fitness test (MSFT), and 6 minutes push test (6MPT).Results: Out of 30 participants, 27 completed the study. The results show that after four weeks of IMT training, there were significant improvements in mean change scores of IMT group as compared to control group. Participants in IMT group performed better on 12MWAT (P = 0.001), MSFT (P = 0.001) and 6MPT (P = 0.001). Improvements in MIP scores (P = 0.001), MEP scores (P = 0.001) and MBS scores (P = 0.004) were also seen in IMT group.Conclusion: Both groups showed significant improvements, however inspiratory muscle training was seen to be more effective than deep breathing exercises for improving aerobic capacity, respiratory muscle strength and rate of perceived exertion in paraplegics.

Inspiratory muscle training is associated with decreased postoperative pulmonary complications: Evidence from randomized trials

ObjectiveTo determine whether preoperative inspiratory muscle training was associated with a significant difference in the rate of postoperative pulmonary adverse outcomes in patients undergoing cardiothoracic or upper abdominal surgery using trial sequential analysis to correct for the risk of random errors. MethodsWe systematically reviewed the Excerpta Medica database, PubMed, Web of Science, Cumulative Index to Nursing and Allied Health Literature, and Cochrane Central Register of Controlled Trials for randomized controlled trials evaluating inspiratory muscle training before cardiothoracic or upper abdominal surgery. Outcome measures included postoperative pulmonary complications, length of hospital stay, maximum inspiratory pressure, and quality of life. A random-effects model was used to estimate relative risks with 95% confidence intervals (CIs). We used trial sequential analysis to calculate a diversity-adjusted required information size for meta-analysis. ResultsThirteen randomized controlled trials were included in the meta-analysis for a total of 784 patients. Compared with the standard care group, the inspiratory muscle training group exhibited significantly decreased postoperative pulmonary complications (risk ratio, 0.59; 95% CI, 0.47-0.74). Trial sequential analysis indicated that the cumulative Z curve crossed both the conventional boundary and the trial sequential monitoring boundary for benefit. The length of hospital stay was reduced in the inspiratory muscle training group (mean difference, −1.15 days; 95% CI, −2.10 to 0.20), and the maximum inspiratory pressure was significantly improved at the end of the preoperative training (mean difference, 13.66; 95% CI, 3.88-23.44). The quality of life outcome was unavailable in most of the studies. ConclusionsPreoperative inspiratory muscle training resulted in significantly improved maximum inspiratory pressure and was associated with decreased postoperative pulmonary complications.

Influence of Inspiratory Muscle Training on Sympatho‐excitation in Healthy Young Adults

Inspiratory muscle training (IMT) lowers blood pressure in healthy young adults and adults with obstructive sleep apnea (Vranish &amp; Bailey, 2015; 2016). Importantly, in healthy young adults, 6 weeks IMT also is associated with significant declines in systemic vascular resistance (Delucia et al. 2017). In light of these outcomes, in the current study we test the hypothesis that 6 weeks IMT reduces sympathetic outflow. Accordingly, we recruited healthy college‐aged students and randomly allocated them to either IMT or to Sham training groups. At intake (Week 1) and study completion (Week 6) we recorded MSNA as subjects performed sympatho‐excitatory challenges as follows: Valsalva maneuver, Mueller maneuver, submaximal grip test, cold pressor test, and mental stress tests (Stroop and mental arithmetic). Additionally, we performed weekly (blinded) assessments of systolic and diastolic blood pressures (SBP and DBP), and assessed maximal inspiratory pressure and respiratory function. Our preliminary results indicate subjects in the IMT group have lowered systolic (114.3 ± 3.4 mmHg vs. 106.7 ± 1.8 mmHg, p=0.0115) and diastolic (68.39 ± 1.58 mmHg vs. 63.5 ± 0.97 mmHg, p=0.0413) blood pressures relative to Sham trained subjects (SBP 114.7 ± 2.94 mmHg vs. 108.9 ± 1.34 mmHg and DBP 72.47 ± 3.29 mmHg vs. 69.99 ± 1.75 mmHg). Consistent with our hypothesis, preliminary analyses highlight lowered sympathetic burst frequency in the IMT group during Valsalva maneuvers (Week 1:15 ± 2.2 bursts per 15 seconds vs. Week 6: 11 ± 1.5 bursts per 15 seconds) as compared to Sham trained subjects (Week 1:12.13 ± 1.48 bursts per 15 seconds vs. Week 6:11.63 ± 0.83 bursts per 15 seconds). Data collection is ongoing however, our early findings show a reduction in sympathetic outflow during respiratory challenges which may underpin declines in peripheral resistance and blood pressure seen in healthy young adults following IMT.Support or Funding InformationThis work was supported by start up monies awarded to EFB.This abstract is from the Experimental Biology 2018 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

Multicentre randomized clinical trial of inspiratory muscle training versus usual care before surgery for oesophageal cancer.

Up to 40 per cent of patients undergoing oesophagectomy develop pneumonia. The aim of this study was to assess whether preoperative inspiratory muscle training (IMT) reduces the rate of pneumonia after oesophagectomy. Patients with oesophageal cancer were randomized to a home-based IMT programme before surgery or usual care. IMT included the use of a flow-resistive inspiratory loading device, and patients were instructed to train twice a day at high intensity (more than 60 per cent of maximum inspiratory muscle strength) for 2 weeks or longer until surgery. The primary outcome was postoperative pneumonia; secondary outcomes were inspiratory muscle function, lung function, postoperative complications, duration of mechanical ventilation, length of hospital stay and physical functioning. Postoperative pneumonia was diagnosed in 47 (39·2 per cent) of 120 patients in the IMT group and in 43 (35·5 per cent) of 121 patients in the control group (relative risk 1·10, 95 per cent c.i. 0·79 to 1·53; P = 0·561). There was no statistically significant difference in postoperative outcomes between the groups. Mean(s.d.) maximal inspiratory muscle strength increased from 76·2(26·4) to 89·0(29·4) cmH2 O (P < 0·001) in the intervention group and from 74·0(30·2) to 80·0(30·1) cmH2 O in the control group (P < 0·001). Preoperative inspiratory muscle endurance increased from 4 min 14 s to 7 min 17 s in the intervention group (P < 0·001) and from 4 min 20 s to 5 min 5 s in the control group (P = 0·007). The increases were highest in the intervention group (P < 0·050). Despite an increase in preoperative inspiratory muscle function, home-based preoperative IMT did not lead to a decreased rate of pneumonia after oesophagectomy. Registration number: NCT01893008 (https://www.clinicaltrials.gov).