Inspiratory Muscle Training Research Articles

Effectiveness of Ultrasonography Visual Biofeedback of the Diaphragm in Conjunction with Inspiratory Muscle Training on Muscle Thickness, Respiratory Pressures, Pain, Disability, Quality of Life and Pulmonary Function in Athletes with Non-Specific Low Back Pain: A Randomized Clinical Trial.

Diaphragmatic weakness and thickness reduction have been detected in athletes with lumbopelvic pain (LPP). Strength training of inspiratory muscles may be necessary for athletes with LPP. Inspiratory muscle training (IMT) and visual biofeedback by rehabilitative ultrasound imaging (RUSI) have been proposed as possible interventions. Here, we determine the effectiveness of visual biofeedback by RUSI with a proposed novel thoracic orthotic device to facilitate diaphragmatic contraction in conjunction with high-intensity IMT in athletes with non-specific LPP. A single-blinded, parallel-group, randomized clinical trial was performed (NCT04097873). Of 86 participants assessed for eligibility, 64 athletes with non-specific LPP (39 males and 25 females; mean age, 33.15 ± 7.79 years) were recruited, randomized, analyzed and received diaphragm visual biofeedback by RUSI in conjunction with high-intensity IMT (RUSI+IMT; n = 32) or isolated high-intensity IMT (IMT; n = 32) interventions for 8 weeks. Diaphragmatic thickness during normal breathing, maximum respiratory pressures, pain intensity, pressure pain threshold on lumbar musculature, disability by the Roland–Morris questionnaire, quality of life by the SF-12 questionnaire and spirometry respiratory parameters were assessed at baseline and after the 8-week intervention. There were significant differences (p = 0.015), within a medium effect size (Cohen’s d = 0.62) for the forced expiratory volume in 1-s (FEV1), which was increased in the RUSI+IMT intervention group relative to the IMT alone group. Adverse effects were not observed. The rest of the outcomes did not show significant differences (p > 0.05). Diaphragm visual biofeedback by RUSI with the proposed novel thoracic orthotic device in conjunction with high-intensity IMT improved lung function by increasing FEV1 in athletes with non-specific LPP.

Feasibility and effectiveness of exercise-based prehabilitation in patients opting for elective abdominal surgeries: A pre-post study

Background: Surgical procedures are accompanied by various complications such as decreased respiratory muscle strength, decreased functional capacity, decreased quality of life, and increased the length of hospital stay. There is a growing body of evidence that indicates that exercise-based prehabilitation offered before major abdominal surgeries can improve the above-mentioned complications. Considering the socioeconomic inequalities, educational characteristics, and healthcare system, which are different in low and lower-middle income countries, it is important to know whether interventions such as prehabilitation are feasible and effective in patients undergoing elective abdominal surgeries. Hence, we set out to determine the role of exercise-based prehabilitation in patients opting for these surgeries. Methods: In this feasibility study, 71% of the eligible patients agreed to participate. Baseline values of respiratory muscle strength, functional capacity and quality of life were recorded preoperatively, and an exercise-based prehabilitation programme consisting of chest physiotherapy, aerobic exercises and inspiratory muscle training according to the patient’s capacity was administered until the day of surgery. A total of 62% of the participants completed the study whose postoperative values and a user satisfaction scale were noted. The feasibility parameters of recruitment rate, dropout rates, adherence events, adverse events and participants satisfaction were evaluated and the differences in the preoperative and postoperative values of respiratory muscle strength, functional capacity and quality of life were calculated using the paired t-test accordingly. Results: Feasibility was measured using five parameters. All the values were > 50% and above. The secondary variables respiratory muscle strength, functional capacity, and quality of life were not significant. Conclusions: This study concluded that prehabilitation is feasible and can be effectively delivered to patients scheduled for elective abdominal surgery. Clinical Trials Registry India registration: CTRI/2021/05/033707 (20/05/2021).

Effects of Inspiratory Muscle Training and High-Intensity Interval Training on Lung Function and Respiratory Muscle Function in Asthma.

Asthma is a heterogeneous disease, usually characterized by chronic airway inflammation. Although inspiratory muscle training (IMT) and high-intensity interval training (HIIT) are beneficial for patients with asthma, controversies persist. Therefore, we aimed to investigate the effects of IMT and HIIT on lung function and respiratory muscle function of subjects with asthma. We searched PubMed, Embase, Web of Science, and the Cochrane Library databases up to May 2021. Inclusion criteria were randomized controlled trials (RCTs) of subjects with asthma who received either IMT or HIIT. The outcome measures were changes in lung function and respiratory muscle function. A total of 13 RCTs (10 in IMT and 3 in HIIT) were included, with a total of 598 subjects. The meta-analysis showed a significantly improved FEV1 of the expected value (FEV1%pred) (mean difference [MD] 4.49% [95% CI 2.31-6.67], P < .001; I2 = 13%), FVC of the expected value (FVC % pred) (MD 5.72% [95% CI 3.56-7.88], P < .001; I2 = 0%), FEV1/FVC % (MD 5.01% [95% CI 2.45-7.58], P < .001; I2 = 25%), FVC (L) (MD 0.21 L [95% CI 0.03-0.40], P = .02; I2 = 0%), maximum inspiratory pressure (PImax) (MD 27.62 cm H2O [95% CI 6.50-48.74], P = .01; I2 = 96%), and PImax (%pred) (MD 27.35% [95% CI 6.94-47.76], P = .009; I2 = 83.5%) in the IMT group. There was no statistical significance in maximum expiratory pressure. IMT improved pulmonary function (FEV1%pred, FVC) and inspiratory muscle strength in subjects with stable asthma. Due to the small number of RCT studies included and the limited outcome measures involving HIIT, we were unable to draw conclusions about whether HIIT was beneficial in this meta-analysis. Moreover, clinical heterogeneity exists in different areas such as population and training programs; the above conclusions still need to be confirmed in future studies.

Effects of Pulmonary Rehabilitation Including Inspiratory Muscle Training in Patients with Chronic Obstructive Pulmonary Disease after Stratification by the Degree of Static Hyperinflation

Inspiratory muscle training (IMT) improves inspiratory muscle strength, exercise capacity and health status in patients with chronic obstructive pulmonary disease (COPD). However, there is no additional effect on top of comprehensive pulmonary rehabilitation (PR). It is unclear whether patients with different baseline degrees of static hyperinflation respond differentially to IMT as part of a PR program. Therefore, the aim was to study the effects of IMT as an add-on on PR after stratification for baseline degrees of static hyperinflation. In this single center retrospective study data were extracted between June 2013 and October 2020 of COPD patients who participated in a comprehensive PR program including IMT. IMT was performed twice daily, one session consisted of 3 series of 10 breaths and training intensity was set initially at a load of approximately 50% of patients' maximal static inspiratory mouth pressure (MIP). The primary outcome measure was MIP. Secondary outcomes were the distance achieved on the 6-min walk test (6MWD), endurance cycling exercise capacity at 75% of the peak work rate (CWRT) and disease-specific health status using the COPD assessment test. 754 patients with COPD were screened for eligibility and 328 were excluded because of repeated PR programs, missing data or baseline residual volume (RV) > 350%. In total, 426 COPD patients were categorized into RV categories 50-130% (n = 84), 131-165% (n = 86), 166-197% (n = 86), 198-234% (n = 85) and 235-349% (n = 85). In the whole sample, MIP, endurance exercise capacity and health status improved significantly. The change in 6MWD was higher in the lowest baseline degree of static hyperinflation [+ 39 (9-92) m] compared with the baseline highest degree of static hyperinflation [+ 11 (- 18-54) m] (p < 0.05). IMT as part of a PR program in patients with COPD with different baseline degrees improved MIP irrespective of the degree of static lung hyperinflation. Improvement in functional exercise capacity was significantly higher in the group with the lowest degree of static hyperinflation compared with the patients with the highest degree of static hyperinflation.

The rationale of applying inspiratory/expiratory muscle training within the same respiratory cycle in children with bronchial asthma: a placebo-controlled randomized clinical investigation

Objective Even though positive implications of inspiratory muscle training (In-MT) have been established in children and adolescents with bronchial asthma (C/AwBA), the role of combined inspiratory and expiratory muscle training (Ex-MT) within the same respiratory cycle (In/Ex-SC) is still unknown. This study was, therefore, set out to explore the effect of In/Ex-SC on respiratory muscle strength, pulmonary functions, and control of asthma symptoms in C/AwBA. Methods This was a placebo-controlled randomized clinical investigation that included 51 C/AwBA (12-18 years). Participants were assigned randomly into three groups: Placebo, In-MT only, or combined In/Ex-SC training (n = 17, each group). The training was conducted for ∼35 min, thrice/week over 12 weeks. The maximal inspiratory (IPmax) and expiratory (EPmax) pressure (indicating the strength of the inspiratory and expiratory muscles, respectively), pulmonary functions [forced expiratory volume in one second (FEV1), forced vital capacity (FVC), and FEV1/FVC index], and asthma control test (ACT) were assessed before and after the intervention. Results The In/Ex-SC yielded larger increases in IPmax and EPmax than either the Placebo training (P=.031 and P=.009 respectively) or the In-MT (P=.029 and P=.032 respectively). Further, In/Ex-SC produced favorable improvement in FEV1, FVC, and FEV1/FVC compared to the Placebo training (P=.001, P=.004, and P=.0005 respectively) or In-MT (P=.038, P=.037, and P=.025 respectively) training. Furthermore, In/Ex-SC led to better control of asthma symptoms than the Placebo (P<.001) or In-MT (P=.002) training. Conclusion This study provides evidence that combined In/Ex-SC can considerably improve respiratory muscle strength, enhance pulmonary function, and promote control over asthma symptoms in C/AwBA.

The Benefits of Inspiratory Muscle Training in Heart Failure Patients – A Systematic Review

Background: Patients with heart failure (HF) have impaired function of respiratory system and frequently experience dyspnea. Inspiratory muscle training (IMT) offers an alternative way of exercise with a lot of benefits for HF patients. Aim: The aim of this review was to summarize and to reveal the effects of IMT in HF patients. Methods: Electronic searches were performed using Pubmed Database, Physiotherapy Evidence Database (PEDro) and Cochrane Library. Inclusion criteria were: RCTs, patients with HF, full text articles after 2010 and at least one intervention group with IMT. Methodological quality was assessed using the PEDro (Physiotherapy Evidence Database) scale. Results: Nineteen articles met the inclusion criteria and were included in this review. In most studies training protocols involved 3 to 7 sessions per week with intensity ≤30-60% of maximal inspiratory pressure (MIP), for a total duration of 4-12 weeks. Respiratory muscle strength improved in 11/12 studies, peripheral muscle strength in 4/5 studies, exercise capacity (peak VO2, VE/VCO2 slope) in 4/10, pulmonary function (FEV1, FEV1/FVC, FVC) in 0/5, functional capacity (6MWT) in 6/8, echocardiography parameters in 1/6, quality of life and dyspnea in 9/16. Control groups followed sham IMT, usual care, no intervention, intervention without exercise, or aerobic training, which could explain in some cases the conflicting results. Conclusions: IMT is beneficial for HF patients and should be included as a complementary method in cardiac rehabilitation programs. The optimal characteristics of ΙΜΤ as well as the benefits when combined with common forms of exercise need further research.

Training the equine respiratory muscles: Inspiratory muscle strength.

Little is known about the response of the equine respiratory muscles to training. 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). Prospective randomised controlled trial. 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. Phase 1: There was a significant increase in IMSi from timepoint A: 22.5 cmH2 O (21-25) to timepoint B: 26 cmH2 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 cmH2 O (28-36) (p =0.001) but not the low-load group 26 cmH2 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). Single centre study with only National Hunt horses undergoing race-training included. In horses undergoing race training there is a significant increase in IMSi in response to conventional exercise training and high-load IMT.

Effect of Threshold Inspiratory Muscle Training on Functional Fitness and Respiratory Muscle Strength Compared to Incentive Spirometry in Children and Adolescents With Obesity: A Randomized Controlled Trial.

BackgroundTo determine the effect of threshold inspiratory muscle training (IMT) on functional fitness and respiratory muscle strength (RMS) compared to incentive spirometry (IS) in children/adolescents with obesity.MethodsA total of 60 obese children/adolescents aged 8–15 years were randomized into the threshold IMT group (n = 20), the IS group (n = 20), or the control group (n = 20). The IMT group performed 30 inspiratory breaths with the intensity set at 40% of baseline maximal inspiratory pressure (MIP) twice daily for 8 weeks; the IS group performed 30 breaths with sustained maximum inspiration twice daily for 8 weeks; and, the control group was assigned no training device for 8 weeks. Six-min walk test (6-MWT), RMS, and spirometry were compared between baseline and 8 weeks.ResultsSix-MWT distance (528.5 ± 36.2 vs. 561.5 ± 35.2 m, p = 0.002) and MIP (121.2 ± 26.8 vs. 135.3 ± 32.1%Predicted, p = 0.03) were significantly improved after 8 weeks of IMT training. There was no significant difference in any evaluated pulmonary function parameters between baseline and 8 weeks in the IS or control groups; however, 6-MWT distance demonstrated a trend toward significant improvement in the IS group (526.9 ± 59.1 vs.549.0 ± 50.6 m, p = 0.10). No significant difference among groups was found for any variable relative to change from baseline to post-training.ConclusionEight weeks of threshold IMT training significantly improved both inspiratory muscle strength (MIP) and functional fitness (6-MWT) in children/adolescents with obesity. Eight weeks of IS training yielded a trend toward significantly improved functional fitness.

Effects of Addition of Inspiratory Muscle Training to Exercise-Based Cardiac Rehabilitation on Inspiratory Muscle Strength, Peak Oxygen Consumption, and Selected Hemodynamics in Chronic Heart Failure.

Evidence supports the clinical benefits of isolated inspiratory muscle training (IMT) in patients with chronic heart failure (CHF); however, the rationale of IMT in combination with exercise training in cardiac rehabilitation settings for CHF has yet to be confirmed. This study aimed to assess the effect of the addition of IMT in combination with aerobic/resistance training (AT/RT) on maximal inspiratory pressure (PImax), peak oxygen consumption (VO2peak), selected hemodynamic variables, and health-related quality of life (HRQoL) compared to sham-IMT combined with AT/RT in patients with CHF. Twenty-five male patients with CHF completed a 6-month cardiac rehabilitation program of either a sham-IMT/AT/RT program (control group, 51.84 ± 4.56 years old, n1 = 13), or a real-IMT/AT/RT program (study group, 51.75 ± 4.73 years old, n2 = 12). Inclusion criteria were ischemic heart failure, New York Heart Association (NYHA) class II-III, and reduced ejection fraction. Outcome measures were PImax, VO2peak, resting heart rate (RHR), heart rate (HR) reserve, rate pressure product (RPP), left-ventricular ejection fraction, and Minnesota Living with Heart Failure Questionnaire (MLwHFQ). Absolute mean changes from baseline (Δ) in the outcome measures were statistically analyzed as independent outcomes. ΔPImax, ΔRHR, ΔHR reserve, and ΔMLwHFQ total score were significantly greater in the study group than in the control group (p < 0.05). In addition, ΔRPP showed an observed difference in favor of the study group with a tendency towards statistical significance (p = 0.07). IMT could be a successful complementary intervention to exercise-based cardiac rehabilitation programs comprising AT/RT, yielding greater improvements in PImax, RHR, HR reserve, and HRQoL in male patients with ischemic heart failure (NYHA class II-III).

Effect of a home-based inspiratory muscular training programme on functional capacity in patients with chronic COVID-19 after a hospital discharge: protocol for a randomised control trial (InsCOVID trial)

IntroductionExercise intolerance and fatigue are the most common symptoms in patients with chronic COVID-19 after hospital discharge. Supervised exercise training programmes improve symptoms, but scarce research has been done on...

Effect of Inspiratory Muscle Training Program on Health Outcomes among Patients with Thoracic Surgery

Effect of Inspiratory Muscle Training Program on Health Outcomes among Patients with Thoracic Surgery

Effect of 4 weeks inspiratory muscle training on inspiratory muscle strength and quality of life in dialysis patients. A pilot study

ABSTRACT:Background: Dialysis is the most preferred way to treat chronic kidney disease (CKD). Thecommonest complication associated with dialysis is uremic myopathy. Inspiratory muscletraining (IMT) improves the strength of respiratory muscles.Methods: 11 patients with Stage 4 and 5 of chronic kidney disease with more than 3 months of dialysis underwent Inspiratory muscle training using self-made inspiratory trainer by taking pre and post intervention values of Maximum inspiratory pressure (MIP) and QOL.Result: Paired t test was used and the MIP and QOL values are statistically significant with a p-value of &lt; 0.0001 and 0.0124 respectively.Conclusion: Inspiratory muscle strength and QOL is reduced in dialysis patients and a 4-week inspiratory muscle training using a self-made inspiratory muscle trainer is effective to reverse the adverse effects of dialysis.Keywords: Kidney disease, complications, respiratory muscles, maximum respiratory pressure, muscle weakness, exercise.

Effectiveness of Pre-operative Inspiratory Muscle Training on Post-Operative Recovery in patients undergone Abdominal Surgery- A Systematic Review

Background – As there is effect of General Anaesthesia on respiratory muscles which also reduces mucocilliary escalator activity for 72 hours that leads to accumulation of mucus in alveola, and it further leads to atelectasis. To reduce all these complications, strength of respiratory muscle must be good. In this study we are mainly focusing on effect of pre-operative inspiratory muscle training improving the post-operative recovery to prevent complications in patients with abdominal surgery. Aims &amp; Objectives- To study the effectiveness of pre-operative inspiratory muscle training on post-operative recovery in patients undergone abdominal surgery. Subjects and Method- Pre-operative exercises are beneficial for the patients under gone abdominal surgery to avoid post-operative pulmonary complications and get faster recovery. Hence, the purpose of the present systemic review is to provide an overview of the recent literature on the role of effectiveness of pre-operative inspiratory muscle training on post-operative recovery in patients undergone abdominal surgery. Articles published on an online electronic database were included. We included studies that were published in English. This systematic review included seven articles which were Randomised controlled trials, controlled trials, prospective study. Result – 7 articles were reviewed out of which 6 articles shown the positive response on research question and 1 article did not showed much impact. Conclusion –The studies show that preoperative inspiratory muscle training will improve post-operative recovery.

Effects of Multimodal Inpatient Rehabilitation vs Conventional Pulmonary Rehabilitation on Physical Recovery After Esophageal Cancer Surgery

ObjectiveTo determine the effects of multimodal rehabilitation initiated immediately after esophageal cancer surgery on physical recovery compared with conventional pulmonary rehabilitation. DesignRetrospective study. SettingPrivate quaternary care hospital. ParticipantsFifty-nine inpatients (N=59) who participated in either conventional pulmonary rehabilitation (n=30) or in multimodal rehabilitation (n=29) after esophageal cancer surgery were included. InterventionsBoth groups performed pulmonary exercises, including deep breathing, chest expansion, inspiratory muscle training, coughing, and manual vibration. In the conventional pulmonary rehabilitation group, light-intensity mat exercise, stretching, and walking were performed. The multimodal rehabilitation group performed resistance exercises and moderate- to high-intensity aerobic interval exercises using a bicycle. Main Outcome MeasuresThe European Organization for Research and Treatment of Cancer Core Quality of Life Questionnaire C30 (EORTC QLQ-C30), pain, 6-minute walk test (6MWT), 30-second chair stand test, and grip strengths were assessed before and after the rehabilitation programs. ResultsSymptom scales of pain, dyspnea, and insomnia in the EORTC QLQ-C30 as well as 6MWT improved significantly after each program (P<.05). 6MWT (73.1±52.6 vs 28.4±14.3, P<.001, d=1.15), 30-second chair stand test (3.5±3.9 vs 0.35±2.0, P<.001, d=1.06), and left grip strength (1.2±1.3 vs 0.0±1.5, P=.002, d=0.42) improved significantly in the multimodal rehabilitation group compared with the pulmonary rehabilitation group. While right grip strength also showed more improvement for those undergoing the multimodal program, the mean strength difference was not clinically meaningful. ConclusionsA multimodal inpatient rehabilitation program instituted early after esophageal cancer surgery improved endurance for walking more than conventional pulmonary rehabilitation as measured by the 6MWT and the 30-second chair stand test.

Complex Network Model Reveals the Impact of Inspiratory Muscle Pre-Activation on Interactions among Physiological Responses and Muscle Oxygenation during Running and Passive Recovery.

Simple SummaryDifferent warm-ups can be used to improve physical and sports performance. Among these strategies, we can include the pre-activation of the inspiratory muscles. Our study aimed to investigate this pre-activation model in high-intensity running performance and recovery using an integrative computational analysis called a complex network. The participants in this study underwent four sessions. The first and second sessions were performed to explain the procedures, characterize them and determine the individualized pre-activation intensity (40% of the maximum inspiratory pressure). Subsequently, on different days, the subjects were submitted to high-intensity tethered runs on a non-motorized treadmill with monitoring of the physiological responses during and after this effort. To understand the impacts of the pre-activation of inspiratory muscles on the organism, we studied the centrality metrics obtained by complex networks, which help in the interpretation of data in a more integrated way. Our results revealed that the graphs generated by this analysis were altered when inspiratory muscle pre-activation was applied, emphasizing muscle oxygenation responses in the leg and arm. Blood lactate also played an important role, especially after our inspiratory muscle strategy. Our findings confirm that the pre-activation of inspiratory muscles promotes modulations in the organism, better integrating physiological responses, which could increase performance and improve recovery.Although several studies have focused on the adaptations provided by inspiratory muscle (IM) training on physical demands, the warm-up or pre-activation (PA) of these muscles alone appears to generate positive effects on physiological responses and performance. This study aimed to understand the effects of inspiratory muscle pre-activation (IMPA) on high-intensity running and passive recovery, as applied to active subjects. In an original and innovative investigation of the impacts of IMPA on high-intensity running, we proposed the identification of the interactions among physical characteristics, physiological responses and muscle oxygenation in more and less active muscle to a running exercise using a complex network model. For this, fifteen male subjects were submitted to all-out 30 s tethered running efforts preceded or not preceded by IMPA, composed of 2 × 15 repetitions (1 min interval between them) at 40% of the maximum individual inspiratory pressure using a respiratory exercise device. During running and recovery, we monitored the physiological responses (heart rate, blood lactate, oxygen saturation) and muscle oxygenation (in vastus lateralis and biceps brachii) by wearable near-infrared spectroscopy (NIRS). Thus, we investigated four scenarios: two in the tethered running exercise (with or without IMPA) and two built into the recovery process (after the all-out 30 s), under the same conditions. Undirected weighted graphs were constructed, and four centrality metrics were analyzed (Degree, Betweenness, Eigenvector, and Pagerank). The IMPA (40% of the maximum inspiratory pressure) was effective in increasing the peak and mean relative running power, and the analysis of the complex networks advanced the interpretation of the effects of physiological adjustments related to the IMPA on exercise and recovery. Centrality metrics highlighted the nodes related to muscle oxygenation responses (in more and less active muscles) as significant to all scenarios, and systemic physiological responses mediated this impact, especially after IMPA application. Our results suggest that this respiratory strategy enhances exercise, recovery and the multidimensional approach to understanding the effects of physiological adjustments on these conditions.

Effects of two different inspiratory muscle training devices on respiratory muscle strength, cardiopulmonary functional capacity, and quality of life of COPD patients

Introduction: Inspiratory muscle weakness is one of the complications of chronic obstructive pulmonary disease (COPD). This condition has been minimized by inspiratory muscle training (IMT). Still, different IMT devices need to be compared to identify the best option. Objective: To evaluate the effects of two IMT devices on respiratory muscle strength, cardiorespiratory functional capacity, and life quality of COPD patients. Method: Before and after the IMT protocol, 17 patients were submitted to manovacuometry, six-minute walk test (6MWT), and questionnaire from the Saint George Hospital in Respiratory Disease (SGRQ) for inspiratory muscle strength, cardiorespiratory functional capacity, and life quality assessments, respectively. Afterwards, they were divided into two groups to perform IMT for four weeks, one by Threshold® IMT (IMTG) and the other by POWERbreathe® Classic (PG). Results: Maximal inspiratory pressure increased significantly from -62.00±16.03 to -75.55±22.84 cmH2O in IMTG, and from -56.00±22.01 to -71.25±27.67 cmH2O in PG. The distance covered in the 6MWT clinically increased with both IMTG and PG. The SGRQ answers showed improvements in all domains evaluated for both groups. However, the intergroup results showed no statistically significant differences. Conclusion: Both IMT devices increased inspiratory muscle strength, improved life quality, and optimized cardiorespiratory functionality in COPD patients. None was superior to the other for the analyzed parameters.

Training the equine respiratory muscles: Ultrasonographic measurement of muscle size.

Limited information exists regarding changes in the size of respiratory and locomotor muscles in response to exercise training in the Thoroughbred racehorse. To describe and compare the responses of the respiratory and locomotor muscles to conventional exercise training and inspiratory muscle training (IMT). Prospective randomised controlled trial. Thoroughbred racehorses, in training for competition in National Hunt races, were recruited from two training establishments. Ultrasonographic images were obtained for selected muscles of the upper airway, diaphragm, accessory respiratory, and locomotor systems and their sizes measured. Examinations were performed at three timepoints: (A) when unfit, (B) following 12 weeks of conventional exercise training and (C) following 10-12 weeks continued training at race fitness. In addition, horses at yard 1 performed IMT, between timepoint B and C, and were randomly assigned into high-load (treatment) or low-load (control) group. Repeated measures models were constructed to compare the change in muscle measurements over time, and to investigate the effects of yard, previous airway surgery and IMT on the change in ultrasonographic size measurements obtained. Upper airway muscle size increased in response to conventional race training between timepoints A-C, and B-C. Diaphragm size increased in response to conventional exercise training between timepoints A and B. The diaphragm size of horses that undertook high-load IMT was either maintained or increased, whereas diaphragm size decreased in horses that undertook low-load IMT or no IMT between timepoints B and C. A significant interaction between gluteal muscle size and airway surgery status was observed, with greater gluteal muscle thicknesses measured in horses that had not previously undergone airway surgery (left gluteal 3.9%, p < 0.001; right 4.5%, p=0.04). Low number of horses underwent IMT. Respiratory and locomotor muscles increase in size in response to conventional exercise training, with a further change in diaphragm size in response to inspiratory muscle training.

Pulmonary rehabilitation and inspiratory muscle training for patients following lung transplantation: A pilot study

BACKGROUND: Lung transplantation (LTx) is an established treatment option for patients with end-stage lung diseases. Nevertheless, exercise intolerance, respiratory muscle function impairment, functional disability, and peripheral muscle weakness often persist following LTx. PURPOSE: To examine the effectiveness of a pulmonary rehabilitation (PR) program and home-based inspiratory muscle training (IMT) alone or in combination, in post lung transplantation (LTx) patients. METHODS: In a prospective pilot study a sample of 22 patients who had undergone LTx 4–18 months prior, were randomized to groups of PR alone, or combined with home-based IMT, or IMT alone, for six months: four months in the intervention program and two months of follow-up. Inspiratory muscle strength was assessed by measuring the maximal inspiratory pressure (MIP). RESULTS: There was a statistically significant increase in MIP values as well as in the 6-min-walk-test, only in the PR combined with home-based IMT, and IMT exercise groups. From baseline after 2- and 4-months intervention and at 6-months at follow-up, there was a statistically significant correlation between MIP and Maximum Voluntary Ventilation (MVV) values. CONCLUSIONS: Pulmonary rehabilitation (PR) program combined with inspiratory muscle training (IMT) or home-based IMT alone, in post lung transplantation patients, seems to be the best exercise combination for achieving the optimal effect, in inspiratory muscle strength and exercise capacity, with evidence for long-term benefits. Patients should be encouraged to participate in a PR program that includes home-based IMT exercise, especially in times of restricted mobility, as currently due to the COVID-19 pandemic.

Short-term effect of inspiratory muscle training on pulmonary function after mitral valve replacement: Quasi-experimental study

BACKGROUND: After cardiac surgery, various pulmonary complications develop which require specific care. These complications affect pulmonary functions and can lengthen the hospital stay of patients, causing increased hospital costs and becoming an important cause of morbidity and mortality. OBJECTIVES: To investigate the short-term effect of inspiratory muscle training on pulmonary function after mitral valve replacement. METHODS: A sample of Thirty five patients (35.5±3.29 years) who underwent mitral valve replacement. Spirometric parameters were measured before and after intervention including forced vital capacity (FVC), forced expiratory volume in the first second (FEV1) and ratio of forced expiratory volume in the first second to forced vital capacity (FEV1/FVC). All participants had received postoperative Inspiratory muscle training (IMT) from the first day in the inpatient unit after discharge from intensive care unit till hospital discharge. Paired t-test was used to investigate differences between means of pulmonary function measures (P &lt; 0.05). Effect size was calculated and post hoc power analysis was performed. RESULTS: After one week of postoperative IMT there was a statistically significant improvement in the studied spirometric parameters (FVC, FEV1, FEV1/FVC) (p = 0.01). All studied spirometric parameters showed very large effect size (d &gt;0.8). The post hoc power analysis revealed that the study power was more than 90%. CONCLUSION: One week of post-operative IMT may have a beneficial short-term effect in improving pulmonary functions after mitral valve replacement.

Effects of inspiratory muscle training versus calf muscle training on quality of life, pain, venous function and activity in patients with chronic venous insufficiency

ObjectiveThe aim of the present study was to evaluate the effects of inspiratory muscle training (IMT) and calf muscle exercise training (CMET), in addition to compression therapy (CT), on quality of life (QoL), venous refilling time, disease severity, pain, edema, range of motion, muscle strength, and functionality in patients with chronic venous insufficiency (CVI) compared with CT alone. MethodsA total of 32 participants with a diagnosis of CVI were randomly divided into three groups: group 1, IMT plus CT; group 2, CMET plus CT; and group 3, CT alone. All 32 patients were assessed using the chronic venous disease QoL 20-item questionnaire, Nottingham health profile, photoplethysmography, venous clinical severity score, visual analog scale for pain, intraoral pressure measurements, dynamometer, digital goniometer, 6-minute walking test, and lower extremity functional scale. ResultsAfter treatment, group 2 had improved more than had groups 1 and 3 in QoL, venous refilling time, pain, edema, range of motion, muscle strength, and functionality. Group 1 had improved more than had groups 2 and 3 in disease severity and inspiratory and expiratory muscle strength values (P < .05). Only physical mobility and right leg venous refilling time had increased in group 3 (P < .05). ConclusionsThe use of IMT and CMET had improved venous function in both legs in patients with CVI, and CT alone had improved venous function only in the right leg of patients with CVI.