Inspiratory Training Research Articles

Effects of combined aerobic, resistance and inspiratory training in patients with pulmonary hypertension: A systematic review

BACKGROUND Pulmonary hypertension (PH) is a serious progressive disorder of the modern world, characterized by endothelial dysfunction and impaired vasoreactivity. Patients with PH usually present exercise intolerance from the very early stages and reduced exercise capacity. Exercise training has been shown to have beneficial effects in patients with cardiovascular comorbidities. However, data regarding the effects of combined exercise training programs in patients with PH still remains limited. AIM To investigate the effects of combined exercise training programs on exercise capacity and quality of life in patients with PH. METHODS Our search included all available randomized controlled trials (RCTs) regarding combined aerobic, resistance and inspiratory training programs in patients with PH in 4 databases (Pubmed, PEDro, Embase, CINAHL) from 2012 to 2022. Five RCTs were included in the final analysis. Functional capacity, assessed by peak VO2 or 6-min walking test (6MWT), as well as quality of life, assessed by the SF-36 questionnaire, were set as the primary outcomes in our study. RESULTS Peak VO2 was measured in 4 out of the 5 RCTs while 6MWT was measured in all RCTs. Both indices of functional capacity were significantly increased in patients with PH who underwent combined exercise training compared to the controls in all of the included RCTs (P < 0.05). Quality of life was measured in 4 out of 5 RCTs. Although patients improved their quality of life in each group, however, only 2 RCTs demonstrated further improvement in patients performing combined training compared to controls. CONCLUSION By this systematic review, we have demonstrated that combined aerobic, resistance and inspiratory exercise training is safe and has beneficial effects on aerobic capacity and quality of life in patients with PH. Such exercise training regimen may be part of the therapeutic strategy of the syndrome.

A Randomized Trial of Inspiratory Training in Children and Adolescents With Obesity.

Introduction: Children with obesity suffer excess dyspnea that contributes to sedentariness. Developing innovative strategies to increase exercise tolerance and participation in children with obesity is a high priority. Because inspiratory training (IT) has reduced dyspnea, we sought to assess IT in children with obesity. Methods: We conducted a 6-week randomized IT trial involving 8- to 17-year-olds with obesity. Participants were randomized 1:1 to either high [75% of maximal inspiratory pressure (MIP)] or low resistance control (15% of MIP) three times weekly. Assessments included adherence, patient satisfaction, and changes in inspiratory strength and endurance, dyspnea scores and total activity level. Results: Among 27 randomized, 24 (89%) completed the intervention. Total session adherence was 72% which did not differ between treatment groups. IT was safe, and more than 90% felt IT benefitted breathing and general health. IT led to a mean improvement (95% CI) in inspiratory strength measured by MIP of 10.0 cm H2O (-3.5, 23.6; paired t-test, p = 0.139) and inspiratory endurance of 8.9 (1.0, 16.8; paired t-test, p = 0.028); however, there was no significant difference between high- and low-treatment groups. IT led to significant reductions in dyspnea with daily activity (p < 0.001) and in prospectively reported dyspnea during exercise (p = 0.024). Among the high- versus low-treatment group, we noted a trend for reduced dyspnea with daily activity (p = 0.071) and increased daily steps (865 vs. -51, p = 0.079). Discussion: IT is safe and feasible for children with obesity and holds promise for reducing dyspnea and improving healthy activity in children with obesity. Breathe-Fit trial NCT05412134.

Effects of Inspiratory Training on Respiratory Function and Balance in Stroke Patients: A Randomized Controlled Trial

Effects of Inspiratory Training on Respiratory Function and Balance in Stroke Patients: A Randomized Controlled Trial

Commentary for "Inspiratory Training for Improving Respiratory Strength, Pulmonary Function, and Walking in Cerebral Palsy: A Meta-Analysis".

Commentary for "Inspiratory Training for Improving Respiratory Strength, Pulmonary Function, and Walking in Cerebral Palsy: A Meta-Analysis".

Breathing Pattern Response after 6 Weeks of Inspiratory Muscle Training during Exercise.

(1) Background: The breathing pattern is defined as the relationship between the tidal volume (VT) and breathing frequency (BF) for a given VE. The aim of this study was to evaluate whether inspiratory muscle training influenced the response of the breathing pattern during an incremental effort in amateur cyclists. (2) Methods: Eighteen amateur cyclists completed an incremental test to exhaustion, and a gas analysis on a cycle ergometer and spirometry were conducted. Cyclists were randomly assigned to two groups (IMTG = 9; CON = 9). The IMTG completed 6 weeks of inspiratory muscle training (IMT) using a PowerBreathe K3® device at 50% of the maximum inspiratory pressure (Pimax). The workload was adjusted weekly. The CON did not carry out any inspiratory training during the experimental period. After the 6-week intervention, the cyclists repeated the incremental exercise test, and the gas analysis and spirometry were conducted. The response of the breathing pattern was evaluated during the incremental exercise test. (3) Results: The Pimax increased in the IMTG (p < 0.05; d = 3.1; +19.62%). Variables related to the breathing pattern response showed no differences between groups after the intervention (EXPvsCON; p > 0.05). Likewise, no differences in breathing pattern were found in the IMTG after training (PREvsPOST; p > 0.05). (4) Conclusions: IMT improved the strength of inspiratory muscles and sport performance in amateur cyclists. These changes were not attributed to alterations in the response of the breathing pattern.

Inspiratory muscle strength training to improve cardiometabolic health in patients with type 2 diabetes mellitus: protocol for the diabetes inspiratory training clinical trial.

Type 2 diabetes mellitus (T2DM) is a complex, chronic metabolic disease that carries with it a high prevalence of comorbid conditions, making T2DM one of the leading causes of death in the U.S. Traditional lifestyle interventions (e.g., diet, exercise) can counter some adverse effects of T2DM, however, participation in these activities is low with reasons ranging from physical discomfort to lack of time. Thus, there is a critical need to develop novel management strategies that effectively reduce cardiometabolic disease risk and address barriers to adherence. High-resistance inspiratory muscle strength training (IMST) is a time-efficient and simple breathing exercise that significantly reduces systolic and diastolic BP and improves vascular endothelial function in adults with above-normal blood pressure. Herein we describe the study protocol for a randomized clinical trial to determine the effects of a 6-week IMST regimen on glycemic control and insulin sensitivity in adults with T2DM. Our primary outcome measures include fasting plasma glucose, fasting serum insulin, and insulin resistance utilizing homeostatic model assessment for insulin resistance (HOMA-IR). Secondary outcome measures include resting systolic BP and endothelium-dependent dilation. Further, we will collect plasma for exploratory proteomic analyses. This trial seeks to establish the cardiometabolic effects of 6 weeks of high-resistance IMST in patients with T2DM.

Effects of a respiratory and neurological rehabilitation treatment plan in post Covid-19 affected university students. Randomized clinical study.

COVID-19 demonstrated the possibility of neurological complications such as loss of sense of smell and taste, together with respiratory problems. Respiratory training and rehabilitation of neurological sequelae are essential to improve respiratory function and thus quality of life, and the aim of this study is to evaluate the efficacy of a pulmonary and neurological rehabilitation program. To apply a treatment to reduce dyspnea, increase exertional capacity, increase vital capacity and respiratory muscle strength, together with an increase in olfactory and gustatory sensitivity in post-SARS-CoV-2 patients. A randomised controlled experimental study was conducted in 220 patients with a medical diagnosis of COVID-19 and more than 5months of evolution, dyspnoea or perceived fatigue, including olfactory and gustatory perception problems, of whom 200 patients completed the study. 100 patients were randomly assigned to the intervention group, consisting of an inspiratory training treatment plan (Powerbreathe Plus®) combined with aerobic exercise and olfactory gustatory treatment for 31days, and 100 patients to the control group, for 31days without any type of therapy. The study was conducted in post-Covid-19 patients for 5months. Two hundred patients were divided into an intervention group (n = 100) and a control group (n = 100). The comparison between the groups showed significant differences in spirometric variables; forced vital capacity (p < .001; Eta2 (0.439); Mean: 0,6135), the ratio between both FEV1/FVC (p < 0.01; Eta2 (0.728); Mean:9,313), peak inspiratory pressure (p < 0.01; Eta2 (0.906); Mean:4,526); changes were observed in dyspnoea measured with the modified Borg scale (p < 0.01; Eta2 (0.811); Mean:1,481) and the modified Medical Research Council scale (p < 0.01; Eta2 (0.881); Mean: 0.777); finally, changes were found in neurological variables, in the questions of the Singapore Smell and Taste Questionnaire, How was your sense of smell after treatment? (p < 0.01; Eta2 (0.813); Mean: 1,721) and How is your sense of taste after treatment? (p < 0.01; Eta2 (0.898); Mean: 1,088). The implementation of a respiratory rehabilitation treatment plan with the Powerbreathe Plus® device, aerobic exercise and neurorehabilitation with olfactory and gustatory training, is a therapeutic option against respiratory and neurological sequelae in patients who have suffered such sequelae due to the SARS-CoV-2 virus. Clinicaltrials.gov: NCT05195099. First posted 18/01/2022; Last Update Posted 29/06/2022.

Evaluation of Recovery Efficacy of Inspiratory Muscle Training After Lobectomy Based on Computed Tomography 3D Reconstruction.

Progressive resistance inspiratory muscle training is the principle of inspiratory air-flow resistance loading training to restore diaphragm function, increase alveolar compliance, and further improve respiratory function. However, there is a lack of research on the effectiveness of progressive resistance inspiratory training in post-lobectomy rehabilitation and the accurate assessment of lung volumes. In this study, 79 subjects diagnosed with lung cancer and undergoing thoracoscopic lobectomy were retrospectively analyzed. The subjects were divided into a control group (n = 40) and an observation group (n =39) according to the different training modalities. The control group received conventional respiratory training. The observation group received progressive resistance inspiratory muscle training based on conventional breathing training. The primary outcome indicators were the following: lung function and lung volume. The secondary outcome indicators were the following: the number of postoperative hospital days, duration of drain retention, and incidence of postoperative pulmonary complications. Baseline data on age, sex, body mass index, smoking history, education level, underlying disease, type of pathology, lung cancer stages, surgical site, preoperative lung volume, and preoperative lung function were not statistically different between the 2 groups (P > .05). The subjects in the observation group had median (interquartile range [IQR]) lung volumes at 1 month after surgery (3.22 [3.12-3.37] L vs 3.14 [2.95-3.24] L; P = .031), median (IQR) FEV1 (2.11 [1.96-2.21] L vs 2.01 [1.81-2.12] L; P = .031), and mean ± SD peak expiratory flow (5.07 ± 0.62 L/s vs 4.66 ± 0.64 L/s; P = .005) were higher than those in the control group. The median (IQR) postoperative hospital stays (5 [4-5] d vs 5 [4-6] d; P = .030) and the median (IQR) chest drain retention times were shorter in the observation group versus the control group (74 [72-96] h vs 96 [84-96] h; P = .02). There was no significant difference in the incidence of postoperative atelectasis (5.1% vs 10.0%; P = .41) and pneumonia (7.7% vs 12.5%; P = .48). Progressive resistance inspiratory muscle training was effective in improving lung volume and lung function, and in reducing the length of hospital stay and chest drain closure time after lobectomy.

Effects of Inspiratory Muscle Warm-Up on Physical Exercise: A Systematic Review

This study aimed to systematically review the literature to examine the effects of inspiratory-muscle warm-up (IMW) on the inspiratory, metabolic, respiratory and performance parameters of a main exercise performed by athletes and healthy and active individuals. Methods: This systematic review included randomized studies in English based on the criteria of the PICOS model. The exclusion criteria adopted were studies that applied inspiratory exercise to: i. promote long-term adaptations through inspiratory training (chronic responses); ii. obtain acute responses to inspiratory load (overload) during and in breaks from physical effort and in an inspiratory-exercise session (acute training effect); iii. evaluate the effects of IMW on participants with cardiorespiratory and/or metabolic disease. Data Sources: PubMed, Embase, MedLine, Scopus, SPORTDiscus and Google Scholar (until 17 January 2023). Results: Thirty-one studies were selected. The performance and respiratory parameters were the most investigated (77% and 74%, respectively). Positive effects of IMW were reported by 88% of the studies that investigated inspiratory parameters and 45% of those that evaluated performance parameters. Conclusions: The analyzed protocols mainly had positive effects on the inspiratory and performance parameters of the physical exercises. These positive effects of IMW are possibly associated with the contractile and biochemical properties of inspiratory muscles.

Usability and Effectiveness Evaluation of a Game-Based Biofeedback System to Strengthen Respiratory Muscles

The assessment and training of respiratory muscles are two essential tasks for indirect screening of status and improvement of lung function, respectively, especially in times of COVID-19. To perform both tasks, we have designed an innovative handheld mouth pressure biofeedback system for assessment and personalized game-based training of respiratory muscle strength. Thirty recovered COVID-19 patients were involved in an across-ages pilot study to evaluate their respiratory muscle strength and the system’s usability, and eight of the thirty patients were involved in a home inspiratory training program of 3 weeks to assess its effectiveness. Results revealed that participants rated the system’s overall usability as excellent (91.3 ± 6.4) and consistently performed respiratory cycles along with the game-based training program in terms of mouth pressure. Furthermore, patients involved in the home training program showed a 40% increase in their Maximal Inspiratory Pressure (Pimax). These results indicate that the proposed system stands for a proper healthcare solution for the initial diagnosis of respiratory muscle dysfunction or disease and for guiding the correct performance of tailored and consecutive threshold load breathing cycles playfully and engagingly. Furthermore, it stands for an attractive and personalized biofeedback solution to promote adherence to at-home therapy. Finally, it can be used to investigate new and effective training protocols that improve respiratory muscle performance.

ACUTE EFFECT OF INSPIRATORY MUSCLE WARM UP PROTOCOL ON DYNAMIC AND STATIC BALANCE PERFORMANCE

The aim of this study is to examine the acute effect of inspiratory muscle warm-up protocol on dynamic and static balance performance. For this purpose, 17 sedentary individuals participated whose ages were between 20-26 years old. On different days, right static, left static, right dynamic and left dynamic tests were applied to the subjects randomly after control, placebo and experimental protocol. PowerBreathe brand inspiratory training device was used for inspiratory warming and Biodex Balance SD isokinetic balance test mechanism was used for measurement. The data obtained as a result of the test were analyzed by using the SPSS package program version 22.0. The data obtained were analyzed separately for General balance, Anterior-Posterior (A-P) balance and Medial-Lateral (M-L) balance groups. According to the result obtained, while the inspiratory warming protocol created a significant positive effect in some balance groups, it did not create a significant effect in some balance groups. Therefore, it can be said that the inspiratory warming protocol affects some balance parameters but this effect is not a level that can directly benefit the performance.&lt;p&gt; &lt;/p&gt;&lt;p&gt;&lt;strong&gt; Article visualizations:&lt;/strong&gt;&lt;/p&gt;&lt;p&gt;&lt;img src="/-counters-/edu_01/0938/a.php" alt="Hit counter" /&gt;&lt;/p&gt;

Effect of 10 cm Loaded Inspiratory Training when Compared to 20 cm Loaded Training in Controlling Hypertension

Background Slow breathing especially with prolonged exhalation appears to reduce sympathetic nerve traffic and thus causes arteriolar dilatation. Loaded inspiratory exercise has been demonstrated in studies to lower blood pressure. However the optimal intensity and duration of loaded training to control hypertension is not known. The objective of the present study was to compare the effect of 10 cm loaded inspiratory training with that of 20 cm loaded training in controlling hypertension after third and sixth week.Methodology Thirty subjects with essential hypertension stage I or II were included and randomized into two groups. Group A received inspiratory loaded training with 20 cm of water loaded training and Group B received inspiratory loaded training with 10 cm of water loaded training. Training was performed at home for 30 minutes every day twice daily for 3 weeks. Blood pressure was measured at baseline before the intervention after 3rd and 6th week.Results Both the groups showed statistically significant reduction in blood pressure after six weeks of loaded training plt.0001. However on comparing the groups both the groups were equally effective in reducing blood pressure after 3rd and 6th week of training p values ndash Systolic gt.850 gt.268 Diastolic gt.761gt.304 respectively.Conclusion Loaded training can reduce both systolic and diastolic hypertension after six weeks of training. There was no difference in effectiveness of 10 cm loaded inspiratory training when compared to 20 cm loaded training in controlling hypertension after 3rd and 6th week.

A randomized trial comparing inspiratory training and positive pressure training in immediate lung recovery after minor pleuro-pulmonary surgery.

BackgroundTwo respiratory physiotherapy modalities were compared in a randomized controlled trial on patients undergoing minor pleuro-pulmonary surgery.MethodsForty-five patients were randomly allocated into positive expiratory pressure (PEP) therapy (n=23) and inspiratory muscle training (IMT) groups (n=22). Individualized group specific physiotherapeutic guidance was administered preoperatively, and once a day postoperatively. Patients also performed independent exercises and kept a logbook. Pain was assessed on a numerical reference scale (NRS). Volumetric pulmonary function values and walking distance were recorded preoperatively, and on first (POD1) and second postoperative days (POD2). Pre- and postoperative values were compared using two-way repeated measures analysis of variance.ResultsPatient characteristics and pleuro-pulmonary interventions were similar between the groups. Thoracotomy was performed in 14/45 and video assisted surgery (VATS) in 31/45 of cases. Preoperative volumetric pulmonary functions were normal or slightly decreased in 29/45, and fell significantly (P<0.001) on the first postoperative day (POD1) and improved but remained significantly lower on the second postoperative day. The recovery of mean FEV1, FIV1 and FIVC values was greater in the IMT than in the PEP group between POD1 and POD2, but without significant difference. The corresponding relative to preoperative values were higher in the IMT group, with a significant difference in FEV1 (P=0.045). Also relative PEF and FIV1 values seemed to be slightly higher in the IMT compared to the PEP group, but not significantly. Average NRS values for pain were lower in the IMT group (P=0.010) but only on POD1. Air leak was noted in 4/45 patients, two in each group, on POD1, and two in PEP groups and one in IMT group on POD2. Mean measured walking distances between groups did not differ. Mean hospital stay was 4 days in the PEP group and 3 days in the IMT group. There was no hospital mortality.ConclusionsPulmonary function values decreased significantly after minor lung resections, supporting rehabilitative respiratory physiotherapy to avoid postoperative pulmonary complications (PPCs). Both PEP and IMT training were well tolerated and equally efficient when comparing spirometry values at three time points. IMT appeared advantageous regarding relative FEV1 recovery and immediate postoperative pain.

Unraveling the Role of Respiratory Muscle Metaboloreceptors under Inspiratory Training in Patients with Heart Failure.

Exercise intolerance may be considered a hallmark in patients who suffer from heart failure (HF) syndrome. Currently, there is enough scientific evidence regarding functional and structural deterioration of skeletal musculature in these patients. It is worth noting that muscle weakness appears first in the respiratory muscles and then in the musculature of the limbs, which may be considered one of the main causes of exercise intolerance. Functional deterioration and associated atrophy of these respiratory muscles are related to an increased muscle metaboreflex leading to sympathetic–adrenal system hyperactivity and increased pulmonary ventilation. This issue contributes to increased dyspnea and/or fatigue and decreased aerobic function. Consequently, respiratory muscle weakness produces exercise limitations in these patients. In the present review, the key role that respiratory muscle metaboloreceptors play in exercise intolerance is accurately addressed in patients who suffer from HF. In conclusion, currently available scientific evidence seems to affirm that excessive metaboreflex activity of respiratory musculature under HF is the main cause of exercise intolerance and sympathetic–adrenal system hyperactivity. Inspiratory muscle training seems to be a useful personalized medicine intervention to reduce respiratory muscle metaboreflex in order to increase patients’ exercise tolerance under HF condition.

Inspiratory Muscle Training With an Electronic Resistive Loading Device Improves Prolonged Weaning Outcomes in a Randomized Controlled Trial.

To test if the use of an inspiratory muscle training program with an electronic resistive loading device is associated with benefits as to muscle strength, weaning, and survival in the ICU. Prospective randomized controlled trial. Study conducted at the ICU of a Navy's hospital, Rio de Janeiro, Brazil, from January 2016 to September 2018. Tracheostomized patients (18-86 yr) on prolonged weaning. Participants were assigned to inspiratory muscle training (intervention group) or a traditional T-piece protocol (control group). In the inspiratory muscle training group, participants underwent training with an electronic inspiratory training device (POWERbreathe K-5; Technologies Ltd, Birmingham, United Kingdom). Changes in respiratory muscle strength and rates of ICU survival and weaning success were compared between groups. Forty-eight participants in the inspiratory muscle training group and 53 ones in the control group were included in the final analysis. The inspiratory muscle training was associated with a substantially higher gain on muscle strength as assessed by the maximal inspiratory pressure (70.5 [51.0-82.5] vs -48.0 cm H2O [36.0-72.0 cm H2O]; p = 0.003) and the timed inspiratory effort index (1.56 [1.25-2.08] vs 0.99 cm H2O/s [0.65-1.71 cm H2O/s]; p = 0.001). Outcomes at the 60th day of ICU were significantly better in the intervention group regarding both survival (71.1% vs 48.9%; p = 0.030) and weaning success (74.8% vs 44.5%; p = 0.001). The use of an inspiratory muscle training program with an electronic resistive loading device was associated with substantial muscle strength gain and positive impacts in two very relevant clinical outcomes: the rates of ICU survival and successful weaning.

Inspiratory training and immediate lung recovery after resective pulmonary surgery: a randomized clinical trial.

BackgroundPrompt and uneventful recovery after resective pulmonary surgery benefits patients by decreasing length and total costs of hospital stay. Postoperative physiotherapy has been shown to be advantageous for patient recovery in several studies and lately inspiratory muscle training (IMT) physiotherapy has been used also in thoracic patients. This randomized controlled trial intended to evaluate whether IMT is an efficient and feasible method of physiotherapy compared to water bottle positive expiratory physiotherapy (PEP) immediately after lung resections.MethodsForty-two patients were randomly allocated into two intervention groups: water bottle PEP (n=20) and IMT group (n=22). Patients were given physiotherapeutic guidance once a day and patients were also instructed to do independent exercises. Measurements of pulmonary function were compared between the treatment groups according to intention to treat by using two-way repeated measures analysis of variances at three time points (preoperative, first postoperative day, and second postoperative day). Walking distance was measured at first and second postoperative day and similarly, evaluation of postoperative air leak during exercises was performed. Physiotherapy was modified or temporarily interrupted, if necessary, because of the air leak.ResultsPostoperative pulmonary function tests were equal between the intervention groups. Air leak was relatively common after lung resections: 31% of all patients had mild or moderate/severe air leak at first postoperative day and 14% of all patients had mild to severe air leak at second postoperative day respectively. There were no statistically significant differences in occurrence of air leak between intervention groups, but water resistance had to be reduced or physiotherapy discontinued significantly more often among the water bottle PEP group patients (P=0.01). Walking distance improved slightly faster in the IMT group between the first and the second postoperative day when compared to the water bottle PEP group, but the difference between the groups was not statistically significant.ConclusionsIMT physiotherapy is equally effective to water bottle PEP training in postoperative physiotherapy after lung resection surgery evaluated with pulmonary function tests and walking distance. In addition, IMT physiotherapy is safe and more feasible form of physiotherapy during postoperative air leak compared to water bottle PEP.

Inspiratory Muscle Training in Patients With Heart Failure: What Is New? Systematic Review and Meta-Analysis.

The benefits of inspiratory muscle training (IMT) have already been demonstrated in patients with heart failure (HF), but the best mode of training and which patients benefit from this intervention are not clear. The purpose of this study was to review the effects of IMT on respiratory muscle strength, functional capacity, pulmonary function, quality of life, and dyspnea in patients with HF; IMT isolated or combined with another intervention (combined IMT), the presence of inspiratory muscle weakness, training load, and intervention time were considered. The search included the databases MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Physiotherapy Evidence Database, and LILACS database through September 2019. The review included randomized studies that assessed IMT in isolation or combined with another intervention-in comparison with a control group, a placebo, or another intervention-in patients with HF. Fourteen studies were included, 13 for meta-analysis (10 for isolated IMT and 3 for combined IMT). Isolated IMT demonstrated an increase in maximal inspiratory pressure (MIP) (25.12cm H2O; 95% CI=15.29 - 34.95), 6-Minute Walk Test (81.18m; 95% CI=9.73 - 152.63), maximum oxygen consumption (12weeks: 3.75mL/kg/min; 95% CI=2.98 to 4.51), and quality of life (-20.68; 95% CI=-29.03 to -12.32). The presence of inspiratory muscle weakness, higher loads, and longer intervention times resulted in greater increases in MIP. IMT combined with another intervention demonstrated an increase only in MIP. Isolated IMT resulted in an increase in inspiratory muscle strength, functional capacity, and quality of life. IMT combined with another intervention resulted only in a small increase in inspiratory strength. Isolated IMT with higher loads can be considered an adjuvant intervention, especially for those who do not adhere to conventional rehabilitation and who have respiratory muscle weakness. A systematic review was necessary to review the effects of IMT on respiratory muscle strength, lung function, functional capacity, quality of life, and dyspnea in patients with HF. Various clinical issues important for a better training prescription were considered; these included whether the performance of the training IMT as a form of isolated training benefits patients with HF, whether the combination of IMT with another intervention has additional effects, whether any patient with HF can benefit from IMT (alone or combined with another intervention), and whether only patients who already have respiratory muscle weakness benefit. Also important was establishing which training load provides the best result and the best intervention time, so that health care can be provided more efficiently. For people with heart failure, IMT by itself, without being combined with other exercise, can improve ease of breathing, increase the amount of distance that they can walk, and improve quality of life. Inspiratory training with higher loads might be helpful for those with respiratory muscle weakness who are unable to do conventional exercise.

Inspiratory muscle training improves strength and health-related quality of life in hemodialysis patients

Background: Patients undergone hemodialysis (HD) suffer with energy-protein malnutrition, uremic myopathy and protein catabolism reducing their functional capacity, tolerance to exercise and aspects related to quality of life. Objective: The aim of this study was to evaluate the effects of the two protocols of inspiratory muscle training (IMT) on muscle strength, pulmonary function and related-health quality of life on male HD patients. Methods: Maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP), peak expiratory flow (PEF), forced expiratory volume in first second (FEV1 ), forced vital capacity (FVC) and the FEV1 /FVC ratio and quality of life were evaluated pre and post six months of IMT in HD patients. IMT was performed by one group using a specific training (Power breathe) device (T-IMT, n=19) and by the other with incentive spirometry (I-IMT, n= 15). Results: Following the inspiratory training, muscle strength improved in both groups. The group that used incentive spirometry had increments in MIP larger (39.8%, p&lt;0.001) than the group that trained with the specific training device (28.3%, p=0.001). The KDQOL-SF dimensions showed significant difference in the T-IMT group in cognitive function (p=0.03), sexual function (p=0.009) and social function dimensions (p=0.04) and in the I-IMT group in the physical function dimension (p=0.03). Conclusion: It was proved that IMT improved muscle strength and I-IMT promoted increments significantly larger in MIP. Aspects of health-related quality of life of HD male patients improved significantly with T-IMT (sexual, social and cognitive functions), while I-IMT ameliorated only physical function.

건장한 대 흡연 비흡연 남성의 흡기근 20 · 호흡 훈련이 폐기능에 미치는 영향

건장한 대 흡연 비흡연 남성의 흡기근 20 · 호흡 훈련이 폐기능에 미치는 영향

Effectiveness of inspiratory muscle training associated with a cardiac rehabilitation program on sympathetic activity and functional capacity in patients with heart failure: a study protocol for a randomized controlled trial

BackgroundIndividuals affected by heart failure (HF) may present fatigue, dyspnea, respiratory muscle weakness, and sympathetic activity hyperstimulation of the myocardium, among other symptoms. Conducting cardiac rehabilitation (CR) programs can be associated with inspiratory muscle training. The aim of this study was to evaluate the efficacy of inspiratory muscular training (IMT) associated with a CR program on modulating myocardial sympathetic activity and maximal functional capacity, submaximal functional capacity, thickness, and mobility of the diaphragm muscle in patients with HF.MethodsWe will conduct a clinical, controlled, randomized, double-blind trial that will include sedentary men and women who are 21–60 years old and who have diagnosed systolic HF and a left ventricular ejection fraction of less than 45%. Participants will be randomly assigned to one of two groups: experimental and control. The control group will follow the conventional CR protocol, and the experimental group will follow the conventional CR protocol associated with IMT 7 days a week. The two proposed exercise protocols will have a frequency of three times a week for a period of 12 weeks. The sympathetic innervation of the cardiac muscle, the maximum and submaximal functional capacity, diaphragm mobility and thickness, and the quality of life of the participants will be evaluated before and after the intervention protocol.DiscussionThis clinical trial will be the first study to investigate the additional effects of IMT on CR in sympathetic hyperstimulation in the myocardium. The results of this study will contribute to developing therapeutic strategies collaborating to elucidate whether the association of IMT with CR can induce clinical benefits for patients with HF.Trial registrationClinicalTrials.gov identifier: NCT02600000. Registered November 9, 2015. Retrospectively registered.