Intensity Inspiratory Muscle Training Research Articles

Characterization of Multiple Regimes of Cardiorespiratory Phase Synchronization in Athletes Undergoing Inspiratory Muscle Training.

Cardiorespiratory phase synchronization (CRPS) is defined as the stable occurrence of n heartbeats within m respiratory cycles according to the n:m phase locking ratio (PLR). Since CRPS is an intermittent phenomenon where different phase synchronization regimes and epochs of phase unlocking can alternate within the same recording, an index of CRPS ideally should assess all potential PLRs present in the recording. However, traditional approaches compute the synchronization index (SYNC%) over a single n:m PLR, namely the one that maximizes CRPS. In the present work, we tested a synchronization index assessing the total percentage of heartbeats coupled to the inspiratory onset regardless of phase locking regimes (SYNC%sum) and we compared its efficacy to the more traditional SYNC%. Analysis was carried out in a cohort of 25 male amateur cyclists (age: 20-40 yrs) undergoing inspiratory muscle training (IMT) at different intensities. CRPS was assessed before and after the IMT protocol, during an experimental condition known to modify CRPS, namely active standing (STAND). We found that after a moderate intensity IMT at 60% of the maximal inspiratory pressure, SYNC%sum could detect the decrease in CRPS following STAND. This result was not visible using the more traditional SYNC%. Therefore, we stress the significant presence of different phase locking regimes in athletes and the importance of accounting for multiple PLRs in CRPS analysis.Clinical Relevance- Multiple phase locking regimes contribute significantly to cardiorespiratory control in amateur cyclists especially after inspiratory muscle training of moderate intensity.

Physical Therapy and Rehabilitation Ideas for Inspiratory Muscle Training in Patients With Subacute Stroke

Objectives: This study aimed to elucidate the outcome of an Inspiratory Muscle Training (IMT) rehabilitation intervention on the lung function, functional mobilization, balance, and peripheral muscle strength of the paretic side in patients with subacute stroke. Methods: This double-blind, randomized controlled trial study was conducted on patients with stable subacute stroke. For 8 weeks, the intervention group (n=16) received 40% intensity IMT while the control group (n=16) received 10% intensity IMT. We assessed the patients’ lung function (spirometer) before and after the intervention, as well as their pulmonary muscle strength (micro-respiratory pressure meter [RPM]), quadriceps strength (handheld dynamometer), grip strength (Jamar), walking speed (10-m walk test), balance (Berg Balance Scale [BBS]), and functional mobilization (sit-to-stand test). Results: There were significant differences between the intervention group and the control group after IMT for forced vital capacity (FVC)% (P<0.01; d=3.20), forced expiratory volume in the first second (FEV1)/FVC (P<0.001; d=2.55), FEV1% (P<0.001; d=5.10), walking speed (P<0.05; d=1.62), hand grip (P<0.001; d=2.45), quadriceps strength (P<0.001; d=4.18), functional mobilization (P<0.01; d=2.41), and maximal inspiratory mouth pressure (P<0.001; d=1.62), but no significant changes were seen in balance (P=0.304; d=0.57). Discussion: IMT improved lung function, functional mobilization, handgrip strength, and quadriceps strength on the paretic side of subacute stroke patients and is expected to improve functional status and allow the patient to participate in social activities. IMT exercise can be included in the rehabilitation program for subacute stroke patients.

Influence of inspiratory muscle strength on exercise capacity before and after cardiac rehabilitation

Background/Aims Coronary artery bypass grafting is a complex procedure that triggers a series of clinical and functional complications. The reduction of inspiratory muscle strength that persists during the late postoperative period has been suggested as an important determinant of functional capacity after coronary artery bypass grafting. The aim of this study was to investigate whether inspiratory muscle strength, functional capacity and quality of life are determinants of exercise capacity before and after a short-term phase II cardiac rehabilitation programme in patients who have had coronary artery bypass graft surgery. Methods A prospective quasi-experimental study was undertaken with 20 patients who had recevied coronary artery bypass surgery. All patients completed a short-term, moderate-to-high intensity inspiratory muscle training programme, followed by aerobic and resistance exercise, two times a week for 12 weeks, totalling 24 sessions, under the direct supervision of a physical therapist. Results Pre-intervention, peak oxygen consumption (peak VO2) was associated with maximum inspiratory pressure (β=0.037; 95% confidence interval 0.01–0.06; P=0.002). Post-intervention, peak VO2 was associated with maximum inspiratory pressure (β=0.03; 95% confidence interval 0.007–0.053; P=0.014) and the 6-Minute Walk Test (β=0.007; 95% confidence interval, 0.001–0.013; P=0.024). Conclusions Inspiratory muscle strength influences exercise capacity before and after a short-term cardiac rehabilitation programme in patients who have had coronary artery bypass graft surgery.

Efeitos dos treinamentos de alta e de baixa intensidade da musculatura inspiratória na qualidade de vida de indivíduos com doença pulmonar obstrutiva crônica (DPOC) grave e desnutridos

OBJETIVO: Analisar efeitos do treinamento da musculatura inspiratória (TMI) na qualidade de vida (QV) de indivíduos com doença pulmonar obstrutiva crônica (DPOC) grave e desnutridos.MÉTODOS: Trata-se de um estudo clínico randomizado, cego, controlado e longitudinal. Foram avaliados 32 homens, divididos igualmente em dois grupos: G1, submetido ao TMI de alta intensidade e, G2, submetido ao de baixa intensidade, ambos durante 12 semanas. Avaliações do grau de dispneia, prova de função pulmonar, pressão inspiratória máxima (PImáx), distância percorrida (DP), Saint George Respiratory Questionnaire (SGRQ) e mobilidade diafragmática (MD) foram realizadas no pré-TMI, na 12ª semana de treinamento e na 24ª semana pós-TMI.RESULTADOS: Após 12 semanas de TMI, G1 apresentou aumentos significativos de ventilação voluntária máxima (VVM), PImáx, DP e MD, além de diminuição na escala Medical Research Council modificada (MRCm) e das porcentagens do SGRQ, que se mantiveram após 12 semanas do encerramento do treinamento. G2 apresentou o mesmo comportamento do G1 em 12 semanas de treinamento, porém, na 24ª semana pós-TMI, os valores de VVM, MRCm e MD voltaram aos iniciais, de PImáx e DP apresentaram abaixo da avaliação inicial e das porcentagens do SGRQ aumentaram significantemente. Na análise intergrupo da 12ª semana, G1 apresentou valores maiores de VVM, PImáx, DP e MD e valores menores nas porcentagens do SGRQ do que G2. Na 24ª semana, G2 apresentou valores menores de VVM, PImáx, DP e MD e maiores de MRCm e das porcentagens do SGRQ do que G1.CONCLUSÕES: Tanto TMI de alta, quanto de baixa intensidade proporcionaram melhora da QV dos indivíduos com DPOC grave e desnutridos, mas somente o treinamento de alta intensidade apresentou efeitos benéficos a longo prazo.

Effects of inspiratory muscle training on resting breathing pattern in patients with advanced lung disease

AimThe aim of this study was to evaluate the effects of interval high intensity inspiratory muscle training (IMT) on resting breathing pattern in patients with advanced lung disease. MethodsIMT was performed daily and training load set at 50 % of the maximal inspiratory pressure. Participants were evaluated at pre-IMT, post 8 weeks of IMT and follow-up (3 months after the end of IMT). Breathing pattern (volume and time variables as well as percentages of contribution to tidal volume) was evaluated by Optoelectronic Plethysmography at rest. Friedman test was used to verify the differences between the three time-points (p < 0.05). ResultsNineteen patients (54 ± 16 years old; 5 males) were evaluated at pre-IMT and post-IMT and fourteen were assessed at follow-up. There was no significant difference (p > 0.05) in any comparison for all evaluated breathing pattern variables at the three time-points. ConclusionResting breathing pattern was not significantly changed after 8 weeks of IMT in patients with advanced lung disease.

High Intensity Inspiratory Muscle Training In Individuals With Chronic Disease: A Systematic Review With Meta-analysis

High Intensity Inspiratory Muscle Training In Individuals With Chronic Disease: A Systematic Review With Meta-analysis

High intensity inspiratory muscle training (HI-IMT) in individuals referred for lung resection surgery

High intensity inspiratory muscle training (HI-IMT) in individuals referred for lung resection surgery

Short period of high-intensity inspiratory muscle training improves inspiratory muscle strength in patients with chronic kidney disease on hemodialysis: a randomized controlled trial

BackgroundChronic kidney disease is a complex disease that impacts multiple organs and systems (including musculoskeletal and cardiorespiratory) leading to reduction of functional capacity. ObjectiveThe aim of this study was to investigate the effect of a short period of high intensity inspiratory muscle training on maximum inspiratory pressure, functional capacity and endothelial function of chronic kidney disease patients on hemodialysis. MethodsThis randomized controlled trial enrolled 25 patients who were allocated into two groups: intervention (IMTG=14) and control (CG=11) groups. Intervention patients received the exercise protocol over a period of 5 weeks, 6 times per week, with each session consisting of 5 sets of 10 repetitions with an initial load of 50% progressing to 70% of maximum inspiratory pressure , measured weekly. The primary outcome was inspiratory muscle strength and the secondary outcomes were functional capacity and endothelial function evaluated before and after the training protocol. ResultsThe inspiratory muscle training induced a marked improvement in maximum inspiratory pressure which was evident after the training period (mean difference 19.0cmH2O – 95%CI 0.4–37.5; IMTG: 102±25.7cmH2O vs CG: 83±19.2; p=0.046). The magnitude of maximum inspiratory pressure improvement was 33.5% at the end of the protocol for the IMTG. Functional capacity and endothelial function did not vary between or within groups. ConclusionA short period of high-intensity inspiratory muscle training for five weeks was able to improve inspiratory muscle strength of chronic kidney disease patients on hemodialysis (ClinicalTrials.gov registration NCT03082404).

Moderate-to-high intensity inspiratory muscle training improves the effects of combined training on exercise capacity in patients after coronary artery bypass graft surgery: A randomized clinical trial

BackgroundThe effects of adding moderate-to-high intensity inspiratory muscle training (IMT) to short-term aerobic and resistance exercise (combined training [CT]), after coronary artery bypass grafting (CABG) are not established. This study aimed to determine the effects of moderate-to-high intensity IMT + CT on exercise capacity, respiratory muscle strength, inspiratory muscle endurance, quality of life (QoL), and laboratory biomarkers in patients after CABG who were participants of a phase II cardiac rehabilitation program. MethodsTwenty-four patients were randomly assigned to either the IMT + CT group (n = 12), who performed moderate-to-high intensity IMT with CT or the sham-IMT + CT group (n = 12). Patients completed two sessions per week for 12 weeks. Each patient underwent a cardiopulmonary exercise test, six-minute walk test (6MWT), respiratory muscle strength and endurance evaluation, QoL questionnaire, and serum advanced oxidation protein products, ferric reducing antioxidant power [FRAP], nitrate/nitrate, and high-sensitivity C-reactive protein, before and after the 12-week intervention. ResultsThe IMT + CT group showed significantly greater improvements in peak oxygen uptake (1.3 mL∙kg−1∙min−1; 95% confidence interval [95% CI], 0.5 to 2.2), distance covered during the 6MWT (78.8 m; 95% CI, 28.1 to 129.5), maximal inspiratory pressure (23.0 cmH2O; 95% CI, 9.3 to 36.7), QoL (−15.1 points; 95% CI, −26.9 to −3.3), and FRAP (83.7 μmol/L; 95% CI, 20.2 to 147.1) compared to the sham-IMT + CT group as a result of the intervention. ConclusionsShort-term moderate-to-high intensity IMT with CT provided additional benefits in exercise capacity, inspiratory muscle strength, QoL, and antioxidant profile in patients after CABG.Trial Registration clinicaltrials.gov Identifier: NCT02885077

Inspiratory muscle training does not improve clinical outcomes in 3-week COPD rehabilitation: results from a randomised controlled trial.

The value of inspiratory muscle training (IMT) in pulmonary rehabilitation in chronic obstructive pulmonary disease (COPD) is unclear. The RIMTCORE (Routine Inspiratory Muscle Training within COPD Rehabilitation) randomised controlled trial examined the effectiveness of IMT added to pulmonary rehabilitation.In total, 611 COPD patients (Global Initiative for Chronic Obstructive Lung Disease stage II-IV) received a 3-week inpatient pulmonary rehabilitation, of which 602 patients were included in the intention-to-treat analyses. The intervention group (n=300) received highly intensive IMT and the control group (n=302) received sham IMT. The primary outcome was maximal inspiratory pressure (PImax). The secondary outcomes were 6-min walk distance, dyspnoea, quality of life and lung function. Outcomes were assessed pre- and post-pulmonary rehabilitation. ANCOVA was used.The intervention group showed higher effects in PImax (p<0.001) and forced inspiratory volume in 1 s (p=0.013). All other outcomes in both study groups improved significantly, but without further between-group differences. Sex and pulmonary rehabilitation admission shortly after hospitalisation modified quality of life effects.IMT as an add-on to a 3-week pulmonary rehabilitation improves inspiratory muscle strength, but does not provide additional benefits in terms of exercise capacity, quality of life or dyspnoea. A general recommendation for COPD patients to add IMT to a 3-week pulmonary rehabilitation cannot be made.

Treino de músculos inspiratórios em indivíduos saudáveis: estudo randomizado controlado

Introduction – The inspiratory muscle training (IMT) emerges as an important intervention in people with COPD, but above all with a growing interest in the healthy population. However, there are not enough studies to prove if the inspiratory muscle training is also reflected in the improvement of the aerobic capacity objectified in oxygen consumption (VO 2 ). Therefore more investigation is relevant to understand the real relationship between IMT and its results on healthy people. Thus, it was considered appropriate to carry out a research study on healthy population that would allow assessing to what extent an inspiratory muscle training program induces changes in inspiratory muscular strength and aerobic capacity. Methods and analysis – The sample was based on healthy individuals ( n =19) between 18 and 21 years old who perform regular physical exercise (≥ 3 times a week or ≥ 4 hours per week). The aerobic capacity was estimated by the Ebbeling Test and inspiratory muscle strength was measured by the maximum inspiratory pressure (MIP) obtained by a specific dynamometer (MicroRPM ® ) at two different times (pre and post-workout). The above mentioned sample was randomly divided into two groups ( n =9 in the experimental group and n =10 in the control group). The experimental group (EG) was subjected to a high intensity IMT (≥50% Pi, max) while the control group (CG) didn´t go through any intervention. The IMT was performed by PowerBreathe Classic ® Level 1 and Level 2 that provides a consistent and specific pressure for inspiratory muscle strength regardless of the individual's inspiratory flow. Conclusions – After the training, there was a 37% increase in EG PIM while the CG showed an improvement of 7%. In intergroup comparison, both groups increased significantly both as MIP and VO 2 ( p <0.05). However, comparing both groups, the differences were significant for the PIM ( p =0.000), but not to VO 2 . Further studies are required to assess in which conditions IMT produces changes in aerobic capacity.

Effects of Inspiratory Muscle Training in Elderly Women on Respiratory Muscle Strength, Diaphragm Thickness and Mobility

Aging results in a decline in the function of the respiratory muscles. Inspiratory muscle training is emerging as a possible intervention to attenuate the decline of respiratory muscles in the elderly. The aim of this study was to evaluate the efficacy of inspiratory muscle training on respiratory strength, diaphragm thickness, and diaphragmatic mobility in elderly women. This was a controlled, randomized, and double-blind clinical trial, performed on 22 elderly women distributed in two groups, training (TG) and control (CG). Over an 8-week period a moderate intensity inspiratory muscle training protocol was followed in the TG, while CG followed a sham protocol. In addition maximum expiratory and inspiratory pressure, mobility of the diaphragm and diaphragmatic thickness were evaluated by ultrasound. After training, in TG maximal inspiratory pressure, maximal expiratory pressure, diaphragm thickness, and mobility increased by 37%, 13%, 11%, and 9% respectively, and their values were significantly higher than CG (p < .005, p = .013, p = .001, and p = .001). Inspiratory muscle training of moderate intensity improves respiratory muscle strength, diaphragm thickness, and diaphragm mobility in elderly women and it should be considered to minimize changes associated with senescence.

Lung Injury Prediction Models to Improve Perioperative Management

Lung Injury Prediction Models to Improve Perioperative Management

Postoperative pulmonary complications: An update on risk assessment and reduction

Postoperative pulmonary complications are common, serious, and expensive. Important predictors of risk are advanced age, poor health as assessed by American Society of Anesthesiologists class, and surgery near the diaphragm. Effective strategies to reduce risk include postoperative lung expansion techniques, preoperative intensive inspiratory muscle training, postoperative thoracic epidural analgesia, selective rather than routine use of nasogastric tubes, and laparoscopic rather than open bariatric surgery.

Reduction in pulmonary complications in high risk patients undergoing surgery for total hip replacement under general anesthesia by preoperative intensive inspiratory muscle training : A randomized controlled clinical trial

Objective To evaluate the effects of preoperative inspiratory muscle training (IMT) on the incidence of atelectasis in patients at high risk of postoperative pulmonary complications scheduled for elective total hip replacement surgery under general anesthesia. Methods Thirty two high-risk patients undergoing elective total hip replacement surgery under general anesthesia were chosen from Nanjing Medical University, Affiliated Nanjing First Hospital. In this single-blind randomized controlled clinical trial, patients were randomly assigned to receive preoperative inspiratory muscle training or conventional treatment (CT). The major effectiveness outcome variables were atelectasis and duration of postoperative hospitalization. Results Both groups were comparable prior to surgery. Seven patients in the CT group and 3 in the IMT group developed atelectasis ( P = 0.25). Median duration of postoperative hospitalization was 13 days (range, 10∼17 days) in the IMT group versus 16 days (range, 11∼23 days) in the CT group (Mann- Whitney U statistics, Z = −2.22, P = 0.03). Mean postoperative inspiratory pressure was 5% higher in the IMT group. Conclusion Preoperative intensive inspiratory muscle training appears to reduce the incidence of atelectasis and duration of postoperative hospitalization in patients at high risk of developing postoperative pulmonary complications who were scheduled for elective total hip replacement surgery under general anesthesia.

Inspiratory muscle training in adults with chronic obstructive pulmonary disease: An update of a systematic review

The purpose was to update an original systematic review to determine the effect of inspiratory muscle training (IMT) on inspiratory muscle strength and endurance, exercise capacity, dyspnea and quality of life for adults with chronic obstructive pulmonary disease (COPD). The original MEDLINE and CINAHL search to August 2003 was updated to January 2007 and EMBASE was searched from inception to January 2007. Randomized controlled trials, published in English, with adults with stable COPD, comparing IMT to sham IMT or no intervention, low versus high intensity IMT, and different modes of IMT were included. Nineteen of 274 articles in the original search met the inclusion criteria. The updated search revealed 17 additional articles; 6 met the inclusion criteria, all of which compared targeted, threshold or normocapneic hyperventilation IMT to sham IMT. An update of the sub-group analysis comparing IMT versus sham IMT was performed with 10 studies from original review and 6 from the update. Sixteen meta-analyses are reported. Results demonstrated significant improvements in inspiratory muscle strength (PI(max), PI(max) % predicted, peak inspiratory flow rate), inspiratory muscle endurance (RMET, inspiratory threshold loading, MVV), exercise capacity (Ve(max), Borg Score for Respiratory Effort, 6MWT), Transitional Dyspnea Index (focal score, functional impairment, magnitude of task, magnitude of effort), and the Chronic Respiratory Disease Questionnaire (quality of life). Results suggest that targeted, threshold or normocapneic hyperventilation IMT significantly increases inspiratory muscle strength and endurance, improves outcomes of exercise capacity and one measure of quality of life, and decreases dyspnea for adults with stable COPD.

Prevention of pulmonary complications after upper abdominal surgery by preoperative intensive inspiratory muscle training: a randomized controlled pilot study

Objective: To investigate the feasibility and effects of preoperative inspiratory muscle training on the incidence of atelectasis in patients at high risk of postoperative pulmonary complications scheduled for elective abdominal aortic aneurysm surgery. Design: Single-blind randomized controlled pilot study. Setting: Gelderse Vallei Hospital Ede, the Netherlands. Subjects: Twenty high-risk patients undergoing elective abdominal aortic aneurysm surgery were randomly assigned to receive preoperative inspiratory muscle training or usual care. Main measures: Effectiveness outcome variables were atelectasis, inspiratory muscle strength and vital capacity, and feasibility outcome variables were adverse effects and patient satisfaction with inspiratory muscle training. Results: Despite randomization, patients in the intervention group were significantly older than the patients in the control group (70 ± 6 years versus 59 ± 6 years, respectively; P = 0.001). Eight patients in the control group and three in the intervention group developed atelectasis (P = 0.07). The median duration of atelectasis was 0 days in the intervention group and 1.5 days in the control group (P = 0.07). No adverse effects of preoperative inspiratory muscle training were observed and patients considered that inspiratory muscle training was a good preparation for surgery. Mean postoperative inspiratory pressure was 10% higher in the intervention group. Conclusion: Preoperative inspiratory muscle training is well tolerated and appreciated and seems to reduce the incidence of atelectasis in patients scheduled for elective abdominal aortic aneurysm surgery.

Immune response to inspiratory muscle training in patients with chronic heart failure

The effects of inspiratory muscle training on plasma cytokines, C-reactive protein and the soluble apoptosis mediators Fas and Fas ligand in chronic heart failure are unknown. Thirty-eight patients with chronic heart failure, age 57+/-2 years, New York Heart Association classification II-III, were assigned to either a high intensity training group (n=15, age 53+/-2 years) exercised at 60% of sustained maximal inspiratory pressure, or a low intensity training group (n=23, age 59+/-2 years), exercised at 15% of sustained maximal inspiratory pressure, three times per week for 10 weeks. Patients in the high intensity training group and low intensity training group were matched for age, sex and New York Heart Association functional class. Plasma levels of tumor necrosis factor (TNF)-alpha, soluble TNF receptor I, interleukin-6, C-reactive protein, soluble apoptosis mediators Fas and Fas ligand were measured at baseline and at post-inspiratory muscle training. Pulmonary function was assessed by spirometry, exercise capacity by a cardiopulmonary exercise test and the 6 min walk test, whereas dyspnea by the Borg scale after the 6 min walk test. High intensity training group improved inspiratory muscle strength (105.1+/-4.9 vs. 79.8+/-4.7 cmH2O, P<0.001), sustained maximal inspiratory pressure (504.5+/-39.7 vs. 312.5+/-26.5 cmH2O/s/10, P<0.001), forced vital capacity (98.9+/-3.9 vs. 96+/-3.3%, P<0.05), peak VO2 (19.4+/-1.2 vs. 17.3+/-0.9 ml/kg per min, P<0.01), 6 min walk test distance (404.3+/-11.9 vs. 378.2+/-10.4 m, P<0.01) and dyspnea (8.0+/-0.4 vs. 9.2+/-0.4, P<0.01). Circulating TNF-alpha, soluble TNF receptor I, interleukin-6, C-reactive protein, soluble apoptosis mediators Fas and Fas ligand were not significantly altered. Low intensity training group increased only the inspiratory muscle strength (90.3+/-5.9 vs. 80.2+/-5 cmH2O, P<0.01). Comparison between groups was significant for soluble TNF receptor I change (high intensity training group, 5.8+/-0.49 vs. 6.1+/-0.42; low intensity training group, 8.4+/-0.6 vs. 7.8+/-0.6, P<0.01). A high intensity inspiratory muscle training program resulted in improvement in functional status of chronic heart failure patients compared with low intensity inspiratory muscle training. Improvement in exercise capacity was not associated with an anti-inflammatory effect, although a beneficial influence on soluble TNF receptor I was recorded. Possible reasons include inadequate level of muscle mass exercise and the low pretraining New York Heart Association class.

Preoperative Intensive Inspiratory Muscle Training to Prevent Postoperative Pulmonary Complications in High-Risk Patients Undergoing CABG Surgery

Postoperative pulmonary complications (PPCs) after coronary artery bypass graft (CABG) surgery are a major source of morbidity and mortality, and increase length of hospital stay and resource utilization. The prehospitalization period before CABG surgery may be used to improve a patient's pulmonary condition. The efficacy of preoperative inspiratory muscle training (IMT) in reducing the incidence of PPCs in high-risk patients undergoing CABG surgery has not yet been determined. To evaluate the prophylactic efficacy of preoperative IMT on the incidence of PPCs in high-risk patients scheduled for elective CABG surgery. A single-blind, randomized clinical trial conducted at the University Medical Center Utrecht, Utrecht, the Netherlands, with enrollment between July 2002 and August 2005. Of 655 patients referred for elective CABG surgery, 299 (45.6%) met criteria for high risk of developing PPCs, of whom 279 were enrolled and followed up until discharge from hospital. Patients were randomly assigned to receive either preoperative IMT (n = 140) or usual care (n = 139). Both groups received the same postoperative physical therapy. Incidence of PPCs, especially pneumonia, and duration of postoperative hospitalization. Both groups were comparable at baseline. After CABG surgery, PPCs were present in 25 (18.0%) of 139 patients in the IMT group and 48 (35.0%) of 137 patients in the usual care group (odds ratio [OR], 0.52; 95% confidence interval [CI], 0.30-0.92). Pneumonia occurred in 9 (6.5%) of 139 patients in the IMT group and in 22 (16.1%) of 137 patients in the usual care group (OR, 0.40; 95% CI, 0.19-0.84). Median duration of postoperative hospitalization was 7 days (range, 5-41 days) in the IMT group vs 8 days (range, 6-70 days) in the usual care group by Mann-Whitney U statistic (z = -2.42; P = .02). Preoperative IMT reduced the incidence of PPCs and duration of postoperative hospitalization in patients at high risk of developing a pulmonary complication undergoing CABG surgery. isrctn.org Identifier: ISRCTN17691887.