Resistive Inspiratory Muscle Training Research Articles

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.

Predictors of positive outcomes following resistive inspiratory muscle training in non-ambulatory persons with advanced multiple sclerosis.

BackgroundInspiratory muscle training (IMT) using a threshold device improves inspiratory muscle strength. What factors influence the IMT outcome has not been examined.ObjectiveTo identify predictors of the positive outcome following IMT in persons with advanced multiple sclerosis (PwAMS).MethodsInclusion criteria were non-ambulatory PwAMS, Expanded Disability Status Scale (EDSS) ≥6.5, age >18 years, no acute medical conditions, current non-smokers, and ability to consent. Participants (n = 38) performed daily inspiratory exercises using a resistive threshold device for 10 weeks. Baseline measurements included age, sex, body mass index, year post multiple sclerosis diagnosis, comorbidities, EDSS, Modified Fatigue Impact Scale-5, and oral Symbol Digit Modality Test. The percentage of completed prescribed exercise trials (Trials%) during the 10-week intervention was calculated. Age- and sex-adjusted predicted values of maximum inspiratory pressure (MIP%pred) and maximum expiratory pressure (MEP%pred) were obtained before and after the 10-week intervention. Backward multivariable regression analyses for the primary outcome (MIP%pred) were conducted.ResultsAfter controlling for the initial MIP%pred, perceived fatigue at the baseline and Trial% were significant and independent predictors of MIP%pred after IMT.ConclusionLess fatigue at the baseline and higher adherence to the prescribed exercise repetitions were positive predictors of the positive outcome following IMT in PwAMS.

Effect of 4 weeks resistive inspiratory muscle training on respiratory functions in patients with tetraplegia during in-patient rehabilitation

There is reduction in lung compliance in first week after spinal cord injury (SCI) that deteriorates further and neuroprotective therapies like strength training of respiratory muscles should begin in first month after SCI since both motor and sensory scores at baseline and their further recovery is maximum during this phase. Few studies on SCI subjects within first month of injury have supported use of resistive inspiratory muscle training (RIMT), but have advocated the need for further research in this patient population owing to pitfalls in these studies. The present study was a prospective randomized control trial being carried out to determine whether RIMT programme of four weeks duration is effective in improving respiratory functions and strength in motor complete cervical SCI patients (AIS grade A, B) during in-patient rehabilitation. Patients within first week of cervical SCI (C4-C7 level) were assigned to RIMT (48 patients) and Control (48 patients) group and completed 40 supervised training sessions over a period of four weeks. Outcome measures included: - Spirometry, inspiratory and expiratory muscle strength. No significant differences of Chi-square test (P < 0.05) and unpaired “t” test (P < 0.05) were found between RIMT and Control group for all demographic and pre-training measurements. Following results were recorded after 2 weeks and 4 weeks of training on all outcome measures: - Highly significant difference (P<0.01) within both groups with One–way ANOVA; Highly significant difference (P<0.01) with unpaired “t-test” between RIMT and control group. Cohen “d” effect sizes for RIMT vs. Control group were in large effect size zone i.e. greater than 0.8. The findings of present study show beneficial effect of RIMT on respiratory functions and strength in patients with tetraplegia in first month post injury and we propose that RIMT should be included early in acute phase rehabilitation of these patients.

저항성 들숨근 훈련이 뇌졸중 환자의 호흡기능에 미치는 영향

저항성 들숨근 훈련이 뇌졸중 환자의 호흡기능에 미치는 영향

A flow resistive inspiratory muscle training mask worn during high-intensity interval training does not improve 5\xa0km running time-trial performance

PurposeThere is little evidence of the ergogenic effect of flow-resistive masks worn during exercise. We compared a flow-resistive face mask (MASK) worn during high-intensity interval training (HIIT) against pressure threshold loading inspiratory muscle training (IMT).Methods23 participants (13 males) completed a 5 km time trial and six weeks of HIIT (3 sessions weekly). HIIT (n = 8) consisted of repeated work (2 min) at the speed equivalent to 95% {dot{text{V}}}O2 peak with equal rest. Repetitions were incremental (six in weeks 1, 2 and 6, eight in weeks 3 and 4 and ten in week 5). Participants were allocated to one of three training groups. MASK (n = 8) wore a flow-resistive mask during all sessions. The IMT group (n = 8) completed 2 × 30 breaths daily at 50% maximum inspiratory pressure (PImax). A control group (CON, n = 7) completed HIIT only. Following HIIT, participants completed two 5 km time trials, the first matched identically to pre-intervention trial (ISO time), and a self-paced effort.ResultsTime trial performance was improved in all groups (MASK 3.1 ± 1.7%, IMT, 5.7 ± 1.5% and CON 2.6 ± 1.0%, p < 0.05). IMT improved greater than MASK and CON (p = 0.004). Post intervention, PImax and diaphragm thickness were improved in IMT only (32% and 9.5%, respectively, p = 0.003 and 0.024).ConclusionA flow-resistive mask worn during HIIT provides no benefit to 5 km performance when compared to HIIT only. Supplementing HIIT with IMT improves respiratory muscle strength, morphology and performance greater than HIIT alone.

A comparative study of Effectiveness between Diaphragmatic Breathing and Resistive Inspiratory Muscle Training on Pulmonary Functions (ERV) during Pregnancy

A comparative study of Effectiveness between Diaphragmatic Breathing and Resistive Inspiratory Muscle Training on Pulmonary Functions (ERV) during Pregnancy

A Comparison between Two Types of Resistive Inspiratory Muscle Training Devices in Normal Subjects in Regards to Pulmonary Functions

Introduction: Inspiratory muscle training (IMT) devices improve respiratory muscle strength, endurance and exercise capacity on healthy subjects. Because of the limited availability of the effect of IMT devices on healthy subjects with minimal activity level, this study was conducted to evaluate the effects of POWERbreath-plus® and Threshold IMT® on healthy subjects by measuring pre and post Maximal inspiratory pressure (MIP), Maximal expiratory pressure (MEP), Peak Expiratory Flow Rate (PEFR) and Mandatory Voluntary Ventilation (MVV) and to compare their effectiveness. Method: In this quantitative comparative pilot study, 17 female subjects from Imam Abdulrahman Bin Faisal University were randomly assigned into four weeks of IMT program and were distributed into three groups Threshold Group (TG) (n=5), POWERbreath-plus Group (PG) (n=7) and Control Group (CG) (n=5). MIP, MEP, PEFR, MVV were measured prior and following training. Subjects were taught to use the device twice daily with 30 repetitions at 60% of their MIP at the first two weeks with gradual increase by 10% for the remaining two weeks, until reaching load of 80% of MIP. Results: MIP was improved significantly in both, TG and PG (p=0.005 and p=0.006, respectively), while no change was noticed in CG. For MEP, both TG and PG improved significantly with a p-value of (p=0.034 and p=0.208, respectively) while no improvements were observed in CG. PEFR proved to be significantly increased in PG (p=0.012), while there was no improvement in TG and CG. MVV showed improvement in both, TG and PG (p=0.023 and p=0.006, respectively), while no change was noticed in CG. Regarding MNOVA test, Threshold IMT® device shows to be superior to POWERbreath-plus® in increasing MIP significantly (p=0.000). Conclusion: In conclusion, this study suggests that Threshold IMT® and POWERbreath-plus® devices improve MIP and MVV, however, threshold devices may have the superiority in improving MIP but still more studies are needed.

Respiratory muscle training for multiple sclerosis.

Multiple sclerosis (MS) is a chronic disease of the central nervous system, affecting approximately 2.5 million people worldwide. People with MS may experience limitations in muscular strength and endurance - including the respiratory muscles, affecting functional performance and exercise capacity. Respiratory muscle weakness can also lead to diminished performance on coughing, which may result in (aspiration) pneumonia or even acute ventilatory failure, complications that frequently cause death in MS. Training of the respiratory muscles might improve respiratory function and cough efficacy. To assess the effects of respiratory muscle training versus any other type of training or no training for respiratory muscle function, pulmonary function and clinical outcomes in people with MS. We searched the Trials Register of the Cochrane Multiple Sclerosis and Rare Diseases of the Central Nervous System Group (3 February 2017), which contains trials from the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, CINAHL, LILACS and the trial registry databases ClinicalTrials.gov and WHO International Clinical Trials Registry Platform. Two authors independently screened records yielded by the search, handsearched reference lists of review articles and primary studies, checked trial registers for protocols, and contacted experts in the field to identify further published or unpublished trials. We included randomized controlled trials (RCTs) that investigated the efficacy of respiratory muscle training versus any control in people with MS. One reviewer extracted study characteristics and study data from included RCTs, and two other reviewers independently cross-checked all extracted data. Two review authors independently assessed risk of bias with the Cochrane 'Risk of bias' assessment tool. When at least two RCTs provided data for the same type of outcome, we performed meta-analyses. We assessed the certainty of the evidence according to the GRADE approach. We included six RCTs, comprising 195 participants with MS. Two RCTs investigated inspiratory muscle training with a threshold device; three RCTs, expiratory muscle training with a threshold device; and one RCT, regular breathing exercises. Eighteen participants (˜ 10%) dropped out; trials reported no serious adverse events.We pooled and analyzed data of 5 trials (N=137) for both inspiratory and expiratory muscle training, using a fixed-effect model for all but one outcome. Compared to no active control, meta-analysis showed that inspiratory muscle training resulted in no significant difference in maximal inspiratory pressure (mean difference (MD) 6.50 cmH2O, 95% confidence interval (CI) -7.39 to 20.38, P = 0.36, I2 = 0%) or maximal expiratory pressure (MD -8.22 cmH2O, 95% CI -26.20 to 9.77, P = 0.37, I2 = 0%), but there was a significant benefit on the predicted maximal inspiratory pressure (MD 20.92 cmH2O, 95% CI 6.03 to 35.81, P = 0.006, I2 = 18%). Meta-analysis with a random-effects model failed to show a significant difference in predicted maximal expiratory pressure (MD 5.86 cmH2O, 95% CI -10.63 to 22.35, P = 0.49, I2 = 55%). These studies did not report outcomes for health-related quality of life.Three RCTS compared expiratory muscle training versus no active control or sham training. Under a fixed-effect model, meta-analysis failed to show a significant difference between groups with regard to maximal expiratory pressure (MD 8.33 cmH2O, 95% CI -0.93 to 17.59, P = 0.18, I2 = 42%) or maximal inspiratory pressure (MD 3.54 cmH2O, 95% CI -5.04 to 12.12, P = 0.42, I2 = 41%). One trial assessed quality of life, finding no differences between groups.For all predetermined secondary outcomes, such as forced expiratory volume, forced vital capacity and peak flow pooling was not possible. However, two trials on inspiratory muscle training assessed fatigue using the Fatigue Severity Scale (range of scores 0-56 ), finding no difference between groups (MD, -0.28 points, 95% CI-0.95 to 0.39, P = 0.42, I2 = 0%). Due to the low number of studies included, we could not perform cumulative meta-analysis or subgroup analyses. It was not possible to perform a meta-analysis for adverse events, no serious adverse were mentioned in any of the included trials.The quality of evidence was low for all outcomes because of limitations in design and implementation as well as imprecision of results. This review provides low-quality evidence that resistive inspiratory muscle training with a resistive threshold device is moderately effective postintervention for improving predicted maximal inspiratory pressure in people with mild to moderate MS, whereas expiratory muscle training showed no significant effects. The sustainability of the favourable effect of inspiratory muscle training is unclear, as is the impact of the observed effects on quality of life.

COMPARING THE EFFECT OF RESISTIVE INSPIRATORY MUSCLE TRAINING AND INCENTIVE SPIROMETRY ON RESPIRATORY PATTERN OF COPD PATIENTS

Background: Resistive Inspiratory Muscle Training (RIMT) is a well-known technique for rehabilitation of patients with Chronic Obstructive Pulmonary Disease (COPD). Incentive spirometry is another technique with potential viability for this application, but there is limited evidence in support of its efficacy in the rehabilitation of COPD patients. Aim: The objective of this study was to compare the effect ofresistive inspiratory muscle training and incentive spirometry on respiratory pattern of COPD patients. Method: This study was a randomized clinical trial on 30 patients with moderate COPD who were referred, in 2011, to the pulmonary clinic of Emamreza Hospital of Mashhad (Iran). The patients were randomly divided into the RIMT and the IS treatment group. In both groups, exercise regimen consisted of two 15-minute sessions of exercise per day, in the morning and evening, four days a week for 4 weeks. Respiratory pattern (respiratory rate and depth) and dyspnea (at rest and during activity) were measured before and after exercise. Data was analyzed with the Mann-Whitney and ratio difference tests using SPSS v.11.5. Results: The average age was 50.8±10.7 in the IS group and 51±10.8 in the RIMT group. The statistical tests found no significant difference between the groups in terms of post-intervention exertional dyspnea, dyspnea at rest, tidal volume, and respiratory rate (P>0.05); but post-intervention maximal inspiratory pressure and maximal voluntary ventilation in the two groups were found to be significantly different (P <0.05). Implications for Practice: despite statistically superior performance of resistive training in improving the maximal voluntary ventilation and maximal inspiratory pressure, the difference between its results and the results of incentive spirometry is not clinically important, therefore positive clinical outcomes of incentive spirometry are sufficiently significant to encourage its use in COPD rehabilitation programs.

NU05.01 Use of Inspiratory Muscle Training in Managing Dyspnoea in Lung Cancer Patients

NU05.01 Use of Inspiratory Muscle Training in Managing Dyspnoea in Lung Cancer Patients

Respiratory Muscle Training Improves Dyspnea and Exercise Performance in Cancer Survivors

It is estimated that up to 70% of survivors experience dyspnea at some point in their recovery. Dyspnea is correlated with functional performance (6 minute walk test, 6MWT) and peak exercise (VO2PEAK), both of which predict survival in lung cancer. Respiratory muscle weakness represents one of the primary mechanisms contributing to exertional dyspnea and reduced exercise performance in cancer survivors. Respiratory muscle training (RMT) protocols have been used to reduce dyspnea in patients with non-malignant lung disease; however, no studies have explored respiratory muscle training to alleviate dyspnea in cancer survivors. PURPOSE: Implement a RMT program to reduce the sensation of dyspnea, as well as to improve exercise capacity, functional performance and QoL in breast and lung cancer survivors. METHODS: Eight participants who have completed all therapies (57.3 ± 6.8 years) performed RMT, 3 sets of 15 repetitions against spring loaded inspiratory and expiratory valves, 3 days/week, for 4 weeks. Pre- and Post-RRMT, subjects performed maximal expiratory (MEP) and inspiratory pressures (MIP), exercise tests (VO2Peak, sub-maximal cycling endurance at 70% of peak and 6MWT) and questionnaires related to dyspnea (Baseline Dyspnea Index) and quality of life (SF-36). RESULTS: Four breast and four lung cancer survivors completed the protocol (mean years ± SD from treatment = 4.1±3.0). At baseline, FVC and FEV1 were 80.3±18.5 and 77.2±18.2% of predicted. MIP and MEP were 51.8±20.0% and 94.8±19.2% of predicted. Post-RMT, MIP and MEP increased 26.5±21.2% and 40.1±32.7%, respectively (p<0.005). Time to peak (8.5±3.5 min vs. 10.1±3.2 min, p=0.015) and submaximal endurance (16.5±7.7 vs. 32.4±8.7 min, p=0.007) exercise and the distance covered in the 6MWT (414±91 m vs. 441±97 m, p=0.03) were all significantly longer. Finally, baseline dyspnea index (p=0.02) and quality of life (p=0.04) improved post-RMT. CONCLUSION: These results suggest that a progressive resistance inspiratory and expiratory respiratory muscle training program helps to improve respiratory muscle strength, the sensation of dyspnea, as well as exercise performance and QoL in cancer survivors.

The effect of resistance inspiratory muscle training in the management of breathlessness in patients with thoracic malignancies: a feasibility randomised trial.

Breathlessness in patients with lung cancer is a common and distressing symptom affecting 50-70 % of patients, rising to some 90 % for those with advanced lung cancer. The aim of the current study was to assess how feasible inspiratory muscle training (IMT) is in the lung cancer population and explore changes in outcome variables. A pilot feasibility randomised trial was conducted in patients with clinically stable lung cancer. The experimental group received training using a pressure threshold device. Patients were instructed to carry out five IMT sessions weekly for 12 weeks for a total of 30 mins/day. Patients in the control group received standard care. Outcome measures were completed at baseline and monthly for 3 months, and included: physiological parameters (FEV1, FVC); perceived severity of breathlessness using six 10-point NRS; modified Borg Scale; quality of life using the short form Chronic Respiratory Disease Questionnaire; Hospital Anxiety and Depression Scale, and safety. Forty-six patients (M = 37, F = 9) at a mean age of 69.5 years old and a mean of 16 months post-diagnosis who were not currently receiving chemotherapy and/or radiotherapy were recruited. Seventy-percent had NSCLC and advanced disease. Statistical (area under the curve-AUC) and clinically important differences were seen with regard to distress from breathlessness (p = 0.03), ability to cope with breathlessness (p = 0.01), satisfaction with breathlessness management (p = 0.001), fatigue (p = 0.005), emotional function (p = 0.011), breathlessness mastery (p = 0.015) and depression (p = 0.028). The m-Borg difference between the two groups at 3 months was 0.80, which is borderline clinically significant. Changes were more evident in the 3-month assessment where the effect of the intervention came to its peak. This trial shows the IMT is feasible and potentially effective in patients with lung cancer. These findings warrant a fully powered larger randomised controlled trial.

Resistive inspiratory muscle training in people with spinal cord injury during inpatient rehabilitation: a randomized controlled trial.

People with spinal cord injury (SCI) may benefit from resistive inspiratory muscle training (RIMT). Current evidence is weak, and little is known about the effect on functional outcomes and long-term effects. The purpose of this study was to assess immediate and long-term effects of RIMT in people with SCI. This was a single-blinded randomized controlled trial. The study was conducted at 4 specialized SCI units in the Netherlands. The study participants were 40 people with SCI (15 with motor complete tetraplegia, 16 with incomplete tetraplegia, 8 with motor complete paraplegia, and 1 with incomplete paraplegia) who had impaired pulmonary function and were admitted for initial inpatient rehabilitation. Study participants were randomized to an RIMT group or a control group. All participants received usual rehabilitation care. In addition, participants in the intervention group performed RIMT with a threshold trainer. Measurements were performed at baseline, after 8 weeks of intervention, 8 weeks later, and 1 year after discharge from inpatient rehabilitation. Primary outcome measures were: respiratory muscle function, lung volumes and flows, and perceived respiratory function. Secondary outcome measures concerned patient functioning, which included health-related quality of life, limitations in daily life due to respiratory problems, and respiratory complications. During the intervention period, maximum inspiratory pressure (MIP) improved more in the RIMT group than in the control group (11.7 cm H2O, 95% confidence interval=4.3 to 19.0). At follow-up, this effect was no longer significant. No effect on other primary or secondary outcome measures was found except for an immediate effect on mental health. The sample size was insufficient to study effects on respiratory complications. Resistive inspiratory muscle training has a positive short-term effect on inspiratory muscle function in people with SCI who have impaired pulmonary function during inpatient rehabilitation.

Inspiratory Muscle Performance Following Diaphragmatic Resistance Training in Healthy Adults

Background: Diaphragmatic weight training has been found to be as effective as resistive inspiratory muscle training and better than the incentive spirometry training in patients with tetraplegia for improving respiratory muscle function. However a previous research concluded no improvement in inspiratory muscle functions among healthy subjects following diaphragmatic weight training. The present study was conducted to know the effects of diaphragmatic weight training on inspiratory muscle performance in healthy adults. Methods: Study had between- subject experimental design. 20 subjects (8 males and 12 females), having mean age 21.1 + 0.7182 yrs., were randomly allocated into two groups. Group A was experiment and Group B was control group. Diaphragmatic resistance training was given to the experimental groups for 5 weeks. Control group was not given any kind of training. Data for vital capacity and inspiratory capacity was recorded from each subject of both the groups (experimental and control) at baseline as well as after 5 weeks. Data analysis and Results: Dependent t-test was used for within group comparison. Independent ttest was used for comparison between group A and B. Highly significant improvement in vital capacity and inspiratory capacity was found (p=.000 and p=.000 respectively) in experimental group as compared to control group. Conclusion: Diaphragmatic resistance training improves vital capacity and inspiratory capacity.

Abstract 4: Improvement of Scoliosis and Pulmonary Function After Resistive Inspiratory Muscle Training in Patients With Spinal Cord Injury

Objective: To determine whether scoliosis and pulmonary function can be improved by resistive inspiratory muscle training in patients with spinal cord injury (SCI) with scoliosis. Design: Matched case-control study, before and after trial. Setting: Hospital affiliated with university. Participants: 46 patients with SCI with scoliosis were assigned to the experimental group (n=23) or to the control group (n=23). Intervention: Patients in the experimental group participated in an 8-week resistive inspiratory muscle training program for 15 minutes twice daily. But patients in the control group did not undergo resistive inspiratory muscle training. Main Outcome Measures: Before the training and at the end of 8-week training, scoliotic angles were measured by Cobb’s method. Pulmonary functions were evaluated by measuring vital capacity (VC), tidal volume (Vt), maximum insufflation capacity (MIC), forced expiratory volume at the first second (FEV1), maximum inspiratory pressure (MIP), and maximum expiratory pressure (MEP). Scoliotic angles and parameters of pulmonary function were analyzed and compared between 2 groups before and after training. Results: Scoliotic angles were significantly improved after training in the experimental group (P<.05), but not in the control group. VC, Vt, MIC, FEV1, MIP, and MEP were significantly improved after training in the experimental group (P<.05), but not in the control group. In the experimental group, the improvements of pulmonary functions after training were related to the improvements of scoliotic angles (P<.05). Conclusions: Our findings suggest that scoliosis and pulmonary function can be improved by regular resistive inspiratory muscle training in patients with SCI with scoliosis.

Resistive inspiratory muscle training in sleep-disordered breathing of traumatic tetraplegia

Wang T-G, Wang Y-H, Tang F-T, Lin K-H, Lien I-N. Resistive inspiratory muscle training in sleep-disordered breathing of traumatic tetraplegia. Arch Phys Med Rehabil 2002;82:491-6. Objective: To assess the effect of resistive inspiratory muscle training (RIMT) on the static pulmonary function and sleep-induced breathing disorder of individuals with chronic cervical cord injury. Design: Before-after training. Setting: Home-setting training program. Patients: Fourteen complete traumatic tetraplegic patients (12 men, 2 women; mean age, 41.1 ± 14y; range, 19-56y) injured for more than 6 months. Intervention: Subjects participated in a 6-week RIMT program for 15 minutes twice daily at a training intensity of 60% of maximum inspiratory pressure (MIP). The participants were reevaluated at the end of 6-week training. Main Outcome Measures: Lung volume, peak expiratory flow (PEF), MIP, and maximum expiratory pressure (MEP) were measured by using a spirometry and inspiratory force meter, respectively. Capnography was used to monitor nocturnal pulse oxyhemoglobin saturation (SpO2) and end-tidal carbon dioxide tension level (ETCO2) of the patients. Results: The maximum voluntary ventilation (MVV) and MIP of individuals with chronic cervical cord injury substantially improved after RIMT. MIP increased from −68.7 ± 27.4cmH2O to −77.3 ± 24.0cmH2O and MVV rose from 62.7 ± 33.2L to 73.4 ± 31.3L (P <.05). Despite increasing from 3.5 ± 1.8L/s to 4.0 ± 1.7L/s, PEF was statistically insignificant. For the individuals with improved MIP, the duration of ETCO2 greater than 48mmHg reduced from 2.2% ± 3.3% to 1.0% ± 2.0% of total sleep time (P =.05) and that of SpO2 less than 90% significantly declined from 1.8% ± 2.8% to 1.3% ± 2.4% of total sleep time (P <.05). Conclusion: These findings suggest that RIMT can enhance the respiratory muscle strength and endurance of chronic tetraplegia and further ameliorate the sleep-induced breathing disorder. Therefore, RIMT is suggested as a home program for patients with sleep-disordered breathing. © 2002 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation

Resistive Inspiratory Muscle Training Improves Inspiratory Muscle Strength in Subjects with Cervical Spinal Cord Injury

Resistive Inspiratory Muscle Training Improves Inspiratory Muscle Strength in Subjects with Cervical Spinal Cord Injury

Inspiratory muscle training improves rowing performance.

To investigate the effects of a period of resistive inspiratory muscle training (IMT) upon rowing performance. Performance was appraised in 14 female competitive rowers at the commencement and after 11 wk of inspiratory muscle training on a rowing ergometer by using a 6-min all-out effort and a 5000-m trial. IMT consisted of 30 inspiratory efforts twice daily. Each effort required the subject to inspire against a resistance equivalent to 50% peak inspiratory mouth pressure (PImax) by using an inspiratory muscle training device. Seven of the rowers, who formed the placebo group, used the same device but performed 60 breaths once daily with an inspiratory resistance equivalent to 15% PImax. The inspiratory muscle strength of the training group increased by 44 +/- 25 cm H2O (45.3 +/- 29.7%) compared with only 6 +/- 11 cm H2O (5.3 +/- 9.8%) of the placebo group (P < 0.05 within and between groups). The distance covered in the 6-min all-out effort increased by 3.5 +/- 1.2% in the training group compared with 1.6 +/- 1.0% in the placebo group (P < 0.05). The time in the 5000-m trial decreased by 36 +/- 9 s (3.1 +/- 0.8%) in the training group compared with only 11 +/- 8 s (0.9 +/- 0.6%) in the placebo group (P < 0.05). Furthermore, the resistance of the training group to inspiratory muscle fatigue after the 6-min all-out effort was improved from an 11.2 +/- 4.3% deficit in PImax to only 3.0 +/- 1.6% (P < 0.05) pre- and post-intervention, respectively. IMT improves rowing performance on the 6-min all-out effort and the 5000-m trial.

Exercise training in heart failure: recommendations based on current research.

A review of methods used for exercise training in stable chronic heart failure patients (CHF) shows a lack of standardization to guide prescription. Previous recommendations have been adopted from fitness training or rehabilitation studies. A model for use in CHF patients requires specific guidelines which respect the various manifestations of this illness. Pathology and exercise tolerance of patients with CHF allow only a few selected activities to be performed, such as walking and cycle ergometer training. Although the steady state method has usually been applied for aerobic exercise, the interval method has been shown to cause greater exercise stimuli to peripheral muscle than that obtained during steady state training methods without inducing greater cardiovascular stress. There is no consensus at present as to an optimal parameter for measuring intensity. An intensity of 40-80% peak oxygen consumption (VO(2)) has been applied successfully. A heart rate reserve of 60-80% or 75% of peak heart rate was used as a guide to exercise intensity without consideration of the impaired force-frequency relationship in myocardial performance. Because intensity, duration, and frequency of exercise are closely interrelated, initial exercise should be kept at 40-50% peak VO(2) with exercise duration of > 3-5 min x session performed several times daily. Progression should be followed in this order: duration, then frequency, then intensity. Resistance training can be recommended when small muscle groups are involved, using short bouts of work phases and small numbers of repetitions. To increase respiratory muscle strength and endurance, resistive inspiratory muscle training at intensity 25--35% maximum inspiratory pressure, and performed 20-30 min x d(-1), is recommended. On the basis of currently available research, supervised inpatient training programs should be preferred. Future research should be performed with respect on statistically sufficient, randomized, and controlled long-term studies that compare different training modes, intensities, frequency/duration ratios, and rates of progression.

Resistive inspiratory muscle training: Its effectiveness in patients with acute complete cervical cord injury

Objective: To evaluate if resistive inspiratory muscle training (RIMT) can improve lung function in patients with complete tetraplegia within half a year after trauma.Design: A prospective study. The experimental patients received training with a Diemolding Healthcare Division inspiratory muscle trainer for 15 to 20 minutes per session, twice per day, 7 days a week for 6 weeks.Setting: Hospital-based rehabilitation units.Patients: Twenty patients who were in their first 6 months of complete cervical cord injury were randomly enrolled into RIMT (10 patients) and control (10 patients) groups.Main Outcome Measure: Spirometry, lung volume test, maximal inspiratory pressure, maximal expiratory pressure, and modified Borg scale measurements at rest were performed before training and at the end of 6 weeks of training.Results: Most of the pulmonary parameters showed statistically significant improvements within the RIMT and control groups, but the improvements were greater in the RIMT group. In addition, the improvements in total lung capacity, total lung capacity predicted percentage, vital capacity, minute ventilation, forced expiratory volume in 1 second predicted percentage, and the resting Borg scale in the RIMT group showed significantly greater improvement.Conclusion: RIMT can improve ventilatory function, respiratory endurance, and the perceived difficulty of breathing in patients with complete cervical spinal cord injury within half a year after trauma.