Respiratory Muscle Training Group Research Articles

Effects of Pulmonary Rehabilitation and Respiratory Muscle Training in Individuals with Acute Respiratory Distress

Background: Acute Respiratory Distress Syndrome (ARDS) arises from accumulation of fluid in the tiny, flexible airsacs of the lungs. Individuals with ARDS may experience muscle weakness, due to a condition known as intensivecare unit acquired weakness, resulting in impaired physical function. To mitigate potential complications namelymuscle weakness and joint contractures, and to assist with weaning from mechanical breathing and enhance theoverall quality of life for individuals with ARDS, early rehabilitation is strongly advised.Purpose: To compare the effectiveness of pulmonary rehabilitation and respiratory muscle training againstconventional care among individuals with ARDS.Materials and Methods: 30 subjects diagnosed with ARDS were randomly selected from the intensive care unit orpatient ward of Saveetha Hospital following certain inclusion and exclusion criteria. The subjects were allocatedinto pulmonary rehabilitation with respiratory muscle training group (n=15) and conventional care group (n=15).The effectiveness of the treatments was assessed at the end of 4 weeks using a 30 seconds sit-to-stand test and St.George’s Respiratory Questionnaire.Results: Descriptive and inferential statistics were used to examine the data collected. All parameters underwentanalysis employing mean and standard deviation. To analyze significant differences, pre-test and post-testmeasures, a paired t-test was performed. P values < 0.0001 were deemed statistically significant.Conclusion: The combination of pulmonary rehabilitation and respiratory muscle training offered an adjunctivetreatment option for patients with ARDS, providing quality of life, and improving strength of the muscle activitiescompared to conventional care alone.

Inspiratory–Expiratory Muscle Training Improved Respiratory Muscle Strength in Dialysis Patients: A Pilot Randomised Trial

End-stage kidney disease (ESKD) exposes patients to progressive physical deconditioning involving the respiratory muscles. The aim of this pilot randomized controlled trial was to determine the feasibility and effectiveness of low-intensity respiratory muscle training (RMT) learned at the hospital and performed at home. A group of ESKD patients (n = 22) were randomized into RMT or usual care (control group, CON) in a 1:1 ratio. The respiratory training was performed at home with an inspiratory-expiratory system for a total of 5 min of breathing exercises in a precise rhythm (8 breaths per minute) interspersed with 1 min of rest, two times per day on nondialysis days for a total of 4 weeks, with the air resistance progressively increasing. Outcome measures were carried out every 4 weeks for 3 consecutive months, with the training executed from the 5th to the 8th week. Primary outcomes were maximal inspiratory and expiratory pressure (MIP, MEP), while secondary outcomes were lung capacity (FEV1, FVC, MVV). Nineteen patients without baseline between-group differences completed the trial (T: n = 10; Age: 63 ± 10; Males: n = 12). Both MIP and MEP significantly improved at the end of training in the T group only, with a significant difference of MEP of 23 cmH2O in favor of the RMT group (p = 0.008). No significant variations were obtained for FVC, FEV1 or MVV in either group, but there was a greater decreasing trend over time for the CON group, particularly for FVC (t = -2.00; p = 0.046). Low-fatiguing home-based RMT, with a simple device involving both inspiratory and expiratory muscles, may significantly increase respiratory muscle strength.

Effects of respiratory muscle training on respiratory efficiency and health-related quality of life in sedentary women with fibromyalgia: a randomised controlled trial

Fibromyalgia syndrome (FM) is a complex disease that is mainly characterised by chronic pain, fatigue, and sleep disturbances and may be precipitated or worsened by many stressors. The aim of this study was to examine the effects of respiratory muscle training (RMT) on respiratory efficiency and health-related quality of life (HRQoL) in women with FM. A total of 30 women with FM were included in the intention to treat analyses: 15 were assigned to the RMT group and 15 to the control group. The intervention consisted of 12 weeks of RMT. The primary outcome was the change in pulmonary function assessed by global body plethysmography at 12 weeks compared with baseline. Secondary outcomes included changes of scores in HRQoL assessed by the Short Form 36 Health Survey-Portuguese version. The maximal inspiratory pressure (MIP) improved by 17.5% (p-value = .033), maximal expiratory pressure (MEP) improved 21.6% (p-value = 0.045) and maximum occlusion pressure (P0.1 max) increased 27.7% (p-value = 0.007). HRQoL improved in the dimensions of physical function, physical role, bodily pain and vitality (p-value <0.05). RMT results in a significant improvement of respiratory efficiency and HRQoL after 12 weeks. RMT could be an effective therapy to enhance respiratory function and quality of life in women with FM.

Walking training augments the effects of expiratory muscle training in Parkinson's disease.

To investigate the effects of walking training combined with respiratory muscle training (RMT) on pulmonary function, respiratory muscle strength, and functional exercise capacity in patients with Parkinson's disease. Thirty patients with Parkinson's disease were included in the study. Patients were randomly divided into two groups: the walking and RMT group (W+RMT, n=15) and the RMT (n=15) group. Spirometry, respiratory muscle strength, and a 6-min walking test were measured before and after the eighth week of the study. RMT was performed using inspiratory and expiratory threshold loading methods. Walking training intensity was adjusted according to the 6-min walking test. Patients performed 15min of inspiratory muscle training and 15min of expiratory muscle training in both groups, and 15min of walking training in the W+RMT group in addition to RMT, twice per day, 5days/week, for a total of 8weeks at home. Training intensity was adjusted once per week for the groups at the hospital. Respiratory muscle strength and 6-min walking distance were significantly increased (p=.001), and UPDRS-III scores were significantly improved (W+RMT: p=.008 and RMT: p=.01) in the two groups. The increase in maximal expiratory pressure was significantly higher in the W+RMT group than in the RMT group (p=.007). Walking training increases the effect of expiratory muscle training in patients with Parkinson's disease.

Effects of Respiratory Muscle Training on Baroreflex Sensitivity, Respiratory Function, and Serum Oxidative Stress in Acute Cervical Spinal Cord Injury.

Background: respiratory complications are a leading cause of morbidity and mortality in individuals with spinal cord injury (SCI). We examined the effects of respiratory muscle training (RMT) in patients with acute cervical SCI. Methods: this prospective trial enrolled 44 adults with acute cervical SCI, of which twenty received RMT and twenty-four did not receive RMT. Respiratory function, cardiovascular autonomic function, and reactive oxidative species (ROS) were compared. The experimental group received 40-min high-intensity home-based RMT 7 days per week for 10 weeks. The control group received a sham intervention for a similar period. The primary outcomes were the effects of RMT on pulmonary and cardiovascular autonomic function, and ROS production in individuals with acute cervical SCI. Results: significant differences between the two groups in cardiovascular autonomic function and the heart rate response to deep breathing (p = 0.017) were found at the 6-month follow-up. After RMT, the maximal inspiratory pressure (p = 0.042) and thiobarbituric acid-reactive substances (TBARS) (p = 0.006) improved significantly, while there was no significant difference in the maximal expiratory pressure. Significant differences between the two groups in tidal volume (p = 0.005) and the rapid shallow breathing index (p = 0.031) were found at 6 months. Notably, the SF-36 (both the physical (PCS) and mental (MCS) component summaries) in the RMT group had decreased significantly at the 6-month follow-up, whereas the clinical scores did not differ significantly (p = 0.333) after RMT therapy. Conclusions: High-intensity home-based RMT can improve pulmonary function and endurance and reduce breathing difficulties in patients with respiratory muscle weakness after injury. It is recommended for rehabilitation after spinal cord injury.

Comprehensive Respiratory Muscle Training Improves Pulmonary Function and Respiratory Muscle Strength in Acute Stroke Patients.

To evaluate the effects of respiratory muscle training (RMT) on pulmonary function, respiratory complications, and stroke-related disabilities in patients with acute stroke. One hundred twenty-two subjects with stroke admitted to the stroke rehabilitation center of Inje Hospital between August 2016 and May 2018 were recruited. After the initial exclusion, the remaining patients were assigned to the RMT group (36 patients) or the standard rehabilitation (SR) group (28 patients who did not undergo RMT). A total of 44 patients completed the study, with 22 patients in each group. The RMT program consisted of air-stacking exercise, manually assisted coughing, inspiratory and expiratory muscle strengthening, cough exercises, and respiratory reeducation. Pulmonary function and respiratory muscle strength were evaluated before commencement and after 1 mo of RMT. The Functional Ambulation Category score, Korean version of the Modified Barthel Index, Shoulder Abduction and Finger Extension score, and handgrip power were assessed. The incidence of pneumonia was also evaluated. Both pulmonary function and respiratory muscle strength significantly improved in both groups. However, differences (%) in the RMT group was greater for all parameters of pulmonary function and respiratory muscle strength. Respiratory complications at 1 yr were significantly lower in the RMT group (P = .016). Four weeks of comprehensive RMT in patients with acute stroke resulted in significantly greater improvements in both pulmonary function and respiratory muscle strength than SR. Therefore, RMT has the potential to reduce post-stroke respiratory complications.

Respiratory muscle training in stroke patients with respiratory muscle weakness, dysphagia, and dysarthria - a prospective randomized trial.

Objective:To examine the efficacy of combined inspiratory and expiratory respiratory muscle training (RMT) with respect to the swallowing function, pulmonary function, functional performance, and dysarthria in patients with stroke.Design:Prospective, randomized controlled trial.Setting:Tertiary hospital.Participants:The trial included 21 subjects (12 men, 9 women) aged 35 to 80 years presenting with 6 months history of unilateral stroke, respiratory muscle weakness (≥70% predicted maximal inspiratory pressure (MIP) and/or ≤70% maximal expiratory pressure (MEP)), dysphagia, or dysarthria. These subjects were randomly assigned to the control (n = 10, rehabilitation) and experimental (n = 11, rehabilitation with RMT) groups.Intervention:Inspiratory RMT starting from 30% to 60% of MIP and expiratory RMT starting from 15% to 75% of MEP for 5 days/week for 6 weeks.Main outcome measures:MIP, MEP, pulmonary function, peak cough flow, perception of dyspnea, Fatigue Assessment Scale, Modified Rankin Scale, Brunnstrom stage, Barthel index, Functional Oral Intake Scale (FOIS), and parameters of voice analysis.Results:Significant differences were observed between both groups in terms of MIP, forced vital capacity (FVC), and forced expiratory volume per second (FEV1) of the percentage predicted. Significant difference was found with respect to the change in fatigue, shimmer percent, amplitude perturbation quotient, and voice turbulence index (VTI) according to the acoustic analysis in the RMT group. The FEV1/FVC ratio was negatively correlated with jitter percent, relative average perturbation, pitch perturbation quotient, and VTI; the maximum mid-expiratory flow (MMEF) and MMEF% were also negatively correlated with VTI. Significant differences among participants of the same group were observed while comparing the Brunnstrom stage before and after training of the affected limbs and the Barthel scale and FOIS scores in both the groups.Conclusions:Altogether, 6-week combined inspiratory and expiratory RMT is feasible as adjuvant therapy for stroke patients to improve fatigue level, respiratory muscle strength, lung volume, respiratory flow, and dysarthria.Clinical trial registration number (Clinical Trial Identifier): NCT03491111.

Progressive Respiratory Muscle Training for Improving Trunk Stability in Chronic Stroke Survivors: A Pilot Randomized Controlled Trial

Stroke weakens the respiratory muscles, which in turn may influence the trunk stability; it is unclear whether the progressive respiratory muscle training (RMT) is effective in improving the trunk stability. The aim of this study was to investigate the effects of progressive RMT with trunk stabilization exercise (TSE) on respiratory muscles thickness, respiratory muscle functions, and trunk stability in chronic stroke survivors. This is a pilot randomized controlled trial. Chronic stroke survivors (n = 33) who were able to sit independently participated in the tstudy. The participants were allocated into the RMP with TSE group or the TSE group. The respiratory muscle thickness during resting and contraction were measured. Maximal expiratory pressure (MEP), peak expiratory flow (PEF), and forceful expiratory volume at 1 sec (FEV1) for forced expiratory muscle function and maximal inspiratory pressure (MIP), peak inspiratory flow (PIF), and vital capacity (VC) for inspiratory muscle function were examined. Trunk stability was estimated by maximal velocity and path length of the center of pressure (COP) by using a balance board with sitting posture. The respiratory muscle thickness was significantly increased on the affected side in the RMT group than in the TSE group. The MEP, PEF, MIP, and PIF were significantly increased in the RMT group than in the TSE group; however, FEV1 and VC showed no significant differences between the 2 groups. Trunk stability for the maximal velocity of COP of extension and affected side bending was significantly increased in the RMT group than in the TSE group. In addition, the maximal path length of COP of flexion, extension, affected/less affected side bending was significantly increased in the RMT group than in the TSE group. RMT combined with TSE can be suggested as an effective method to improve the respiratory muscle thickness, respiratory muscle functions, and trunk stability in chronic stroke survivors as opposed to TSE only.

Effect of high- and low-resistance inspiratory muscle training on physiological response to exercise in cross-country skiers.

The aim of the study was to evaluate the effect of different kinds of respiratory muscle training (RMT) on work capacity and selected spirometric indices in trained male cross-country skiers. The study involved 13 competitively trained, elite Polish male cross-country skiers. The subjects were randomly divided into two groups who completed 7 weeks of RMT: one with gradually increasing resistance (power RMT) and the other with constant resistance (endurance RMT). Both groups' training programs consisted of 30 inspiratory maneuvers performed twice a day, 6 days a week. The first week of RMT started with a low resistance (29 cmH2O). In the following weeks, resistance in the power RMT group was gradually increased, while in the endurance RMT group, inspiratory resistance was maintained at a constant level of 53 cm H2O (36±8% PImax). Maximal inspiratory pressure (PImax), peak inspiratory flow rate (PIF), and stress test indices were measured before and after RMT. The stress test was conducted on a ski ergometer, with a gradual increase in intensity in all-out effort. A significant increase in PImax, PIF, and exercise work capacity (test time, work output, and peak power) was noted in both groups. No significant changes were observed in the VO2max or the selected respiratory variables. During a short training period (up to 7 weeks), the use of gradual and constant inspiratory resistance during RMT improves exercise and spirometric parameters in a similar way. RMT did not have a considerable impact on breathing efficiency in maximal effort.

Respiratory muscle training positively affects vasomotor response in young healthy women

Vasomotor response is related to the capacity of the vessel to maintain vascular tone within a narrow range. Two main control mechanisms are involved: the autonomic control of the sympathetic neural drive (global control) and the endothelial smooth cells capacity to respond to mechanical stress by releasing vasoactive factors (peripheral control). The aim of this study was to evaluate the effects of respiratory muscle training (RMT) on vasomotor response, assessed by flow-mediated dilation (FMD) and heart rate variability, in young healthy females. The hypothesis was that RMT could enhance the balance between sympathetic and parasympathetic neural drive and reduce vessel shear stress. Thus, twenty-four women were randomly assigned to either RMT or SHAM group. Maximal inspiratory mouth pressure and maximum voluntary ventilation were utilized to assess the effectiveness of the RMT program, which consisted of three sessions of isocapnic hyperventilation/ week for eight weeks, (twenty-four training sessions). Heart rate variability assessed autonomic balance, a global factor regulating the vasomotor response. Endothelial function was determined by measuring brachial artery vasodilation normalized by shear rate (%FMD/SR). After RMT, but not SHAM, maximal inspiratory mouth pressure and maximum voluntary ventilation increased significantly (+31% and +16%, respectively). Changes in heart rate variability were negligible in both groups. Only RMT exhibited a significant increase in %FMD/SR (+45%; p<0.05). These data suggest a positive effect of RMT on vasomotor response that may be due to a reduction in arterial shear stress, and not through modulation of sympatho-vagal balance.

Evaluation of a clinical implementation of a respiratory muscle training group during spinal cord injury rehabilitation.

Retrospective cohort study. To evaluate the clinical implementation of a respiratory muscle training group during rehabilitation of individuals with spinal cord injury. Spinal cord injury rehabilitation center. Individuals with complete or incomplete lesions during inpatient rehabilitation, level C4-T12.Ten or more training sessions of either an inspiratory or a combined in- and expiratory muscle training were performed in a group setting with respiratory function measurements before and after the training period. Analysis of 79 persons. Inspiratory muscle training was performed for 7 weeks with a median of 3.1 training sessions per week. Median training intensity was at 33% of baseline PImax and 58 repetitions were performed per training session. Respiratory mucle strength parameters improved by 18-68% of baseline values and lung function parameters by 11-31% after inspiratory muscle training.The combined respiratory muscle training was performed for 13 weeks with a median of 2.8 sessions per week and 88 repetitions per training session. Median inspiratory training resistance was at 39% of baseline PImax and median expiratory training resistance was at 27% of baseline PEmax. Respiratory muscle strength parameters improved by 14-51% of baseline values and lung function parameters improved by 15-34% after the combined in- and expiratory muscle training. Respiratory resistance training improved respiratory function of individuals with acute spinal cord injury. Even if the combined respiratory muscle training was performed with more repetitions per training and nearly twice as long, relative improvements of respiratory function parameters were comparable with isolated inspiratory muscle training.

Respiratory Muscle Training Positively Affects Vasomotor Response in Young Healthy Women

Vasomotor response is related to the capacity of the vessel to maintain the homeostasis of the vascular tone. Two main control mechanisms are involved: the autonomic control of the sympathetic neural drive (global control) and the endothelial smooth cells capacity to respond to mechanical stress by releasing vasoactive factors (local control). The aim of the study was to evaluate the effects of respiratory muscle training (RMT) on vasomotor response, assessed by flow‐mediated dilation and heart rate variability, in young healthy females. The hypothesis was that RMT may enhance the balance between sympathetic and parasympathetic neural drive and reduce vessels shear stress. To this purpose, twenty‐four women were assigned randomly to RMT or SHAM group. Maximal inspiratory mouth pressure and maximum voluntary ventilation were utilized to assess the effectiveness of the RMT program, which consisted of three sessions of isocapnic hyperventilation per week, eight weeks, for a total of twenty‐four training sessions. Heart rate variability was utilized to evaluate the autonomic balance, a global factor regulating vasomotor response. Endothelial function was determined by measuring brachial artery vasodilation normalized by the shear rate (%FMD/SR). After RMT, maximal inspiratory mouth pressure and maximum voluntary ventilation increased significantly (+31% and +16%, respectively) only in RMT. Changes in heart rate variability were negligible in both groups. Only RMT exhibited a significant increase in endothelial function (%FMD/SR +45%; p&lt;0.05). These data indicate a positive effect of RMT on vasomotor response likely via a reduction in shear stress in the vessels, and not through a modulation of sympatho‐vagal balance.Support or Funding InformationGrant from the Department of Biomedical Sciences for Health, Università degli Studi di Milano.This abstract is from the Experimental Biology 2018 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

Effects of Resistance Training of Peripheral Muscles Versus Respiratory Muscles in Older Adults With Sarcopenia Who are Institutionalized: A Randomized Controlled Trial.

This study compares the effects of two resistance training programs in peripheral and respiratory musculature on muscle mass and strength and physical performance and identifies the appropriate muscle mass parameter for assessing the intervention effects. Thirty-seven institutionalized older Spanish adults with sarcopenia were analyzed: control group (n = 17), respiratory muscle training group (n = 9), and peripheral muscle training group (n = 11). Measured outcomes were appendicular skeletal muscle mass (ASM/height2, ASM/weight, and ASM/BMI), isometric knee extension, arm flexion and handgrip strength, maximal inspiratory and expiratory pressures, and gait speed pre- and postintervention. Trained groups participated in a 12-week program and improved in maximum static inspiratory pressure, maximum static expiratory pressure, knee extension, and arm flexion (p < .05), whereas nonsignificant changes were found in gait speed and ASM indexes pre- and postintervention in the three groups. In conclusion, resistance training improved skeletal muscle strength in the studied population, and any ASM index was found to be appropriate for detecting changes after physical interventions.

Noninvasive ventilation and respiratory physical therapy reduce exercise-induced bronchospasm and pulmonary inflammation in children with asthma: randomized clinical trial.

Background:Asthma is characterized by hyperresponsiveness of the airways, and exercise-induced bronchospasm (EIB) is a symptom that limits a large proportion of asthmatic patients, especially children. Continuous positive airway pressure (CPAP) leads to a reduction in the reactivity of the airways. The aim of this study was to evaluate the effect of outpatient treatment with CPAP and bilevel pressure combined with respiratory physical therapy for children and adolescents with asthma following bronchial hyperresponsiveness caused by an exercise bronchoprovocation test.Methods:A randomized, controlled, blind, clinical trial was conducted involving 68 asthmatic children and adolescents aged 4 to 16 years divided into three groups: G1, treated with bilevel pressure (inspiratory positive airway pressure: 12 cm H2O; expiratory positive airway pressure: 8 cm H2O), G2, treated with CPAP (8 cm H2O) and G3, treated with respiratory muscle training (RMT), considered as the control group. All groups were treated at an outpatient clinic and submitted to 10 1-hour sessions, each of which also included respiratory exercises. Evaluations were performed before and after treatment and involved spirometry, an exercise bronchoprovocation test, respiratory pressures, fraction of nitric oxide (FeNO), the Asthma Control Questionnaire (ACQ6) and anthropometric variables. This study received approval from the local ethics committee (certificate number: 1487225/2016) and is registered with ClinicalTrials [ClinicalTrials.gov identifier: NCT02939625].Results:A total of 64 patients concluded the protocol; the mean age of the patients was 10 years. All were in the ideal weight range and had adequate height (z score: −2 to +2). The three groups demonstrated improved asthma control after the treatments, going from partial to complete control. A significant increase in maximal inspiratory pressure occurred in the three groups, with the greatest increase in the RMT group. A reduction in FeNO in the order of 17.4 parts per billion (effect size: 2.43) and a reduction in bronchial responsiveness on the exercise bronchoprovocation test occurred in the bilevel group. An improvement in FeNO on the order of 15.7 parts per billion (effect size: 2.46) and a reduction in bronchial responsiveness occurred in the CPAP group. No changes in lung function or responsiveness occurred in the RMT group.Conclusion:Positive pressure and respiratory exercises were effective in reducing pulmonary inflammation, exercise-innduced bronchoespasm (EIB), and increased the clinical control of asthma, as well as RMT, which also resulted in improved clinical control.

Effect of Artificial Respiratory Muscle Training in Patients with Chronic Obstructive Pulmonary Disease

Chronic obstructive lung disease (COPD) is a chronic lung pathology that leads to respiratory muscle weakness and decreased function capacity. Patients need to have pulmonary rehabilitation to increase respiratory muscle strength. The aim of the study was to assess the effect of artificial respiratory muscle training (ARMT) on respiratory muscle function and exercise performance in chronic obstructive pulmonary disease (COPD). Thirty patients in the mild to moderate COPD stage were randomly classified into an ARMT (n = 10), a control group (n = 10), and a standard respiratory muscle training group (SRMT; n = 10) by following the blind procedure. The control group received no training. The training groups, however, were trained at home for 30 min per day, every day, for 6 weeks. The measurement analyses included spirometry, an inspiratory muscle strength examination, and an exercise performance test. Exercise performance was evaluated by a 6 min walk test (SWT). The results showed that the maximal inspiratory pressure (PImax) and the maximal expiratory pressure (PEmax) were observed to have significantly increased in both the ARMT group and the SRMT group compared with the control group (p &lt; 0.05). Moreover, the ARMT group was found to have significantly increased the 6 min walking distance in comparison with the control group. However, the ARMT group and the SRMT group did not differ significantly in those parameters. We conclude that it would be possible for the ARMT group among COPD patients to have improved respiratory muscle strength and increased capacity to walk.

Short-term effects of respiratory muscle training combined with the abdominal drawing-in maneuver on the decreased pulmonary function of individuals with chronic spinal cord injury: A pilot randomized controlled trial

Objective: To investigate the effects of respiratory muscle training (RMT) combined with the abdominal drawing-in maneuver (ADIM) on the pulmonary function in patients with chronic spinal cord injury (SCI).Methods: Thirty-seven subjects with SCI (level of injury: C4–T6, time since injury: 4–5 years) were randomly allocated to three groups; the integrated training group (ITG), the RMT group (RMTG), and the control group (CG). The ITG performed RMT using an incentive respiratory spirometer (IRS) and the ADIM using a stabilizer. The RMTG received only RMT using an IRS. Subjects in the CG received alternative and routine physical therapy or usual care. The interventions were conducted over an eight-week period. Pulmonary function was evaluated using spirometry to measure the forced vital capacity (FVC) and forced expiratory volume in 1 second (FEV1).Results: The differences between the pre- and post-test values for FVC (0.47 ± 0.05 versus 0.15 ± 0.06 versus –0.03 ± 0.01) and FEV1 (0.74 ± 0.07 versus 0.27 ± 0.17 versus 0.02 ± 0.67)were significant among the groups. Post-test, in the ITG, the FVC and FEV1 values showed significant differences from those in the RMTG and CG (F = 11.48 and 11.49, P = 0.002 and 0.001). Furthermore, following the 8­week intervention, the change ratio values of the FVC and FEV1 of the ITG were increased further by an average of 9.75% and 7.91%, respectively, compared with those of the RMTG.Conclusion: These findings suggest positive evidence that RMT with additional ADIM training can improve pulmonary function in SCI pulmonary rehabilitation.

Effect of respiratory muscle training on pulmonary function and aerobic endurance in soccer players.

Few studies investigated the effects of the respiratory muscle training (RMT) in soccer although exhaustive high intensity exercise is known to lead to muscle fatigue in respiratory muscles. The purpose of this study was to investigate the effect of RMT on pulmonary function and aerobic endurance in soccer players. Eighteen male soccer players (mean age 22.2±1.4 years) participated in this study. Participants were assigned randomly to either an RMT or a control (CON) group. The RMT group performed a 15-minute endurance training of respiratory muscles twice a week for 5 weeks. The CON group did not receive RMT during this period. All participants were evaluated for aerobic endurance using 20-meter shuttle run test (20-MST), pulmonary function, maximal inspiratory mouth pressure (MIP), and maximal expiratory mouth pressure (MEP) using spirometry. There was a significant improvement in RMT group (14%) as compared to CON group (4%) in MIP measurement (P=0.04). No significant differences were observed in forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), maximum voluntary ventilation (MVV), and MEP after a five week of RMT (P>0.05). Similarly, there was no difference in 20-MST in the RMT group compared to CON group (P>0.05). We concluded that a five week of RMT increased MIP, but FVC, FEV1, MVV, MEP and aerobic endurance did not improve in soccer players. The RMT in addition to soccer training may improve MIP but not the tolerance to high intensity exercise.

Effects of the combination of respiratory muscle training and abdominal drawing-in maneuver on respiratory muscle activity in patients with post-stroke hemiplegia: a pilot randomized controlled trial

Purpose:No study has examined the effects of the combination of respiratory muscle training (RMT) and abdominal drawing-in maneuver (ADIM) on respiratory muscle activity and function in stroke patients during early pulmonary rehabilitation. The purpose of this study was to investigate the effects of RMT combined with ADIM on decreased respiratory muscle activity and function in patients with post-stroke hemiplegia.Methods:Thirty-seven subjects with post-stroke hemiplegia were randomly allocated to three groups; integrated training group (ITG), respiratory muscle training group (RMTG), and control group (CG). All of the subjects received routine therapy for stroke rehabilitation for 1 hour, five times a week for 6 weeks. Especially, the ITG received RMT using an incentive respiratory spirometer and ADIM using a Stabilizer, and the RMTG only received RMT using incentive respiratory spirometer for 15 minutes a day, five times a week for 6 weeks. Pulmonary function was evaluated using spirometry for measuring the forced vital capacity (FVC) and force expiratory volume in 1 second (FEV1). Additional surface electromyography (sEMG) analysis was included by measuring the respiratory muscle activity.Results:Our results showed that changes between the pre- and post-test values of FVC (F = 12.50, P = 0.02) and FEV1 (F = 12.81, P = 0.01) (P < 0.05) in the ITG were significantly (P < 0.05) greater. Changes in EMG activation of the diaphragm (F = 13.75, P = 0.003) and external intercostal (F = 14.33, P = 0.002) (P < 0.01) muscles of patients in the ITG during maximal static inspiratory efforts were significantly (P < 0.05) greater than those in patients of the RMTG and the CG at post-test.Conclusions:Our findings suggested that RMT combined with ADIM could improve pulmonary function in patients with post-stroke hemiplegia.

Treinamento muscular respiratório na revascularização do miocárdio

1) To demonstrate the impaired ventilatory capacity during the post operatory period, in patients submitted to coronary arterial bypass graft surgery (CABG). 2) To test the hypothesis that the respiratory muscle training (RMT), performed after the surgery, may increase the ventilatory capacity in this population. Thirty-eight patients (age: 65 ± 7 years, 29 male), whose underwent CABG with extra-corporeal circulation. Patients were randomized in two groups: 23 patients in the RMT group and 15 in the control group (CO). RMT group received conventional physiotherapy plus RMT. The CO group received the conventional physiotherapy. Evaluated parameters: maximum inspiratory and expiratory pressures (MIP) (MEP), dyspnea (Borg), peak expiratory flow (PEF), pain, tidal volume and hospitalization days. Measures were performed at pre, first post operatory day and also at the patients discharge from the hospital). MIP and MEP in the RMT group were higher when compared with CO at the patients discharge (MIP: 90 ± 26 vs. 55 ± 38 cmH2O, P = 0.01) (MEP: 99 ± 30 vs. 53 ± 26 cmH2O, P = 0.02). The PEF was higher after hospitalization in the RMT group (237 ± 93 vs. 157 ± 102 lpm, P=0.02). Tidal volume was also higher in the RMT group at discharge (0.71 ± 0.21 vs. 0.44 ± 0.12 liters, P = 0,00). No differences were observed among the groups in the aspects: admission days, dyspnea and pain. Patients submitted to CABG presents an impaired respiratory muscle strength in their post operatory. RMT performed in this phase was effective to restore the ventilatory capacity in the following parameters: MIP, MEP, PEF and tidal volume, in this group of patients.

Respiratory muscle training and maximum aerobic power in hypoxia

In a recent paper, Keramidas et al. (2010) investigated the effects of respiratory muscle training (RMT) on endurance exercise performance in normoxia (N) and hypoxia (H; FIO2 = 0.12). Participants were randomly assigned either to RMT or control training group. Both groups performed regular (1 h/day, 5 days/week at 50% of peak power output) aerobic training on a cycle ergometer, while RMT group performed an additional specific training programme of respiratory muscles (isocapnic hyperpnoea) prior to the cycle ergometry. After 4 weeks of training, both groups enhanced maximum oxygen uptake _ VO2max in N, but only the RMT group improved _ VO2max (only specific, not absolute) significantly in H. The enhanced _ VO2max in H in the RMT group was accompanied by increased maximum ventilation _ VE , but at an identical peak power output, most likely resulting in an increased metabolic demand of the respiratory muscles. However, in this study, peak power output was calculated as the last workload completed of a ramp test (30 W/min). If this is the case, peak power output would be a supramaximal power, which both aerobic and anaerobic energy sources would contribute to, and thus cannot be defined as the maximum aerobic mechanical power, which corresponds to the lowest power requiring a _ VO2 equal to _ VO2max. Always, whether in N or in H, an increase in _ VO2max is accompanied by an increase in maximum mechanical power. In a similar paper, Esposito et al. (2010) assessed the effects of 8 weeks RMT (isocapnic hyperpnoea, 5 training sessions per week, 10–20 min each including warm up; the volume and the frequency of respiratory cycles were increased progressively, based on participants’ response to training work loads) on _ VO2max in N and H (FIO2 = 0.11). After 8 weeks of RMT, no changes in cardiorespiratory and metabolic variables were detected at maximal exercise in N. On the contrary, in H _ VE and alveolar ventilation _ VA at maximal exercise were significantly higher than in pre-training condition. Accordingly, alveolar O2 partial pressure (PAO2 ) after RMT significantly increased by *10%. Nevertheless, arterial PO2 and _ VO2max did not change with respect to pre-training condition. Thus, the authors provided evidence that RMT did not have any effect on _ VO2max, under either normoxic or hypoxic condition. They concluded that in H, the significant increase in _ VE and _ VA at maximum exercise after RMT lead to higher alveolar but not arterial PO2 values, revealing an increased A–a gradient. Thus, a possible role of increased ventilation–perfusion mismatch was suggested. According to multifactorial models of _ VO2max limitation (di Prampero 1985; di Prampero and Ferretti 1990), the O2 transfer from ambient air to mitochondria is set by a cascade of resistances in series, each resistance being overcome by a specific O2 partial pressure gradient. Four major resistances have been identified in the studies cited above (1) ventilatory (RV) between ambient and alveoli; (2) lung (RL) between alveoli and arterial blood; (3) circulatory (RQ) between arterial blood and muscle capillaries; (4) peripheral (Rp) between muscle capillaries and Communicated by Susan Ward.