Role Of Inspiratory Muscle Training Research Articles

The Therapeutic Role of Inspiratory Muscle Training in The Management of Asthma: A Narrative Review.

Asthma is a disorder of the airways characterized by chronic airway inflammation, hyperresponsiveness, and variable recurring airway obstruction. Treatment options for asthma include pharmacological strategies, while non-pharmacological strategies are limited. Established pharmacological approaches to treating asthma may cause unwanted side effects and do not always afford adequate protection against asthma, possibly due to an individual's variable response to medications. A potential non-pharmacological intervention that is most available and cost-effective is inspiratory muscle training (IMT), which is a technique targeted at increasing the strength and endurance of the diaphragm and accessory muscles of inspiration. Studies examining the impact of IMT on asthma have reported increases in inspiratory muscle strength, and a reduction in the perception of dyspnea and medication use. However, due to the limited number and discordant methods between studies more evidence is required to elucidate in asthmatics the efficacy of IMT on inspiratory muscle endurance, exercise capacity, asthma control, symptoms, quality of life, as well as adolescents with differing severities of asthma. Large randomized controlled trials would be a significant step forward in clarifying the effectiveness of IMT in asthmatics. While IMT may have favorable effects on inspiratory muscle strength, dyspnea and medication use, the current evidence that IMT is an effective treatment for asthma is inconclusive.

Inspiratory muscle training enhances recovery post-COVID-19: a randomised controlled trial.

BackgroundMany people recovering from coronavirus disease 2019 (COVID-19) experience prolonged symptoms, particularly breathlessness. We urgently need to identify safe and effective COVID-19 rehabilitative strategies. The aim of the current study was to investigate the potential rehabilitative role of inspiratory muscle training (IMT).Methods281 adults (age 46.6±12.2 years; 88% female) recovering from self-reported COVID-19 (9.0±4.2 months post-acute infection) were randomised 4:1 to an 8-week IMT or a “usual care” waitlist control arm. Health-related quality-of-life and breathlessness questionnaires (King's Brief Interstitial Lung Disease (K-BILD) and Transition Dyspnoea Index (TDI)), respiratory muscle strength, and fitness (Chester Step Test) were assessed pre- and post-intervention. The primary end-point was K-BILD total score, with the K-BILD domains and TDI being key secondary outcomes.ResultsAccording to intention to treat, there was no difference between groups in K-BILD total score post-intervention (control: 59.5±12.4; IMT: 58.2±12.3; p<0.05) but IMT elicited clinically meaningful improvements in the K-BILD domains for breathlessness (control: 59.8±12.6; IMT: 62.2±16.2; p<0.05) and chest symptoms (control: 59.2±18.7; IMT: 64.5±18.2; p<0.05), along with clinically meaningful improvements in breathlessness according to TDI (control: 0.9±1.7 versus 2.0±2.0; p<0.05). IMT also improved respiratory muscle strength and estimated aerobic fitness.ConclusionsIMT may represent an important home-based rehabilitation strategy for wider implementation as part of COVID-19 rehabilitative strategies. Given the diverse nature of long COVID, further research is warranted on the individual responses to rehabilitation; the withdrawal rate herein highlights that no one strategy is likely to be appropriate for all.

Abstract 13927: Sustained Maximal Inspiratory Pressure: A Novel Measure of Inspiratory Muscle Performance and Its Relationship to Physiology and Function in Heart Failure

Introduction: The sustained maximal inspiratory pressure (SMIP) is a novel measure of inspiratory muscle performance that reflects the ability of the inspiratory muscles to maintain force over time from residual volume (RV) to total lung capacity (TLC) and has been described as single-breath work capacity. In chronic obstructive pulmonary disease SMIP has been found to be more highly correlated to a greater number of physiologic and functional measures than maximal inspiratory pressure (MIP). This study examined the relationship of SMIP and MIP to a variety of physiologic and functional measures in patients with heart failure (HF). Methods: Fifty male Veterans (mean±SD age, BMI, LVEF = 69.9±8.0 years, 33.6±7.2 kg/m 2 , 40.1±14.4%, respectively) with HF underwent measurement of MIP and SMIP with the PrO2 device (Smithfield, RI) which were measured from RV during initial inhalation and to TLC, respectively. Pulmonary function and maximal expiratory pressure (MEP) were also assessed. Exercise capacity was assessed via cardiopulmonary exercise testing (CPET) and leg strength testing. Physical function was assessed with grip strength, 6-minute walk distance (6MWD), and sit-to-stand test (STS). Results: The mean±SD MIP and SMIP were 66.3±24.8 cmH 2 O and 351.3±151.4 PTU, respectively. Both MIP and SMIP were significantly (p&lt;0.05) correlated to many physiologic (r=.33-.48) and functional measures (r=.38-.62) with the greatest correlate to MIP being MEP (r=.58) and the greatest correlate to SMIP being FEV 1 (r=.62). The greatest physiologic correlate to MIP and SMIP was CPET peak tidal volume with identical r-values (.48). Absolute and relative peak oxygen consumption (pVO 2 ) were correlated to both MIP and SMIP with identical r-values for absolute pVO 2 (.33) and slightly higher r-values between MIP and relative pVO 2 (.37 vs .34). The greatest functional correlate to MIP and SMIP was leg strength/endurance (r=.53 and .46, respectively) followed by STS (r=.52 and .45, respectively) and 6MWD (r=.49 and .45, respectively). Conclusions: MIP and SMIP are significantly correlated in a positive direction to many physiologic and functional measures supporting the role of inspiratory muscle training and further study of SMIP and MIP in HF.

Inspiratory Muscle Training in Patients With Heart Failure With Preserved Ejection Fraction: A Meta-Analysis

ObjectivesTo explore the role of inspiratory muscle training (IMT) in improving cardiorespiratory fitness of stable heart failure with preserved ejection fraction (HFpEF) patients.BackgroundThere is a paucity of data on the role of IMT in patients with HFpEF. HFpEF is a growing problem in the developed world, especially in the aging population.MethodsWe conducted a systematic literature search for English studies in PubMed, EMBASE, and Cochrane Central Register of Controlled Trials. We searched databases using terms relating to or describing breathing exercise, IMT, and HFpEF. RevMan 5.4 (The Cochrane Collaboration, 2020) was used for data analysis, and two independent investigators performed literature retrieval and data extraction.ResultsWe identified three randomized controlled trials (RCTs) and one prospective study on the role of IMT in HFpEF. We calculated the pooled mean difference of peak oxygen consumption (Peak VO2) and six-min walk distance (6MWD) between the IMT and standard care (SC) groups. Our meta-analysis showed that compared with SC, IMT could significantly improve peak VO2 with a mean difference (MD) of 2.82 ml/kg/min, 95% CI [1.90, 3.74] P < 0.00001 and improve 6MWD with MD of 83.97 meters, 95% CI [59.18, 108.76] P< 0.00001 to improve cardiorespiratory fitness at 12 weeks of IMT and improve peak VO2 with MD of 2.18 ml/kg/min, 95% CI [0.38, 3.99] P < 0.00001 at 24 weeks of therapy.ConclusionIMT should be further studied as a possible treatment option to improve cardiorespiratory fitness for patients with stable HFpEF.

Effect of inspiratory muscle training in hypercapnic chronic obstructive pulmonary disease patients during acute care: a randomised clinical trial

Weakness of respiratory muscles along with respiratory failure is a common finding in chronic obstructive pulmonary disease (COPD) patients which leads to dyspnoea and hence decreased functional capacity. Despite a sound theoretical rationale regarding the potential role of inspiratory muscles, the role of inspiratory muscle training (IMT) along with the conventional non-invasive ventilation (NIV) on important clinical outcomes has not been investigated in these patients during acute care. 34 hypercapnic stable COPD patients were randomly allocated to one of the interventions that lasted for 10 days: IMT with NIV (n=17), and NIV alone (n=17). IMT was administered 2 times in a day (15 min each time) by threshold loading at an intensity starting from 30% and progressed to 60% of their maximal inspiratory effort (PImax). NIV was given at an optimal pressure titrated for each patient for at least &gt;8 h per day. Outcome measures (respiratory muscle strength, respiratory failure, dyspnoea, and functional capacity) were assessed before and after 10 days of intervention. Clinical characteristics and outcome variables of patients were similar between the groups at baseline. Addition of IMT led to a significantly greater increase in respiratory muscle strength (P=0.01), reduction in dyspnea (modified medical research council dyspnea scale, P=0.001); improved outcomes of respiratory failure (PaCO2, P=0.03; PaO2, P=0.002) and improved functional capacity (6 min walk distance, P=0.001) as compared to NIV alone. A short duration IMT program in addition to NIV was found to be effective in improving respiratory muscle strength, perception of dyspnoea, functional capacity and respiratory failure in hypercapnic COPD patients.

Modified inspiratory muscle training (m-IMT) as promising treatment for gastro-oesophageal reflux disease (GERD)

BackgroundGastro-oesophageal reflux disease (GERD) is one of the most common diseases, but is still a challenge to cure. Different medical treatments are used, first of all Proton pump inhibitors (PPIs), however these are sometimes ineffective and long-term intake can lead to underestimated complications. Recently, some studies investigated the role of inspiratory muscle training (IMT) in the medical treatment of GERD. It seems that IMT is able to increase the pressure generated by the lower oesophageal sphincter (LES), reduce spontaneous releases of LES, acid exposure, use of PPIs, and improve symptoms and quality of life for GERD patients. ObjectiveThe aim of this study was to evaluate the effectiveness of IMT in association with myofunctional therapy exercises of swallowing set by Daniel Garliner (m-IMT) on the symptoms of patients with non-erosive gastro-oesophageal reflux disease (NERD). MethodsTwenty-one adult patients with NERD were enrolled from May to December 2017 and performed m-IMT over a period of 4 weeks. Before and after treatment, all the patients completed the following questionnaires: GERD oesophageal symptomatology (GERDQ), extra-oesophageal GERD symptomatology (RSI), quality of life (GERD-Health Related Quality of Life Questionnaire (GERD-HRQL), and underwent laryngeal endoscopy. ResultsNineteen patients completed m-IMT. GERDQ (from 8.36±3.94 to 1.7±3.41; p<.05), RSI (from to 21.68±10.26 to 6.93±8.37; p<.05) and GERDHRQL (from 25.68±16.03 to 8.4±11.06; p<.05) the questionnaire scores significantly reduced after treatment. In addition, the laryngeal endoscopy score greatly improved (from 14.24±4.15 to 7.4±1.77; p<.05). Conclusionsm-IMT is a low cost therapy without side effects. It could be useful in association with PPI or alone for selected GERD cases and for mild NERD forms, in association with diet. Further studies are required to prove the effects of m-IMT on GERD symptoms and decide the best treatment schedule.

Modified inspiratory muscle training (m-IMT) as promising treatment for gastro-oesophageal reflux disease (GERD)

BackgroundGastro-oesophageal reflux disease (GERD) is one of the most common diseases, but is still a challenge to cure. Different medical treatments are used, first of all Proton pump inhibitors (PPIs), however these are sometimes ineffective and long-term intake can lead to underestimated complications. Recently, some studies investigated the role of inspiratory muscle training (IMT) in the medical treatment of GERD. It seems that IMT is able to increase the pressure generated by the lower oesophageal sphincter (LES), reduce spontaneous releases of LES, acid exposure, use of PPIs, and improve symptoms and quality of life for GERD patients. ObjectiveThe aim of this study was to evaluate the effectiveness of IMT in association with myofunctional therapy exercises of swallowing set by Daniel Garliner (m-IMT) on the symptoms of patients with non-erosive gastro-oesophageal reflux disease (NERD). MethodsTwenty-one adult patients with NERD were enrolled from May to December 2017 and performed m-IMT over a period of 4 weeks. Before and after treatment, all the patients completed the following questionnaires: GERD oesophageal symptomatology (GERDQ), extra-oesophageal GERD symptomatology (RSI), quality of life (GERD-Health Related Quality of Life Questionnaire (GERD-HRQL), and underwent laryngeal endoscopy. ResultsNineteen patients completed m-IMT. GERDQ (from 8.36±3.94 to 1.7±3.41; p<.05), RSI (from to 21.68±10.26 to 6.93±8.37; p<.05) and GERDHRQL (from 25.68±16.03 to 8.4±11.06; p<.05) the questionnaire scores significantly reduced after treatment. In addition, the laryngeal endoscopy score greatly improved (from 14.24±4.15 to 7.4±1.77; p<.05). Conclusionsm-IMT is a low cost therapy without side effects. It could be useful in association with PPI or alone for selected GERD cases and for mild NERD forms, in association with diet. Further studies are required to prove the effects of m-IMT on GERD symptoms and decide the best treatment schedule.

The Role of Inspiratory Muscle Training in Sickle Cell Anemia Related Pulmonary Damage due to Recurrent Acute Chest Syndrome Attacks.

Background. The sickling of red blood cells causes a constellation of musculoskeletal, cardiovascular, and pulmonary manifestations. A 32-year-old gentleman with sickle cell anemia (SCA) had been suffering from recurrent acute chest syndrome (ACS). Aim. To examine the effects of inspiratory muscle training (IMT) on pulmonary functions, respiratory and peripheral muscle strength, functional exercise capacity, and quality of life in this patient with SCA. Methods. Functional exercise capacity was evaluated using six-minute walk test, respiratory muscle strength using mouth pressure device, hand grip strength using hand-held dynamometer, pain using Visual Analogue Scale, fatigue using Fatigue Severity Scale, dyspnea using Modified Medical Research Council Scale, and health related quality of life using European Organization for Research and Treatment of Cancer QOL measurement. Results. A significant improvement has been demonstrated in respiratory muscle strength, functional exercise capacity, pain, fatigue, dyspnea, and quality of life. There was no admission to emergency department due to acute chest syndrome in the following 12 months after commencing regular erythrocytapheresis. Conclusion. This is the first report demonstrating the beneficial effects of inspiratory muscle training on functional exercise capacity, respiratory muscle strength, pain, fatigue, dyspnea, and quality of life in a patient with recurrent ACS.

The Role of Inspiratory Muscle Training in the Process of Rehabilitation of Patients with Chronic Obstructive Pulmonary Disease.

Chronic obstructive pulmonary disease (COPD) adversely affects the quality of life and life expectancy of patients. Shortness of breath, cough, and fatigue in lower limbs are the main reasons limiting physical activities of patients. The lack of physical activity results in poorer muscle strength. The latest guidelines regarding breathing rehabilitation in COPD patients emphasize a significant role of inspiratory muscle exercises. The objective of the present study was to evaluate the effects of an 8-week long inspiratory muscle training, interval training on a cycle ergometer, and training combining both kinds of rehabilitation, on pulmonary function, health-related quality of life, and the tolerance to exercise in patients with COPD. The study was conducted in a group of 43 patients with diagnosed COPD stage II and III according to GOLD. They were randomly divided into four training groups: inspiratory muscle training (Group 1), cycle ergometer training (Group 2), cycle ergometer and inspiratory muscle training (Group 3), control group - patients who did not participate in any rehabilitation programs (Group 4 - control). Before the rehabilitation process and after its completion the patients were medically examined, they completed a health-related quality of life questionnaire, performed a 6-min walk test, spirometry, and a treadmill exercise test according to the modified Bruce protocol. The results demonstrate a significant improvement in the quality of life measured for Group 3 in comparison with the control group.

The case for inspiratory muscle training in COPD

I speak not to disprove what Brutus spoke, But here I am to speak what I do know. William Shakespeare. Julius Caesar . Act 3, Scene 2, line 100–101. Pulmonary rehabilitation is a cornerstone for the management of chronic obstructive pulmonary disease (COPD), since treatments other than smoking cessation and long-term oxygen therapy are merely symptomatic [1]. The current recommendations in the Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines are that all stages of the disease may benefit from such programmes 1. The most effective component of these programmes is peripheral (preferably lower limbs) muscle exercise training, whereas the role of inspiratory muscle training (IMT) of patients with stable COPD remains controversial 2–5. The American Thoracic Society/European Respiratory Society statement on pulmonary rehabilitation suggested that “although the data are inconclusive, IMT could be considered as adjunctive therapy in pulmonary rehabilitation, primarily in patients with suspected or proven respiratory muscle weakness” 4. The Joint American College of Chest Physicians/American Association of Cardiovascular and Pulmonary Rehabilitation evidence-based clinical practice guidelines panel 5, (including some of the most respected contributors to the previous statement 4) recommended that “IMT be considered in selected patients with COPD who have decreased inspiratory muscle strength and breathlessness despite receiving optimal medical therapy.” That panel suggested that a large-scale, multicentre randomised controlled trial (RCT) should be performed with appropriate statistical power to more completely examine the role of IMT in treating patients with COPD, concluding that “the scientific evidence does not support the routine use of IMT as an essential component of pulmonary rehabilitation” (grade of recommendation 1B) 5. However, why should “inconclusive data” 4 or “grade of recommendation 1B” 5 be considered synonymous with “ineffective”, or prevent a treatment modality in the individual patient 6? Clinical practice …

The Role of Inspiratory Muscle Training in a Pulmonary Rehabilitation Program

Topics discussed in this article include methods and results of inspiratory muscle training and inspiratory muscle rest. The role of inspiratory muscle training remains controversial. No study has shown conclusively that improving inspiratory muscle strength and endurance will decrease CO 2 retention. Likewise, no study has shown that inspiratory muscle training is superior to other treatments in increasing a person’s ability to perform a particular task or activity of daily living. To be recommended to patients on a long-term basis, improvement in inspiratory muscle strength or endurance should be shown to be associated positively with a reduction in a person’s morbidity and mortality or an improvement in their ability to perform activities of daily living or vocational tasks.

Performance and histochemical composition of guinea pig and human diaphragm.

Performance and histochemical composition of guinea pig and human diaphragm.

"Geriatric emergencies"

<b>Introduction:</b> One in ten people recovering from COVID-19 experience prolonged symptoms (&gt;12 weeks), with many reporting breathlessness more than a year after acute infection. There is an urgent need to understand the recovery from COVID-19 and to identify safe, effective rehabilitative strategies. <b>Aims:</b> To investigate the recovery from COVID-19 and the potential rehabilitative role of inspiratory muscle training (IMT). <b>Methods:</b> 250 adults (48±16 yrs; 84% female) recovering from self-reported COVID-19, with a primary symptom of shortness of breath, were randomised 4:1 to an 8-week IMT or control arm, respectively. Breathlessness (King’s Brief Interstitial Lung Disease (KBILD) Questionnaire), respiratory muscle strength, fitness (Chester Step Test) and device-based physical activity (PA) were assessed at baseline and post-intervention. <b>Results:</b> In the first 87 participants (68 IMT) completed to date, IMT improved all domains of the KBILD, with breathlessness reduced by 33% (P&lt;.001) - twice the minimal clinically important difference. Furthermore, IMT improved maximal inspiratory pressure (MIP; baseline 75±32 vs. post 117±58 cmH2O; P&lt;.001), sustained MIP (420±204 vs. 575±265 PTUs; P&lt;.001), fatigue index (17±12 vs. 23±16 au; P&lt;.001) and fitness (36±13 vs. 44±19 ml·kg-1·min-1; P&lt;.001). PA was unchanged. Time was associated with non-significant improvements in all parameters, but the magnitude of improvement was 2–14 times greater with IMT. <b>Conclusions:</b> IMT significantly accelerated the rate of recovery from COVID-19 and represents an acceptable and feasible home-based rehabilitation tool that should be considered for wider implementation as part of COVID-19 recovery strategies.