Test Of Incremental Respiratory Endurance Research Articles

Peak oxygen uptake and respiratory muscle performance in patients with chronic obstructive pulmonary disease: Clinical findings and implications.

The maximal oxygen uptake (VO2max) is the gold standard measure of aerobic exercise capacity and is an important outcome measure in patients with chronic obstructive pulmonary disease (COPD). And respiratory muscle performance is also an important functional parameter for COPD patients. In addition to the traditional respiratory muscle strength test, the Test of Incremental Respiratory Endurance has recently been introduced and validated in patients with COPD. However, the relationship between VO2 and respiratory muscle performance in COPD is not well understood. Therefore, this study investigated the correlations among VO2 and respiratory muscle performance and other functional markers in COPD. A total of 32 patients with COPD were enrolled. All study participants underwent the following assessments: cardiopulmonary exercise test, pulmonary function test, respiratory muscle strength test, peripheral muscle strength test, and bioelectrical impedance analysis. When comparing VO2peak and respiratory muscle parameters, the sustained maximal inspiratory pressure (SMIP) was the only factor with a significant relationship with VO2peak. Among other functional parameters, the forced expiratory volume in one second (FEV1) showed the strongest correlation with VO2peak. It was followed by phase angle values of lower limbs, leg extension peak torque, age, and total skeletal muscle mass. When comparing respiratory muscle performance with other functional parameters, the SMIP showed the strongest correlation with hand grip strength, followed by peak cough flow, forced vital capacity, maximal inspiratory pressure, and FEV1. The results showed that the SMIP was more significantly correlated with VO2peak than the static measurement of respiratory muscle strength. This suggests that TIRE may be a useful assessment tool for patients with COPD. Additionally, FEV1 and other functional markers were significantly correlated with VO2peak, suggesting that various parameters may be used to evaluate aerobic power indirectly.

The Impact of Yoga on Inspiratory Muscle Performance in Veterans with COPD: A Pilot Study.

Chronic obstructive pulmonary disease (COPD) causes respiratory muscle weakness that leads to disabling dyspnea and poor functional performance. Therapies are often geared to improve inspiratory muscle performance. Yoga has been shown to improve exercise capacity, quality of life, and some pulmonary function measures in COPD, but little research has examined the effects of yoga training on inspiratory muscle performance. The purpose of this study was to investigate the effects of yoga training on inspiratory muscle performance in military veterans using the Test of Incremental Respiratory Endurance (TIRE). A prospective pilot study examined a 6-week yoga training program consisting of asana (poses) and pranayama (controlled breathing). Subjects had baseline inspiratory muscle weakness. The TIRE measured inspiratory muscle performance via the PrO2 device, providing maximal inspiratory pressure, sustained maximal inspiratory pressure, and inspiratory duration. Secondary measures included 6-minute walk distance, St. George Respiratory Questionnaire, Hospital Anxiety and Depression Scale, and spirometry. Mean age and BMI of subjects were 67 ± 3.6 years and 20.7 ± 3.3, respectively. The majority of subjects had severe (28.7%) or very severe (57.1%) COPD. Statistically significant improve m e n t s were seen in maximal inspiratory pressure (39.0 ± 14.1 cmH2O to 56.4 ± 20.6 cmH2O) and sustained maximal inspiratory pressure (244.1 ± 100.6 PTU to 308.1 ± 121.2 PTU). No statistically significant improvements we re observed in 6-minute walk distance, St. George Respiratory Questionnaire, Hospital Anxiety and Depression Scale, or spirometry. Yoga training has the potential in improve inspiratory muscle performance in veterans with severe to very severe COPD who present with inspiratory muscle weakness. This is of importance because improving inspira-tory muscle performance has been shown to improve COPD outcomes.

Higher serum levels of systemic inflammatory markers are linked to greater inspiratory muscle dysfunction in COPD.

Chronic obstructive pulmonary disease (COPD) is associated with an inflammatory response that becomes more pronounced in acute exacerbations. Considerable attention has recently focused on the value of several inflammatory mediators in predicting worsening of COPD-related symptoms. Whereas respiratory muscle dysfunction is also widely present in this population, little is known about how systemic inflammation relates to inspiratory muscle dysfunction in COPD. Fifty-three males with mild-to-very severe airflow obstruction underwent blood sampling for 23 inflammatory markers, including acute-phase proteins, cytokines and adipokines. Inspiratory muscle performance was assessed via the test of incremental respiratory endurance, providing measures of maximal (MIP) and sustained maximal (SMIP) inspiratory pressures. The mean ± SD MIP and SMIP were 75.32±19.62 cmH2 O and 406.15±124.55 PTU. MIP negatively correlated with CRP, SAA and cystatin C (r-values from -0.333 to -0.378, P < 0.02), while SMIP was inversely related to SAA and cystatin C (r = -0.534 and r = -0.396, P = 0.00). Significant differences in CRP, SAA, cystatin C and PARC were also found between subjects with and without inspiratory muscle weakness. No additional significant relationships were observed between either MIP or SMIP and other inflammatory markers in the study. MIP and SMIP are markedly reduced with greater degrees of inflammation in COPD as expressed by higher levels of CRP, SAA and cystatin C. Future research is needed to further examine the above findings and determine the impact of systemic inflammation along with its underlying mechanisms on inspiratory muscle function in COPD.

The BODE index and inspiratory muscle performance in COPD: Clinical findings and implications.

Objectives:The Test of Incremental Respiratory Endurance is a novel testing method that provides a unique examination of one’s inspiratory muscle strength, work and endurance. Little is known about the relationship between inspiratory muscle performance and mortality risk in obstructive lung disease. We examined the relationship between the Test of Incremental Respiratory Endurance measures and the Body-mass index, airflow Obstruction, Dyspnea and Exercise index in chronic obstructive pulmonary disease.Methods:In all, 70 males with mild-to-very severe chronic obstructive pulmonary disease (mean ± standard deviation of 70.2 ± 5.9 years) underwent measurements of body-mass index, spirometry, dyspnea and a 6-min walk test from which the Body-mass index, airflow Obstruction, Dyspnea and Exercise score was calculated. The Test of Incremental Respiratory Endurance provided measures of maximal inspiratory pressure, sustained maximal inspiratory pressure and inspiratory duration.Results:All Test of Incremental Respiratory Endurance parameters inversely correlated with the Body-mass index, airflow Obstruction, Dyspnea and Exercise score: maximal inspiratory pressure (r = −0.355, p = 0.00), sustained maximal inspiratory pressure (r = −0.426, p = 0.00) and ID (r = −0.278, p = 0.02), with sustained maximal inspiratory pressure displaying the highest correlation. Independent significant correlations were also observed between the sustained maximal inspiratory pressure and all Body-mass index, airflow Obstruction, Dyspnea and Exercise score components, except for body-mass index. Finally, sustained maximal inspiratory pressure was significantly different among the Body-mass index, airflow Obstruction, Dyspnea and Exercise index quartiles.Discussion:The significant association between the Body-mass index, airflow Obstruction, Dyspnea and Exercise score and inspiratory muscle performance, in particular sustained maximal inspiratory pressure, suggests that these measures may have a potential prognostic value in the evaluation of chronic obstructive pulmonary disease.

Inspiratory Muscle Performance of Former Smokers and Nonsmokers Using the Test of Incremental Respiratory Endurance.

Smoking has potential deleterious effects on respiratory muscle function. Smokers may present with reduced inspiratory muscle strength and endurance. We compared inspiratory muscle performance of nonsmokers with that of former smokers without overt respiratory problems via the Test of Incremental Respiratory Endurance. This study was performed on 42 healthy subjects between the ages of 30 and 79 y (mean ± SD of 56.5 ± 14.4 y). Fourteen male and 7 female former smokers were matched to nonsmokers based on sex, age, height, and weight. Subjects completed a questionnaire about their health and current smoking status. Testing included the best of 3 or more consistent trials. The Test of Incremental Respiratory Endurance measurements included maximal inspiratory pressure measured from residual volume as well as sustained maximal inspiratory pressure and inspiratory duration measured from residual volume to total lung capacity during a maximal sustained inhalation. No significant difference in inspiratory performance of the entire group of former smokers compared with nonsmokers was found. However, separate sex analyses found a significant difference in sustained maximal inspiratory pressure between male former smokers and nonsmokers (518.7 ± 205.0 pressure time units vs 676.5 ± 255.2 pressure time units, P = .041). We found similar maximal inspiratory pressure between former smokers and nonsmokers via the Test of Incremental Respiratory Endurance, but the significant difference in sustained maximal inspiratory pressure between male former smokers and nonsmokers suggests that the sustained maximal inspiratory pressure may have greater discriminatory ability in assessing the effects of smoking on inspiratory muscle performance. Further investigation of the effects of smoking on inspiratory performance via the Test of Incremental Respiratory Endurance is warranted.

Inspiratory Muscle Performance is Significantly Related to Agility and Speed in Collegiate Tennis Players

The Illinois Agility Test (IAT) measures sport agility by combining multi-directional skills with sprints. The Test of Incremental Respiratory Endurance (TIRE) evaluates inspiratory muscle strength and endurance via Maximal Inspiratory Pressure (MIP) and Sustained Maximal Inspiratory Pressure (SMIP). The relationship between athletic agility and inspiratory muscle performance (IMP) is unclear. PURPOSE: To examine the association between IMP and IAT results of Collegiate Tennis Players (CTP). METHODS: IMP of 7 male CTP (mean ± SD age = 20.3 ± 0.8 years, height = 186.2 ± 3.4 cm, and weight = 77.7 ± 6.5 kg) and 8 female CTP (age = 20.9 ± 0.8 years, height = 168.9 ± 6.2 cm, and weight = 64.7 ± 6.5 kg) was assessed via TIRE with the best of 3–5 trials providing MIP [measured from residual volume (RV)] and SMIP (measured from RV to total lung capacity). The IAT was performed twice with a 10-min rest between trials. The first and last intervals of the IAT comprised sprints to and from cones set 10 m apart, while the second interval involved weaving back and forth through four cones placed 3.3 m apart. A custom mobile app and tablet were used to time each IAT interval. RESULTS: MIP and SMIP of men were significantly (p<.05) greater than women (134.5 ± 19.4 vs. 99.5 ± 35.3 cm H2O and 791.1 ± 193.9 vs. 471.7 ± 162.8 PTU, respectively). Men were significantly (p<.05) faster during all IAT intervals and had a significant (p<.05) negative correlation between MIP and last sprint times of both trials (r = - .77 and - .89, respectively). In women, significant (p<.05) negative correlations existed between weaving time and SMIP of the first trial (r = - .77) and MIP and SMIP of the second trial (r = - .93 and - .89, respectively). CONCLUSIONS: IMP was significantly correlated to IAT time in CTP but gender differences existed. The correlation between MIP and last sprints in men suggests that men depend on IMP for speed. MIP and SMIP were related to the weave interval in women suggesting that women depend more on IMP for agility. Stronger correlations existed between IMP and IAT during the second IAT trials suggesting that greater IMP provides less susceptibility to performance decrement associated with fatigue. Greater IMP may provide greater balance and contribute to greater agility in women and speed in men, resulting in improved performance in CTP.

Comparison of inspiratory performance in division 1 collegiate athletes using the Test of Incremental Respiratory Endurance (TIRE)

Comparison of inspiratory performance in division 1 collegiate athletes using the Test of Incremental Respiratory Endurance (TIRE)

Novel methods of inspiratory muscle training via the Test of Incremental Respiratory Endurance (TIRE).

The favorable effects of inspiratory muscle training (IMT) in health and disease are becoming much more apparent. A variety of IMT methods exist, but few studies have compared IMT methods. The purpose of this article is to review the methods and outcomes of the Test of Incremental Respiratory Endurance (TIRE).

Airway clearance in bronchiectasis: a randomized crossover trial of active cycle of breathing techniques (incorporating postural drainage and vibration) versus test of incremental respiratory endurance

The purpose of this study was to compare the efficacy of the test of incremental respiratory endurance (TIRE) with active cycle of breathing techniques (ACBT) [incorporating postural drainage (PD) and vibration] as methods of airway clearance in adults with bronchiectasis. A randomized crossover study in which a single session of ACBT (incorporating PD and vibration) was compared to a single session of TIRE was carried out in 20 patients (14 female) with stable, productive bronchiectasis. Weight of sputum (treatment plus 30 min) was the primary outcome measure recorded. Pre- and post-treatment measures of lung function and SpO2 were also recorded. All 20 patients were stable during the study period. Sputum weight expectorated during and 30 min post-ACBT (incorporating PD and vibration) treatment was significantly greater than the sputum weight expectorated during and 30 min post-TIRE treatment [mean difference 2.44 g (95% CI 0.43-4.45)]. ACBT (incorporating PD and vibration) is a more effective method of airway clearance in bronchiectasis than TIRE during single treatment sessions.

Individualised Fixed Load Inspiratory Muscle Training Responses in a Patient with Severe Restrictive Lung Disease and an Élite Sportsman: Case Report

We have suggested ( Chatham et al., 1999 Chatham K Baldwin J Griffiths H Summers L Enright S ‘Inspiratory muscle training improves shuttle run performance in healthy subjects’. Physiotherapy. 1999; 85: 676-683 Abstract Full Text Full Text PDF Scopus (32) Google Scholar ) that inspiratory muscle training (IMT) may be prescribed successfully to individuals with all grades of respiratory fitness if set at 80% of their individual sustained maximum inspiratory pressure (SMIP). Two subjects underwent eight weeks of IMT. One man was referred by his senior registrar and had restrictive lung disease secondary to severe kyphoscoliosis and poliomyositis. The second individual was Ian Gough, who is a Welsh Rugby international player, second row. He had been forced to withdraw from the Wales tour of Argentina due to a spiral fracture of the radius. He was aware of Rob Howley's use of the Test of Incremental Respiratory Endurance (TIRE) IMT after dislocating his shoulder on the British Lions tour of South Africa in 1997. Rob has continued training with the device and Ian wanted to try to maintain his fitness while in a plaster cast.

Inspiratory Muscle Training Improves Shuttle Run Performance in Healthy Subjects

Background Respiratory muscle training (RMT) has been extensively investigated over the past two decades. To date no method of ventilatory muscle training has fixed load throughout range in a manner consistent with the general principles of skeletal muscle training. The purpose of this study was to assess the use of computer-generated fixed-load incremental RMT produced by the performance of repeated sustained sub-maximal inspiratory efforts (80% of maximum, generated from RV to TLC; a full range of contraction/muscle shortening) with progressively reduced recovery times in healthy volunteers. Methods A ten-week controlled study of RMT was undertaken in healthy volunteers. Twenty-two subjects (mean age 26 years: 12 women) were randomly allocated to control or training groups. Each group performed the Test of Incremental Respiratory Endurance (TIRE) set at 80% of peak, three times weekly at weeks one and ten. The training group continued with the TIRE-based RMT over the intervening eight weeks. The control group ceased RMT at the end of week one and started training again only during the tenth week of the study. Before and at completion of the investigation each participant performed the multi-stage fitness test (shuttle run) and completed visual analogue scores of dyspnoea and perception of sports performance. Results Respiratory muscle strength (RMS) and endurance (RME) increased (P < 0.002, P < 0.0001) in RMT subjects with a concurrent reduction in breathlessness (P < 0.0001) and a perception of improved sports performance (P < 0.0001). The work per breath, measured as sustained inspiratory pressure and predicted VO2 max derived from the shuttle run also increased in this group (P < 0.01, P < 0.001). Despite the increases seen in shuttle run there was no associated increase in breathlessness scored by modified Borg scale at completion of the test. There were no significant changes in any of the measured parameters in the control group. Conclusions We conclude that TIRE-based RMT set at 80% of peak through range increases RMS, single-breath work capacity and RME and that these improvements result in reduced levels of breathlessness, an increase in predicted VO2 max and a perceived improvement in sports performance. Respiratory muscle training (RMT) has been extensively investigated over the past two decades. To date no method of ventilatory muscle training has fixed load throughout range in a manner consistent with the general principles of skeletal muscle training. The purpose of this study was to assess the use of computer-generated fixed-load incremental RMT produced by the performance of repeated sustained sub-maximal inspiratory efforts (80% of maximum, generated from RV to TLC; a full range of contraction/muscle shortening) with progressively reduced recovery times in healthy volunteers. A ten-week controlled study of RMT was undertaken in healthy volunteers. Twenty-two subjects (mean age 26 years: 12 women) were randomly allocated to control or training groups. Each group performed the Test of Incremental Respiratory Endurance (TIRE) set at 80% of peak, three times weekly at weeks one and ten. The training group continued with the TIRE-based RMT over the intervening eight weeks. The control group ceased RMT at the end of week one and started training again only during the tenth week of the study. Before and at completion of the investigation each participant performed the multi-stage fitness test (shuttle run) and completed visual analogue scores of dyspnoea and perception of sports performance. Respiratory muscle strength (RMS) and endurance (RME) increased (P < 0.002, P < 0.0001) in RMT subjects with a concurrent reduction in breathlessness (P < 0.0001) and a perception of improved sports performance (P < 0.0001). The work per breath, measured as sustained inspiratory pressure and predicted VO2 max derived from the shuttle run also increased in this group (P < 0.01, P < 0.001). Despite the increases seen in shuttle run there was no associated increase in breathlessness scored by modified Borg scale at completion of the test. There were no significant changes in any of the measured parameters in the control group. We conclude that TIRE-based RMT set at 80% of peak through range increases RMS, single-breath work capacity and RME and that these improvements result in reduced levels of breathlessness, an increase in predicted VO2 max and a perceived improvement in sports performance.