Threshold Inspiratory Muscle Training Research Articles

Elastic Taping’s Effect on Exercise Capacity in Recreational Runner with Inspiratory Muscle Training

Background: Running is a new trend of recreational sports in Indonesia. About 70% of recreational runners have difficulty in improving exercise capacity due to exercise-related transient abdominal pain (ETAP), caused by fatigue of the diaphragmatic muscles. Previous studies have shown that various training methods may increase diaphragmatic muscle strength and endurance, for example, inspiratory muscle training (IMT). Unfortunately, improvement of inspiratory muscle strength and endurance after exercise and IMT are still varies. Therefore, other methods are needed to optimize the effect of IMT. Application of the elastic taping on thoracic wall during exercise allows the inspiratory muscles to contract optimally which might improve functional capacity.Aim: To assess the effect of elastic taping on inspiratory muscle training using the pressure threshold IMT, in increasing the functional exercise capacity of recreational runners. Functional capacity was measured based on VO2max value, rating of perceived breathlessness (RPB) and rating of perceived exertion (RPE).Methods: an experimental study involved 14 nonsmoker recreational runners, ages 20-40 years, at Outpatient Clinic of Physical Medicine and Rehabilitation Department of Dr. Soetomo Hospital Surabaya. Subjects were divided into two groups (pressure threshold IMT with and without elastic taping groups), which were observed for four weeks. IMT was done five times a week, twice a day, with 30 repetitions, and 60% resistance 30 RM using Respironics®. Elastic taping Leukotape® was applied on the first until fifth day in each IMT sessions. The running exercises were done three times a week with EnMill® Treadmill ETB-03195 with a speed of 4.5 mph and 0% inclination. RBP, RPE and VO2max were measured using Borg Dyspneu scale, Borg Scale, and Bruce Treadmill Protocol test, respectively, before the first exercise and after 4 weeks of exercise.Results: There were an improvement of functional exercise capacity in both groups which were marked with a decline of RPB and RPE and increase of VO2max (p values < 0.05). However, there were no significant differences in the decrease of RPB and RPE and an increase of VO2max between groups (p values of were 0.31, 0.83, and 0.13, respectively). The effect of the elastic taping (r2 = 0.99) was not reflected in the differences of RPB, RPE and increasing VO2max.Conclusion: Inspiratory muscle training using pressure threshold IMT with or without the elastic taping for four weeks can improve exercise capacity of recreational runners.

Effects of inspiratory muscle training in advanced multiple sclerosis

BackgroundRespiratory training using Threshold Inspiratory Muscle Trainer (IMT) has not been examined adequately in multiple sclerosis (MS). The primary objective in this study of persons with advanced MS was to investigate the training effect of IMT. The secondary objective was to evaluate the retention of IMT benefits. MethodsThis study was a repeated measures within-subject design (before-after trial).. Participants were recruited from a long-term care facility specialized in progressive neurologic conditions. Thirty-six non-ambulatory persons with advanced MS volunteered. Inspiratory muscle exercise using the threshold IMT were performed daily for 10 weeks at 3 sets of 15 repetitions per day. Resistance was progressed weekly based on perceived rate of exertion and symptoms. Primary outcome measures were maximum inspiratory pressure (MIP) and maximum expiratory pressure (MEP) that were measured at baseline, after 5 and 10 weeks of IMT exercises (training period), and at 4 and 8 weeks after the IMT training ended (retention). Linear mixed-effect regression models with time (i.e. weeks from baseline) as the fixed factor and participants as the random effect factor were applied separately to test each hypothesis. Effect size was calculated using partial eta square (η2p). Two-tailed significance level was p < 0.05. ResultsParticipants were 60.5 ± 8.6 years old. Expanded Disability Status Scale was 8.5 ± 0.4. Baseline MIP were 25.9 ± 16.4 cmH2O (33.2% %± 19.8% of predicted values) and MEP were 23.5 ± 15.7 cmH2O (25.8% %± 14.4% of predicted values). Compared to the baseline, MIP increased significantly to 30.1 ± 17.9 cmH2O (38.9% %± 22.4% of predicted values) and 30.6 ± 17.6 cmH2O (39.6% %± 22.3% of predicted values) after 5 (p < 0.05) and 10 weeks (p < 0.05) of IMT exercises. MIP improvements were retained in an 8-week washout period. MEP did not differ significantly by time. ConclusionIn persons with advanced MS, 10-week IMT training increased inspiratory muscle strength. This study is the first to demonstrate the retention of benefits following daily IMT exercises at 8 weeks after training ended.

The effects of threshold inspiratory muscle training in patients with obstructive sleep apnea: a randomized experimental study.

Patients with obstructive sleep apnea (OSA) (an obstructed airway and intermittent hypoxia) negatively affect their respiratory muscles. We evaluated the effects of a 12-week threshold inspiratory muscle training (TIMT) program on OSA severity, daytime sleepiness, and pulmonary function in newly diagnosed OSA. Sixteen patients with moderate-to-severe OSA were randomly assigned to a TIMT group and 6 to a control group. The home-based TIMT program was 30-45min/day, 5days/week, for 12weeks using a TIMT training device. Their apnea-hypopnea index (AHI), Epworth sleepiness scale (ESS), and forced vital capacity (FVC) scores were evaluated pre- and post-treatment. Polysomnographic (PSG) analysis showed that 9 TIMT-group patients had positively responded (TIMT-responder group: post-treatment AHI < pre-treatment) and that 7 had not (TIMT non-responder group: post-treatment AHI > pre-treatment). Post-treatment AHI and ESS scores were significantly (both P < 0.05) lower 6% and 20.2%, respectively. A baseline AHI ≤ 29.0/h predicted TIMT-responder group patients (sensitivity 77.8%; specificity 85.7%). FVC was also significantly (P < 0.05) higher 7.2%. Baseline AHI and FEV6.0 were significant predictors of successful TIMT-responder group intervention. OSA severity and daytime sleepiness were also significantly attenuated. Home-based TIMT training is simple, efficacious, and cost-effective.

Methodologies of inspiratory muscle training techniques in obstructive lung diseases

Background: Inspiratory muscle training (IMT) is a non-pharmacological, non-invasive therapeutic method that can improve the quality of life in patients with obstructive lung diseases. The effectiveness of IMT may depends on the type of the device used in the training and the parameters of the training programme. Objectives: The aim of the review was to present different techniques and protocols of IMT used in patients with obstructive lung diseases. Methods: The MEDLINE and EMBASE were searched to identify the potentially eligible publications from the previous 5 years. The various protocols of IMT used in different studies were analysed and described in detail. Results: A database search identified 333 records, of which 22 were included into the final analysis. All of the finally analysed studies were conducted in patients with chronic obstructive pulmonary disease (COPD). The protocols of IMT used in the studies differed in the type of the device used, the duration of the training programme, the number and the duration of training sessions, the initial load, and the rate at which the load was changed during the training. Conclusions: IMT is used mainly in studies on patients with COPD and not with asthma. There is no one approved training programme for IMT. The most predominant type of IMT is a training with threshold loading. The most frequently used devices for IMT are POWERbreath and Threshold IMT. The protocols of IMT used in the studies are very diverse.

Maximum inspiratory pressure of the patients after open-heart surgery following physiotherapy

Background: After open-heart surgery, various complications require specific care, especially in the respiratory system. To reestablish it, several strategies should be used, such as respiratory muscle training, which aims to improve respiratory muscle strength, leading to a reduction in post-operative pulmonary complications in patients undergoing cardiac surgery. Aims and Objectives: The objective of the study was to measure and compare maximum inspiratory pressure (MIP) in open-heart surgery patients following conventional physiotherapy group and conventional physiotherapy plus inspiratory muscle training (IMT) group. Materials and Methods: The study was an experimental design and it was a prospective randomized control study where participants were taken from cardiac hospital using balance block computer-generated randomization method. Fifty participants were divided into two groups of 25 each. Group A received conventional physiotherapy and Group B received conventional plus inspiratory muscle exercise (B) by pressure threshold IMT instrument. Physiotherapy treatment was delivered by qualified physiotherapy, twice a day preoperatively and after extubation, 4–5 sessions per day were given until they discharged. The pre-operative, at discharge, and at the 1st follow-up, patient MIP was measured. Results: There was no statistically significant change in inspiratory muscle strength in patients exposed to an IMT program compared to the control group (P > 0.05). Conclusion: There was no difference in MIP in conventional physiotherapy and conventional plus inspiratory muscle trainer group in “pre-operative,” “discharged,” and “1st follow-up” in open-heart surgery patient.

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.

Effects of inspiratory muscle training on pulmonary functions and muscle strength in sedentary hemodialysis patients.

[Purpose] This study was conducted to evaluate the effect of Inspiratory Muscle Trainer (IMT) on respiratory muscle strength and pulmonary functions. [Subjects and Methods] Fifteen sedentary unemployed patients were recruited from both genders who received regular hemodialysis sessions from at least three months. Those patients received Threshold IMT program for 12 weeks. Pulmonary functions and respiratory muscle strength in form of (PImax) and (PEmax) were measured by electronic spirometry and digital pressure vacuum meter respectively. Additionally oxygen saturation was measured by Finger pulse oximeter. All measurements were performed before and at the end of the treatment program after 12 weeks. [Results] The results of this study revealed significant improvement in FVC%, FEV1%, PEF%, PImax and PEmax after three months of treatment by using inspiratory muscle trainer while no significant difference was recorded regarding to FEV1/FVC% ratio and SpO2. [Conclusion] Inspiratory muscle trainer is an effective therapeutic technique to improve respiratory muscle strength and pulmonary functions in patients undergoing hemodialysis.

The effects of threshold inspiratory muscle training in patients with chronic obstructive pulmonary disease: Arandomised experimental study.

To investigate the effects of threshold inspiratory muscle training in patients with stages II through IV chronic obstructive pulmonary disease using maximum inspiratory pressure, baseline dyspnoea index, 6-minute walk test and quality of life. A threshold inspiratory muscle training device provides pressure for inspiratory muscle strength, but there is limited information on the effects of threshold inspiratory muscle training starting at low pressure training. Randomised experimental design. A total of 55 patients completed this study between September 2013-April 2014. The experimental group (n=27) was provided medical treatment and routine care, along with five sessions of threshold inspiratory muscle training per week (21-30min per session), accompanied by a progressive increase in the pressure threshold over a period of 8weeks. The control group (n=28) was provided medical treatment and routine care only, without intervention. In the inferential analysis, p values <.05 were considered to indicate statistical significance. After 8weeks in the experimental group, mean maximum inspiratory pressure improved by -17.6±0.18cmH2 O, mean 6-minute walk test improved by 47.8±1.46m, and the baseline dyspnoea index increased from 4.48±2.12 points to 9.0±2.27 points. These data and quality of life were statistically different between the experimental and the control groups (p<.05). The threshold inspiratory muscle training can reduce patients' difficulties with respect to daily activities, thereby reducing the burden on the family, and improving prognosis in patients with moderate-to-very severe chronic obstructive pulmonary disease.

Effects Of Inspiratory Muscle Training On Inspiratory And Locomotor Muscle Hemodynamics During Exercise In Men

High levels of respiratory muscle work may elicit a redistribution of blood flow from the locomotor to the respiratory muscles during exercise. It is unknown if specific inspiratory muscle training (IMT) can attenuate this response during high-intensity, whole-body exercise. PURPOSE: To examine the hemodynamic responses of multiple inspiratory muscles and the vastus lateralis (VL) during incremental cycling before and after 5 weeks of IMT. METHODS: After a comprehensive familiarization visit, 25 recreationally active healthy men (mean±SD; age=24±4; maximal aerobic power (V[Combining Dot Above]O2max)=52±10 ml·kg-1·min-1) completed two maximal incremental cycle exercise tests (25W/2min steps) separated by 5 weeks of pressure threshold IMT or sham-control training (SC). The IMT group (n=12) performed 30 inspiratory efforts twice daily against a minimum resistance of 50% of maximum inspiratory pressure (MIP), adjusted weekly. The SC (n=13) group performed a daily bout of 60 inspiratory efforts against 10% MIP using the same device with no weekly adjustments. During the incremental cycle tests, participants were instrumented with NIRS optodes on the sternocleidomastoid (SCM), parasternal intercostals (PIC), 7th intercostal space (7IC), and VL to measure changes in oxygenated, deoxygenated, and total hemoglobin (tHb) concentrations. RESULTS: The IMT and SC groups were well matched for age, height, mass, and V[Combining Dot Above]O2max. There was a significant increase in MIP in the IMT group (mean±SD, 135±44 vs. 159±35 cmH2O, p<0.05) but not in the SC group (134±39 vs. 134±44 cmH2O, p>0.05). No differences were detected when comparing pre vs. post-IMT for any NIRS derived variables at relative percentages of maximal work rate (20, 40, 60, 80,100%) for any muscle in both the IMT and SC groups. The tHb (muscle blood volume) at the highest equivalent absolute work rate achieved by an individual on each test in the IMT group (pre vs. post-IMT) was 3±15 vs. 1±25, 1±9 vs. 2±11, -6±12 vs. -6±12, and 12±10 vs. 11±9[INCREMENT]μM whereas the SC group was 2±11 vs. 3±6, 1±9 vs. 4±8, -6±6 vs. -6±8, and 12±8 vs. 9±10[INCREMENT]μM in the SCM, PIC, 7IC, and VL, respectively (all p>0.05). CONCLUSION: Five weeks of pressure-threshold IMT had no effect on respiratory or locomotor muscle hemodynamics during incremental cycle exercise in healthy recreationally active men. Supported NSERC

Effect of Threshold Inspiratory Muscle Training on Maximal Inspiratory Pressure and Pulmonary Gas Exchange in Patients Undergoing Coronary Artery Bypass Graft Surgery

Effect of Threshold Inspiratory Muscle Training on Maximal Inspiratory Pressure and Pulmonary Gas Exchange in Patients Undergoing Coronary Artery Bypass Graft Surgery

Brief Research Report: The Feasibility of Expiratory Resistive Loading Using the Threshold Inspiratory Muscle Training Device

Brief Research Report: The Feasibility of Expiratory Resistive Loading Using the Threshold Inspiratory Muscle Training Device

Effects of Inspiratory Muscle Training and Yoga Breathing Exercises on Respiratory Muscle Function in Institutionalized Frail Older Adults

In older adults, respiratory function may be seriously compromised when a marked decrease of respiratory muscle (RM) strength coexists with comorbidity and activity limitation. Respiratory muscle training has been widely studied and recommended as a treatment option for people who are unable to participate in whole-body exercise training (WBET); however, the effects of inspiratory muscle training and yoga breathing exercises on RM function remain unknown, specifically in impaired older adults. To evaluate the effects of inspiratory threshold training (ITT) and yoga respiratory training (YRT) on RM function in institutionalized frail older adults. Eighty-one residents (90% women; mean age, 85 years), who were unable to perform WBET (inability to independently walk more than 10 m), were randomly assigned to a control group or one of the 2 experimental groups (ITT or YRT). Experimental groups performed a supervised interval-based training protocol, either through threshold inspiratory muscle training device or yoga breathing exercises, which lasted 6 weeks (5 days per week). Outcome measures were collected at 4 time points (pretraining, intermediate, posttraining, and follow-up) and included the maximum respiratory pressures (maximum inspiratory pressure [MIP] and maximum expiratory pressure [MEP]) and the maximum voluntary ventilation (MVV). Seventy-one residents completed the study: control (n = 24); ITT (n = 23); YRT (n = 24). The treatment on had a significant effect on MIP YRT (F(6,204) = 6.755, P < .001, η2 = 0.166), MEP (F(6,204) = 4.257, P < .001, η2 = 0.111), and MVV (F(6,204) = 5.322, P < .001, η2 = 0.135). Analyses showed that the YRT group had a greater increase of RM strength (MIP and MEP) and endurance (MVV) than control and/or ITT groups. Yoga respiratory training appears to be an effective and well-tolerated exercise regimen in frail older adults and may therefore be a useful alternative to ITT or no training, to improve RM function in older population, when WBET is not possible.

Effects of respiratory muscle training on pulmonary functions in patients with slowly progressive neuromuscular disease: a randomized controlled trial

Objective: To investigate the effects of inspiratory and expiratory muscle training on pulmonary functions in patients with slowly progressive neuromuscular disease. Design: Prospective randomized controlled double-blinded study. Setting: Chest diseases clinic of university hospital. Subjects: Twenty-six patients with slowly progressive neuromuscular disease followed for respiratory problems were included in the study. Patients were randomly divided into two groups; experimental (n = 14; age 31.6 ±12.3 years) and sham (n = 12; age 26.5 ±8.6 years) groups. Methods: Spirometry, peak cough flow, maximal inspiratory pressure, maximal expiratory pressure, and sniff nasal inspiratory pressure were measured before the eighth week of study, and subsequently at end of it. Respiratory muscle training was performed by inspiratory (Threshold Inspiratory Muscle Trainer) and expiratory (Threshold Positive Expiratory Pressure) threshold loading methods. Training intensities were increased according to maximal inspiratory and expiratory pressures in the experimental group, while the lowest loads were used for training in the sham group. Patients performed 15 minutes inspiratory muscle training and 15 minutes expiratory muscle training, twice a day, five days/week, for a total of eight weeks at home. Training intensity was adjusted in the training group once a week. Results: Maximal inspiratory and expiratory pressures (cmH2O, % predicted) (respectively p = 0.002, p = 0.003, p = 0.04, p = 0.03) and sniff nasal inspiratory pressure (p = 0.04) were improved in the experimental group when compared with the sham group. However, there was no improvement in spirometric measurements when groups were compared (p > 0.05). Conclusions: As a conclusion of our study, we found that respiratory muscle strength improved by inspiratory and expiratory muscle training in patients with slowly progressive neuromuscular disease.

Effects of inspiratory muscle training on exercise responses in Paralympic athletes with cervical spinal cord injury

We asked whether specific inspiratory muscle training (IMT) improves respiratory structure and function and peak exercise responses in highly trained athletes with cervical spinal cord injury (SCI). Ten Paralympic wheelchair rugby players with motor-complete SCI (C5-C7) were paired by functional classification then randomly assigned to an IMT or placebo group. Diaphragm thickness (B-mode ultrasonography), respiratory function [spirometry and maximum static inspiratory (PI ,max ) and expiratory (PE ,max ) pressures], chronic activity-related dyspnea (Baseline and Transition Dyspnea Indices), and physiological responses to incremental arm-crank exercise were assessed before and after 6 weeks of pressure threshold IMT or sham bronchodilator treatment. Compared to placebo, the IMT group showed significant increases in diaphragm thickness (P = 0.001) and PI ,max (P = 0.016). There was a significant increase in tidal volume at peak exercise in IMT vs placebo (P = 0.048) and a strong trend toward an increase in peak work rate (P = 0.081, partial eta-squared = 0.33) and peak oxygen uptake (P = 0.077, partial eta-squared = 0.34). No other indices changed post-intervention. In conclusion, IMT resulted in significant diaphragmatic hypertrophy and increased inspiratory muscle strength in highly trained athletes with cervical SCI. The strong trend, with large observed effect, toward an increase in peak aerobic performance suggests IMT may provide a useful adjunct to training in this population.

Respiratory physiotherapy can increase lower esophageal sphincter pressure in GERD patients

Inspiratory muscle training (IMT) has been shown to increase diaphragm thickness. We evaluated the effect of IMT on mid-respiratory pressure (MRP) in patients with gastroesophageal reflux disease (GERD) and hypotensive lower esophageal sphincter (LES), and compared the results with a sham group. Twenty consecutive patients (progressive loading group) and 9 controls (sham group) were included. All patients had end expiratory pressure (EEP) between 5 and 10mmHg, underwent esophageal manometry and pulmonary function tests before and after 8weeks of training, and used a threshold IMT twice daily. The threshold IMT was set at 30% of the maximal inspiratory pressure for the progressive loading group; while, the threshold for sham-treated patients was set at 7cmH(2)O for the whole period. There was an increase in MRP in 15 (75%) patients in the progressive loading group, with an average gain of 46.6% (p<0.01), and in six (66%) patients in the sham group with a mean increase of 26.2% (p<0.01). However, there was no significant difference between the groups (p=0.507). The EEP also increased compared with measurements before training (p<0.01), but it did not differ between groups (p=0.727). IMT increased LES pressure in patients with GERD, in both the treatment and sham groups, after an eight-week program. Although there was no statistically significant difference between groups, suggesting the pressure increase in LES occurs regardless of the resistance load of the threshold IMT. These findings need to be confirmed in further studies with a larger sample. 0922/09.

Extubation process in bed-ridden elderly intensive care patients receiving inspiratory muscle training: a randomized clinical trial

BackgroundThe purpose of this study was to evaluate the extubation process in bed-ridden elderly intensive care patients receiving inspiratory muscle training (IMT) and identify predictors of successful weaning.MethodsTwenty-eight elderly intubated patients in an intensive care unit were randomly assigned to an experimental group (n = 14) that received conventional physiotherapy plus IMT with a Threshold IMT® device or to a control group (n = 14) that received only conventional physiotherapy. The experimental protocol for muscle training consisted of an initial load of 30% maximum inspiratory pressure, which was increased by 10% daily. The training was administered for 5 minutes, twice daily, 7 days a week, with supplemental oxygen from the beginning of weaning until extubation. Successful extubation was defined by the ventilation time measurement with noninvasive positive pressure. A vacuum manometer was used for measurement of maximum inspiratory pressure, and the patients’ Tobin index values were measured using a ventilometer.ResultsThe maximum inspiratory pressure increased significantly (by 7 cm H2O, 95% confidence interval [CI] 4–10), and the Tobin index decreased significantly (by 16 breaths/ min/L, 95% CI −26 to 6) in the experimental group compared with the control group. The Chi-squared distribution did not indicate a significant difference in weaning success between the groups (χ2 = 1.47; P = 0.20). However, a comparison of noninvasive positive pressure time dependence indicated a significantly lower value for the experimental group (P = 0.0001; 95% CI 13.08–18.06). The receiver-operating characteristic curve showed an area beneath the curve of 0.877 ± 0.06 for the Tobin index and 0.845 ± 0.07 for maximum inspiratory pressure.ConclusionThe IMT intervention significantly increased maximum inspiratory pressure and significantly reduced the Tobin index; both measures are considered to be good extubation indices. IMT was associated with a reduction in noninvasive positive pressure time in the experimental group.

Evaluation of respiratory conditions in early phase of hematopoietic stem cell transplantation

ObjectivesTo investigate the effectiveness of respiratory physiotherapy based on clinical evidence and analyze the improvement in respiratory parameters.MethodsA prospective study was carried out in the Bone Marrow Transplant Unit of the Universidade Estadual de Campinas (UNICAMP). Two different previously established respiratory physiotherapy protocols were applied from days D-1 to D+7 that aimed to improve airway clearance, pulmonary re-expansion and the strengthening of respiratory muscles. Group A were subjected to diaphragmatic proprioceptive stimulation, breathing exercises, incentive spirometry with Respiron®, inspiratory muscle training with the Threshold® Inspiratory Muscle Training device, bronchial hygienization with Shaker® and cough stimulation. Group B performed a protocol that only used incentive spirometry. The parameters analyzed were: tidal volume, minute volume, maximal inspiratory pressure, maximal expiratory pressure, oxygen saturation, heart rate and respiratory frequency.ResultsSixty-seven patients submitted to myeloablative hematopoietic stem cell transplantation were included in this study. Among these, thirty-nine were evaluated and randomized in the two groups. There were significant differences between the groups for tidal volume at D+2 (p-value = 0.007) and maximal inspiratory pressure (p-value = 0.03), maximal expiratory pressure (p-value = 0.03) and tidal volume (p-value = 0.004) at D+7.ConclusionsOn comparing Group A with Group B, the authors concluded that the protocol of respiratory physiotherapy applied in this study resulted in an improvement in ventilation and in respiratory muscle strength of patients submitted to hematopoietic stem cell transplantation.

Pulmonary Rehabilitation Using Modified Threshold Inspiratory Muscle Trainer (IMT) in Patients with Tetraplegia

It is aimed to present the usefulness of inspiratory muscle trainer (IMT) in treatment of a 20-year-old male patient with diaphragmatic paralysis and tetraplegia due to spinal cord injury (SCI), and supporting effect of IMT in recovering from respiratory failure by rendering his diaphragm functions. The treatment was applied through the tracheostomy cannula by a modified IMT device. After applying IMT for three weeks, it was observed that the diaphragm recovered its functions in electromyography (EMG) test. As a result, in this study, we present a case where a patient could live without any respiratory device for the rest of his life with the help of modified IMT.

Effects of High-Intensity Inspiratory Muscle Training Following a Near-Fatal Gunshot Wound

Severe injuries sustained during combat may classify individuals as undeployable for active service. It is imperative that every effort is made to optimize physical function following such injuries. A 38-year-old man sustained a gunshot wound during armed combat. The bullet entered via the left axilla and exited from the right side of the abdomen, resulting in severe thoracic and abdominal injuries. Five months later, he continued to describe severe dyspnea on exertion. During a cardiopulmonary exercise test on a cycle ergometer, he achieved a maximum rate of oxygen uptake of 2,898 mL·min(-1) (114% predicted) and maximum power of 230 W (114% predicted). His maximum forced inspiratory flow was 5.95 L·s(-1), and inspiratory reserve volume at test end was ∼80 mL. The test was terminated by the patient due to dyspnea that was too severe to tolerate. Video fluoroscopy demonstrated impaired right hemidiaphragm function. The main goals of therapy were to reduce dyspnea on exertion and to enable return to full work duties. A program of high-intensity, interval-based threshold inspiratory muscle training (IMT) was undertaken. An average of 5 sessions of IMT were completed each week for 10 weeks. During a repeat cardiopulmonary exercise test, the patient achieved a similar power and maximum rate of oxygen uptake. His maximum forced inspiratory flow increased by 48% to 8.83 L·s(-1), and he was limited by leg fatigue. High-intensity IMT was safe and well tolerated. It was associated with improvements in maximum forced inspiratory flow and changed the locus of symptom limitation during high-intensity exercise from dyspnea to leg fatigue.

Acute Cardiorespiratory Responses to Inspiratory Pressure Threshold Loading

We tested the acute responses to differing pressure threshold inspiratory loading intensities in well-trained rowers. The purpose of this study was to evaluate 1) how the magnitude of inspiratory pressure threshold loading influences repetition maximum (RM), tidal volume (VT), and external work undertaken by the inspiratory muscle; and 2) whether the inspiratory muscle metaboreflex is activated during acute inspiratory pressure threshold loading. Eight males participated in seven trials. Baseline measurements of maximal inspiratory pressure (PImax), resting tidal volume (VT), and forced vital capacity (FVC) were made. During the remaining sessions, participants undertook a series of resistive inspiratory breathing tasks at loads corresponding to 50%, 60%, 70%, 80%, and 90% of PImax using a pressure threshold inspiratory muscle trainer. The number of repetitions completed at each load, VT, heart rate (fc), and measures of arterial blood pressure was assessed continuously during each trial. A standardized cutoff of 10% FVC was used to define the RM, which decreased as loading intensity increased (P < 0.05). This response was nonlinear, with an abrupt decrease in RM occurring at loads > or =70% of PImax. The most commonly used inspiratory muscle training regimen of 30RM corresponded to 62.5% +/- 4.6% of PImax and also resulted in the highest external work output. Tidal volume (VT) decreased significantly over time at 60%, 70%, and 80% of PImax (P < 0.05), as did the amount of external work completed (P<0.05). Although all loads elicited a sustained increase in fc, only the 60% load elicited a sustained rise in mean arterial blood pressure (P = 0.016), diastolic blood pressure (P = 0.015), and systolic blood pressure (P = 0.002), providing evidence for a metaboreflex response at this load.