The effect of respiratory muscle training on children and adolescents with cystic fibrosis: a systematic review and meta-analysis.

BACKGROUND: Cystic fibrosis is a chronic genetic disease that can affect the function of the respiratory system. Previous reviews of the effects of respiratory muscle training in people with cystic fibrosis are uncertain and do not consider the effect of age on disease progression. This systematic review aims to determine the effectiveness of respiratory muscle training in the clinical outcomes of children and adolescents with cystic fibrosis. METHODS: Up to July 2023, electronic databases and clinical trial registries were searched. Controlled clinical trials comparing respiratory muscle training with sham intervention or no intervention in children and adolescents with cystic fibrosis. The primary outcomes were respiratory muscle strength, respiratory muscle endurance, lung function, and cough. Secondary outcomes included exercise capacity, quality of life and adverse events. Two review authors independently extracted data and assessed study quality using the Cochrane Risk of Bias Tool 2. The certainty of the evidence was assessed according to the GRADE approach. Meta-analyses where possible; otherwise, take a qualitative approach. RESULTS: Six studies with a total of 151 participants met the inclusion criteria for this review. Two of the six included studies were published in abstract form only, limiting the available information. Four studies were parallel studies and two were cross-over designs. There were significant differences in the methods and quality of the methodology included in the studies. The pooled data showed no difference in respiratory muscle strength, lung function, and exercise capacity between the treatment and control groups. However, subgroup analyses suggest that inspiratory muscle training is beneficial in increasing maximal inspiratory pressure, and qualitative analyses suggest that respiratory muscle training may benefit respiratory muscle endurance without any adverse effects. CONCLUSIONS: This systematic review and meta-analysis indicate that although the level of evidence indicating the benefits of respiratory muscle training is low, its clinical significance suggests that we further study the methodological quality to determine the effectiveness of training. TRIAL REGISTRATION: The protocol for this review was recorded in the International Prospective Register of Systematic Reviews (PROSPERO) under registration number CRD42023441829.

Does inspiratory muscle training improve lung function and quality of life in people with inclusion body myositis? A pilot study.

Inclusion body myositis is the most common acquired myositis in adults, predominantly weakening forearm flexor and knee extensor muscles. Subclinical respiratory muscle weakness has recently been recognised in people with inclusion body myositis, increasing their risk of respiratory complications. Inspiratory muscle training, a technique which demonstrates efficacy and safety in improving respiratory function in people with neuromuscular disorders, has never been explored in those with inclusion body myositis. In this pilot study, six adults with inclusion body myositis (age range 53 to 81 years) completed eight weeks of inspiratory muscle training. Measures of respiratory function, quality of life, sleep quality and a two-minute walk test were performed pre and post-intervention. All participants improved their respiratory function, with maximal inspiratory pressure, sniff nasal inspiratory pressure and forced vital capacity increasing by an average of 50 % (p = .002), 43 % (p = .018) and 13 % (p = .003) respectively. No significant change was observed in quality of life, sleep quality or two-minute walk test performance. No complications occurred due to inspiratory muscle training This pilot study provides the first evidence that inspiratory muscle training may be safe and effective in people with Inclusion Body Myositis, potentially mitigating the complications of poor respiratory function.

Efficacy of Respiratory Muscle Training in the Immediate Postoperative Period of Cardiac Surgery: A Systematic Review and Meta-Analysis.

INTRODUCTION: This study aimed to evaluate the efficacy of respiratory muscle training during the immediate postoperative period of cardiac surgery on respiratory muscle strength, pulmonary function, functional capacity, and length of hospital stay. METHODS: This is a systematic review and meta-analysis. A comprehensive search on PubMed®, Excerpta Medica Database (or Embase), Cumulative Index of Nursing and Allied Health Literature (or CINAHL), Latin American and Caribbean Health Sciences Literature (or LILACS), Scientific Electronic Library Online (or SciELO), Physiotherapy Evidence Database (or PEDro), and Cochrane Central Register of Controlled Trials databases was performed. A combination of free-text words and indexed terms referring to cardiac surgery, coronary artery bypass grafting, respiratory muscle training, and clinical trials was used. A total of 792 studies were identified; after careful selection, six studies were evaluated. RESULTS: The studies found significant improvement after inspiratory muscle training (IMT) (n = 165, 95% confidence interval [CI] 9.68, 21.99) and expiratory muscle training (EMT) (n = 135, 95% CI 8.59, 27.07) of maximal inspiratory pressure and maximal expiratory pressure, respectively. Also, IMT increased significantly (95% CI 19.59, 349.82, n = 85) the tidal volume. However, no differences were found in the peak expiratory flow, functional capacity, and length of hospital stay after EMT and IMT. CONCLUSION: IMT and EMT demonstrated efficacy in improving respiratory muscle strength during the immediate postoperative period of cardiac surgery. There was no evidence indicating the efficacy of IMT for pulmonary function and length of hospital stay and the efficacy of EMT for functional capacity.

Feasibility of oropharyngeal and respiratory muscle training in individuals with OSA and spinal cord injury or disease: A pilot study.

OBJECTIVES: To examine the feasibility of individuals with spinal cord injury or disease (SCI/D) to perform combined oropharyngeal and respiratory muscle training (RMT) and determine its impact on their respiratory function. METHODS: A prospective study at a single Veterans Affairs (VA) Medical Center. Inclusion criteria included: 1) Veterans with chronic SCI/D (>6 months postinjury and American Spinal Injury Association (ASIA) classification A-D) and 2) evidence of OSA by apnea-hypopnea index (AHI ≥5 events/h). Eligible participants were randomly assigned to either an experimental (exercise) group that involved performing daily inspiratory, expiratory (using POWERbreathe and Expiratory Muscle Strength Trainer 150 devices, respectively), and tongue strengthening exercises or a control (sham) group that involved using a sham device, for a 3-month period. Spirometry, maximal expiratory pressure (MEP), maximal inspiratory pressure (MIP), polysomnography, and sleep questionnaires were assessed at baseline and at 3 months. RESULTS: Twenty-four individuals were randomized (12 participants in each arm). A total of eight (67%) participants completed the exercise arm, and ten (83%) participants completed the sham arm. MIP was significantly increased (p < 0.05) in the exercise group compared with the baseline. CONCLUSIONS: Combined oropharyngeal and RMT are feasible for individuals with SCI/D. Future studies are needed to determine the clinical efficacy of these respiratory muscle exercises.

Electromyogram Power Spectrum and Cardiac Function Changes After Combined Aerobic Interval Training and Inspiratory Muscle Training in Chronic Heart Failure Patients.

Exercise intolerance and dyspnea are the major symptoms of patients with chronic heart failure (CHF) and are associated with a poor quality of life. In addition to impaired central hemodynamics, symptoms may be attributed to changes in peripheral skeletal muscles. This study aimed to evaluate the effects of aerobic interval training (AIT) combined with inspiratory muscle training (IMT) on cardiac and skeletal muscle function and on functional capacity and dyspnea in patients with CHF and inspiratory muscle weakness.Left ventricle ejection fraction was improved significantly after AIT and AIT & IMT with a high percentage of amelioration (17%, P < 0.042) in the combined group compared to the control group. Therefore, we showed a significant improvement in maximal voluntary isometric force, isometric endurance time, root mean square, and frequency median in both strength and endurance manipulations in the aerobic and combined group; however, the improvement was superior in the combined group compared to the control group. Significant amelioration was proved in functional capacity and dyspnea after all types of training but was performed at 18% higher in 6 minutes' walk test and 43% lower in dyspnea for the combined group compared to the control group.Combining AIT to IMT had optimized exercise training benefits in reversing the cardiac remodeling process and improving skeletal muscle function, functional capacity, and dyspnea in patients with CHF.

The effect of respiratory muscle training on respiratory muscle strength, diaphragm thickness/mobility, and exercise capacity in patients with systemic lupus erythematosus and associated shrinking lung syndrome.

Systemic lupus erythematosus (SLE) is a chronic autoimmune disorder that can impact any organ in the body. The pathophysiology of shrinking lung syndrome (SLS), a rare pulmonary complication of SLE, remains unknown. The objective of the current case series was to investigate the effects of inspiratory muscle training (IMT) on diaphragm thickness/mobility, respiratory muscle strength, peripheral muscle thickness/strength, and functional exercise capacity in patients with SLE and associated SLS. Three patients with SLE were included in the case series. Respiratory muscle strength, peripheral muscle strength, peripheral muscle thickness, diaphragm muscle thickness, diaphragm muscle mobility, functional exercise capacity, and pulmonary function test were assessed. A significant improvement has been determined in respiratory muscle strength, functional exercise capacity, peripheral muscle strength, peripheral muscle thickness, diaphragm muscle thickness, and diaphragm muscle mobility. This is the first case series showing the beneficial effects of IMT on respiratory muscle strength, diaphragm thickness/mobility, peripheral muscle thickness/strength, and exercise capacity in patients with SLE.

The effects of inspiratory muscle training on cardiorespiratory functions in juvenile idiopathic arthritis: A randomized controlled trial.

INTRODUCTION: Although inspiratory muscle training (IMT) has proven effective in adult rheumatic diseases, its impact on juvenile idiopathic arthritis (JIA) remains unexplored. The present study aimed to investigate the effects of IMT in children with JIA. METHODS: Thirty-three children (13-18 years) with JIA were divided into two groups as exercise (n = 17) and control (n = 16). The exercise group performed IMT at home daily for 8 weeks. The initial IMT load was set as 60% of maximal inspiratory pressure (PImax ) and increased by %10 of the initial load every 2 weeks. The control group received no additional intervention. Forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1 ), FVC/FEV1 , PImax , and maximal expiratory pressure (PEmax ) were evaluated. Peak oxygen consumption (VO2max ), metabolic equivalents (METs), and maximal heart rate were measured with cardiopulmonary exercise test. Functional capacity and quality of life were assessed with 6-min walk distance and Pediatric Quality of Life Inventory 3.0 Arthritis Module. All participants were evaluated at baseline and post-treatment. RESULTS: FVC ( ↑ 0.20 (95% CI: 0.07/0.32) liters), FEV1 ( ↑ 0.14 (95% CI: 0.02/0.25) liters), PImax (↑19.11 (95% CI: 9.52/28.71) cmH2 O), PEmax (↑12.41 (95% CI: 3.09/21.72) cmH2 O), VO2peak (↑158.29 (95% CI: 63.85/252.73) ml/min), and METs (↑0.92 (95% CI: 0.34/1.49) [ml/kg/min]) significantly improved only in the exercise group (p < .05). The difference over time in FVC, FEV1 , PImax , VO2peak , and METs were significantly higher in exercise group compared to control group (p < .05). CONCLUSIONS: IMT seems to be an effective option for improving respiratory functions and aerobic exercise capacity in JIA.

Effect of respiratory muscle endurance training on performance and respiratory function in professional cyclists during the off-season.

BACKGROUND: The study aimed to analyze the effect of respiratory muscle endurance training (RMT) on performance and respiratory function in professional road cyclists during the off-season period. METHODS: Twenty professional road cyclists from the Czech Republic were divided into the control (CON) (N.=10) and the RMT (N.=10) groups. Cyclists from the RMT group accomplished 30 sessions over 10 weeks. Performance in the incremental cycling test and respiratory capacity via test were assessed before and after 10 weeks in both groups. The comparison between and within the groups was performed, together with effect size and delta % (P<0.05). RESULTS: Significant effects on respiratory function during the exercise, on lung volume utilization at 90% of VO2max (TV-90%) and maximal voluntary ventilation (MVV) were found in RMT compared to the CON group, with a moderate effect size (0.71 and 0.61), and improvements of 13% and 14%, respectively. Parameters of performance in the cycling protocol and respiratory function at rest presented better values in the RMT group, however with no significance and in minor magnitude. CONCLUSIONS: Using RMT during off-season benefits professional road cyclists by improving the major efficiency of respiratory function during progressive efforts. Therefore, the protocol of RMT could be used as an ergogenic aid during this period in order to maintain respiratory adaptations, optimizing the pre-season training. Adjustments can be made to improve the parameters outcomes.

Effect of Pulmonary Rehabilitation Exercise on Lung Volume and Respiratory Muscle Recovery in Lung Cancer Patients Undergoing Lobectomy.

Objective: This work assessed the impact of drug therapy combined with pulmonary rehabilitation exercise training on specific lung function and respiratory parameters of lung cancer (LC) patients after thoracoscopic lobectomy. Methods: 88 LC patients who had undergone thoracoscopic lobectomy were selected based on their surgical indications and health condition. The study aimed to explore methods to assist patients in their postoperative recovery; therefore, patients meeting the surgical criteria were chosen to ensure the internal validity and external applicability of the results. Meanwhile, these 88 LC patients undergoing thoracoscopic lobectomy were randomly allocated into an experimental group (EG, 44 cases) and a control group (CG, 44 cases). The EG received inhalation therapy with albuterol sulfate nebulizer solution and personalized pulmonary rehabilitation exercise training, while the CG received nebulized treatment alone. The study lasted for three months. The pulmonary rehabilitation program included regular physical exercises, including respiratory training and physical fitness training, among other activities. Results: After pulmonary lobectomy surgery, both groups of patients showed a significant decrease in (1) forced vital capacity (FVC), (2) forced expiratory volume in 1 second (FEV1), (3) maximum voluntary ventilation (MVV), and (4) peak expiratory flow (PEF). However, the values of FVC, FEV1, MVV, and PEF in the EG were significantly higher than those in the CG (P < .05). Furthermore, both groups demonstrated significant improvements in the 6-minute walk test (6MWT) results after lung lobectomy; however, the 6MWT results in the EG also significantly increased (P < .05). In terms of dyspnea index (DI), after lung lobectomy, the DI for both groups of patients significantly increased, but the DI in the EG was significantly lower than that in the CG (P < .05). Conclusions: The combined application of drug therapy and pulmonary rehabilitation exercise training contributed to promoting cardiopulmonary function and respiratory muscle recovery in LC patients after thoracoscopic lobectomy. This was crucial for improving the quality of life of patients, as enhanced cardiopulmonary function and respiratory muscle recovery can alleviate postoperative respiratory difficulties, increase the physical stamina and activity levels of patients. This may help reduce the risk of postoperative complications, shorten hospital stays, and potentially improve long-term survival rates. Consequently, these results could have a positive impact on the development of postoperative care and treatment strategies. However, this work was subjected to several limitations, including a relatively short duration, necessitating longer-term follow-up to assess long-term effects. Additionally, the sample size was relatively small, and further large-scale research was needed to validate these findings.

Preoperative respiratory muscle training reduces the risk of pulmonary complications and the length of hospital stay after cardiac surgery: a systematic review.

QUESTIONS: What is the effect of preoperative respiratory muscle training (RMT) on the incidence of postoperative pulmonary complications (PPCs) after open cardiac surgery? What is the effect of RMT on the duration of mechanical ventilation, postoperative length of stay and respiratory muscle strength? DESIGN: Systematic review of randomised trials with meta-analysis. PARTICIPANTS: Adults undergoing elective open cardiac surgery. INTERVENTION: The experimental groups received preoperative RMT and the comparison groups received no intervention. OUTCOME MEASURES: The primary outcomes were PPCs, length of hospital stay, respiratory muscle strength, oxygenation and duration of mechanical ventilation. The methodological quality of studies was assessed using the PEDro scale and the overall certainty of the evidence was assessed using the GRADE approach. RESULTS: Eight trials involving 696 participants were included. Compared with the control group, the respiratory training group had fewer PPCs (RR 0.51, 95% CI 0.38 to 0.70), less pneumonia (RR 0.44, 95% CI 0.25 to 0.78), shorter hospital stay (MD -1.7 days, 95% CI -2.4 to -1.1) and higher maximal inspiratory pressure values at the end of the training protocol (MD 12 cmH2O, 95% CI 8 to 16). The mechanical ventilation time was similar in both groups. The quality of evidence was high for pneumonia, length of hospital stay and maximal inspiratory pressure. CONCLUSION: Preoperative RMT reduced the risk of PPCs and pneumonia after cardiac surgery. The training also improved the maximal inspiratory pressure and reduced hospital stay. The effects on PPCs were large enough to warrant use of RMT in this population. REGISTRATION: CRD42021227779.

The Association Between Preoperative Inspiratory Muscle Training Variables and Postoperative Pulmonary Complications in Subjects With Esophageal Cancer.

BACKGROUND: Preoperative inspiratory muscle training (IMT) is frequently used in patients waiting for major surgery to improve respiratory muscle function and to reduce the risk of postoperative pulmonary complications (PPCs). Currently, the mechanism of action of IMT in reducing PPCs is still unclear. Therefore, we investigated the associations between preoperative IMT variables and the occurrence of PPCs in patients with esophageal cancer. METHODS: A multi-center cohort study was conducted in subjects scheduled for esophagectomy, who followed IMT as part of a prehabilitation program. IMT variables included maximum inspiratory pressure (PImax) before and after IMT and IMT intensity variables including training load, frequency, and duration. Associations between PImax and IMT intensity variables and PPCs were analyzed using independent samples t tests and logistic regression analyses, corrected for age and pulmonary comorbidities and stratified for the occurrence of anastomotic leakages. RESULTS: Eighty-seven subjects were included (69 males; mean age 66.7 ± 7.3 y). A higher PImax (odds ratio 1.016, P = .07) or increase in PImax during IMT (odds ratio 1.020, P = .066) was not associated with a reduced risk of PPCs after esophagectomy. Intensity variables of IMT were also not associated (P ranging from .16 to .95) with PPCs after esophagectomy. Analyses stratified for the occurrence of anastomotic leakages showed no associations between IMT variables and PPCs. CONCLUSIONS: This study shows that an improvement in preoperative inspiratory muscle strength during IMT and training intensity of IMT were not associated with a reduced risk on PPCs after esophagectomy. Further research is needed to investigate other possible factors explaining the mechanism of action of preoperative IMT in patients undergoing major surgery, such as the awareness of patients related to respiratory muscle function and a diaphragmatic breathing pattern.

Insights into the Serum Metabolic Adaptations in Response to Inspiratory Muscle Training: A Metabolomic Approach Based on 1H NMR and UHPLC-HRMS/MS.

Inspiratory muscle training (IMT) is known to promote physiological benefits and improve physical performance in endurance sports activities. However, the metabolic adaptations promoted by different IMT prescribing strategies remain unclear. In this work, a longitudinal, randomized, double-blind, sham-controlled, parallel trial was performed to investigate the effects of 11 weeks (3 days·week-1) of IMT at different exercise intensities on the serum metabolomics profile and its main regulated metabolic pathways. Twenty-eight healthy male recreational cyclists (30.4 ± 6.5 years) were randomized into three groups: sham (6 cm·H2O of inspiratory pressure, n = 7), moderate-intensity (MI group, 60% maximal inspiratory pressure (MIP), n = 11) and high-intensity (HI group, 85-90% MIP, n = 10). Blood serum samples were collected before and after 11 weeks of IMT and analyzed by 1H NMR and UHPLC-HRMS/MS. Data were analyzed using linear mixed models and metabolite set enrichment analysis. The 1H NMR and UHPLC-HRMS/MS techniques resulted in 46 and 200 compounds, respectively. These results showed that ketone body metabolism, fatty acid biosynthesis, and aminoacyl-tRNA biosynthesis were upregulated after IMT, while alpha linolenic acid and linoleic acid metabolism as well as biosynthesis of unsaturated fatty acids were downregulated. The MI group presented higher MIP, Tryptophan, and Valine levels but decreased 2-Hydroxybutyrate levels when compared to the other two studied groups. These results suggest an increase in the oxidative metabolic processes after IMT at different intensities with additional evidence for the upregulation of essential amino acid metabolism in the MI group accompanied by greater improvement in respiratory muscle strength.

Effects of pulmonary rehabilitation in hematopoietic stem cell transplantation recipients: a randomized controlled study.

PURPOSE: During hematopoietic stem cell transplantation (HSCT), patients' exercise capacity and quality of life (QOL) are impaired. Exercise training is recommended to preserve cardiorespiratory fitness during the compelling HSCT period. However, studies investigating the effects of pulmonary rehabilitation (PR) in HSCT recipients are limited. Therefore, this study aimed to investigate the effects of two different PR programs on maximal exercise capacity, respiratory muscle strength and endurance, pulmonary function, and QOL. METHODS: This is a prospective, randomized, controlled, triple-blinded study. Thirty hospitalized patients undergoing HSCT were randomized to the pulmonary rehabilitation plus inspiratory muscle training (PR + IMT) group and the PR group. PR group performed upper extremity aerobic exercise training (AET) and progressive resistance exercise training (PRET), PR + IMT group performed IMT in addition to the upper extremity AET and PRET. Maximal exercise capacity (cardiopulmonary exercise testing), respiratory muscle strength (mouth pressure device, (MIP and MEP)) and respiratory muscle endurance (threshold loading test), pulmonary function (spirometry), and QOL (European Organization for Research and Treatment of Cancer (EORTC QLQ-C30) were evaluated before HSCT and after discharge. RESULTS: Changes in pulmonary function, respiratory muscle strength and endurance, and QOL were similar within groups (p > 0.05). The MEP, peak oxygen consumption, and oxygen pulse significantly decreased in both groups (p < 0.05). CONCLUSION: Pulmonary function, inspiratory muscle strength and endurance, and QOL preserved after HSCT. Expiratory muscle strength and maximal exercise capacity decreased even though PR during HSCT. Breathing reserve and restriction improved in the PR + IMT group. In addition, minute ventilation and dyspnea were preserved in the PR + IMT group, while these values were worsened during two structured PR programs. Therefore, PR should be applied in accordance with the patient's current clinical and hematologic status to patients undergoing HSCT. CLINICALTRIALS: gov (19/07/2018, NCT03625063).

Effectiveness of a respiratory rehabilitation program including an inspiration training device versus traditional respiratory rehabilitation: a randomized controlled trial.

Background: In the context of COVID-19, respiratory training is vital for the care and recuperation of individuals. Both exercise-based and instrumental respiratory training have been employed as interventions to enhance respiratory function, providing relief from symptoms in those impacted by the virus. The aim of this study was to evaluate the efficacy of two different respiratory rehabilitation programs. Methods: A total of 200 participants affected with COVID-19 respiratory sequels were recruited, with a block randomization regarding sex to ensure equal and appropriate applicability of the results. An experimental controlled and randomized study was conducted, with participants engaging in a 31 days respiratory rehabilitation program, (a) experimental group, inspiratory training device combined with aerobic exercise and (b) traditional respiratory exercises combined with aerobic exercise. Results: Both groups improved in cardiorespiratory parameters, with a decrease in systolic and diastolic pressure, dyspnea and lower limbs fatigue, and increased oxygen saturation, 6 min walking distance, diaphragmatic thickness, forced vital capacity, forced expiratory volume during the first second, peak expiratory flow rate, forced inspiratory vital capacity and maximal inspiratory pressure. Comparison between groups showed statistically significant differences in all variables except for oxygen saturation, 6 min walking distance and diaphragmatic thickness. The results of this study support the use of specific inspiration training devices for respiratory rehabilitation in COVID-19 sequels.

Effect of diaphragmatic breathing, respiratory muscle stretch gymnastics and conventional physiotherapy on chest expansion, pulmonary function and pain in patients with mechanical neck pain: A single group pretest-posttest quasi-experimental pilot study.

BACKGROUND: There is evidence that mechanical neck pain results in respiratory dysfunction. Physiotherapy management for mechanical neck pain is well documented but the evidence regarding inclusion of breathing strategies to improve pulmonary functions in mechanical neck pain patients is scarce. OBJECTIVE: To investigate the combined effect of diaphragmatic breathing, respiratory muscles stretch gymnastics (RMSG) and conventional physiotherapy on chest expansion, pulmonary function and pain in patient with mechanical neck pain. METHOD: Thirteen patients with mechanical neck pain (18-35years) with neck pain history of ≥ three months and NPRS (numeric pain rating scale) score ≥3 were recruited for this single group pre pretest-posttest quasi experimental pilot study. Informed consent was taken from all participants. After initial screening and assessment, diaphragmatic breathing, RSMG (5 patterns) and conventional physiotherapy (hot pack and TENS for 10 min) were given for one week. Chest expansion, spirometry (FEV1, FVC, FEV1/FVC, PEFR), NDI (neck disability index) and NPRS were assessed on baseline and after one week following the intervention. RESULTS: The normality of data was tested by using Shapiro-wilk test and the data was found to be normally distributed. Paired t-test was used to compare the baseline and post intervention values. Diaphragmatic breathing, RMSG and conventional physiotherapy had significant effect on chest expansion, FEV1, NPRS and NDI in patients with mechanical neck pain. CONCLUSION: The rehabilitation strategies should emphasize breathing exercises to improve the lung function and pain scores in addition to conventional physiotherapy in rehabilitation of mechanical neck pain patients.

Similar effects on exercise performance following different respiratory muscle training programs in healthy young men.

Both respiratory muscle endurance training (RMET) and inspiratory resistive training (IMT) seem to increase whole-body exercise performance, but direct comparisons between the two are scarce. We hypothesized that the similarity of RMET to exercise-induced ventilation would induce larger improvements compared to IMT. Twenty-six moderately-trained men performed either 4 weeks of RMET, IMT or SHAM training. Before and after the interventions, respiratory muscle endurance, 3-km running time-trial performance and leg muscle fatigue after intense constant-load cycling (assessed with femoral nerve magnetic stimulation) were measured. Both RMET (+ 59%) and IMT (+ 38%) increased respiratory muscle endurance (both p < 0.01 vs. SHAM) but only IMT increased inspiratory strength (+ 32%, p < 0.001 vs. SHAM). 3-km time improved showing a main effect of training (p = 0.026), however with no differences between groups. Leg fatigue after cycling was not attenuated with training (p = 0.088 for group-training interaction). All groups showed a significant (~ 0.3 l) increase in average tidal volume during cycling exercise combined with a concomitant reduction in respiratory exertion. While RMET and IMT improved specific aspects of respiratory muscles performance, no benefits beyond SHAM were seen during whole-body exercise. Changes in respiratory sensations might be a result of altered breathing pattern.

Effects of high-intensity respiratory muscle training on respiratory muscle strength in individuals with Parkinson's disease: Protocol of a randomized clinical trial.

OBJECTIVE: To investigate the efficacy of high-intensity respiratory muscle training (combined inspiratory and expiratory muscle training) in improving inspiratory and expiratory muscle strength, inspiratory muscle endurance, peak cough flow, dyspnea, fatigue, exercise capacity, and quality of life in this population. METHODS: A randomized controlled trial, concealed allocation, blinded assessments, and intention-to-treat analysis will be carried out. Altogether, 34 individuals with PD (age ≥ 50 years old, with maximum inspiratory pressure (MIP) <80cmH2O or maximum expiratory pressure (MEP) <90cmH2O) will be recruited. Patients will be randomly assigned to either (1) high-intensity respiratory muscle training (experimental group, 60% of MIP and MEP) or (2) sham training (control group, 0cmH2O). Individuals will perform a home-based intervention, with indirect home supervision, consisting of two daily 20-min sessions (morning and afternoon), seven times a week, during eight weeks. Primary outcomes are MIP and MEP. Secondary outcomes are inspiratory muscle endurance, peak cough flow, dyspnea, fatigue, exercise capacity, and quality of life. The effects of the training will be analyzed from the collected data using intention-to-treat. Between-group differences will be measured using a two-way ANOVA with repeated measures (2*3), considering baseline, post-intervention, and 12-week follow-up. IMPACT: The results of this trial will provide valuable new information on the efficacy of high-intensity respiratory muscle training in improving muscle strength, functional outcomes, and quality of life in individuals with PD. Performing combined inspiratory and expiratory muscle training using a single equipment is cheaper and feasible, takes less time and is easy to use. In addition, this intervention will be carried out in the home environment that increases accessibility, reduces time, and costs of transport, which increases the feasibility to reproduce their findings in clinical practice. TRIAL REGISTRATION: NCT05608941. Registered on November 8, 2022.

The effects of inspiratory muscle training on swimming performance: A study on the cohort of swimming specialization students.

PURPOSE: Current evidence posits a strong correlation between respiratory muscle function and swimming performance. Despite this, few studies have explored the integration of inspiratory muscle training (IMT) into standard swimming training regimens, which remains an unexplored avenue for improving performance in swimmers. This study aims to evaluate the potential advantages of IMT for enhancing respiratory function and swimming performance and determine whether such training could induce beneficial physiological adaptations. METHODS: We designed and conducted a randomized controlled trial involving 43 swimming specialization students aged 18-25 years. Participants were randomly allocated to two groups: a control group, which followed regular swimming training, and an experimental group, which complemented the standard training with IMT. The intervention lasted for six weeks. Key outcomes measured included swimming performance metrics (time of 50 m freestyle, number of breaths in 50 m freestyle, distance before first breath in freestyle, time of 100 m freestyle) and various inspiratory muscle function parameters such as vital capacity (VC), maximum inspiratory pressure (MIP), maximum inspiratory flow (MIF), and maximum inspiratory capacity (MIC). We also assessed certain biochemical parameters, including hemoglobin, creatine kinase (CK), blood urea nitrogen (BUN), testosterone, and cortisol concentrations. RESULTS: Following the training period, the experimental group exhibited significant improvements in swimming performance and respiratory function parameters. We also noted an increase in hemoglobin levels and a reduction in testosterone concentrations in this group, suggesting beneficial physiological adaptations in response to the combined IMT and swimming training. CONCLUSION: Our findings underline the potential of IMT as a supplementary training modality for enhancing respiratory function and improving swimming performance. The changes in biochemical parameters suggest physiological adaptations that might contribute to these observed improvements. This study opens the door for future research on the benefits of integrating IMT into training regimens for competitive swimmers. Further investigation is warranted to fully elucidate the mechanisms behind the observed benefits and to validate these findings in a larger cohort and other athlete populations.

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, whereas nonpharmacological strategies are limited. Established pharmacological approaches to treating asthma may cause unwanted side effects and do not always afford adequate protection against asthma, possibly because of an individual's variable response to medications. A potential nonpharmacological 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, because of the limited number of studies and discordant methods between studies more evidence is required to elucidate in individuals with asthma the efficacy of IMT on inspiratory muscle endurance, exercise capacity, asthma control, symptoms, and quality of life as well as in adolescents with differing severities of asthma. Large randomized controlled trials would be a significant step forward in clarifying the effectiveness of IMT in individuals with asthma. Although 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.