SummaryRuckground: It has been previously shown that the inspiratory muscles of patients with congestive heart failure (CHF) are weaker than those of normal persons. This weakness may contribute to the dyspnea and limit exercise capacity in these patients. The respiratory muscles can be trained for both strength and endurance.Hypothesis: The present study was designed to evaluate the effect of specific inspiratory muscle training (SIMT) on inspiratory muscle performance, lung function, dyspnea, and exercise capacity in patients with moderate heart failure.Methods: Twenty patients with CHF (NYHA functional class 11-111) were recruited for the study. The subjects were randomized into two groups: 10 patients were included in the study group and received SIMT and 10 patients were assigned to the control group and received sham training. Subjects in both groups trained daily, 6 timedweek, for one-half h, for 3 months. The subjects started breathing at a resistance equal to 15% of their PImax for 1 week and the resistance was then increased incrementally to 60%. Spirometry, inspiratory muscle strength (assessed by measuring the PImax at residual volume), and endurance (expressed by the relationship between PmPeak and PImax), the 12-min walk test, and peak V02 were performed before the beginning and at the end of the training period.Results: All patients in the training group showed an increase in the inspiratory muscle strength [mean (-+ standard error of the mean) PImax increased from 46.5 2 4.7 to 63.6 f 4.0 cm H20, p < 0.0051, and endurance (mean PmPeMImax

Abstractimprovement in lung volumes and respiratory muscle function. Background -Morbidly obese subjects are (Thorax 1998;53:39-42) known to have impaired respiratory function and inefficient respiratory muscles. A study was undertaken to investigate the Keywords: respiratory muscle strength, respiratory muscle endurance, weight loss.influence of excessive weight loss on pulmonary and respiratory muscle function in morbidly obese individuals who underwent gastroplasty to induce weight loss.It is well established that obesity without asMethods -Twenty one obese individuals sociated disease affects respiratory function in with mean (SE) body mass index (BMI) humans, the most persistent abnormality being 41.5 (4.5) kg/m 2 without overt obstructive a restrictive respiratory impairment. [1][2][3][4] The airways disease (FEV 1 /FVC ratio >80%) most characteristic pulmonary function abwere studied before and six months after normalities in obesity are reduced expiratory vertical banded gastroplasty. Only patients reserve volume (ERV) and functional residual who had lost at least 20% of baseline BMI capacity (FRC), due to alterations in chest wall were included in the study. Standard pul-mechanics.1 5 6 Other lung volumes, as well as monary function tests and respiratory the maximal voluntary ventilation (MVV) and muscle strength and endurance were flow rates, have been variously reported as measured.normal, increased, or decreased. 7 8 The resResults -Before operation the pre-piratory muscles are inefficient in obese indominant abnormalities in respiratory dividuals 9 and the MVV, which may be affected function were significant reductions in by reduced respiratory muscle strength, was lung volumes and respiratory muscle en-also found to be low in obese patients. 10durance and, to a lesser degree, reductionsThere are few studies that deal with the in respiratory muscle strength. All para-effect of weight loss on respiratory function. meters increased towards normal values Increased vital capacity (VC), ERV, FRC, and after weight loss with significant increases total lung capacity (TLC) have all been in functional residual capacity (FRC) from described.11 12 Respiratory muscle performance 84.0 (2.2) to 91.3 (2.5)% of predicted nor-has been less frequently studied. Wadströ m mal values (mean difference 7.3, 95% con-and associates 13 found a decrease in respiratory fidence interval of difference (CI) 4.2 to muscle strength following weight reduction of 10.5), total lung capacity (TLC) from 85.6 10% after gastroplasty but several weeks later, (3.0) to 93.5 (3.7)% of predicted normal when the mean weight loss was already 18%, values (mean difference 7.9, 95% CI 4.5 to the respiratory muscle strength did not differ 11.5), residual volume (RV) from 86.7 (3.1) from baseline values. to 96.4 (3.0)% of predicted normal valuesWe have studied pulmonary function and (mean difference 9.7, 95% CI 5.2 to 14.1), respiratory muscle performance in a group of expiratory reserve volume (ERV) from obese individuals without evidence of sig-...

In patients undergoing lung resection the simple calculation of predicted postoperative FEV1 underestimates the actual postoperative FEV1 by a small fraction. Lung functions can be increased significantly when incentive spirometry and specific inspiratory muscle training are used before and after operation.

ABSTRACT:Background:Pulmonary and respiratory muscle function impairment are common in patients with Parkinson's disease (PD). Inspiratory muscle training may improve strength, dyspnea and functional capacity in healthy subjects and in those with chronic obstructive pulmonary disease. This study investigated the effect of specific inspiratory muscle training (SIMT) on pulmonary functions, inspiratory muscle performance, dyspnea and quality of life, in patients with PD.Patients and Methods:Twenty patients with PD (stage II and III Hoehn and Yahr scale) were recruited for the study and were divided into two groups: a) ten patients who received SIMT and b) ten patients who received sham training, for three months. Pulmonary functions, the respiratory muscle strength and endurance, the perception of dyspnea (POD) and the quality of life were studied before and within one week after the training period. All subjects trained daily, six times a week, each session consisting of 1/2 hour, for 12 weeks.Results:Following the training period, there was a significant improvement, in the training group but not in the control group, in the following parameters: inspiratory muscle strength, (PImax, increased from 62.0±8.2 to 78.0±7.5 cm of H2O (p<0.05), inspiratory muscle endurance (increased from 20.0±2.8 to 29.0±3.0 cm of H2O (p<0.05), and the POD (decreased from 17.9±3.2 to 14.0±2.4 units (p<0.05). There was a close correlation between the increase in the inspiratory muscle performance and the decrease in the POD.Conclusions:The inspiratory muscle performance may be improved by SIMT in patients with PD. This improvement is associated with a significant decrease in their POD.

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Maintenance of inspiratory muscle training in COPD patients: one year follow-up. P. Weiner, R. Magadle, M. Beckerman, M. Weiner, N. Berar-Yanay. #ERS Journals Ltd 2004. ABSTRACT: In most chronic obstructive pulmonary disease (COPD) patients, dyspnoea and functional exercise capacity may improve as a result of inspiratory muscle training (IMT). However, the long-term benefits of IMT have been investigated to a much lesser extent.The present study investigated the short-term and long-term benefits of IMT on inspiratory muscle performance (strength and endurance), exercise capacity and the perception of dyspnoea.Thirty-eight patients with significant COPD had 3 months of basic IMT and were then randomised into a group that received maintenance IMT for the next year, and a group that got training with very low load. Following the basic training there was a statistically significant increase in inspiratory muscle performance, 6-min walk test (6MWT), and a decrease in the dyspnoea. During the second stage of the study, the training group continued to maintain the improvement in all parameters, while there was already deterioration in the inspiratory muscle performance, exercise capacity and dyspnoea in the low intensity group during the 6-12 month period.The present study concludes that, in patients with significant chronic obstructive pulmonary disease, inspiratory muscle training results in improvement in performance, exercise capacity and in the sensation of dyspnoea. The benefits of 12-weeks of inspiratory muscle training decline gradually over 1 yr of follow-up if maintenance training is not performed. Patients with significant chronic obstructive pulmonary disease (COPD) have respiratory and peripheral muscle weakness [1]. Respiratory muscle weakness may contribute to dyspnoea and to poor exercise performance [2,3]. Therefore, it was rational to try ventilatory muscle training in these patients, to enhance respiratory muscle function and potentially reduce the severity of breathlessness and improve exercise tolerance.Inspiratory muscle training has been extensively investigated in patients with COPD. Although, in their meta-analysis, SMITH et al. [4] concluded that inspiratory muscle training (IMT) in patients with COPD did not reveal significant treatment effect, it was later shown, in studies in which the training stimulus was adequate, that in most COPD patients, dyspnoea and functional exercise capacity may improve as a result of such training [5][6][7]. The joint American College of Chest Physicians/American Association of Cardiovascular and Pulmonary Rehabilitation committee [8] declared that when the stimulus or load placed on the respiratory muscles during training is sufficient to augment inspiratory muscle strength, there is an associated increase in exercise capacity and decrease in dyspnoea. In a recent meta-analysis performed by LÖ TTERS et al. [9] it was concluded that IMT, alone or as an adjunct to general exercise reconditioning, decreases dyspnoea and improves functional exercise capacity in pat...

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