Combined aerobic/inspiratory muscle training vs. aerobic training in patients with chronic heart failure

Abstract

Aims Vent‐HeFT is a multicentre randomized trial designed to investigate the potential additive benefits of inspiratory muscle training (IMT) on aerobic training (AT) in patients with chronic heart failure (CHF). Methods and results Forty‐three CHF patients with a mean age of 58 ± 12 years, peak oxygen consumption (peak VO2) 17.9 ± 5 mL/kg/min, and LVEF 29.5 ± 5% were randomized to an AT/IMT group (n = 21) or to an AT/SHAM group (n = 22) in a 12‐week exercise programme. AT involved 45 min of ergometer training at 70–80% of maximum heart rate, three times a week for both groups. In the AT/IMT group, IMT was performed at 60% of sustained maximal inspiratory pressure (SPImax) while in the AT/SHAM group it was performed at 10% of SPImax, using a computer biofeedback trainer for 30 min, three times a week. At baseline and at 3 months, patients were evaluated for exercise capacity, lung function, inspiratory muscle strength (PImax) and work capacity (SPImax), quality of life (QoL), LVEF and LV diameter, dyspnoea, C‐reactive protein (CRP), and NT‐proBNP. IMT resulted in a significantly higher benefit in SPImax (P = 0.02), QoL (P = 0.002), dyspnoea (P = 0.004), CRP (P = 0.03), and NT‐proBNP (P = 0.004). In both AT/IMT and AT/SHAM groups PImax (P < 0.001, P = 0.02), peak VO2 (P = 0.008, P = 0.04), and LVEF (P = 0.005, P = 0.002) improved significantly; however, without an additional benefit for either of the groups. Conclusion This randomized multicentre study demonstrates that IMT combined with aerobic training provides additional benefits in functional and serum biomarkers in patients with moderate CHF. These findings advocate for application of IMT in cardiac rehabilitation programmes.

Impact of Inspiratory Muscle Training Versus Resistance Training on Ventricular Dysfunction in Patients With Dilated Cardiomyopathy: A Randomized Controlled Trial

“…These results are broadly consistent with those of Laoutaris et al, who concluded that improvements in dyspnea and exercise tolerance after and consistent with those of previous studies, which have shown a similar attenuation of remodeling mainly attributed to a decrease in peripheral vascular resistance following aerobic exercise [31]. The results of this study are in agreement with those of previous studies that compared inspiratory muscle training with other modes of training These studies reported that the addition of inspiratory muscle training to aerobic training [13,28] or combined aerobic and resistance training [32] resulted in significant improvements in respiratory muscle strength, functional capacity, and cardiorespiratory responses to exercise in patients with chronic heart failure and inspiratory muscle weakness. [13,28,32] However, our findings are contradicted by those of Weiner et al [33], who failed to achieve a significant improvement in peak exercise oxygen consumption following 3 months of specific inspiratory muscle training, and Adamop-oulos et al, who reported that the addition of inspiratory muscle training to aerobic training gained an additional improvement in respiratory muscle function without significant changes in cardiopulmonary exercise testing [13].…”

“…Maximum inspiratory pressure was assessed as a parameter of inspiratory muscle strength. Measurement was performed in a sitting position using Maximum Inspiratory Pressure Meter (care fusion UK 2321td) [13]. Each pa tient was asked to expire all of the air inside their lungs through the device, and then apply the mouthpiece while the nose was clipped, inspire as rapidly and deeply as possible, and hold their breath for at least 1.5 s so that the maximum pressure could be recorded.…”

Cardiac rehabilitation program in patients with Chagas heart failure: a single-arm pilot study

“…Indeed, it is possible that any training stimulus, regardless of specificity to respiratory muscles, may improve respiratory muscle strength and decrease related symptoms, such as dyspnea and exercise intolerance (38) . In a recent clinical trial, Adamapoulos et al (39) demonstrated important benefits with aerobic training exercise for respiratory muscle strength, supporting the results observed in this study.…”

Effects of High-Intensity Inspiratory Muscle Training Associated with Aerobic Exercise in Patients Undergoing CABG: Randomized Clinical Trial

“…When associated with aerobic exercise, high-intensity IMT presented significant improvement in MIP, quality of life, dyspnea, and C-reactive protein [16] .…”