Maintenance of inspiratory muscle training in COPD patients: one year follow-up

Abstract

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...

The role of inspiratory muscle function and training in the genesis of dyspnoea in asthma and COPD

“…The load (or weight) of the valve can be adjusted to accommodate a wide range of starting abilities, as well as the rapid improvements in strength that accompany training. Increases in strength of 25-40% are achievable within 4-6 weeks [38,48,50,[53][54][55][56][57]. The training programme is simple, can be conducted in the patients' own home and with a minimal imposition upon their daily lives.…”

“…Successful outcomes of IMT have most commonly employed a technique of inspiratory muscle strength training known as pressure threshold training [29,38,48,50,[53][54][55][56]. In pressure threshold IMT the user breathes in against a spring-loaded valve.…”

The Effect of Expiratory Muscle Training on Pulmonary Function in Normal Subjects

“…However, a meta-analysis by Salman et al 5) showed that IMT does not improve gait distance or respiratory d i s t r e s s . S u b s e q u e n t s t u d i e s h a v e s i n c e documented the efficacy of IMT [6][7][8][9][10][11] , and the American Thoracic Society and European Respiratory Society 2) issued a statement that, "IMT could be considered as adjunctive therapy in pulmonary rehabilitation, primarily with suspected or proven respiratory muscle weakness." Studies have shown that expiratory muscle training (EMT) increases maximal expiratory muscle pressure (PE max ), improves pulmonary function, ventilation function and exercise capability and alleviates respiratory distress caused by inspiratory load, activities of daily living or exercise in patients with COPD 12,13) , healthy individuals 10,[14][15][16][17][18][19] , multiple sclerosis (MS) patients [20][21][22] , myasthenia gravis (MG) patients 23) , neuromuscular disease (NMD) patients 24,25) , patients with tetraplegia caused by spinal cord injury 26,27) and Parkinson's disease patients 28,29) .…”

Predicting maximum voluntary ventilation in normal healthy individuals using indirect inspiratory muscle strength measurements: a correlation study

“…As the pressure-generating capacity of the respiratory muscles falls and as the ratio of the pressures produced by the respiratory muscles to the maximum pressure that can be achieved increases dyspnea progressively worsens [11]. Since there is an established association between respiratory muscle dysfunction and dyspnea, an improvement in respiratory muscle function with inspiratory muscle training (IMT) could lead to a reduction in dyspnea [12,13]. A meta-analysis of IMT in 17 clinical trials found limited support for its use in terms of improving pulmonary function, respiratory muscle strength and endurance, exercise capacity, and functional status in patients with COPD [14][15][16].…”