Translational Potential of High-Resistance Inspiratory Muscle Strength Training

Craighead, Daniel H.; Freeberg, Kaitlin A.; Maurer, Grace S; Myers, Valerie H.; Seals, Douglas R.

doi:10.1249/jes.0000000000000293

Cited by 6 publications

(4 citation statements)

References 113 publications

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“…In addition, the concept of "exercise snacks" (brief isolated bouts of vigorous exercise performed over the course of the day with the goal of reducing sedentary time) and vigorous intermittent lifestyle physical activity (unstructured vigorousintensity physical activities that occur as part of daily living) -may represent viable and time-efficient methods to improve CV function with aging [168,169] . Current evidence on both high-resistance IMST [170,171] and interval-based aerobic exercise [135] for improving CV aging has been reviewed recently. We recently completed a randomized, double-blind, sham-controlled, parallel-design pilot clinical trial on highresistance IMST.…”

Section: Time-efficient Forms Of Physical Trainingmentioning

confidence: 99%

Promoting healthy cardiovascular aging: emerging topics

Clayton¹,

Craighead²,

Darvish³

et al. 2022

J Cardiovasc Aging

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The development of age-related cardiovascular (CV) dysfunction increases the risk of CV disease as well as other chronic age-associated disorders, including chronic kidney disease, and Alzheimer’s disease and related dementias. Major manifestations of age-associated CV dysfunction that increase disease risk are vascular dysfunction, primarily vascular endothelial dysfunction and arterial stiffening, and elevated systolic blood pressure. Declines in nitric oxide bioavailability secondary to increased oxidative stress and inflammation are established mechanisms of CV dysfunction with aging. Moreover, fundamental mechanisms of aging, termed the “hallmarks of aging” extend to the CV system and, as such, may be considered “hallmarks of CV aging”. These mechanisms represent viable therapeutic targets for treating CV dysfunction with aging. Healthy lifestyle behaviors, such as regular aerobic exercise and certain dietary patterns, are considered “first-line” strategies to prevent and/or treat age-associated CV dysfunction. Despite the well-established benefits of these strategies, many older adults do not meet the recommended guidelines for exercise or consume a healthy diet. Therefore, it is important to establish alternative and/or complementary evidence-based approaches to prevent or reverse age-related CV dysfunction. Targeting fundamental mechanisms of CV aging with interventions such as time-efficient exercise training, food-derived molecules, termed nutraceuticals, or select synthetic pharmacological agents represents a promising approach. In the present review, we will highlight emerging topics in the field of healthy CV aging with a specific focus on how exercise, nutrition/dietary patterns, nutraceuticals and select synthetic pharmacological compounds may promote healthy CV aging, in part, by targeting the hallmarks of CV aging.

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Section: Time-efficient Forms Of Physical Trainingmentioning

confidence: 99%

Promoting healthy cardiovascular aging: emerging topics

Clayton¹,

Craighead²,

Darvish³

et al. 2022

J Cardiovasc Aging

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“…In contrast to conventional inspiratory muscle training against low-to-moderate levels of resistance performed for extended durations, high-resistance IMST utilizes a low number of repetitions against a near-maximal resistance, resulting in a daily time commitment of only approximately 5 min, overcoming the critical time-availability barrier ( Craighead et al, 2021a ). Additionally, by using an affordable, portable device, high-resistance IMST overcomes many common barriers associated with aerobic exercise and holds promise for future public health translation ( Craighead et al, 2022 ). However, the efficacy of high-resistance IMST for inducing cardiovascular health benefits, particularly in estrogen-deficient postmenopausal women, needs to be firmly established.…”

Section: Introductionmentioning

confidence: 99%

Inspiratory muscle strength training for lowering blood pressure and improving endothelial function in postmenopausal women: comparison with “standard of care” aerobic exercise

Craighead

Freeberg²,

McCarty³

et al. 2022

Front. Physiol.

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Background: High blood pressure (BP), particularly systolic BP (SBP), is the major modifiable risk factor for cardiovascular diseases and related disorders of aging. SBP increases markedly with aging in women such that the prevalence of above-normal SBP (i.e., ≥120 mmHg) in postmenopausal women exceeds rates in age-matched men. This increase in SBP is associated with vascular endothelial dysfunction, mediated by excessive reactive oxygen species-induced oxidative stress and consequent reductions in nitric oxide bioavailability. Moderate-intensity aerobic exercise is a recommended lifestyle strategy for reducing SBP. However, adherence to aerobic exercise guidelines among postmenopausal women is low (<30%) and aerobic exercise does not consistently enhance endothelial function in estrogen-deficient postmenopausal women. High-resistance inspiratory muscle strength training (IMST) is a time-efficient, adherable lifestyle intervention that involves inhaling against resistance through a handheld device (30 breaths/day). Here, we present the protocol for a randomized controlled trial investigating the efficacy of 3 months of high-resistance IMST compared to guideline-based, “standard-of-care” aerobic exercise training for decreasing SBP and improving endothelial function in estrogen-deficient postmenopausal women with above-normal SBP (120–159 mmHg) at baseline (ClinicalTrials.gov Identifier: NCT05000515).Methods: A randomized, single-blind, parallel-group design clinical trial will be conducted in 72 (36/group) estrogen-deficient postmenopausal women with above-normal SBP. Participants will complete baseline testing and then be randomized to either 3 months of high-resistance IMST (30 breaths/day, 6 days/week, 75% maximal inspiratory pressure) or moderate-intensity aerobic exercise training (brisk walking 25 min/day, 6 days/week, 40–60% heart rate reserve). Outcome measures will be assessed after 3 months of either intervention. Following end-intervention testing, participants will abstain from their assigned intervention for 6 weeks, after which BP and endothelial function will be assessed to evaluate the potential persistent effects of the intervention on the primary and secondary outcomes.Discussion: This study is designed to compare the effectiveness of time-efficient, high-resistance IMST to guideline-based aerobic exercise training for lowering SBP and improving endothelial function, and interrogating potential mechanisms of action, in estrogen-deficient postmenopausal women.Clinical Trial Registration:ClinicalTrials.gov, Identifier: NCT05000515.

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“…Although specific patterns of respiratory muscle activation during IMST have not been fully characterized, it is expected that IMST activates the diaphragm and may engage other muscle groups, such as those of the head and neck (e.g., scalenes), upper airway (e.g., cricothyroid), thorax (e.g., external intercostals), or back (e.g., erector spinae) (10,11). High-resistance IMST protocols comprise only 30 resisted inspirations and can be completed in as little as ~5 min•d −1 , overcoming time availability-related barriers associated with conventional aerobic exercise (12). Our laboratory recently completed a double-blind, randomized, sham-controlled clinical trial testing high-resistance IMST in midlife and older adults with above-normal initial systolic blood pressure (i.e., ≥120 mm Hg).…”

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confidence: 99%

Time-Efficient, High-Resistance Inspiratory Muscle Strength Training Increases Exercise Tolerance in Midlife and Older Adults

CRAIGHEAD,

FREEBERG,

HEINBOCKEL

et al. 2023

Medicine &Amp; Science in Sports &Amp; Exercise

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Purpose To determine if time-efficient, high-resistance inspiratory muscle strength training (IMST), comprising 30 inhalation-resisted breaths per day, improves cardiorespiratory fitness, exercise tolerance, physical function and/or regional body composition in healthy midlife and older adults. Methods We performed a double-blind, randomized, sham-controlled clinical trial (NCT03266510) testing 6 weeks of IMST (30 breaths/day, 6 days/week, 55%-75% maximal inspiratory pressure) versus low-resistance sham training (15% maximal inspiratory pressure) in healthy men and women aged 50-79 years. Subjects performed a graded treadmill exercise test to exhaustion, physical performance battery (e.g., handgrip strength, leg press), and body composition testing (dual x-ray absorptiometry) at baseline and after 6 weeks of training. Results Thirty-five participants (17 women, 18 men) completed high-resistance IMST (n = 17) or sham training (n = 18). Cardiorespiratory fitness (V̇O2peak) was unchanged, but exercise tolerance, measured as treadmill exercise time during a graded exercise treadmill test, increased with IMST (baseline: 539 ± 42 s, end-intervention: 606 ± 42 s; p = 0.01) but not sham training (baseline: 562 ± 39 s, end-intervention: 553 ± 38 s; p = 0.69). IMST increased peak respiratory exchange ratio (baseline: 1.09 ± 0.02, end-intervention: 1.13 ± 0.02; p = 0.012), peak ventilatory efficiency (baseline: 25.2 ± 0.8, end-intervention: 24.6 ± 0.8; p = 0.036) and improved submaximal exercise economy (baseline: 23.5 ± 1.1 ml/kg/min, end-intervention: 22.1 ± 1.1 ml/kg/min; p < 0.001); none of these factors were altered by sham training (all p > 0.05). Changes in plasma acylcarnitines (targeted metabolomics analysis) were consistently positively correlated with changes in exercise tolerance following IMST but not sham training. IMST was associated with regional increases in thorax lean mass (+4.4%; p = 0.06) and reductions in trunk fat mass (-4.8%; p = 0.04); however, peripheral muscle strength, muscle power, dexterity and mobility were unchanged. Conclusions These data suggest that high-resistance IMST is an effective, time-efficient lifestyle intervention for improving exercise tolerance in healthy midlife and older adults.

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Translational Potential of High-Resistance Inspiratory Muscle Strength Training

Abstract: Time-efficient, high-resistance inspiratory muscle strength training, a novel lifestyle intervention for improving cardiovascular aging, holds translational potential for improving public health.

Cited by 6 publications

References 113 publications

Promoting healthy cardiovascular aging: emerging topics

Promoting healthy cardiovascular aging: emerging topics

Inspiratory muscle strength training for lowering blood pressure and improving endothelial function in postmenopausal women: comparison with “standard of care” aerobic exercise

Time-Efficient, High-Resistance Inspiratory Muscle Strength Training Increases Exercise Tolerance in Midlife and Older Adults

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