Ventilatory load characteristics during ventilatory muscle training.

Belman, Michael J.; Botnick, Warren C.; Nathan, Steven D.; Chon, Ki H.

doi:10.1164/ajrccm.149.4.8143057

Cited by 41 publications

(16 citation statements)

References 15 publications

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“…However, it requires build up of negative pressure before flow occurs, and hence, is inertive in nature. BELMAN et al [57] showed that similar work loads were obtained during resistive loading and threshold loading. Whether resistive loading or this inertive loading produces different training effects, remains to be studied.…”

Section: Respiratory Muscle Trainingmentioning

confidence: 78%

Exercise training in COPD patients: the basic questions

Gosselink¹,

Troosters²,

Decramer³

1997

Eur Respir J

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Pulmonary rehabilitation programmes aim at improving exercise capacity, activities of daily living, quality of life and perhaps survival in patients with chronic obstructive pulmonary disease (COPD). Recently, well-designed studies investigated and confirmed the efficacy of comprehensive pulmonary rehabilitation programmes, including exercise training, breathing exercises, optimal medical treatment, psychosocial support and health education. In the present overview, the contribution of exercise training in clinical practice to the demonstrated effects of pulmonary rehabilitation is discussed by means of six basic questions. These include: 1) the significance of exercise training; 2) the optimal intensity for exercise training; 3) prescribing training modalities; 4) the effects of exercise training combined with medication, nutrition or oxygen; 5) how training effects should be maintained; and 6) where the rehabilitation programme should be performed: in-patient, out-patient or homecare? First, exercise training has been proven to be an essential component of pulmonary rehabilitation. Training intensity is of key importance. High-intensity training (>70% maximal workload) is feasible even in patients with more advanced COPD. In addition, the effects on peripheral muscle function and ventilatory adaptations are superior to low-intensity training. There is, however, no consensus on the optimal training modalities. Both walking and cycling improved exercise performance. Since peripheral muscle function has been recognized as an important contributor to exercise performance, specific peripheral muscle training recently gained interest. Improved submaximal exercise performance and increased quality of life were found after muscle training. The optimal training regimen (strength or endurance) and the muscle groups to be trained, remain to be determined. Training of respiratory muscles is recommended in patients with ventilatory limitation during exercise. The additional effects of anabolic-androgenic drugs, oxygen and nutrition are not well-established in COPD patients and need further research. In order to maintain training effects, close attention of the rehabilitation team is required. The continuous training frequency necessary to maintain training effects remains to be defined. At this point in time, out-patient-based programmes show the best results and guarantee the best supervision and a multidisciplinary approach. Future research should focus on the role of homecare programmes to maintain improvements.

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Section: Respiratory Muscle Trainingmentioning

confidence: 78%

Exercise training in COPD patients: the basic questions

Gosselink¹,

Troosters²,

Decramer³

1997

Eur Respir J

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“…Threshold loading has the advantage of being independent of inspiratory flow rate [46], but requires a buildup of negative pressure before flow occurs, and hence, is inertive in nature. Belman et al [61] showed that similar workloads were obtained during resistive loading and threshold loading. Threshold loading enhances velocity of inspiratory muscle shortening [62].…”

Section: Respiratory Muscle Trainingmentioning

confidence: 82%

Controlled breathing and dyspnea in patients with chronic obstructive pulmonary disease (COPD)

Gosselink

2003

JRRD

119

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Abstract-Controlled breathing is included in the rehabilitation program of patients with chronic obstructive pulmonary disease (COPD). This article discusses the efficacy of controlled breathing aimed at improving dyspnea. In patients with COPD, controlled breathing works to relieve dyspnea by (1) reducing dynamic hyperinflation of the rib cage and improving gas exchange, (2) increasing strength and endurance of the respiratory muscles, and (3) optimizing the pattern of thoracoabdominal motion. Evidence of the effectiveness of controlled breathing on dyspnea is given for pursed-lips breathing, forward leaning position, and inspiratory muscle training. All interventions require careful patient selection, proper and repeated instruction, and control of the techniques and assessment of its effects. Despite the proven effectiveness of controlled breathing, several problems still need to be solved. The limited evidence of the successful transfer of controlled breathing from resting conditions to exercise conditions raises several questions: Should patients practice controlled breathing more in their daily activities? Does controlled breathing really complement the functional adaptations that patients with COPD must make? These questions need to be addressed in further research.

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“…BELMAN et al [44] investigated the characteristics of the load applied to the inspiratory muscles using four methods of overload: flow resistive, pressure threshold, maximal isometric contraction (Mueller manoeuvre) and unloaded hyperpnoea. Whilst there were some similarities between the methods in terms of the stimulus delivered to the muscles (e.g.…”

Section: Specificitymentioning

confidence: 99%

Inspiratory muscle training in obstructive lung disease

McConnell

Romer

Weiner

2005

Breathe

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Key pointsDyspnoea is influenced by inspiratory muscle strength and the load placed upon the inspiratory muscles.Dynamic hyperinflation is a major cause of dyspnoea and exercise intolerance in patients with expiratory flow limitation due to its detrimental effect upon inspiratory muscle loading.Specific IMT improves inspiratory muscle strength, reduces dyspnoea and improves exercise tolerance, even in individuals without inspiratory muscle weakness or hyperinflation.Pressure threshold IMT is the most reliable, convenient and commonly used method of IMT, eliciting improvements in a wide range of muscle functional characteristics, including strength, shortening velocity, power and endurance.Inspiratory muscles adhere to the same training principles as other skeletal muscles, with respect to overload, specificity and reversibility.Training loads must exceed 30% of inspiratory muscle strength, with at least once daily training and weekly increases in training load. Programmes should be least 6 weeks in duration, after which frequency can be reduced to two sessions, three times per week.IMT can be implemented as a stand-alone intervention or as part of a comprehensive programme of rehabilitation.Monitored outcomes should include inspiratory muscle strength, an index of dyspnoea (e.g. BDI/TDI and/or Borg CR-10) and exercise tolerance (e.g. 6MWD).Educational aimsTo provide an overview of the role of respiratory muscle function in the genesis of dyspnoea.To describe the response of inspiratory muscles to different types of training stimuli.To offer guidance on the implementation and monitoring of IMT.SummaryDyspnoea is strongly influenced by respiratory muscle function. Patients with obstructive lung disease become hyperinflated and experience an associated functional deficit in inspiratory muscle function, as well as a concomitant increase in the work of breathing. These changes result in a heightened sense of respiratory effort and a propensity for inspiratory muscle fatigue. There is now convincing evidence that specific inspiratory muscle training (IMT) improves respiratory muscle function, reduces dyspnoea and improves exercise tolerance. This review will describe the two most commonly implemented methods of IMT, and the specific functional adaptations that are elicited by each. It will also describe successful, evidence-based implementation and monitoring of the most commonly used method of IMT.

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Ventilatory load characteristics during ventilatory muscle training.

Cited by 41 publications

References 15 publications

Exercise training in COPD patients: the basic questions

Exercise training in COPD patients: the basic questions

Controlled breathing and dyspnea in patients with chronic obstructive pulmonary disease (COPD)

Inspiratory muscle training in obstructive lung disease

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