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Inspiratory muscle training in patients with chronic obstructive pulmonary disease: the state of the evidence.

ABSTRACT: PURPOSE:The purpose of the present review was to assess the quality of evidence in the literature regarding the specific benefits of inspiratory muscle training (IMT) with an emphasis on training intensity and the relationships between changes in inspiratory muscle function and other clinical outcome measures. METHODS:Articles were found by searching CINAHL, PubMed, Medline via First Search, and ProQuest databases. Articles used in the review were randomized trials of IMT vs. sham IMT or no intervention, published in English in a peer-reviewed journal, included patients with chronic obstructive pulmonary disease (COPD), and specified the intensity of training. The quality of the studies was evaluated by 2 independent reviewers using the methodological rigor scale described by Medlicott and Harris as well as Sackett's levels of evidence. Fifteen articles met the inclusion criteria and were used in this review. RESULTS:Consistent improvements in maximal inspiratory pressures (ranging from -11 to -30 cm H(2)O) and inspiratory muscle endurance were found. Improvements in dyspnea and health-related quality of life were also observed. Inspiratory muscle training may result in improved exercise tolerance as measured using walking tests. High-intensity IMT resulted in improved training efficiency with respect to inspiratory muscle strength, but evidence of the effect of high-intensity IMT on other clinical outcomes is lacking. CONCLUSION:Despite research spanning decades, there are numerous limitations in the literature regarding IMT. IMT appears to improve dyspnea, waking test distance, and health-related quality of life in individuals with COPD, but it is not clear whether this improvement is mediated through improved inspiratory muscle strength and endurance. This review discussed several considerations critical to the design of future trials.

SUBMITTER: Shoemaker MJ

PROVIDER: S-EPMC2845249 | biostudies-literature | 2009 Sep

REPOSITORIES: biostudies-literature

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Inspiratory muscle training in patients with chronic obstructive pulmonary disease: the state of the evidence.

Shoemaker Michael J MJ Donker Sarah S Lapoe Ashley A

Cardiopulmonary physical therapy journal 20090901 3

<h4>Purpose</h4>The purpose of the present review was to assess the quality of evidence in the literature regarding the specific benefits of inspiratory muscle training (IMT) with an emphasis on training intensity and the relationships between changes in inspiratory muscle function and other clinical outcome measures.<h4>Methods</h4>Articles were found by searching CINAHL, PubMed, Medline via First Search, and ProQuest databases. Articles used in the review were randomized trials of IMT vs. sham ...[more]

PMID: 20467518

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Project description:IntroductionInspiratory muscle training (IMT) has been applied during pulmonary rehabilitation in patients with chronic obstructive pulmonary disease (COPD). However, it remains unclear if the addition of IMT to a general exercise training programme leads to additional clinically relevant improvements in patients with COPD. In this study, we will investigate whether the addition of IMT to a general exercise training programme improves 6 min walking distance, health-related quality of life, daily physical activity and inspiratory muscle function in patients with COPD with inspiratory muscle weakness.Methods and analysisPatients with COPD (n=170) with inspiratory muscle weakness (Pi,max <60 cm H2O or <50%pred) will be recruited to a multicentre randomised placebo controlled trial of IMT and allocated into one of the two groups. Patients in both groups will follow a 3 month general exercise training programme, in combination with home-based IMT. IMT will be performed with a recently developed device (POWERbreathe KH1). This device applies an inspiratory load that is provided by an electronically controlled valve (variable flow resistive load). The intervention group (n=85) will undertake an IMT programme at a high intensity (?50% of their Pi,max), whereas the placebo group (n=85) will undertake IMT at a low training intensity (?10% of Pi,max). Total daily IMT time for both groups will be 21 min (6 cycles of 30 breaths). Improvement in the 6 min walking distance will be the primary outcome. Inspiratory muscle function, health-related quality of life and daily physical activity will be assessed as secondary outcomes.Ethics and disseminationEthics approval has been obtained from relevant centre committees and the study has been registered in a publicly accessible clinical trial database. The results will be easily interpretable and should immediately be communicated to healthcare providers, patients and the general public.ResultsThis can be incorporated into evidence-based treatment recommendations for clinical practice.ClinicaltrialsgovNCT01397396.

Project description:BackgroundChronic obstructive pulmonary disease (COPD) leads to peripheral and respiratory muscle dysfunctions. Nowadays, inspiratory muscle training can be geared toward strength or endurance gains. This study aims to investigate the effects of an inspiratory muscle training (IMT) protocol using different therapeutic modalities to be implemented in pulmonary rehabilitation programs. The effects of IMT on exercise capacity were considered as the primary endpoint, and the effects of IMT on inspiratory muscle function, health-related quality of life, and daily physical activity level were considered as the secondary outcomes.MethodsThis study is a blinded-investigator randomized controlled clinical trial. Sixty subjects will be randomly allocated into three groups: (1) pulmonary rehabilitation (PR) associated with inspiratory muscle training without any load (PRWIMT), (2) PR associated with inspiratory muscle training with a linear load (PRIMTLL), and (3) PR associated with inspiratory muscle training with isocapnic voluntary hyperpnea (PRIMTIVH). The protocol will be performed 5 days a week (3 days with supervision) for 10 weeks. The study will assess anthropometric data, lung function, respiratory muscle strength, and functional capacity by the Incremental Shuttle Walking Test and the Six-Minute Walk Test, lung volumes during the submaximal endurance test, peripheral muscle strength of the upper and lower limbs, dyspnea, and quality of life related to health, before and after the training protocol. Normality will be tested using the Kolmogorov-Smirnov test, and variables will be compared by two-way analysis of variance. The significance level was set at p < 0.05. Ethics approval was obtained from the Institutional Ethics Committee in Research (1.663.411). The study results will be disseminated through presentation at specific scientific conferences and publication in peer-reviewed journals.DiscussionThe different IMT protocols used in our study will be able to guide respiratory therapists to understand and to include in conventional PR programs the most effective respiratory muscle training type in subjects with COPD.Trial registrationBrazilian Clinical Trials Registry, RBR-94v6kd . Registered on 11 March 2017.

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Inspiratory muscle training in patients with chronic obstructive pulmonary disease: the state of the evidence.

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Inspiratory muscle training in patients with chronic obstructive pulmonary disease: the state of the evidence.

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