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Purpose: An inspiratory muscle warm-up (IMW) improves inspiratory muscle function, but the effects of high-intensity exercise are inconsistent. We aimed to determine the effects of high-intensity IMW on high-intensity exercise performance and muscle oxygenation. Methods: Ten healthy men (maximal oxygen uptake [ V ˙ O 2 max ] 52.2 [5.0] mL·kg–1·min–1) performed constant-load exercise to exhaustion on a cycle ergometer at V ˙ O 2 max under 2 IMW conditions: a placebo condition (PLA) and a high-intensity IMW condition (HIGH). The inspiratory loads were set at 15% and 80% of maximal inspiratory pressure, respectively. Maximal inspiratory pressure was measured before and after IMW. Oxyhemoglobin was measured in the vastus lateralis by near-infrared spectroscopy during exercise. Rating of perceived exertion (RPE) for a leg was measured after 1 and 2 minutes of exercise. Results: Exercise tolerance was significantly higher under HIGH than PLA (228 [49] s vs 218 [49] s, P =.003). Maximal inspiratory pressure was significantly increased by IMW under HIGH (from 125 [20] to 136 [25] cm H2O, P =.031). Oxyhemoglobin was significantly higher under HIGH than PLA at 80% of the total duration of exercise (P =.048). RPE for the leg was significantly lower under HIGH than PLA after 2 minutes of exercise (P =.019). Conclusions: Given that oxyhemoglobin is an index of local oxygen supply, the results of this study suggest that high-intensity IMW increases the oxygen supply to active limbs. It may also reflect a reduction in RPE in the leg. In addition, high-intensity IMW may improve exercise performance. [ABSTRACT FROM AUTHOR]

OBJECTIVE: This study aimed to establish normative values for maximum inspiratory pressure and maximal expiratory pressure in the Turkish population while creating specific equations to calculate these values. MATERIAL AND METHODS: The study involved 219 healthy adults, with a minimum of 50 individuals in specific age ranges: 20-29, 30-39, 40-49, and 50-60 years. Each age group comprised at least 25 males and 25 females. Participants were required to be free from health conditions influencing respiratory muscle strength and non-smokers. Measurements of maximum inspiratory pressure and maximal expiratory pressure were recorded for all participants. RESULTS: As a result of the regression analysis performed for the maximum inspiratory pressure values, the model P value was < .001, and the R2 value was found to be 0.261. The equation obtained as a result of the model was: 82.583 - 3.218 × gender - 0.093 × age + 9.534 × height + 0.343 × weight. As a result of the regression analysis performed for maximal expiratory pressure values, the model P value was <.001, and the R2 value was found to be 0.285. The equation obtained as a result of the model was: 157.165 - 35.522 × gender - 0.271 × age-42.036 × height + 0.787 × weight. CONCLUSIONS: The newly developed equations offer valuable tools for evaluating respiratory muscle strength in the Turkish population. These results confirm the importance of using maximum inspiratory pressure and maximal expiratory pressure to monitor changes in each patient, while also emphasizing the necessity of reliable reference equations. [ABSTRACT FROM AUTHOR]

• In a large cohort of myasthenia gravis patients with mild respiratory symptoms and disability, portable respiratory function tests were useful to screen those at risk of deterioration. • MIP and SNIPs were good indicators of respiratory muscle weakness and MIP best correlated with measures of disability and quality of life. • Females had a higher likelihood of presenting with an abnormal FVC and MIP than males. Patients with myasthenia gravis (MG) can present with respiratory dysfunction, ranging from exercise intolerance to overt respiratory failure, increased fatigue, or sleep-disordered breathing. To investigate the value of multiple respiratory tests in MG, we performed clinical and respiratory assessments in patients with mild to moderate generalized disease. One-hundred and thirty-six patients completed the myasthenia gravis quality-of-life score(MG-QOL-15), myasthenia gravis impairment index(MGII), Epworth sleepiness scale(ESS), University of California-San Diego Shortness of Breath Questionnaire(UCSD-SOB), Modified Medical Research Council Dyspnea Scales(MRC-DS), supine and upright forced vital capacity(FVC), maximal inspiratory pressures(MIPs) and sniff nasal inspiratory pressures(SNIP). Seventy-three (54 %) had respiratory and/or bulbar symptoms and 45 (33 %) had baseline abnormal FVC, with no significant postural changes (p = 0.89); 55 (40.4 %) had abnormal MIPs and 50 (37 %) had abnormal SNIPs. Overall, there were low scores on respiratory and disability scales. Females had increased odds of presenting with abnormal FVC (OR 2.89, p = 0.01) and MIPs (OR 2.48, p = 0.022). There were significant correlations between MIPs, FVC and SNIPs; between MGII/MG-QOL15 and UCSD-SOB/MRC-DS and between ESS and respiratory scales in the whole group. Our data suggests that office-based respiratory measurements are a useful screening method for stable MG patients, even when presenting with minimal respiratory symptoms and no significant disability. [ABSTRACT FROM AUTHOR]

Respiratory complications are a leading cause of mortality post spinal cord injury (SCI). Along with breathing, respiratory muscles have a role in maintaining seated balance. Postinjury breathing influences respiratory muscle function. Preliminary evidence indicates a relation between respiratory muscle function and seated balance in people with chronic SCI dwelling in the community, but the relationship between balance and body habitus has not been explored. To explore the relationships among inspiratory muscle function, functional seated balance (FSB), and body habitus in people with SCI. A convenience sample of inpatients with SCI (C5-T12) aged 18 to 60 years who were using a wheelchair was recruited from November 2022 to March 2023. Those with additional neurological disorders or respiratory support were excluded. Respiratory muscle function measures included maximal inspiratory pressure (MIP), sustained MIP (SMIP), and Fatigue Index Test (FIT). FSB was scored using the Function in Sitting Test (FIST). Body habitus was assessed using the axillary: umbilical (A:U) ratio. Spearman correlations explored the relationships. Thirty-eight of 42 screened participants were eligible and participated (male, 32). Levels of injury ranged from C5 to T12. The mean (SD) age and duration of injury of the sample was 25.61 (6.68) years and 31.03 (28.69) months, respectively. SMIP and FIT correlated significantly with FSB (rs=.441, p =.01, and rs=.434, p =.006, respectively). A significant correlation between SMIP and A:U ratio (rs= -.330, p =.043) was observed. We observed a significant correlation between inspiratory pressure parameters and both functional seated balance and body habitus, adding to evidence on postural role of respiratory muscles. [ABSTRACT FROM AUTHOR]

Introduction: Measurement of Maximal Static Respiratory Pressures (MSRP) is a non invasive tool to determine global respiratory muscle strength. The unique lifestyle factors in the Himalayan region, prompted the need for establishing normative values. Aim: To establish the typical maximum respiratory pressures in the Himalayan region and, secondarily, to develop a predictive equation based on the normative data collected. Materials and Methods: A cross-sectional observational study was conducted at the Department of Respiratory Medicine, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Dehradun, Uttarakhand, India. A total of 101 non smokers (78 males, 23 females) aged from 19-70 years were selected after initial screening by a questionnaire and spirometry from the attendants of patients attending Himalayan Hospital from July 2000 to May 2022. Sustained Nasal Inspiratory Pressure (SNIP), Maximal Expiratory Pressure (MEP), and Maximal Inspiratory Pressure (MIP) values were measured using Micro Respiratory Pressure Meter (RPM) following the American Thoracic Society Technical Statement (ATS) standard protocol. The prediction model for the Maximal Respiratory Pressure (MRP) was obtained using regression analysis. Height, age, weight, and Body Mass Index (BMI) were included as variables in the calculations. The statistical analysis was conducted using the Statistical Package for Social Sciences (SPSS) program for Windows (Version 22.0). Results: There was a statistically significant difference observed in MIP among males 91.77±29.41 cmH2O and females 65.26±19.55 cmH2O and in MEP among males 86.37±26.96 cmH2O and females 56.04±18.29 cmH2O. Both MIP and MEP averages were more in males than in females. In the present study, there was no significant relationship between height, weight, BMI, and respiratory pressure in females. There was no significant relationship between MIP and MEP plus height, age, weight, or BMI. Weight (r-value=0.24), age (r-value=0.27), and BMI (r-value=0.27) all had a significant association in men. Conclusion: Based on these findings, it can be concluded that there are gender-based disparities in MRP in the Himalayan population, with males exhibiting higher average values than females. Additionally, while there was no significant correlation between anthropometric factors and respiratory pressures in females, in males, weight, age, and BMI showed significant associations with these respiratory parameters. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to examine the appropriate body position and anatomical site for DUS through comparisons with maximal inspiratory pressure (MIP). Methods: Thirty healthy adults were included in the study. MIP was measured using a spirometer. DUS was performed in both the right and left intercostal spaces in both sitting and supine positions. The diaphragm thickness at functional residual volume (TDFRC) and total lung capacity (TDTLC) were measured, and the fractional change in diaphragm thickness (TF) was calculated under each condition. To assess interobserver reproducibility, DUS was performed by an experienced examiner and a novice examiner. Results: Among the DUS parameters, the TDFRC measured at the right intercostal space in the sitting position showed the strongest correlation with MIP (r = 0.68, p

Purpose: Diaphragm ultrasonography is used to identify causes of diaphragm dysfunction. However, its correlation with pulmonary function tests, including maximal inspiratory (MIP) and expiratory pressures (MEP), remains unclear. This study investigated this relationship by measuring diaphragm thickness, thickening fraction (TF), and excursion (DE) using ultrasonography, and their relationship to MIP and MEP. It also examined the influence of age, sex, height, and BMI on these measures. Methods: We recruited healthy Japanese volunteers and conducted pulmonary function tests and diaphragm ultrasonography in a seated position. Diaphragm ultrasonography was performed during quiet breathing (QB) and deep breathing (DB) to measure the diaphragm thickness, TF, and DE. A multivariate analysis was conducted, adjusting for age, sex, height, and BMI. Results: Between March 2022 and January 2023, 109 individuals (56 males) were included from three facilities. The mean (standard deviation) MIP and MEP [cmH2O] were 72.2 (24.6) and 96.9 (35.8), respectively. Thickness [mm] at the end of expiration was 1.7 (0.4), TF [%] was 50.0 (25.9) during QB and 110.7 (44.3) during DB, and DE [cm] was 1.7 (0.6) during QB and 4.4 (1.4) during DB. Multivariate analysis revealed that only DE (DB) had a statistically significant relationship with MIP and MEP (p = 0.021, p = 0.008). Sex, age, and BMI had a statistically significant influence on relationships between DE (DB) and MIP (p = 0.008, 0.048, and < 0.001, respectively). Conclusion: In healthy adults, DE (DB) has a relationship with MIP and MEP. Sex, age, and BMI, but not height, are influencing factors on this relationship. [ABSTRACT FROM AUTHOR]

Introduction: Measurement of Maximal Static Respiratory Pressures (MSRP) is a non invasive tool to determine global respiratory muscle strength. The unique lifestyle factors in the Himalayan region, prompted the need for establishing normative values. Aim: To establish the typical maximum respiratory pressures in the Himalayan region and, secondarily, to develop a predictive equation based on the normative data collected. Materials and Methods: A cross-sectional observational study was conducted at the Department of Respiratory Medicine, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Dehradun, Uttarakhand, India. A total of 101 non smokers (78 males, 23 females) aged from 19-70 years were selected after initial screening by a questionnaire and spirometry from the attendants of patients attending Himalayan Hospital from July 2000 to May 2022. Sustained Nasal Inspiratory Pressure (SNIP), Maximal Expiratory Pressure (MEP), and Maximal Inspiratory Pressure (MIP) values were measured using Micro Respiratory Pressure Meter (RPM) following the American Thoracic Society Technical Statement (ATS) standard protocol. The prediction model for the Maximal Respiratory Pressure (MRP) was obtained using regression analysis. Height, age, weight, and Body Mass Index (BMI) were included as variables in the calculations. The statistical analysis was conducted using the Statistical Package for Social Sciences (SPSS) program for Windows (Version 22.0). Results: There was a statistically significant difference observed in MIP among males 91.77±29.41 cmH2O and females 65.26±19.55 cmH2O and in MEP among males 86.37±26.96 cmH2O and females 56.04±18.29 cmH2O. Both MIP and MEP averages were more in males than in females. In the present study, there was no significant relationship between height, weight, BMI, and respiratory pressure in females. There was no significant relationship between MIP and MEP plus height, age, weight, or BMI. Weight (r-value=0.24), age (r-value=0.27), and BMI (r-value=0.27) all had a significant association in men. Conclusion: Based on these findings, it can be concluded that there are gender-based disparities in MRP in the Himalayan population, with males exhibiting higher average values than females. Additionally, while there was no significant correlation between anthropometric factors and respiratory pressures in females, in males, weight, age, and BMI showed significant associations with these respiratory parameters.

Coronary artery disease (CAD) is a prominent cause of illness and mortality worldwide, with a significant amount of coronary artery bypass graft (CABG) surgeries performed each year. It is a complicated technique that results in several clinical and functional issues. While CABG is an effective treatment, it comes with clinical and functional challenges, including reduced lung volume, maximal inspiratory and expiratory pressure, and thoracic mobility after surgery. Incisional pain has been associated with a decline in postoperative lung function; however, this resolves a month following surgery. There is no documented association between respiratory muscle strength and lung function after heart surgery. The POWERbreathe Medic Plus is intended for patients who have extremely weak breathing muscles as a result of illness, hospitalization, or existing respiratory health disorders such as Chronic Obstructive Pulmonary Disease (COPD) and asthma. To address these challenges, a study will investigate the efficacy of the POWERbreathe Medic Plus device in improving maximal inspiratory pressure, functional capacity, and quality of life in CABG patients. CTRI no. – CTRI/2023/04/052116 Link- https://ctri.nic.in/Clinicaltrials/pmaindet2.php?EncHid=ODMxNTA=&Enc=&userName=CTRI/2023/04/052116 CTRI registration date – 28/04/2023

Background and Purpose: Pulmonary dysfunction and inspiratory muscle weakness are frequently observed after cardiac surgery. Understanding the load on and capacity of respiratory muscles can provide valuable insights into the overall respiratory mechanics and neural regulation of breathing. This study aimed to assess the extent of neural respiratory drive (NRD) and determine whether admission‐to‐discharge differences in NRD were associated with inspiratory muscle strength changes among patients undergoing open‐heart surgery. Methods: This cross‐sectional study was conducted on 45 patients scheduled for coronary artery bypass graft or heart valve surgery. NRD was measured using a surface parasternal intercostal electromyogram during resting breathing (sEMGpara tidal) and maximal inspiratory effort (sEMGpara max). Maximal inspiratory pressure (MIP) was used to determine inspiratory muscle strength. Evaluations were performed on the day of admission and discharge. Results: There was a significant increase in sEMGpara tidal (6.9 ± 3.6 μV, p < 0.001), sEMGpara %max (13.7 ± 11.2%, p = 0.008), and neural respiratory drive index (NRDI, the product of EMGpara %max and respiratory rate) (337.7 ± 286.8%.breaths/min, p < 0.001), while sEMGpara max (−43.6 ± 20.4 μV, p < 0.01) and MIP (−24.4 ± 10.7, p < 0.001) significantly decreased during the discharge period. Differences in sEMGpara tidal (r = −0.369, p = 0.045), sEMGpara %max (r = −0.646, p = 0.001), and NRDI (r = −0.639, p = 0.001) were significantly associated with a reduction in MIP. Discussion: The findings indicate that NRD increases after open‐heart surgery, which corresponds to a decrease in inspiratory muscle strength. [ABSTRACT FROM AUTHOR]

IntroductionObesity is a chronic medical condition that affects, among others, the cardiovascular and respiratory systems. Interventions for its treatment focus on sustained weight reduction and general health improvement, leaving respiratory management aside. Our objective was to determine the effects of inspiratory muscle training (IMT) in patients with obesity.MethodsA systematic review was performed in Embase, Cochrane Library (CENTRAL), CINAHL, Web of Science, and PubMed/MEDLINE on June 26, 2023. Randomized clinical trials (RCTs), and quasi-randomized clinical trials investigating the effects of IMT in people with obesity were included. Selected studies were screened by two independent reviewers who extracted data and assessed the quality of the evidence.ResultsThe initial search returned 705 potential studies were included. Ultimately, eight studies met the criteria for eligibility and were included in the review. IMT improves physical capacity [6-minute walk test (6MWT): 44.5 m, 95% CI: 30.5 to 58.5; p

Objective The role of inspiratory muscle performance in functional performance in patients with coronavirus disease 2019 (COVID-19) is poorly understood. The purpose of this study was to perform a longitudinal examination of inspiratory and functional performance from intensive care unit (ICU) discharge (ICUD) to hospital discharge (HD) and symptoms at HD and 1 month after HD in patients with COVID-19. Methods Thirty patients (19 men, 11 women) with COVID-19 were included. Examination of inspiratory muscle performance at ICUD and HD was performed with an electronic manometer, which provided the maximal inspiratory pressure (MIP) and several other inspiratory measures. Examination of dyspnea and functional performance was performed at ICUD and HD with the Modified Borg Dyspnea Scale and the 1-minute sit-to-stand test (1MSST), respectively. Results The mean age was 71 (SD = 11) years, the mean length of ICU stay was 9 (SD = 6) days, and the mean length of hospital stay was 26 (SD = 16) days. Most of the patients were diagnosed with severe COVID-19 (76.7%) and had a mean Charlson Comorbidity Index of 4.4 (SD = 1.9), reflecting high comorbidity. The mean MIP of the entire cohort increased minimally from ICUD to HD (from 36 [SD = 21] to 40 [SD = 20] cm H2O), reflecting predicted values for men and women at ICUD and HD of 46 (25%) to 51 (23%) and 37 (24%) to 37 (20%), respectively. The 1MSTS score increased significantly from ICUD to HD (9.9 [SD = 7.1] vs 17.7 [SD = 11.1]) for the entire cohort but remained far below population-based reference values (2.5th percentile) for the majority of patients at ICUD and HD. At ICUD, MIP was found to be a significant predictor of a favorable change in 1MSTS performance (β = 0.308; odds ratio = 1.36) at HD. Conclusion A significant reduction in inspiratory and functional performance exists in patients with COVID-19 at both ICUD and HD, with a greater MIP at ICUD being a significant predictor of a greater 1MSTS score at HD. Impact This study shows that inspiratory muscle training may be an important adjunct after COVID-19. [ABSTRACT FROM AUTHOR]

The possible benefits of inspiratory muscle training (IMT) on mechanical and clinical outcomes in patients with Coronavirus disease‐2019 (COVID‐19) remain controversial. We conducted a meta‐analysis to evaluate the effect of IMT in the rehabilitation strategy of patients with COVID‐19. The Pubmed, Embase, Web of Science (WOS), and Cochrane Central Register of Controlled Trials (CENTRAL) were searched to identify trials evaluating the efficacy of IMT in the treatment of patients with COVID‐19. The primary outcome included change from baseline of VO2max, maximal inspiratory pressure (PImax), 6‐min walk test(6MWT), forced expiratory volume in the first second predicted (FEV1%pred), and quality of life (QOL). Six studies with 349 participants were analyzed. Significant improvements were found in change from baseline of VO2max (MD: 4.54, 95% confidence interval [CI]: 1.79–7.30, Z = 3. 32, I2 = 0, p = 0.001), PImax (MD: 21.43, 95% CI: 1.33–41.52, Z = 2.09, I2 = 90%, p = 0.04), 6MWD (MD: 40.13, 95% CI: 24.92–55.35, Z = 5.17, I2 = 0, p < 0.00001) and FEV1%pred (MD: 8.73, 95% CI 3.07–14.39, Z = 3.02, p = 0.002) while no statistical improvements were found in QOL (SMD: 0.70, 95% CI: 0.37–1.03, Z = 4.15, I2 = 89% p = 0.32) between IMT group and control group. The application of IMT might elicit mechanical and clinical improvement in patients with COVID‐19. IMT could be recommended as an effective strategy of pulmonary rehabilitation for COVID‐19. However, the proper timing, optimal duration, as well as appropriate frequency and intensity of IMT remain uncertain and further studies are needed. [ABSTRACT FROM AUTHOR]

Background: Congenital heart disease is a general phrase that refers to any heart conditions that exist at birth, the most prevalent of which being ventricular septal defects (VSD) and foetal congenital malformations. VSD refers to the presence of aperture between the ventricles which leads to mixing of oxygenated and de-oxygenated blood. Although many VSDs close on their own, failing to do so can result in a number of issues and typically necessitates open heart surgery for closure of the defect. According to various studies, there is reduced functioning of diaphragm post cardiac surgeries which leads to occurrences of pulmonary complications such as lung collapse, fluid accumulation in pleura, pneumonia, acute respiratory distress syndrome and pneumothorax which can be debilitating and jeopardize recovery as well as increase hospital stay. There are several devices which are proven to improve the strength of inspiratory musculature and hence improve maximal inspiratory pressure and functional capacity post cardiac surgeries. Method: In this study we aimed to assess and evaluate the effectiveness of Powerbreath Medic Plus and Threshold Inspiratory Muscle Trainer (IMT) adjunct to conservative physiotherapy management on subjects who underwent VSD closure in a two arm parallel superiority randomized control trial on improving maximal inspiratory pressure and functional capacity. 60 individuals in total will be allocated equally into two groups, and both groups will be receiving treatment for four weeks with five sessions per week. After four weeks of therapy and two weeks after the intervention is through, the results will be assessed for follow-up. Predicted results: By increasing maximal inspiratory pressure and functional capacity, this technique may be used to treat complications following heart surgery if our study’s premise is found to be significant. CTRI registration: CTRI/2023/03/051090

Background: Patients with advanced lung cancer tend to experience dyspnea. Pulmonary rehabilitation has been reported as a method for relieving dyspnea. However, exercise therapy imposes a high burden on patients, and it is difficult to sustain in many cases. Inspiratory muscle training (IMT) imposes a relatively low burden on patients with advanced lung cancer; however, its benefits have not been demonstrated. Methods: We retrospectively analyzed 71 patients who were hospitalized for medical treatment. The participants were divided into an exercise therapy group and an IMT load + exercise therapy group. Changes in maximal inspiratory pressure (MIP) and dyspnea were examined using a two-way repeated measures analysis of variance. Results: MIP variations significantly increase in the IMT load group, with significant differences between baseline and week 1, between week 1 and week 2, and between baseline and week 2. The analysis also showed that the variations in dyspnea decreased in the IMT load + exercise therapy group with significant differences between baseline and week 1 and between baseline and week 2. Conclusions: The results show that IMT is useful and has a high persistence rate in patients with advanced lung cancer who present dyspnea and cannot perform high-intensity exercise therapy. [ABSTRACT FROM AUTHOR]

Purpose: Kinesiology Tape (KT) has been used to improve mobility and muscle activation. Limited research has studied its effect on respiratory function. The purpose of this study was to investigate the influence of KT on chest wall excursion (CWE) and magnitude of respiratory muscle activation. Methods: Ninety subjects were randomly assigned to receive KT, sham tape, or no tape around the lower thoracic region. Measures, including CWE, maximal inspiratory pressure (MIP), and surface electromyography (sEMG) of intercostal and scalene muscles, were taken during a maximal inspiratory effort before (T-B) and after (T-1) tape application. Subjects continued to wear the tape and returned 48 hours later for another set of measurements (T-2). Repeated measures Analysis of Variance and post-hoc paired t-tests were used to determine the influence of tape. Results: No significant differences were identified for sEMG amplitude or CWE. Maximal inspiratory pressure scores showed no significant between-group effect; however, a significant within-group effect was found. Post-hoc analyses revealed significant differences between T-B and T-2 and T-1 and T-2 for all groups. Conclusion: Kinesiology Tape application did not show increased muscle activation, CWE, or MIP compared with sham and control scenarios. A significant training effect for MIP was identified. Future research should investigate KT effects in other age groups or with the presence of pulmonary pathology. [ABSTRACT FROM AUTHOR]

Simple Summary: There is currently a growing interest in respiratory muscle training in athletes, so we set out to systematically assess with meta-analyses the effects of IMT with PowerBretah® (PwB), a threshold work device for IMT, on respiratory parameters and athletic performance in healthy physically active adults. Eleven studies were included in the systematic review and nine in the meta-analysis. IMT by PwB significantly increased maximal inspiratory pressure (MIP) and substantial improvements in forced vital capacity (FVC) in the results of the meta-analysis, and sports performance was significantly increased. In conclusion, the IMT with PwB would improve respiratory, MIP, FVC, and sports performance. Sports performance in athletes can be limited by respiratory factors, so it is understandable to propose that inspiratory muscle training (IMT) can improve respiratory function and exercise performance. Power-Breathe® (PwB) is a sectorized respiratory muscle training tool that uses a resistive load to train IMT. There is currently a growing interest in respiratory muscle training, so we set out to systematically assess the effects of IMT with PwB on respiratory parameters and athletic performance in physically active, healthy adults. Based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline, the Cochrane and PEDro scales to assess methodological quality, effect size using the Rosenthal formula, and the Cochrane tool for estimation of risk of bias, studies searchable in Medline, Web of Science, and Cochrane. In addition, for the performance of the meta-analysis, the documentation and quantification of the heterogeneity in each meta-analysis were directed through the Cochran's Q test and the I2 statistic; in addition, a publication bias analysis was performed using funnel plots. Of the total of 241 studies identified in the search, 11 studies for the systematic review and nine for the meta-analysis met the exclusion and/or inclusion criteria. IMT, with PwB, showed significant improvements in maximal inspiratory pressure (MIP) and substantial improvements in forced vital capacity (FVC) in the meta-analysis results. Also, sports performance was significantly increased by IMT with PwB. In conclusion, the use of PwB is an IMT tool that improves respiratory and sports performance. [ABSTRACT FROM AUTHOR]

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Introduction: In subject-based literature, there are no studies in which the results obtained simultaneously from surface electromyography of respiratory muscles and measurements of maximal respiratory pressures in stroke patients would be analysed.Research objective: The purpose of the study was to evaluate the effects of physiotherapy with breathing exercises in a subject with stroke-induced hemiplegia.Material and methods: In this pilot study, we presented a 36-year-old female with a medical history of haemorrhagic stroke in the left hemisphere, and with right-sided hemiparesis 76 months prior to research. The patient underwent 5, 60-minute individual physiotherapy sessions with general fitness training and breathing exercises for 1-week, with pre- and post-intervention outcome measures including functional assessment, respiratory pressure measurements using spirometer together with the electromyographic assessment of the respiratory muscles.Results: After implementing the physiotherapy with breathing exercises, equalisation of EMG activity and proper muscle recruitment during forced inhalation and exhalation have been demonstrated. The subject increased maximal expiratory and inspiratory pressures: (69.3% to 95.8% and 79.5% to 100.1% of predicted values, respectively).Conclusion: The results from this pilot study allow to indicate that the use of physiotherapy with breathing pattern correction may have positive impact on pulmonary function in a chronic stroke patient.

Background: Aging is associated with structural degeneration and functional limitations in the respiratory system, reducing exercise capacity. Respiratory muscle stretch gymnastics (RMSG) is used to improve the function of lungs and respiratory muscles with some success in various populations. Materials and Methods: Eighty-four individuals in the age group of 60–70 years were randomly allocated to the experimental and control group. Individuals in the experimental group were put on a 4-week RMSG supervised program. Distance covered in incremental shuttle walk test (ISWT), maximal inspiratory pressure (MIP), and quality of life (QoL) were the outcome measures for the study. Results: There was an improvement in distance covered in ISWT, MIP, and scores of World Health Organization QoL-BREF (WHO QoL-BREF) questionnaire of subjects in the experimental group (P = 0.000) as compared to the control group. Conclusion: Prescription of RMSG for 4 weeks was beneficial in improving exercise performance, maximal inspiratory muscle strength, and QoL in elderly individuals.

Background: Persistent symptoms after acute coronavirus-disease-2019 (COVID-19) are common, and there is no significant correlation with the severity of the acute disease. In long-COVID (persistent symptoms >4 weeks after acute COVID-19), respiratory symptoms are frequent, but lung function testing shows only mild changes that do not explain the symptoms. Although COVID-19 may lead to an impairment of the peripheral nervous system and skeletal muscles, respiratory muscle function has not been examined in this setting. Methods: In this study, we assessed the severity of dyspnea (NYHA-function class) in long-COVID patients and analyzed its association with body mass index (BMI), FEV1, forced vital capacity, other parameters of body plethysmography, diffusing capacity for carbon monoxide (DLCO), arterial blood gases, and inspiratory muscle function, assessed by airway occlusion pressure (P0.1) and maximal inspiratory pressure (PImax) in two respiratory clinics in Germany between Oct 2020 and Aug 2021. Results: A total of 116 patients were included in the study. The mean age was 50.2 ± 14.5 years; BMI, 26.7 ± 5.87 kg/m2; NYHA class I, 19%; II, 27%; III, 41%; and IV, 14%. While lung function values and computed tomography or conventional X-ray of the chest were in the normal range, inspiratory muscle function was markedly impaired. P01 was elevated to 154 ± 83%predicted and PImax was reduced to 41 ± 25%predicted. PImax reduction was strongly associated with the severity of dyspnea but independent of BMI, time after acute COVID-19 and most of the other parameters. Conclusions: This study shows that in long-COVID patients, respiratory symptoms may be mainly caused by reduced inspiratory muscle strength. Assessment of PImax and P0.1 might better explain dyspnea than classical lung function tests and DLCO. A prospective study is needed to confirm these results. [ABSTRACT FROM AUTHOR]

Aims Although the developmental mechanism of respiratory muscle weakness (RMW) and frailty are partly similar in patients with cardiovascular disease (CVD), their relationship remains unclear. This study aimed to investigate the correlation between RMW and frailty and its impact on clinical outcomes in patients with CVD. Methods and results In this retrospective observational study, consecutive 1217 patients who were hospitalized for CVD treatment were enrolled. We assessed frailty status by using the Fried criteria and respiratory muscle strength by measuring the maximal inspiratory pressure (PImax) at hospital discharge, with RMW defined as PImax <70% of the predicted value. The endpoint was a composite of all-cause death and/or readmission for heart failure. We examined the prevalence of RMW and frailty and their correlation. The relationships of RMW with the endpoint for each presence or absence of frailty were also investigated. Respiratory muscle weakness and frailty were observed in 456 (37.5%) and 295 (24.2%) patients, respectively, and 149 (12.2%) patients had both statuses. Frailty was detected as a significant indicator of RMW [odds ratio: 1.84, 95% confidence interval (CI): 1.39–2.44]. Composite events occurred in 282 patients (23.2%). Respiratory muscle weakness was independently associated with an increased incidence of events in patients with both non-frailty [hazard ratio (HR): 1.40, 95% CI: 1.04–1.88] and frailty (HR: 1.68, 95% CI: 1.07–2.63). Conclusions This is the first to demonstrate a correlation between RMW and frailty in patients with CVD, with 12.2% of patients showing overlap. RMW was significantly associated with an increased risk of poor outcomes in patients with CVD and frailty. [ABSTRACT FROM AUTHOR]

Above-normal blood pressure (BP) is a primary risk factor for cardiovascular diseases. In a retrospective analysis of five pilot trials, we assessed the BP-lowering effects of high-resistance inspiratory muscle strength training (IMST) in adults aged 18–82 years and the impact of IMST on maximal inspiratory pressure (PIMAX), a gauge of inspiratory muscle strength and independent disease risk factor. Participants were randomized to high-resistance IMST (75% PIMAX) or low-resistance sham (15% PIMAX) training (30 breaths/day, 5–7 days/wk, 6 wk). IMST (n = 67) reduced systolic BP (SBP) by 9 ± 6 mmHg (P < 0.01) and diastolic BP (DBP) by 4 ± 4 mmHg (P < 0.01). IMST-related reductions in SBP and DBP emerged by week 2 of training (−4 ± 8 mmHg and −3 ± 6 mmHg; P ≤ 0.01, respectively) and continued across the 6-wk intervention. SBP and DBP were unchanged with sham training (n = 61, all P > 0.05). Select subject characteristics slightly modified the impact of IMST on BP. Greater reductions in SBP were associated with older age (β = −0.07 ± 0.03; P = 0.04) and greater reductions in DBP associated with medication-naïve BP (β = −3 ± 1; P = 0.02) and higher initial DBP (β = −0.12 ± 0.05; P = 0.04). PIMAX increased with high-resistance IMST and low-resistance sham training, with a greater increase from high-resistance IMST (+20 ± 17 vs. +6 ± 14 cmH2O; P < 0.01). Gains in PIMAX had a modest inverse relation with age (β = −0.20 ± 0.09; P = 0.03) and baseline PIMAX (β = −0.15 ± 0.07; P = 0.04) but not to reductions in SBP or DBP. These compiled findings from multiple independent trials provide the strongest evidence to date that high-resistance IMST evokes clinically significant reductions in SBP and DBP, and increases in PIMAX, in adult men and women. NEW & NOTEWORTHY In young-to-older adult men and women, 6 wk of high-resistance inspiratory muscle strength training lowers casual systolic and diastolic blood pressure by 9 mmHg and 4 mmHg, respectively, with initial reductions observed by week 2 of training. Given blood pressure outcomes with the intervention were only slightly altered by subject baseline characteristics (i.e., age, blood pressure medication, and health status), inspiratory muscle strength training is effective in lowering blood pressure in a broad range of adults. [ABSTRACT FROM AUTHOR]

BackgroundInspiratory muscle training (IMT) is a simple and well-tolerated physical therapy that increases respiratory muscle strength and relieving the degree of dyspnea and fatigue. Therefore, it may be used as a transitional modality before exercise training or as a specific physical therapy intervention for those who are diagnosed with respiratory muscle weakness. However, the current evidence on IMT in pulmonary hypertension (PH) patients is inconclusive. The purpose of this systematic review and meta-analysis was to summarize the current role of IMT in this group of patients.MethodsPubMed, EMBASE, and Cochrane databases were searched through May 2022. Trials examining the feasibility and effectiveness of IMT in PH patients. Outcome measures included adverse events, training adherence and compliance, maximum inspiratory pressure (MIP), maximum expiratory pressure (MEP), forced vital capacity (FVC%), forced expiratory volume in 1 s (FEV1%), FEV1/FVC%, 6 min walk distance (6MWD), Peak VO2, dyspnea, and fatigue perception after the IMT training program. Only randomized controlled trials were included. The Cochrane Risk of Bias tool for controlled trials was adopted to assess study quality. Statistical heterogeneity was evaluated with the chi-square test and I2 statistic. Mean differences and 95% confidence intervals (CIs) were estimated.ResultsWe ultimately identified four studies that met the criteria. These studies comprised 80 patients with 16 males and 64 females. The mean age was 53.25. The main types of PH were group I (pulmonary arterial hypertension, 95%) and group IV (chronic thromboembolic PH, 5%). No severe adverse events were reported in the included studies. IMT had a significant effect on improving MIP (18.89 cmH2O; 95% CI: 9.43–28.35, P < 0.001) and MEP (8.06 cmH2O; 95% CI: 2.39–13.73; P = 0.005), increase in the 6MWD (30.16 m; 95% CI: 1.53–58.79; P = 0.04). No significant improvement was found in pulmonary function (P > 0.05), and uncertain effect on the quality of life (QoL) score.ConclusionBased on currently limited evidence, IMT is an effective physical therapy for increasing respiratory muscle function and exercise capacity, but still a lack of evidence on dyspnea and fatigue levels, pulmonary function, and QoL in PH patients. There are reasons to believe that IMT is a promising intervention in PH patients, enriching rehabilitation options and serving as a bridge before formal exercise training. It is expected that IMT will play an important role in the future clinical pathway of physical therapy for this group of patients.Systematic review registration[https://www.crd.york.ac.uk/PROSPERO/logout.php], identifier [CRD42022335972].

To evaluate the association between Maximal Inspiratory Pressure (MIP) and health-related quality of life (HRQoL) and to verify the reliability of the MIP in patients on hemodialysis. In a repeated-measures design, patients on hemodialysis performed MIP and specific HRQoL questionnaire (trial 1). The MIP was repeated after 6 to 8 weeks (trial 2) and reliability was assessed using Intra-class Correlation Coefficient. Standard Error of Measurement and Minimal Detectable Change scores were calculated. Sixty-one individuals (68.9% men) were evaluated in trial 1. MIP was associated with specific domains "Symptoms" (r = 0.45; R2 adjusted = 0.192) and the kidney disease component summary (r = 0.38; R2 adjusted = 0.138). Regarding generic domains, the MIP was associated with "Physical Functioning" (r = 0.57; R2 adjusted = 0.375) and Physical component summary (r = 0.47; R2 adjusted = 0.258). Thirty-three patients were randomly selected to perform a second MIP test (trial 2). The Intra-class Correlation Coefficient was 0.94 (95%CI 0.88–0.97). By Bland-Altman analysis, the bias was 3.2 cmH2O, which represents a difference of 3.7%. The Standard Error of Measurement and Minimal Detectable Change for MIP were 5.9 cmH2O and 13.8 cmH2O, respectively. The MIP is a reliable test, associated with physical domains of HRQoL in patients on hemodialysis. Thus, it is a useful method for respiratory evaluation in this population. [ABSTRACT FROM AUTHOR]

Background/aims Although an increasing volume of research is emerging, rehabilitative treatment of patients with COVID-19 still continues to be a matter of great importance that must be explored further. The purpose of the present study was to describe the effects of inpatient rehabilitation in acute patients treated in a sub-intensive hospital setting during the COVID-19 pandemic. Methods A retrospective analysis was conducted based on the prospectively collected data of 192 patients with COVID-19 undergoing a physiotherapeutic regimen during their hospitalisation. Patients were admitted because of COVID-19-related pneumonia from the periods of 25 March-12 June 2020 and 2 November 2020-9 June 2021. This study investigated dyspnoea intensity using the modified Borg scale, motor function through the 1-minute sit-to-stand test, and daily walked distance. In a subset of 57 patients, handgrip strength and respiratory muscle function was also evaluated. Measurements were taken at baseline and discharge. Results Patients were classified according to the severity of their ratio of arterial oxygen partial pressure to fractional inspired oxygen (mean 225 ± 82 mmHg). At discharge to home or to another hospital facility, patients performed a mean of 12 repetitions (1-minute sit-to-stand test); dyspnoea intensity was 1.4 (modified Borg scale), and they were able to walk a mean distance of 266.7 metres. The mean handgrip strength of the dominant hand was 29.3 kg, the maximal inspiratory pressure was 43.5 cmH2O, and the maximal expiratory pressure was 59.1 cmH2O. Overall, significant differences before and after treatment were detected for all clinical variables. Dyspnoea improved by 0.7 points; walked distance by 200 metres; the number of repetitions at the 1-minute sit-to-stand test by 5.6; the handgrip strength by 1.2 kg (right hand) and 1.7 kg (left hand); maximal inspiratory pressure by 7.7 cmH2O; and maximal expiratory pressure by 9.5 cmH2O. Conclusions Patients obtained significant improvements in functional capacity, dyspnoea perception, handgrip strength and respiratory muscle function. In addition, the treatment was feasible and well tolerated by patients, and no adverse related events were observed in a sub-intensive care setting. [ABSTRACT FROM AUTHOR]

It has been suggested that inspiratory muscles fatigue impairing blood flow to the active limb muscle via respiratory muscle metaboreflex. The purpose of this study was to investigate the effects of inspiratory muscle fatigue on exercise performance and muscle tissue oxygenation in high-intensity exercise takes about 3.5~5min. Eleven healthy males subjects performed two conditions of constant-load exercise to exhaustion (TTE) on a cycle ergometer at 100% of maximal oxygen uptake. The two conditions—inspiratory muscle fatiguing (IMF) and non-fatiguing (PLA)—which had different intensity inspiratory resistance breathing (IRB) were performed before exercise. Muscle tissue oxygenations were measured by deoxyhemogrobin (HHb), oxygen saturation index (StO2) from right vastus lateralis during TTE. All data were analyzed from nine subjects whose inspiratory muscle were fatigued by IRB in IMF. Results: TTE was significantly shorter in IMF compare to PLA (244±31s vs. 268±38s, p<0.05). HHb was significantly higher and StO2 was significantly lower in IMF than in PLA (p<0.05). Conclusion: High-intensity exercise completed in 3.5~5 minutes, it was suggested that inspiratory muscle fatigue reduced the oxygen deriver to active limb muscle, resulting in decrease exercise performance. Improving function of inspiratory muscles, such as in inspiratory muscle training, may improve oxygenation of the active limb muscle and enhance exercise performance. [ABSTRACT FROM AUTHOR]

Anthropometric variables will influence maximal respiratory pressure (MRP) values. Because significant variations exist in pulmonary nomograms among different races, it is important that tribe-specific tables of normal maximal inspiratory pressures (MIPs) and maximal expiratory pressures (MEPs) be developed. To date, MRP prediction equations do not exist for Hopi children. Purpose: The purpose of this study was to develop MRP reference values and prediction equations for Hopi children in the ages 4 to 13 years. Methods: A cross-sectional study was undertaken with 288 healthy children (125 boys, 163 girls), a 36% representative population of all the Hopi Native children attending Hopi Tribal Elementary Schools in Arizona. Maximal inspiratory pressure and MEP values were measured. Results: Age and the inverse of body mass were consistently significant predictors of the MRPs for both sexes. Predictions using the derived Hopi equations were significantly different (P ≤ 0.001) than those using the equations for Navajo and Caucasian youth across both sexes, making it important for this population to have specific formulae to provide more accurate reference values. Conclusions: These data were collected from the children of Hopi ancestry resulting in MIP and MEP reference equations which should be used when measuring MIP and MEP in these children ages 4 to 13 years. [ABSTRACT FROM AUTHOR]

Saloni Pawar,1 Amitesh Narayan,1 Shreekanth D Karnad,1 Gopala Krishna Alaparthi,2 Kalyana Chakravarthy Bairapareddy2 1Department of Physiotherapy, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, India; 2Department of Physiotherapy, College of Health Sciences, University of Sharjah, Sharjah, United Arab EmiratesCorrespondence: Shreekanth D KarnadDepartment of Physiotherapy, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, IndiaTel +91 9035551146Email shrikanth.dk@manipal.eduPurpose: As the values of respiratory muscle strength vary according to race, ethnicity, and geographical area, there is a wide-ranging difference among different populations. Thus, the available reference values may not have an application for use in the Indian paediatric population, creating a need for generating values which will be appropriate for the Indian paediatric context.Materials and Methods: Assessment of respiratory muscle strength was carried out by assessing maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP) and synthesising predictive formulas using anthropometric variables like height, gender and age, which will be suitable for Indian children.Results: We calculated MIP and MEP of 320 (boys=160 and girls= 160) children in the age range of 7 years to 17 years of Mangaluru city, India. Results stated that mean MIP and MEP for boys were 72.5± 32.8 cm H2O and 73± 33.2 cm H2O, while for the girls it was 67± 30.2 cm H2O and 68± 30.1 cm H2O, respectively.Conclusion: This study concluded that there is a difference in respiratory pressure values of Indian children with respect to those of other countries. Age, gender, height and BMI have a significant role in determining respiratory muscle strength. Boys demonstrated higher MIP and MEP. As age, height, weight and BMI increases, so does MIP and MEP.Keywords: maximal expiratory pressure, maximal inspiratory pressure, respiratory muscle pressure, respiratory muscle strength

Limited research has examined inspiratory muscle performance (IMP) and functional performance (FP) of patients after valve replacement surgery (VRS). The purpose of this study was to examine IMP as well as several measures of FP in patients post-VRS. The study results of 27 patients revealed that patients undergoing transcatheter VRS were significantly (p = 0.01) older than patients undergoing minimally invasive or median sternotomy VRS with the median sternotomy VRS group performing significantly (p < 0.05) better than the transcatheter VRS group in the 6-min walk test, 5x sit-to-stand test, and sustained maximal inspiratory pressure. The 6-min walk test and IMP measures in all groups were significantly (p < 0.001) lower than predicted values. Significant (p < 0.05) relationships were found between IMP and FP with greater IMP being associated with greater FP. Pre-operative and early post-operative rehabilitation may improve IMP and FP post-VRS.

Copyright of Medical Rehabilitation / Rehabilitacja Medyczna is the property of Medical Rehabilitation and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Inspiratory muscle fatigue (IMF) may limit exercise performance. It has been reported that IMF occurs after various exercises; however, it remains unclear whether IMF occurs after tennis singles match play. The purpose of this study was to test whether tennis singles match play induced IMF. Nine female college tennis players participated in this study. The players were paired in accordance with their skill level, and then played a singles match for an effective playing time (EPT) of 20 minutes. A portable autospirometer was used to measure the maximal inspiratory pressure (MIP) before and immediately after the match as an index of IMF. Heart rate and perceptual measurements were recorded after every 2.5 minutes of effective playing time. The total match duration in this study was 96 ± 8 minutes. Post-match MIP was significantly lower than pre-match MIP (103 ± 21 cmH2O vs. 92 ± 22 cmH2O, p < 0.05, effect size = 0.47), and the magnitude of the decrease in MIP was 10.0 ± 9.7%. The present results show that IMF occurs after tennis singles match play in females.

BACKGROUND: Lung transplantation (LTx) is an established treatment option for patients with end-stage lung diseases. Nevertheless, exercise intolerance, respiratory muscle function impairment, functional disability, and peripheral muscle weakness often persist following LTx. PURPOSE: To examine the effectiveness of a pulmonary rehabilitation (PR) program and home-based inspiratory muscle training (IMT) alone or in combination, in post lung transplantation (LTx) patients. METHODS: In a prospective pilot study a sample of 22 patients who had undergone LTx 4–18 months prior, were randomized to groups of PR alone, or combined with home-based IMT, or IMT alone, for six months: four months in the intervention program and two months of follow-up. Inspiratory muscle strength was assessed by measuring the maximal inspiratory pressure (MIP). RESULTS: There was a statistically significant increase in MIP values as well as in the 6-min-walk-test, only in the PR combined with home-based IMT, and IMT exercise groups. From baseline after 2- and 4-months intervention and at 6-months at follow-up, there was a statistically significant correlation between MIP and Maximum Voluntary Ventilation (MVV) values. CONCLUSIONS: Pulmonary rehabilitation (PR) program combined with inspiratory muscle training (IMT) or home-based IMT alone, in post lung transplantation patients, seems to be the best exercise combination for achieving the optimal effect, in inspiratory muscle strength and exercise capacity, with evidence for long-term benefits. Patients should be encouraged to participate in a PR program that includes home-based IMT exercise, especially in times of restricted mobility, as currently due to the COVID-19 pandemic. [ABSTRACT FROM AUTHOR]

The study aimed to provide within-race data on the time course of pulmonary function during a mountain ultramarathon (MUM). Additionally, we wanted to assess possible sex differences regarding pre- to post-race change in pulmonary and inspiratory muscle function. Lastly, we were interested in evaluating whether changes in respiratory function were associated with relative running speed and due to general or specific fatigue. 47 athletes (29 males and 18 females; 41 ± 5 years) were submitted to a cardiopulmonary exercise test (CPET) before a 107-km MUM. Spirometric variables: forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), FEV1/FVC and peak expiratory flow (PEF); maximal inspiratory pressure (MIP); squat jump (SJ) and handgrip strength (HG) were assessed before and after the race. Additionally PEF was measured at three aid stations (33rd, 66th and 84th km) during the race. PEF declined from the 33rd to the 66th km (p = 0.004; d = 0.72) and from the 84th km to the finish line (p = 0.003; d = 0.90), while relative running speed dropped from the first (0-33 km) to the second (33-66 km) race section (p < 0.001; d = 1.81) and from the third (66-84 km) to the last race section (p < 0.001; d = 1.61). Post-race, a moderate reduction was noted in FVC (-13%; p < 0.001; d = 0.52), FEV1 (-19.5%; p < 0.001; d = 0.65), FEV1/FVC (-8.4%; p = 0.030; d = 0.59), PEF (- 20.3%; p < 0.001; d = 0.58), MIP (-25.3%; p < 0.001; d = 0.79) and SJ (-31.6%; p < 0.001; d = 1.42). Conversely, HG did not change from pre- to post-race (-1.4%; p = 0.56; d = 0.05). PEF declined during the race in parallel with running speed drop. No sex differences were noted regarding post-race respiratory function, except that FEV1/FVC decay was significantly greater among women. The magnitude of pre- to post-race respiratory function decline was uncorrelated with relative running speed. [ABSTRACT FROM AUTHOR]

Background A lot of indices can be used as predictors of weaning off mechanical ventilation, such as rapid shallow breathing index (RSBI), integrative weaning index (IWI), vital capacity (VC), maximal inspiratory pressure (MIP), and respiratory rate (RR). MIP and IWI were considered the most sensitive parameters for prediction of weaning. Objective To compare between the efficacies of some predictors of successful weaning in ventilated patients with chronic obstructive pulmonary disease with acute respiratory failure. Design A total of 30 patients with chronic obstructive pulmonary disease with acute respiratory failure were mechanically ventilated and classified into two groups, with 15 patients each. Clinical and demographic data assessment and routine investigations were done for all patients, and then RSBI and IWI were measured in group I, and also VC and MIP were measured in group II, whereas RR was measured in the two groups. Results Successful cases had significantly short duration of ventilation and high IWI, MIP, and VC, but RSBI was significantly lower in successful cases, whereas RR was significantly high in failed cases. Conclusion MIP and IWI were considered the most sensitive parameters in predicting the outcome of weaning, and prolonged duration on mechanical ventilation was associated with weaning failure.

In this study, the literature review focuses on the available evidence for the effects of inspiratory muscle strength training (IMST) using a threshold loading device in participants with chronic obstructive pulmonary disease (COPD). The search involved a computerized database pertaining to studies that included the outcomes of a pressure threshold IMST published after the year 2000. Sixteen articles were selected which showed outcomes relating to inspiratory muscle strength (maximal inspiratory pressure), respiratory muscle function, dyspnea, functional capacity, and health-related quality of life in COPD participants. However, the IMST protocols varied in the different studies. Most of the studies demonstrated promising and significant improvements in most of the outcomes of IMST in COPD patients; however, the effects on respiratory function remain equivocal and need to be explored further through future research.

Background: Exercise intolerance is common among adults with heart failure (HF) and is a strong prognostic indicator. We examined maximal inspiratory pressure (MIP) as an indicator of maximal and submaximal exercise capacity in older HF patients., Methods: Fifty-one patients age ≥ 50 years with HF underwent MIP testing via the PrO 2 device. Peak oxygen uptake (VO 2 ), 6 min walk distance (6MWD), 30 s sit-to-stand test (STS), gait speed (GS), grip strength and lower extremity muscle strength [one-repetition maximum (1RM)] were measured. Correlation and exploratory multiple regression analyses investigated relationships between MIP, left ventricular ejection fraction (LVEF), age, body mass index (BMI) and physical function. MIP was then stratified by median (64 cm H 2 O), and endpoints were compared between median groups., Results: The median age was 69 years [interquartile range (IQR): 66-73], and the median LVEF was 36.5% (IQR: 30%-45%). Regression identified MIP as an independent predictor for grip strength, 6MWD, 1RM weight and 30 s STS after adjustment for age, BMI and LVEF. MIP greater than the median (n = 25) independently predicted and reflected greater peak VO 2 [14.2 (12.8-18.1) vs. 11.5 (9.7-13.0) mL/kg/min; P = 0.0007] as well as 6MWD, 1RM, 30 s STS and GS (all P < 0.05)., Conclusion: The analysis demonstrates that MIP is a novel biometric for exercise tolerance in adults with HF. Assessments of MIP are safe and convenient, with the potential to enhance routine HF surveillance and provide novel biometrics to guide HF therapeutics., (© 2024 The Author(s). ESC Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology.)

Sports performance in athletes can be limited by respiratory factors, so it is understandable to propose that inspiratory muscle training (IMT) can improve respiratory function and exercise performance. Power-Breathe® (PwB) is a sectorized respiratory muscle training tool that uses a resistive load to train IMT. There is currently a growing interest in respiratory muscle training, so we set out to systematically assess the effects of IMT with PwB on respiratory parameters and athletic performance in physically active, healthy adults. Based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline, the Cochrane and PEDro scales to assess methodological quality, effect size using the Rosenthal formula, and the Cochrane tool for estimation of risk of bias, studies searchable in Medline, Web of Science, and Cochrane. In addition, for the performance of the meta-analysis, the documentation and quantification of the heterogeneity in each meta-analysis were directed through the Cochran’s Q test and the I2 statistic; in addition, a publication bias analysis was performed using funnel plots. Of the total of 241 studies identified in the search, 11 studies for the systematic review and nine for the meta-analysis met the exclusion and/or inclusion criteria. IMT, with PwB, showed significant improvements in maximal inspiratory pressure (MIP) and substantial improvements in forced vital capacity (FVC) in the meta-analysis results. Also, sports performance was significantly increased by IMT with PwB. In conclusion, the use of PwB is an IMT tool that improves respiratory and sports performance.

Copyright of Fisioterapia e Pesquisa is the property of Universidade de Sao Paulo, Faculdade de Medicina and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objectives Chronic Obstructive Pulmonary Disease (COPD) is one of the most important progressive pulmonary disorders. Diaphragmatic dysfunction is an essential factor in the worsening and progression of symptoms in patients with COPD. Therefore, we investigated the effect of diaphragmatic respiratory training on some pulmonary indexes in these patients. Methods & Materials This quasi-experimental study type with pretest-posttest design, 16 male patients (Mean±SD=55 ± 5.4 y) with moderate COPD were selected through convenient sampling method and were randomly divided into two groups of 8 (diaphragmatic training and control group). A demographic questionnaire was used to control the inclusion criteria. Maximal inspiratory pressure, forced expiratory volume in 1 second, and respiratory rate per minute were measured by laboratory equipment. The training group performed the respiratory exercises 3 sessions per week for 8 weeks. The control group did not do any exercise. After the end of training, the pulmonary indexes were re-evaluated. Statistical data were analyzed by ANOVA and Tukey's post hoc test in SPSS21. Results The results indicated that diaphragmatic respiratory exercises had a significant effect on pulmonary indexes (P=0.001). There was no improvement in any of the variables in the control group (P ˃ 0.05). Conclusion Diaphragmatic respiratory training seems to play an essential role in improving the respiratory indexes of patients with pulmonary disease. The results of our study showed that respiratory training improves the respiratory function of patients and should be included in the pulmonary rehabilitation program for these patients.

Background The ageing process can result in the decrease of respiratory muscle strength and consequently increased work of breathing and associated breathlessness during activities of daily living in older adults. Objective This systematic review and meta-analysis aims to determine the effects of inspiratory muscle training (IMT) in healthy older adults. Methods A systematic literature search was conducted across four databases (Medline/Pubmed, Web of Science, Cochrane Library CINAHL) using a search strategy consisting of both MeSH and text words including older adults, IMT and functional capacity. The eligibility criteria for selecting studies involved controlled trials investigating IMT via resistive or threshold loading in older adults (>60 years) without a long-term condition. Results Seven studies provided mean change scores for inspiratory muscle pressure and three studies for functional capacity. A significant improvement was found for maximal inspiratory pressure (PImax) following training (n  = 7, 3.03 [2.44, 3.61], P  = <0.00001) but not for functional capacity (n  = 3, 2.42 [−1.28, 6.12], P  = 0.20). There was no significant correlation between baseline PImax and post-intervention change in PImax values (n  = 7, r  = 0.342, P  = 0.453). Conclusions IMT can be beneficial in terms of improving inspiratory muscle strength in older adults regardless of their initial degree of inspiratory muscle weakness. Further research is required to investigate the effect of IMT on functional capacity and quality of life in older adults. [ABSTRACT FROM AUTHOR]

Purpose: We assessed the feasibility of a 6-week combined program of autonomous walking plus highintensity inspiratory muscle training (IMT) in individuals with heart failure (HF) during the transitional care period. Methods: Individuals with HF being discharged within the past 3 months were enrolled. This was a preliminary, 2-armed randomized controlled trial with participants blinded: (1) the autonomous walking-only program with a weekly step goal; and (2) the combined program with IMT added at 60% maximal inspiratory pressure. Feasibility was assessed by frequency of participation. Average 7-day step count and PImax were determined weekly. Additional outcomes included 6-minute walk test and the Minnesota living with heart failure questionnaire (MLHFQ). Results: Sixteen participants were randomized (age, 56 6 12 years), but only 8 completed the study. Seven participants had good adherence of 80% to 100% in activity and breathing exercise logs. Four participants in the combined program showed a 21% to 58% improvement based on the MLHFQ. A small sample size and the high dropout rate were addressed. Conclusions: The combined program of autonomous walking and high-intensity IMT appeared to be feasible and beneficial after the transitional care period. Novel strategies to enhance subject recruitment and adherence are needed for future studies. [ABSTRACT FROM AUTHOR]

ositive pressure ventilation (PPV) can increase exercise performance in cyclists, but its effects are unclear in other exercise modes, especially those using large muscle mass. The aim of this study was to compare the exercise performance and postexercise inspiratory muscles' strength with and without PPV (NO-PPV) during rowing. Nine male rowers (19 ± 1 year) participated in 3 experimental days (M1, M2, and M3) separated by 1 week. In M1, rowers performed a 2,000-m test (2k) on a rowing ergometer to obtain average power (W2k). In M2 and M3, the rowers performed 4 minutes' workouts at 55, 65, 75, and 85% W2k, respectively, separated by 1 minute of recovery, with PPV and NO-PPV application in randomized order. Blood lactate (La) was measured during intervals. After submaximal exercises, with 10 minutes of "cool down," the rowers performed a maximal performance test of 4 minutes (4-minute all-out rowing). Traveled distance was computed and correlated with maximal inspiratory pressure (MIP) changes from pretest to posttest (Δ). Positive pressure ventilation application increased the traveled distance in relation to NO-PPV exercise (1,210.7 ± 45.5 vs. 1,199.8 ± 43.4 m, p ≤ 0.05). The ΔMIP (cmH2O) was lower in PPV as compared to NO-PPV exercise (-19.1 ± 10.2 vs. -26.3 ± 7.9 cmH2O, p ≤ 0.05). The [La] showed no significant difference between PPV and NO-PPV exercises (p > 0.05). Therefore, the PPV during whole-body rowing exercise improved the exercise performance and attenuated the inspiratory postexercise fatigue. These findings suggest that inspiratory muscles' strength plays a role during high-intensity exercise with large muscle mass. [ABSTRACT FROM AUTHOR]

Objective. Coronavirus disease 2019 (COVID-19) has dominated the attention of health care systems globally since January 2020. Various health disciplines, including physical therapists, are still exploring the best way to manage this new disease. The role and involvement of physical therapists in the management of COVID-19 are not yet well defined and are limited in many hospitals. This article reports a physical therapy service specially commissioned by the Health Commission of Sichuan Province to manage COVID-19 during patients’ stay in the intensive care unit (ICU) at the Public Health Clinical Center of Chengdu in China. Methods. Patients diagnosed with COVID-19 were classified into 4 categories under a directive from the National Health Commission of the People’s Republic of China. Patients in the “severe” and “critical” categories were admitted to the ICU irrespective of mechanical ventilation was required. Between January 31, 2020, and March 8, 2020, a cohort of 16 patients was admitted to the ICU at the Public Health Clinical Center of Chengdu. The median (minimum to maximum) hospital and ICU stays for these patients were 27 (11–46) and 15 (6–38) days, respectively. Medical management included antiviral, immunoregulation, and supportive treatment of associated comorbidities. Physical therapist interventions included body positioning, airway clearance techniques, oscillatory positive end-expiratory pressure, inspiratory muscle training, and mobility exercises. All patients had at least 1 comorbidity. Three of the 16 patients required mechanical ventilation and were excluded for outcome measures that required understanding of verbal instructions. In the remaining 13 patients, respiratory outcomes—including the Borg Dyspnea Scale, peak expiratory flow rate, Pao2/Fio2 ratio, maximal inspiratory pressure, strength outcomes, Medical Research Council Sum Score, and functional outcomes (including the Physical Function in Intensive Care Test score, De Morton Mobility Index, and Modified Barthel Index)—were measured on the first day the patient received the physical therapist intervention and at discharge. Results. At discharge from the ICU, while most outcome measures were near normal for the majority of the patients, 61% and 31% of these patients had peak expiratory flow rate and maximal inspiratory pressure, respectively, below 80% of the predicted value and 46% had De Morton Mobility Index values below the normative value. Conclusion. The respiratory and physical functions of some patients remained poor at ICU discharge, suggesting that longterm rehabilitation may be required for these patients. Impact. Our experience in the management of patients with COVID-19 has revealed that physical therapist intervention is safe and appears to be associated with an improvement in respiratory and physical function in patients with COVID-19 in the ICU. [ABSTRACT FROM AUTHOR]

Background: Decreased respiratory muscle strength and muscle mass is key in diagnosing respiratory sarcopenia. However, the role of reduced diaphragm activity, expressed as the maximal level of diaphragmatic excursion (DEmax), in diagnosing respiratory sarcopenia in patients with chronic obstructive pulmonary disease (COPD) remains unclear. This study aimed to characterize patients with COPD and low DEmax and maximal inspiratory pressure (MIP), a measure of inspiratory muscle strength, and assess the role of DEmax in respiratory sarcopenia., Methods: Patients with COPD underwent spirometry, exercise tolerance (VO 2peak ) test, and MIP measurement. DEmax and sternocleidomastoid thickness at the maximal inspiratory level (TscmMIL) were assessed using ultrasound sonography., Results: Overall, 58 patients with COPD (median age, 76 years; median %FEV 1 , 51.3 %) were included, 28 of whom showed a %MIP of ≥80 %, defined as having preserved MIP. Based on the %MIP of 80 % and median value of DEmax (48.0 mm) as thresholds, the patients were stratified into four groups: both-high (n = 18), %MIP-alone low (n = 11), DEmax-alone low (n = 10), and both-low (n = 19) groups. The both-low group exhibited the lowest %FEV 1 , Δinspiratory capacity, VO 2peak , and TscmMIL, and these values were significantly lower than those of the both-high group. Except for %FEV 1 , these values were significantly lower in the both-low group than in the %MIP-alone low group despite adjusting DEmax level for body mass index., Conclusion: Measuring DEmax along with MIP can characterize patients with COPD, reduced exercise capacity, and decreased accessory respiratory muscle mass and can help diagnose respiratory sarcopenia., Competing Interests: Declaration of competing interest The authors have no conflicts of interest., (Copyright © 2024 The Japanese Respiratory Society. Published by Elsevier B.V. All rights reserved.)

Abstract Background Current therapies for heart failure (HF) are followed by strategies to improve quality of life and exercise tolerance, besides reducing morbidity and mortality. Some HF patients present changes in the musculoskeletal system and inspiratory muscle weakness, which may be restored by inspiratory muscle training, thus increasing respiratory muscle strength and endurance, maximal oxygen uptake (VO2), functional capacity, respiratory responses to exercise, and quality of life. Yoga therapies have been shown to improve quality of life, inflammatory markers, and peak VO2 mostly in HF patients with a reduced ejection fraction. However, the effect of different yoga breathing techniques in patients showing HF with a preserved ejection fraction (HFpEF) remain to be assessed. Methods/design A PROBE (prospective randomized open blinded end-point) parallel-group trial will be conducted at two specialized HF clinics. Adult patients previously diagnosed with HFpEF will be included. After signing informed consent and performing a pre-test intervention, patients will be randomized into three groups and provided with either (1) active yoga breathing techniques; (2) passive yoga breathing techniques (pranayama); or and (3) control (standard pharmacological treatment). Follow-up will last 8 weeks (16 sessions). The post-intervention tests will be performed at the end of the intervention period for analysis of outcomes. Interventions will occur continuously according to patients’ enrollment. The main outcome is respiratory muscular resistance. A total of 33 enrolled patients are expected. The present protocol followed the SPIRIT guidelines and fulfilled the SPIRIT checklist. Discussion This trial is probably the first to assess the effects of a non-pharmacological intervention, namely yoga and specific breathing techniques, to improve cardiorespiratory function, autonomic system, and quality of life in patients with HFpEF. Trial registration REBEC Identifier: RBR-64mbnx (August 19, 2012). Clinical Trials Register: NCT03028168. Registered on 16 January 2017).

Introduction: We sought to describe: 1) The influence of orthotopic liver transplantation (OLT) on exercise capacity, pulmonary function and respiratory muscle strength after surgery, 2) The relationship between exercise capacity and symptoms of anxiety and depression.Material and methods. This is a prospective follow up study conducted with patients submitted to OLT. All patients were assessed before and 1 month after surgery through measurements: six minute walk test (6MWT), 6 min step test (6MST) and HADS (Hospital Anxiety and Depression Scale). FEV1% (forced expiratory volume), maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP) were measured in the pre-operative and on 1st, 3rd, 5th day and 1 month after surgery.Results. In 77 patients, 6MWD improved 20.2 m (95%CI 8.1-32.3) and 6MST improved 7.8 steps after surgery (95%CI 3.9-11.6). Change in 6 MWD and 6 MST did not correlated with change HADS. The FEV1% at each time point were 88.8 ± 21.3 before surgery, 32.9 ± 9.9 on 1st day, 39.6 ± 11.5 on 3rd day, 46 ± 12.1 on 5th day and 86.6 ± 21.1 one month after surgery. MIP and MEP values at each time point were -67.4 ± 23.2 and 79.7 ± 26 before surgery, −30.8 ± 12.3 and 36.4 ± 15.4 on 1st day, −38.6 ± 14.1 and 43.8 ± 17 on 3rd day, −45.8 ± 15.9 and 49.7 ± 18.7 on 5th day and −67.1 ± 29.4 and 80.9 ± 23.9 one month after surgery.Conclusion. Exercise capacity was modestly increased after OLT without any correlation with symptoms of anxiety and depression. Pulmonary function and respiratory muscle strength decreased immediately after liver transplantation, and progressively recovered, returning to baseline values after 1 month.

Introduction: Respiratory muscle dysfunction is a cardinal feature in chronic obstructive pulmonary disease (COPD) contributing to decreased exercise capacity and pulmonary function test (PFT) limitation with progression of the disease. Maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP) are reliable parameters for assessing the respiratory muscle strength. Aims: This study aims to measure maximal inspiratory and expiratory pressures in male COPD patients, to determine their correlates, and to study the relationship between the severity of COPD and respiratory muscle strength. Patients and Methods: This was an observational, cross-sectional study. A total of 100 males, who were known COPD patients and who were clinically stable, were recruited. Both inpatients and outpatients were studied. Spirometric PFT test was done, and MIP and MEP were measured using respiratory pressure meter. Descriptive statistics and Pearson's correlation were used. Results: The mean (± standard deviation) MIP and MEP were 47.73 (±19.6) cm H2O and 60.76 (±11.6) cm H2O, respectively. MIP and MEP showed a highly significant correlation (P < 0.001) with forced expiratory volume at 1 s (FEV1) and forced vital capacity. The correlation of MIP and MEP with FEV1shows a positive linear trend, and the MEP values were higher than MIP values. There was a decrease in MIP and MEP with increasing severity of COPD. Conclusion: MIP decreases with progression of the disease, and thus, inspiratory muscle training should be included in a pulmonary rehabilitation program.