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Parodi-Feye AS, Cappuccio-Díaz ÁD, Magallanes-Mira CA. Effects of Inspiratory Muscle Training on Physiological Performance Variables in Women's Handball. J Hum Kinet 2023; 89:101-112. [PMID: 38053961 PMCID: PMC10694718 DOI: 10.5114/jhk/169366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 06/05/2023] [Indexed: 12/07/2023] Open
Abstract
Inspiratory muscle training (IMT) has been used in different sports, although there is no consensus on its benefits. We investigated the effects of eight weeks of IMT in women's handball. Twenty-four players were randomly distributed into experimental (EXP; n = 13) and control (CON; n = 11) groups. Only the EXP group performed IMT using the POWERBreathe device, following indications of the manufacturers. Before and after the intervention, spirometric variables were evaluated at rest and during a graded test using direct analysis of respiratory gases. Perception of exertion at submaximal intensity was also determined. No significant differences were observed post- vs. pre-intervention (p ≥ 0.05) regarding forced vital capacity (FVC), forced expiratory volume in the 1st second (VEF1), FVC/VEF1, maximal expiratory flow at 50% of FVC or peak inspiratory flow. Post-intervention, only the CON group increased their absolute and relative VO2max (2.1 ± 0.2 L/min pre vs. 2.2 ± 0.3 L/min post; 33.6 ± 3.6 ml/kg∙min pre vs. 34.5 ± 3.2 ml/kg∙min post, respectively). No significant improvements (p ≥ 0.05) were observed in VO2 associated with ventilatory threshold 1 (VT1), nor in the intensity associated with VO2max and VT1. However, there was a tendency for the mentioned variables to decrease in the CON group, while in the EXP group the trend was to maintain or increase previous values. IMT did not determine an improvement in the perception of exertion at submaximal intensity. The use of POWERBreathe, as described in the present study, is feasible in terms of time and effort, although its benefits may not be significant.
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Affiliation(s)
- Andrés Santiago Parodi-Feye
- Department of Physical Education and Sport, Superior Institute of Physical Education, University of the Republic (Udelar), Montevideo, Uruguay
| | - Álvaro Daniel Cappuccio-Díaz
- Department of Physical Education and Sport, Superior Institute of Physical Education, University of the Republic (Udelar), Montevideo, Uruguay
| | - Carlos Alberto Magallanes-Mira
- Department of Physical Education and Sport, Superior Institute of Physical Education, University of the Republic (Udelar), Montevideo, Uruguay
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Olaya-Cuartero J, Pueo B, Villalon-Gasch L, Jiménez-Olmedo JM. Prediction of Half-Marathon Power Target using the 9/3-Minute Running Critical Power Test. J Sports Sci Med 2023; 22:526-531. [PMID: 37711711 PMCID: PMC10499150 DOI: 10.52082/jssm.2023.526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 08/14/2023] [Indexed: 09/16/2023]
Abstract
Running power output allows for controlling variables that have been previously overlooked by relying solely on speed, such as surface, gradient and weight. The ability to measure this external load variable now enables the analysis of concepts that have predominantly been studied in cycling, such as the Critical Power (CP), in the context of running. This study aims to predict the CP target at which trained athletes run a half-marathon and determine whether races of this distance can serve as a valid alternative to update the CP record. A group of nine trained athletes performed the 9/3-minute Stryd CP test and participated in a half-marathon race in two separate testing sessions conducted in the field. The average power during a half-marathon race is a valid alternative method for determining the CP in trained athletes, as evidenced by the agreement (95% CI: -0.11 to 0.37 W/kg) and trivial systematic bias (0.13 W/kg) between methods. The linear regression model half-marathon power = 0.97 + 0.75·CP (W/kg) showed low standard error of estimate (0.29 W/kg) and significant large association between methods (r = 0.88; p = 0.002). Coaches and athletes should be aware that the CP target for a half-marathon race is 97.3% of the CP determined by the 9/3-minute Stryd CP test.
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Affiliation(s)
- Javier Olaya-Cuartero
- Research Group in Health, Physical Activity, and Sports Technology (Health-Tech), Faculty of Education, University of Alicante, San Vicente del Raspeig, Spain
| | - Basilio Pueo
- Research Group in Health, Physical Activity, and Sports Technology (Health-Tech), Faculty of Education, University of Alicante, San Vicente del Raspeig, Spain
| | - Lamberto Villalon-Gasch
- Research Group in Health, Physical Activity, and Sports Technology (Health-Tech), Faculty of Education, University of Alicante, San Vicente del Raspeig, Spain
| | - Jose Manuel Jiménez-Olmedo
- Research Group in Health, Physical Activity, and Sports Technology (Health-Tech), Faculty of Education, University of Alicante, San Vicente del Raspeig, Spain
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Espinosa-Ramírez M, Riquelme S, Araya F, Rodríguez G, Figueroa-Martínez F, Gabrielli L, Viscor G, Reid WD, Contreras-Briceño F. Effectiveness of Respiratory Muscles Training by Voluntary Isocapnic Hyperpnea Versus Inspiratory Threshold Loading on Intercostales and Vastus Lateralis Muscles Deoxygenation Induced by Exercise in Physically Active Adults. BIOLOGY 2023; 12:biology12020219. [PMID: 36829497 PMCID: PMC9953077 DOI: 10.3390/biology12020219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 01/24/2023] [Accepted: 01/26/2023] [Indexed: 01/31/2023]
Abstract
Respiratory muscle training (RMT) improves physical performance, although it is still debated whether this effect depends on the type of training. The purpose of this study was to compare the effects of two different types of RMT, i.e., voluntary isocapnic hyperpnea (VIH) and inspiratory threshold loading (ITL), on the deoxygenation of intercostal (ΔSmO2-m. intercostales) and vastus lateralis (ΔSmO2-m. vastus lateralis) muscles during exercise. Twenty-four participants performed eight weeks of RMT by: (i) VIH (3 days·week-1 for 12 min at 60% maximal voluntary ventilation) or (ii) ITL (5 sets·week-1 of 30 breaths·minute-1 at 60% maximal inspiratory pressure). Cardiopulmonary exercise testing (CPET) included ΔSmO2 (the change from baseline to end of test) of intercostal and vastus lateralis muscles. After RMT, both groups showed decreased ΔSmO2-m. intercostales (VIH = 12.8 ± 14.6%, p = 0.04 (effect size, ES = 0.59), and ITL = 8.4 ± 9.8%, p = 0.04 (ES = 0.48)), without a coincident change of ∆SmO2-m. vastus lateralis. ITL training induced higher V˙O2-peak absolute values than VIH (mean Δ post-pre, ITL = 229 ± 254 mL·min-1 [95% CI 67-391] vs. VIH, 39 ± 153 mL·min-1 [95% CI -58-136.0], p = 0.01). In conclusion, both RMT improved the balance between supply and oxygen consumption levels of m. intercostales during CPET, with ITL also inducing an increase of aerobic capacity.
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Affiliation(s)
- Maximiliano Espinosa-Ramírez
- Laboratory of Exercise Physiology, Department of Health Science, Faculty of Medicine, Pontificia Universidad Católica de Chile, Av. Vicuña Mackenna #4860, Santiago 7820436, Chile
| | - Santiago Riquelme
- Laboratory of Exercise Physiology, Department of Health Science, Faculty of Medicine, Pontificia Universidad Católica de Chile, Av. Vicuña Mackenna #4860, Santiago 7820436, Chile
| | - Felipe Araya
- Laboratory of Exercise Physiology, Department of Health Science, Faculty of Medicine, Pontificia Universidad Católica de Chile, Av. Vicuña Mackenna #4860, Santiago 7820436, Chile
| | - Guido Rodríguez
- Laboratory of Exercise Physiology, Department of Health Science, Faculty of Medicine, Pontificia Universidad Católica de Chile, Av. Vicuña Mackenna #4860, Santiago 7820436, Chile
| | - Fernanda Figueroa-Martínez
- Laboratory of Voice, Department of Health Science, Faculty of Medicine, Pontificia Universidad Católica de Chile, Av. Vicuña Mackenna #4860, Santiago 7820436, Chile
| | - Luigi Gabrielli
- Advanced Center for Chronic Diseases (ACCDiS), Division of Cardiovascular Diseases, Faculty of Medicine, Pontificia Universidad Católica de Chile, Marcoleta #367, Santiago 8380000, Chile
| | - Ginés Viscor
- Physiology Section, Department of Cell Biology, Physiology and Immunology, Faculty of Biology, Universitat de Barcelona, 08028 Barcelona, Spain
| | - W. Darlene Reid
- Department of Physical Therapy and Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON M5G 2C4, Canada
- KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, ON M5G 2A2, Canada
| | - Felipe Contreras-Briceño
- Laboratory of Exercise Physiology, Department of Health Science, Faculty of Medicine, Pontificia Universidad Católica de Chile, Av. Vicuña Mackenna #4860, Santiago 7820436, Chile
- Advanced Center for Chronic Diseases (ACCDiS), Division of Cardiovascular Diseases, Faculty of Medicine, Pontificia Universidad Católica de Chile, Marcoleta #367, Santiago 8380000, Chile
- Physiology Section, Department of Cell Biology, Physiology and Immunology, Faculty of Biology, Universitat de Barcelona, 08028 Barcelona, Spain
- Millennium Institute for Intelligent Healthcare Engineering, Av. Vicuña Mackenna #4860, Santiago 7820436, Chile
- Correspondence: ; Tel.: +56-9-82288153
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Effect of Moderate- or High-Intensity Inspiratory Muscle Strength Training on Maximal Inspiratory Mouth Pressure and Swimming Performance in Highly Trained Competitive Swimmers. Int J Sports Physiol Perform 2021; 17:343-349. [PMID: 34686614 DOI: 10.1123/ijspp.2021-0119] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 05/24/2021] [Accepted: 06/24/2021] [Indexed: 11/18/2022]
Abstract
PURPOSE Inspiratory muscle strength training (IMST) can improve exercise performance. Increased maximal inspiratory mouth pressure (MIP) could be beneficial for swimmers to enhance their performance. This study aimed to clarify the effect of high-intensity IMST for 6 weeks on MIP and swimming performance in highly trained competitive swimmers. METHODS Thirty male highly trained competitive swimmers were assigned to high-intensity IMST (HI; n = 10), moderate-intensity IMST (MOD; n = 10), and control (n = 10) groups. The 6-week IMST intervention comprised twice daily sessions for 6 d/wk at inspiratory pressure threshold loads equivalent to 75% MIP (HI) and 50% MIP (MOD). Before and after the intervention, MIP and swimming performance were assessed. Swimming performance was evaluated in free and controlled frequency breathing 100-m freestyle swimming time trials in a 25-m pool. For controlled frequency breathing, participants took 1 breath every 6 strokes. RESULTS The MIP values after 2 and 6 weeks of IMST in the HI and MOD groups were significantly higher than those before IMST (P = .0001). The magnitudes of the MIP increases after 6 weeks of IMST did not differ between the HI (13.4% [8.7%]) and MOD (13.1% [10.1%]) groups (P = .44). The 100-m freestyle swimming times under the controlled frequency condition were significantly shorter after IMST than those before IMST in both the HI (P = .046) and MOD (P = .042) groups. CONCLUSIONS Inspiratory pressure threshold load equivalent to 50% MIP could be sufficient to improve MIP and swimming performance under the controlled frequency breathing condition in highly trained competitive swimmers.
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León-Morillas F, León-Garzón MC, Del Mar Martínez-García M, Reina-Abellán J, Palop-Montoro MV, de Oliveira-Sousa SL. Effects of respiratory muscle training in soccer players: a systematic review with a meta-analysis. SPORTVERLETZUNG-SPORTSCHADEN 2021; 35:154-164. [PMID: 34261153 DOI: 10.1055/a-1524-0021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Respiratory muscle training can improve strength and reduce respiratory muscle fatigue during high-intensity exercise. Little is known about the existing evidence in soccer players. A systematic review with a meta-analysis was performed to analyse the existing evidence on the effects of respiratory muscle training in soccer players. Two independent researchers reviewed 17 databases until July 2019. Inclusion criteria were controlled clinical trials (randomised or not), soccer players (professional or recreational), females and/or males, and respiratory muscle training compared with simulated or regular training groups. The methodological quality and quality of evidence were evaluated with the Cochrane Collaboration Tool and GRADE score, respectively. Statistical analysis was performed using the integral meta-analysis 3.3.070. Nine studies met the eligibility criteria. The meta-analysis was performed for eight variables related to respiratory muscle function, lung function and sports performance. Respiratory muscle training provided a significant improvement compared with simulated or regular training in maximal inspiratory buccal pressure (6 studies, SDM = 0.89; 95 % CI = 0.42, 1.35) and maximum consumption of oxygen (3 studies, SDM = 0.92; 95 % CI = 0.24; 1.61). No significant improvements were observed for other variables. The quality of the evidence was rated as low or very low.
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Muranaka M, Suzuki Y, Ando R, Sengoku Y. Change in short distance swimming performance following inspiratory muscle fatigue. J Sports Med Phys Fitness 2021; 61:1433-1440. [PMID: 34109947 DOI: 10.23736/s0022-4707.20.11775-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Inspiratory muscle fatigue (IMF) may impair performance in a subsequent exercise. A few studies have reported that IMF decreased swimming performance in sub-maximal intensity or severe intensity domain. However, the impact of IMF on high-intensity short-duration swimming is not clear. The purpose of this study was to clarify the effect of pre-induced IMF on extreme intensity domain swimming. METHODS Seven male competitive swimmers swam two 100-m all-out front crawl swimming trials with and without pre-induced IMF. Maximal inspiratory and expiratory mouth pressure (PImax and PEmax, respectively) was used as indicators of inspiratory and expiratory muscle strength before and after swimming, and stroke parameters during swimming were measured. IMF was achieved by having the subjects breathe against an inspiratory pressure threshold load while generating 40% of their predetermined PImax for 10 min. RESULTS After the induction of IMF, swimming time (55.94 ± 1.15 s) was significantly slower compared with that in control swimming without IMF (54.09 ± 0.91 s) (p < 0.05). During swimming followed IMF, a significant decrease in stroke rate and a significant increase in stroke length were observed in the latter half of the 100-m swimming trial. In addition, the sense of dyspnea was significantly higher in swimming in the IMF condition than in control condition. CONCLUSIONS IMF prior to swimming negatively affects swimming performance in the extreme intensity domain. It is suggested that due to the dual use of respiration and generate propulsion in accessory respiratory muscles, IMF affected swimmers' ability to maintain swimming velocity.
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Affiliation(s)
- Miina Muranaka
- Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba, Japan -
| | - Yasuhiro Suzuki
- Department of Sports Research, Japan Institute of Sports Sciences, Tokyo, Japan
| | - Ryosuke Ando
- Department of Sports Research, Japan Institute of Sports Sciences, Tokyo, Japan
| | - Yasuo Sengoku
- Faculty of Health and Sport Sciences, University of Tsukuba, Tsukuba, Japan
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Barnes KR, Ludge AR. Inspiratory Muscle Warm-up Improves 3,200-m Running Performance in Distance Runners. J Strength Cond Res 2021; 35:1739-1747. [PMID: 30640308 DOI: 10.1519/jsc.0000000000002974] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
ABSTRACT Barnes, KR and Ludge, AR. Inspiratory muscle warm-up improves 3,200-m running performance in distance runners. J Strength Cond Res 35(6): 1739-1747, 2021-This study examined the effects of an inspiratory muscle exercise as part of a warm-up (IMW) using a resisted breathing trainer on running performance. In a randomized crossover design, 17 trained distance runners completed two 3,200-m performance trials on separate days, preceded by 2 different warm-up procedures: IMW or sham IMW (CON). In each condition, subjects performed 30 breaths against either 50% of each athlete's peak strength (IMW) or 30 slow protracted breaths against negligible resistance (CON). Perceived race readiness and inspiratory muscle strength, flow, power, and volume were measured before and after each warm-up. Heart rate (HR), rating of perceived exertion (RPE) and dyspnea (RPD), and expired gases were collected during each trial. A 3,200-m run performance was 2.8% ± 1.5% (20.4-second) faster after IMW (effect size [ES] = 0.37, p = 0.02). After each warm-up condition, there was as small effect on peak inspiratory strength (6.6 ± 4.8%, ES = 0.22, p = 0.02), flow (5.2 ± 4.4%, ES = 0.20, p = 0.03), power (17.6 ± 16.7%, ES = 0.22, p = 0.04), and volume (6.7 ± 6.3%, ES = 0.24, p = 0.01) after IMW compared with CON. There were no differences in HR, minute volume, peak V̇o2, or V̇o2 at each 800-m interval between conditions (ES ≤ 0.13, p > 0.17). There were small differences in RPE at 800 m and 1,600 m (ES = 0.32, p = 0.17; ES = 0.21, p = 0.38, respectively), but no difference at the last 1,600 m (p = 1.0). There was a moderate positive effect on RPD (ES = 0.81, p < 0.001) and race readiness (ES = 0.76, p < 0.01) after IMW. Overall, the data suggest that IMW improves 3,200-m performance because of enhancements in inspiratory muscle function characteristics and reduction in dyspnea.
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Affiliation(s)
- Kyle R Barnes
- Department of Movement Science, Grand Valley State University, Allendale, Michigan
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Chronic Effects of a Training Program Using a Nasal Inspiratory Restriction Device on Elite Cyclists. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18020777. [PMID: 33477587 PMCID: PMC7831303 DOI: 10.3390/ijerph18020777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 01/15/2021] [Accepted: 01/15/2021] [Indexed: 11/16/2022]
Abstract
This study compared the response of a 9-week cycling training on ventilatory efficiency under two conditions: (i) Combined with respiratory muscle training (RMT) using a new nasal restriction device (FeelBreathe) (FB group) and (ii) without RMT (Control group). Eighteen healthy elite cyclists were randomly separated into the FB group (n = 10) or Control group (n = 8). Gas exchange was measured breath by breath to measure ventilatory efficiency during an incremental test on a cycloergometer before (Pre) and after (Post) the nine weeks of training. The FB group showed higher peak power (Δ (95%HDI) (0.82 W/kg (0.49, 1.17)), VO2max (5.27 mL/kg/min (0.69, 10.83)) and VT1 (29.3 W (1.8, 56.7)) compared to Control at PostFINAL. The FB group showed lower values from Pre to PostPRE in minute ventilation (VE) (−21.0 L/min (−29.7, −11.5)), Breathing frequency (BF) (−5.1 breaths/min (−9.4, −0.9)), carbon dioxide output (VCO2) (−0.5 L/min (−0.7, −0.2)), respiratory equivalents for oxygen (EqO2) (−0.8 L/min (−2.4, 0.8)), heart rate (HR) (−5.9 beats/min (−9.2, −2.5)), respiratory exchange ratio (RER) (−0.1 (−0.1, −0.0) and a higher value in inspiratory time (Tin) (0.05 s (0.00, 0.10)), expiratory time (Tex) (0.11 s (0.05, 0.17)) and end-tidal partial pressure of CO2 (PETCO2) (0.3 mmHg (0.1, 0.6)). In conclusion, RMT using FB seems to be a new and easy alternative ergogenic tool which can be used at the same time as day-to-day training for performance enhancement.
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Effects of 4-Week Inspiratory Muscle Training on Sport Performance in College 800-Meter Track Runners. ACTA ACUST UNITED AC 2021; 57:medicina57010072. [PMID: 33467421 PMCID: PMC7830231 DOI: 10.3390/medicina57010072] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 01/09/2021] [Accepted: 01/12/2021] [Indexed: 11/17/2022]
Abstract
Background and objectives: Respiratory muscle fatigue is one of the important factors limiting sports performance due to the metaboreflex. This reflex will cause a decrease in blood flow to the extremities and accelerate exercising limb fatigue. Previous studies found that inspiratory muscle training (IMT) can effectively enhance the respiratory muscle endurance and reduce fatigue during long-duration exercise or aerobic exercise, thereby enhancing athletic performance. However, the mechanism between inspiratory muscle strength, change of limb blood flow and sports performance still requires investigation, especially in short-duration exercise, anaerobic or both aerobic and anaerobic exercise. The purpose of this study was to investigate the effects of 4-week inspiratory muscle training on respiratory muscle strength, limb blood flow change rate and sports performance in recreational 800-m college runners. Materials and Methods: Twenty healthy 800-m college runners randomized into the IMT group (11 subjects) and control group (9 subjects). IMT consisted of 30 inspiratory efforts twice daily, 5 days a week, with intensity at 50%, 60%, 70% and 80% of maximum inspiratory pressure (MIP) for 4 weeks, while a control group kept 50% of MIP for 4 weeks. An 800-m trial test, limb blood flow change rate by using Impedance Plethysmography, and MIP were as the outcome measured variables and be evaluated. All measured variables were assessed before and after 4-week IMT training. Two-way ANOVA was conducted for statistical analysis. Results: The results showed significantly interaction between groups and pre-posttest. IMT group significantly decreased limb blood flow change rate from 19.91 ± 11.65% to 9.63 ± 7.62% after received the IMT training program (p < 0.05). The MIP significantly improved from 112.95 ± 27.13 cmH2O to 131.09 ± 28.20 cm H2O in IMT group, and the 800-m trial test also shorted the running time from 162.97 ± 24.96 s to 156.75 ± 20.73 s. But the control group no significantly changed in MIP and 800-m trial test. Conclusions: Our results indicated that the 4-week IMT training (twice a day, 5 days a week) significantly improves participants’ inspiratory muscle strength, 800-m running performance and decreases the limb blood flow change rate.
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Lorca-Santiago J, Jiménez SL, Pareja-Galeano H, Lorenzo A. Inspiratory Muscle Training in Intermittent Sports Modalities: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17124448. [PMID: 32575827 PMCID: PMC7344680 DOI: 10.3390/ijerph17124448] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Revised: 06/11/2020] [Accepted: 06/17/2020] [Indexed: 11/16/2022]
Abstract
The fatigue of the respiratory muscles causes the so-called metabolic reflex or metaboreflex, resulting in vasoconstriction of the blood vessels in the peripheral muscles, which leads to a decrease in respiratory performance. Training the respiratory muscles is a possible solution to avoid this type of impairment in intermittent sports. The objective of this systematic review was to evaluate the results obtained with inspiratory muscle training (IMT) in intermittent sports modalities, intending to determine whether its implementation would be adequate and useful in intermittent sports. A search in the Web of Science (WOS) and Scopus databases was conducted, following the Preferred Reporting Elements for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The methodological quality of the articles was assessed using the PEDro (Physiotherapy Evidence Database) scale. In conclusion, the introduction of specific devices of IMT seems to be a suitable method to improve performance in intermittent sports, mainly due to a reduction of the metaboreflex, fatigue sensation, and dyspnea. The ideal protocol would consist of a combination of acute and chronic treatment, and, even if IMT is done daily, the duration will not exceed one hour per week.
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Affiliation(s)
- Juan Lorca-Santiago
- Faculty of Sport Sciences, Universidad Europea De Madrid, 28670 Madrid, Spain; (J.L.-S.); (H.P.-G.)
| | - Sergio L. Jiménez
- Faculty of Sport Sciences, Universidad Europea De Madrid, 28670 Madrid, Spain; (J.L.-S.); (H.P.-G.)
- Correspondence: ; Tel.: +34-670-723-696
| | - Helios Pareja-Galeano
- Faculty of Sport Sciences, Universidad Europea De Madrid, 28670 Madrid, Spain; (J.L.-S.); (H.P.-G.)
| | - Alberto Lorenzo
- Sport Department, Facultad de Ciencias de la Actividad Física y del Deporte, Universidad Politécnica de Madrid, 28040 Madrid, Spain;
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Johnson MA, Williams NC, Graham AW, Ingram LAL, Cooper SB, Sharpe GR. Effects of Prior Upper Body Exercise on the 3-min All-Out Cycling Test in Men. Med Sci Sports Exerc 2020; 52:2402-2411. [PMID: 32366795 DOI: 10.1249/mss.0000000000002395] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Prior upper body exercise reduces the curvature constant (W') of the hyperbolic power-duration relationship without affecting critical power. This study tested the hypothesis that prior upper body exercise reduces the work done over the end-test power (WEP; analog of W') during a 3-min all-out cycling test (3MT) without affecting the end-test power (EP; analog of critical power). METHODS Ten endurance-trained men (V˙O2max = 62 ± 5 mL·kg·min) performed a 3MT without (CYC) and with (ARM-CYC) prior severe-intensity, intermittent upper body exercise. EP was calculated as the mean power output over the last 30 s of the 3MT, whereas WEP was calculated as the power-time integral above EP. RESULTS At the start of the 3MT, plasma [La] (1.8 ± 0.4 vs 14.1 ± 3.4 mmol·L) and [H] (42.8 ± 3.1 vs 58.6 ± 5.5 nmol·L) were higher, whereas the strong ion difference (41.4 ± 2.2 vs 30.9 ± 4.6 mmol·L) and [HCO3] (27.0 ± 1.9 vs 16.9 ± 3.2 mmol·L) were lower during ARM-CYC than CYC (P < 0.010). EP was 12% lower during the 3MT of ARM-CYC (298 ± 52 W) than CYC (338 ± 60 W; P < 0.001), whereas WEP was not different (CYC: 12.8 ± 3.3 kJ vs ARM-CYC: 13.5 ± 4.1 kJ, P = 0.312). EP in CYC was positively correlated with the peak [H] (r = 0.78, P = 0008) and negatively correlated with the lowest [HCO3] (r = -0.74, P = 0.015). CONCLUSIONS These results suggest that EP during a 3MT in endurance-trained men is sensitive to fatigue-related ionic perturbation.
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Affiliation(s)
- Michael A Johnson
- Exercise and Health Research Group, Sport, Health and Performance Enhancement (SHAPE) Research Centre, School of Science and Technology, Nottingham Trent University, Nottingham, UNITED KINGDOM
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Katz LM, Stallard J, Holtby A, Hill EW, Allen K, Sweeney J. Inspiratory muscle training in young, race-fit Thoroughbred racehorses during a period of detraining. PLoS One 2020; 15:e0225559. [PMID: 32275657 PMCID: PMC7147778 DOI: 10.1371/journal.pone.0225559] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 03/25/2020] [Indexed: 11/19/2022] Open
Abstract
Although inspiratory muscle training (IMT) is reported to improve inspiratory muscle strength in humans little has been reported for horses. We tested the hypothesis that IMT would maintain and/or improve inspiratory muscle strength variables measured in Thoroughbreds during detraining. Thoroughbreds from one training yard were placed into a control (Con, n = 3 males n = 7 females; median age 2.2±0.4 years) or treatment group (Tr, n = 5 males, n = 5 females; median age 2.1±0.3 years) as they entered a detraining period at the end of the racing/training season. The Tr group underwent eight weeks of IMT twice a day, five days per week using custom-made training masks with resistance valves and an incremental threshold of breath-loading protocol. An inspiratory muscle strength test to fatigue using an incremental threshold of breath-loading was performed in duplicate before (T0) and after four (T1) and eight weeks (T2) of IMT/no IMT using a custom-made testing mask and a commercial testing device. Inspiratory measurements included the total number of breaths achieved during the test, average load, peak power, peak volume, peak flow, energy and the mean peak inspiratory muscle strength index (IMSi). Data were analysed using a linear mixed effects model, P≤0.05 significant. There were no differences for inspiratory measurements between groups at T0. Compared to T0, the total number of breaths achieved (P = 0.02), load (P = 0.003) and IMSi (P = 0.01) at T2 had decreased for the Con group while the total number of breaths achieved (P<0.001), load (P = 0.03), volume (P = 0.004), flow (P = 0.006), energy (P = 0.01) and IMSi (P = 0.002) had increased for the Tr group. At T2 the total number of breaths achieved (P<0.0001), load (P<0.0001), volume (P = 0.02), energy (P = 0.03) and IMSi (P<0.0001) were greater for the Tr than Con group. In conclusion, our results support that IMT can maintain and/or increase aspects of inspiratory muscle strength for horses in a detraining programme.
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Affiliation(s)
- Lisa M. Katz
- UCD School of Veterinary Medicine, University College Dublin, Belfield, Dublin, Ireland
- * E-mail:
| | - Jessica Stallard
- UCD School of Veterinary Medicine, University College Dublin, Belfield, Dublin, Ireland
| | | | - Emmeline W. Hill
- UCD School of Agriculture and Food Science, University College Dublin, Belfield, Dublin, Ireland
| | - Kate Allen
- School of Veterinary Sciences, University of Bristol, Bristol, United Kingdom
| | - James Sweeney
- Department of Mathematics & Statistics, University of Limerick, Limerick, Ireland
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Bissett B, Gosselink R, van Haren FMP. Respiratory Muscle Rehabilitation in Patients with Prolonged Mechanical Ventilation: A Targeted Approach. Crit Care 2020; 24:103. [PMID: 32204719 PMCID: PMC7092518 DOI: 10.1186/s13054-020-2783-0] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
This article is one of ten reviews selected from the Annual Update in Intensive Care and Emergency Medicine 2020. Other selected articles can be found online at https://www.biomedcentral.com/collections/annualupdate2020. Further information about the Annual Update in Intensive Care and Emergency Medicine is available from http://www.springer.com/series/8901.
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Affiliation(s)
- Bernie Bissett
- Discipline of Physiotherapy, University of Canberra, Bruce, ACT, Australia
- Intensive Care Unit, Canberra Hospital, Garran, ACT, Australia
| | - Rik Gosselink
- Department of Rehabilitation Sciences, KU Leuven, Health Science Campus Gasthuisberg O&N IV, Leuven, Belgium
| | - Frank M P van Haren
- Intensive Care Unit, Canberra Hospital, Garran, ACT, Australia.
- Australian National University Medical School, Canberra, ACT, Australia.
- Faculty of Health, University of Canberra, Bruce, ACT, Australia.
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Najafi A, Ebrahim K, Ahmadizad S, Jahani Ghaeh Ghashlagh GR, Javidi M, Hackett D. Improvements in soccer-specific fitness and exercise tolerance following 8 weeks of inspiratory muscle training in adolescent males. J Sports Med Phys Fitness 2020; 59:1975-1984. [DOI: 10.23736/s0022-4707.19.09578-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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15
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Lomax M, Kapus J, Brown PI, Faghy M. Impact of Weekly Swimming Training Distance on the Ergogenicity of Inspiratory Muscle Training in Well-Trained Youth Swimmers. J Strength Cond Res 2019; 33:2185-2193. [PMID: 31344014 DOI: 10.1519/jsc.0000000000002375] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Lomax, M, Kapus, J, Brown, PI, and Faghy, M. Impact of weekly swimming training distance on the ergogenicity of inspiratory muscle training in well-trained youth swimmers. J Strength Cond Res 33(8): 2185-2193, 2019-The aim of this study was to examine the impact of weekly swimming training distance on the ergogenicity of inspiratory muscle training (IMT). Thirty-three youth swimmers were recruited and separated into a LOW and HIGH group based on weekly training distance (≤31 km·wk and >41 km·wk, respectively). The LOW and HIGH groups were further subdivided into control and IMT groups for a 6-week IMT intervention giving a total of 4 groups: LOWcon, LOWIMT, HIGHcon, and HIGHIMT. Before and after the intervention period, swimmers completed maximal effort 100- and 200-m front crawl swims, with maximal inspiratory and expiratory mouth pressures (PImax and PEmax, respectively) assessed before and after each swim. Inspiratory muscle training increased PImax (but not PEmax) by 36% in LOWIMT and HIGHIMT groups (p ≤ 0.05), but 100- and 200-m swims were faster only in the LOWIMT group (3 and 7% respectively, p ≤ 0.05). Performance benefits only occurred in those training up to 31 km·wk and indicate that the ergogenicity of IMT is affected by weekly training distance. Consequently, training distances are important considerations, among others, when deciding whether or not to supplement swimming training with IMT.
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Affiliation(s)
- Mitch Lomax
- Department of Sport and Exercise Science, University of Portsmouth, Portsmouth, United Kingdom
| | - Jernej Kapus
- Laboratory of Biodynamics, Faculty of Sports, University of Ljubljana, Ljubljana, Slovenia
| | - Peter I Brown
- English Institute of Sport, Loughborough Performance Center, Loughborough University, Loughborough, United Kingdom
| | - Mark Faghy
- Sport, Outdoor and Exercise Science, University of Derby, Derby, United Kingdom
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Faghy MA, Brown PI. Functional training of the inspiratory muscles improves load carriage performance. ERGONOMICS 2019; 62:1439-1449. [PMID: 31389759 DOI: 10.1080/00140139.2019.1652352] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Accepted: 07/29/2019] [Indexed: 06/10/2023]
Abstract
Inspiratory Muscle Training (IMT) whilst adopting body positions that mimic exercise (functional IMT; IMTF) improves running performance above traditional IMT methods in unloaded exercise. We investigated the effect of IMTF during load carriage tasks. Seventeen males completed 60 min walking at 6.5 km·h-1 followed by a 2.4 km load carriage time-trial (LCTT) whilst wearing a 25 kg backpack. Trials were completed at baseline; post 4 weeks IMT (consisting of 30 breaths twice daily at 50% of maximum inspiratory pressure) and again following either 4 weeks IMTF (comprising four inspiratory loaded core exercises) or maintenance IMT (IMTCON). Baseline LCTT was 15.93 ± 2.30 min and was reduced to 14.73 ± 2.40 min (mean reduction 1.19 ± 0.83 min, p < 0.01) after IMT. Following phase two, LCTT increased in IMTF only (13.59 ± 2.33 min, p < 0.05) and was unchanged in post-IMTCON. Performance was increased following IMTF, providing an additional ergogenic effect beyond IMT alone. Practitioner Summary: We confirmed the ergogenic benefit of Inspiratory Muscle Training (IMT) upon load carriage performance. Furthermore, we demonstrate that functional IMT methods provide a greater performance benefit during exercise with thoracic loads. Abbreviations: [Lac-]B: blood lactate; FEV1: forced expiratory volume in one second; FEV1/FVC: forced expiratory volume in one second/forced vital capacity ratio; FVC: forced vital capacity; HR: heart rate; IMT: inspiratory muscle training; IMTCON: inspiratory muscle training maintenance; IMTF: functional inspiratory muscle training; LC: load carriage; LCTT: load carriage time trial; Pdi: transdiaphragmatic pressure; PEF: peak expiratory flow; PEmax: maximum expiratory mouth pressure; PImax: maximum inspiratory mouth pressure; RPE: rating of perceived exertion; RPEbreating: rating of perceived exertion for the breathing; RPEleg: rating of perceived exertion for the legs; SEPT: sport-specific endurance plank test; V̇ O2: oxygen consumption; V̇ O2peak: peak oxygen consumption.
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Affiliation(s)
- Mark A Faghy
- Human Science Research Centre, University of Derby , Derby , UK
| | - Peter I Brown
- English Institute of Sport, High Performance Centre, Loughborough University , Manchester , United Kingdom of Great Britain and Northern Ireland
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The effect of inspiratory muscle training on swimming performance, inspiratory muscle strength, lung function, and perceived breathlessness in elite swimmers: a randomized controlled trial. Porto Biomed J 2019; 4:e49. [PMID: 33501396 PMCID: PMC7819540 DOI: 10.1097/j.pbj.0000000000000049] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 07/16/2019] [Indexed: 11/27/2022] Open
Abstract
Background: According to studies performed on terrestrial sports athletes, inspiratory muscle training (IMT) may improve athletes’ performance. However, evidence of its effects in elite swimmers is lacking. Therefore, we aimed to assess the effect of 12-week IMT on swimming performance, inspiratory muscle strength, lung function, and perceived breathlessness in elite swimmers. Methods: Elite swimmers from the main FC Porto swimming team (in competitive training for a minimum period of 3 years) were invited to participate and were randomly allocated into intervention or control groups. The intervention group performed 30 inspiratory efforts, twice a day, 5 times a week, against a pressure threshold load equivalent to 50% of maximal inspiratory pressure, whereas the control group performed inspiratory efforts at the same frequency but against a 15% load. Swimming performance was assessed through time trials, converted into points according to International Swimming Federation Points Table. Outcomes were evaluated before and following the 12-week study period. Results: A total of 32 participants (22 girls) were included. The median age was 15 and 14 years old for the intervention (n = 17) and control (n = 12) groups, respectively. No differences were found in swimming performance (P = .271), inspiratory muscle strength (P = .914), forced vital capacity (P = .262), forced expiratory volume in 1st second (P = .265), peak expiratory flow (P = .270), and perceived breathlessness (P = .568) between groups after 12 weeks of intervention. Conclusion: Twelve weeks of IMT had no effect on swimming performance, lung function, and perceived breathlessness in elite swimmers. These results may be related to swimming-specific factors and/or an applied load insufficient to achieve training overload that could induce further improvements.
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Inspiratory Muscle Training: Improvement of Exercise Performance With Acute Hypoxic Exposure. Int J Sports Physiol Perform 2019; 14:1124-1131. [PMID: 30702370 DOI: 10.1123/ijspp.2018-0483] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 01/15/2019] [Accepted: 01/16/2019] [Indexed: 11/18/2022]
Abstract
Endurance exercise performance in hypoxia may be influenced by an ability to maintain high minute ventilation (V˙E) in defense of reduced arterial oxyhemoglobin saturation. Inspiratory muscle training (IMT) has been used as an effective intervention to attenuate the negative physiological consequences associated with an increased V˙E, resulting in improved submaximal-exercise performance in normoxia. However, the efficacy of IMT on hypoxic exercise performance remains unresolved. PURPOSE To determine whether chronic IMT improves submaximal-exercise performance with acute hypoxic exposure. METHODS A total of 14 endurance-trained men completed a 20-km cycling time trial (TT) in normobaric hypoxia (fraction of inspired oxygen [FiO2] = 0.16) before and after either 6 wk of an IMT protocol consisting of inspiratory loads equivalent to 80% of sustained maximal inspiratory pressure (n = 9) or a SHAM protocol (30% of sustained maximal inspiratory pressure; n = 5). RESULTS In the IMT group, 20-km TT performance significantly improved by 1.45 (2.0%), P = .03, after the 6-wk intervention. The significantly faster TT times were accompanied by a higher average V˙E (pre vs post: 99.3 [14.5] vs 109.9 [18.0] L·min-1, P = .01) and absolute oxygen uptake (pre vs post: 3.39 [0.52] vs 3.60 [0.58] L·min-1, P = .010), with no change in ratings of perceived exertion or dyspnea (P > .06). There were no changes in TT performance in the SHAM group (P = .45). CONCLUSION These data suggest that performing 6 wk of IMT may benefit hypoxic endurance exercise performance lasting 30-40 min.
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Riganas C, Papadopoulou Z, Margaritelis NV, Christoulas K, Vrabas IS. Inspiratory muscle training effects on oxygen saturation and performance in hypoxemic rowers: Effect of sex. J Sports Sci 2019; 37:2513-2521. [DOI: 10.1080/02640414.2019.1646582] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Christos Riganas
- Laboratory of Exercise Physiology and Biochemistry, Department of Physical Education and Sports Science at Serres, Aristotle University of Thessaloniki, Serres, Greece
- Ergophysiology Laboratory, Department of Physical Education and Sports Science, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Zacharoula Papadopoulou
- Laboratory of Exercise Physiology and Biochemistry, Department of Physical Education and Sports Science at Serres, Aristotle University of Thessaloniki, Serres, Greece
- Ergophysiology Laboratory, Department of Physical Education and Sports Science, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Nikos V. Margaritelis
- Laboratory of Exercise Physiology and Biochemistry, Department of Physical Education and Sports Science at Serres, Aristotle University of Thessaloniki, Serres, Greece
- Intensive Care Unit, 424 General Military Hospital of Thessaloniki, Thessaloniki, Greece
| | - Kosmas Christoulas
- Ergophysiology Laboratory, Department of Physical Education and Sports Science, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Ioannis S. Vrabas
- Laboratory of Exercise Physiology and Biochemistry, Department of Physical Education and Sports Science at Serres, Aristotle University of Thessaloniki, Serres, Greece
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Rehder-Santos P, Minatel V, Milan-Mattos JC, Signini ÉDF, de Abreu RM, Dato CC, Catai AM. Critical inspiratory pressure - a new methodology for evaluating and training the inspiratory musculature for recreational cyclists: study protocol for a randomized controlled trial. Trials 2019; 20:258. [PMID: 31064379 PMCID: PMC6505302 DOI: 10.1186/s13063-019-3353-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2018] [Accepted: 04/03/2019] [Indexed: 11/13/2022] Open
Abstract
Background Inspiratory muscle training (IMT) has brought great benefits in terms of improving physical performance in healthy individuals. However, there is no consensus regarding the best training load, as in most cases the maximal inspiratory pressure (MIP) is used, mainly the intensity of 60% of MIP. Therefore, prescribing an IMT protocol that takes into account inspiratory muscle strength and endurance may bring additional benefits to the commonly used protocols, since respiratory muscles differ from other muscles because of their greater muscular resistance. Thus, IMT using critical inspiratory pressure (PThC) can be an alternative, as the calculation of PThC considers these characteristics. Therefore, the aim of this study is to propose a new IMT protocol to determine the best training load for recreational cyclists. Methods Thirty recreational cyclists (between 20 and 40 years old) will be randomized into three groups: sham (SG), PThC (CPG) and 60% of MIP, according to age and aerobic functional capacity. All participants will undergo the following evaluations: pulmonary function test (PFT), respiratory muscle strength test (RMS), cardiopulmonary exercise test (CPET), incremental inspiratory muscle endurance test (iIME) (maximal sustained respiratory pressure for 1 min (PThMAX)) and constant load test (CLT) (95%, 100% and 105% of PThMÁX) using a linear load inspiratory resistor (PowerBreathe K5). The PThC will be calculated from the inspiratory muscle endurance time (TLIM) and inspiratory loads of each CLT. The IMT will last 11 weeks (3 times/week and 55 min/session). The session will consist of 5-min warm-up (50% of the training load) and three sets of 15-min breaths (100% of the training load), with a 1-min interval between them. RMS, iIME, CLT and CPET will be performed beforehand, at week 5 and 9 (to adjust the training load) and after training. PFT will be performed before and after training. The data will be analyzed using specific statistical tests (parametric or non-parametric) according to the data distribution and their respective variances. A p value <0.05 will be considered statistically significant. Discussions It is expected that the results of this study will enable the training performed with PThC to be used by health professionals as a new tool to evaluate and prescribe IMT. Trial registration ClinicalTrials.gov, NCT02984189. Registered on 6 December 2016. Electronic supplementary material The online version of this article (10.1186/s13063-019-3353-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Patricia Rehder-Santos
- Cardiovascular Physical Therapy Laboratory, Nucleus of Research in Physical Exercise, Department of Physical Therapy, Federal University of São Carlos, Via Washington Luiz, km 235, CP: 676, São Carlos, São Paulo, 13565-905, Brazil
| | - Vinicius Minatel
- Cardiovascular Physical Therapy Laboratory, Nucleus of Research in Physical Exercise, Department of Physical Therapy, Federal University of São Carlos, Via Washington Luiz, km 235, CP: 676, São Carlos, São Paulo, 13565-905, Brazil
| | - Juliana Cristina Milan-Mattos
- Cardiovascular Physical Therapy Laboratory, Nucleus of Research in Physical Exercise, Department of Physical Therapy, Federal University of São Carlos, Via Washington Luiz, km 235, CP: 676, São Carlos, São Paulo, 13565-905, Brazil
| | - Étore De Favari Signini
- Cardiovascular Physical Therapy Laboratory, Nucleus of Research in Physical Exercise, Department of Physical Therapy, Federal University of São Carlos, Via Washington Luiz, km 235, CP: 676, São Carlos, São Paulo, 13565-905, Brazil
| | - Raphael Martins de Abreu
- Cardiovascular Physical Therapy Laboratory, Nucleus of Research in Physical Exercise, Department of Physical Therapy, Federal University of São Carlos, Via Washington Luiz, km 235, CP: 676, São Carlos, São Paulo, 13565-905, Brazil
| | - Carla Cristina Dato
- Nutrition Course, Central University of Paulista, São Carlos, São Paulo, Brazil
| | - Aparecida Maria Catai
- Cardiovascular Physical Therapy Laboratory, Nucleus of Research in Physical Exercise, Department of Physical Therapy, Federal University of São Carlos, Via Washington Luiz, km 235, CP: 676, São Carlos, São Paulo, 13565-905, Brazil.
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Álvarez-Herms J, Julià-Sánchez S, Corbi F, Odriozola-Martínez A, Burtscher M. Putative Role of Respiratory Muscle Training to Improve Endurance Performance in Hypoxia: A Review. Front Physiol 2019; 9:1970. [PMID: 30697170 PMCID: PMC6341067 DOI: 10.3389/fphys.2018.01970] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Accepted: 12/31/2018] [Indexed: 12/22/2022] Open
Abstract
Respiratory/inspiratory muscle training (RMT/IMT) has been proposed to improve the endurance performance of athletes in normoxia. In recent years, due to the increased use of hypoxic training method among athletes, the RMT applicability has also been tested as a method to minimize adverse effects since hyperventilation may cause respiratory muscle fatigue during prolonged exercise in hypoxia. We performed a review in order to determine factors potentially affecting the change in endurance performance in hypoxia after RMT in healthy subjects. A comprehensive search was done in the electronic databases MEDLINE and Google Scholar including keywords: “RMT/IMT,” and/or “endurance performance,” and/or “altitude” and/or “hypoxia.” Seven appropriate studies were found until April 2018. Analysis of the studies showed that two RMT methods were used in the protocols: respiratory muscle endurance (RME) (isocapnic hyperpnea: commonly 10–30′, 3–5 d/week) in three of the seven studies, and respiratory muscle strength (RMS) (Powerbreathe device: commonly 2 × 30 reps at 50% MIP (maximal inspiratory pressure), 5–7 d/week) in the remaining four studies. The duration of the protocols ranged from 4 to 8 weeks, and it was found in synthesis that during exercise in hypoxia, RMT promoted (1) reduced respiratory muscle fatigue, (2) delayed respiratory muscle metaboreflex activation, (3) better maintenance of SaO2 and blood flow to locomotor muscles. In general, no increases of maximal oxygen uptake (VO2max) were described. Ventilatory function improvements (maximal inspiratory pressure) achieved by using RMT fostered the capacity to adapt to hypoxia and minimized the impact of respiratory stress during the acclimatization stage in comparison with placebo/sham. In conclusion, RMT was found to elicit general positive effects mainly on respiratory efficiency and breathing patterns, lower dyspneic perceptions and improved physical performance in conditions of hypoxia. Thus, this method is recommended to be used as a pre-exposure tool for strengthening respiratory muscles and minimizing the adverse effects caused by hypoxia related hyperventilation. Future studies will assess these effects in elite athletes.
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Affiliation(s)
- Jesús Álvarez-Herms
- Department of Cell Biology, Physiology and Immunology, Faculty of Biology, University of Barcelona, Barcelona, Spain
| | - Sonia Julià-Sánchez
- Department of Cell Biology, Physiology and Immunology, Faculty of Biology, University of Barcelona, Barcelona, Spain
| | - Francisco Corbi
- National Institute of Physical Education of Catalonia (INEFC) - Lleida Centre, University of Lleida, Lleida, Spain
| | - Adrian Odriozola-Martínez
- Department of Genetics, Anthropology and Physiology, University of the Basque Country (UPV), Campus de Bizkaia, Bilbao, Spain
| | - Martin Burtscher
- Department of Sport Science, University Innsbruck, Innsbruck, Austria
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Karsten M, Ribeiro GS, Esquivel MS, Matte DL. The effects of inspiratory muscle training with linear workload devices on the sports performance and cardiopulmonary function of athletes: A systematic review and meta-analysis. Phys Ther Sport 2018; 34:92-104. [DOI: 10.1016/j.ptsp.2018.09.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Revised: 08/31/2018] [Accepted: 09/10/2018] [Indexed: 01/09/2023]
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Shei RJ. Recent Advancements in Our Understanding of the Ergogenic Effect of Respiratory Muscle Training in Healthy Humans: A Systematic Review. J Strength Cond Res 2018; 32:2665-2676. [PMID: 29985221 PMCID: PMC6105530 DOI: 10.1519/jsc.0000000000002730] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Shei, R-J. Recent advancements in our understanding of the ergogenic effect of respiratory muscle training in healthy humans: a systematic review. J Strength Cond Res 32(9): 2674-2685, 2018-Respiratory muscle training (RMT) has been shown to be an effective ergogenic aid for sport performance. Respiratory muscle training has been documented to improve performance in a wide range of exercise modalities including running, cycling, swimming, and rowing. The physiological effects of RMT that may explain the improvements in performance have been proposed to include diaphragm hypertrophy, muscle fiber-type switching, improved neural control of the respiratory muscles, increased respiratory muscle economy, attenuation of the respiratory muscle metaboreflex, and decreases in perceived breathlessness and exertion. This review summarizes recent studies on the ergogenicity and mechanisms of RMT since 2013 when the topic was last systematically reviewed. Recent evidence confirms the ergogenic effects of RMT and explores different loading protocols, such as concurrent exercise and RMT (i.e., "functional" RMT). These studies suggest that adapting new training protocols may have an additive improvement effect, but evidence of the efficacy of such an approach is conflicting thus far. Other recent investigations have furthered our understanding of the mechanisms underpinning RMT-associated improvements in performance. Importantly, changes in ventilatory efficiency, oxygen delivery, cytokine release, motor recruitment patterns, and respiratory muscle fatigue resistance are highlighted as potential mechanistic factors linking RMT with performance improvements. It is suggested that future investigations focus on development of sport-specific RMT loading protocols, and that further work be undertaken to better understand the mechanistic basis of RMT-induced performance improvements.
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Affiliation(s)
- Ren-Jay Shei
- Division of Pulmonary, Allergy, and Critical Care Medicine, and Gregory Fleming James Cystic Fibrosis Research Center, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
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Bissett B, Leditschke IA, Green M, Marzano V, Collins S, Van Haren F. Inspiratory muscle training for intensive care patients: A multidisciplinary practical guide for clinicians. Aust Crit Care 2018; 32:249-255. [PMID: 30007823 DOI: 10.1016/j.aucc.2018.06.001] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Revised: 05/29/2018] [Accepted: 06/01/2018] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVES To describe a multidisciplinary approach to inspiratory muscle training (IMT) for patients in the intensive care unit (ICU). BACKGROUND Inspiratory muscle weakness is a known consequence of prolonged mechanical ventilation, and there is emerging evidence that specific IMT can ameliorate this weakness. However, IMT is not yet standard practice in many ICUs, possibly because of the wide variety of methods reported and a lack of published practical guidelines. While the optimal parameters for IMT are yet to be established, we share our detailed methodology which has been shown to be safe in selected ventilator-dependent patients and is the only approach which has been shown to increase quality of life in ICU patients. METHODS Patients who have experienced invasive mechanical ventilation for at least 7 days can commence IMT in either the ventilator-dependent phase or when weaned from mechanical ventilation. Intensity should be prescribed based on maximum inspiratory pressure, which is measurable through the tracheostomy or endotracheal tube via the ventilator or a respiratory pressure meter. Using a removable threshold device, we recommend high-intensity training (5 sets of 6 breaths at a minimum of 50% of maximum inspiratory pressure) performed once per day, supervised by the physiotherapist, with intensity increased daily such that patients can only just complete the 6th breath in each set. RESULTS Using this high-intensity approach, IMT is likely to improve not only inspiratory muscle strength but also quality of life in patients recently weaned from mechanical ventilation of 7 days' duration or longer. Effective IMT requires a multidisciplinary approach to maximise feasibility, with doctors, nurses, and therapists working closely to optimise conditions for successful IMT. CONCLUSIONS This multidisciplinary approach to implement IMT in ICU patients should assist clinicians in translating best-available evidence into practice, with the potential to enhance patient recovery.
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Affiliation(s)
- Bernie Bissett
- Discipline of Physiotherapy, University of Canberra, Canberra Hospital, Canberra, Australia; Physiotherapy Department, Canberra Hospital, Canberra, Australia.
| | - I Anne Leditschke
- Intensive Care Unit, Mater Health, Mater Research Institute, University of Queensland, Brisbane, Australia
| | - Margot Green
- Physiotherapy Department, Canberra Hospital, Canberra, Australia
| | - Vince Marzano
- Physiotherapy Department, Canberra Hospital, Canberra, Australia
| | | | - Frank Van Haren
- Intensive Care Unit, Canberra Hospital, Canberra, Australia; School of Medicine, Australian National University, Canberra, Australia; Faculty of Health, University of Canberra, Canberra, Australia
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Kim DS, Jeon BH. Effects of 8 Weeks of Inspiratory Muscle Training on Pulmonary Function and Maximum Inspiratory Pressure and Skill-related Physical Fitness in Women. THE ASIAN JOURNAL OF KINESIOLOGY 2018. [DOI: 10.15758/ajk.2018.20.1.27] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Cases J, Romain C, Marín-Pagán C, Chung LH, Rubio-Pérez JM, Laurent C, Gaillet S, Prost-Camus E, Prost M, Alcaraz PE. Supplementation with a Polyphenol-Rich Extract, PerfLoad ®, Improves Physical Performance during High-Intensity Exercise: A Randomized, Double Blind, Crossover Trial. Nutrients 2017; 9:nu9040421. [PMID: 28441760 PMCID: PMC5409760 DOI: 10.3390/nu9040421] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Revised: 03/21/2017] [Accepted: 04/13/2017] [Indexed: 01/08/2023] Open
Abstract
Workout capacity is energy-production driven. To produce peak metabolic power outputs, the organism predominantly relies more on anaerobic metabolism, but this undoubtedly has a negative and limiting impact on muscle function and performance. The aim of the study was to evaluate if an innovative polyphenol-based food supplement, PerfLoad®, was able to improve metabolic homeostasis and physical performance during high-intensity exercises under anaerobic conditions. The effect of a supplementation has been investigated on fifteen recreationally-active male athletes during a randomized, double-blind and crossover clinical investigation. The Wingate test, an inducer of an unbalanced metabolism associated to oxidative stress, was used to assess maximum anaerobic power during a high-intensity exercise on a cycle ergometer. Supplementation with PerfLoad® correlated with a significant increase in total power output (5%), maximal peak power output (3.7%), and average power developed (5%), without inducing more fatigue or greater heart rate. Instead, oxidative homeostasis was stabilized in supplemented subjects. Such results demonstrated that PerfLoad® is a natural and efficient solution capable of, similarly to training benefits, helping athletes to improve their physical performance, while balancing their metabolism and reducing exercise-induced oxidative stress.
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Affiliation(s)
- Julien Cases
- Fytexia, Innovation and Scientific Affairs, 34350 Vendres, France.
| | - Cindy Romain
- Fytexia, Innovation and Scientific Affairs, 34350 Vendres, France.
| | - Cristian Marín-Pagán
- Research Center in High Performance Sport, UCAM Universidad Católica de Murcia, 30107 Murcia, Spain.
| | - Linda H Chung
- Research Center in High Performance Sport, UCAM Universidad Católica de Murcia, 30107 Murcia, Spain.
| | - José Miguel Rubio-Pérez
- Research Center in High Performance Sport, UCAM Universidad Católica de Murcia, 30107 Murcia, Spain.
| | - Caroline Laurent
- UMR 204 Nutripass, Institut de Recherche pour le Développement, Université de Montpellier, 34095 Montpellier, France.
| | - Sylvie Gaillet
- UMR 204 Nutripass, Institut de Recherche pour le Développement, Université de Montpellier, 34095 Montpellier, France.
| | | | | | - Pedro E Alcaraz
- Research Center in High Performance Sport, UCAM Universidad Católica de Murcia, 30107 Murcia, Spain.
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Faghy MA, Brown PI. Whole-body active warm-up and inspiratory muscle warm-up do not improve running performance when carrying thoracic loads. Appl Physiol Nutr Metab 2017; 42:810-815. [PMID: 28288302 DOI: 10.1139/apnm-2016-0711] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Whole-body active warm-ups (AWU) and inspiratory muscle warm-up (IMW) prior to exercise improves performance on some endurance exercise tasks. This study investigated the effects of AWU with and without IMW upon 2.4-km running time-trial performance while carrying a 25-kg backpack, a common task and backpack load in physically demanding occupations. Participants (n = 9) performed five 2.4-km running time-trials with a 25-kg thoracic load preceded in random order by (i) IMW comprising 2 × 30 inspiratory efforts against a pressure-threshold load of 40% maximal inspiratory pressure (PImax), (ii) 10-min unloaded running (AWU) at lactate turnpoint (10.33 ± 1.58 km·h-1), (iii) placebo IMW (PLA) comprising 5-min breathing using a sham device, (iv) AWU+IMW, and (v) AWU+PLA. Pooled baseline PImax was similar between trials and increased by 7% and 6% following IMW and AWU+IMW (P < 0.05). Relative to baseline, pooled PImax was reduced by 9% after the time-trial, which was not different between trials (P > 0.05). Time-trial performance was not different between any trials. Whole-body AWU and IMW performed alone or combination have no ergogenic effect upon high-intensity, short-duration performance when carrying a 25-kg load in a backpack.
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Affiliation(s)
- Mark A Faghy
- a College of Life and Natural Sciences, University of Derby, Derby DE22 1GB, UK
| | - Peter I Brown
- b English Institute of Sport, Loughborough High Performance Centre, Loughborough Leicestershire LE11 3TU, UK
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Nepomuceno Júnior BRV, Gómez TB, Gomes Neto M. Use of Powerbreathe® in inspiratory muscle training for athletes: systematic review. FISIOTERAPIA EM MOVIMENTO 2016. [DOI: 10.1590/1980-5918.029.004.ao19] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Abstract Introduction: Inspiratory muscle training (IMT) has been used as part of athletic training. It is beneficial due to an increase in respiratory capacity, and can be related to the optimization of exercise tolerance. There are a growing number of publications on the subject, however the methodological rigor of these publications is still unknown. Objective: To perform a systematic literature review in order to analyze the effects of Powerbreathe® on inspiratory muscle training by athletes. Methods: Original scientific studies published in English, from 2000 to 2015, were included. Their typology was classified. The literature search was performed in the Lilacs, Medline, Pubmed, and Scielo databases using the following keywords: inspiratory muscle training, athletes, and Sports medicine (in English), treinamento muscular inspiratório, atleta, medicina esportiva (in Portuguese). Results: Inspiratory muscle training with specific linear resistance has been used in some athletic training, and its results are promising. However, its application is still recent and generally supported by experiments with limited population and which do not properly define the confounding factors for the results. Conclusion: The state of the art suggests that IMT is useful as a respiratory therapy supporting the training of athletes for some specific sports. However, there is a scarcity of studies of high methodological quality, thus requiring further experiments on the subject.
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Bissett BM, Leditschke IA, Neeman T, Boots R, Paratz J. Inspiratory muscle training to enhance recovery from mechanical ventilation: a randomised trial. Thorax 2016; 71:812-9. [PMID: 27257003 PMCID: PMC5013088 DOI: 10.1136/thoraxjnl-2016-208279] [Citation(s) in RCA: 69] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Accepted: 05/08/2016] [Indexed: 12/14/2022]
Abstract
Background In patients who have been mechanically ventilated, inspiratory muscles remain weak and fatigable following ventilatory weaning, which may contribute to dyspnoea and limited functional recovery. Inspiratory muscle training may improve inspiratory muscle strength and endurance following weaning, potentially improving dyspnoea and quality of life in this patient group. Methods We conducted a randomised trial with assessor-blinding and intention-to-treat analysis. Following 48 hours of successful weaning, 70 participants (mechanically ventilated ≥7 days) were randomised to receive inspiratory muscle training once daily 5 days/week for 2 weeks in addition to usual care, or usual care (control). Primary endpoints were inspiratory muscle strength and fatigue resistance index (FRI) 2 weeks following enrolment. Secondary endpoints included dyspnoea, physical function and quality of life, post-intensive care length of stay and in-hospital mortality. Results 34 participants were randomly allocated to the training group and 36 to control. The training group demonstrated greater improvements in inspiratory strength (training: 17%, control: 6%, mean difference: 11%, p=0.02). There were no statistically significant differences in FRI (0.03 vs 0.02, p=0.81), physical function (0.25 vs 0.25, p=0.97) or dyspnoea (−0.5 vs 0.2, p=0.22). Improvement in quality of life was greater in the training group (14% vs 2%, mean difference 12%, p=0.03). In-hospital mortality was higher in the training group (4 vs 0, 12% vs 0%, p=0.051). Conclusions Inspiratory muscle training following successful weaning increases inspiratory muscle strength and quality of life, but we cannot confidently rule out an associated increased risk of in-hospital mortality. Trial registration number ACTRN12610001089022, results.
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Affiliation(s)
- Bernie M Bissett
- School of Medicine, University of Queensland, Brisbane, Queensland, Australia Discipline of Physiotherapy, University of Canberra, Australia Physiotherapy Department, Canberra Hospital, Canberra, Australian Capital Territory, Australia
| | - I Anne Leditschke
- Intensive Care Unit, Canberra Hospital, Canberra, Australian Capital Territory, Australia Intensive Care Unit, Mater Hospital, Brisbane, Queensland, Australia School of Medicine, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Teresa Neeman
- Statistical Consulting Unit, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Robert Boots
- School of Medicine, University of Queensland, Brisbane, Queensland, Australia Intensive Care Unit, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - Jennifer Paratz
- School of Medicine, University of Queensland, Brisbane, Queensland, Australia Intensive Care Unit, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia School of Alllied Health Sciences, Griffith University, Australia
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Faghy MA, Brown PI. Training the inspiratory muscles improves running performance when carrying a 25 kg thoracic load in a backpack. Eur J Sport Sci 2015; 16:585-94. [PMID: 26274785 DOI: 10.1080/17461391.2015.1071878] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Load carriage (LC) exercise in physically demanding occupations is typically characterised by periods of low-intensity steady-state exercise and short duration, high-intensity exercise while carrying an external mass in a backpack; this form of exercise is also known as LC exercise. This induces inspiratory muscle fatigue and reduces whole-body performance. Accordingly we investigated the effect of inspiratory muscle training (IMT, 50% maximal inspiratory muscle pressure (PImax) twice daily for six week) upon running time-trial performance with thoracic LC. Nineteen healthy males formed a pressure threshold IMT (n = 10) or placebo control group (PLA; n = 9) and performed 60 min LC exercise (6.5 km h(-1)) followed by a 2.4 km running time trial (LCTT) either side of a double-blind six week intervention. Prior to the intervention, PImax was reduced relative to baseline, post-LC and post-LCTT in both groups (pooled data: 13 ± 7% and 16 ± 8%, respectively, p < .05) and similar changes were observed post-PLA. Post-IMT only, resting PImax increased +31% (p < .05) and relative to pre-IMT was greater post-LC (+19%) and post-LCTT (+18%, p < .05), however, the relative reduction in PImax at each time point was unchanged (13 ± 11% and 17 ± 9%, respectively, p > .05). In IMT only, heart rate and perceptual responses were reduced post-LC (p < .05). Time-trial performance was unchanged post-PLA and improved 8 ± 4% after IMT (p < .05). In summary, when wearing a 25 kg backpack, IMT attenuated the cardiovascular and perceptual responses to steady-state exercise and improved high-intensity time-trial performance which we attribute in part to reduced relative work intensity of the inspiratory muscles due to improved inspiratory muscle strength. These findings have real-world implications for occupational contexts.
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Affiliation(s)
- Mark A Faghy
- a School of Science, University of Derby , Derby , UK
| | - Peter I Brown
- b English Institute of Sport, Loughborough High Performance Centre , Loughborough , UK
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Sales ATDN, Fregonezi GADF, Ramsook AH, Guenette JA, Lima INDF, Reid WD. Respiratory muscle endurance after training in athletes and non-athletes: A systematic review and meta-analysis. Phys Ther Sport 2015; 17:76-86. [PMID: 26626464 DOI: 10.1016/j.ptsp.2015.08.001] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Revised: 07/03/2015] [Accepted: 08/07/2015] [Indexed: 11/13/2022]
Abstract
The objectives of this systematic review was to evaluate the effects of respiratory muscle training (RMT) on respiratory muscle endurance (RME) and to determine the RME test that demonstrates the most consistent changes after RMT. Electronic searches were conducted in EMBASE, MEDLINE, COCHRANE CENTRAL, CINHAL and SPORTDiscus. The PEDro scale was used for quality assessment and meta-analysis were performed to compare effect sizes of different RME tests. Twenty studies met the inclusion criteria. Isocapnic hyperpnea training was performed in 40% of the studies. Meta-analysis showed that RMT improves RME in athletes (P = 0.0007) and non-athletes (P = 0.001). Subgroup analysis showed differences among tests; maximal sustainable ventilatory capacity (MSVC) and maximal sustainable threshold loading tests demonstrated significant improvement after RMT (P = 0.007; P = 0.003 respectively) compared to the maximal voluntary ventilation (MVV) (P = 0.11) in athletes whereas significant improvement after RMT was only shown by MSVC in non-athletes. The effect size of MSVC was greater compared to MVV in studies that performed both tests. The meta-analysis results provide evidence that RMT improves RME in athletes and non-athletes and MSVC test that examine endurance over several minutes are more sensitive to improvement after RMT.
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Affiliation(s)
- Ana Tereza do N Sales
- Department of Physical Therapy, University Federal of the Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil.
| | - Guilherme A de F Fregonezi
- Department of Physical Therapy, University Federal of the Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | - Andrew H Ramsook
- Centre for Heart Lung Innovation, University of British Columbia and St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Jordan A Guenette
- Centre for Heart Lung Innovation, University of British Columbia and St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Illia Nadinne D F Lima
- Department of Physical Therapy, University Federal of the Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | - W Darlene Reid
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
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MILLS DEANE, JOHNSON MICHAELA, BARNETT YVONNEA, SMITH WILLIAMHT, SHARPE GRAHAMR. The Effects of Inspiratory Muscle Training in Older Adults. Med Sci Sports Exerc 2015; 47:691-7. [DOI: 10.1249/mss.0000000000000474] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Johnson MA, Mills DE, Brown PI, Sharpe GR. Prior upper body exercise reduces cycling work capacity but not critical power. Med Sci Sports Exerc 2015; 46:802-8. [PMID: 24042306 DOI: 10.1249/mss.0000000000000159] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSE This study examined whether metabolite accumulation, induced by prior upper body exercise, affected the power-duration relationship for leg cycle ergometry. METHODS Seven males performed, to the limit of tolerance and both without (L) and with (AL) prior severe-intensity arm-cranking exercise, an incremental cycling test and four constant power cycling tests to determine the parameters of the power-duration relationship: critical power (CP) and W'. RESULTS At the onset of cycling exercise plasma lactate (L vs AL: 1.2 ± 0.1 vs 11.6 ± 2.9 mEq · L) and hydrogen ion (40.4 ± 1.3 vs 53.1 ± 4.3 nEq · L), concentrations were higher during AL compared with L, whereas the strong ion difference (37.8 ± 1.8 vs 32.4 ± 2.0 mEq · L) and bicarbonate concentration (25.7 ± 0.7 vs 18.3 ± 1.9 mEq · L) were lower during AL compared with L (P < 0.01). During incremental exercise, maximum cycling power (358 ± 15 vs 332 ± 21 W) and peak oxygen uptake (VO2peak) (4.31 ± 0.36 vs 3.71 ± 0.44 L · min) were lower during AL compared with L (P < 0.05). The rate of increase in plasma potassium concentration during constant power cycling was greater during AL compared with L (0.09 ± 0.08 vs 0.14 ± 0.13 mEq · L · min) (P < 0.05), and exercise duration was 35 ± 15% shorter (P < 0.01). CP was not different between L and AL (267 ± 19 vs 264 ± 20 W), whereas W' was lower in AL (17.3 ± 5.7 vs 11.8 ± 4.2 kJ) (P < 0.01). CONCLUSION The reduced W' after prior upper body exercise indicates that the magnitude of W' is partly dependent on metabolite accumulation.
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Affiliation(s)
- Michael A Johnson
- 1Sport, Health and Performance Enhancement (SHAPE) Research Group, School of Science and Technology, Nottingham Trent University, Nottingham, UNITED KINGDOM; and 2Department of Sport and Exercise, Derby University, UNITED KINGDOM
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Mills DE, Johnson MA, McPhilimey MJ, Williams NC, Gonzalez JT, Barnett YA, Sharpe GR. Influence of oxidative stress, diaphragm fatigue, and inspiratory muscle training on the plasma cytokine response to maximum sustainable voluntary ventilation. J Appl Physiol (1985) 2014; 116:970-9. [DOI: 10.1152/japplphysiol.01271.2013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
The influence of oxidative stress, diaphragm fatigue, and inspiratory muscle training (IMT) on the cytokine response to maximum sustainable voluntary ventilation (MSVV) is unknown. Twelve healthy males were divided equally into an IMT or placebo (PLA) group, and before and after a 6-wk intervention they undertook, on separate days, 1 h of ( 1) passive rest and ( 2) MSVV, whereby participants undertook volitional hyperpnea at rest that mimicked the breathing and respiratory muscle recruitment patterns commensurate with heavy cycling exercise. Plasma cytokines remained unchanged during passive rest. There was a main effect of time ( P < 0.01) for plasma interleukin-1β (IL-1β) and interleukin-6 (IL-6) concentrations and a strong trend ( P = 0.067) for plasma interleukin-1 receptor antagonist concentration during MSVV. Plasma IL-6 concentration was reduced after IMT by 27 ± 18% (main effect of intervention, P = 0.029), whereas there was no change after PLA ( P = 0.753). There was no increase in a systemic marker of oxidative stress [DNA damage in peripheral blood mononuclear cells (PBMC)], and diaphragm fatigue was not related to the increases in plasma IL-1β and IL-6 concentrations. A dose-response relationship was observed between respiratory muscle work and minute ventilation and increases in plasma IL-6 concentration. In conclusion, increases in plasma IL-1β and IL-6 concentrations during MSVV were not due to diaphragm fatigue or DNA damage in PBMC. Increases in plasma IL-6 concentration during MSVV are attenuated following IMT, and the plasma IL-6 response is dependent upon the level of respiratory muscle work and minute ventilation.
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Affiliation(s)
- Dean E. Mills
- Sport, Health and Performance Enhancement (SHAPE) Research Group, School of Science and Technology, Nottingham Trent University, Nottingham, United Kingdom; and
| | - Michael A. Johnson
- Sport, Health and Performance Enhancement (SHAPE) Research Group, School of Science and Technology, Nottingham Trent University, Nottingham, United Kingdom; and
| | - Martin J. McPhilimey
- Sport, Health and Performance Enhancement (SHAPE) Research Group, School of Science and Technology, Nottingham Trent University, Nottingham, United Kingdom; and
| | - Neil C. Williams
- Sport, Health and Performance Enhancement (SHAPE) Research Group, School of Science and Technology, Nottingham Trent University, Nottingham, United Kingdom; and
| | - Javier T. Gonzalez
- School of Life Sciences, Northumbria University, Newcastle upon Tyne, United Kingdom
| | - Yvonne A. Barnett
- Sport, Health and Performance Enhancement (SHAPE) Research Group, School of Science and Technology, Nottingham Trent University, Nottingham, United Kingdom; and
| | - Graham R. Sharpe
- Sport, Health and Performance Enhancement (SHAPE) Research Group, School of Science and Technology, Nottingham Trent University, Nottingham, United Kingdom; and
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Determinants of inspiratory muscle strength in healthy humans. Respir Physiol Neurobiol 2014; 196:50-5. [PMID: 24598814 DOI: 10.1016/j.resp.2014.02.014] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2013] [Revised: 02/24/2014] [Accepted: 02/25/2014] [Indexed: 11/23/2022]
Abstract
We investigated (1) the relationship between the baseline and inspiratory muscle training (IMT) induced increase in maximal inspiratory pressure (P(I,max)) and (2) the relative contributions of the inspiratory chest wall muscles and the diaphragm (P(oes)/P(di)) to P(I,max) prior to and following-IMT. Experiment 1: P(I,max) was assessed during a Müeller manoeuvre before and after 4-wk IMT (n=30). Experiment 2: P(I,max) and the relative contribution of the inspiratory chest wall muscles to the diaphragm (P(oes)/P(di)) were assessed during a Müeller manoeuvre before and after 4-wk IMT (n=20). Experiment 1: P(I,max) increased 19% (P<0.01) post-IMT and was correlated with baseline P(I,max) (r=-0.373, P<0.05). Experiment 2: baseline P(I,max) was correlated with P(oe)/P(di) (r=0.582, P<0.05) and after IMT PI,max increased 22% and Poe/Pdi increased 5% (P<0.05). In conclusion, baseline P(I,max) and the contribution of the chest wall inspiratory muscles relative to the diaphragm affect, in part, baseline and IMT-induced P(I,max). Great care should be taken when designing future IMT studies to ensure parity in the between-subject baseline P(I,max).
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Faghy MA, Brown PI. Thoracic load carriage-induced respiratory muscle fatigue. Eur J Appl Physiol 2014; 114:1085-93. [DOI: 10.1007/s00421-014-2839-4] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2013] [Accepted: 01/27/2014] [Indexed: 10/25/2022]
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Guy JH, Edwards AM, Deakin GB. Inspiratory Muscle Training Improves Exercise Tolerance in Recreational Soccer Players Without Concomitant Gain in Soccer-Specific Fitness. J Strength Cond Res 2014; 28:483-91. [DOI: 10.1519/jsc.0b013e31829d24b0] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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Abstract
During dynamic exercise, the healthy pulmonary system faces several major challenges, including decreases in mixed venous oxygen content and increases in mixed venous carbon dioxide. As such, the ventilatory demand is increased, while the rising cardiac output means that blood will have considerably less time in the pulmonary capillaries to accomplish gas exchange. Blood gas homeostasis must be accomplished by precise regulation of alveolar ventilation via medullary neural networks and sensory reflex mechanisms. It is equally important that cardiovascular and pulmonary system responses to exercise be precisely matched to the increase in metabolic requirements, and that the substantial gas transport needs of both respiratory and locomotor muscles be considered. Our article addresses each of these topics with emphasis on the healthy, young adult exercising in normoxia. We review recent evidence concerning how exercise hyperpnea influences sympathetic vasoconstrictor outflow and the effect this might have on the ability to perform muscular work. We also review sex-based differences in lung mechanics.
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Affiliation(s)
- Andrew William Sheel
- The School of Kinesiology, The University of British Columbia, Vancouver, Canada.
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Wilson EE, McKeever TM, Lobb C, Sherriff T, Gupta L, Hearson G, Martin N, Lindley MR, Shaw DE. Respiratory muscle specific warm-up and elite swimming performance. Br J Sports Med 2013; 48:789-91. [DOI: 10.1136/bjsports-2013-092523] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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40
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Edwards AM. Respiratory muscle training extends exercise tolerance without concomitant change to peak oxygen uptake: Physiological, performance and perceptual responses derived from the same incremental exercise test. Respirology 2013; 18:1022-7. [DOI: 10.1111/resp.12100] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2012] [Revised: 01/29/2013] [Accepted: 02/03/2013] [Indexed: 11/28/2022]
Affiliation(s)
- A. M. Edwards
- Institute of Sport and Exercise Science; James Cook University; Cairns; Queensland; Australia
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HajGhanbari B, Yamabayashi C, Buna TR, Coelho JD, Freedman KD, Morton TA, Palmer SA, Toy MA, Walsh C, Sheel AW, Reid WD. Effects of Respiratory Muscle Training on Performance in Athletes. J Strength Cond Res 2013; 27:1643-63. [DOI: 10.1519/jsc.0b013e318269f73f] [Citation(s) in RCA: 110] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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42
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Brown P, McConnell A. To the Editor. J Strength Cond Res 2013; 27:e1. [DOI: 10.1519/jsc.0b013e31825b7a88] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Illi SK, Held U, Frank I, Spengler CM. Effect of Respiratory Muscle Training on Exercise Performance in Healthy Individuals. Sports Med 2012; 42:707-24. [DOI: 10.1007/bf03262290] [Citation(s) in RCA: 135] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Illi SK, Held U, Frank I, Spengler CM. Effect of Respiratory Muscle Training on Exercise Performance in Healthy Individuals. Sports Med 2012. [DOI: 10.2165/11631670-000000000-00000] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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45
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Bissett B, Leditschke IA, Paratz JD, Boots RJ. Respiratory Dysfunction in Ventilated Patients: Can Inspiratory Muscle Training Help? Anaesth Intensive Care 2012; 40:236-46. [DOI: 10.1177/0310057x1204000205] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Respiratory muscle dysfunction is associated with prolonged and difficult weaning from mechanical ventilation. This dysfunction in ventilator-dependent patients is multifactorial: there is evidence that inspiratory muscle weakness is partially explained by disuse atrophy secondary to ventilation, and positive end-expiratory pressure can further reduce muscle strength by negatively shifting the length-tension curve of the diaphragm. Polyneuropathy is also likely to contribute to apparent muscle weakness in critically ill patients, and nutritional and pharmaceutical effects may further compound muscle weakness. Moreover, psychological influences, including anxiety, may contribute to difficulty in weaning. There is recent evidence that inspiratory muscle training is safe and feasible in selected ventilator-dependent patients, and that this training can reduce the weaning period and improve overall weaning success rates. Extrapolating from evidence in sports medicine, as well as the known effects of inspiratory muscle training in chronic lung disease, a theoretical model is proposed to describe how inspiratory muscle training enhances weaning and recovery from mechanical ventilation. Possible mechanisms include increased protein synthesis (both Type 1 and Type 2 muscle fibres), enhanced limb perfusion via dampening of a sympathetically-mediated metaboreflex, reduced lactate levels and modulation of the perception of exertion, resulting in less dyspnoea and enhanced exercise capacity.
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Affiliation(s)
- B. Bissett
- Physiotherapy Department and Intensive Care Unit, Canberra Hospital, Canberra, Australian Capital Territory and University of Queensland, Brisbane, Queensland, Australia
- Physiotherapy Department, Canberra Hospital and PhD Candidate, University of Queensland
| | - I. A. Leditschke
- Physiotherapy Department and Intensive Care Unit, Canberra Hospital, Canberra, Australian Capital Territory and University of Queensland, Brisbane, Queensland, Australia
- Intensive Care Unit, Canberra Hospital and Australian National University
| | - J. D. Paratz
- Physiotherapy Department and Intensive Care Unit, Canberra Hospital, Canberra, Australian Capital Territory and University of Queensland, Brisbane, Queensland, Australia
- Department of Intensive Care Medicine, Royal Brisbane and Women's Hospital and University of Queensland
| | - R. J. Boots
- Physiotherapy Department and Intensive Care Unit, Canberra Hospital, Canberra, Australian Capital Territory and University of Queensland, Brisbane, Queensland, Australia
- Deputy Director, Intensive Care Unit, Department of Intensive Care Medicine, Royal Brisbane and Women's Hospital and University of Queensland
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Specific inspiratory muscle training is safe in selected patients who are ventilator-dependent: a case series. Intensive Crit Care Nurs 2012; 28:98-104. [PMID: 22340987 DOI: 10.1016/j.iccn.2012.01.003] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2011] [Revised: 01/09/2012] [Accepted: 01/10/2012] [Indexed: 11/20/2022]
Abstract
BACKGROUND Mechanical ventilation of intensive care patients results in inspiratory muscle weakness. Inspiratory muscle training may be useful, but no studies have specifically described the physiological response to training. RESEARCH QUESTIONS Is inspiratory muscle training with a threshold device safe in selected ventilator-dependent patients? Does inspiratory muscle strength increase with high-intensity inspiratory muscle training in ventilator-dependent patients? DESIGN Prospective cohort study of 10 medically stable ventilator-dependent adult patients. SETTING Tertiary adult intensive care unit. METHODS Inspiratory muscle training 5-6 days per week with a threshold device attached to the tracheostomy without supplemental oxygen. OUTCOME MEASURES Physiological response to training (heart rate, mean arterial pressure, oxygen saturation and respiratory rate), adverse events, training pressures. RESULTS No adverse events were recorded in 195 sessions studied. For each patient's second training session, no significant changes in heart rate (Mean Difference 1.3 bpm, 95% CI -2.7 to 5.3), mean arterial pressure (Mean Difference -0.9 mmHg, 95% CI -6.4 to 4.6), respiratory rate (Mean Difference 1.2 bpm, 95% CI -1.1 to 3.5 bpm) or oxygen saturation (Mean Difference 1.2%, 95% CI -0.6 to 3.0) were detected Training pressures increased significantly (Mean Difference 18.6 cmH(2)O, 95% CI 11.8-25.3). CONCLUSION Threshold-based inspiratory muscle training can be delivered safely in selected ventilator-dependent patients without supplemental oxygen. Inspiratory muscle training is associated with increased muscle strength, which may assist ventilatory weaning.
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Inspiratory muscle training abolishes the blood lactate increase associated with volitional hyperpnoea superimposed on exercise and accelerates lactate and oxygen uptake kinetics at the onset of exercise. Eur J Appl Physiol 2011; 112:2117-29. [PMID: 21964908 DOI: 10.1007/s00421-011-2185-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2010] [Accepted: 09/15/2011] [Indexed: 11/27/2022]
Abstract
We examined the effects of inspiratory muscle training (IMT) upon volitional hyperpnoea-mediated increases in blood lactate ([lac(-)](B)) during cycling at maximal lactate steady state (MLSS) power, and blood lactate and oxygen uptake kinetics at the onset of exercise. Twenty males formed either an IMT (n = 10) or control group (n = 10). Prior to and following a 6-week intervention, two 30 min trials were performed at MLSS (207 ± 28 W), determined using repeated 30 min constant power trials. The first was a reference trial, whereas during the second trial, from 20 to 28 min, participants mimicked the breathing pattern commensurate with 90% of the maximal incremental exercise test minute ventilation ([Formula: see text]). Prior to the intervention, the MLSS [lac(-)](B) was 3.7 ± 1.8 and 3.9 ± 1.6 mmol L(-1) in the IMT and control groups, respectively. During volitional hyperpnoea, [Formula: see text] increased from 79.9 ± 9.5 and 76.3 ± 15.4 L min(-1) at 20 min to 137.8 ± 15.2 and 135.0 ± 19.7 L min(-1) in IMT and control groups, respectively; [lac(-)](B) concurrently increased by 1.0 ± 0.6 (+27%) and 0.9 ± 0.7 mmol L(-1) (+25%), respectively (P < 0.05). Following the intervention, maximal inspiratory mouth pressure increased 19% in the IMT group only (P < 0.01). Following IMT only, the increase in [lac(-)](B) during volitional hyperpnoea was abolished (P < 0.05). In addition, the blood lactate (-28%) and phase II oxygen uptake (-31%) kinetics time constants at the onset of exercise and the MLSS [lac(-)](B) (-15%) were reduced (P < 0.05). We attribute these changes to an IMT-mediated increase in the oxidative and/or lactate transport capacity of the inspiratory muscles.
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MccONNELL ALISONK, GRIFFITHS LISAA. Acute Cardiorespiratory Responses to Inspiratory Pressure Threshold Loading. Med Sci Sports Exerc 2010; 42:1696-703. [DOI: 10.1249/mss.0b013e3181d435cf] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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BROWN PETERI, SHARPE GRAHAMR, JOHNSON MICHAELA. Loading of Trained Inspiratory Muscles Speeds Lactate Recovery Kinetics. Med Sci Sports Exerc 2010; 42:1103-12. [DOI: 10.1249/mss.0b013e3181c658ac] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Bailey SJ, Romer LM, Kelly J, Wilkerson DP, DiMenna FJ, Jones AM. Inspiratory muscle training enhances pulmonary O(2) uptake kinetics and high-intensity exercise tolerance in humans. J Appl Physiol (1985) 2010; 109:457-68. [PMID: 20507969 DOI: 10.1152/japplphysiol.00077.2010] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Fatigue of the respiratory muscles during intense exercise might compromise leg blood flow, thereby constraining oxygen uptake (Vo(2)) and limiting exercise tolerance. We tested the hypothesis that inspiratory muscle training (IMT) would reduce inspiratory muscle fatigue, speed Vo(2) kinetics and enhance exercise tolerance. Sixteen recreationally active subjects (mean + or - SD, age 22 + or - 4 yr) were randomly assigned to receive 4 wk of either pressure threshold IMT [30 breaths twice daily at approximately 50% of maximum inspiratory pressure (MIP)] or sham treatment (60 breaths once daily at approximately 15% of MIP). The subjects completed moderate-, severe- and maximal-intensity "step" exercise transitions on a cycle ergometer before (Pre) and after (Post) the 4-wk intervention period for determination of Vo(2) kinetics and exercise tolerance. There were no significant changes in the physiological variables of interest after Sham. After IMT, baseline MIP was significantly increased (Pre vs. Post: 155 + or - 22 vs. 181 + or - 21 cmH(2)O; P < 0.001), and the degree of inspiratory muscle fatigue was reduced after severe- and maximal-intensity exercise. During severe exercise, the Vo(2) slow component was reduced (Pre vs. Post: 0.60 + or - 0.20 vs. 0.53 + or - 0.24 l/min; P < 0.05) and exercise tolerance was enhanced (Pre vs. Post: 765 + or - 249 vs. 1,061 + or - 304 s; P < 0.01). Similarly, during maximal exercise, the Vo(2) slow component was reduced (Pre vs. Post: 0.28 + or - 0.14 vs. 0.18 + or - 0.07 l/min; P < 0.05) and exercise tolerance was enhanced (Pre vs. Post: 177 + or - 24 vs. 208 + or - 37 s; P < 0.01). Four weeks of IMT, which reduced inspiratory muscle fatigue, resulted in a reduced Vo(2) slow-component amplitude and an improved exercise tolerance during severe- and maximal-intensity exercise. The results indicate that the enhanced exercise tolerance observed after IMT might be related, at least in part, to improved Vo(2) dynamics, presumably as a consequence of increased blood flow to the exercising limbs.
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Affiliation(s)
- Stephen J Bailey
- School of Sport and Health Sciences, St. Luke's Campus, Univ. of Exeter, Heavitree Road, Exeter, Devon EX1 2LU, UK
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