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Okrzymowska P, Seidel W, Rozek-Piechura K. The Effectiveness and Validity of Inspiratory Muscle Training in the Training Process of Disabled Swimmers. J Clin Med 2024; 13:5365. [PMID: 39336852 PMCID: PMC11432610 DOI: 10.3390/jcm13185365] [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: 08/25/2024] [Revised: 09/07/2024] [Accepted: 09/09/2024] [Indexed: 09/30/2024] Open
Abstract
Objectives: The aim of this study was to evaluate the effect of medium-intensity inspiratory muscle training added to standard swimming training on inspiratory muscle strength and aerobic endurance levels and training status in disabled swimming athletes. Methods: This study involved 16 disabled athletes: group I-athletes performing swimming training with 8 weeks inspiratory muscle training-IMT (50% of the maximum inspiratory pressure); group II-athletes performing standard swimming training with 8 weeks inspiratory muscle training (15% MIP). The following tests were performed three times: MIP, MEP, Borg RPE scale and swimming test: T-30 test; 8 × 100 progressive test. Results: There was a significant increase in the MIP and MEP in group I after IMT. There was a significant increase in the distance swam during the T-30 only in group I after IMT. Significant differences were found between the first and third measurements in group I, and the effect was maintained at follow-up. There was also a significant reduction in La concentration in group I after IMT. There was a significant reduction in heart rate at 88% and 93% of the maximum speed in group I after the applied training. Conclusion: Inspiratory muscle training with 50% of the maximum inspiratory pressure load significantly increased the respiratory muscle strength of disabled swimmers. The application of higher-intensity IMT effectively improved the training level and physiological parameters of the swimmers' effort, indicating the need to include this type of training in the standard preparation of disabled swimmers.
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Affiliation(s)
- Paulina Okrzymowska
- Department of Physiotherapy in Interal Medicine, University of Health and Sport Sciences, 51-612 Wroclaw, Poland
| | - Wojciech Seidel
- Department of Paralympic Sport, University of Health and Sport Sciences, 51-612 Wroclaw, Poland
| | - Krystyna Rozek-Piechura
- Department of Physiotherapy in Interal Medicine, University of Health and Sport Sciences, 51-612 Wroclaw, Poland
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Manifield J, Alexiou C, Megaritis D, Baker K, Adams N, Barry G, Vogiatzis I. Effects of inspiratory muscle training on thoracoabdominal volume regulation in older adults: A randomised controlled trial. Respir Physiol Neurobiol 2024; 326:104278. [PMID: 38735425 DOI: 10.1016/j.resp.2024.104278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 04/22/2024] [Accepted: 05/04/2024] [Indexed: 05/14/2024]
Abstract
OBJECTIVES We investigated the effect of inspiratory muscle training (IMT) on inspiratory muscle strength, functional capacity and respiratory muscle kinematics during exercise in healthy older adults. METHODS 24 adults were randomised into an IMT or SHAM-IMT group. Both groups performed 30 breaths, twice daily, for 8 weeks, at intensities of ∼50 % maximal inspiratory pressure (PImax; IMT) or <15 % PImax (SHAM-IMT). Measurements of PImax, breathing discomfort during a bout of IMT, six-minute walk distance, physical activity levels, and balance were assessed pre- and post-intervention. Respiratory muscle kinematics were assessed via optoelectronic plethysmography (OEP) during constant work rate cycling. RESULTS PImax was significantly improved (by 20.0±11.9 cmH2O; p=0.001) in the IMT group only. Breathing discomfort ratings during IMT significantly decreased (from 3.5±0.9-1.7±0.8). Daily sedentary time was decreased (by 28.0±39.8 min; p=0.042), and reactive balance significantly improved (by 1.2±0.8; p<0.001) in the IMT group only. OEP measures showed a significantly greater contribution of the pulmonary and abdominal rib cage compartments to total tidal volume expansion post-IMT. CONCLUSIONS IMT significantly improves inspiratory muscle strength and breathing discomfort in this population. IMT induces greater rib cage expansion and diaphragm descent during exercise, thereby suggesting a less restrictive effect on thoracic expansion and increased diaphragmatic power generation.
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Affiliation(s)
- James Manifield
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle Upon Tyne NE1 8ST, UK.
| | - Charikleia Alexiou
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle Upon Tyne NE1 8ST, UK
| | - Dimitrios Megaritis
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle Upon Tyne NE1 8ST, UK
| | - Katherine Baker
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle Upon Tyne NE1 8ST, UK
| | - Nicola Adams
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle Upon Tyne NE1 8ST, UK
| | - Gill Barry
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle Upon Tyne NE1 8ST, UK
| | - Ioannis Vogiatzis
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle Upon Tyne NE1 8ST, UK
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Schaer CE, Erne D, Tageldin D, Wüthrich TU, Beltrami FG, Spengler CM. Effects of Sprint Interval and Endurance Respiratory Muscle Training on Postcycling Inspiratory and Quadriceps Fatigue. Med Sci Sports Exerc 2023; 55:1683-1694. [PMID: 37076980 DOI: 10.1249/mss.0000000000003192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/21/2023]
Abstract
PURPOSE We investigated whether a 4-wk period of respiratory muscle endurance training (RMET) or respiratory muscle sprint interval training (RMSIT) would lead to an attenuation of inspiratory muscle and quadriceps fatigue after a bout of high-intensity cycling compared with a placebo intervention (PLAT), as predicted by the respiratory metaboreflex model. METHODS Thirty-three active, young healthy adults performed RMET, RMSIT, or PLAT. Changes in inspiratory muscle and quadriceps twitches in response to a cycling test at 90% of peak work capacity were assessed before and after training. EMG activity and deoxyhemoglobin (HHb, via near-infrared spectroscopy) of the quadriceps and inspiratory muscles were also monitored during the cycling test, along with cardiorespiratory and perceptual variables. RESULTS At pretraining, cycling reduced the twitch force of the inspiratory muscles (86% ± 11% baseline) and quadriceps (66% ± 16% baseline). Training did not attenuate the drop in twitch force of the inspiratory muscles (PLAT, -3.5 ± 4.9 percent-points [p.p.]; RMET, 2.7 ± 11.3 p.p.; RMSIT, 4.1 ± 8.5 p.p.; group-training interaction, P = 0.394) or quadriceps (PLAT, 3.8 ± 18.6 p.p.; RMET, -2.6 ± 14.0 p.p.; RMSIT, 5.2 ± 9.8 p.p.; group-training interaction P = 0.432). EMG activity and HHb levels during cycling did not change after training for either group. Only RMSIT showed a within-group decrease in the perception of respiratory exertion with training. CONCLUSIONS Four weeks of RMET or RMSIT did not attenuate the development of exercise-induced inspiratory or quadriceps fatigue. The ergogenic effects of respiratory muscle training during whole-body exercise might be related to an attenuation of perceptual responses.
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Affiliation(s)
- Corina E Schaer
- Exercise Physiology Lab, Institute of Human Movement Sciences and Sport, ETH Zurich, Zurich, SWITZERLAND
| | - Desirée Erne
- Exercise Physiology Lab, Institute of Human Movement Sciences and Sport, ETH Zurich, Zurich, SWITZERLAND
| | - Dina Tageldin
- Exercise Physiology Lab, Institute of Human Movement Sciences and Sport, ETH Zurich, Zurich, SWITZERLAND
| | - Thomas U Wüthrich
- Exercise Physiology Lab, Institute of Human Movement Sciences and Sport, ETH Zurich, Zurich, SWITZERLAND
| | - Fernando G Beltrami
- Exercise Physiology Lab, Institute of Human Movement Sciences and Sport, ETH Zurich, Zurich, SWITZERLAND
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Fitzharris LE, Hezzell MJ, McConnell AK, Allen KJ. Training the equine respiratory muscles: Inspiratory muscle strength. Equine Vet J 2023; 55:306-314. [PMID: 35711132 PMCID: PMC10084158 DOI: 10.1111/evj.13606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Accepted: 05/27/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Little is known about the response of the equine respiratory muscles to training. OBJECTIVES To measure an index of inspiratory muscle strength (IMSi) before and after a period of conventional exercise training (phase 1) and inspiratory muscle training (IMT), comparing high-load (treatment) and low-load (control) groups (phase 2). STUDY DESIGN Prospective randomised controlled trial. METHODS Phase 1: Twenty National Hunt Thoroughbred racehorses performed an inspiratory muscle strength test (IMST) twice on two occasions; when unfit at timepoint A (July), and when race fit at timepoint B (October). Phase 2: Thirty-five Thoroughbred racehorses at race fitness were randomly assigned into a high-load (treatment, n = 20) or low-load (control, n = 15) IMT group. The high-load group followed an IMT protocol that gradually increased the inspiratory pressure applied every 4 days. The low-load group underwent sham IMT with a low training load. The IMT was performed 5 days/week for 10 weeks. The IMST was performed twice on two occasions, timepoint B (October) and timepoint C (January). Conventional exercise training and racing continued during the study period. The peak IMSi values obtained from the different groups at timepoints A, B and C were compared using a Wilcoxon Signed Rank Test. RESULTS Phase 1: There was a significant increase in IMSi from timepoint A: 22.5 cmH2 O (21-25) to timepoint B: 26 cmH2 O (24-30) (p = 0.015). Phase 2: From timepoint B to C there was a significant increase in IMSi for the high-load group 34 cmH2 O (28-36) (p = 0.001) but not the low-load group 26 cmH2 O (24-30) (p = 0.929). The peak IMSi at timepoint C was significantly higher for the high-load than low-load group (p = 0.019). MAIN LIMITATIONS Single centre study with only National Hunt horses undergoing race-training included. CONCLUSIONS In horses undergoing race training there is a significant increase in IMSi in response to conventional exercise training and high-load IMT.
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Affiliation(s)
| | - Melanie J Hezzell
- Bristol Veterinary School, University of Bristol, Langford, Bristol, UK
| | | | - Kate J Allen
- Bristol Veterinary School, University of Bristol, Langford, Bristol, UK
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Wheelock CE, Hess HW, Johnson BD, Schlader ZJ, Clemency BM, St James E, Hostler D. Endurance and Resistance Respiratory Muscle Training and Aerobic Exercise Performance in Hypobaric Hypoxia. Aerosp Med Hum Perform 2020; 91:776-784. [PMID: 33187563 DOI: 10.3357/amhp.5624.2020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
INTRODUCTION: Hypoxia-induced hyperventilation is an effect of acute altitude exposure, which may lead to respiratory muscle fatigue and secondary locomotor muscle fatigue. The purpose of this study was to determine if resistive and/or endurance respiratory muscle training (RRMT and ERMT, respectively) vs. placebo respiratory muscle training (PRMT) improve cycling performance at altitude.METHODS: There were 24 subjects who were assigned to PRMT (N 8), RRMT (N 8), or ERMT (N 8). Subjects cycled to exhaustion in a hypobaric chamber decompressed to 3657 m (12,000 ft) at an intensity of 55% sea level maximal oxygen consumption (Vo2max) before and after respiratory muscle training (RMT). Additionally, subjects completed a Vo2max, pulmonary function, and respiratory endurance test (RET) before and after RMT. All RMT protocols consisted of three 30-min training sessions per week for 4 wk.RESULTS: The RRMT group increased maximum inspiratory (PImax) and expiratory (PEmax) mouth pressure after RMT (PImax: 117.7 11.6 vs. 162.6 20.0; PEmax: 164.0 33.2 vs. 216.5 44.1 cmH₂O). The ERMT group increased RET after RMT (5.2 5.2 vs.18.6 16.9 min). RMT did not improve Vo2max in any group. Both RRMT and ERMT groups increased cycling time to exhaustion (RRMT: 35.9 17.2 vs. 45.6 22.2 min and ERMT: 33.8 9.6 vs. 42.9 27.0 min).CONCLUSION: Despite different improvements in pulmonary function, 4 wk of RRMT and ERMT both improved cycle time to exhaustion at altitude.Wheelock CE, Hess HW, Johnson BD, Schlader ZJ, Clemency BM, St. James E, Hostler D. Endurance and resistance respiratory muscle training and aerobic exercise performance in hypobaric hypoxia. Aerosp Med Hum Perform. 2020; 91(10):776784.
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A flow resistive inspiratory muscle training mask worn during high-intensity interval training does not improve 5 km running time-trial performance. Eur J Appl Physiol 2020; 121:183-191. [PMID: 33001229 PMCID: PMC7815609 DOI: 10.1007/s00421-020-04505-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 09/19/2020] [Indexed: 11/30/2022]
Abstract
Purpose There is little evidence of the ergogenic effect of flow-resistive masks worn during exercise. We compared a flow-resistive face mask (MASK) worn during high-intensity interval training (HIIT) against pressure threshold loading inspiratory muscle training (IMT). Methods 23 participants (13 males) completed a 5 km time trial and six weeks of HIIT (3 sessions weekly). HIIT (n = 8) consisted of repeated work (2 min) at the speed equivalent to 95% \documentclass[12pt]{minimal}
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\begin{document}$${\dot{\text{V}}}$$\end{document}V˙O2 peak with equal rest. Repetitions were incremental (six in weeks 1, 2 and 6, eight in weeks 3 and 4 and ten in week 5). Participants were allocated to one of three training groups. MASK (n = 8) wore a flow-resistive mask during all sessions. The IMT group (n = 8) completed 2 × 30 breaths daily at 50% maximum inspiratory pressure (PImax). A control group (CON, n = 7) completed HIIT only. Following HIIT, participants completed two 5 km time trials, the first matched identically to pre-intervention trial (ISO time), and a self-paced effort. Results Time trial performance was improved in all groups (MASK 3.1 ± 1.7%, IMT, 5.7 ± 1.5% and CON 2.6 ± 1.0%, p < 0.05). IMT improved greater than MASK and CON (p = 0.004). Post intervention, PImax and diaphragm thickness were improved in IMT only (32% and 9.5%, respectively, p = 0.003 and 0.024). Conclusion A flow-resistive mask worn during HIIT provides no benefit to 5 km performance when compared to HIIT only. Supplementing HIIT with IMT improves respiratory muscle strength, morphology and performance greater than HIIT alone.
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Effects of home-based inspiratory muscle training on sickle cell disease (SCD) patients. Hematol Transfus Cell Ther 2020; 43:443-452. [PMID: 32967805 PMCID: PMC8573026 DOI: 10.1016/j.htct.2020.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 07/09/2020] [Accepted: 08/23/2020] [Indexed: 11/22/2022] Open
Abstract
Introduction Inspiratory muscle training (IMT) has been shown to be an efficient method of improving exercise tolerance and inspiratory and expiratory muscle strength in several diseases. The effects of IMT on patients with sickle cell anemia (SCD) are relatively unknown. Our study aimed to evaluate the effects of IMT on adult SCD patients, regarding respiratory muscle strength (RMS) variables, lung function, exercise tolerance, blood lactation concentration, limitation imposed by dyspnea during daily activities and impact of fatigue on the quality of life. Methods This was a randomized single-blind study, with an IMT design comprising true load (TG) and sham load (SG) groups. Initial assessment included spirometry, volumetric capnography (VCap) and measurement of RMS by maximal inspiratory and expiratory pressure (PImax and PEmax). The Medical Research Council dyspnea scale and modified fatigue impact scale were also applied and blood lactate concentration was measured before and after the 6-minute walk test. After this initial assessment, the patient used the IMT device at home daily, returning every 6 weeks for RMS reassessment. Both groups used the same device and were unaware of which group they were in. After a period totaling 18 weeks, patients underwent the final evaluation, as initially performed. Results Twenty-five patients in total participated until the end of the study (median age 42 years). There were no significant differences between TG and SG based on age, sex, body mass index or severity of genotype. At the end of the training, both groups showed a significant increase in PEmax and PImax, improvement in Vcap and in exercise tolerance and dyspnea reduction while performing daily life activities. The same was observed in patients grouped according to disease severity (HbSS and HbSβ0vs HbSC and HbSβ+), without differences between groups. Conclusion Home-based inspiratory muscle training benefits outpatients with SCD, including the sham load group. Trial registration http://www.ensaiosclinicos.gov.br; registration number: RBR-6g8n92.
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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: 0.4] [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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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: 1.0] [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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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: 2.7] [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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Leelarungrayub J, Pinkaew D, Puntumetakul R, Klaphajone J. Effects of a simple prototype respiratory muscle trainer on respiratory muscle strength, quality of life and dyspnea, and oxidative stress in COPD patients: a preliminary study. Int J Chron Obstruct Pulmon Dis 2017; 12:1415-1425. [PMID: 28553094 PMCID: PMC5440008 DOI: 10.2147/copd.s131062] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Background The aim of this study was to evaluate the efficiency of a simple prototype device for training respiratory muscles in lung function, respiratory muscle strength, walking capacity, quality of life (QOL), dyspnea, and oxidative stress in patients with COPD. Methods Thirty COPD patients with moderate severity of the disease were randomized into three groups: control (n=10, 6 males and 4 females), standard training (n=10, 4 males and 6 females), and prototype device (n=10, 5 males and 5 females). Respiratory muscle strength (maximal inspiratory pressure [PImax] and maximal expiratory pressure [PEmax]), lung function (forced vital capacity [FVC], percentage of FVC, forced expiratory volume in 1 second [FEV1], percentage of FEV1 [FEV1%], and FEV1/FVC), 6-minute walking distance (6MWD), QOL, and oxidative stress markers (total antioxidant capacity [TAC]), glutathione (GSH), malondialdehyde (MDA), and nitric oxide (NO) were evaluated before and after 6 weeks of training. Moreover, dyspnea scores were assessed before; during week 2, 4, and 6 of training; and at rest after training. Results All parameters between the groups had no statistical difference before training, and no statistical change in the control group after week 6. FVC, FEV1/FVC, PImax, PEmax, QOL, MDA, and NO showed significant changes after 6 weeks of training with either the standard or prototype device, compared to pre-training. FEV1, FEV1%, 6MWD, TAC, and GSH data did not change statistically. Furthermore, the results of significant changes in all parameters were not statistically different between training groups using the standard and prototype device. The peak dyspnea scores increased significantly in week 4 and 6 when applying the standard or prototype device, and then lowered significantly at rest after 6 weeks of training, compared to pre-training. Conclusion This study proposes that a simple prototype device can be used clinically in COPD patients as a standard device to train respiratory muscles, improving lung function and QOL, as well as involving MDA and NO levels.
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Affiliation(s)
- Jirakrit Leelarungrayub
- Department of Physical Therapy, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai
| | - Decha Pinkaew
- Department of Physical Therapy, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai
| | - Rungthip Puntumetakul
- Research Center in Back, Neck, Other Joint Pain and Human Performance (BNOJPH), Khon Kaen University, Khon Kaen
| | - Jakkrit Klaphajone
- Department of Rehabilitation Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
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Faghy M, Blacker S, Brown PI. Effects of load mass carried in a backpack upon respiratory muscle fatigue. Eur J Sport Sci 2016; 16:1032-8. [DOI: 10.1080/17461391.2016.1202326] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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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: 1.3] [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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Effects of an additional pressure support level on exercise duration in patients on prolonged mechanical ventilation. J Formos Med Assoc 2014; 114:1204-10. [PMID: 25304086 DOI: 10.1016/j.jfma.2014.09.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2013] [Revised: 09/01/2014] [Accepted: 09/02/2014] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND/PURPOSE Noninvasive positive pressure ventilation has been regarded as a strategy for improving exercise performance. Whether an increase in the ventilatory support level improves exercise performance in patients who have received invasive ventilation is unknown. The purpose of this study is to examine the effects of an additional level of pressure support (PS) ventilation on exercise tolerance in patients undergoing prolonged mechanical ventilation (PMV). METHODS This study examined 15 patients who were undergoing PMV. All patients performed an upper-arm exercise test at three PS levels: the baseline PS level (PS), a level 2 cmH2O higher than the baseline level (PS+2), and a level 4 cmH2O higher than the baseline level (PS+4). The physiological response, reasons for discontinuing the exercise test, and exercise duration were recorded and analyzed. RESULTS The tidal volume increased significantly from 271.7 ± 54.7 mL to 398.3 ± 88.7 mL at the PS+4 level (p = 0.01). Significant differences in exercise duration were observed at different PS levels. The exercise duration was significantly longer at the PS+4 level than at the PS and PS+2 levels (146.3 ± 139.9 seconds vs. 108.5 ± 85.9 seconds vs. 72.8 ± 43.9 seconds, p = 0.038) as their corresponding order. There were significant relationships between resting respiratory rate and exercise duration at the PS (r = -0.639, p = 0.034) and PS+2 levels (r = -0.668, p = 0.025). CONCLUSION In patients undergoing PMV, an additional PS level of up to 4 cmH2O compared with the baseline setting may help to improve exercise tolerance by prolonging exercise duration.
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Galvin HM, Cooke K, Sumners DP, Mileva KN, Bowtell JL. Repeated sprint training in normobaric hypoxia. Br J Sports Med 2014; 47 Suppl 1:i74-9. [PMID: 24282212 PMCID: PMC3903144 DOI: 10.1136/bjsports-2013-092826] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Repeated sprint ability (RSA) is a critical success factor for intermittent sport performance. Repeated sprint training has been shown to improve RSA, we hypothesised that hypoxia would augment these training adaptations. Thirty male well-trained academy rugby union and rugby league players (18.4±1.5 years, 1.83±0.07 m, 88.1±8.9 kg) participated in this single-blind repeated sprint training study. Participants completed 12 sessions of repeated sprint training (10×6 s, 30 s recovery) over 4 weeks in either hypoxia (13% FiO2) or normoxia (21% FiO2). Pretraining and post-training, participants completed sports specific endurance and sprint field tests and a 10×6 s RSA test on a non-motorised treadmill while measuring speed, heart rate, capillary blood lactate, muscle and cerebral deoxygenation and respiratory measures. Yo-Yo Intermittent Recovery Level 1 test performance improved after RS training in both groups, but gains were significantly greater in the hypoxic (33±12%) than the normoxic group (14±10%, p<0.05). During the 10×6 s RS test there was a tendency for greater increases in oxygen consumption in the hypoxic group (hypoxic 6.9±9%, normoxic (−0.3±8.8%, p=0.06) and reductions in cerebral deoxygenation (% changes for both groups, p=0.09) after hypoxic than normoxic training. Twelve RS training sessions in hypoxia resulted in twofold greater improvements in capacity to perform repeated aerobic high intensity workout than an equivalent normoxic training. Performance gains are evident in the short term (4 weeks), a period similar to a preseason training block.
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Johnson MA, Gregson IR, Mills DE, Gonzalez JT, Sharpe GR. Inspiratory muscle warm-up does not improve cycling time-trial performance. Eur J Appl Physiol 2014; 114:1821-30. [PMID: 24878690 DOI: 10.1007/s00421-014-2914-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Accepted: 05/15/2014] [Indexed: 11/30/2022]
Abstract
PURPOSE This study examined the effects of an active cycling warm-up, with and without the addition of an inspiratory muscle warm-up (IMW), on 10-km cycling time-trial performance. METHODS Ten cyclists (VO₂ = 65 ± 9 mL kg(-1) min(-1)) performed a habituation 10-km cycling time-trial and three further time-trials preceded by either no warm-up (CONT), a cycling-specific warm-up (CYC) comprising three consecutive 5-min bouts at powers corresponding to 70, 80, and 90% of the gas exchange threshold, or a cycling-specific warm-up preceded by an IMW (CYC + IMW) comprising two sets of 30 inspiratory efforts against a pressure-threshold load of 40% maximal inspiratory pressure (MIP). The cycling warm-up was followed by 2-min rest before the start of the time-trial. RESULTS Time-trial performance times during CYC (14.75 ± 0.79 min) and CYC + IMW (14.70 ± 0.75 min) were not different, although both were faster than CONT (14.99 ± 0.90 min) (P < 0.05). Throughout the time-trial, physiological (minute ventilation, breathing pattern, pulmonary gas exchange, heart rate, blood lactate concentration and pH) and perceptual (limb discomfort and dyspnoea) responses were not different between CYC and CYC + IMW. Baseline MIP during CONT and CYC was 151 ± 31 and 156 ± 39 cmH₂O, respectively, and was unchanged following the time-trial. MIP increased by 8% after IMW (152 ± 27 vs. 164 ± 27 cmH2O, P < 0.05) and returned to baseline after the time-trial. CONCLUSIONS Improvements in 10-km cycling time-trial performance following an active cycling warm-up were not magnified by the addition of an IMW. Therefore, an appropriately designed active whole-body warm-up does adequately prepare the inspiratory muscles for cycling time-trials lasting approximately 15 min.
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Affiliation(s)
- M A Johnson
- Sport, Health and Performance Enhancement (SHAPE) Research Group, School of Science and Technology, Nottingham Trent University, Nottingham, NG11 8NS, UK,
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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: 0.5] [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: 1.5] [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: 2.5] [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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Mills DE, Johnson MA, McPhilimey MJ, Williams NC, Gonzalez JT, Barnett YA, Sharpe GR. The effects of inspiratory muscle training on plasma interleukin-6 concentration during cycling exercise and a volitional mimic of the exercise hyperpnea. J Appl Physiol (1985) 2013; 115:1163-72. [DOI: 10.1152/japplphysiol.00272.2013] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
It is unknown whether the respiratory muscles contribute to exercise-induced increases in plasma interleukin-6 (IL-6) concentration, if this is related to diaphragm fatigue, and whether inspiratory muscle training (IMT) attenuates the plasma IL-6 response to whole body exercise and/or a volitional mimic of the exercise hyperpnea. 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, 2) cycling exercise at estimated maximal lactate steady state power (EX), and 3) volitional hyperpnea at rest, which mimicked the breathing and respiratory muscle recruitment patterns achieved during EX (HYPEX). Plasma IL-6 concentration remained unchanged during passive rest. The plasma IL-6 response to EX was reduced following IMT (main effect of intervention, P = 0.039) but not PLA ( P = 0.272). Plasma IL-6 concentration increased during HYPEX (main effect of time, P < 0.01) and was unchanged postintervention. There was no evidence of diaphragm fatigue (measured by phrenic nerve stimulation) following each trial. In conclusion, plasma IL-6 concentration is increased during EX and HYPEX and this occurred in the absence of diaphragm fatigue. Furthermore, IMT reduced the plasma IL-6 response to EX but not HYPEX. These findings suggest that the respiratory muscles contribute to exercise-induced increases in plasma IL-6 concentration in the absence of diaphragm fatigue and that IMT can reduce the magnitude of the response to exercise but not a volitional mimic of the exercise hyperpnea.
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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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Brown PI, Venables HK, Liu H, de-Witt JT, Brown MR, Faghy MA. Ventilatory muscle strength, diaphragm thickness and pulmonary function in world-class powerlifters. Eur J Appl Physiol 2013; 113:2849-55. [DOI: 10.1007/s00421-013-2726-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2013] [Accepted: 09/10/2013] [Indexed: 11/24/2022]
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Chiappa GR, Roseguini BT, Neder JA, Ribeiro JP. Inspiratory Loading and Lactate Clearance after Exercise. Med Sci Sports Exerc 2013; 45:212-3. [DOI: 10.1249/mss.0b013e31826aaba7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Johnson MA, Mills DE, Brown PI, Sharpe GR. RESPONSE. Med Sci Sports Exerc 2013; 45:214-5. [DOI: 10.1249/mss.0b013e31826aade2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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