Diaphragm and intercostal surface EMG and muscle performance after acute inspiratory muscle loading

Inspiratory muscles pre-activation in young swimmers submitted to a tethered swimming test: effects on mechanical, physiological, and skin temperature parameters

Inspiratory muscles pre-activation (IMPA) has been studied to improve subsequent performance in swimming. However, the effects of IMPA on various parameters in swimmers are still unknown. Therefore, this study aimed to investigate the effects of IMPA on the mechanical parameters, physiological responses, and their possible correlations with swimming performance. A total of 14 young swimmers (aged 16 ± 0 years) underwent a 30-s all-out tethered swimming test, preceded or not by IMPA, a load of 40% of the maximal inspiratory pressure (MIP), and with a volume of 2 sets of 15 repetitions. The mechanical (strength, impulse, and fatigue index) and physiological parameters (skin temperature and lactatemia) and the assessment of perceived exertion and dyspnea were monitored in both protocols. The IMPA used did not increase the swimming force, and skin temperature, decrease blood lactate concentration, or subjective perception of exertion and dyspnea after the high-intensity tethered swimming exercises. Positive correlations were found between mean force and blood lactate (without IMPA: r = 0.62, P = 0.02; with IMPA: r = 0.65, P = 0.01). The impulse was positively correlated with blood lactate (without IMPA: r = 0.71, P < 0.01; with IMPA: r = 0.56, P = 0.03). Our results suggest that new IMPA protocols, possibly with increased volume, should be developed in order to improve the performance of young swimmers.

Determining the Optimal Position of Surface Electrodes for Diaphragm Electromyography: A Cross-Sectional Study

BACKGROUND

Placing electrodes on different aspects of the chest determines the motor firing from the diaphragm. The electrode placement close to the extent of the muscle gave promising readings as compared to the ones that were placed away. The position with the maximum amplitude and least duration was chosen. Positions of the electrodes were decided as per the extent of the muscle. The aim is to determine the appropriate position of surface electrodes for surface diaphragm electromyography (EMG).

MATERIAL AND METHODOLOGY

Thirty healthy individuals of age ranging from 21 to 45 years were included in the study. Participants were made to lie down in a supine position and different positions like G1 (recording electrode) 5 cm superior to the tip of the xiphoid process and G2 (reference) 16 cm along the costal margin from G1, G1 over the xiphoid tip and G2 at the seventh intercostal space at the costochondral junction and G1 over the xiphoid tip and G2 at the eight intercostal space at the costochondral junction were used for assessing maximum amplitudes and durations were observed by using a Octopus New Wave EMG machine (Octopus Medical Technologies, Vadodara, IND). After observing all the positions, an optimum position for maximum amplitude and least duration was analyzed.

RESULTS

As per the study, out of the four positions, the electrode placements on the tip of the xiphoid process and 16 cm away diagonally on the sixth intercostal space showed maximum amplitude and the least duration with maximum mean amplitude and less mean duration of 232.35 and 7.316. On the seventh intercostal space it was 199.15 and 7.887 and on the eighth intercostal space was 176.055 and 8.639. The tip of the xiphoid process and 16 cm away diagonally on the sixth intercostal space is chosen as the appropriate position for electrode placement for EMG of the diaphragm.

CONCLUSION

We conclude that the best electrode position was when the electrodes were placed 5 cm superior to the xiphoid process, i.e., G1, and 16 cm away from the recording electrode on the costochondral junction, i.e., G2, at the sixth intercostal space. Ground electrode placement is the nearest bony prominence, i.e., xiphisternum.

Analysis and applications of respiratory surface EMG: report of a round table meeting

Surface electromyography (sEMG) can be used to measure the electrical activity of the respiratory muscles. The possible applications of sEMG span from patients suffering from acute respiratory failure to patients receiving chronic home mechanical ventilation, to evaluate muscle function, titrate ventilatory support and guide treatment. However, sEMG is mainly used as a monitoring tool for research and its use in clinical practice is still limited-in part due to a lack of standardization and transparent reporting. During this round table meeting, recommendations on data acquisition, processing, interpretation, and potential clinical applications of respiratory sEMG were discussed. This paper informs the clinical researcher interested in respiratory muscle monitoring about the current state of the art on sEMG, knowledge gaps and potential future applications for patients with respiratory failure.

Effects of high-intensity inspiratory muscle warm-up on inspiratory muscle strength and accessory inspiratory muscle activity

This study aimed to determine the effects of work-matched moderate-intensity and high-intensity inspiratory muscle warm-up (IMW) on inspiratory muscle strength and accessory inspiratory muscle activity. Eleven healthy men performed three IMWs at different intensities, namely, placebo, moderate-intensity, and high-intensity, set, respectively, at 15%, 40%, and 80% of maximal inspiratory mouth pressure (MIP). MIP was measured before and after IMW. Electromyography (EMG) was recorded for the sternocleidomastoid muscle (SCM) and intercostal muscles (IC) during IMW. MIP increased significantly in the moderate-intensity condition (104.2 ± 5.1%, p<0.05) and high-intensity condition (106.5 ± 6.2%, p<0.01) after IMW. The EMG amplitudes of the SCM and IC during IMW were significantly higher in the order of high-intensity, moderate-intensity, and placebo conditions. There was a significant correlation between changes in MIP and EMG amplitude of the SCM (r=0.60, p<0.01) and IC (r=0.47, p<0.01) during IMW. These findings suggest that high-intensity IMW increases neuromuscular activity in the accessory inspiratory muscles, which may improve inspiratory muscle strength.

Effects of Inspiratory Muscle Warm-Up on Physical Exercise: A Systematic Review

This study aimed to systematically review the literature to examine the effects of inspiratory-muscle warm-up (IMW) on the inspiratory, metabolic, respiratory and performance parameters of a main exercise performed by athletes and healthy and active individuals. Methods: This systematic review included randomized studies in English based on the criteria of the PICOS model. The exclusion criteria adopted were studies that applied inspiratory exercise to: i. promote long-term adaptations through inspiratory training (chronic responses); ii. obtain acute responses to inspiratory load (overload) during and in breaks from physical effort and in an inspiratory-exercise session (acute training effect); iii. evaluate the effects of IMW on participants with cardiorespiratory and/or metabolic disease. Data Sources: PubMed, Embase, MedLine, Scopus, SPORTDiscus and Google Scholar (until 17 January 2023). Results: Thirty-one studies were selected. The performance and respiratory parameters were the most investigated (77% and 74%, respectively). Positive effects of IMW were reported by 88% of the studies that investigated inspiratory parameters and 45% of those that evaluated performance parameters. Conclusions: The analyzed protocols mainly had positive effects on the inspiratory and performance parameters of the physical exercises. These positive effects of IMW are possibly associated with the contractile and biochemical properties of inspiratory muscles.

Functional assessment of respiratory muscles and lung capacity of CrossFit athletes

CrossFit is a high-intensity training related to physical fitness and respiratory capacity that can promote changes in lung function. This cross-sectional study was aimed at evaluating respiratory muscle strength, electromyographic (EMG) activity, and lung capacity in CrossFit athletes. Thirty subjects aged between 25 and 35 years were divided into groups: CrossFit athletes (n=15) and sedentary individuals without comorbidities (n=15). Respiratory muscle strength was evaluated using maximal inspiratory and expiratory pressures, lung capacity, and EMG of the sternocleidomastoid, serratus anterior, external intercostal, and diaphragm muscles at respiratory rest, maximal inspiration and expiration, and respiratory cycle. Data were tabulated and subjected to statistical analyses (t-test and Spearman test, P<0.05). Respiratory muscle strength on EMG of the sternocleidomastoid, serratus, external intercostal, and diaphragm muscles at the respiratory cycle and maximal forced inspiration and expiration were higher in the CrossFit athletes group than in the sedentary group without comorbidities. CrossFit athlete group showed significantly strong positive correlation between maximal inspiratory and expiratory muscle strengths (Spearman rho= 0.903, P=0.000), with increasing muscle strength during inspiration favoring an increase in strength during expiration. The forced vital capacity (FVC) and forced expiratory volume in 1 sec (FEV₁) also showed a significantly high positive correlation (Spearman rho=0.912, P=0.000) in the CrossFit athletes group, showing that higher FVC favors higher FEV₁. The results of this study suggest that improved fitness is based on increased respiratory muscle strength on EMG in CrossFit athletes.

Swimming performance, physiology, and post-activation performance enhancement following dryland transition phase warmup: A systematic review

Background

In swimming, the period between the end of the swimming warmup and the beginning of competition is critical to performance, here termed the transition phase. Several options are available during this phase, necessitating a systematic review to understand if optimal strategies exist.

Objectives

To synthesise and critically evaluate the current literature investigating land-based warmup interventions on subsequent performance in competitive swimmers.

Methods

A search of three electronic databases (PubMed, EBSCO SPORTDiscus and Web of Science) was conducted to identify original studies until February 2022. Selection criteria dictated that (i) a control condition was used, (ii) participants were ≥ 15 years of age, (iii) a pool-based warmup was done prior to the land-based warmup. A total of 25 articles met the selection criteria.

Results

Reducing the transition phase duration by at least half led to consistently faster time-trial times of between 1.1–1.5% for all included studies. Passive warmups using clothing interventions resulted in mostly faster time-trial’s of 0.4–0.8% with increases in skin temperature frequent, though little change occurred in core temperature. The methodology of passive respiratory warmups were vastly different with positive time-trial’s effects ranging between 0.9–1.1% for two studies, though one reported no meaningful difference. Active warmups led to consistently faster time-trial’s between 0.7–0.9%, though the unpinning factors are not clear. Warmups which combined passive and active options frequently led to faster time-trial’s between 0.8–3%. Upper and combined limb post-activation performance enhancement led to mostly unfavourable time-trial changes. Lower limb exclusive protocols results were inconsistent, with limited beneficial effects on time-trial or start performance reported following plyometric protocols. However, there does appear merit in heavier loaded lower limb protocols.

Conclusion

Each of a reduced transition phase length, and passive, active or combination warmup have demonstrated improvements in swimming performance. Conversely, PAPE protocols should be used with caution, especially when including the upper limbs.

Breathing pattern and muscle activity using different inspiratory resistance devices in children with MBS

Aim

The aim of this study was to evaluate the acute effects of different inspiratory resistance devices and intensity of loads via nasal airway on the breathing pattern and activity of respiratory muscles in children with mouth breathing syndrome (MBS).

Methods

Children with MBS were randomised into two groups based on inspiratory load intensity (20% and 40% of the maximal inspiratory pressure). These subjects were assessed during quiet breathing, breathing against inspiratory load via nasal airway and recovery. The measurements were repeated using two different devices (pressure threshold and flow resistance). Chest wall volumes and respiratory muscle activity were evaluated by optoelectronic plethysmography and surface electromyography, respectively.

Results

During the application of inspiratory load, there was a significant reduction in respiratory rate (p<0.04) and an increase in inspiratory time (p<0.02), total time of respiratory cycle (p<0.02), minute ventilation (p<0.03), tidal volume (p<0.01) and scalene and sternocleidomastoid muscles activity (root mean square values, p<0.01) when compared to quiet spontaneous breathing and recovery, regardless of load level or device applied. The application of inspiratory load using the flow resistance device showed an increase in the tidal volume (p<0.02) and end-inspiratory volume (p<0.02).

Conclusion

For both devices, the addition of inspiratory loads using a nasal interface had a positive effect on the breathing pattern. However, the flow resistance device was more effective in generating volume and, therefore, has advantages compared to pressure threshold.

In children with mouth breathing syndrome, adding inspiratory load using a nasal interface improves chest wall volumes and respiratory muscle activity, and a flow resistance device increases lung volume more than a pressure threshold devicehttps://bit.ly/3IzlayK

Inspiratory Muscle Warm-up Improves 3,200-m Running Performance in Distance Runners

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.

The Effect of Preexercise Expiratory Muscle Loading on Exercise Tolerance in Healthy Men

PURPOSE

Acute nonfatiguing inspiratory muscle loading transiently increases diaphragm excitability and global inspiratory muscle strength and may improve subsequent exercise performance. We investigated the effect of acute expiratory muscle loading on expiratory muscle function and exercise tolerance in healthy men.

METHODS

Ten males cycled at 90% of peak power output to the limit of tolerance (TLIM) after 1) 2 × 30 expiratory efforts against a pressure-threshold load of 40% maximal expiratory gastric pressure (PgaMAX) (EML-EX) and 2) 2 × 30 expiratory efforts against a pressure-threshold load of 10% PgaMAX (SHAM-EX). Changes in expiratory muscle function were assessed by measuring the mouth pressure (PEMAX) and PgaMAX responses to maximal expulsive efforts and magnetically evoked (1 Hz) gastric twitch pressure (Pgatw).

RESULTS

Expiratory loading at 40% of PgaMAX increased PEMAX (10% ± 5%, P = 0.001) and PgaMAX (9% ± 5%, P = 0.004). Conversely, there was no change in PEMAX (166 ± 40 vs 165 ± 35 cm H2O, P = 1.000) or PgaMAX (196 ± 38 vs 192 ± 39 cm H2O, P = 0.215) from before to after expiratory loading at 10% of PgaMAX. Exercise time was not different in EML-EX versus SHAM-EX (7.91 ± 1.96 vs 8.09 ± 1.77 min, 95% CI = -1.02 to 0.67, P = 0.651). Similarly, exercise-induced expiratory muscle fatigue was not different in EML-EX versus SHAM-EX (-28% ± 12% vs -26% ± 7% reduction in Pgatw amplitude, P = 0.280). Perceptual ratings of dyspnea and leg discomfort were not different during EML-EX versus SHAM-EX.

CONCLUSION

Acute expiratory muscle loading enhances expiratory muscle function but does not improve subsequent severe-intensity exercise tolerance in healthy men.

Neurophysiological Changes in the First Year After Cell Transplantation in Sub-acute Complete Paraplegia

Neurophysiological testing can provide quantitative information about motor, sensory, and autonomic system connectivity following spinal cord injury (SCI). The clinical examination may be insufficiently sensitive and specific to reveal evolving changes in neural circuits after severe injury. Neurophysiologic data may provide otherwise imperceptible circuit information that has rarely been acquired in biologics clinical trials in SCI. We reported a Phase 1 study of autologous purified Schwann cell suspension transplantation into the injury epicenter of participants with complete subacute thoracic SCI, observing no clinical improvements. Here, we report longitudinal electrophysiological assessments conducted during the trial. Six participants underwent neurophysiology screening pre-transplantation with three post-transplantation neurophysiological assessments, focused on the thoracoabdominal region and lower limbs, including MEPs, SSEPs, voluntarily triggered EMG, and changes in GSR. We found several notable signals not detectable by clinical exam. In all six participants, thoracoabdominal motor connectivity was detected below the clinically assigned neurological level defined by sensory preservation. Additionally, small voluntary activations of leg and foot muscles or positive lower extremity MEPs were detected in all participants. Voluntary EMG was most sensitive to detect leg motor function. The recorded MEP amplitudes and latencies indicated a more caudal thoracic level above which amplitude recovery over time was observed. In contrast, further below, amplitudes showed less improvement, and latencies were increased. Intercostal spasms observed with EMG may also indicate this thoracic “motor level.” Galvanic skin testing revealed autonomic dysfunction in the hands above the injury levels. As an open-label study, we can establish no clear link between these observations and cell transplantation. This neurophysiological characterization may be of value to detect therapeutic effects in future controlled studies.

Differences in Respiratory Muscle Responses to Hyperpnea or Loaded Breathing in COPD

INTRODUCTION

We aimed to compare acute mechanical and metabolic responses of the diaphragm and rib cage inspiratory muscles during two different types of respiratory loading in patients with chronic obstructive pulmonary disease.

METHODS

In 16 patients (age, 65 ± 13 yr; 56% male; forced expiratory volume in the first second, 60 ± 6%pred; maximum inspiratory pressure, 82 ± 5%pred), assessments of respiratory muscle EMG, esophageal pressure (Pes) and gastric pressures, breathing pattern, and noninvasive assessments of systemic (V˙O2, cardiac output, oxygen delivery and extraction) and respiratory muscle hemodynamic and oxygenation responses (blood flow index, oxygen delivery index, deoxyhemoglobin concentration, and tissues oxygen saturation [StiO2]), were performed during hyperpnea and loaded breathing.

RESULTS

During hyperpnea, breathing frequency, minute ventilation, esophageal and diaphragm pressure-time product per minute, cardiac output, and V˙O2 were higher than during loaded breathing (P < 0.05). Average inspiratory Pes and transdiaphragmatic pressure per breath, scalene (SCA), sternocleidomastoid, and intercostal muscle activation were higher during loading breathing compared with hyperpnea (P < 0.05). Higher transdiaphragmatic pressure during loaded breathing compared with hyperpnea was mostly due to higher inspiratory Pes (P < 0.05). Diaphragm activation, inspiratory and expiratory gastric pressures, and rectus abdominis muscle activation did not differ between the two conditions (P > 0.05). SCA-blood flow index and oxygen delivery index were lower, and SCA-deoxyhemoglobin concentration was higher during loaded breathing compared with hyperpnea. Furthermore, SCA and intercostal muscle StiO2 were lower during loaded breathing compared with hyperpnea (P < 0.05).

CONCLUSION

Greater inspiratory muscle effort during loaded breathing evoked larger rib cage and neck muscle activation compared with hyperpnea. In addition, lower SCA and intercostal muscle StiO2 during loaded breathing compared with hyperpnea indicates a mismatch between inspiratory muscle oxygen delivery and utilization induced by the former condition.

A flow resistive inspiratory muscle training mask worn during high-intensity interval training does not improve 5 km running time-trial performance

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} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \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 (P_Imax). 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, P_Imax 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.

Effect of laterotrusive occlusal scheme on chewing duration, external intercostal muscular activity, heart rate, and oxygen saturation

Objective: To evaluate the effect of the laterotrusive occlusal scheme on chewing duration, external intercostal (EIC) electromyographic (EMG) activity, heart rate (HR), and oxygen saturation (OS) during different tasks in the upright seated position.Methods: Fifty young participants, 25 with canine guidance and 25 with group function, were included. Chewing duration, bilateral EIC EMG activity, HR, and OS were recorded during the following tasks: 1) chewing until swallowing threshold; 2) laterotrusive teeth grinding.Results: Chewing duration, bilateral EIC EMG activity, HR, and OS showed no significant differences between the two laterotrusive occlusal schemes during the tasks studied.Conclusion: These results suggest that chewing duration, EIC muscle activity, HR, and OS were not significantly influenced by the laterotrusive occlusal scheme. Therefore, when a modification of the laterotrusive occlusal scheme is needed during oral rehabilitation or orthodontic treatment, canine guidance or group function should not significantly change EMG activity of EIC muscles.

Functional training of the inspiratory muscles improves load carriage performance

Inspiratory Muscle Training (IMT) whilst adopting body positions that mimic exercise (functional IMT; IMT_F) improves running performance above traditional IMT methods in unloaded exercise. We investigated the effect of IMT_F 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 (LC_TT) 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 IMT_F (comprising four inspiratory loaded core exercises) or maintenance IMT (IMT_CON). Baseline LC_TT 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, LC_TT increased in IMT_F only (13.59 ± 2.33 min, p < 0.05) and was unchanged in post-IMT_CON. Performance was increased following IMT_F, 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; IMT_CON: inspiratory muscle training maintenance; IMT_F: functional inspiratory muscle training; LC: load carriage; LC_TT: load carriage time trial; P_di: transdiaphragmatic pressure; PEF: peak expiratory flow; P_Emax: maximum expiratory mouth pressure; P_Imax: maximum inspiratory mouth pressure; RPE: rating of perceived exertion; RPE_breating: rating of perceived exertion for the breathing; RPE_leg: rating of perceived exertion for the legs; SEPT: sport-specific endurance plank test; V̇ O₂: oxygen consumption; V̇ O_2peak: peak oxygen consumption.

Dataset from spirometer and sEMG wireless sensor for diaphragmatic respiratory activity monitoring

We introduce a dataset to provide insights into the relationship between the diaphragm surface electromyographic (sEMG) signal and the respiratory air flow. The data presented had been originally collected for a research project jointly developed by the Department of Information Engineering and the Department of Industrial Enginering and Mathematical Sciences, Polytechnic University of Marche, Ancona, Italy. This article describes data recorded from 8 subjects, and includes 8 air flow and 8 surface electromyographic (sEMG) signals for diaphragmatic respiratory activity monitoring, measured with a sampling frequency of 2 kHz.

Acute Effects of Inspiratory Loads and Interfaces on Breathing Pattern and Activity of Respiratory Muscles in Healthy Subjects

Objectives

The aim of this study was to evaluate the acute effects of different inspiratory loads and different interfaces on the breathing pattern and activity of the respiratory muscles.

Methods

Twenty healthy adults were recruited and assigned to two groups (20 and 40% of the Maximal Inspiratory Pressure) by way of randomized crossover allocation. Subjects were evaluated during quiet breathing, breathing against inspiratory load, and recovery. The measurements were repeated using two different interfaces (nasal and oral). Chest wall volumes and respiratory muscle activity were assessed with optoelectronic plethysmography and surface electromyography, respectively.

Results

During the application of inspiratory load, significant changes were observed in the respiratory rate (p < 0.04), inspiratory time (p < 0.02), minute ventilation (p < 0.04), tidal volume (p < 0.01), end-inspiratory volume (p < 0.04), end-expiratory volume (p < 0.03), and in the activity of the scalene, sternocleiomastoid, and parasternal portion of the intercostal muscles (RMS values, p < 0.01) when compared to quiet breathing, regardless of the load level or the interface applied. Inspiratory load application yielded significant differences between using nasal and oral interfaces with an increase in the tidal volume (p < 0.01), end-inspiratory volume (p < 0.01), and electrical activity of the scalene and sternocleiomastoid muscles (p < 0.01) seen with using the nasal interface.

Conclusion

The addition of an inspiratory load has a significant effect on the breathing pattern and respiratory muscle electrical activity, and the effects are greater when the nasal interface is applied.

Surface electromyography in inspiratory muscles in adults and elderly individuals: A systematic review

INTRODUCTION

Electromyography (EMG) helps to evaluate disorders and pulmonary behavior, as impairments in respiratory muscle function are associated with the development of diseases. There is a wide range of methods and protocols used to record and analyze EMG obtained from respiratory muscles, demonstrating a lack of standardization.

OBJECTIVE

To identify the most common procedures used to record surface EMG (sEMG) of inspiratory muscles in adults and elderly individuals through a systematic review (primary), and to evaluate the quality of the report presented by the studies (secondary).

METHOD

Studies published from January 1995 until June 2018 were searched for in the Web of Science, PubMed, LILACS, EBSCO and Embase databases. Only studies evaluating sEMG of inspiratory muscles were included.

RESULTS

The electronic search retrieved a total of 6697 titles and 92 of them were included. A great variability on the methods applied to both recording and processing/analyzing data was found. Therefore, the synthesis of practical/clinical evidence to support immediate recommendations was impaired. In general, the descriptions presented by the studies are poor.

CONCLUSION

The most common procedures used for sEMG were identified. Methodological studies with objective comparisons were fundamental for improving standardization, given the impossibility of recommendations from this review.

Changes in training posture induce changes in the chest wall movement and respiratory muscle activation during respiratory muscle training

Postural changes induce changes in chest wall kinematics and eventually pulmonary function, and affect chest wall shape and chest motion. This study aimed to examine the effects of postural change on changes in the chest wall during respiratory muscle training. Using a repeated measures design, this study followed 13 healthy adults (13 men; mean age, 23.73 years). All participants performed four postures (neutral, full trunk rotation, half-range trunk rotation, and lateral ribcage shift postures) during respiratory muscle training. The chest wall movement during the four postures was measured using a three-dimensional motion-analysis system during respiratory muscle training. Surface electromyography data were collected from the diaphragm and sternocleidomastoid muscles, and the asymmetric ratio of muscle activation was calculated based on the collected data. The chest wall movements of the upper costal and middle costal region were greater in the neutral posture than in the full rotation, half rotation, and lateral ribcage shift postures (P<0.05). The respiratory muscle activation on diaphragm of left was greater in the full rotation posture than in the neutral posture, half rotation, and lateral ribcage shift postures (P<0.05). The asymmetric ratio of muscle activation was greater in the full rotation posture than in the neutral posture, half rotation, and lateral ribcage shift postures (P<0.05). This study verified that postural change during respiratory muscle training may affect chest wall movement and muscle activation. Thus, this study recommends respiratory muscle training to be performed in neutral posture.

Surface mechanomyography and electromyography provide non-invasive indices of inspiratory muscle force and activation in healthy subjects

The current gold standard assessment of human inspiratory muscle function involves using invasive measures of transdiaphragmatic pressure (Pdi) or crural diaphragm electromyography (oesEMGdi). Mechanomyography is a non-invasive measure of muscle vibration associated with muscle contraction. Surface electromyogram and mechanomyogram, recorded transcutaneously using sensors placed over the lower intercostal spaces (sEMGlic and sMMGlic respectively), have been proposed to provide non-invasive indices of inspiratory muscle activation, but have not been directly compared to gold standard Pdi and oesEMGdi measures during voluntary respiratory manoeuvres. To validate the non-invasive techniques, the relationships between Pdi and sMMGlic, and between oesEMGdi and sEMGlic were measured simultaneously in 12 healthy subjects during an incremental inspiratory threshold loading protocol. Myographic signals were analysed using fixed sample entropy (fSampEn), which is less influenced by cardiac artefacts than conventional root mean square. Strong correlations were observed between: mean Pdi and mean fSampEn |sMMGlic| (left, 0.76; right, 0.81), the time-integrals of the Pdi and fSampEn |sMMGlic| (left, 0.78; right, 0.83), and mean fSampEn oesEMGdi and mean fSampEn sEMGlic (left, 0.84; right, 0.83). These findings suggest that sMMGlic and sEMGlic could provide useful non-invasive alternatives to Pdi and oesEMGdi for the assessment of inspiratory muscle function in health and disease.

Effects of diaphragm and deep abdominal muscle exercise on walking and balance ability in patients with hemiplegia due to stroke

The aim of this study was to investigate the effects of diaphragm and deep abdominal muscle exercise (DDAME) on walking ability (WA) and balance ability (BA) in subjects with hemiplegia due to stroke. Study subjects consisted of twenty patients diagnosed with hemiplegia due to stroke. They were randomized into a control group (CG) (n=10) that performed traditional exercise and an experimental group (EG) (n=10) that performed DDAME. The WA was measured using the 10-m walking test (10MWT) and 6-min walk test (6MWT). The BA was measured using the Timed Up and Go test (TUG) and Berg’s balance scale (BBS). Paired t-test was performed to compare differences within the groups before and after intervention. The analysis of covariance was performed to compare the differences between the EG and CG. The level of significance was set at α=0.05. Within-group changes in 10MWT and 6MWT were significantly different in both the EG (P<0.05) and CG (P<0.05). There was significantly more improvement in the 10MWT and 6MWT in the EG than in the CG (P<0.05). Within-group changes in TUG and BBS were significantly different in both the EG (P<0.05) and the CG (P<0.05). There was significantly more improvement in TUG and BBS in the EG than in the CG (P<0.05). DDAME program, with diaphragm and inspiratory muscle strengthening exercises, is needed for patients experiencing difficulty in WA, BA, trunk asymmetry, abnormal alignment, mobility of trunk muscles, power, or endurance decline.

Surface electromyographic evaluation of the neuromuscular activation of the inspiratory muscles during progressively increased inspiratory flow under inspiratory-resistive loading

This study aimed to evaluate neuromuscular activation in the scalene and sternocleidomastoid muscles using surface electromyography (EMG) during progressively increased inspiratory flow, produced by increasing the respiratory rate under inspiratory-resistive loading using a mask ventilator. Moreover, we attempted to identify the EMG inflection point (EMG^IP) on the graph, at which the root mean square (RMS) of the EMG signal values of the inspiratory muscles against the inspiratory flow velocity acceleration abruptly increases, similarly to the EMG anaerobic threshold (EMG^AT) reported during incremental-resistive loading in other skeletal muscles. We measured neuromuscular activation of healthy male subjects and found that the inspiratory flow velocity increased by approximately 1.6-fold. We successfully observed an increase in RMS that corresponded to inspiratory flow acceleration with ρ ≥ 0.7 (Spearman's rank correlation) in 17 of 27 subjects who completed the experimental protocol. To identify EMG^IP, we analyzed the fitting to either a straight or non-straight line related to the increasing inspiratory flow and RMS using piecewise linear spline functions. As a result, EMG^IP was identified in the scalene and sternocleidomastoid muscles of 17 subjects. We believe that the identification of EMG^IP in this study infers the existence of EMG^AT in inspiratory muscles. Application of surface EMG, followed by identification of EMG^IP, for evaluating the neuromuscular activation of respiratory muscles may be allowed to estimate the signs of the respiratory failure, including labored respiration, objectively and non-invasively accompanied using accessory muscles in clinical respiratory care.

Surface electromyography (sEMG) of extradiaphragm respiratory muscles in healthy subjects: A systematic review

The aim of this systematic review was to examine procedures used and outcome measures reported from surface EMG (sEMG) of extradiaphragm inspiratory muscles in healthy people. Relevant articles were searched using the concepts "electromyography (EMG)", "respiratory muscles (sternocleidomastoid [SM], scalene, intercostal [IC] and parasternal)" and "healthy" in the electronic databases: MEDLINE, PubMed, EMBASE, Cochrane CENTRAL and Database of Systematic Reviews, CINAHL, SPORTDiscus, LILACS, and PEDro. Twenty-five papers were included and quality assessment was performed using an adapted Downs and Black checklist. Twenty-eight percent of included papers were classified as moderate quality and the rest were low quality. The SM was the muscle most often investigated. Description of EMG techniques were often incomplete for features such as the procedure before electrode placement, description of the surface electrodes, the EMG detection mode and amplification. Of note, descriptions of the IC muscle electrode positioning varied widely. Comparison of outcomes among studies was challenging because of the very diverse EMG outcomes reported. There are many controversies regarding methods and technique used to assess sEMG of extradiaphragm inspiratory muscles. Therefore, studies with higher methodological quality utilizing standardized EMG procedures including electrode positioning will enable accurate and reliable comparison among studies of the extradiaphragm inspiratory muscles.

Combined respiratory muscle training facilitates expiratory muscle activity in stroke patients

[Purpose] The aim of this study was to investigate the effect of combined respiratory muscle training on expiratory muscle activity in stroke patients. [Subjects and Methods] Twenty-five stroke patients were assigned to either the intervention group (n=12) or the control group (n=13). Both groups participated in a conventional stroke rehabilitation program, while the intervention group also received respiratory muscle training for 20 to 30 minutes a day, 3 times a week, for 8 weeks. Surface electromyographic data were collected from the rectus abdominis, internal oblique, and external oblique on the paretic side. Pulmonary function (forced vital capacity) and cough capacity (peak expiratory flow) also were measured. [Results] Both groups showed a significant increase in muscle activity after the intervention. However, the intervention group also showed significant increases in forced vital capacity and peak expiratory flow. Comparison of the 2 groups revealed that the intervention group had greater improvements in pulmonary function, cough capacity, and muscle activity. [Conclusion] The results of this study suggest that combined respiratory muscle training has positive effects on both respiratory function and expiratory muscle activity in stroke patients.

Activation of respiratory muscles during respiratory muscle training

It is unknown which respiratory muscles are mainly activated by respiratory muscle training. This study evaluated Inspiratory Pressure Threshold Loading (IPTL), Inspiratory Flow Resistive Loading (IFRL) and Voluntary Isocapnic Hyperpnea (VIH) with regard to electromyographic (EMG) activation of the sternocleidomastoid muscle (SCM), parasternal muscles (PARA) and the diaphragm (DIA) in randomized order. Surface EMG were analyzed at the end of each training session and normalized using the peak EMG recorded during maximum inspiratory maneuvers (Sniff nasal pressure: SnPna, maximal inspiratory mouth occlusion pressure: PImax). 41 healthy participants were included. Maximal activation was achieved for SCM by SnPna; the PImax activated predominantly PARA and DIA. Activations of SCM and PARA were higher in IPTL and VIH than for IFRL (p<0.05). DIA was higher applying IPTL compared to IFRL or VIH (p<0.05). IPTL, IFRL and VIH differ in activation of inspiratory respiratory muscles. Whereas all methods mainly stimulate accessory respiratory muscles, diaphragm activation was predominant in IPTL.

Whole-body active warm-up and inspiratory muscle warm-up do not improve running performance when carrying thoracic loads

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 (P_Imax), (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 P_Imax was similar between trials and increased by 7% and 6% following IMW and AWU+IMW (P < 0.05). Relative to baseline, pooled P_Imax 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.

Relative activity of respiratory muscles during prescribed inspiratory muscle training in healthy people

[Purpose] This study aimed to determine the effects of different intensities of inspiratory muscle training on the relative respiratory muscle activity in healthy adults. [Subjects and Methods] Thirteen healthy male volunteers were instructed to perform inspiratory muscle training (0%, 40%, 60%, and 80% maximal inspiratory pressure) on the basis of their individual intensities. The inspiratory muscle training was performed in random order of intensities. Surface electromyography data were collected from the right-side diaphragm, external intercostal, and sternocleidomastoid, and pulmonary functions (forced expiratory volume in 1 s, forced vital capacity, and their ratio; peak expiratory flow; and maximal inspiratory pressure) were measured. [Results] Comparison of the relative activity of the diaphragm showed significant differences between the 60% and 80% maximal inspiratory pressure intensities and baseline during inspiratory muscle training. Furthermore, significant differences were found in sternocleidomastoid relative activity between the 60% and 80% maximal inspiratory pressure intensities and baseline during inspiratory muscle training. [Conclusion] During inspiratory muscle training in the clinic, the patients were assisted (verbally or through feedback) by therapists to avoid overactivation of their accessory muscles (sternocleidomastoid). This study recommends that inspiratory muscle training be performed at an accurate and appropriate intensity through the practice of proper deep breathing.

The effects of breathing exercise types on respiratory muscle activity and body function in patients with mild chronic obstructive pulmonary disease

[Purpose] Fragmentary studies on characteristics of respiratory muscles are being done to increase respiratory capacity by classifying exercises into voluntary respiratory exercise which relieves symptoms and prevents COPD and exercise using breathing exercise equipment. But this study found changes on respiratory pattern through changes on the activity pattern of agonist and synergist respiratory muscles and studied what effect they can have on body function improvement. [Subjects and Methods] Fifteen subjects in experimental group I that respiratory exercise of diaphragm and 15 subjects in experimental group II that feedback respiratory exercise were randomly selected among COPD patients to find the effective intervention method for COPD patients. And intervention program was conducted for 5 weeks, three times a week, once a day and 30 minutes a session. They were measured with BODE index using respiratory muscle activity, pulmonary function, the six-minute walking test, dyspnea criteria and BMI Then the results obtained were compared and analyzed. [Results] There was a significant difference in sternocleidomastoid muscle and scalene muscle and in 6-minute walk and BODE index for body function. Thus the group performing feedback respiratory had more effective results for mild COPD patients. [Conclusion] Therefore, the improvement was significant regarding the activity of respiratory muscles synergists when breathing before doing breathing exercise. Although, it is valuable to reduce too much mobilization of respiratory muscles synergists through the proper intervention it is necessary to study body function regarding improvement of respiratory function for patients with COPD.

Inspiratory muscle warm-up has no impact on performance or locomotor muscle oxygenation during high-intensity intermittent sprint cycling exercise

The purpose of this study was to investigate the effect of inspiratory muscle (IM) warm-up on performance and locomotor muscle oxygenation during high-intensity intermittent sprint cycling exercise. Ten subjects performed identical exercise tests (10 × 5 s with 25-s recovery on a cycle ergometer) after performing one of two different IM warm-up protocols. The IM warm-up consisted of two sets of 30 inspiratory efforts against a pressure-threshold load equivalent to 15 % (PLA) or 40 % (IMW) of maximal inspiratory pressure (MIP). MIP was measured with a portable autospirometer. Peak power and percent decrease in power were determined. Oxyhemoglobin (O₂Hb) was measured using near-infrared spectroscopy. The MIP increased relative to baseline after IMW (115 ± 21 vs. 123 ± 17 cmH₂O, P = 0.012, ES = 0.42), but not after PLA (115 ± 20 vs. 116 ± 17 cmH₂O). Peak power (PLA: 10.0 ± 0.6 vs. IMW: 10.2 ± 0.5 W kg⁻¹), percent decrease in power (PLA: 13.4 ± 5.6 vs. IMW: 13.2 ± 5.5 %), and changes in O₂Hb levels (PLA: −10.8 ± 4.8 vs. −10.7 ± 4.1 μM) did not differ between the trials. IM function was improved by IMW. However, this did not enhance performance or locomotor muscle oxygenation during high-intensity intermittent sprint cycling exercise in untrained healthy males.

Inspiratory muscle warm-up does not improve cycling time-trial performance

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.

Effect of training on inspiratory load compensation in weaned and unweaned mechanically ventilated ICU patients

BACKGROUND

While inspiratory muscle weakness is common in prolonged mechanical ventilation, inspiratory muscle strength training (IMST) can facilitate strengthening and ventilator weaning. However, the inspiratory load compensation (ILC) responses to threshold loads are not well characterized in patients. We retrospectively compared ILC responses according to the clinical outcomes of IMST (ie, maximum inspiratory pressure [PImax], weaning outcome), in difficult-to-wean ICU patients.

METHODS

Sixteen tracheostomized subjects (10 weaned, 6 unweaned) from a previous clinical trial underwent IMST 5 days/week, at the highest tolerated load, in conjunction with daily, progressive spontaneous breathing trials. PImax and ILC with a 10 cm H2O load were compared in the subjects before and after IMST. Changes in ILC performance were further characterized (5, 10, 15 cm H2O loads) in the trained subjects who weaned.

RESULTS

Demographics, respiratory mechanics, and initial PImax (52 ± 26 cm H2O vs 42 ± 13 cm H2O) did not significantly differ between the groups. Upon enrollment, PImax significantly correlated with flow ILC responses with the 10 cm H2O load (r = 0.64, P = .008). After IMST, PImax significantly increased in the entire sample (P = .03). Both before and after IMST, subjects who weaned generated greater flow and volume ILC than subjects who failed to wean. Additionally, ILC flow, tidal volume, and duty cycle increased upon ventilator weaning, at loads of 5, 10, and 15 cm H2O.

CONCLUSIONS

Flow ILC at a threshold load of 10 cm H2O in ventilated, tracheostomized subjects positively correlated with PImax. Although PImax improved in both groups, the flow and volume ILC responses of the weaned subjects were more robust, both before and after IMST. The results suggest that ILC response is different in weaned and unweaned subjects, reflecting dynamic inspiratory muscular efforts that could be influential in weaning.

Effects of body positions on respiratory muscle activation during maximal inspiratory maneuvers

We evaluated the maximal mouth inspiratory pressure and the EMG patterns of major respiratory and accessory muscles used in the generation of voluntary inspiratory maneuvers during different body positions. Ten healthy subjects (F/M-4/6), the mean age 22.000B10.6 years, participated in the study. The maximal inspiratory mouth pressure (MIP) during Müller's maneuver was measured from residual volume in the standing, sitting, right-sided (RSL) and left-sided lying (LSL), supine, and head-down-tilt (HDT) (3000B0; relatively horizon) positions. EMG of the diaphragmatic (D), parasternal (PS), sternocleidomastoid (SM), and genioglossus (GG) muscles were assessed in each body position. The baseline MIP was 105.3 00B1; 12.0 in men and 59.9 00B110.1 cmH(2)O in women in the standing position and did not appreciable differ in the other positions, except the HDT where it was lower by 23 and 27% in men and women, respectively (P003C0.05). During Müllers maneuver, diaphragmatic EMG activity also was similar in all the body positions, but it was significantly enhanced in the HDT. In contrast, PS EMG showed the highest level of activation in the standing position, taken as the control, reference level, and was lower in the HDT. Activation of SM during the maneuver was near the control in the sitting position, lower in the supine (79%), RSL (85%), LSL (80%), and HDT (72%) positions (P 003C0.05). GG EMG was significantly greater during maximal inspiratory effort in the supine and HDT positions (125and 130%, respectively), while it was lower in the sitting, LRS, and LLS positions (76, 57, and 43%) compared with standing (P 003C; 0.05). We conclude that the inspiratory pressure generated during Muller maneuver is a reflection of complex interactions between several muscle groups during changes in body positions.

The effect of inspiratory muscle training on high-intensity, intermittent running performance to exhaustion

The effects of inspiratory muscle (IM) training on maximal 20 m shuttle run performance (Ex) during Yo-Yo intermittent recovery test and on the physiological and perceptual responses to the running test were examined. Thirty men were randomly allocated to 1 of 3 groups. The experimental group underwent a 6 week pressure threshold IM training program by performing 30 inspiratory efforts twice daily, 6 d/week, against a load equivalent to 50% maximal static inspiratory pressure. The placebo group performed the same training procedure but with a minimal inspiratory load. The control group received no training. In post-intervention assessments, IM function was enhanced by >30% in the experimental group. The Ex was improved by 16.3% ± 3.9%, while the rate of increase in intensity of breathlessness (RPB/4i) was reduced by 11.0% ± 6.2%. Further, the whole-body metabolic stress reflected by the accumulations of plasma ammonia, uric acid, and blood lactate during the Yo-Yo test at the same absolute intensity was attenuated. For the control and placebo groups, no significant change in these variables was observed. In comparison with previous observations that the reduced RPB/4i resulting from IM warm-up was the major reason for improved Ex, the reduced RPB/4i resulting from the IM training program was lower despite the greater enhancement of IM function, whereas improvement in Ex was similar. Such findings suggest that although both IM training and warm-up improve the tolerance of intense intermittent exercise, the underlying mechanisms may be different.

Specific inspiratory muscle warm-up enhances badminton footwork performance

The effects of inspiratory muscle (IM) warm-up on IM function and on the maximum distance covered in a subsequent incremental badminton-footwork test (FWmax) were examined. Ten male badminton players were recruited to perform identical tests in three different trials in a random order. The control trial did not involve an IM warm-up, whereas the placebo and experimental trials did involve an IM warm-up consisting of two sets of 30-breath manoeuvres with an inspiratory pressure-threshold load equivalent to 15% (PLA) and 40% (IMW) maximum inspiratory mouth pressure, respectively. In the IMW trial, IM function was improved with 7.8%+/-4.0% and 6.9%+/-3.5% increases from control found in maximal inspiratory pressure at zero flow (P0) and maximal rate of P0 development (MRPD), respectively (p<0.05). FWmax was enhanced 6.8%+/-3.7%, whereas the slope of the linear relationship of the increase in the rating of perceived breathlessness for every minute (RPB/min) was reduced (p<0.05). Reduction in blood lactate ([La-]b) accumulation was observed when the test duration was identical to that of the control trial (P<0.05). In the PLA trial, no parameter was changed from control. For the changes (Delta) in parameters in IMW (n=10), negative correlations were found between DeltaP0 and DeltaRPB/min (r2=0.58), DeltaMRPD and DeltaRPB/min (r2=0.48), DeltaRPB/min, and DeltaFWmax (r2=0.55), but not between Delta[La-]b accumulation and DeltaFWmax. Such findings suggest that the IM-specific warm-up improved footwork performance in the subsequent maximum incremental badminton-footwork test. The improved footwork was partly attributable to the reduced breathless sensation resulting from the enhanced IM function, whereas the contribution of the concomitant reduction in [La-]b accumulation was relatively minor.