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Reed BL, Tavoian D, Bailey EF, Funk JL, Coletta DK. Inspiratory muscle strength training to improve cardiometabolic health in patients with type 2 diabetes mellitus: protocol for the diabetes inspiratory training clinical trial. Front Endocrinol (Lausanne) 2024; 15:1383131. [PMID: 39345888 PMCID: PMC11427269 DOI: 10.3389/fendo.2024.1383131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Accepted: 08/28/2024] [Indexed: 10/01/2024] Open
Abstract
Type 2 diabetes mellitus (T2DM) is a complex, chronic metabolic disease that carries with it a high prevalence of comorbid conditions, making T2DM one of the leading causes of death in the U.S. Traditional lifestyle interventions (e.g., diet, exercise) can counter some adverse effects of T2DM, however, participation in these activities is low with reasons ranging from physical discomfort to lack of time. Thus, there is a critical need to develop novel management strategies that effectively reduce cardiometabolic disease risk and address barriers to adherence. High-resistance inspiratory muscle strength training (IMST) is a time-efficient and simple breathing exercise that significantly reduces systolic and diastolic BP and improves vascular endothelial function in adults with above-normal blood pressure. Herein we describe the study protocol for a randomized clinical trial to determine the effects of a 6-week IMST regimen on glycemic control and insulin sensitivity in adults with T2DM. Our primary outcome measures include fasting plasma glucose, fasting serum insulin, and insulin resistance utilizing homeostatic model assessment for insulin resistance (HOMA-IR). Secondary outcome measures include resting systolic BP and endothelium-dependent dilation. Further, we will collect plasma for exploratory proteomic analyses. This trial seeks to establish the cardiometabolic effects of 6 weeks of high-resistance IMST in patients with T2DM.
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Affiliation(s)
- Baylee L Reed
- Department of Physiology, University of Arizona, Tucson, AZ, United States
| | - Dallin Tavoian
- Department of Physiology, University of Arizona, Tucson, AZ, United States
| | - E Fiona Bailey
- Department of Physiology, University of Arizona, Tucson, AZ, United States
| | - Janet L Funk
- Department of Medicine, Division of Endocrinology, University of Arizona, Tucson, AZ, United States
| | - Dawn K Coletta
- Department of Physiology, University of Arizona, Tucson, AZ, United States
- Department of Medicine, Division of Endocrinology, University of Arizona, Tucson, AZ, United States
- Center for Disparities in Diabetes, Obesity and Metabolism, University of Arizona, Tucson, AZ, United States
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Li W, Zhu X, Wang X, Liu H, Liu J, Xiao H, Dong L, Wang C, Wu Y. A hypotensive protocol of inspiratory muscle strength training: Systematic review and meta-analysis with trial sequential analysis. J Clin Hypertens (Greenwich) 2023; 25:971-982. [PMID: 37803506 PMCID: PMC10631095 DOI: 10.1111/jch.14655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 03/06/2023] [Accepted: 03/07/2023] [Indexed: 10/08/2023]
Abstract
The aim of this study was to evaluate the hypotensive effect and optimal protocol of inspiratory muscle resistance training (IMST). Randomized controlled trials using IMST to lower blood pressure (BP) were retrieved from 12 databases as of July 2022. A meta-analysis of BP and heart rate variability (HRV) was performed and a trial sequence analysis was performed using trial sequential analysis (TSA) software. Twelve articles (n = 386 participants) from five countries were included, with a mean quality score of 5.83. IMST achieved significant results in reducing systolic, diastolic, and mean arterial pressure (-7.93 [-12.08, -3.78]; -3.80 [-6.08, -1.53]; -4.90 [-13.76, 3.96]). Furthermore, TSA has shown that the findings for systolic and diastolic BP are conclusive. Finally, considerable variation remained between studies when analyzing HRV. The overall hypotensive effect of IMST was demonstrated by the TSA and was well tolerated in different populations. Of these, two interventions, high resistance or low resistance combined with slow breathing, showed the best efficacy under an 8-week exercise intervention. In addition, the process of lowering BP by modulating sympathetic vagal activity has not been further confirmed in this study. Future long-term interventions, especially those over 3 months, are needed to observe the prolonged antihypertensive effects and modulatory mechanisms; controlling for variables such as respiratory rate and executing more rigorous studies to further explore antihypertensive options.
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Affiliation(s)
- Wenjing Li
- The School of Graduate, Tianjin University of Traditional Chinese MedicineTianjinChina
| | - Xiaoping Zhu
- Nursing DepartmentShanghai Tenth People's HospitalShanghaiChina
| | - Xinai Wang
- The School of Graduate, Tianjin University of Traditional Chinese MedicineTianjinChina
| | - Hao Liu
- The School of Graduate, Tianjin University of Traditional Chinese MedicineTianjinChina
| | - Jingying Liu
- The School of Nursing, Tianjin University of Traditional Chinese MedicineTianjinChina
| | - Hongling Xiao
- The School of Nursing, Tianjin University of Traditional Chinese MedicineTianjinChina
| | - Liang Dong
- Ruijin‐Hainan HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
| | - Chenqi Wang
- The School of Graduate, Tianjin University of Traditional Chinese MedicineTianjinChina
| | - Yaxuan Wu
- The School of Graduate, Tianjin University of Traditional Chinese MedicineTianjinChina
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Plouffe AA, Fischer KP, Vranish JR. Acute upper and lower limb hemodynamic responses during single sessions of low- versus high-intensity inspiratory muscle strength training. J Appl Physiol (1985) 2023; 135:995-1000. [PMID: 37732375 DOI: 10.1152/japplphysiol.00558.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 09/18/2023] [Accepted: 09/19/2023] [Indexed: 09/22/2023] Open
Abstract
Inspiratory muscle strength training (IMST) has shown potential to improve both respiratory and cardiovascular function in health and disease. Less is known about acute hemodynamic responses to a single IMST session, therefore we assessed upper and lower limb blood flow via Doppler ultrasound in the brachial and popliteal arteries, respectively. Mean, anterograde, and retrograde blood flow (BF) and shear rate (SR) were assessed relative to baseline during low-intensity (15% maximal inspiratory pressure - PImax) and high-intensity (75% PImax) IMST. During low-intensity IMST, popliteal BF and SR were reduced by ∼10%, and brachial BF and SR were reduced by ∼40%. During high-intensity IMST, popliteal BF and SR were reduced by ∼20%, and brachial BF and SR were reduced by ∼35%. BF and SR responses were not statistically different between low-intensity and high-intensity training for either blood vessel (P > 0.05). In addition, anterograde BF and SR were significantly decreased in the brachial artery for both low-intensity and high-intensity training (P < 0.05), but not the popliteal artery (P > 0.05). Finally, during IMST retrograde BF and SR were significantly increased in both the upper and lower limbs during low-intensity and high-intensity training (P < 0.05). These data provide novel insight into the acute BF and SR responses to a single bout of IMST and may enhance our understanding of the mechanism(s) by which IMST imparts its beneficial chronic effects on cardiovascular function.NEW & NOTEWORTHY Herein, we demonstrate for the first time that upper and lower limb blood flow and shear rate patterns are altered during a single bout of IMST, at low- and high-intensity training. Specifically, anterograde blood flow and shear rate are significantly reduced in the brachial artery, whereas retrograde blood flow is significantly elevated in both the brachial and popliteal arteries. These findings provide insight into the vascular impact of IMST, which may inform future mechanistic studies.
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Affiliation(s)
- Audrey A Plouffe
- Department of Integrative Physiology and Health Science, Alma College, Alma, Michigan, United States
| | - Kylah P Fischer
- Department of Integrative Physiology and Health Science, Alma College, Alma, Michigan, United States
| | - Jennifer R Vranish
- Department of Integrative Physiology and Health Science, Alma College, Alma, Michigan, United States
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DeLucia CM, Tavoian D, Debonis DR, Wyatt Snell E, Schwyhart SM, Bailey EF. A short course of high-resistance, low-volume breathing exercise extends respiratory endurance and blunts cardiovascular responsiveness to constant load respiratory testing in healthy young adults. Respir Physiol Neurobiol 2023; 307:103974. [PMID: 36180018 PMCID: PMC10136372 DOI: 10.1016/j.resp.2022.103974] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 09/20/2022] [Accepted: 09/25/2022] [Indexed: 10/14/2022]
Abstract
Our objective was to evaluate the effects of 6-weeks high-resistance, low-volume inspiratory muscle strength training (IMST) on respiratory endurance, blood pressure (BP) and heart rate (HR) responsiveness to high respiratory workloads. Ten healthy young adults completed two constant-load resistive breathing tests to exhaustion (Tlim) (target pressure =65 % maximal inspiratory pressure [PImax]; duty cycle = 0.7; breathing frequency matched to eupnea) separated by 6-weeks high-resistance (75 % maximal inspiratory pressure, PImax), low-volume (30 inspiratory efforts/day, 5 days/week) IMST. Throughout resistive breathing trials we measured beat-to-beat changes in BP and HR, mouth pressure, inspiratory muscle work and perceived exertion. POST resistive breathing tests revealed significant gains in endurance (PRE: 362.0 ± 46.6 s vs. POST: 663.8 ± 110.3 s, p = 0.003) and increases in respiratory muscle work (PRE: -9445 ± 1562 mmHg.s vs. POST: -16648 ± 3761 mmHg.s, p = 0.069). Conversely, systolic and diastolic BP responses, HR and ratings of perceived exertion all declined. Consistent with previous observations, 6 weeks high resistance, low volume IMST lowered casual resting SBP (p = 0.002), DBP (p = 0.007) and mean arterial pressure (p = 0.001) and improved static inspiratory pressure. High resistance, low volume inspiratory muscle strength training extends respiratory endurance and attenuates BP responsiveness in healthy, recreationally-active young adults. The outcomes have implications for improved athletic performance and for attaining and/or maintaining cardiorespiratory fitness.
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Craighead DH, Tavoian D, Freeberg KA, Mazzone JL, Vranish JR, DeLucia CM, Seals DR, Bailey EF. A multi-trial, retrospective analysis of the antihypertensive effects of high-resistance, low-volume inspiratory muscle strength training. J Appl Physiol (1985) 2022; 133:1001-1010. [PMID: 36107991 PMCID: PMC9550580 DOI: 10.1152/japplphysiol.00425.2022] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 08/31/2022] [Accepted: 09/08/2022] [Indexed: 11/22/2022] Open
Abstract
Above-normal blood pressure (BP) is a primary risk factor for cardiovascular diseases. In a retrospective analysis of five pilot trials, we assessed the BP-lowering effects of high-resistance inspiratory muscle strength training (IMST) in adults aged 18-82 years and the impact of IMST on maximal inspiratory pressure (PIMAX), a gauge of inspiratory muscle strength and independent disease risk factor. Participants were randomized to high-resistance IMST (75% PIMAX) or low-resistance sham (15% PIMAX) training (30 breaths/day, 5-7 days/wk, 6 wk). IMST (n = 67) reduced systolic BP (SBP) by 9 ± 6 mmHg (P < 0.01) and diastolic BP (DBP) by 4 ± 4 mmHg (P < 0.01). IMST-related reductions in SBP and DBP emerged by week 2 of training (-4 ± 8 mmHg and -3 ± 6 mmHg; P ≤ 0.01, respectively) and continued across the 6-wk intervention. SBP and DBP were unchanged with sham training (n = 61, all P > 0.05). Select subject characteristics slightly modified the impact of IMST on BP. Greater reductions in SBP were associated with older age (β = -0.07 ± 0.03; P = 0.04) and greater reductions in DBP associated with medication-naïve BP (β = -3 ± 1; P = 0.02) and higher initial DBP (β = -0.12 ± 0.05; P = 0.04). PIMAX increased with high-resistance IMST and low-resistance sham training, with a greater increase from high-resistance IMST (+20 ± 17 vs. +6 ± 14 cmH2O; P < 0.01). Gains in PIMAX had a modest inverse relation with age (β = -0.20 ± 0.09; P = 0.03) and baseline PIMAX (β = -0.15 ± 0.07; P = 0.04) but not to reductions in SBP or DBP. These compiled findings from multiple independent trials provide the strongest evidence to date that high-resistance IMST evokes clinically significant reductions in SBP and DBP, and increases in PIMAX, in adult men and women.NEW & NOTEWORTHY In young-to-older adult men and women, 6 wk of high-resistance inspiratory muscle strength training lowers casual systolic and diastolic blood pressure by 9 mmHg and 4 mmHg, respectively, with initial reductions observed by week 2 of training. Given blood pressure outcomes with the intervention were only slightly altered by subject baseline characteristics (i.e., age, blood pressure medication, and health status), inspiratory muscle strength training is effective in lowering blood pressure in a broad range of adults.
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Affiliation(s)
- Daniel H Craighead
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, Colorado
| | - Dallin Tavoian
- Department of Physiology, University of Arizona College of Medicine, Tucson, Arizona
| | - Kaitlin A Freeberg
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, Colorado
| | - Josie L Mazzone
- Department of Physiology, University of Arizona College of Medicine, Tucson, Arizona
| | - Jennifer R Vranish
- Department of Integrative Physiology and Health Science, Alma College, Alma, Michigan
| | - Claire M DeLucia
- Department of Physiology, University of Arizona College of Medicine, Tucson, Arizona
| | - Douglas R Seals
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, Colorado
| | - E Fiona Bailey
- Department of Physiology, University of Arizona College of Medicine, Tucson, Arizona
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Craighead DH, Freeberg KA, McCarty NP, Rossman MJ, Moreau KL, You Z, Chonchol M, Seals DR. Inspiratory muscle strength training for lowering blood pressure and improving endothelial function in postmenopausal women: comparison with “standard of care” aerobic exercise. Front Physiol 2022; 13:967478. [PMID: 36105300 PMCID: PMC9465043 DOI: 10.3389/fphys.2022.967478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Accepted: 08/01/2022] [Indexed: 11/13/2022] Open
Abstract
Background: High blood pressure (BP), particularly systolic BP (SBP), is the major modifiable risk factor for cardiovascular diseases and related disorders of aging. SBP increases markedly with aging in women such that the prevalence of above-normal SBP (i.e., ≥120 mmHg) in postmenopausal women exceeds rates in age-matched men. This increase in SBP is associated with vascular endothelial dysfunction, mediated by excessive reactive oxygen species-induced oxidative stress and consequent reductions in nitric oxide bioavailability. Moderate-intensity aerobic exercise is a recommended lifestyle strategy for reducing SBP. However, adherence to aerobic exercise guidelines among postmenopausal women is low (<30%) and aerobic exercise does not consistently enhance endothelial function in estrogen-deficient postmenopausal women. High-resistance inspiratory muscle strength training (IMST) is a time-efficient, adherable lifestyle intervention that involves inhaling against resistance through a handheld device (30 breaths/day). Here, we present the protocol for a randomized controlled trial investigating the efficacy of 3 months of high-resistance IMST compared to guideline-based, “standard-of-care” aerobic exercise training for decreasing SBP and improving endothelial function in estrogen-deficient postmenopausal women with above-normal SBP (120–159 mmHg) at baseline (ClinicalTrials.gov Identifier: NCT05000515). Methods: A randomized, single-blind, parallel-group design clinical trial will be conducted in 72 (36/group) estrogen-deficient postmenopausal women with above-normal SBP. Participants will complete baseline testing and then be randomized to either 3 months of high-resistance IMST (30 breaths/day, 6 days/week, 75% maximal inspiratory pressure) or moderate-intensity aerobic exercise training (brisk walking 25 min/day, 6 days/week, 40–60% heart rate reserve). Outcome measures will be assessed after 3 months of either intervention. Following end-intervention testing, participants will abstain from their assigned intervention for 6 weeks, after which BP and endothelial function will be assessed to evaluate the potential persistent effects of the intervention on the primary and secondary outcomes. Discussion: This study is designed to compare the effectiveness of time-efficient, high-resistance IMST to guideline-based aerobic exercise training for lowering SBP and improving endothelial function, and interrogating potential mechanisms of action, in estrogen-deficient postmenopausal women. Clinical Trial Registration:ClinicalTrials.gov, Identifier: NCT05000515.
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Affiliation(s)
- Daniel H. Craighead
- Integrative Physiology of Aging Laboratory, Department of Integrative Physiology, University of Colorado Boulder, Boulder, CO, United States
| | - Kaitlin A. Freeberg
- Integrative Physiology of Aging Laboratory, Department of Integrative Physiology, University of Colorado Boulder, Boulder, CO, United States
| | - Narissa P. McCarty
- Integrative Physiology of Aging Laboratory, Department of Integrative Physiology, University of Colorado Boulder, Boulder, CO, United States
| | - Matthew J. Rossman
- Integrative Physiology of Aging Laboratory, Department of Integrative Physiology, University of Colorado Boulder, Boulder, CO, United States
| | - Kerrie L. Moreau
- Division of Geriatric Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
- Veterans Affairs Eastern Colorado Geriatric Research, Educational and Clinical Center, Denver, CO, United States
| | - Zhiying You
- Division of Renal Diseases and Hypertension, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Michel Chonchol
- Division of Renal Diseases and Hypertension, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Douglas R. Seals
- Integrative Physiology of Aging Laboratory, Department of Integrative Physiology, University of Colorado Boulder, Boulder, CO, United States
- *Correspondence: Douglas R. Seals,
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Stutz J, Casutt S, Spengler CM. Respiratory muscle endurance training improves exercise performance but does not affect resting blood pressure and sleep in healthy active elderly. Eur J Appl Physiol 2022; 122:2515-2531. [PMID: 36018510 PMCID: PMC9613745 DOI: 10.1007/s00421-022-05024-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 08/04/2022] [Indexed: 11/29/2022]
Abstract
Purpose Ageing is associated with increased blood pressure (BP), reduced sleep, decreased pulmonary function and exercise capacity. The main purpose of this study was to test whether respiratory muscle endurance training (RMET) improves these parameters. Methods Twenty-four active normotensive and prehypertensive participants (age: 65.8 years) were randomized and balanced to receive either RMET (N = 12) or placebo (PLA, N = 12). RMET consisted of 30 min of volitional normocapnic hyperpnea at 60% of maximal voluntary ventilation while PLA consisted of 1 inhalation day−1 of a lactose powder. Both interventions were performed on 4–5 days week−1 for 4–5 weeks. Before and after the intervention, resting BP, pulmonary function, time to exhaustion in an incremental respiratory muscle test (incRMET), an incremental treadmill test (IT) and in a constant-load treadmill test (CLT) at 80% of peak oxygen consumption, balance, sleep at home, and body composition were assessed. Data was analyzed with 2 × 2 mixed ANOVAs. Results Compared to PLA, there was no change in resting BP (independent of initial resting BP), pulmonary function, IT performance, sleep, body composition or balance (all p > 0.05). Performance significantly increased in the incRMET (+ 6.3 min) and the CLT (+ 3.2 min), resulting in significant interaction effects (p < 0.05). Conclusion In the elderly population, RMET might be used to improve respiratory and whole body endurance performance either as an adjunct to physical exercise training or as a replacement thereof for people not being able to intensively exercise even if no change in BP or sleep may be expected.
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Affiliation(s)
- Jan Stutz
- Exercise Physiology Lab, Institute of Human Movement Sciences and Sport, ETH Zurich, Zurich, Switzerland
| | - Selina Casutt
- Exercise Physiology Lab, Institute of Human Movement Sciences and Sport, ETH Zurich, Zurich, Switzerland
| | - Christina M Spengler
- Exercise Physiology Lab, Institute of Human Movement Sciences and Sport, ETH Zurich, Zurich, Switzerland. .,Zurich Center for Integrative Human Physiology (ZIHP), University of Zurich, Winterthurerstrasse 190, 8057, Zurich, Switzerland.
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Craighead DH, Freeberg KA, Maurer GS, Myers VH, Seals DR. Translational Potential of High-Resistance Inspiratory Muscle Strength Training. Exerc Sport Sci Rev 2022; 50:107-117. [PMID: 35394978 PMCID: PMC9203907 DOI: 10.1249/jes.0000000000000293] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Age-associated cardiovascular (CV) dysfunction increases the risk for CV diseases. Aerobic exercise training can improve CV function, but only a minority of adults meet aerobic exercise guidelines. High-resistance inspiratory muscle strength training is a time-efficient lifestyle intervention that may promote adherence and improve CV function. However, further investigation is needed to translate inspiratory muscle strength training into the public health domain.
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Affiliation(s)
- Daniel H. Craighead
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, Colorado
| | - Kaitlin A. Freeberg
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, Colorado
| | - Grace S. Maurer
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, Colorado
| | | | - Douglas R. Seals
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, Colorado
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Tavoian D, Ramos-Barrera LE, Craighead DH, Seals DR, Bedrick EJ, Alpert JS, Mashaqi S, Bailey EF. Six Months of Inspiratory Muscle Training to Lower Blood Pressure and Improve Endothelial Function in Middle-Aged and Older Adults With Above-Normal Blood Pressure and Obstructive Sleep Apnea: Protocol for the CHART Clinical Trial. Front Cardiovasc Med 2021; 8:760203. [PMID: 34901220 PMCID: PMC8652071 DOI: 10.3389/fcvm.2021.760203] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 10/18/2021] [Indexed: 01/23/2023] Open
Abstract
Background: Cardiovascular disease is a major global health concern and prevalence is high in adults with obstructive sleep apnea (OSA). Lowering blood pressure (BP) can greatly reduce cardiovascular disease risk and physical activity is routinely prescribed to achieve this goal. Unfortunately, many adults with OSA suffer from fatigue, daytime sleepiness, and exercise intolerance—due to poor sleep quality and nocturnal hypoxemia—and have difficulty initiating and maintaining an exercise program. High-resistance inspiratory muscle strength training (IMST) is a simple, time-efficient breathing exercise consistently reported to reduce BP in small, selective groups of both healthy and at-risk adults. Herein we present the study protocol for a randomized clinical trial to determine the long-term efficacy of IMST performed regularly for 24 weeks in middle-aged and older adults with OSA. The primary outcome is casual systolic BP. Secondary outcomes are 24-h systolic BP and circulating plasma norepinephrine concentration. Other outcomes include vascular endothelial function (endothelial-dependent and -independent dilation), aortic stiffness, casual and 24-h diastolic BP, and the influence of circulating factors on endothelial cell nitric oxide and reactive oxygen species production. Overall, this trial will establish efficacy of high-resistance IMST for lowering BP and improving cardiovascular health in middle-aged and older adults with OSA. Methods: This is a single-site, double-blind, randomized clinical trial. A minimum of 92 and maximum of 122 male and female adults aged 50–80 years with OSA and above-normal BP will be enrolled. After completion of baseline assessments, subjects will be randomized in a 1:1 ratio to participate in either high-resistance or sham (low-resistance) control IMST, performed at home, 5 min/day, 5 days/week, for 24 weeks. Repeat assessments will be taken after the 24-week intervention, and after 4 and 12 weeks of free living. Discussion: This study is designed to assess the effects of 24 weeks of IMST on BP and vascular function. The results will characterize the extent to which IMST can reduce BP when performed over longer periods (i.e., 6 months) than have been assessed previously. Additionally, this study will help to determine underlying mechanisms driving IMST-induced BP reductions that have been reported previously. Clinical Trial Registration: This trial is registered with ClinicalTrials.gov (Registration Number: NCT04932447; Date of registration June 21, 2021).
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Affiliation(s)
- Dallin Tavoian
- Arizona Respiratory Neurophysiology Laboratory, Department of Physiology, University of Arizona, Tucson, AZ, United States
| | - Lupita E Ramos-Barrera
- Arizona Respiratory Neurophysiology Laboratory, Department of Physiology, University of Arizona, Tucson, AZ, United States
| | - Daniel H Craighead
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, CO, United States
| | - Douglas R Seals
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, CO, United States
| | - Edward J Bedrick
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, United States
| | - Joseph S Alpert
- College of Medicine, University of Arizona, Tucson, AZ, United States.,Division of Cardiology, Sarver Heart Center, College of Medicine, University of Arizona, Tucson, AZ, United States
| | - Saif Mashaqi
- College of Medicine, University of Arizona, Tucson, AZ, United States.,Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Banner - University Medical Center, Tucson, AZ, United States.,Sleep Disorders Center, Banner - University Medical Center, Tucson, AZ, United States
| | - E Fiona Bailey
- Arizona Respiratory Neurophysiology Laboratory, Department of Physiology, University of Arizona, Tucson, AZ, United States
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10
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Krause-Sorio B, An E, Aguila AP, Martinez F, Aysola RS, Macey PM. Inspiratory Muscle Training for Obstructive Sleep Apnea: Protocol Development and Feasibility of Home Practice by Sedentary Adults. Front Physiol 2021; 12:737493. [PMID: 34803729 PMCID: PMC8599350 DOI: 10.3389/fphys.2021.737493] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 10/12/2021] [Indexed: 01/19/2023] Open
Abstract
Background: Inspiratory muscle training (IMT) may improve respiratory and cardiovascular functions in obstructive sleep apnea (OSA) and is a potential alternative or adjunct treatment to continuous positive airway pressure (CPAP). IMT protocols were originally designed for athletes, however, we found some OSA patients could not perform the exercise, so we aimed for a more OSA-friendly protocol. Our feasibility criteria included (1) participants successfully managing the technique at home; (2) participants completing daily practice sessions and recording data logs; and (3) capturing performance plateaus to determine an optimal length of the intervention. Methods: Five sedentary OSA patients participated in this feasibility study (three men, mean age = 61.6 years, SD = 10.2). Using a digital POWERbreathe K4 or K5 device, participants performed 30 daily inhalations against a resistance set at a percentage of maximum, recalculated weekly. Participants were willing to perform one but not two daily practice sessions. Intervention parameters from common IMT protocols were adapted according to ability and subjective feedback. Some were unable to perform the typically used 75% of maximum inspiratory resistance so we lowered the target to 65%. The technique required some practice; therefore, we introduced a practice week with a 50% target. After an initial 8 weeks, the intervention was open-ended and training continued until all participants demonstrated at least one plateau of inspiratory strength (2 weeks without strength gain). Weekly email and phone reminders ensured that participants completed all daily sessions and logged data in their online surveys. Weekly measures of inspiratory resistance, strength, volume, and flow were recorded. Results: Participants successfully completed the practice and subsequent 65% IMT resistance targets daily for 13 weeks. Inspiratory strength gains showed plateaus in all subjects by the end of 10 weeks of training, suggesting 12 weeks plus practice would be sufficient to achieve and capture maximum gains. Participants reported no adverse effects. Conclusion: We developed and tested a 13-week IMT protocol in a small group of sedentary, untreated OSA patients. Relative to other IMT protocols, we successfully implemented reduced performance requirements, a practice week, and an extended timeframe. This feasibility study provides the basis for a protocol for clinical trials on IMT in OSA.
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Affiliation(s)
- Beatrix Krause-Sorio
- UCLA School of Nursing, University of California, Los Angeles, Los Angeles, CA, United States
| | - Eunjoo An
- UCLA School of Nursing, University of California, Los Angeles, Los Angeles, CA, United States
| | - Andrea P Aguila
- UCLA School of Nursing, University of California, Los Angeles, Los Angeles, CA, United States
| | - Fernando Martinez
- UCLA School of Nursing, University of California, Los Angeles, Los Angeles, CA, United States
| | - Ravi S Aysola
- Division of Pulmonary and Critical Care, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - Paul M Macey
- UCLA School of Nursing, University of California, Los Angeles, Los Angeles, CA, United States
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Time-efficient, high-resistance inspiratory muscle strength training for cardiovascular aging. Exp Gerontol 2021; 154:111515. [PMID: 34389471 DOI: 10.1016/j.exger.2021.111515] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 07/29/2021] [Accepted: 08/09/2021] [Indexed: 01/14/2023]
Abstract
Cardiovascular diseases (CVD) remain the leading cause of death in developed and developing societies and aging is the primary risk factor for CVD. Much of the increased risk of CVD in midlife/older adults (i.e., adults aged 50 years and older) is due to increases in blood pressure, vascular endothelial dysfunction and stiffening of the large elastic arteries. Aerobic exercise training is an effective lifestyle intervention to improve CV function and decrease CVD risk with aging. However, <40% of midlife/older adults meet guidelines for aerobic exercise, due to time availability-related barriers and other obstacles to adherence. Therefore, there is a need for new lifestyle interventions that not only improve CV function with aging but also promote adherence. High-resistance inspiratory muscle strength training (IMST) is an emerging, time-efficient (5 min/day) lifestyle intervention. Early research suggests high-resistance IMST may promote adherence, lower blood pressure and potentially improve vascular endothelial function. However, additional investigation will be required to more definitively establish high-resistance IMST as a healthy lifestyle intervention for CV aging. This review will summarize the current evidence on high-resistance IMST for improving CV function with aging and will identify key research gaps and future directions.
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Craighead DH, Heinbockel TC, Freeberg KA, Rossman MJ, Jackman RA, Jankowski LR, Hamilton MN, Ziemba BP, Reisz JA, D’Alessandro A, Brewster LM, DeSouza CA, You Z, Chonchol M, Bailey EF, Seals DR. Time-Efficient Inspiratory Muscle Strength Training Lowers Blood Pressure and Improves Endothelial Function, NO Bioavailability, and Oxidative Stress in Midlife/Older Adults With Above-Normal Blood Pressure. J Am Heart Assoc 2021; 10:e020980. [PMID: 34184544 PMCID: PMC8403283 DOI: 10.1161/jaha.121.020980] [Citation(s) in RCA: 48] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 04/22/2021] [Indexed: 12/13/2022]
Abstract
Background High-resistance inspiratory muscle strength training (IMST) is a novel, time-efficient physical training modality. Methods and Results We performed a double-blind, randomized, sham-controlled trial to investigate whether 6 weeks of IMST (30 breaths/day, 6 days/week) improves blood pressure, endothelial function, and arterial stiffness in midlife/older adults (aged 50-79 years) with systolic blood pressure ≥120 mm Hg, while also investigating potential mechanisms and long-lasting effects. Thirty-six participants completed high-resistance IMST (75% maximal inspiratory pressure, n=18) or low-resistance sham training (15% maximal inspiratory pressure, n=18). IMST was safe, well tolerated, and had excellent adherence (≈95% of training sessions completed). Casual systolic blood pressure decreased from 135±2 mm Hg to 126±3 mm Hg (P<0.01) with IMST, which was ≈75% sustained 6 weeks after IMST (P<0.01), whereas IMST modestly decreased casual diastolic blood pressure (79±2 mm Hg to 77±2 mm Hg, P=0.03); blood pressure was unaffected by sham training (all P>0.05). Twenty-four hour systolic blood pressure was lower after IMST versus sham training (P=0.01). Brachial artery flow-mediated dilation improved ≈45% with IMST (P<0.01) but was unchanged with sham training (P=0.73). Human umbilical vein endothelial cells cultured with subject serum sampled after versus before IMST exhibited increased NO bioavailability, greater endothelial NO synthase activation, and lower reactive oxygen species bioactivity (P<0.05). IMST decreased C-reactive protein (P=0.05) and altered select circulating metabolites (targeted plasma metabolomics) associated with cardiovascular function. Neither IMST nor sham training influenced arterial stiffness (P>0.05). Conclusions High-resistance IMST is a safe, highly adherable lifestyle intervention for improving blood pressure and endothelial function in midlife/older adults with above-normal initial systolic blood pressure. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT03266510.
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Affiliation(s)
| | | | | | - Matthew J. Rossman
- Department of Integrative PhysiologyUniversity of Colorado BoulderBoulderCO
| | - Rachel A. Jackman
- Department of Integrative PhysiologyUniversity of Colorado BoulderBoulderCO
| | | | | | - Brian P. Ziemba
- Department of Integrative PhysiologyUniversity of Colorado BoulderBoulderCO
| | - Julie A. Reisz
- Department of Biochemistry and Molecular GeneticsUniversity of Colorado Anschutz Medical CampusAuroraCO
| | - Angelo D’Alessandro
- Department of Biochemistry and Molecular GeneticsUniversity of Colorado Anschutz Medical CampusAuroraCO
| | - L. Madden Brewster
- Department of Integrative PhysiologyUniversity of Colorado BoulderBoulderCO
| | | | - Zhiying You
- Division of Renal Diseases and HypertensionUniversity of Colorado Anschutz Medical CampusAuroraCO
| | - Michel Chonchol
- Division of Renal Diseases and HypertensionUniversity of Colorado Anschutz Medical CampusAuroraCO
| | - E. Fiona Bailey
- Department of PhysiologyUniversity of Arizona College of MedicineTucsonAZ
| | - Douglas R. Seals
- Department of Integrative PhysiologyUniversity of Colorado BoulderBoulderCO
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DeLucia CM, DeBonis DR, Schwyhart SM, Bailey EF. Acute cardiovascular responses to a single bout of high intensity inspiratory muscle strength training in healthy young adults. J Appl Physiol (1985) 2021; 130:1114-1121. [PMID: 33600284 DOI: 10.1152/japplphysiol.01015.2020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
High intensity, low volume inspiratory muscle strength training (IMST) has favorable effects on casual systolic blood pressure and systemic vascular resistance. However, the acute effects of IMST on heart rate (HR), blood pressure (BP), and sympathetic regulation of vascular resistance and the trajectory of post exercise recovery are not known. We recruited 14 young adults (7 women/7 men, age: 22 ± 2 years) to perform a single bout of high intensity IMST (inspiratory resistance set at 75% of maximal inspiratory pressure) importantly, female and male subjects were matched in regard to the target inspiratory pressure and target inspiratory muscle work per breath. We recorded HR, beat-to-beat changes in BP and postganglionic, muscle sympathetic nerve activities (MSNA) continuously throughout baseline, a single bout of IMST (comprising five sets of 6 inspiratory efforts) and in recovery. We show that one bout of IMST does not effect a change in BP, however, it effects a significant increase in HR (68.4 ± 11.7 beats/min versus 85.4 ± 13.6 beats/min; P < 0.001) and a significant decline in MSNA (6.8 ± 1.1 bursts/15 s bin; P < 0.001 versus 3.6 ± 0.6 bursts/15 s bin) relative to baseline. Remarkably, among men MSNA rebounded to baseline levels within the first minute of recovery, however, in women, MSNA suppression persisted for 5 min. We show that in healthy young adults, high intensity, low volume respiratory training results in the acute suppression of MSNA. Importantly, MSNA suppression is of greater magnitude and longer duration in women than in men.NEW & NOTEWORTHY Previous studies show 6 weeks of high intensity, low volume inspiratory muscle strength training (IMST) lowers blood pressure (BP) and systemic vascular resistance in young adults. However, the acute response to IMST is unknown. We characterized BP, heart rate, and sympathetic nervous activity (SNA) in healthy young adults at baseline, during IMST, and in recovery. There was no acute effect of IMST on BP, however, there was significant IMST-related suppression of SNA that was of greater magnitude in women than men.
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Affiliation(s)
- Claire M DeLucia
- Department of Physiology University of Arizona College of Medicine, Tucson, Arizona
| | - Dean R DeBonis
- Department of Physiology University of Arizona College of Medicine, Tucson, Arizona
| | - Sarah M Schwyhart
- Department of Physiology University of Arizona College of Medicine, Tucson, Arizona
| | - E Fiona Bailey
- Department of Physiology University of Arizona College of Medicine, Tucson, Arizona
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Beltrami FG, Mzee D, Spengler CM. No Evidence That Hyperpnea-Based Respiratory Muscle Training Affects Indexes of Cardiovascular Health in Young Healthy Adults. Front Physiol 2020; 11:530218. [PMID: 33391004 PMCID: PMC7773763 DOI: 10.3389/fphys.2020.530218] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 11/20/2020] [Indexed: 01/05/2023] Open
Abstract
Introduction The chronic effects of respiratory muscle training (RMT) on the cardiovascular system remain unclear. This investigation tested to which degree a single sessions of RMT with or without added vibration, which could enhance peripheral blood flow and vascular response, or a 4-week RMT program could result in changes in pulse wave velocity (PWV), blood pressure (systolic, SBP; diastolic, DBP) and other markers of cardiovascular health. Methods Sixteen young and healthy participants (8 m/8f) performed 15 min of either continuous normocapnic hyperpnea (RMET), sprint-interval-type hyperpnea (RMSIT) or a control session (quiet sitting). Sessions were performed once with and once without passive vibration of the lower limbs. To assess training-induced adaptations, thirty-four young and healthy participants (17 m/17f) were measured before and after 4 weeks (three weekly sessions) of RMET (n = 13, 30-min sessions of normocapnic hyperpnea), RMSIT [n = 11, 6 × 1 min (1 min break) normocapnic hyperpnea with added resistance] or placebo (n = 10). Results SBP was elevated from baseline at 5 min after each RMT session, but returned to baseline levels after 15 min, whereas DBP was unchanged from baseline following RMT. Carotid-femoral PWV (PWVCF) was elevated at 5 and 15 min after RMT compared to baseline (main effect of time, P = 0.001), whereas no changes were seen for carotid-radial PWV (PWVCR) or the PWVCF/PWVCR ratio. Vibration had no effects in any of the interventions. Following the 4-week training period, no differences from the placebo group were seen for SBP (P = 0.686), DBP (P = 0.233), PWVCF (P = 0.844), PWVCR (P = 0.815) or the PWVCF/PWVCR ratio (P = 0.389). Discussion/Conclusion Although 15 min of RMT sessions elicited transient increases in PWVCF and SBP, no changes were detected following 4 weeks of either RMET or RMSIT. Adding passive vibration of the lower limbs during RMT sessions did not provide additional value to the session with regards to vascular responses.
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Affiliation(s)
- Fernando G Beltrami
- Exercise Physiology Lab, Institute of Human Movement Sciences and Sport, ETH Zurich, Zurich, Switzerland
| | - David Mzee
- Exercise Physiology Lab, Institute of Human Movement Sciences and Sport, ETH Zurich, Zurich, Switzerland
| | - Christina M Spengler
- Exercise Physiology Lab, Institute of Human Movement Sciences and Sport, ETH Zurich, Zurich, Switzerland.,Zurich Center for Integrative Human Physiology (ZIHP), University of Zurich, Zurich, Switzerland
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Beltrami FG. Is inspiratory muscle training a magic bullet to lower blood pressure? J Appl Physiol (1985) 2020; 129:1439. [PMID: 33306944 DOI: 10.1152/japplphysiol.00803.2020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Fernando Gabe Beltrami
- Exercise Physiology Lab, Institute of Human Movement Sciences and Sport, ETH Zurich, Switzerland
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16
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Jones HN, Kuchibhatla M, Crisp KD, Hobson-Webb LD, Case L, Batten MT, Marcus JA, Kravitz RM, Kishnani PS. Respiratory muscle training in late-onset Pompe disease: Results of a sham-controlled clinical trial. Neuromuscul Disord 2020; 30:904-914. [PMID: 33127291 DOI: 10.1016/j.nmd.2020.09.023] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 08/12/2020] [Accepted: 09/08/2020] [Indexed: 01/14/2023]
Abstract
To address progressive respiratory muscle weakness in late-onset Pompe disease (LOPD), we developed a 12-week respiratory muscle training (RMT) program. In this exploratory, double-blind, randomized control trial, 22 adults with LOPD were randomized to RMT or sham-RMT. The primary outcome was maximum inspiratory pressure (MIP). Secondary and exploratory outcomes included maximum expiratory pressure (MEP), peak cough flow, diaphragm ultrasound, polysomnography, patient-reported outcomes, and measures of gross motor function. MIP increased 7.6 cmH2O (15.9) in the treatment group and 2.7 cmH2O (7.6) in the control group (P = 0.4670). MEP increased 14.0 cmH2O (25.9) in the treatment group and 0.0 cmH2O (12.0) in the control group (P = 0.1854). The only statistically significant differences in secondary/exploratory outcomes were improvements in time to climb 4 steps (P = 0.0346) and daytime sleepiness (P = 0.0160). The magnitude of changes in MIP and MEP in the treatment group were consistent with our pilot findings but did not achieve statistical significance in comparison to controls. Explanations for this include inadequate power and baseline differences in subject characteristics between groups. Additionally, control group subjects appeared to exhibit an active response to sham-RMT and therefore sham-RMT may not be an optimal control condition for RMT in LOPD.
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Affiliation(s)
- Harrison N Jones
- Department of Head and Neck Surgery & Communication Sciences, Duke University School of Medicine, 155 Baker House, Trent Dr., DUMC 3887, Durham, NC 27710, USA; Division of Speech Pathology and Audiology, Duke University Medical Center, Durham, NC, USA.
| | - Maragatha Kuchibhatla
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC, USA
| | - Kelly D Crisp
- Department of Head and Neck Surgery & Communication Sciences, Duke University School of Medicine, 155 Baker House, Trent Dr., DUMC 3887, Durham, NC 27710, USA
| | - Lisa D Hobson-Webb
- Department of Neurology, Neuromuscular Division, Duke University School of Medicine, Durham, NC, USA
| | - Laura Case
- Division of Physical Therapy, Duke University School Of Medicine, Durham, NC, USA
| | - Milisa T Batten
- Division of Speech Pathology and Audiology, Duke University Medical Center, Durham, NC, USA
| | - Jill A Marcus
- Division of Speech Pathology and Audiology, Duke University Medical Center, Durham, NC, USA
| | - Richard M Kravitz
- Division of Pediatric Pulmonary and Sleep Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Priya S Kishnani
- Department of Pediatrics, Division of Medical Genetics, Duke University School of Medicine, Durham, NC, USA
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17
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Ramos-Barrera GE, DeLucia CM, Bailey EF. Inspiratory muscle strength training lowers blood pressure and sympathetic activity in older adults with OSA: a randomized controlled pilot trial. J Appl Physiol (1985) 2020; 129:449-458. [PMID: 32730174 DOI: 10.1152/japplphysiol.00024.2020] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Previous work has shown lowered casual blood pressure after just 6 wk of inspiratory muscle strength training (IMST), suggesting IMST as a potential therapeutic in the prevention/treatment of hypertension. In this study, we assessed the effects of IMST on cardiovascular parameters in older, overweight adults diagnosed with moderate and severe obstructive sleep apnea (OSA). Subjects were randomly assigned to one of two interventions 1) high-intensity IMST (n = 15, 75% maximal inspiratory pressure), or 2) a control intervention (n = 10, 15% maximum inspiratory pressure). Subjects in both groups trained at home completing 30 training breaths/day, 5 days/wk for 6 wk. Pre- and posttraining measures included maximal inspiratory pressure, casual and ambulatory blood pressures, spontaneous cardiac baroreflex sensitivity, and muscle sympathetic nerve activity. Men and women in the high-intensity IMST group exhibited reductions in casual systolic (SBP), diastolic (DBP), and mean arterial blood pressures (MAP) [SBP: -8.82 ± 4.98 mmHg; DBP: -4.69 ± 2.81 mmHg; and MAP: -6.06 ± 1.03 mmHg; P < 0.002] and nighttime SBP (pre: -12.00 ± 8.20 mmHg; P < 0.01). Muscle sympathetic nerve activities also were lower (-6.97 ± 2.29 bursts/min-1; P = 0.01 and -9.55 ± 2.42 bursts/100 heartbeats; P = 0.002) by week 6. Conversely, subjects allocated to the control group showed no change in casual blood pressure or muscle sympathetic nerve activity and a trend toward higher overnight blood pressures. A short course of high-intensity IMST may offer significant respiratory and cardiovascular benefits for older, overweight adults with OSA. For Clinical Trial Registration, see https://www.clinicaltrials.gov (Identifier: NCT02709941).NEW & NOTEWORTHY Older, obese adults with moderate-severe obstructive sleep apnea who perform 5 min/day high-intensity inspiratory muscle strength training (IMST) exhibit lowered casual and nighttime systolic blood pressure and sympathetic nervous outflow. In contrast, adults assigned to a control (low-intensity) intervention exhibit no change in casual blood pressure or muscle sympathetic nerve activity and a trend toward increased overnight blood pressure. Remarkably, adherence to IMST even among sleep-deprived and exercise-intolerant adults is high (96%).
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Affiliation(s)
| | - Claire M DeLucia
- Department of Physiology, University of Arizona College of Medicine, Tucson, Arizona
| | - E Fiona Bailey
- Department of Physiology, University of Arizona College of Medicine, Tucson, Arizona
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Inspiratory muscle training improves cerebrovascular and postural control responses during orthostatic stress in older women. Eur J Appl Physiol 2020; 120:2171-2181. [DOI: 10.1007/s00421-020-04441-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Accepted: 07/16/2020] [Indexed: 12/15/2022]
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19
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de Abreu RM, Catai AM, Cairo B, Rehder-Santos P, da Silva CD, Signini ÉDF, Sakaguchi CA, Porta A. A Transfer Entropy Approach for the Assessment of the Impact of Inspiratory Muscle Training on the Cardiorespiratory Coupling of Amateur Cyclists. Front Physiol 2020; 11:134. [PMID: 32158402 PMCID: PMC7052290 DOI: 10.3389/fphys.2020.00134] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Accepted: 02/07/2020] [Indexed: 12/23/2022] Open
Abstract
The strength of cardiorespiratory interactions diminishes with age. Physical exercise can reduce the rate of this trend. Inspiratory muscle training (IMT) is a technique capable of improving cardiorespiratory interactions. This study evaluates the effect of IMT on cardiorespiratory coupling in amateur cyclists. Thirty male young healthy cyclists underwent a sham IMT of very low intensity (SHAM, n = 9), an IMT of moderate intensity at 60% of the maximal inspiratory pressure (MIP60, n = 10) and an IMT of high intensity at the critical inspiratory pressure (CIP, n = 11). Electrocardiogram, non-invasive arterial pressure, and thoracic respiratory movement (RM) were recorded before (PRE) and after (POST) training at rest in supine position (REST) and during active standing (STAND). The beat-to-beat series of heart period (HP) and systolic arterial pressure (SAP) were analyzed with the RM signal via a traditional non-causal approach, such as squared coherence function, and via a causal model-based transfer entropy (TE) approach. Cardiorespiratory coupling was quantified via the HP-RM squared coherence at the respiratory rate (K 2 HP-R M), the unconditioned TE from RM to HP (TER M → HP) and the TE from RM to HP conditioned on SAP (TER M → HP| SAP). In PRE condition we found that STAND led to a decrease of TER M → HP| SAP. After SHAM and CIP training this tendency was confirmed, while MIP60 inverted it by empowering cardiorespiratory coupling. This behavior was observed in presence of unvaried SAP mean and with usual responses of the baroreflex control and HP mean to STAND. TER M → HP and K 2 HP- RM were not able to detect the post-training increase of cardiorespiratory coupling strength during STAND, thus suggesting that conditioning out SAP is important for the assessment of cardiorespiratory interactions. Since the usual response of HP mean, SAP mean and baroreflex sensitivity to postural stressor were observed after MIP60 training, we conclude that the post-training increase of cardiorespiratory coupling during STAND in MIP60 group might be the genuine effect of some rearrangements at the level of central respiratory network and its interactions with sympathetic drive and vagal activity.
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Affiliation(s)
| | - Aparecida Maria Catai
- Department of Physical Therapy, Federal University of São Carlos, São Carlos, Brazil
| | - Beatrice Cairo
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | | | | | | | | | - Alberto Porta
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
- Department of Cardiothoracic – Vascular Anesthesia and Intensive Care, IRCCS Policlinico San Donato, Milan, Italy
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Craighead DH, Heinbockel TC, Hamilton MN, Bailey EF, MacDonald MJ, Gibala MJ, Seals DR. Time-efficient physical training for enhancing cardiovascular function in midlife and older adults: promise and current research gaps. J Appl Physiol (1985) 2019; 127:1427-1440. [PMID: 31556835 PMCID: PMC10205162 DOI: 10.1152/japplphysiol.00381.2019] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 08/28/2019] [Accepted: 09/18/2019] [Indexed: 12/11/2022] Open
Abstract
Cardiovascular diseases (CVD) remain the leading cause of death in developed societies, and "midlife" (50-64 yr) and older (65+) men and women bear the great majority of the burden of CVD. Much of the increased risk of CVD in this population is attributable to CV dysfunction, including adverse changes in the structure and function of the heart, increased systolic blood pressure, and arterial dysfunction. The latter is characterized by increased arterial stiffness and vascular endothelial dysfunction. Conventional aerobic exercise training, as generally recommended in public health guidelines, is an effective strategy to preserve or improve CV function with aging. However, <40% of midlife and older adults meet aerobic exercise guidelines, due in part to time availability-related barriers. As such, there is a need to develop evidence-based time-efficient exercise interventions that promote adherence and optimize CV function in these groups. Two promising interventions that may meet these criteria are interval training and inspiratory muscle strength training (IMST). Limited research suggests these modes of training may improve CV function with time commitments of ≤60 min/wk. This review will summarize the current evidence for interval training and IMST to improve CV function in midlife/older adults and identify key research gaps and future directions.
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Affiliation(s)
- Daniel H Craighead
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, Colorado
| | - Thomas C Heinbockel
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, Colorado
| | - Makinzie N Hamilton
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, Colorado
| | - E Fiona Bailey
- Department of Physiology, University of Arizona College of Medicine, Tucson, Arizona
| | | | - Martin J Gibala
- Department of Kinesiology, McMaster University, Ontario, Canada
| | - Douglas R Seals
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, Colorado
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21
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Jones HN, Kuchibhatla M, Crisp KD, Hobson Webb LD, Case L, Batten MT, Marcus JA, Kravitz RM, Kishnani PS. [Not Available]. Mol Genet Metab 2019; 127:346-354. [PMID: 31303277 PMCID: PMC6717661 DOI: 10.1016/j.ymgme.2019.05.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 05/02/2019] [Accepted: 05/05/2019] [Indexed: 12/12/2022]
Abstract
INTRODUCTION: Morbidity and mortality in adults with late-onset Pompe disease (LOPD) results primarily from persistent progressive respiratory muscle weakness despite treatment with enzyme replacement therapy (ERT). To address this need, we have developed a 12-week respiratory muscle training (RMT) program that provides calibrated, individualized, and progressive pressure-threshold resistance against inspiration and expiration. Our previous results suggest that our RMT regimen is safe, well-tolerated, and results in large increases in respiratory muscle strength. We now conduct an exploratory double-blind, randomized control trial (RCT) to determine: 1) utility and feasibility of sham-RMT as a control condition, 2) the clinically meaningful outcome measures for inclusion in a future efficacy trial. This manuscript provides comprehensive information regarding the design and methods used in our trial and will aid in the reporting and interpretation of our future findings. METHODS: Twenty-eight adults with LOPD will be randomized (1:1) in blocks of 4 to RMT (treatment) or sham-RMT (control). Assessments will be conducted at pretest, posttest, 3-months detraining, and 6-months detraining. The primary outcome is maximum inspiratory pressure (MIP). Secondary outcomes include maximum expiratory pressure (MEP), 6-minute walk test (6MWT), Gait, Stairs, Gowers, and Chair test (GSGC), peak cough flow (PCF), and patient-reported life activity/social participation (Rasch-built Pompe-specific Activity scale [R-Pact]). Exploratory outcomes include quantitative measures from polysomnography; patient reported measures of fatigue, daytime sleepiness, and sleep quality; and ultrasound measures of diaphragm thickness. This research will use a novel tool to provide automated data collection and user feedback, and improve control over dose. ETHICS AND DISSEMINATION: The results of this clinical trial will be promptly analyzed and submitted for publication. Results will also be made available on clinicaltrials.gov. CLINICALTRIALS.GOV: ,
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Affiliation(s)
- Harrison N Jones
- Department of Surgery, Division of Head and Neck Surgery & Communication Sciences, Duke University Medical Center, Durham, NC, USA; Department of Speech Pathology and Audiology, Duke University Medical Center, Durham, NC, USA.
| | - Maragatha Kuchibhatla
- Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, NC, USA
| | - Kelly D Crisp
- Department of Surgery, Division of Head and Neck Surgery & Communication Sciences, Duke University Medical Center, Durham, NC, USA
| | - Lisa D Hobson Webb
- Department of Neurology, Neuromuscular Division, Duke University Medical Center, Durham, NC, USA
| | - Laura Case
- Division of Physical Therapy, Duke University School Of Medicine, Durham, NC, USA
| | - Milisa T Batten
- Department of Speech Pathology and Audiology, Duke University Medical Center, Durham, NC, USA
| | - Jill A Marcus
- Department of Speech Pathology and Audiology, Duke University Medical Center, Durham, NC, USA
| | - Richard M Kravitz
- Division of Pediatric Pulmonary and Sleep Medicine, Duke University Medical Center, Durham, NC, USA
| | - Priya S Kishnani
- Department of Pediatrics, Division of Medical Genetics, Duke University Medical Center, Durham, NC, USA
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Affiliation(s)
- Kristen L Nowak
- From the University of Colorado Anschutz Medical Campus, Aurora (K.L.N., M.C.); and University of Colorado Boulder (M.J.R., D.R.S.).
| | - Matthew J Rossman
- From the University of Colorado Anschutz Medical Campus, Aurora (K.L.N., M.C.); and University of Colorado Boulder (M.J.R., D.R.S.)
| | - Michel Chonchol
- From the University of Colorado Anschutz Medical Campus, Aurora (K.L.N., M.C.); and University of Colorado Boulder (M.J.R., D.R.S.)
| | - Douglas R Seals
- From the University of Colorado Anschutz Medical Campus, Aurora (K.L.N., M.C.); and University of Colorado Boulder (M.J.R., D.R.S.)
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DeLucia CM, De Asis RM, Bailey EF. Daily inspiratory muscle training lowers blood pressure and vascular resistance in healthy men and women. Exp Physiol 2018; 103:201-211. [PMID: 29178489 DOI: 10.1113/ep086641] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Accepted: 11/21/2017] [Indexed: 01/14/2023]
Abstract
NEW FINDINGS What is the central question of this study? What impact does inspiratory muscle training have on systemic vascular resistance, cardiac output and baroreflex sensitivity in adult men and women? What is the main finding and its importance? Inspiratory muscle training exerts favorable effects on blood pressure, vascular resistance and perception of stress. This exercise format is well-tolerated and equally effective whether implemented in men or women. ABSTRACT Previous work has shown that inspiratory muscle training (IMT) lowers blood pressure after a mere 6 weeks, identifying IMT as a potential therapeutic intervention to prevent or treat hypertension. Here, we explore the effects of IMT on respiratory muscle strength and select cardiovascular parameters in recreationally active men and women. Subjects were randomly assigned to IMT (n = 12, 75% maximal inspiratory pressure) or sham training (n = 13, 15% maximal inspiratory pressure) groups and underwent a 6-week intervention comprising 30 breaths day-1 , 5 days week-1 . Pre- and post-training measures included maximal inspiratory pressure and resting measures of blood pressure, cardiac output, heart rate, spontaneous cardiac baroreflex sensitivity and systemic vascular resistance. We evaluated psychological and sleep status via administration of the Cohen-Hoberman inventory of physical symptoms and the Epworth sleepiness scale. Male and female subjects in the IMT group showed declines in systolic/diastolic blood pressures (-4.3/-3.9 mmHg, P < 0.025) and systemic vascular resistance (-3.5 mmHg min l-1 , P = 0.008) at week 6. There was no effect of IMT on cardiac output (P = 0.722), heart rate (P = 0.795) or spontaneous cardiac baroreflex sensitivity (P = 0.776). The IMT subjects also reported fewer stress-related symptoms (pre- versus post-training, 12.5 ± 8.5 versus 7.2 ± 9.7, P = 0.025). Based on these results, we suggest that a short course of IMT confers significant respiratory and cardiovascular improvements and parallel (modest) psychological benefits in healthy men and women.
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Affiliation(s)
- Claire M DeLucia
- Department of Physiology, College of Medicine, University of Arizona, Tucson, AZ, USA
| | - Roxanne M De Asis
- Department of Physiology, College of Medicine, University of Arizona, Tucson, AZ, USA
| | - E Fiona Bailey
- Department of Physiology, College of Medicine, University of Arizona, Tucson, AZ, USA
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Vranish JR, Bailey EF. Inspiratory Muscle Training Improves Sleep and Mitigates Cardiovascular Dysfunction in Obstructive Sleep Apnea. Sleep 2016; 39:1179-85. [PMID: 27091540 DOI: 10.5665/sleep.5826] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Accepted: 03/09/2016] [Indexed: 01/26/2023] Open
Abstract
STUDY OBJECTIVES New and effective strategies are needed to manage the autonomic and cardiovascular sequelae of obstructive sleep apnea (OSA). We assessed the effect of daily inspiratory muscle strength training (IMT) on sleep and cardiovascular function in adults unable to use continuous positive airway pressure (CPAP) therapy. METHODS This is a placebo-controlled, single-blind study conducted in twenty four adults with mild, moderate, and severe OSA. Subjects were randomly assigned to placebo or inspiratory muscle strength training. Subjects in each group performed 5 min of training each day for 6 w. All subjects underwent overnight polysomnography at intake and again at study close. RESULTS We evaluated the effects of placebo training or IMT on sleep, blood pressure, and plasma catecholamines. Relative to placebo-trained subjects with OSA, subjects with OSA who performed IMT manifested reductions in systolic and diastolic blood pressures (-12.3 ± 1.6 SBP and -5.0 ± 1.3 DBP mmHg; P < 0.01); plasma norepinephrine levels (536.3 ± 56.6 versus 380.6 ± 41.2 pg/mL; P = 0.01); and registered fewer nighttime arousals and reported improved sleep (Pittsburgh Sleep Quality Index scores: 9.1 ± 0.9 versus 5.1 ± 0.7; P = 0.001). These favorable outcomes were achieved without affecting apneahypopnea index. CONCLUSIONS The results are consistent with our previously published findings in normotensive adults but further indicate that IMT can modulate blood pressure and plasma catecholamines in subjects with ongoing nighttime apnea and hypoxemia. Accordingly, we suggest IMT offers a low cost, nonpharmacologic means of improving sleep and blood pressure in patients who are intolerant of CPAP.
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Affiliation(s)
| | - E Fiona Bailey
- The University of Arizona College of Medicine, Tucson, AZ
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