Respiratory muscle endurance training improves exercise performance but does not affect resting blood pressure and sleep in healthy active elderly

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.

Exercise Related Respiratory Problems in the Young-Is It Exercise-Induced Bronchoconstriction or Laryngeal Obstruction?

Complaints of breathlessness during heavy exercise is common in children and adolescents, and represent expressions of a subjective feeling that may be difficult to verify and to link with specific diagnoses through objective tests. Exercise-induced asthma and exercise-induced laryngeal obstruction are two common medical causes of breathing difficulities in children and adolescents that can be challenging to distinguish between, based only on the complaints presented by patients. However, by applying a systematic clinical approach that includes rational use of tests, both conditions can usually be diagnosed reliably. In this invited mini-review, we suggest an approach we find feasible in our everyday clinical work.

Training Specificity of Inspiratory Muscle Training Methods: A Randomized Trial

Introduction

Inspiratory muscle training (IMT) protocols are typically performed using pressure threshold loading with inspirations initiated from residual volume (RV). We aimed to compare effects of three different IMT protocols on maximal inspiratory pressures (PImax) and maximal inspiratory flow (V̇Imax) at three different lung volumes. We hypothesized that threshold loading performed from functional residual capacity (FRC) or tapered flow resistive loading (initiated from RV) would improve inspiratory muscle function over a larger range of lung volumes in comparison with the standard protocol.

Methods

48 healthy volunteers (42% male, age: 48 ± 9 years, PImax: 110 ± 28%pred, [mean ± SD]) were randomly assigned to perform three daily IMT sessions of pressure threshold loading (either initiated from RV or from FRC) or tapered flow resistive loading (initiated from RV) for 4 weeks. Sessions consisted of 30 breaths against the highest tolerable load. Before and after the training period, PImax was measured at RV, FRC, and midway between FRC and total lung capacity (1/2 IC). V̇Imax was measured at the same lung volumes against a range of external threshold loads.

Results

While PImax increased significantly at RV and at FRC in the group performing the standard training protocol (pressure threshold loading from RV), it increased significantly at all lung volumes in the two other training groups (all p < 0.05). No significant changes in V̇Imax were observed in the group performing the standard protocol. Increases of V̇Imax were significantly larger at all lung volumes after tapered flow resistive loading, and at higher lung volumes (i.e., FRC and 1/2 IC) after pressure threshold loading from FRC in comparison with the standard protocol (all p < 0.05).

Conclusion

Only training with tapered flow resistive loading and pressure threshold loading from functional residual capacity resulted in consistent improvements in respiratory muscle function at higher lung volumes, whereas improvements after the standard protocol (pressure threshold loading from residual volume) were restricted to gains in PImax at lower lung volumes. Further research is warranted to investigate whether these results can be confirmed in larger samples of both healthy subjects and patients.

No Evidence That Hyperpnea-Based Respiratory Muscle Training Affects Indexes of Cardiovascular Health in Young Healthy Adults

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 (PWV_CF) 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 (PWV_CR) or the PWV_CF/PWV_CR 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), PWV_CF (P = 0.844), PWV_CR (P = 0.815) or the PWV_CF/PWV_CR ratio (P = 0.389).

Discussion/Conclusion

Although 15 min of RMT sessions elicited transient increases in PWV_CF 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.

Music, A “Body-Mind Medicine” In Rehabilitation Programs of Patients with Chronic Obstructive Pulmonary Disease

Chronic obstructive pulmonary disease (COPD) is a progressive disease characterized by dyspnea and chronic cough. The main risk factor is cigarette smoking, but there are other ones implicated in the COPD etiology such as air pollution, childhood asthma, aging, chemical exposure, dietary factors, and genetic predisposition. Besides, COPD is associated with several comorbidities that influence prognostic and management, like asthma, lung cancer, obstructive sleep apnea, cardiovascular disease, metabolic syndrome, and depression or anxiety. The management is multidisciplinary and its role is to ease symptoms, prevent complications, slow disease progression, and improve the quality of life. In the last years, many alternative techniques have been implemented such as speleotherapy, halotherapy, muscular training, neuromuscular electrostimulation, acupuncture, thermotherapy, and music therapy. From those, music therapy has become a form of “mind-body medicine” indispensable in rehabilitation programs, whether used actively or passively, and has gained a lot of interest in alternative medicine. Keywords: COPD, music therapy, alternative medicine,

Beneficial Effects of Inspiratory Muscle Training Combined With Multicomponent Training in Elderly Active Women

Purpose: This study aims to analyze changes in Maximum Inspiratory Pressure (MIP), lung function, cardiorespiratory fitness, and blood pressure, in 10 healthy active elderly women, following 7 weeks of inspiratory muscle training (IMT) combined with a multicomponent training program (MCTP). The association among these health parameters, their changes after training (deltas), and the influence of MIP at baseline (MIP_pre) are also considered. Methods: IMT involved 30 inspirations at 50% of the MIP, twice daily, 7 days a week, while MCTP was 1 hr, twice a week. MIP, lung function (FVC, FEV₁, FEV₁/FVC, FEF_25-75%, PEF), 6MWT, and blood pressure (SBP, DBP), jointly with body composition, were assessed before and after the intervention. Results: Seven weeks were enough to improved MIP (p = .019; d = 1.397), 6MWT (p = .012; d = .832), SBP (p = .003; d = 1.035) and DBP (p = .024; d = .848). Despite the high physical fitness (VO₂ peak: M = 23.38, SD = 3.39 ml·min·Kg^-1), MIP_pre was low (M = 39.00, SD = 7.63 cmH₂O) and displayed a significant negative correlation with ΔMIP_pre-post (r = -.821; p < .004), showing that women who started the intervention with lower MIP achieved higher improvements in inspiratory muscle strength after training. Conclusions: No significant changes in spirometric parameters may signal that lung function is independent of early improvements in inspiratory muscles and cardiorespiratory fitness. Absence of correlation between physical fitness and respiratory outcomes suggests that being fit does not ensure cardiorespiratory health in active elderly women, so IMT might be beneficial and should supplement the MCTP in this population.

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.