Efficacy of a Novel Method for Inspiratory Muscle Training in People With Chronic Obstructive Pulmonary Disease.

Most inspiratory muscle training (IMT) interventions in patients with chronic obstructive pulmonary disease (COPD) have been implemented as fully supervised daily training for 30 minutes with controlled training loads using mechanical threshold loading (MTL) devices. Recently, an electronic tapered flow resistive loading (TFRL) device was introduced that has a different loading profile and stores training data during IMT sessions. The aim of this study was to compare the efficacy of a brief, largely unsupervised IMT protocol conducted using either traditional MTL or TFRL on inspiratory muscle function in patients with COPD. Twenty patients with inspiratory muscle weakness who were clinically stable and participating in a pulmonary rehabilitation program were randomly allocated to perform 8 weeks of either MTL IMT or TFRL IMT. Participants performed 2 daily home-based IMT sessions of 30 breaths (3-5 minutes per session) at the highest tolerable intensity, supported by twice-weekly supervised sessions. Adherence, progression of training intensity, increases in maximal inspiratory mouth pressure (Pimax), and endurance capacity of inspiratory muscles (Tlim) were evaluated. More than 90% of IMT sessions were completed in both groups. The TFRL group tolerated higher loads during the final 3 weeks of the IMT program, with similar effort scores on the 10-Item Borg Category Ratio (CR-10) Scale, and achieved larger improvements in Pimax and Tlim than the MTL group. A limitation of the study was the absence of a study arm involving a sham IMT intervention. The short and largely home-based IMT protocol significantly improved inspiratory muscle function in both groups and is an alternative to traditional IMT protocols in this population. Participants in the TFRL group tolerated higher training loads and achieved larger improvements in inspiratory muscle function than those in the MTL group.

Langer D ，Charususin N ，Jácome C ，Hoffman M ，McConnell A ，Decramer M ，Gosselink R ... -  《-》

Inspiratory muscle training during pulmonary rehabilitation in chronic obstructive pulmonary disease: A randomized trial.

Although recommended by international guidelines, the benefit of inspiratory muscle training (IMT) in addition to rehabilitation remains uncertain. The objective was to demonstrate the effectiveness of IMT on dyspnea using Borg scale and multidimensional dyspnea profile questionnaire at the end of a 6-minute walk test (6MWT) in patients with chronic obstructive pulmonary disease (COPD) with preserved average maximum inspiratory pressure (PImax) of 85 cm H2O (95% of predicted (pred.) value) and admitted for a rehabilitation program in a dedicated center. In a randomized trial, comparing IMT versus no IMT in 32 COPD patients without inspiratory muscle weakness (PImax >60 cm H2O) who were admitted for pulmonary rehabilitation (PR) for 3 weeks, we evaluated the effect of IMT on dyspnea, using both Borg scale and multidimensional dyspnea profile (MDP) at the end of the 6MWT, and on functional parameters included inspiratory muscle function (PImax) and 6MWT. All testings were performed at the start and the end of PR. In unadjusted analysis, IMT was not found to be associated with an improvement of either dyspnea or PImax. After adjustment on confounders (initial Borg score) and variables of interaction (forced expiratory volume in 1 second (FEV1)), we found a trend toward an improvement of "dyspnea sensory intensity", items from MDP and a significant improvement on the variation in the 2 items of MDP ("tight or constricted" and "breathing a lot"). In the subgroup of patients with FEV1 < 50% pred., 5 items of MDP were significantly improved, whereas no benefit was observed in patients with FEV1 > 50% pred. IMT did not significantly improve dyspnea or functional parameter in COPD patients with PImax > 60 cm H2O. However, in the subgroup of patients with FEV1 < 50% pred., MDP was significantly improved.

Beaumont M ，Mialon P ，Le Ber-Moy C ，Lochon C ，Péran L ，Pichon R ，Gut-Gobert C ，Leroyer C ，Morelot-Panzini C ，Couturaud F ... -  《-》

Comparison of effectiveness of pressure threshold and targeted resistance devices for inspiratory muscle training in patients with chronic obstructive pulmonary disease.

Hsiao SF ，Wu YT ，Wu HD ，Wang TG ... -  《JOURNAL OF THE FORMOSAN MEDICAL ASSOCIATION》

High-intensity inspiratory muscle training in COPD.

Hill K ，Jenkins SC ，Philippe DL ，Cecins N ，Shepherd KL ，Green DJ ，Hillman DR ，Eastwood PR ... -  《EUROPEAN RESPIRATORY JOURNAL》

Effects of two types of equal-intensity inspiratory muscle training in stable patients with chronic obstructive pulmonary disease: A randomised controlled trial.

We conducted a randomised controlled trial to assess the effects of daily breathing pattern changes to stable patients with COPD excluding the confounding factors of inspiratory muscle mobilization, by ensuring the load intensities of two inspiratory training devices were equal. Sixty patients with COPD were randomised to three groups: resistive-IMT group (T-IMT, 21 patients), threshold-IMT (R-IMT, 19 patients), and a control group (20 patients). Inspiratory load intensity for both methods was set at 60% of maximal inspiratory pressure (MIP), a measure of inspiratory muscle strength, which, along with health-related quality of life (HRQoL), degree of dyspnoea, and exercise capacity, were conducted before and after 8 weeks of daily IMT. At 8 weeks, there was no significantly difference of MIP between the R- and T-IMT groups (P > 0.05). Chronic Respiratory Disease Questionnaire and Transition Dyspnea Index scores improved significantly after each training program compared with controls (P < 0.05), and R-IMT was significant better (P < 0.05). R-IMT was better than T-IMT in performance of exercise (P < 0.05). In summary, in clinically stable patients with COPD, 8 weeks of R-IMT was superior to 8 weeks of equal-intensity T-IMT in improving HRQoL, degree of dyspnoea, and exercise capacity.

Wu W ，Guan L ，Zhang X ，Li X ，Yang Y ，Guo B ，Ou Y ，Lin L ，Zhou L ，Chen R ... -  《-》