Pulmonary complications after cardiac surgery are a leading cause of postoperative morbidity and mortality. Respiratory muscle weakness may contribute to the postoperative pulmonary abnormalities. We hypothesized that: (1) there is a decrease in inspiratory muscle strength (PImax at residual volume) and endurance (Pmpeak/PImax) following coronary artery bypass graft (CABG); (2) this weakness is associated with reduced pulmonary function tests (PFTs), impaired gas exchange, and a higher rate of pulmonary complications; and (3) prophylactic inspiratory muscle training (IMT) can prevent those changes. Eighty-four candidates for CABG, with ages ranging from 33 to 82 years, were evaluated prior to operation and randomized into two groups: 42 patients underwent IMT using a threshold trainer for 30 min/day for 2 weeks, 1 month before operation (group A); 42 patients served as a control group and underwent sham training (group B). There was a significant decrease in respiratory muscle function, PFTs, and gas exchange in the control group following CABG, whereas these parameters remained similar to those before entering the study in the training group. The differences between the groups were statistically significant. In addition 11 (26%) patients in the control group but only 2 (5%) in the training group needed postsurgical mechanical ventilation longer than 24 hours, CABGs have a significant deteriorating effect on inspiratory muscle function, PFTs, and arterial blood gases. The decrease in these parameters can be prevented by prophylactic inspiratory muscle training, which may also prevent postsurgical pulmonary complications.

Maintenance of inspiratory muscle training in COPD patients: one year follow-up. P. Weiner, R. Magadle, M. Beckerman, M. Weiner, N. Berar-Yanay. #ERS Journals Ltd 2004. ABSTRACT: In most chronic obstructive pulmonary disease (COPD) patients, dyspnoea and functional exercise capacity may improve as a result of inspiratory muscle training (IMT). However, the long-term benefits of IMT have been investigated to a much lesser extent.The present study investigated the short-term and long-term benefits of IMT on inspiratory muscle performance (strength and endurance), exercise capacity and the perception of dyspnoea.Thirty-eight patients with significant COPD had 3 months of basic IMT and were then randomised into a group that received maintenance IMT for the next year, and a group that got training with very low load. Following the basic training there was a statistically significant increase in inspiratory muscle performance, 6-min walk test (6MWT), and a decrease in the dyspnoea. During the second stage of the study, the training group continued to maintain the improvement in all parameters, while there was already deterioration in the inspiratory muscle performance, exercise capacity and dyspnoea in the low intensity group during the 6-12 month period.The present study concludes that, in patients with significant chronic obstructive pulmonary disease, inspiratory muscle training results in improvement in performance, exercise capacity and in the sensation of dyspnoea. The benefits of 12-weeks of inspiratory muscle training decline gradually over 1 yr of follow-up if maintenance training is not performed. Patients with significant chronic obstructive pulmonary disease (COPD) have respiratory and peripheral muscle weakness [1]. Respiratory muscle weakness may contribute to dyspnoea and to poor exercise performance [2,3]. Therefore, it was rational to try ventilatory muscle training in these patients, to enhance respiratory muscle function and potentially reduce the severity of breathlessness and improve exercise tolerance.Inspiratory muscle training has been extensively investigated in patients with COPD. Although, in their meta-analysis, SMITH et al. [4] concluded that inspiratory muscle training (IMT) in patients with COPD did not reveal significant treatment effect, it was later shown, in studies in which the training stimulus was adequate, that in most COPD patients, dyspnoea and functional exercise capacity may improve as a result of such training [5][6][7]. The joint American College of Chest Physicians/American Association of Cardiovascular and Pulmonary Rehabilitation committee [8] declared that when the stimulus or load placed on the respiratory muscles during training is sufficient to augment inspiratory muscle strength, there is an associated increase in exercise capacity and decrease in dyspnoea. In a recent meta-analysis performed by LÖ TTERS et al. [9] it was concluded that IMT, alone or as an adjunct to general exercise reconditioning, decreases dyspnoea and improves functional exercise capacity in pat...

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