Effects of combined inspiratory muscle and cycle ergometer training on exercise performance in patients with COPD

Abstract

E Ef ff fe ec ct ts s o of f c co om mb bi in ne ed d i in ns sp pi ir ra at to or ry y m mu us sc cl le e a an nd d c cy yc cl le e e er rg go om me et te er r t tr ra ai in ni in ng g o on n e ex xe er rc ci is se e p pe er rf fo or rm ma an nc ce e i in n p pa at ti ie en nt ts s w wi it th h C CO OP PD D To determine whether inspiratory muscle training could intensify the known beneficial effects of cycle ergometer training on exercise performance in these patients, we compared the effect of an 8 week inspiratory muscle training combined with cycle ergometer training with that of an 8 week cycle ergometer training alone on inspiratory muscle performance and general exercise capacity. Patients were randomly assigned to the two training groups; 21 patients received additional inspiratory muscle training (Group 1) and 21 did not (Group 2). Maximal sniff assessed oesophageal and transdiaphragmatic pressures served as parameters for global inspiratory muscle strength and diaphragmatic strength, respectively. The duration for which the patient could breathe against a constant inspiratory pressure load was used as an index of inspiratory muscle endurance. Exercise capacity was determined by an incremental symptom-limited cycle ergometer test.After the training period, inspiratory muscle performance improved significantly in the patients with inspiratory muscle training, but not in those without. Both training regimens increased maximal power output and oxygen uptake, but this improvement was significantly greater in the patients with inspiratory muscle training than in those without.We conclude that inspiratory muscle training in addition to cycle ergometer training, can intensify the beneficial effects of cycle ergometer training on exercise performance in COPD patients.

Effects of Inspiratory Muscle Training and Calisthenics-and-Breathing Exercises in COPD With and Without Respiratory Muscle Weakness

“…Such reductions, when of 1 point or more, are considered clinically important differences. 8 Sustained maximum inspiratory pressure Such results are consistent with previous studies, which showed that inspiratory muscle training increases abdominal mobility 10 and significantly decreases dyspnea, 30,31,34 which is paramount in patients with COPD in pulmonary rehabilitation programs.…”

“…There are also studies that show that by adding inspiratory muscle training to general physical training, an increase in submaximal exercise capacity can be achieved, with clinically important improvement in relation to general physical training. 32,34 In our study, there was no difference between those subjects with and without respiratory muscle weakness for both interventions.…”

“…Minoguchi et al, 10 when implementing calisthenics-and-breathing exercises based on stretching exercises, unlike in our study, did not notice an increase in maximum inspiratory pressure. Because there is evidence in the literature that, in general, physical training does not improve the strength and endurance of the inspiratory muscles, 31,34 it is likely that the increased maximum inspiratory pressure of subjects with COPD in this study has occurred due to the proposed exercises.…”

Inspiratory muscle training: where are we?

“…Improvements in exercise capacity with IRT alone were generally smaller than with exercise conditioning and IRT combined [4,5]. In this issue of the European Respiratory Journal, the study by WANKE et al [19] supports this finding. They observed that inspiratory muscle training additional to general exercise conditioning, resulted in a 24% increase in maximal work load on the cycle ergonometer, whereas in the general exercise condition alone group only a 12% increase was found.…”

“…Recently, PARDY and ROCHESTER [20] demonstrated, in a literature review, a close relationship between training intensity and percentage improvement in PImax. The data of the present study by WANKE et al [19] fall within this relationship as they found a 40% increase in PImax with high imposed pressures (70% and 100% PImax). On the other hand, lower training intensities (30% PImax) in the study of LISBOA et al [5] resulted in a 34% increase in PImax.…”