Inspiratory muscle training in adults with chronic obstructive pulmonary disease: An update of a systematic review

Abstract

The purpose was to update an original systematic review to determine the effect of inspiratory muscle training (IMT) on inspiratory muscle strength and endurance, exercise capacity, dyspnea and quality of life for adults with chronic obstructive pulmonary disease (COPD). The original MEDLINE and CINAHL search to August 2003 was updated to January 2007 and EMBASE was searched from inception to January 2007. Randomized controlled trials, published in English, with adults with stable COPD, comparing IMT to sham IMT or no intervention, low versus high intensity IMT, and different modes of IMT were included. Nineteen of 274 articles in the original search met the inclusion criteria. The updated search revealed 17 additional articles; 6 met the inclusion criteria, all of which compared targeted, threshold or normocapneic hyperventilation IMT to sham IMT. An update of the sub-group analysis comparing IMT versus sham IMT was performed with 10 studies from original review and 6 from the update. Sixteen meta-analyses are reported. Results demonstrated significant improvements in inspiratory muscle strength (PI(max), PI(max) % predicted, peak inspiratory flow rate), inspiratory muscle endurance (RMET, inspiratory threshold loading, MVV), exercise capacity (Ve(max), Borg Score for Respiratory Effort, 6MWT), Transitional Dyspnea Index (focal score, functional impairment, magnitude of task, magnitude of effort), and the Chronic Respiratory Disease Questionnaire (quality of life). Results suggest that targeted, threshold or normocapneic hyperventilation IMT significantly increases inspiratory muscle strength and endurance, improves outcomes of exercise capacity and one measure of quality of life, and decreases dyspnea for adults with stable COPD.

Management of respiratory problems in people with neurodegenerative conditions: a narrative review

“…overload, specificity and reversibility, have been shown to improve respiratory strength and endurance in healthy subjects (32) and in chronic respiratory disease (33). Training may also influence respiratory muscle endurance, dependent upon the training protocol.…”

Types of Physical Exercise Training for COPD Patients

“…The role of inspiratory muscle training (IMT) for individuals with stable COPD is unclear (Geddes, O'Brien, Reid, Brooks, & Crowe, 2008). The first systematic review on IMT found little evidence to support the use of IMT (Shoemaker, Donker, & Lapoe, 2009).…”

“…Using IMT in combination with other interventions and using flow-dependent resistive training is important in the pulmonary rehabilitation program (Geddes et al, 2008). However, there are no established thresholds for what constitutes a clinically meaningful change in inspiratory muscle strength or endurance, other methods must be utilized to infer clinical benefit (Shoemaker et al, 2009).…”

Development of a Theory-Based Intervention to Increase Prescription of Inspiratory Muscle Training by Health Professionals in the Management of People with Chronic Obstructive Pulmonary Disease

“…33 This conclusion, however, was refuted by several later systematic reviews. [8][9][10] For example, Geddes et al 8 accounted for studies with methodological differences by examining threshold and targeted trainers separately from inspiratory resistive trainers with no target, and concluded that normocapneic hyperventilation, targeted inspiratory resistive, or threshold IMT significantly increased inspiratory muscle strength and endurance compared to sham IMT (see Table 1). The conflicting messages from the literature may have contributed to the confusion among physiotherapists with respect to this intervention (see Table 1).…”

“…1 Studies from Australia, 2,3 England, 3 Sweden, 4 the United States, 5,6 and Canada 7 have shown that physical therapists have a positive attitude toward EBP, but this attitude does not always translate into practice. For example, a variety of studies [8][9][10] have provided evidence supporting the use of inspiratory muscle training (IMT) for some people with chronic obstructive pulmonary disease (COPD), such as those who are unable to participate fully in whole-body exercise training because of comorbid conditions or those who have intractable dyspnea despite whole-body exercise. However, a survey of Canadian acute-care hospitals and pulmonary rehabilitation programmes found that less than 5% of physiotherapists prescribe IMT for COPD rehabilitation.…”