Inspiratory Muscle Training

1
Inspiratory Muscle Training

• Presented by Anabel Sciriha

2
Aims

• To present an brief overview about what IMT is.
• To discuss results obtained from a study carried
  out on COPD patients and discuss future
  developments.

3
Rationale for Inspiratory Muscle Training

• Many conditions are associated with abnormal
  functions of the respiratory muscles.
• This is due to a number of causes but
  principally
• Weakness and or increased fatigability of the
  respiratory muscles induced by structural/metaboli
  c changes in the muscle themselves (e.g. muscular
  dystrophy)
• Failure of muscle activation by the nervous
  system (e.g. multiple sclerosis)
• Functional weakness induced by alterations in the
  mechanics of the respiratory system that induce
  an increased requirement for muscle force output
  (e.g. emphysema)
• Combination of these factors (e.g. CHF)

4
Can inspiratory muscles be trained?

• To acquire a given outcome when training a
  skeletal muscle, the stimulus must be
• Specific
• Of adequate intensity and duration (Lotters
  et al 2002).

5
Methods of respiratory muscle training

• Normocapnic hyperpnoea
• Inspiratory resistive training
• - Flow dependent
• - Flow independent

6
(No Transcript)
7
The study Rationale for

• COPD is a respiratory disease characterized by
  airflow limitation resulting from intrinsic
  airways disease such as chronic bronchitis and/or
  emphysema.
• It is the fifth most common condition worldwide
  and is reported to be on a steady increase.
• Pulmonary rehabilitation has an established place
  in the comprehensive care of COPD patients.
• Two of the components of a pulmonary
  rehabilitation programme include Inspiratory
  muscle training and
• Upper limb exercises.

8

• Inspiratory muscle weakness is present because
  these muscles are submitted to multiple factors
  related to the presence and severity of COPD.
• Dysfunction of the upper limbs is present due to
  weak musculature.
• For a given workload, the upper limbs require
  more energy and are accompanied by higher
  ventilatory demands than lower limbs.
• Thinking of the importance given to upper limb
  exercises in COPD patients, we wanted to look
  into whether there would be any additive effects
  if Inspiratory Muscle Training and unsupported
  arm exercises are combined.

9

• In this study, a combination of unsupported arm
  exercises with Inspiratory Muscle Training was
  examined to discover whether additional
  improvements, when compared to Inspiratory Muscle
  Training only and a control group, in dyspnoea
  management, daily living performance, respiratory
  strength and upper limb endurance occurred.

10
Method

• 45 participants were recruited. 40 finished the
  programme.
• 30 males and 10 female patients
• Average age of 68 2years.
• The participants were allocated to three groups
• 1) Inspiratory Muscle Training group
  (IMT),
• 2) Combination group of IMT and upper
  limb exercises and
• 3) Control group receiving no exercise
  intervention.
• Each subject had their lung function, inspiratory
  muscle strength and endurance, exercise tolerance
  and dyspnoea rate measured before the start of
  the programme and after 8weeks.
• The study was a quasi-experimental type allowing
  the researcher to look at the relationship
  between the variables being IMT and upper limb
  exercises.

11

• The London Chest Activities of Daily Living
  questionnaire was also administered.
• The first exercise group had 15minutes of IMT
  at 30 their PImax twice daily using a threshold
  trainer.
• The combination group had 15minutes of IMT
• Upper limb training.
• The upper limb exercises consisted of
• throwing a ball against a wall,
• lifting arms above horizontal,
• passing bean bags over the head and
• doing shoulder flexion using a dowel.
• Each exercise was performed for 40 seconds
  followed by 20 second rest periods repeated four
  times in four minutes for a total of 15minutes.

12
Inclusion/ Exclusion criteria

• The participants were recruited if they
• Were between 45 and 75 years
• Had moderate to severe airflow obstruction (FEV1
  lt65 predicted, FEV1/FVC lt 70).
• Complained of dyspnoea on exertion (American
  Thoracic Society- Division of Lung Disease, ATS
  DLD breathlessness question 1978)
• Were medically stable - had no exacerbation for
  the previous 2 months and their condition was
  well controlled.
• Were willing to participate.
• The exclusion criteria included
• History of asthma
• Required home oxygen therapy
• Experienced oxyhaemoglobin desaturation below 85
  with exercise examined after the 6 minute walk
  test.
• Were free from cardiovascular, musculoskeletal or
  neuromuscular disease that could interfere with
  exercise after being verified by their medical
  consultant.

13
Components of the exercise programme

• The study consisted of 2 parts a learning phase
  where both exercise groups were familiarized with
  the Threshold Trainer (Health Scan Prod. NJ,
  USA).
• 8 week
  exercise programme.

14
Results
plt0.0406 plt0.0627 plt0.0002 plt 0.0004)
15
plt0.0010
16
plt0.0117, plt0.0020, 0.0002, 0.007
17
plt 0.0010. plt 0.0351
18
plt0.0182, plt 0.0412, plt0.0180
19
plt0.0181, 0.0007, plt0.0152, plt 0.0004
20
Discussion of the findings

• Chronic Obstructive Pulmonary Disease is a
  respiratory condition
• which is thought to be irreversible.
• With pulmonary rehabilitation coming to the
  forefront, there are
• ways and means to help in the management of this
  respiratory
• condition.
• This study shows that IMT using threshold devices
  and Upper limb exercises in COPD patients
  ameliorates dyspnoea, respiratory muscle strength
  and endurance and ADL scoring and increases the
  distance the patient can walk in 6 minutes.

21

• When comparing the combination group with the IMT
  group one
• could notice a trend towards additive affect but
  this did not reach
• significance. Possible reasons for not having
  reached significance
• are the small sample group used and the length
  of time over which
• this study was carried out.
• The beneficial effects obtained in this study
  were observed when a
• load of 30 peak PImax was employed.

22
Conclusion of the study

• In the present study it has been shown that the
  inspiratory muscles can be trained leading to
• Reduction in dyspnoea scores
• Changes in inspiratory muscle strength and
  endurance.
• Amelioration of exercise tolerance and
  
• Improvement in lung function.

23
Use of IMT in other conditions

• 1. Asthma (Weiner et al 2000), Cystic fibrosis
  (De Jong et al 2001) IMT helps decrease
  hyperinflation by increasing the aspiratory
  muscles strength.
• 2. Neuromuscular disorders (Winkler et al 2000) -
  Deuchenne muscular dystrophy
• - Multiple sclerosis
• 3. Spinal Cord Injury (Liaw et al 2000)
• 4. Conditions having an imbalance in supply and
  demand inspiratory muscle function diminished
  and/or inspiratory muscle work increased
• Myasthenia gravis (Weiner et al 1998)
• Chronic Renal failure (Weiner et al 1996)
• 5. Conditions associated with respiratory muscle
  dysfunction and/or increased work of breathing
  (McConnell 2002) Parkinson's
• Thoracic surgery and upper abdomen
• Scoliosis/ kyphosis

24
Thank you Questions?