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Inspiratory Muscle Training

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... that induce an increased requirement for muscle force output (e.g. emphysema) ... from intrinsic airways disease such as chronic bronchitis and/or emphysema. ... – PowerPoint PPT presentation

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Title: 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
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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
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15
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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
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