Title: Inspiratory Muscle Training
1Inspiratory Muscle Training
- Presented by Anabel Sciriha
2Aims
- 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.
3Rationale 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)
4Can 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). -
5Methods of respiratory muscle training
- Normocapnic hyperpnoea
-
- Inspiratory resistive training
- - Flow dependent
- - Flow independent
6(No Transcript)
7The 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.
10Method
- 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.
12Inclusion/ 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.
13Components 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.
14Results
plt0.0406 plt0.0627 plt0.0002 plt 0.0004)
15plt0.0010
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
20Discussion 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.
22Conclusion 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.
23Use 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
24Thank you Questions?