Novel versus Traditional Inspiratory Muscle Training Regimens as Home-Based, Stand-Alone Therapies in COPD: Protocol for a Randomized Controlled Trial

While we acknowledge the value of threshold loading IMT protocols, we believe that the PrO2 TIRE training method has the potential to provide additional clinical benefits in COPD given its sophisticated remote tracking system and ability to modulate all aspects of muscular performance, including not only strength but also endurance, power and work capacity, allowing users to achieve considerably higher inspiratory pressures throughout the full range of inspiration when compared to other more traditionally used IMT methods.

Inspiratory muscle training enhances recovery post-COVID-19: a randomised controlled trial

Many people recovering from coronavirus disease 2019 (COVID-19) experience prolonged symptoms, particularly breathlessness. IMT may represent an important home-based rehabilitation strategy for wider implementation as part of COVID-19 rehabilitative strategies.

Respiratory Muscle Performance Screening for Infectious Disease Management Following COVID-19: A Highly Pressurized Situation

Screening for respiratory muscle impairment in patients with dyspnea or characteristics associated with an increased risk of severe respiratory complications due to viral infection may be advantageous. Furthermore, respiratory muscle training may prove valuable in mitigating the health impact of future pandemics.

Heterogeneous Treatment Effects after Inspiratory Muscle Training during Recovery from Postacute COVID-19 Syndrome

The objective of this study is to investigate whether heterogeneous treatment effects occur for changes in inspiratory muscle strength, perceived dyspnea, and health-related quality of life after 8 wk of unsupervised home-based inspiratory muscle training (IMT) in adults with postacute coronavirus disease 2019 (COVID-19) syndrome. Consistent with standard exercise theory, larger improvements in inspiratory muscle strength are strongly related to a greater cumulative dose of IMT.

A case for inspiratory muscle training in SCI: potential role as a preventative tool in infectious respiratory diseases like COVID-19

Respiratory complications (RC) are a leading cause of death after spinal cord injury (SCI) due to compromised immune function and respiratory muscle weakness. Thus, individuals with SCI are at high risk of developing COVID-19 related RC.

The effects of COVID-19 on respiratory muscle performance: making the case for respiratory muscle testing and training

Screening for Respiratory Muscle (RM) weakness and providing interventions to improve RM performance are essential for patients with COVID-19. This article will review the impact of SARS-CoV-2 infection on RM performance and provide clinical recommendations for screening RM performance and treatment interventions.

The Effect of a High-Intensity PrO2Fit Inspiratory Muscle Training Intervention on Physiological and Psychological Health in Adults with Bronchiectasis: A Mixed-Methods Study

Bronchiectasis participants reported high levels of perceived competence and motivation, reporting higher adherence and improved physical ability. Eight weeks of IMT increased inspiratory muscle strength and endurance in those with bronchiectasis. IMT also had a positive effect on perceived competency and autonomy, with bronchiectasis participants reporting improved physical ability and motivation, and high adherence.

Inspiratory Muscle Performance of Former Smokers and Nonsmokers Using the Test of Incremental Respiratory Endurance (TIRE)

Significant difference in sustained maximal inspiratory pressure between male former smokers and nonsmokers suggests that the sustained maximal inspiratory pressure may have greater discriminatory ability in assessing the effects of smoking on inspiratory muscle performance. Further investigation of the effects of smoking on inspiratory performance via the Test of Incremental Respiratory Endurance is warranted.

Novel Methods of Inspiratory Muscle Training via the Test of Incremental Respiratory Endurance (TIRE)

The favorable effects of inspiratory muscle training (IMT) in health and disease are becoming much more apparent. A variety of IMT methods exist, but very few studies have compared IMT methods. The purpose of this paper is to review the methods and outcomes of the Test of Incremental Respiratory Endurance (TIRE). The Test of Incremental Respiratory Endurance (TIRE) appears to have substantial potential to better direct and target inspiratory muscle training.

Novel Measures of Inspiratory Muscle Function in Chronic Obstructive Pulmonary Disease: Assessment and Training Implications

Inspiratory muscles of patients with COPD also have the capacity to express structural remodeling that relate to functional improvements after specific inspiratory training. Although a variety of IMT methods exist, most use a constant, pre-determined training load that does not allow dynamic adjustments as the subject improves, thus limiting its potential. This dissertation aimed at evaluating a novel inspiratory muscle assessment and training method for COPD called the Test of Incremental Respiratory Endurance (TIRE).

Test of incremental respiratory endurance as a home-based, stand-alone therapy in Chronic Obstructive Pulmonary Disease: A case report

Respiratory telerehabilitation was greatly beneficial in a cooperative patient with COPD and may represent an alternative therapeutic approach to the increasing incidence of all lung diseases. The system of long-term pulmonary rehabilitation care is insufficient. The main reasons for the absence of these outpatient programs are the lack of experience, the lack of interest of insurance companies in secondary prevention programs, and the lack of healthcare facilities in large geographical areas. The possibility of at-home pulmonary rehabilitation models (telemonitoring and telecoaching) could solve this problem.

Reliability and validity of the test of incremental respiratory endurance measures of inspiratory muscle performance in COPD

The Test of Incremental Respiratory Endurance (TIRE) provides a comprehensive assessment of inspiratory muscle performance by measuring maximal inspiratory pressure (MIP) over time. The TIRE measures of MIP, SMIP and ID have excellent test–retest reliability and demonstrated known-groups validity in subjects with COPD. SMIP and ID also demonstrated evidence of moderate convergent validity and appear to be more stable measures in this patient population than the traditional MIP.

Inspiratory muscle training in heart disease and heart failure: a review of the literature with a focus on method of training and outcomes

Evidence to date strongly suggests that poor inspiratory muscle performance is associated with dyspnea, poor exercise tolerance and poor functional status in patients with heart failure (HF). A growing body of literature has examined the effects of inspiratory muscle training (IMT) in HF patients with the majority of studies reporting favorable effects on several of the above limitations and a substantial number of related deficiencies due to inadequate inspiration and inspiratory muscle strength and endurance.

The role of inspiratory muscle training in the management of asthma and exercise-induced bronchoconstriction

IMT has been shown to decrease dyspnea, increase inspiratory muscle strength, and improve exercise capacity in asthmatic individuals. In order to develop more concrete recommendations regarding IMT as an effective low-cost adjunct in addition to traditional asthma treatments, we recommend that a standard treatment protocol be developed and tested in a placebo-controlled clinical trial with a large representative sample.

Effect of High-Intensity Inspiratory Muscle Training on Lung Volumes, Diaphragm Thickness and Exercise Capacity in Subjects Who Are Healthy

The findings of this study suggest that high-intensity IMT results in increased contracted diaphragm thickness and increased lung volumes and exercise capacity in people who are healthy. [Enright SJ, Unnithan VB, Heward C, et al. Effect of high-intensity inspiratory muscle training on lung volumes, diaphragm thickness, and exercise capacity in subjects who are healthy.

Inspiratory muscle training improves lung function and exercise capacity in adults with cystic fibrosis

Investigated the effects of high-intensity inspiratory muscle training (IMT) on inspiratory muscle function (IMF), diaphragm thickness, lung function, physical work capacity (PWC), and psychosocial status in patients with cystic fibrosis (CF). An 8-week program of high-intensity IMT resulted in significant benefits for CF patients, which included increased IMF and thickness of the diaphragm (during contraction), improved lung volumes, increased PWC, and improved psychosocial status.

Inspiratory muscle training improves exercise capacity with thoracic load carriage

6 weeks of flow-resistive IMT improves exercise capacity with thoracic LC. The improvement in exercise performance could be a consequence of increased inspiratory muscle strength, which may be associated with delays in the onset of diaphragmatic fatigue. Both occupational and recreational situations that require LC may benefit from incorporating IMT into their normal exercise routine.

A temporal examination of inspiratory muscle strength and endurance in hospitalized COVID-19 patients

IMP was examined at ICUD and HD via the PrO2 device (PrO2 Health, Smithfield, RI) which provided the maximal inspiratory pressure (MIP), sustained MIP (SMIP), inspiratory duration (ID), and fatigue index test (FIT). Patient symptoms were assessed at ICUD, HD, and 1-month post-HD. Impaired inspiratory muscle endurance rather than strength was associated with greater dyspnea at HD.

Respiratory Effects of Thoracic Load Carriage Exercise and Inspiratory Muscle Training as a Strategy to Optimize Respiratory Muscle Performance with Load Carriage

Many occupational and recreational settings require the use of protective and/or load-bearing apparatuses worn over the thoracic cavity, known as thoracic load carriage (LC). Inspiratory muscle training is an intervention that aims to increase the strength and endurance of the diaphragm and accessory inspiratory muscle and may therefore be a useful strategy to optimize performance with thoracic LC.

Time to Move Beyond a “One-Size Fits All” Approach to Inspiratory Muscle Training

The effects of IMT have been discrepant between populations, with some studies showing improvements with IMT and others not. This may be due to the use of standardized IMT protocols which are uniformly applied to all study participants without considering individual characteristics and training needs. As such, we suggest that research on IMT veer away from a standardized, one-size-fits-all intervention, and instead utilize specific IMT training protocols.

Clinical Improvements of a Veteran with COPD Following a Remote Inspiratory Muscle Training Program as a Stand-Alone Therapy

Studies suggest that adherence to pulmonary rehabilitation (PR) is low among veterans with COPD. This can be explained in part because PR programs are typically hospital-based, which limits accessibility. Home-based therapies are then a promising approach that might produce equivalent benefits to PR.

Inspiratory Muscle Rehabilitation Training in Pediatrics: What Is the Evidence?

Pulmonary rehabilitation is typically used for reducing respiratory symptoms and improving fitness and quality of life for patients with chronic lung disease. However, it is rarely prescribed and may be underused in pediatric conditions. Pulmonary rehabilitation can include inspiratory muscle training that improves the strength and endurance of the respiratory muscles. The purpose of this narrative review is to summarize the current literature related to inspiratory muscle rehabilitation training (IMRT) in healthy and diseased pediatric populations. This review highlights the different methods of IMRT and their effects on respiratory musculature in children.

Inspiratory flow resistive loading improves respiratory muscle function and endurance capacity in recreational runners

The purpose of this study was to assess the efficacy of inspiratory flow resistive loading (IFRL) on respiratory muscle function, exercise performance and cardiopulmonary and metabolic responses to exercise. Results suggest that IFRL can alter breathing mechanics, attenuate the oxygen cost, ventilation, HR, blood lactate and the perceptual response during constant workload exercise and improve endurance exercise performance in recreational runners.

Inspiratory resistive loading improves cycling capacity: a placebo controlled trial

After the 10-week IRL intervention, respiratory muscle strength (maximum inspiratory pressure) and endurance (sum of sustained maximum inspiratory pressure) had significantly improved (by 34% and 38%, respectively). An increase in diaphragm thickness was also observed. These improvements translated into a 36% increase in cycling time to exhaustion at a 75% VO(2)peak.

Effect of flow-resistive inspiratory loading on pulmonary and respiratory muscle function in sub-elite swimmers

This study evaluated the effects of a 12-week swim training and inspiratory muscle training (IMT) program on respiratory muscle and pulmonary function in competitively trained sub-elite swimmers. In conjunction with swim training, inspiratory muscle training (IMT) improves respiratory muscle function in sub-elite swimmers compared to swim training only.

Suspected statin-induced respiratory muscle myopathy during long-term inspiratory muscle training in a patient with diaphragmatic paralysis

This case report suggests that high-intensity Inspiratory Muscle Training (IMT) can be used effectively in a patient with impaired diaphragmatic function and during recovery from a respiratory SISM. The marked reduction in IMP and inability to perform IMT resolved with the cessation of statin therapy

Inspiratory Muscle Training: Improvement of Exercise Performance With Acute Hypoxic Exposure

Research to determine whether chronic IMT (Inspiratory Muscle Training) improves submaximal-exercise performance with acute hypoxic (deficiency in the amount of oxygen
reaching the tissues) exposure.

Sustained Maximal Inspiratory Pressure: A Novel Measure of Inspiratory Muscle Performance and Its Relationship to Physiology and Function in Heart Failure

This study examined the relationship of SMIP and MIP to a variety of physiologic and functional measures in patients with heart failure (HF). MIP and SMIP are significantly correlated in a positive direction to many physiologic and functional measures supporting the role of inspiratory muscle training and further study of SMIP and MIP in HF.

Beyond inspiratory muscle strength: Clinical utility of single-breath work capacity assessment in veterans with COPD

The assessment of SMIP appears to have superior clinical value than MIP in COPD. Our analyses revealed that subjects whose SMIP was reduced experienced more severe airflow obstruction, greater hyperinflation, as well as worse health and mental status with increased symptomatology and impaired quality of life.

Home-Based Inspiratory Muscle Training as Stand-Alone Therapy in COPD: A Randomized Sham-Controlled Trial Assessing Novel and Established Training Methods

This study highlights the potential of home-based IMT as a feasible stand-alone intervention for patients with COPD, particularly for those who face barriers in accessing traditional PR programs. Both the threshold loading and IFRL with biofeedback interventions demonstrated significant gains in inspiratory muscle strength. Notably, the TIRE IFRL approach also led to significant improvements in inspiratory muscle work and endurance, as well as in functional exercise capacity.

Using Respiratory Training to Assist Breathing and Swallowing in COVID-19 Patients

At Duke University Hospital, speech-language pathologists are the primary providers of RMT to strengthen the respiratory and/or upper airway muscles. We administer the therapy with devices that provide resistance against inspiration and/or expiration. There are two types of training. Expiratory muscle training (EMT) targets laryngeal vestibular closure during swallowing and enhances cough strength for airway protection. Inspiratory muscle training (IMT) targets diaphragmatic weakness that can impact speech, swallowing, and weaning from mechanical ventilation.

We measure maximum inspiratory pressure and maximum expiratory pressure, and factor in normative and individual patient data to determine candidacy for the training. Those who qualify begin a program using RMT devices with appropriate resistance levels based on their diagnosis (see sources) and assessed capabilities.