Assessing respiratory muscle strength is a key component of our assessment at Breathing Works. Part 1 of this 2 part blog series will explore Inspiratory Muscle Training (IMT).
The diaphragm muscle is our primary muscle of inspiration and is commonly weak and under-recruited in people with dysfunctional breathing patterns. In the clinic, our technology allows us to measure maximal inspiratory pressure (MIP) and monitor variables such as inspiratory volume, power and flow whilst someone performs resisted inspiratory efforts. We pay close attention to the breathing pattern and strategies employed by the individual whilst they perform the assessment. This enables us to ascertain whether inspiratory muscle weakness is contributing to the individual’s presentation.
WHAT IS IMT?
IMT is a strengthening programme which uses an inspiratory muscle trainer, designed to achieve increased inspiratory muscle strength, endurance, reduce breathlessness, improve exercise tolerance and enhance athletic performance. When we find someone has a reduced MIP or they demonstrate poor breathing patterns under load, we will commonly start them on an IMT programme. The key to successful outcomes is ensuring the individual uses their device at an appropriate resistance with an optimal breathing pattern to strengthen the correct muscles.
WHAT’S THE EVIDENCE TO SUPPORT IMT?
- IMT is effective at lowering blood pressure in adults (Craighead et al., 2021; Craighead et al., 2022).
- IMT has been found to increase exercise tolerance in middle aged to older adults (Freeberg et al., 2022; Heinbockel et al., 2019) and can improve balance in older adults (Ferraro et al., 2020).
- IMT assists with ventilator weaning in ICU patients (Bissett et al., 2020; da Silva Guimarães et al., 2021).
- IMT improves inspiratory muscle strength in patients with asthma (Duruturk et al., 2018; Lage et al., 2021), and improves dyspnea and exercise tolerance in patients with COPD (Langer et al., 2018; O'Connor et al., 2019).
- IMT has been proven to enhance athletic performance and accelerate recovery across a range of different sporting disciplines (Fernández-Lázaro et al., 2021; Manchado-Gobatto et al., 2022).
- IMT can reduce symptoms associated with Gastro-oesophageal reflux (Nobre e Souza et al., 2013).
- IMT can assist with reducing breathlessness and improving exercise tolerance in patients with phrenic nerve injury by improving the compensatory strength and coordination of extra-diaphragmatic respiratory muscles (Schaeffer et al., 2023).
For both our IMT and EMT programmes, we commonly prescribe POWERbreathe respiratory muscle trainers.
Breathing Works is also the New Zealand distributor of POWERbreathe products. Check out our online shop for the full range of POWERBREATHE products
Full reference list:
Bissett, B., Gosselink, R., & van Haren, F. M. P. (2020). Respiratory Muscle Rehabilitation in Patients with Prolonged Mechanical Ventilation: A Targeted Approach. Crit Care, 24(1), 103. https://doi.org/10.1186/s13054-020-2783-0
Craighead, D. H., Heinbockel, T. C., Freeberg, K. A., Rossman, M. J., Jackman, R. A., Jankowski, L. R., Hamilton, M. N., Ziemba, B. P., Reisz, J. A., D’Alessandro, A., Brewster, L. M., DeSouza, C. A., You, Z., Chonchol, M., Bailey, E. F., & Seals, D. R. (2021). Time‐Efficient Inspiratory Muscle Strength Training Lowers Blood Pressure and Improves Endothelial Function, NO Bioavailability, and Oxidative Stress in Midlife/Older Adults With Above‐Normal Blood Pressure. Journal of the American Heart Association, 10(13), e020980. https://doi.org/doi:10.1161/JAHA.121.020980
Craighead, D. H., Tavoian, D., Freeberg, K. A., Mazzone, J. L., Vranish, J. R., DeLucia, C. M., Seals, D. R., & Bailey, E. F. (2022). A multi-trial, retrospective analysis of the antihypertensive effects of high-resistance, low-volume inspiratory muscle strength training. J Appl Physiol (1985), 133(4), 1001-1010. https://doi.org/10.1152/japplphysiol.00425.2022
da Silva Guimarães, B., de Souza, L. C., Cordeiro, H. F., Regis, T. L., Leite, C. A., Puga, F. P., Alvim, S. H., & Lugon, J. R. (2021). Inspiratory Muscle Training With an Electronic Resistive Loading Device Improves Prolonged Weaning Outcomes in a Randomized Controlled Trial*. Critical Care Medicine, 49(4), 589-597. https://doi.org/10.1097/ccm.0000000000004787
Duruturk, N., Acar, M., & Doğrul, M. I. (2018). Effect of Inspiratory Muscle Training in the Management of Patients With Asthma: A RANDOMIZED CONTROLLED TRIAL. J Cardiopulm Rehabil Prev, 38(3), 198-203. https://doi.org/10.1097/hcr.0000000000000318
Fernández-Lázaro, D., Gallego-Gallego, D., Corchete, L. A., Fernández Zoppino, D., González-Bernal, J. J., García Gómez, B., & Mielgo-Ayuso, J. (2021). Inspiratory Muscle Training Program Using the PowerBreath(®): Does It Have Ergogenic Potential for Respiratory and/or Athletic Performance? A Systematic Review with Meta-Analysis. Int J Environ Res Public Health, 18(13). https://doi.org/10.3390/ijerph18136703
Ferraro, F. V., Gavin, J. P., Wainwright, T. W., & McConnell, A. K. (2020). Comparison of balance changes after inspiratory muscle or Otago exercise training. PLoS One, 15(1), e0227379. https://doi.org/10.1371/journal.pone.0227379
Freeberg, K. A., Heinbockel, T. C., Rossman, M. J., Jackman, R. A., McCarty, N. P., Jankowski, L. R., Nemkov, T., Reisz, J. A., D'Alessandro, A., Chonchol, M., Bailey, E. F., Seals, D. R., & Craighead, D. H. (2022). High-Resistance Inspiratory Muscle Strength Training-Associated Increases in Exercise Tolerance in Midlife/Older Adults are Related to Circulating Acylcarnitines. The FASEB Journal, 36(S1). https://doi.org/https://doi.org/10.1096/fasebj.2022.36.S1.R3869
Heinbockel, T. C., Rossman, M. J., Jankowski, L. R., Jackman, R. A., Bailey, E. F., Chonchol, M. B., Seals, D. R., & Craighead, D. H. (2019). Effects of Inspiratory Muscle Strength Training on Cardiorespiratory Fitness in Middle-Aged to Older Adults. The FASEB Journal, 33(S1), 695.694-695.694. https://doi.org/https://doi.org/10.1096/fasebj.2019.33.1_supplement.695.4
Lage, S. M., Pereira, D. A. G., Corradi Magalhães Nepomuceno, A. L., Castro, A. C. d., Araújo, A. G., Hoffman, M., Silveira, B. M. F., & Parreira, V. F. (2021). Efficacy of inspiratory muscle training on inspiratory muscle function, functional capacity, and quality of life in patients with asthma: A randomized controlled trial. Clinical Rehabilitation, 35(6), 870-881. https://doi.org/10.1177/0269215520984047
Langer, D., Ciavaglia, C., Faisal, A., Webb, K. A., Neder, J. A., Gosselink, R., Dacha, S., Topalovic, M., Ivanova, A., & O’Donnell, D. E. (2018). Inspiratory muscle training reduces diaphragm activation and dyspnea during exercise in COPD. Journal of Applied Physiology, 125(2), 381-392. https://doi.org/10.1152/japplphysiol.01078.2017
Manchado-Gobatto, F. B., Torres, R. S., Marostegan, A. B., Rasteiro, F. M., Hartz, C. S., Moreno, M. A., Pinto, A. S., & Gobatto, C. A. (2022). Complex Network Model Reveals the Impact of Inspiratory Muscle Pre-Activation on Interactions among Physiological Responses and Muscle Oxygenation during Running and Passive Recovery. Biology (Basel), 11(7). https://doi.org/10.3390/biology11070963
Nobre e Souza, M., Lima, M. J., Martins, G. B., Nobre, R. A., Souza, M. H., de Oliveira, R. B., & dos Santos, A. A. (2013). Inspiratory muscle training improves antireflux barrier in GERD patients. Am J Physiol Gastrointest Liver Physiol, 305(11), G862-867. https://doi.org/10.1152/ajpgi.00054.2013
O'Connor, C., Lawson, R., Waterhouse, J., & Mills, G. H. (2019). Is inspiratory muscle training (IMT) an acceptable treatment option for people with chronic obstructive pulmonary disease (COPD) who have declined pulmonary rehabilitation (PR) and can IMT enhance PR uptake? A single-group prepost feasibility study in a home-based setting. BMJ Open, 9(8), e028507. https://doi.org/10.1136/bmjopen-2018-028507
Schaeffer, M. R., Louvaris, Z., Rodrigues, A., Poddighe, D., Gayan-Ramirez, G., Gojevic, T., Geerts, L., Heyndrickx, E., Hollebeke, M. V., Janssens, L., Gosselink, R., Testelmans, D., & Langer, D. (2023). Effects of inspiratory muscle training on exertional breathlessness in patients with unilateral diaphragm dysfunction: a randomised trial. ERJ Open Research, 00300-02023. https://doi.org/10.1183/23120541.00300-2023