Inspiratory and expiratory muscle training in subacute stroke

Randomised Clinical Trial:

Inspiratory and expiratory muscle training in subacute stroke
Monique Messaggi-Sartor, Anna Guillen-Solà, Marina Depolo et al

The objective of this randomised clinical trial, published in Neurology (Neurology 10.1212/WNL.0000000000001827) is to assess the effectiveness, feasibility, and safety of short-term inspiratory and expiratory muscle training (IEMT) in subacute stroke patients.


Inspiratory and Expiratory Muscle Training induces significant improvement in inspiratory and expiratory muscle strength and could potentially offer an additional therapeutic tool aimed to reduce respiratory complications at 6 months in stroke patients.

POWERbreathe Meet Physios At The London Clinic

POWERbreathe popped in to meet up with new members of the physiotherapy team at The London Clinic (23rd July). The London Clinic is one of the UK’s largest private hospitals, dedicated to providing the best, personalised healthcare with a breadth of surgical and medical expertise.

We presented POWERbreathe Inspiratory Muscle Training to 10 new members of the team and to their clinical specialist, respiratory physiotherapist, Anne Pitman.

The physiotherapy team already use the POWERbreathe K5 with Breathe-Link Live Feedback Software to test and monitor breathing parameters in patients, and then patients use their own POWERbreathe Plus device for breathing training at home.

We provided training to the new physiotherapists on how to utilise the analysis from the POWERbreathe K5 Breathe-Link Software results for the initial set-up of each patient’s own POWERbreathe Plus device. The physios took a turn using the POWERbreathe K5 to help them understand how Inspiratory Muscle Training worked, what it felt like, how to perform the training properly, what breathing parameters it registered, and how this data can help in prescribing a breathing training program that’s bespoke for each patient.

We’d like to thank the team at The London Clinic for their time and kind hospitality.

IMT facilitates weaning from mechanical ventilation in ICU


Inspiratory muscle training facilitates weaning from mechanical ventilation among patients in the intensive care unit: a systematic review

This study, published in the Journal of Physiotherapy, questioned whether Inspiratory Muscle Training (IMT) improves inspiratory muscle strength in adults receiving mechanical ventilation. It also asks if it improves the duration or success of weaning; if it affects the length of stay, reintubation, tracheostomy, survival, or the need for post-extubation non-invasive ventilation; if it’s tolerable; and whether it causes adverse events.

The intervention used was Inspiratory Muscle Training (IMT) versus sham or no IMT.


The study revealed that “Inspiratory muscle training improves weaning success, with potential reductions in length of stay and the duration of non-invasive ventilatory support after extubation. Patients who are having difficulty weaning may particularly benefit from the training, especially in weaning success and the duration of mechanical ventilation.”


Inspiratory Muscles Strengthening Among Coronary Patients on RICAOS


Effects of Inspiratory Muscles Strengthening Among Coronary Patients on the Sleep Apnea Obstructive Syndrome (RICAOS)

This study from Centre Hospitalier Universitaire de Saint Etienne is currently recruiting for participants, the aim of which is to assess the relevance of inspiratory muscles strengthening on reducing Apnea Hypopnea Index (AHI) in Coronary Artery Disease (CAD) patients with moderate Obstructive Sleep Apnea (OSA) (AHI between 15 and 30).

The intervention used is the POWERbreathe Plus Level 2 (MR) model.

The study began in May 2015 and the estimated study completion date is December 2018.

POWERbreathe For Patients With Spinal Cord Injury

Grupo GNAP in Salvador – Bahia offers specialised care in neurological rehabilitation, offering rehabilitation to their spinal cord injury patients that is efficient and motivating.

Respiratory approach to the neurological patient

GNAP believes that the treatment of neurological patients should not be limited to a motor or sensory approach of the limbs and trunk only, but also to their respiratory ability, because in many patient cases a reduction in functional performance limitations is associated with their respiratory ability.

To verify this, using the POWERbreathe K5 with Breathe-Link Live Feedback Software, they assess the patient’s respiratory ability by asking them to perform specific tasks, after which they identify issues and begin a course of POWERbreathe Inspiratory Muscle Training to help them improve not only their respiratory function but in turn their functional performance.

We’d like to thank Mateus Esquivel, Departamento De Fisioterapia Sbc Bahia and Fabio Carvalho, Physical therapist, expert in physical therapy neurofuncionnal and MBA in Business Management (FGV) from GNAP for bringing this important and encouraging work to our attention. Thank you!


Diaphragm paralysis and the role for IMT

This presentation took place at the Canadian Physiotherapy Association’s National Congress (June 18-20) where physiotherapists and physiotherapist assistants met up to learn and discuss scientific advances and professional issues and dialogue about challenges and achievements, with colleagues from across the country.

P018: Diaphragm Paralysis – it is Not Always Permanent. The Role for Inspiratory Muscle Training

Judy L. Kay, BScPT, Clinical Specialist, Cardiorespiratory Eastern Health, St. John’s, NL

Diaphragm paralysis associated with phrenic nerve injury can leave patients with an impairment in their breathing, ranging from mild shortness of breath to severe dyspnoea, depending on their circumstances, and it may be temporary or permanent. When the diaphragm becomes impaired, activation in other muscles increases to make up for the loss, yet when phrenic nerve function recovers, diaphragm recruitment doesn’t necessarily automatically dominate again and requires activation. Targeted, progressive diaphragm muscle training can be prescribed effectively for a cross section of patients.

The intention of this presentation was to:

1. Identify the range of causes of diaphragm paralysis.
2. Complete a physiotherapy specific assessment of diaphragm function.
3. Prescribe an inspiratory muscle training program that can be completed in either an in or outpatient setting.

“IMT is a very important adjunct to the overall management of patients with diaphragm dysfunction in a variety of contexts.”

You can read the presentation here in this extract taken from ‘Abstracts Scientific papers, education sessions to be presented at the June 18–20, 2015 Halifax, Nova Scotia’

IMT in mechanical ventilation: suitable protocols and endpoints


Inspiratory muscle training in mechanical ventilation: suitable protocols and endpoints, the key to clear results – a critical review

Silva, Paulo Eugênio

This research from Faculdade de Educação Física, Universidade de Brasília looked into whether Inspiratory Muscle Training (IMT) led to a shorter duration of mechanical ventilation, improved weaning success, or improved survival.

The purpose of this critical review was to determine:

1. What is the ideal prescription of IMT for patients on MV?
2. What is the best time to measure treatment effect?
3. Which kind of device should be used to IMT?
4. What are the best endpoints to evaluate the effects of IMT on the process of discontinuing from MV?

Which kind of device should be used to IMT? POWERbreathe K-Series.

“The biggest challenge in the training of mechanically ventilated patients is the use of conventional devices to impose loads on the respiratory muscles. When training starts, the patient must be disconnected from the ventilator and the respiratory monitoring is lost.”

“A new class of device is now available that is possible to monitor respiratory variables during the training. One example of this is the POWERbreathe K-Series (POWERbreathe-HaB UK) an electronic K-device with feedback software that helps professionals to understand what is happening with patients during their training. This device provides automatically processed information on external inspiratory work. Moreover, power and breathing patterns during loaded breathing tasks is shown, thus the onset of fatigue can be detected earlier.”

“POWERbreathe K-Series was externally evaluated by Belgian researchers and they concluded that the K-Series technology provides automatically processed and valid estimates of physical units of energy during loaded breathing tasks. Recently, de Souza et al. published a case report showing good results using the same technology to train a prolonged mechanically ventilated patient.”

“Another great advantage of this kind of technology is the capacity of load adjustment (1 cmH2O per 1 cmH2O) reaching 3 to 200 cmH2O. Beyond that, the device can adjust the load dynamically, imposing higher load at the beginning of inspirations and lower load close to vital capacity. Thus, a greater range of motion can be reached improving the effectiveness of the training.”


“This review demonstrated the necessity of new RCTs despite of some well designed RCTs have already been published. Many evidences point out that a high intensity training with loads ≥ 50% of MIP in 5 to 6 sets, aiming to reach thirty breathes, one or twice a day, seven days per week is a suitable protocol to improve performance on mechanical ventilation. Patients must be trained at least for two weeks in order to IMT promotes clinically significant effects. It is possible, that outcomes such as the onset of weaning process, duration and success on the weaning, have higher correlation with IMT.” “In conclusion, IMT on mechanically ventilated patients seems to be a promissory treatment despite controversial results. RCTs should be carried out to verify the efficacy of the high intensity training during a suitable period of training using electronic kinetic devices in mechanically ventilated patients.”

Read Inspiratory muscle training in mechanical ventilation: suitable protocols and endpoints, the key to clear results – a critical review

Addressing dysfunctional breathing at conference

Jessica DeMars BSc.P.T. from Breathe Naturally in Canada recently attended the Canadian Respiratory Conference, organised by the Canadian Lung Association where she submitted the poster, Addressing Dysfunctional Breathing Patterns as a Contributor to Disproportionate or Unexplained Dyspnea: A Case Series.

Here we share the poster from the authors Jessica DeMars, BSc.P.T. and Brandie Walker MD, PhD FRCPC., which included Inspiratory Muscle Training with POWERbreathe as one of the Treatment Interventions, along with a screenshot of the POWERbreathe K5 Breathe-Link Live Feedback Software showing improvements in Maximum Inspiratory Pressure and Peak Inspiratory Flow following pressure threshold inspiratory muscle training.


IMT in Allo-HSC Transplantation Recipients


Effects of Inspiratory Muscle Training in Allogeneic Hematopoietic Stem Cell Transplantation Recipients

Although meta-analysis, systematic reviews and studies have all demonstrated beneficial effects of inspiratory muscle training (IMT) on several outcomes in different disease groups; chronic obstructive pulmonary disease, bronchiectasis and heart failure, no published paper has yet reported the effects of IMT in Allogeneic Hematopoietic Stem Cell Transplantation Recipients (allo-HSC) recipients. This is the purpose of this clinical trial undertaken in Turkey.


The intervention for the treatment group receiving IMT is the POWERbreathe Classic

Read the clinical trial, Effects of Inspiratory Muscle Training in Allogeneic Hematopoietic Stem Cell Transplantation Recipients

Check out more Inspiratory Muscle Training Research here >

Discover POWERbreathe used in Research here >

IMT improves aerobic capacity & pulmonary function in patients with AS

Ankylosing Spondylitis (AS) is a chronic condition in which the spine and other areas of the body become inflamed, with symptoms usually involving back pain and stiffness that improves with exercise and isn’t relieved by rest; pain and swelling in other parts of the body, such as the hips, knees and ribs; and extreme fatigue.

The objective of this randomised controlled study was to evaluate the impact of inspiratory muscle training on aerobic capacity and pulmonary function in patients with AS.


Inspiratory muscle training improves aerobic capacity and pulmonary function in patients with ankylosing spondylitis: A randomized controlled study

Răzvan-Gabriel Drăgoi, Elena Amaricai, Mihai Drăgoi, Horatiu Popoviciu, Claudiu Avram


Ankylosing spondylitis patients who performed eight weeks of inspiratory muscle training associated to conventional exercise training had an increased chest expansion, a better aerobic capacity, resting pulmonary function and ventilatory efficiency than those who performed conventional exercise training only.

See more Inspiratory Muscle Training Research >