Home-based Respiratory Training After Stroke

This new clinical trial, which is not yet open for participant recruitment, will test the hypothesis that home-based combined inspiratory muscular training (IMT) plus expiratory muscular training (EMT) program is effective in improving strength and endurance of the inspiratory and expiratory muscles, fatigue, exercise capacity, and quality of life (QoL) with stroke subjects.

Located at the Department of Physical Therapy, Universidade Federal de Minas Gerais in Brazil, the starting date for this trial is July 2015, with an estimated study completion of December 2017.

OFFICIAL TITLE:

Effects of Home-based Respiratory Training After Stroke: A Randomized Controlled Trial

Rationale:

“Weakness of the respiratory muscles demonstrated by individuals with stroke, may generate important symptoms, such as fatigue and dyspnea. Since adequate strength of the inspiratory and expiratory muscles is required, mainly when performing physical activities, rehabilitation interventions for stroke subjects should include respiratory training.”

See more Inspiratory Muscle Training Research >

Cardiac & Respiratory Function Supported by Abdominal Muscles in Muscular Dystrophy

This study, reported in the Journal of Neuromuscular Diseases found that “abdominal muscles may be severely involved in the muscular dystrophy process. The abdominal muscles are important to provide respiratory support when the diaphragm muscle has been damaged by the disease, so that additional abdominal muscle involvement can worsen the respiratory situation considerably.”

“In MD where both breathing muscles and cardiac muscles are affected, this interdependence can lead to accelerated pathology. Normally, the diaphragm muscle drives about 50% of respiratory force, but other muscles provide the remainder. In MD, that balance is changed once the diaphragm becomes damaged. As the disease progresses, the abdominal muscles take over more of the respiratory function, but little is known about how the abdominal muscles themselves are affected by the progression of the disease, and whether these changes in abdominal muscle function correlate to underlying cardiopulmonary pathology.”

Lead investigator Elizabeth M. McNally, MD, PhD, Director, Center for Genetic Medicine, Northwestern University Feinberg School of Medicine, discussed the implications for human muscular dystrophy, saying,

“Supporting and maintaining proper cardiopulmonary function in neuromuscular disease is a mainstay of therapy. Maintaining diaphragm health has been the focus of many studies in both humans and mice with muscular dystrophy, but few studies have focused on supporting and evaluating the accessory muscles of respiration such as the abdominal muscles. Therapies that spare or protect the muscles of respiration in muscular dystrophy have been shown to slow down overall disease progression and prolong life. The accessory muscles of respiration, whether in human patients or animal models, may prove a viable target especially for therapy directed at specific muscle groups.”

Read more about the study here >

Also check out Respiratory Muscle Training for children with Duchenne Muscular Dystrophy >

The value of breathing retraining

This interesting article, written by osteopath Leon Chaitow, reviews ‘The Value of Breathing Retraining for Better Posture, Balance & Less Pain and Dyskinesis.’

It talks about how problems arising from poor posture, such as back pain for instance, can come about as a result of faulty breathing mechanics.

Chaitow refers to the study, ‘Inspiratory Muscle Training Affects Proprioceptive Use and Low Back Pain’ which supports evidence that breathing training can be successful in rehabilitating function as well as reducing a variety of symptoms.

Participants in the study completed an Inspiratory Muscle Training (IMT) program using the POWERbreathe Medic over a period of 8 weeks, “known as an effective training duration”.

The study concluded: “After 8 wks of high IMT, individuals with LBP (low back pain) showed an increased reliance on back proprioceptive signals during postural control and improved inspiratory muscle strength and severity of LBP, not seen after low IMT. Hence, IMT may facilitate the proprioceptive involvement of the trunk in postural control in individuals with LBP and thus might be a useful rehabilitation tool for these patients.

Read more about the POWERbreathe Medic Classic (used in this study) and the second generation POWERbreathe Medic Plus.

Alleviate screen apnoea by breathing deeply

‘Screen apnoea’ is a new, 21st Century condition. The term is a play on the name for the serious condition, ‘sleep apnoea’. Sufferers with sleep apnoea may stop breathing for short periods of time while they sleep. Surprisingly, a similar thing happens to users of electronic devices. Findings show that people have a tendency to hold their breath while communicating electronically.

About screen apnoea

Screen apnoea is a term now in use by those treating office workers. Findings from a 2009 study leads to this diagnosis. In fact, findings show that while using mobile devices, participants hold their breath and begin to breathe shallowly and rapidly. Additionally, researchers at UCI ICS, (Gloria Mark, Stephen Voida, and Anthony Cardello), formally validate this impact of email, using heart rate variability. Their research shows that our heart rate starts to increase. Furthermore, evidence shows that we tense our muscles while sending and receiving text messages or emails. Although the trial only invited 12 participants, anecdotal evidence is now proving this to be the case.

Have you ever noticed that when you’re really focussed and concentrating hard, you have a tendency to hold your breath? And when concentrating on a small screen, this can result in a tightness in the neck and shoulders. Consequently, this hunching of the body may also cause back pain, thanks to the compromised posture.

Back pain

In a 2006 study of more than 38,000 women, researchers found that back pain was more strongly related to breathing disorders than to obesity or physical activity. This is because the main breathing muscle, the diaphragm, is also one of the core muscles that supports and stabilises the torso. So when the diaphragm’s dual role of breathing and stabilisation is too great, breathing wins out.

Improve your breathing strength

All is not lost though, because the breathing muscles can be exercised to improve their strength and stamina. One of the most effective – and simple – ways of achieving this is through Inspiratory Muscle Training (IMT). IMT uses a resistance that you breathe IN against. It’s this that strengthens your breathing muscles, and in turn, improves your breathing stamina. Furthermore, IMT will help you to breathe deeply into your diaphragm, as opposed to your chest. Finally, IMT is a good teaching practice for your breathing, in an age when we seem to be suffering from screen apnoea.

POWERbreathe and The Arthrogryposis Group

In April we were honoured to be asked by Emma Foden, Sport Scientist and Personal Trainer in disability sport, to talk to the charity, The Arthrogryposis Group at one of their summer events. Each event showcases different health, wellbeing and lifestyle opportunities that are available to them under the banner of Moving and Grooving with Otto; Otto being the charity’s mascot. Naturally we were delighted to be asked and agreed to assist at the event.

The Arthrogryposis Group is a UK based charity for those affected by Arthrogryposis Multiplex Congenita which causes curved joints in parts of the body.

The event we attended was the first in their calendar and took place on the 5th April at Uppingham School, Leicester. It was a ‘Swim Big Meet’ where the focus was to encourage people to swim more as a leisure activity as it helps to mobilise joints, activate muscles and improve cardiovascular strength.

During the event POWERbreathe provided a 30 – 45 minute presentation about the benefits of Inspiratory Muscle Training (IMT) as well as a demonstration of how POWERbreathe works. The importance of stronger breathing muscles for people affected by Arthrogryposis was brought home to us when we heard about a lady who’d been affected so much by this condition that she didn’t have enough air in her lungs to be able to speak.Thankfully POWERbreathe was there to offer her hope…

Because the lungs aren’t a muscle, they rely on the muscles surrounding them for their expansion and contraction. It’s this supporting structure that you need to strengthen and condition in order to appreciate proper, full breathing. So, by using POWERbreathe to exercise her breathing muscles, this lady will be strengthening her lungs’ supporting structure and improving her vital capacity, the usable portion of her lungs.

The day started at 10.30am and we were able to chat to members of the AGM about POWERbreathe before our presentation. We set up the presentation in a sports hall where we were also able to demonstrate the POWERbreathe K5 with Breathe-Link Software. Attendees came and tried out the K5 and took a strength-index test to see how their breathing faired. We were given permission by one member of the group, Neil Andrews, to record his first impressions of the POWERbreathe which you can view here:
“This could change my life” – WATCH VIDEO > 

In the afternoon the pool was open for people who wished to have a leisurely swim or take part in a lesson, as well as shooting, trampolining and fencing to have a go at. It proved to be a very positive, enjoyable day for all involved.

Emma already had personal experience of POWERbreathe and its benefits following the work she did for the study published in the BJSM (British Journal of Sports Medicine), Effects of inspiratory muscle training on respiratory function and repetitive sprint performance in wheelchair basketball players.

Thank you to Emma for contacting us in the first instance and allowing us to help people with potential breathing problems; to The Arthrogryposis Group for being so attentive and interested in POWERbreathe and making it such an enjoyable day; and to Uppingham School for making us all feel welcome in such a lovely environment.

POWERbreathe for Firefighters with Chronic Respiratory Conditions

A study recently published (February 2014) in the International Archives of Occupational and Environmental Health assessed the prevalence of chronic respiratory conditions in (South Australian) metropolitan fire fighters. It also studied associations between occupational exposure, use of respiratory protection and health-related quality of life (HRQoL) in firefighters with and without chronic respiratory conditions.

Study: Chronic respiratory conditions in a cohort of metropolitan fire-fighters: associations with occupational exposure and quality of life.

Methods:

Respiratory symptoms, medical conditions, occupational tasks and exposures and consistency of using respiratory protection were inquired by questionnaire. The Health Survey was used to measure physical and mental health-related quality of life.

Fire-fighters were categorised in subgroups: asthma; COPD/emphysema/chronic bronchitis; no chronic respiratory conditions; and as being ‘not involved’ or ‘involved’ in fire-fighting tasks, the latter further categorised as ‘consistent’ or ‘inconsistent’ use of respiratory protection.

Conclusions:

Ten percent of metropolitan fire-fighters reported underlying chronic respiratory conditions. Presence of such a condition in combination with suboptimal protection from inhaled exposures may lead to poorer physical health-related quality of life.

Read Abstract: Chronic respiratory conditions in a cohort of metropolitan fire-fighters: associations with occupational exposure and quality of life.

How could POWERbreathe help?

A project conducted at the University of Birmingham Sports Medicine and Human Performance Unit into the respiratory performance in firefighters unearthed some not-so-surprising findings:

  • Lung function is impaired whilst wearing SCBA (Self-Contained Breathing Apparatus)
  • Respiratory muscle strength and lung function are impaired further after physical work in SCBA
  • Firefighters adopt a special breathing strategy to minimise the breathlessness induced by working in SCBA

Looking at data from scientific studies, if firefighters performed POWERbreathe Inspiratory Muscle Training for a minimum of 4-weeks, they could:

  • Increase their inspiratory muscle strength
  • Reduce breathlessness
  • Reduce heart rate (1)
  • Reduce the rate of air use from the cylinder (increasing wear time by around 1.5 min from a 15 min cylinder) (1)
  • Increase time to exhaustion (findings from a standard laboratory treadmill test)

(1) Donovan K, McConnell A. Fire-fighters’ Self-contained Breathing Apparatus (SCBA): The Effects of Inspiratory Muscle Training (IMT) during Fire-Fighting Simulations in the Laboratory. In: Hanson, Lovesey, Robertson, editors. Annual Conference of the Ergonomics Society; 1999: Ergonomics Society; 1999. p. 348-52.

Read more about how POWERbreathe could benefit those in the Fire Service.

POWERbreathe, Exercise Training & Long Term Management of Heart Failure Patients

On 19th September POWERbreathe friend and distributor in Switzerland, Health MG, attended this 3-day training workshop on Rehabilitation and Long Term Management of Heart Failure Patients, at University Hospital, Switzerland.

Regular physical exercise for patients with heart failure is recommended in the guidelines of the European Society of Cardiology as it could ultimately lead to positive changes in myocardial function, symptoms, functional capacity and probably survival. But physical activity is poorly implemented in daily clinical practice.

The aim of the course was to demonstrate the art of exercise training and secondary prevention as well as the interplay between key elements of long term management of heart failure patients.

The workshop was aimed at cardiac rehab physicians, heart failure specialists, cardiologists and GP’s, physiotherapists, sports scientists and nurses and included many aspects of exercise training and testing, including POWERbreathe respiratory muscle training.

The workshop summarised the most current evidence of the benefits of exercise training in patients with heart failure, with practical advice for long-term management, assessment of exercise capacity and the application of different exercise modalities.

POWERbreathe respiratory muscle training has been used as a stand-alone therapy and in cardiac rehabilitation in patients with heart failure and heart disease. Because patients with chronic heart failure (CHF) experience a restrictive pattern of lung function due to pulmonary hypertension, their lung ‘stiffness’ increases the load on their respiratory muscles and makes a significant contribution to their breathlessness. Respiratory muscle training has been shown to successfully increase inspiratory strength and endurance, alleviate breathlessness (dyspnea) and improve functional status in chronic heart failure. POWERbreathe training will only provide a very low cardiovascular strain, making it suitable for the most physically compromised patients and those who’re too ill for rehabilitation.

Read more about POWERbreathe respiratory muscle training for medical conditions, or if you’re already using POWERbreathe to help reduce breathlessness due to breathing problems , then please leave a comment here or on the POWERbreathe Forum, Facebook or Twitter as we’d love to hear from you. You can also read more about POWERbreathe for medical conditions in our POWERbreathe blog.

Effects of IMT in patients with heart failure with preserved ejection fraction

The European Journal of Preventative Cardiology has just published the Abstract of a study that looked to evaluate whether inspiratory muscle training (IMT) would improve exercise capacity, as well as left ventricular diastolic function, biomarker profile and quality of life in patients with advanced heart failure with preserved ejection fraction (HFpEF) and nonreduced maximal inspiratory pressure (MIP).

The results revealed that the IMT group significantly improved their MIP, peak VO2, exercise oxygen uptake at anaerobic threshold, ventilator efficiency, metabolic equivalents and quality of life compared to the control group.

The study concluded therefore, “In HFpEF patients with low aerobic capacity and non-reduced MIP, IMT was associated with marked improvement in exercise capacity and QoL (quality of life).”

Read the full Abstract:

Effects of inspiratory muscle training in patients with heart failure with preserved ejection fraction

Patricia Palau, Eloy Domínguez, Eduardo Núñez et al

Patricia Palau, Cardiology Department, Hospital Clínico Universitario, Blasco Ibáñez 17, 46010 Valencia, Spain

Read more about Inspiratory Muscle Training with POWERbreathe for Chronic Heart Failure as a standalone therapy and for cardiac rehabilitation.

Laryngeal Movements During Inspiratory Muscle Training in Healthy Subjects

The Journal of Voice has just published online (17th May 2013), a study that looked at Laryngeal Movements During Inspiratory Muscle Training in Healthy Subjects.

As Inspiratory Muscle Training has been used to treat patients with exercise-induced vocal cord dysfunction, the theory behind this being the close relationship between the diaphragm and the posterior cricoarytenoid muscle, the study aimed to substantiate this theory by performing laryngoscopy in healthy subjects during standardized Inspiratory Muscle Training programs.

Conclusions showed that Inspiratory Muscle Training can produce laryngeal abduction in healthy subjects, and training programs may conceivably contribute positively in patients suffering from laryngeal adduction during exercise.

Here’s the Article in Press, the Abstract for which can be found online at the Journal of Voice.

Laryngeal Movements During Inspiratory Muscle Training in Healthy Subjects

Authors:
Astrid Sandnes, Tiina Andersen, Magnus Hilland, Thor Andre Ellingsen, Thomas Halvorsen, John-Helge Heimdal, Ola Drange Røksund

Summary

Background
Inspiratory muscle training (IMT) has been used to treat patients with exercise-induced vocal cord dysfunction (VCD); the theoretical basis being the close relationship between the diaphragm and the posterior cricoarytenoid muscle, which is the main abductor of the larynx. Before launching a treatment protocol in patients with VCD, we aimed to substantiate this theory by performing laryngoscopy in healthy subjects during standardized IMT programs.

Methods
Twenty healthy volunteers at mean age 24 years were examined with video-recorded continuous transnasal flexible laryngoscopy while performing standardized training programs using a resistive loading IMT device (Respifit S). All subjects were exposed to two modes of training, that is, the resistance set to generate mouth pressures ≥80% of the maximal attainable inspiratory mouth pressure (PImax) and 60–80% of PImax. Laryngeal movements were scored in retrospect from the video recordings by a senior laryngologist.

Results
At pressure settings of ≥80% of PImax, laryngeal movements could not be assessed in one subject. Abduction was observed in 10 (53%) subjects, six to a maximal extent and four to a moderate extent. At pressure settings of 60–80% of PImax, abduction was observed in 18 (90%) subjects, seven to a maximal extent and 11 to a moderate extent.

Conclusions
IMT can produce laryngeal abduction in healthy subjects, and training programs may conceivably contribute positively in patients suffering from laryngeal adduction during exercise. Individual response patterns varied between subjects and individualized programs seem crucial for effect. Use of high resistances seemed to be counterproductive.

Further evidence in Respiratory muscle strength training applications (which looked at the handful of studies discussing the use of strengthening techniques for the voice-disordered population), revealed how inspiratory muscle strength training showed promise for use with upper airway disorders including abductor vocal fold paralysis and paradoxical vocal cord dysfunction.

The purpose of this study, Inspiratory Muscle Training in Exercise-Induced Paradoxical Vocal Fold Motion, was to determine if IMT would result in increased inspiratory muscle strength, reduced perception of exertional dyspnea and improved measures of maximal exercise effort in an athlete with exercise-induced paradoxical vocal fold motion (PVFM). At end of the study, the findings suggested that Inspiratory Muscle Training may be a promising treatment approach for athletes with exercise-induced PVFM.

If you’re already using the POWERbreathe Inspiratory Muscle Training device to help with a voice or speech disorder, then please leave a comment here or on the POWERbreathe Forum as we’d love to hear from you. Read more about why IMT is a useful adjunct to your breathing exercises and breathing technique for Performing Arts. You might also find our blog for Singers and Vocal Exercises blog to be of interest too.

Benefits of combining inspiratory muscle with ‘whole muscle’ training in children with CF

The British Journal of Sports Medicine has just published details online (16th May) of a randomised trial that looked at assessing the effects of an 8-week combined ‘whole muscle’ (resistance + aerobic) and inspiratory muscle training on lung volume, inspiratory muscle strength and cardiorespiratory fitness, and dynamic muscle strength, body composition and quality of life in children with cystic fibrosis.

The trial concluded that the 8-week training programme induced significant benefits in important health phenotypes, and that inspiratory muscle training was an easily applicable intervention that could be included, along with supervised exercise training, in the standard care of these patients.

Here’s the Original Article, the Abstract for which can be found online at the British Journal of Sports Medicine.

Benefits of combining inspiratory muscle with ‘whole muscle’ training in children with cystic fibrosis: a randomised controlled trial

Authors:

Elena Santana-Sosa1, Laura Gonzalez-Saiz1, Iris F Groeneveld2, José R Villa-Asensi3, María I Barrio Gómez de Aguero3, Steven J Fleck4, Luis M López-Mojares1, Margarita Pérez1, Alejandro Lucia1,5

Author Affiliations:

1 School of Doctorate Studies and Research, Universidad Europea de Madrid, Spain

2 Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands

3 Department of Pneumology, Hospital ‘Nino Jesus’ of Madrid, Madrid, Spain

4 Department of Health, Exercise Science and Sport Management, University of Wisconsin-Parkside, Kenosha, Wisconsin, USA

5 Instituto de Investigación i+12, Madrid, Spain

Correspondence to:

Dr Alejandro Lucia, Universidad Europea de Madrid, Villaviciosa de Odón, Madrid 28670, Spain; alejandro.lucia@uem.es

Abstract

Background
The purpose of this study (randomised controlled trial) was to assess the effects of an 8-week combined ‘whole muscle’ (resistance+aerobic) and inspiratory muscle training (IMT) on lung volume, inspiratory muscle strength (PImax) and cardiorespiratory fitness (VO2 peak) (primary outcomes), and dynamic muscle strength, body composition and quality of life in paediatric outpatients with CF (cystic fibrosis, secondary outcomes). We also determined the effects of a detraining period.

Methods
Participants were randomly allocated with a block on gender to a control (standard therapy) or intervention group (initial n=10 (6 boys) in each group; age 10±1 and 11±1 years). The latter group performed a combined programme (IMT (2 sessions/day) and aerobic+strength exercises (3 days/week, in-hospital)) that was followed by a 4-week detraining period. All participants were evaluated at baseline, post-training and detraining.

Results
Adherence to the training programme averaged 97.5%±1.7%. There was a significant interaction (group×time) effect for PImax, VO2peak and five-repetition maximum strength (leg-press, bench-press, seated-row) (all (p<0.001), and also for %fat (p<0.023) and %fat-free mass (p=0.001), with training exerting a significant beneficial effect only in the intervention group, which was maintained after detraining for PImax and leg-press.

Conclusion
The relatively short-term (8-week) training programme used here induced significant benefits in important health phenotypes of paediatric patients with CF. IMT is an easily applicable intervention that could be included, together with supervised exercise training in the standard care of these patients.

In another study, Improved Pulmonary Function and Exercise Tolerance With Inspiratory Muscle Conditioning in Children With Cystic Fibrosis, published in the Chest Journal (November 1993, Vol 104, No. 5) the effect of inspiratory muscle conditioning in children with cystic fibrosis was also documented, with findings indicating that the experimental group that trained at a high pressure load (> or = 29 cm H2O) showed significant increases in inspiratory muscle strength, vital capacity, total lung capacity, and exercise tolerance in comparison to the control group. The study suggested that IMT may provide some benefit to the young CF population with respect to functional status. “…the results are promising and may potentially be useful as an adjunct to well-established physical therapy regimens in this patient group.”

If you’re already using POWERbreathe to help with symptoms of cystic fibrosis, then please leave a comment here or on the POWERbreathe Forum as we’d love to hear from you. You can also read a POWERbreathe blog from Evan Scully who was diagnosed with CF at the age of just 6-months, about his first experience of using POWERbreathe.