Lower Blood Pressure with POWERbreathe IMT

The University of Colorado Boulder is using the POWERbreathe K-Series in their independent research. They are investigating the effects of just 30 breaths of inspiratory muscle strength training (IMST). Specifically, they are looking to see if it could lower blood pressure and reduce heart attack risk. They are also investigating whether it could help you think more clearly and boost sports performance.

Lower blood pressure

One of the key findings of the research so far is that 30 breaths of IMST (about five minutes) will lower blood pressure. Crucially, with about half the tests completed, researchers report significant drops in blood pressure and improvements in large-artery function. In fact, their findings show that about 5-minutes of IMST lowers blood pressure as much as aerobic exercise and more than some medications.

Other preliminary findings

The research findings also suggest that just 5-minutes of IMST may also boost cognitive function. Furthermore, their findings show that it may also improve fitness and increase sports performance. In fact, these improvements are already proven in previous research studies. However, this study reiterates such findings.

With the help of the university’s new National Institute on Ageing grant, researchers are launching a clinical trial.

The research

Research subjects will either be a part of a sham group (using low/no IMST) or the IMST group. The IMST group will perform 30 breaths of inspiratory muscle strength training (taking approximately 5-minutes). IMST is strength training for the muscles you use to inhale. Both groups will be performing their version of IMST over a period of 6 weeks. Researchers are hoping that by doing this for 5 minutes a day in the comfort of their own home, people will get health benefits they otherwise might not get.

The tests

Researchers will be performing tests to evaluate:

  • Vascular function – how healthy the blood vessels are
  • Cerebral vascular function – how healthy the blood vessels in the brain are
  • Cognitive function
  • Physical performance – VO2 max testing assesses this
  • Motor function

Results so far are showing that the IMST group, compared to sham subjects, are lowering their blood pressure and improving blood vessel health. Also, the IMST group is performing better on certain cognitive and memory tests. In addition, the IMST group are able to keep their heart rate and oxygen consumption lower during exercise. Consequently, subjects are also showing an increase in exercise tolerance time too.

Positive outcomes

With all this evidence, researchers hope that by using IMST, people may be able to get their blood pressure under control, decrease their risk of chronic conditions and live healthier lives.

Pilates Plus IMT Improves Lung Function

Researchers from Brazil are looking at the effects of combining Inspiratory Muscle Training (IMT) with Pilates on lung function in elderly women. The reason for this is because ageing affects the respiratory system. In fact, it can change the composition of the lung’s connective tissue.

Ageing and the lungs

Ageing will ultimately affect bones and muscles. Moreover, natural ageing also affects the bones and muscles of the chest. Consequently, it may affect the shape of the ribcage. As a result, the ribcage may no longer expand or contract as well as it once did, during breathing. Additionally, the main breathing muscle, the diaphragm, becomes weaker too. This will affect how much air a person is able to breathe in and out.

Furthermore, ageing affects lung tissue and the airways may lose their ability to stay open. Additionally, the air sacs begin to lose their shape. Consequently, air may become trapped in the lungs. This affects how well you’re able to breathe.

Why inspiratory muscle training?

Inspiratory Muscle Training (IMT) is a form of resistance training that exercises the inspiratory muscles. The main inspiratory muscles are the diaphragm and intercostals. It’s these muscles that are responsible for drawing air into the lungs. Furthermore, it’s these muscles that will be affected by ageing. Therefore, exercising these muscles with IMT will limit the effects of ageing. IMT will help them to become stronger and less prone to fatigue.

The IMT device that participants use in this trial is the POWERbreathe K5.

Participants breathe in through the K5 for 30 breaths. They perform this twice, with a one-minute interval between each set. After two weeks’ training, they must increase the training resistance by 10%. Researchers then assess an individual’s results following Pilates exercise.

Why Pilates?

Pilates is an exercise programme, developed in the 20th Century by Joseph Pilates. The exercises focus on improving core strength and muscular imbalance. Furthermore, Pilates improves flexibility, overall muscle strength and is low-impact, making it ideal for the age group in this study.

As we age, we become less active and more sedentary. Consequently, sitting for long periods limits movement and affects the body. In fact, age affects the entire musculoskeletal system: joints, muscles and bones. As a result, posture is affected and we also start to lose muscle tone, balance and joint mobility. Pilates can help to minimise these age-related changes.

For this study, participants use the Cadillac, Combo Chair and Reformer devices for the Pilates method. The researchers recommend nine exercises per session. Participants perform up to three sets of 12 repetitions of each exercise. They do this for a maximum of 45-minutes.

Study results

To establish if IMT positively effects breathing muscle strength, each participant’s maximum inspiratory pressure (MIP) is measured. MIP is an index of diaphragm strength and an independent predictor of all-cause mortality (longevity). Study findings show that MIP significantly evolved in the elderly. Additionally, the study highlights:

“the use of the POWERbreathe K5 device, which further favoured the gain in this variable.”

Findings also show:

“that all the variables were significantly better in the intervention groups than in the Control Group, thus strengthening the importance of the association between IMT and Pilates.”

In conclusion

“In conclusion, physiotherapy is an excellent ally in the prevention, promotion, and maintenance of health, quality of life and functional capacity in the gerontological population. The use of the Pilates Studio method, associated with technological equipment that allows more detailed analysis and treatment of pulmonary conditions, strength, function and mobility, was shown to be beneficial for this type of application.”

The influence of inspiratory muscle training combined with the Pilates method on lung function in elderly women: A randomized controlled trial >

New Asthma Treatment for Severe Asthma

The National Institute for Health and Care Excellence (NICE), are consulting again on the safety and efficacy of a new asthma treatment. The new treatment, bronchial thermoplasty, is likely to be offered to adults with severe asthma. The procedure involves applying thermal energy (heat) to the inside walls of the airways.

New asthma treatment

Bronchial thermoplasty will take place under sedation or general anaesthetic. Short pulses of radiofrequency energy are applied to the airway wall. Following that, patients will need to attend an additional two sessions, with 3-week intervals, to complete the procedure.

The aim of this new treatment is to reduce the smooth muscle mass lining the airways, decreasing their ability to constrict. Hopes are that by having this procedure, the severity and frequency of severe asthma attacks may decrease. NICE is currently in the process of considering the evidence for this treatment. Additionally, it’s listening to the views of specialist advisers with knowledge of the procedure.

Furthermore, to ensure safety, NICE is recommending that only a multidisciplinary team treat patients. In addition, they recommend that only specialist centres with on-site access to intensive care should carry out the procedure. Finally, they are proposing that only clinicians with experience of bronchial thermoplasty and managing severe asthma should perform the procedure.

As it stands, NICE believe there is adequate evidence to support the use of this new asthma treatment.

Severe asthma

In their consultation document, NICE say that in severe asthma, the lining of the airways becomes inflamed and narrow. Furthermore, this narrows the airways, making it harder for air to pass through. This makes it harder to breathe. And it is this that bronchial thermoplasty aims to tackle.

Complementary treatment for asthma

Research shows there to be an alternative, complimentary asthma treatment for opening up the airways and assist in easier breathing. This treatment is Inspiratory Muscle Training (IMT). Simply put, it is breathing muscle training, such as with the POWERbreathe IMT device. It too is clinically proven. Furthermore, it is drug-free.

The research reaches the conclusion that six-months of specific inspiratory muscle training improves inspiratory muscle strength and endurance. It also results in improvement in asthma symptoms, hospitalisations for asthma, visits to the emergency department, absence from school or work, and medication consumption in patients with asthma.

Alternative treatment for asthma – IMT

Inspiratory Muscle Training, such as with POWERbreathe IMT, is easy to use, straight out of the box. Because it is drug-free, there are only minimal precautions and contraindications that the Healthcare Professional needs to be aware of before prescribing IMT.

POWERbreathe IMT is an evidence-based, non-invasive asthma treatment. In fact, it is the amount of medical research behind the rigorous assessment that led to the POWERbreathe Medic being made available for prescription on the NHS. It offers people with asthma a clinically-proven method of reducing symptoms and putting them in control of their asthma.

Research shows that after only 3-weeks of IMT, asthma symptoms improve by up to 75%. Furthermore, patients with asthma experience improvement of symptoms, quality of life and a reduction in the consumption of medication of up to 79%.

In fact, three separate studies show an average 51% reduction in β2-agonist consumption (from 3.9 to 1.6 puffs per day) after IMT. One study also shows a decrease in corticosteroid use ~80%.

Finally, longer observations show that 6-months of IMT reduces absence from school/work (by ~95%) and use of healthcare resources (by ~75%).

S-Index assessment improves inspiratory muscle performance

S-Index stands for Strength-Index. It is one of the POWERbreathe K-Series’ test modes. Its purpose is to calculate inspiratory muscle strength based upon peak inspiratory flow.

Peak Inspiratory Flow (PIF)

We can evaluate improvements in inspiratory muscle strength by monitoring changes in a person’s peak inspiratory flow.

Peak Inspiratory Flow is a measure which reflects the ability of the inspiratory muscles (the muscles we use to breathe in) to contract rapidly and overcome the inherent resistance and elastance of the respiratory system.

Another of the K-Series’ test modes is the measurement of maximal inspiratory pressure (MIP). In fact, MIP is the most common measure in use for gauging inspiratory muscle strength. It is used as a diagnostic tool and an independent predictor of all-cause mortality.

Purpose of study

Currently, the most common test for assessing inspiratory muscle performance is the maximum ‘quasi-static’ inspiratory pressure (PImax).

However, the K-Series’ S-Index test has since become available for ‘dynamically’ evaluating the maximum inspiratory pressure.

In fact, it is suggested that the S-Index might be more appropriate for measuring inspiratory muscle performance than PImax.

Therefore, this study investigates this premise. It also assesses its reliability and whether an inspiratory muscle warm-up effects strength—index assessment.

Measurement validity of the K-Series

There are, in fact, current studies that have independently verified the measurement validity of the K-Series. Consequently, findings from these previous studies demonstrate its accuracy to measure dynamic inspiratory muscle pressure 1,2.

Therefore, this study feels that a proper assessment and the reliability of the S-Index should be addressed. In particular, it investigates the variability in response to repeated measurements. Furthermore, it evaluates whether an inspiratory muscle warm-up effects strength-index assessment. It is investigating whether using strength-index assessment improves clinical outcomes by reducing the bias effect.

Reliable values of the S-Index

What this study demonstrates is that at least 8 inspiratory manoeuvres are necessary to reach maximum and reliable values of the S-Index. Moreover, it also shows that specific inspiratory muscle warm-up could improve inspiratory muscle performance.

The authors believe this to be the first study to evaluate S-Index reliability in healthy subjects. Furthermore, they believe it to be the first study to investigate the effect of inspiratory warm-up in strength-index assessment.

In conclusion, inspiratory muscle warm-up should be used for detecting the true maximum values of the S-Index to evaluate the performance of inspiratory muscles for any intervention.

Assessment of Maximum Dynamic Inspiratory Pressure >

References

  1. Measurement validity of an electronic inspiratory loading device during a loaded breathing task in patients with COPD
  2. Repeated-Sprint Cycling Does Not Induce Respiratory Muscle Fatigue in Active Adults: Measurements from The POWERbreathe Inspiratory Muscle Trainer 

Hospitalised Patients Benefit from POWERbreathe IMT

A new clinical trial in Brazil has found that POWERbreathe IMT improves inspiratory muscle strength and shortens the length of stay in hospitalised patients.

Objective

The aim of this double-blind randomised controlled trial is to assess the impact of IMT on hospitalised patients. IMT stands for Inspiratory Muscle Training. It trains the inspiratory muscles (the ones we use to breathe in) to become stronger and more resistant to fatigue. IMT is undertaken using the POWERbreathe Plus IMT device.

Proposed Outcomes for Hospitalised Patients

Hospitalised patients, with no existing respiratory issues, may encounter inpatient complications.

The clinical trial believes that, if implemented early, POWERbreathe IMT could prevent in-hospital adverse outcomes. These may, or may not, be directly associated with the loss of respiratory muscle mass inherent to a prolonged hospital stay.

Trial Method

Subjects are randomly assigned to either an IMT intervention group or an IMT sham group. Both groups were also to undergo conventional physiotherapy interventions.

The IMT intervention group performs IMT using the POWERbreathe Plus. Each patient trains against a load equivalent to 50% of their maximum inspiratory pressure. Maximum inspiratory pressure, or MIP, is a marker of respiratory muscle function and strength. All they need to do is breathe in through the device for 30 breaths. And they do this twice a day for 4 weeks.

Trial Results

Results show that patients in the IMT intervention group had a significantly shorter length of stay in hospital. They also show a lower risk of endotracheal intubation, muscle weakness and mortality.

Findings

The trial’s findings demonstrate that POWERbreathe IMT is a safe addition to physiotherapy. Results also show that it improves inspiratory muscle strength and functional status, as well as a shortened length of hospital stay.

Conclusion

This clinical trial shows that early implementation of POWERbreathe IMT is effective at preventing complications due to prolonged hospitalisation. It is also effective at reducing associated in-hospital mortality rates. Its therapeutic use is safe and well-tolerated in the hospital environment, providing respiratory gain and improving functional capacity.

Full details of this clinical trial are freely available for all to read on the internet. Safety and efficacy of inspiratory muscle training for preventing adverse outcomes in patients at risk of prolonged hospitalisation.

IMT associated with Improved Inspiratory Muscle Strength in Fontan Circulation patients

Like other forms of heart failure, low cardiac output and raised central venous pressure is what characterises the Fontan Circulation. However unlike other forms of heart failure, in Fontan circulation patients the primary limitation is absence of a subpulmonary ventricle.

Affects of Fontan circulation

Patients will experience reduced exercise capacity and respiratory muscle strength. Fortunately Inspiratory Muscle Training (IMT) improves exercise capacity and quality of life in adults with heart failure. This is evident from previous studies.

Purpose and method of study

The purpose of this study is to assess whether a home-based IMT program improves inspiratory muscle strength and the ventilatory efficiency of exercise in adolescent patients with a Fontan circulation.

To assess this, Fontan circulation patients underwent 30 minutes of IMT daily for six weeks. Exercise capacity (cardiopulmonary exercise testing), lung function and respiratory muscle strength (maximal inspiratory pressure and expiratory pressure) are all assessed.

Study findings

Findings from the study show that IMT is a simple and beneficial addition to the management of Fontan patients. It shows that IMT potentially reduces exercise intolerance and long-term morbidity and mortality.

Conclusions

The study shows that six weeks of IMT is associated with improving inspiratory muscle strength, ventilatory efficiency of exercise, and resting cardiac output in young Fontan patients.

The study

Inspiratory Muscle Training Is Associated With Improved Inspiratory Muscle Strength, Resting Cardiac Output, and the Ventilatory Efficiency of Exercise in Patients With a Fontan Circulation >

New Trial into Effects of IMT in COPD Patients

A new clinical trial will be looking at the effects of inspiratory muscle training (IMT) on shortness of breath (dyspnea) and postural control in patients with COPD.

Shortness of breath in patients with COPD

Patients with chronic obstructive pulmonary disorder (COPD) experience shortness of breath, or dyspnea, during physical activity. It is related to weakness of their respiratory muscles. There is much evidence of IMT improving breathing muscle function and reducing the intensity of dyspnea.

Balance impairment in patients with COPD

Patients with COPD and pronounced respiratory muscle weakness also show impaired postural balance. But improvements in respiratory muscle function might improve balance control in patients.

Purpose of the controlled trial

The trial will consider whether eight week’s of controlled IMT will reduce the intensity and feeling of dyspnea. It will also investigate if it improves postural control. And finally it will look to see if IMT improves blood flow and oxygen delivery to a patient’s limb muscles too.

Inspiratory muscle training intervention

The trial will use the POWERbreathe KHP2 Inspiratory Muscle Training device for monitoring breathing parameters. And patients will each use a POWERbreathe Medic Plus twice a day, mostly in their home and without supervision. However they will perform one training session each week under supervision, during which the training load will be increased. A sham group will perform three daily sessions of 30 breaths and will train at a constant inspiratory load of no more than 10% of their initial Pi,max.

The Principal Investigator is Rik Gosselink, PT, PhD. The trial is open to all sexes ageing from 40 to 90 years of age. It will take place at the University Hospital Leuven, Belgium. And the estimated completion date for the trial is January 31st 2018.

Heart Transplant Patient Represents Country in Triathlon

After years of waiting, Patricia Fonseca from Brazil has undergone a heart transplant. And after several months of recovery Patricia represented her country at the XX1 Malaga-Spain World Transplant Games 2017.  The event she entered is the triathlon; swimming, cycling and running her way to a medal.

Because of her inspirational story she has been interviewed by the Brazilian TV channel, Globo. Her six-minute interview has been broadcast on prime time TV, and we are fortunate enough to also be able to view it.

During the interview Patricia talks about her experience, from a little girl to where she is now, after her transplant. The video shows her in hospital after her operation. She appears very frail. But the clinical team around her help her to improve her health and fitness.

Heart transplant patient performs breathing training in recovery

During recovery Patricia is provided with the Respiron flow-based lung trainer by POWERbreathe. She uses it to exercise her lung muscles by encouraging controlled, long, slow, deep and focused breathing. It helps to maintain lung capacity and function after periods of inactivity.

Patricia is also provided with a POWERbreathe Inspiratory Muscle Training (IMT) device. This is to help improve the breathing strength and stamina of her breathing muscles. And in turn this reduces breathing fatigue and helps Patricia to improve her respiratory system. This breathing muscle training will also help prepare Patricia for the demands of a triathlon.

Benefits of IMT in triathlon

During triathlon Patricia’s lungs will be subjected to huge demands in each of the three endurance disciplines.

During the swimming stage of the triathlon, Patricia will need to inhale as much oxygen as possible in the shortest time possible. This will help her return to the optimal position for generating propulsive force.

During the cycling stage of the triathlon, the very nature of the hunched position on the bike creates breathing problems. It restricts normal breathing movement and will make breathing feel much harder.

Finally, during the running stage of the triathlon, Patricia’s breathing muscles will not only be working hard at their job of breathing, but they will also be working hard to stabilise her upper body during every foot strike.

Triathlon results post-transplant

The effort and commitment by Patricia Fonseca and her team of professionals in helping her through recovery and training was rewarded with a podium finish by Patricia who won a medal!

Congratulations Patricia!

POWERbreathe IMT is Beneficial for Patients with Asthma

POWERbreathe Inspiratory Muscle Training is clinically proven to be beneficial for patients with asthma.

POWERbreathe Medic IMT available for prescription in the UK

After 20 months of rigorous assessment, the POWERbreathe Medic IMT device was made available in the UK for prescription in the National Health Service (NHS) Drug Tariff: PIP 232-1040. It found that the POWERbreathe Medic offers people with asthma a drug-free and clinically-proven method to reduce symptoms and put them in control of their asthma.

POWERbreathe Medic IMT rigorously assessed

Although the role of IMT in the management of asthma has been less widely studied than in COPD, data exists from five randomised controlled trials that are unanimously supportive of IMT in the management of asthma.

Asthma patients benefit from POWERbreathe Medic IMT

After as little as 3 weeks’ POWERbreathe training, patients experience a reduction in dyspnoea, the medical term for breathlessness or shortness of breath, as well as improvements in quality of life. Most striking however are the observations that longer-term IMT (6 months) reduces absence from school/work (by ~95%), use of healthcare resources (by ~75%), and the consumption of medication (by ~79%).

The five randomised controlled clinical trials in support of POWERbreathe IMT

  1. Inspiratory muscle training improves lung function and reduces exertional dyspnoea in mild/moderate asthmatics – McConnell, A. K., M. P. Caine, et al. (1998). Clinical Science 95(2): 4P.
  2. Inspiratory muscle training in patients with bronchial asthma 
  3. Specific inspiratory muscle training in patients with mild asthma with high consumption of inhaled beta(2)-agonists
  4. The relationship among inspiratory muscle strength, the perception of dyspnea and inhaled beta2-agonist use in patients with asthma
  5. Influence of gender and inspiratory muscle training on the perception of dyspnea in patients with asthma

Menopause & Lung Function Decline

New research finds that menopausal women may experience an increase in lung function decline. Menopause is Associated with Accelerated Lung Function Decline is published in the American Journal of Respiratory and Critical Care Medicine.

Cause of the menopause

As a woman gets older the balance in her sex hormones changes. The ovaries stop producing so much of the hormone oestrogen. This causes what we know as the menopause. Furthermore these changing levels of oestrogen, progesterone and testosterone play a role in age-related inflammation. And although we don’t yet fully understand why, it appears that this decrease in oestrogen corresponds with a rise in the cytokines interleukin-1 and interleukin-6. This changes the rate at which new bone forms and is a leading indicator of osteoporosis.

Lung function decline

It’s this systemic inflammation that is associated with lung function decline. This is because osteoporosis shortens the height of the chest vertebrae. Consequently this limits the amount of air that can be inhaled.

The researchers say that lung function decline in menopausal women is comparable to smoking 20 cigarettes a day for 10 years. And researcher Kai Triebner at the Department of Clinical Science, University of Bergen (UiB), Norway says that “The decline in lung function may cause an increase in shortness of breath, reduced work capacity and fatigue.”

Maintain respiratory health during and after menopause

The study shows this lung function decline exceeded the expected age-related decline. And because women are living longer beyond the menopause, it is important to maintain respiratory health. The study suggests that clinicians should be aware that respiratory health often deteriorates during reproductive ageing.

Reducing lung function decline

Healthy lungs have a large breathing reserve. But if you have reduced lung function you may use a large part of your breathing reserve. And it’s this that will make you feel short of breath. However regular physical exercise can help improve your lung function. In addition breathing exercises such as POWERbreathe Inspiratory Muscle Training (IMT) are also beneficial.

POWERbreathe IMT can help

POWERbreathe IMT exercises your inspiratory muscles; the muscles you use to breathe in. These are mainly your diaphragm and intercostal muscles.

As you breathe in through the POWERbreathe IMT device your breathing has to work harder. This is because you are breathing in against a resistance. This resistance is adjustable so you are able to challenge yourself as your breathing becomes easier. And because you are exercising your breathing muscles they become stronger. And with stronger breathing muscles your breathing stamina improves too. Furthermore breathing fatigue will reduce. This means you’ll be able to do more with less effort. So the increase in shortness of breath, reduction in work capacity and fatigue that is highlighted in the study as a result of the menopause will reduce.