Smokers lungs work better after POWERbreathe IMT

This new study investigates the effects of inspiratory muscle training (IMT) on smokers and non-smokers. Researchers from Ondokuz Mayıs University and Gaziantep University in Turkey look into how IMT may affect pulmonary function and respiratory muscle strength in both these groups.

Pulmonary function & respiratory muscle strength

Pulmonary function indicates how well a person’s lungs are working to help them breathe. There are different tests that measure pulmonary function, otherwise known as lung function.

Respiratory muscle strength is an indication of how much pressure the breathing muscles generate when a person breathes in or out. Assessment of respiratory muscle strength involves measuring MIP or MEP. MIP or maximal inspiratory pressure reflects the strength of the inspiratory muscles, such as the diaphragm. Meanwhile MEP or maximal expiratory pressure reflects the strength of the expiratory muscles.

The IMT program

For the IMT program, subjects use the POWERbreathe Classic IMT device. The procedure consists of 30 x 2 dynamic inspiratory efforts with a 1-minute interval. They perform this for four weeks, seven days a week. The reason researchers chose this procedure is that it has been previously applied in healthy individuals.

Smokers group, non-smokers & placebo groups

Forty-two healthy males enrol in this randomised, double-blind, placebo-controlled experimental design study. There are 16 subjects in the IMT smokers group (IMTS), 16 in the IMT non-smokers group (IMTN) with the final 10 subjects in the placebo group. This final group receive a sham ‘placebo’ treatment that will have no real effect.

By using a double-blind, placebo-controlled experimental design study, researchers can test out a therapy. The placebo treatment will feel just like the actual treatment, in this case, IMT. The reason for this is so that both the subject and the researcher’s expectations will not affect the outcome. Furthermore, a double-blind controlled study means that neither the researchers nor the subjects taking part know who will be receiving which treatment. This is vital in helping to avoid bias when measuring outcomes.

For the study, the experimental groups (IMTS and IMTN) perform POWERbreathe IMT at 50% of maximal inspiratory pressure. Researchers increase this each week. Meanwhile, in the placebo group, subjects perform POWERbreathe IMT at only 15% of MIP.

Improvements occur in smokers after IMT

Results of the study show significant improvements in respiratory muscle strength and pulmonary functions after the 4-week POWERbreathe IMT program. Even more promising is the fact that improvements in smokers are greater. Potentially, this is a result of a:

“greater influence of exercise on smokers’ lung microbiome in reversing the negative effects of smoking.”

For smokers, this means that their stronger inspiratory muscles will improve their ability to breathe in more air, for longer and with less fatigue. This will have a positive impact on daily life by helping them improve their ability to perform daily activities that may have been prohibitive before.

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.

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 >

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!

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.

Post-stroke exercise tolerance improves after RMT

Many conditions may develop post-stroke. There are common conditions that improve over time and with rehabilitation. These include physical conditions, cognitive impairment and how you feel emotionally.

Physical conditions post-stroke

Although everyone will experience different effects after a stroke, there are  commonalities. For instance after a stroke you may feel fatigued. And in fact it is fatigue, or lack of energy that is one of the most common effects after a stroke. This can lead to difficulty in everyday life and during rehabilitation. Fatigue is influenced by several factors, including depression, poor sleep, medication and pain. But physical symptoms too will cause fatigue. For instance limb weakness will make movement harder work. Consequently movement will require more energy and subsequently fatigue will set in. Finally this results in a reduction in exercise tolerance, the level of exertion you can achieve before you become exhausted.

Improving exercise tolerance post-stroke

The good news is that new research shows Respiratory Muscle Training (RMT) to be effective at improving exercise tolerance poststroke.

What is RMT

RMT is a technique that aims to improve the function of the respiratory muscles. It is achieved through specific exercises. These exercises increase the strength and endurance of your respiratory muscles. Your respiratory muscles are those you use for inhalation and exhalation. As exhalation is mostly passive, it’s inhalation that you can influence. You can exercise the muscles you use to inhale with Inspiratory Muscle Training (IMT).

POWERbreathe IMT is beneficial post-stroke

POWERbreathe IMT is clinically proven Inspiratory Muscle Training. It is a Class 1 Medical Device. POWERbreathe IMT exercises the muscles you use to inhale, your inspiratory muscles. And scientific tests show that it increases inspiratory muscle strength, improves inspiratory stamina and reduces fatigue.

Latest research in poststroke patients

Findings from this new research are that RMT should be considered an effective method of improving respiratory function, inspiratory muscle strength, and exercise tolerance in patients poststroke.

Improve quality of life in children with Cystic Fibrosis

The Pulmocardio Fisioterapia clinic in Brazil are working with children with Cystic Fibrosis (CF) to help improve their quality of life. They are offering children breathing assessments and breathing training. This is performed under the strict supervision of the therapists and parents. The training will help the children to tackle the respiratory restrictions that CF imposes. Their aim is to help these children live as ‘normal’ a life as possible. To do this they will be prescribing pulmonary rehab for children and adolescents with Cystic Fibrosis.

Cystic Fibrosis and breathing

Pulmocardio Fisioterapia will be focusing on breathing training for the children. And the reason for this is because CF impacts lung function leading to breathlessness. Not only that, it can impact exercise tolerance, increase fatigue and diminish quality of life. Furthermore it adversely affects muscle strength. As a consequence CF affects daily activities. So the aim of this breathing training is to help children maintain an ‘active’ lifestyle.

Improve breathing and improve quality of life

Pulmonary Rehab, offered to patients with CF, consists of exercise training and breathing strategies. This will help to increase exercise tolerance. POWERbreathe Inspiratory Muscle Training (IMT) is beneficial as part of a Pulmonary Rehab programme. This is because POWERbreathe IMT exercises the breathing muscles.  It makes the breathing muscles stronger. And with stronger breathing muscles exercise tolerance increases. In addition, breathing endurance increases. And by increasing breathing strength and endurance, breathing fatigue reduces. As a result, children are able to perform more daily activities. In turn this helps to improve their quality of life.

POWERbreathe IMT is clinically proven

POWERbreathe IMT is a clinically proven, drug-free treatment for people with breathing problems. And it is the only Inspiratory Muscle Training device available on prescription in the UK. It is widely used in research into the benefits of IMT for a variety of medical conditions. And healthcare professionals are prescribing it as a standalone treatment or as part of a rehab programme.

A randomised controlled trial

Benefits Of Combining Inspiratory Muscle With ‘Whole Muscle’ Training In Children With Cystic Fibrosis: A Randomised Controlled Trial.

The conclusion

In conclusion, ‘IMT is an easily applicable intervention that could be included, together with supervised exercise training in the standard care of these (Cystic Fibrosis) patients.’

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POWERbreathe Medic helps patients with breathing problems AND saves NHS money and resources

Health bosses announced back in October 2014 that the NHS in England needed extra money and an overhaul to services in order for patient care not to suffer.

When it comes to respiratory care the NHS could save both money and resources if they prescribed POWERbreathe Medic Respiratory Muscle Training (RMT) for patients with medical conditions such as COPD, Heart Failure, Asthma, Thoracic Surgery, Ventilator Weaning, Cystic Fibrosis and Neuromuscular Disease.

In a 2005 study of the benefits of a 12-month programme of POWERbreathe RMT, researchers observed significant reductions in the use of healthcare resources.1

POWERbreathe RMT for COPD

Accordingly to Professor Peter Calverley (Lung Report III. British Lung Foundation), in the average PCT serving 250,000 people, there would be 14,200 GP consultations per year for chronic obstructive pulmonary disease (COPD), and 9,600 inpatient bed days. Reducing length of hospital stay is an NHS productivity indicator.

POWERbreathe reduced hospital bed days by 29% and GP consultations by 23% compared with placebo (see table above).

POWERbreathe RMT for Asthma

In another study, Weiner et al2 observed an 86% reduction in hospitalisations/emergency room visits following respiratory muscle training in moderate/severe asthmatics (from 1.4 to 0.2 per 3 months per patient).

And in three separate studies, Weiner et al. observed an average 51% reduction in β2-agonist consumption (from 3.9 to 1.6 puffs per day)2,3,4 after respiratory muscle training, and in one study3, corticosteroid use decreased ~80%.

How POWERbreathe Medic could save NHS money & resources

In 2005 when this study was conducted, the total potential annual savings derived from POWERbreathe Medic prescription per average PCT due to reduced hospital bed days and medication consumption (not including savings due to reduction in GP consultations) were substantial.

The POWERbreathe Medic offers an evidence-based, drug-free treatment for patients with medical conditions such as COPD, Heart Failure, Asthma, Thoracic Surgery, Ventilator Weaning, Cystic Fibrosis and Neuromuscular Disease. It is the only Inspiratory Muscle Training device for RMT available for prescription that has been used in research into the benefits of IMT for a variety of medical conditions and prescribed by medical professionals as either a standalone intervention or as part of a rehabilitation programme.

For respiratory care professionals there is a POWERbreathe Medic Try-Before-You-Prescribe demonstration kit; an educational tool designed to help healthcare professionals and patients understand and experience the effect POWERbreathe Medic has on the respiratory muscles.

Since the approval of the POWERbreathe Medic for prescription in 2006, POWERbreathe has introduced the revolutionary, electronic POWERbreathe KH1, intended for use by healthcare professionals for respiratory muscle training and assessment in patients with dyspnoea, including patients with asthma, COPD, bronchitis, cystic fibrosis, emphysema, heart disease, neuromuscular disease, Parkinson’s disease and spinal injury.

The POWERbreathe KH1 is also suitable for use with disposable TrySafe filters and can be used bedside, on the ward, as part of a pulmonary program, or for single patient use at home under medical supervision.

Launched after the POWERbreathe Medic, following the latest technological advances in research and design, is the next generation POWERbreathe Medic: the POWERbreathe Medic Plus for patients to use at home, straight out of the box, with improved airflow dynamics and a more comfortable user experience. And for healthcare professionals (and their patients), is the new POWERbreathe KH2 with Breathe-Link Medic Live Feedback Software.

References:

  1. Beckerman M, Magadle R, Weiner M, Weiner P. The effects of 1 year of specific inspiratory muscle training in patients with COPD. Chest. 2005 Nov;128(5):3177-82.
  2. Weiner P, Azgad Y, Ganam R, Weiner M. Inspiratory muscle training in patients with bronchial asthma. Chest. 1992;102(5):1357-61.
  3. Weiner P, Berar-Yanay N, Davidovich A, Magadle R, Weiner M. Specific inspiratory muscle training in patients with mild asthma with high consumption of inhaled beta(2)-agonists. Chest. 2000;117(3):722-7.
  4. Weiner P, Magadle R, Massarwa F, Beckerman M, Berar-Yanay N. Influence of gender and inspiratory muscle training on the perception of dyspnea in patients with asthma. Chest. 2002;122(1):197-201.

Low Back Pain

After 8 wk of high IMT, individuals with LBP 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.1

1 Inspiratory Muscle Training Affects Proprioceptive Use and Low Back Pain