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 >

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 

Rugby & the Beneficial Effects of Inspiratory Muscle Training

The nature of the game of rugby involves high and low-intensity action. Also, the physical demands of the game are specific to each player’s positional role. However, despite the player’s position, all need to be aerobically fit. Each must also have a high lactate tolerance and be strong and powerful.

Challenges facing rugby players

Most of the game of rugby is sub-maximal. This means that the intensity at which the player performs increases at a steady rate. Furthermore, this sub-maximal exercise will only work the player up to 85% of their maximum heart rate.

However, integral to the game are intermittent sprints, tackling, scrums, rucks and mauls. These are supra-maximal. And it’s this part of the game that pushes players beyond their maximum limit. Consequently, breathing effort will be a challenge.

The pattern of exertion rugby has on players places extreme demands upon their breathing. This is because these activities are anaerobic and generate high levels of lactic acid. Furthermore, the lactic acid stimulates their breathing to increase. In addition, a unique feature of rugby is the involvement of high-intensity upper body activity. This can induce conflicting demands upon the breathing muscles, which as well as bringing about breathing, are also essential in activities that involve the upper body.

This 2018 study from Brazil reiterates the fact that the respiratory muscles need adequate work to maintain sustained effective breathing in the sport of rugby.

The scientific study

This scientific study set about analysing the effects of high-intensity inspiratory muscle training (IMT) in 20 amateur rugby players. These players are from the city of Uberaba, Minas Gerais, Brazil.

For the trial, the amateur players undergo a pulmonary function test, respiratory muscle strength and physical capacity assessment. Researchers then split them into two groups: the IMT group and the control group, each consisting of 10 players. The study has approval from the Research Ethics Committee of the Federal University of Triângulo Mineiro under protocol no. 2398.

Rugby training & conditioning for the trial

During the trial, players begin training with a warm-up by jogging for 5-minutes. They then perform dynamic stretching of the major muscle groups. Following this, the researchers have the players simulate specific moves applied to the game of rugby to improve its fundamentals. These include such moves as passing, blocking, feinting and collective strategic moves. Ultimately, the training session ends with stretching.

Players in the Inspiratory Muscle Training group perform three weekly sessions of an inspiratory muscle training programme, using the POWERbreathe Plus, for 12 consecutive weeks. These sessions are supervised by a physiotherapist and a physical education professional.

The IMT group protocol

This group protocol consists of:

  • 10 minutes’ stretching of the trunk muscles, upper and lower limbs
  • 10-minute inspiratory warm-up by performing a full and vigorous inspiration through the POWERbreathe Plus IMT device
  • A series of 30 repetitions using 80% of maximal inspiratory pressure using the POWERbreathe Plus IMT device. After the fourth training session, the level is increased.

The control group protocol

This group of 10 players perform the same protocol as above, except they do not perform the 30 repetitions of inspiratory muscle training using the POWERbreathe Plus.

Effects of high-intensity IMT in Rugby Players

Results show that the 12-week course of high-intensity POWERbreathe IMT provides significant increases in maximal voluntary ventilation (22%), maximum inspiratory pressure (38%), PEmax (32%), and distance travelled (13%) in the YoYo Test.

Also worthy of note is how physical capacity will be compromised if the respiratory system does not provide sufficient oxygen supply to satisfy the demands. Researchers explain that when the arrival of blood to the respiratory muscles decrease, it experiences fatigue and leads to lactic acid buildup. Consequently, this situation causes a decrease in the strength and resistance of the respiratory muscles.

Results of this trial suggest therefore that the POWERbreathe IMT training protocol provides beneficial, positive effects for rugby players.

The study

Effects of high-intensity Inspiratory Muscle Training in Rugby Players >

Metaboreflex & Performance in Elite Female Soccer

ECSS is the European College of Sport Science (ECSS). Part of its purpose is to promote junior scientists and foster state-of-the-art research. And in order to do this, ECSS have created the Young Investigators Award (YIA). This award-winning research, presented in the video, is for Metaboreflex and Performance in Elite Female Soccer: Effects of Inspiratory Muscle Training.

Video presentation of ECSS YIA winning research

Metaboreflex & Performance in Elite Female Soccer

This research aims to determine the effects of Inspiratory Muscle Training (IMT) on respiratory and peripheral muscles oxygenation. It examines this during a maximal exercise tolerance test and on repeated-sprint ability (RSA) performance in professional women football players.

Inspiratory Muscle Training

All participants in the study perform 6-weeks of IMT. The device they use for IMT is the POWERbreathe K5 with Breathe-Link Live Feedback software.

At the end of their 6 weeks’ training, all participants are reevaluated.

Research Findings

The findings show that,

“…only the IMT group present lower deoxyhaemoglobin and total haemoglobin blood concentrations on intercostal muscles concomitantly to an increased oxyhemoglobin and total haemoglobin blood concentrations on vastus lateralis muscle during time-to-exhaustion”

Research Conclusions

Results suggest the potential role of IMT to attenuate inspiratory muscles metaboreflex. Consequently, oxygen and blood supply to limb muscles during high-intensity exercise improves. Furthermore, there is also a potential impact on inspiratory muscle strength, exercise tolerance and sprints performance in professional women football players.

ECSS YIA Award

ECSS presents scientists with the opportunity of entering this prestigious competition for scientific excellence, every year. And it’s at the ECSS annual congress where young scientists present their scientific work, as they compete to win the YIA Award.

Following presentations, members of the ECSS Scientific Board and ECSS Scientific Committee, grant the awards. They base this decision upon an oral and mini-oral presentation for the top ten presentations respectively.

Bruno Archiza is the winner of this 2016 YIA award, and his presentation took place at the 21st annual congress of the ECSS in Vienna.

Effects of work of breathing on blood flow during exercise

Published in Experimental Physiology this research sought to simultaneously assess leg and respiratory muscle blood flow during intense exercise while manipulating the work of breathing (WOB).

Researchers from Canada & Brazil hypothesised:

  1. Increasing the work of breathing would increase respiratory muscle blood flow and decrease leg blood flow.
  2. Decreasing the work of breathing would decrease respiratory muscle blood flow and increase leg blood flow.

The work of breathing (WOB)

Changes in work of breathing are significantly and positively related to changes in respiratory muscle blood flow. By which it shows that increasing the work of breathing increases blood flow.

On the other hand, changes in work of breathing are inversely related to changes in locomotor blood flow. So decreasing the work of breathing increases locomotor blood flow.

Study findings

Therefore findings from the study support the concept that respiratory muscle work significantly influences the distribution of blood flow to both respiratory and locomotor muscles.

The study

Effects of respiratory muscle work on respiratory and locomotor blood flow during exercise >

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!

Rio Gold Medal Winner Uses POWERbreathe

Robson Conceição is Brazil’s first Olympic boxing gold medalist, winning at this year’s Rio Olympics. And he is using POWERbreathe Inspiratory Muscle Training (IMT).

Why Conceição began boxing

As a child Robson Conceição took to fighting with other children on the streets of Salvador. His uncle is an ex-street fighter and is known as one of the bravest street fighters. Conceição wished to improve his fighting skills and so a friend began teaching him boxing techniques. It’s thanks to a social project in Salvador that Conceição took the decision to stop street fighting and start boxing instead. He could then see it as a way of life.

Conceição is an Olympic champion

Robson is having more success than his previous Olympic appearances in Beijing and London. He is fighting in the lightweight boxing weight class. And this year he made history at the Rio Olympics in Brazil. Robson is Brazil’s First Olympic Boxing Gold Medalist.

POWERbreathe Inspiratory Muscle Training

Robson Conceição is training his inspiratory muscles with POWERbreathe under the guidance of Brazilian physiotherapist, Mateus Esquivel. It will improve his breathing strength and stamina when fighting. It also helps to improve his general fitness without exerting his body any more than his sparring sessions do. POWERbreathe IMT is also beneficial in speeding up his recovery between bouts of fighting.

POWERbreathe for recovery

Conceição performs a recovery breathing set by using his POWERbreathe IMT on a lower setting. This training speeds up lactate clearance more effectively than a traditional recovery. Researchers in Brazil have found that breathing against a small inspiratory load straight after exercise reduces lactate by 16%. And it’s quick. When using POWERbreathe for recovery, after just 5-minutes lactate concentration is the same as that found after 15 minutes of passive recovery.

Congratulations

We are sending our congratulations to Brazil’s First Olympic Boxing Gold Medalist, Robson Conceição! We also would like to thank Mateus Esquivel for supporting Robson throughout his breathing training.

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A New Device For IMT In Patients With Tracheostomy Tube In ICU: A Randomized Trial

The objective of this randomised controlled trial was to compare the inspiratory muscle strength between two groups of tracheostomy patients: Inspiratory Muscle Training with POWERbreathe and breathing through a humidified t-piece (T-tune).

Conclusion:

“The Inspiratory Muscle Training with POWERbreathe in tracheostomy patients promotes increased muscle strength.”

Read A new device for inspiratory muscle training in patients with tracheostomy tube in ICU: A randomized trial >

IMT in mechanical ventilation: suitable protocols and endpoints

RESEARCH:

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.”

CONCLUSION:

“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