Expiratory + IMT Improves Respiratory Muscle Strength in Subjects With COPD

Published in Respiratory Care: September 1, 2014 vol. 59 no. 9 1381-1388


Expiratory and Expiratory Plus Inspiratory Muscle Training Improves Respiratory Muscle Strength in Subjects With COPD: Systematic Review

Leonardo F Neves, Manoela H Reis, Rodrigo DM Plentz, Darlan L Matte, Christian C Coronel, Graciele Sbruzzi


“Inspiratory muscle training (IMT) produces beneficial effects in COPD subjects, but the effects of expiratory muscle training (EMT) and EMT plus IMT in ventilatory training are still unclear. The aim of this study was to systematically review the effects of EMT and EMT plus IMT compared to control groups of COPD subjects.”


“This study is a systematic review and meta-analysis. The search strategy included MEDLINE, Embase, LILACS, PEDro, and Cochrane CENTRAL and also manual search of references in published studies on the subject.”


“EMT and EMT plus IMT improve respiratory muscle strength and can be used as part of the treatment during pulmonary rehabilitation of subjects with severe to very severe COPD.”

View the Abstract here

View list of published research that used POWERbreathe as the IMT intervention of choice in POWERbreathe in Research.

Find more published research on our Inspiratory Muscle Training Research blog.

Inspiratory Muscle Training During Pulmonary Rehabilitation in COPD

On March 04, 2014 ClinicalTrials.gov processed data on a new Clinical Trial: “Effects of Inspiratory Muscle Training (IMT) on Dyspnea in COPD During Pulmonary Rehabilitation: Randomized Controlled Trial

Brief Summary of the Clinical Trial

“Demonstrate that IMT associated with a conventional pulmonary rehabilitation program allows a significant improvement of dyspnea in subjects with severe or very severe COPD than a conventional pulmonary rehabilitation program alone.”

Study Primary Completion Date: August 2015

Interventions Used in this Clinical Trial

  • Inspiratory Muscle Training (IMT) using POWERbreathe

For more details about this Clinical Trial including Arms, Groups and Cohorts; Outcome Measures; Criteria for Participation; and other additional information about this trial, visit ClinicalTrialsFeeds.org

Find more published research on our Inspiratory Muscle Training Research blog.

Inspiratory Muscle training prevents fatigue in your respiratory muscles

Inspiratory Muscle TrainingIn the final miles of a long run or triathlon run, your leg muscles become very tired. But your hamstrings, quadriceps and calves are not the only muscles that become fatigued during a hard run.

Your respiratory muscles may also become tired during the workout that you are giving them. As it is these muscles which fatigue first it is the fatigue of these muscles that limit your performance. As these muscles fatigue signals are sent to your nervous system telling it to redirect oxygen from the muscles of your limbs to those of your diaphragm to keep them going. Therefore, during the running the reason your legs may begin to fatigue first is because your respiratory muscles have begun to fatigue first.

Anyone who is a triathlete will be fully aware that during each phase – running, swimming or cycling they will be breathing hard. But few pause to consider that hard breathing requires intense work by the respiratory muscles, which are just as susceptible to fatigue as other muscles. Some scientific evidence does suggest that respiratory muscle fatigue is a limiting factor when it comes to endurance sports performance. However, you may not know this but these muscles can be trained independently of the rest of the body.  Take a moment and think you may be doing this right now as you are sitting still and breathing.

Naturally, our everyday breathing is too easy to have a conditioning effect on your respiratory muscles, but when you inhale and/or exhale against resistance with a respiratory muscle training device, these muscles may be taxed even more than they are when you swim, bike and run. As a result, they become stronger and more fatigue-resistant and therefore less limiting in your triathlon performance.

Inspiratory muscle training can benefit all the three disciplines of a triathlon.  Where using a breathing training device if you are a runner this is where you will see the benefit of using such device as when running your body is demanding more oxygen


Effects of respiratory muscle training on performance in athletes: a systematic review with meta-analyses

Journal of Strength and Conditioning Research“Effects of respiratory muscle training on performance in athletes: a systematic review with meta-analyses”

Hajghanbari B, Yamabayashi C, Buna T, Coelho J, Freedman K, Morton T, Palmer S, Toy M, Walsh C, Sheel AW, Reid WD.

More research recently published (July 25th 2012) to determine if respiratory muscle training (RMT) improves sport performance, and respiratory muscle strength and endurance.

The conclusion revealed that RMT can improve sport performance. Inspiratory muscle strength and endurance improved in most studies, which in part, was dependent on the type of RMT employed.


Read the Abstract online at The Journal of Strength and Conditioning Research


Deep Breathing Exercises for Intercostal Muscles & the Diaphragm

Deep breathing exercises are often referred to as pranayama in yoga, an ancient system of holistic health. Regular practice of deep breathing exercises can help tone the intercostal muscles, a group of muscles that form the chest wall, and the diaphragm, a thin muscle located under the lungs.

Deep Chest Breathing

Deep chest breathing requires two yoga blocks. You need to sit on the floor and place the blocks behind you – one in a flat position and the other at the medium position. You need to lay your shoulder blades on the flat block and your head on the other. Then relax your arms out to each side with palms faced upwards. Next, you need to stretch your legs out in front of you. Inhale deeply and allow your chest to completely rise. On the exhale, allow your stomach to fall first, then your diaphragm, then your lungs and finally your chest. Repeat this exercise nine times with a regular breath in-between each repetition. Deep chest breathing tones both the diaphragm and the intercostal muscles.

Bellow’s Breath

Bellow’s breath is a detoxifying breathing exercise which is good for the diaphragm muscle. To carry out this exercise you need to be in a seated position. Once comfortable, you need to inhale naturally through your nose. On the exhale you need to snap your stomach muscles in, forcing the exhalation. While in a seated position, inhale naturally through your nose. On the exhale, snap your stomach muscles in, forcing the exhalation. Repeat this breathing pattern for 30 seconds, gradually increasing the pace.

Intercostal Stretching Breath

To perform an intercostal stretching breath, come to a standing position and stretch both of your arms over the head. Inhale deeply and on the exhale, stretch your arms to the right, stretching your intercostal muscles on the left side of your body. Inhale and come back to the centre; on the next exhale, stretch your arms to the left, feeling your right intercostal muscles being stretched. Repeat two more times on each side.

Focused Diaphragmatic Breath

To perform focused diaphragmatic breath, it is helpful to understand exactly where your diaphragm is. Take your fingers and place them on the bottom of your sternum. Take a few breaths and feel your diaphragm move. To perform this breathing exercise, tense your stomach muscles and keep your fingers on your diaphragm. Inhale and exhale several times, focusing on the diaphragm’s movement. This exercise can help increase awareness of and tone the diaphragm.

Regular inspiratory muscle training can strengthen and condition the core vital muscle required to help us breathe each day.  As with any muscle training always consult your GP for advice.

Quarter of Team GB Suffer Exercise-Induced Asthma (EIA)

It’s 2012 and the year of the London Olympics. The London Evening Standard reports that 25% of Team GB is suffering from exercise-induced asthma (EIA). Such athletes include swimmers Rebecca Adlington and Jo Jackson, as well as, Tour de France champion Bradley Wiggins. Also, marathon runner Paula Radcliffe and footballer Craig Bellamy. And defending Olympic rowing champions Pete Reed and Tom James experience symptoms of EIA too.

Can asthma sufferers exercise?

Well, yes. Asthma UK recommend people with asthma participate in exercise. This is because it improves lung function and can help you manage your symptoms.

EIA is high among elite athletes

It seems endurance sports, such as long-distance running, cross-country skiing and cycling are the most likely activities to cause problems for people with exercise-induced asthma and inspiratory stridor. A high-pitched, wheezing sound when breathing-in is indicative of inspiratory stridor.

A case study of inspiratory stridor

A Case Report in the British Journal of Sports Medicine looks at Inspiratory Muscle Training: a simple cost-effective treatment for inspiratory stridor. It describes the support given to a British elite athlete in the build-up to the 2004 Olympic Games in Athens.

The athlete had been complaining of breathing symptoms during high intensity training. Because of this they couldn’t manage to complete their training sessions. Consequently, they experienced a reduction in performance. The athlete then undertook a gold-standard test for diagnosing exercise-induced asthma (EIA). The EVH challenge is a 6-min test during which the athlete breathes a cold, dry gas at very high ventilation rates. After the test their airway function is compared against normal resting airway function.

Following consultation with a sports physician and physiologist, a diagnosis of inspiratory stridor was given. The advice was to implement a course of inspiratory muscle training (IMT).

Inspiratory Muscle Training (IMT) as a treatment

The course of IMT used a POWERbreathe device and required 30 loaded breaths, twice daily, five times per week for 11 weeks.

The athlete reported a sudden fall in symptoms and was able to complete high intensity training without symptoms. This case shows that IMT is a suitable cost-effective intervention for athletes who present with inspiratory stridor.

Four Weeks of Inspiratory Muscle Training Improves Self-Paced Walking Performance in Overweight and Obese Adults: A Randomised Controlled Trial

Journal of ObesityA new Clinical Study, published in the Journal of Obesity (Volume 2012, Article ID 918202), examined whether a programme of inspiratory muscle training (IMT), using POWERbreathe, improves accumulative distance of self-paced walking in overweight and obese adults.

Fifteen overweight and obese adults were randomised into experimental and placebo groups. Lung function, inspiratory muscle performance, 6-minute walking test, and predicted VO2 max were assessed prior to and following the 4-week IMT intervention.

Both groups performed 30 inspiratory breaths, twice daily using POWERbreathe.

They concluded the study by suggesting that inspiratory muscle training (IMT) provides a practical, minimally intrusive intervention to significantly augment both inspiratory muscle performance and walking distance covered by overweight and obese adults in a clinically relevant 6-minute walk test. This indicates that IMT may provide a useful priming (preparatory) strategy prior to entry in a physical training programme for overweight and obese adults.

Read the full text pdf of the article here


Inspiratory muscle training for strength

Our bodies respond to exercise in a variety of ways to increase efficiency. One key factor that contributes to you exercising less is the efficiency of your respiratory health. Regular exercise can improve your fitness by strengthening these respiratory muscles as these are the muscles that aid you in breathing. Not only will regular exercise strengthen your muscles, your lungs will also change to increase your endurance and energy production.

Benefits of inspiratory muscle training

Exercising to increase the strength of your respiratory muscles is beneficiary to you as you are then able to increase your respiratory volumes. it is these volumes that measure the amount of air you can inhale and exhale, as well as the residual amount which remains in your lungs.

Target Heart Zone

Any type of respiratory muscle strength training depends on how you exercising within your target heart zone. For those of you not familiar with heart zones, this blog on the importance of heart rate monitors will help. Typically the heart rate zone is when your heart beats at 50 to 75 percent of its maximum rate.


Like everything if you have been inactive with your training your muscles will not be as flexible. You need to slowly ease back into training and get your body used to the demands that you are placing on it. When coming back to training after a long period of absence you should always start at the lower end of your heart target zone. The heart and the lungs will work together to build the strength in these organs, something which will take some time and effort. Overtime you will become stronger which will mean you can increase the intensity of your workout and get back towards the higher end of your heart rate zone.


Reaching this intensity will not be easy. However, to help you will need to incorporate aerobic activity into your workout. You can maintain your level of fitness by exercising at least three to five times per week. This regular pattern of exercise will also help you strengthen and condition the main large muscles of your body. These muscles will require more oxygen therefore increasing the strength that is required by the respiratory system. The correct intensity for your workout includes activity such as cycling or running.

As with any strength and conditioning exercise, inspiratory muscle training is a key ingredient. Using an inspiratory muscle trainer can help increase your performance in sports and fitness as well as help you to breathe with ease.



Home-based respiratory muscle training used to improve quality of life in patients with Chronic Heart Failure

The Journal of Cardiopulmonary Rehabilitation & Prevention published the following clinical trial to evaluate the effect of inspiratory muscle training (IMT) on cardiac autonomic modulation and on peripheral nerve sympathetic activity in patients with chronic heart failure (CHF).

The Clinical Trial:

Inspiratory Muscle Training Reduces Sympathetic Nervous Activity and Improves Inspiratory Muscle Weakness and Quality of Life in Patients With Chronic Heart Failure: A CLINICAL TRIAL


Functional capacity, low-frequency (LF) and high-frequency (HF) components of heart rate variability, muscle sympathetic nerve activity inferred by microneurography, and quality of life were determined in 27 patients with CHF who had been sequentially allocated to 1 of 2 groups: (1) control group (with no intervention) and (2) IMT group. Inspiratory muscle training consisted of respiratory exercises, with inspiratory threshold loading of seven 30-minute sessions per week for a period of 12 weeks, with a monthly increase of 30% in maximal inspiratory pressure (PImax) at rest. Multivariate analysis was applied to detect differences between baseline and follow up period.


Inspiratory muscle training significantly increased PImax (59.2 +/- 4.9 vs 87.5 +/- 6.5 cmH2O, P = .001) and peak oxygen uptake (14.4 +/- 0.7 vs 18.9 +/- 0.8 mL[middle dot]kg-1[middle dot]min-1, P = .002); decreased the peak ventilation (VE)/carbon dioxide production (VCO2) ratio (35.8 +/- 0.8 vs 32.5 +/- 0.4, P = .001) and the VE VCO2 slope (37.3 +/- 1.1 vs 31.3 +/- 1.1, P = .004); increased the HF component (49.3 +/- 4.1 vs 58.4 +/- 4.2 normalized units, P = .004) and decreased the LF component (50.7 +/- 4.1 vs 41.6 +/- 4.2 normalized units, P = .001) of heart rate variability; decreased muscle sympathetic nerve activity (37.1 +/- 3 vs 29.5 +/- 2.3 bursts per minute, P = .001); and improved quality of life. No significant changes were observed in the control group.


Home-based IMT represents an important strategy to improve cardiac and peripheral autonomic controls, functional capacity, and quality of life in patients with CHF.

(C) 2012 Lippincott Williams & Wilkins, Inc.

You can read the Abstract here on the Journal of Cardiopulmonary Rehabilitation and Prevention website.

In patients with chronic heart failure, inspiratory muscle training, such as with the POWERbreathe Medic, has been shown to:

  • Improve exercise tolerance by 19%
  • Improve quality of life by 16%

Read more about POWERbreathe inspiratory muscle training for patients with chronic heart failure (CHF).


Respiratory Muscle Training improves endurance in healthy individuals with greater improvements in less fit individuals and in sports of longer durations.

A systematic review and meta-analysis was performed in order to determine the factors that affect the change in endurance performance after RMT (Respiratory Muscle Training) in healthy subjects.

The conclusion was that RMT improves endurance exercise performance in healthy individuals with greater improvements in less fit individuals and in sports of longer durations (rowing, running, swimming and cycling).

Read the Abstract for this meta-analysis recently published on PubMed: ‘Effect of Respiratory Muscle Training on Exercise Performance in Healthy Individuals: A Systematic Review and Meta-Analysis’.


Read more about POWERbreathe respiratory muscle training for rowing, running, swimming and cycling.