Cutrim et al.99. Cutrim ALC, Duarte AAM, Silva-Filho AC, Dias CJ, Urtado CB, et al. Inspiratory muscle training improves autonomic modulation and exercise tolerance in chronic obstructive pulmonary disease subjects: a randomized-controlled trial. Respir Physiol Neurobiol. 2019;263:31-7.doi: 10.1016/j.resp.2019.03.003. https://doi.org/10.1016/j.resp.2019.03.0...
(2019) |
Randomized clinical trial |
Male: 17 |
IMTG (11) |
Training time: 30min*/day |
IMTG showed improvement in MIP after 12 weeks when compared with the control group. |
IMTG showed no significant improvement in exercise tolerance when compared with CG in the 6MWT. |
IMTG did not show significant improvements in the reduction of dyspnea when compared with CG in the 6MWT. |
Female: 5 |
CG (11) |
Training frequency: 3×/week |
The MIP of the study participants before the intervention was ±62cmH2O*; after the intervention, the MIP was ±84cmH2O. |
Age: ±66 to 80 years |
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Total intervention time: 12 weeks |
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Device used: Threshold Inspiratory Muscle Training; POWERbreathe Medic +Plus |
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Load adopted: 30% of the initial MIP*. |
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CG: control group who received no intervention and was evaluated before and after 12 weeks. |
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Chuang et al. (1010. Chuang HY, Chang HY, Fang YY, Guo SE. The effects of threshold inspiratory muscle training in patients with chronic obstructive pulmonary disease: a randomized experimental study. J Clin Nurs. 2017;26(23-24):4830-8. doi: 10.1111/jocn.13841. https://doi.org/10.1111/jocn.13841...
(2017) |
Randomized Clinical Study |
Male: 36 |
IMTG (27) |
Training time: 21 to 30min/day, consisting of a IMT cycle of 2min and 1min of rest; and then seven repeated cycles. |
IMTG showed significant improvement in MIP when compared with CG. |
IMTG showed an increase in distance in the 6MWT of 47.8±1.46 meters, while CG showed an increase of 5.6±1.1 meters. |
IMTG showed an increase in BDI, from 4.48±2.12 points to 9.0±2.27 points. Consequently, there was a reduction in dyspnea. |
Female: 19 |
CG (28) |
Training frequency: 5×/week |
The mean improvement in MIP in the IMT group was (−17.6±0.18cmH2O), while in the CG it was (−2.21±0.4cmH2O) |
Age: ≥66 |
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Total intervention time: eight weeks. |
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Device used: NS |
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Load adopted: NS |
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CG: only medical treatment and routine care were provided, without intervention. |
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Langer et al. (1111. Langer D, Ciavaglia C, Faisal A, Webb KA, Neder JA, et al. Inspiratory muscle training reduces diaphragm activation and dyspnea during exercise in COPD. J Appl Physiol (1985). 2018;125(2):381-92. doi: 10.1152/japplphysiol.01078.2017. https://doi.org/10.1152/japplphysiol.010...
(2018) |
Study Clinical Randomized |
Male: 7 |
IMTG (10) |
Training time: 15min/session Training frequency: 2 to 3×/day, 4 to 7×/week. |
IMTG showed significant improvement in MIP after the intervention: the initial value (−76±16cmH2O) increased to −80±15cmH2O after IMT. |
IMTG showed reduced dyspnea during cycling exercise. It was observed that the exercise time increased more in the IMT group when compared with the CG. |
IMTG showed a significant decrease in the dyspnea scale, whose initial value was 3.0±1.0; and after the intervention, 2.9±1.0. Unlike the CG, which maintained the same pattern (3.0±1.1). |
Female: 13 |
CG (10) |
Total intervention time: eight weeks. |
Age: ≥70 |
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Device used: electronic device POWERbreathe KH2. |
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Adopted load: initial load was ±40% of the base MIP and was progressively increased up to 40% to 50% of the current MIP. |
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CG: performed three daily sessions with unchanged load of ≤10% of the initial MIP. |
Charususin et al. (1212. Charususin N, Gosselink R, Decramer M, Demeyer H, McConnell A, et al. Randomised controlled trial of adjunctive inspiratory muscle training for patients with COPD. Thorax. 2018;73(10):942-50. doi: 10.1136/thoraxjnl-2017-211417. https://doi.org/10.1136/thoraxjnl-2017-2...
(2018) |
Randomized clinical trial |
Male: 95 |
IMTG (85) |
Training time: 60min/session. |
IMTG showed greater improvements in inspiratory muscle strength when compared with CG. The baseline MIP training load in the first week was 47±2% and evolved to 84±4% of their baseline MIP at week 12.
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IMTG showed an additional 75s improvement in endurance time in cycling exercise. However, no significant differences were observed between IMTG and CG in the 6MWT. |
IMTG showed significant reductions in the Borg dyspnea score during the cycling test, after IMT. |
Female: 124 |
CG (89) |
Training frequency: 3 to 5 sessions/week. |
Age: ≥65 |
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Total intervention time: from 20 to 36 sessions. |
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Device used: POWERbreathe KHP2. |
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Load adopted: NS |
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CG: Both groups undertook an identical general training program. However, the intensity of training in the intervention group was initially defined as a load of approximately 50% of the maximum inspiratory pressure of the patient’s mouth (MIP). The training intensity in the control group was set at 10% of baseline MIP and was not modified throughout the intervention period. |
Mehani1313. Mehani SHM. Comparative study of two different respiratory training protocols in elderly patients with chronic obstructive pulmonary disease. Clin Interv Aging. 2017;12:1705-15. doi: 10.2147/CIA.S145688. https://doi.org/10.2147/CIA.S145688...
(2017) |
Randomized clinical trial |
Male: 40. |
IMTG (20) |
Training time: six sessions of five deep breaths each. |
IMTG showed a significant increase in MIP, and the initial value of −0.59±0.83cmH2O increased to −23.18±4.63cmH2O after the intervention. |
IMTG expressed a significant increase in the 6MWT, about 25% when compared with the CG, which had an increase of 2.5%. |
This variable was not evaluated in the study. |
Age: ≥59 |
CG (20) |
Training frequency: 3×/week |
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Total intervention time: two months. |
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Device used: Threshold/Respironics Inc. |
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Load adopted: 15% of baseline MIP, increasing by 5% to 10% to reach 60% of baseline MIP. They also received placebo EMT with a fixed load of 7cmH2O. |
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CG: Received EMT with an initial load of 15% of their baseline MEP and progressively increased to 60%. They also received placebo IMT with a fixed load of 7cmH2O. |
Beaumont et al. (1414. Beaumont M, Mialon P, Le Ber C, Le Mevel P, Péran L, et al. Effects of inspiratory muscle training on dyspnoea in severe COPD patients during pulmonary rehabilitation: controlled randomized trial. Eur Respir J. 2018;51(1):1701107. doi: 10.1183/13993003.01107-2017. https://doi.org/10.1183/13993003.01107-2...
(2018) |
Randomized clinical trial |
Male: 94 |
GTMI+PR (74) |
Training time: 15min/session |
IMTG showed a significant increase in MIP (−14.8cmH2O) when compared with CG, which showed an increase of −9.9cmH2O. |
IMTG reported no significant difference in the 6MWT. |
IMTG showed a reduction in dyspnea, assessed using the Borg scale and the mMRC scale. (Borg 5.4±2.2 to 4.0±2.1; mMRC 2.3±1.1 to 1.4±1.2) |
Female: 55 |
CG (75) |
Training frequency: 2 sessions/day, 5×/week. |
Age: 60 to 65 years |
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Total intervention time: four weeks |
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Device used: PowerBreathe Medic. |
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Load adopted: 50% of the initial MIP of each session, the load was increased (±10%) after 10 days of training during the program, to reach 60% of the initial MIP. They also received a standardized pulmonary rehabilitation program. |
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CG: received a standardized PR program for a period of four weeks. |
Wu et al. (1515. Wu W, Guan L, Zhang X, Li X, Yang Y, et al. Effects of two types of equal-intensity inspiratory muscle training in stable patients with chronic obstructive pulmonary disease: a randomised controlled trial. Respir Med. 2017;132:84-91. doi: 10.1016/j.rmed.2017.10.001. https://doi.org/10.1016/j.rmed.2017.10.0...
)_ (2017) |
Randomized clinical trial |
60 patients |
IMTG 1 (21) |
Training time: 30min/day, divided into two cycles of 15min. |
GTMI 1 showed a significant increase in inspiratory muscle strength after IMT. MIP increased from −37.31±6.18cmH2O to −45.77±5.84cmH2O after IMT. |
The intervention groups significantly increased in the duration of cycling exercise. The IMTG 1 went from 401.84±97.29s to 405.58±96.57s. While IMTG 2 went from 429.10±105.50s to 522.05±129.41s, indicating increased exercise tolerance. |
The IMT groups, in the BDI*, showed improvement after the IMT. |
Sex: NS |
IMTG 2 (19) |
Training frequency: 7×/week |
IMTG 2 also showed improvement in inspiratory muscle strength: MIP increased from −37.53±6.46cmH2O to −45.11±8.71cmH2O after IMT. |
IMTG 2: 2.52±2.04; IMTG 1: 1.58±2.93, significant improvement compared with CG (0.30±3.31). |
Age: 59 to 62 years |
CG (20) |
Total intervention time: eight weeks. |
There was no significant difference between IMT groups 1 and 2. |
There was no significant difference in BDI between the three groups. |
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Device used: IMTG 1 used the Inspiratory Resistive Training PFLEX device; IMTG 2 used the Threshold Inspiratory Muscle Training device. |
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Load adopted: 60% of MIP. |
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CG: did not receive any intervention other than medication, did not include any rehabilitation program for eight weeks. |
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Arnedillo et al. (1616. Arnedillo A, Gonzalez-Montesinos JL, Fernandez-Santos JR, Vaz-Pardal C, España-Dominguez C, et al. Effects of a rehabilitation programme with a nasal inspiratory restriction device on exercise capacity and quality of life in COPD. Int J Environ Res Public Health. 2020;17(10):3669. doi: 10.3390/ijerph17103669. https://doi.org/10.3390/ijerph17103669...
(2020) |
Randomized clinical trial |
16 patients |
IMTG (7) |
Training time: 60min/session. |
IMTG achieved a significant increase in MIP when compared with CG 1 and CG 2. |
IMTG obtained a greater increase in the distance covered in the 6MWT in relation to CG 1 and CG 2. |
This variable was not evaluated in the study. |
Sex: NS |
CG 1 (5) |
Training frequency: 3×/week |
Age: ≥65 |
CG 2 (4) |
Total intervention time: eight weeks. |
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Device used: nasal restriction device for inspiratory muscle training called Feelbreathe, associated with a PR program composed of warm-up phase, main phase, and recovery phase. |
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Load adopted: NS. |
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CGs: CG 1 received the same pulmonary rehabilitation as the intervention group, but without IMT (Feelbreathe). CG 2 received standard medical recommendations for patients with COPD. |
Xu et al. (1717. Xu W, Li R, Guan L, Wang K, Hu Y, et al. Combination of inspiratory and expiratory muscle training in same respiratory cycle versus different cycles in COPD patients: a randomized trial. Respir Res. 2018;19(1):225. doi: 10.1186/s12931-018-0917-6. https://doi.org/10.1186/s12931-018-0917-...
(2018) |
Randomized clinical trial |
Male: 82 |
IMTG (21) |
Training time: 48min/session, 3min of training and 2min of rest. |
The MIP of IMTG, CG A, and CG B was significantly higher than CG C (only group that did not perform IMT). |
IMTG, CG A, and CG B showed a decrease in the degree of dyspnea, indicating that respiratory muscle training can relieve dyspnea in patients with COPD. |
IMTG did not show significant improvements in the reduction of dyspnea, when compared with the control groups in the 6MWT. |
Female: 5 |
CG A (22) |
Training frequency: 7×/week |
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CG B (22) |
Total intervention time: eight weeks. |
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CG C (22) |
Device used: Threshold IMT and Threshold PEP. |
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Load adopted: NS. The IMT group performed eight series of IMT and eight series of respiratory muscle training without any daily load. |
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CGs: CG A performed 16 training sets daily, combined with a respiratory cycle. CG B performed eight series of IMT and eight series of EMT separately in different daily cycles. CG C performed 16 sets of respiratory muscle training without any daily load. |
Buran Cirak et al. (1818. Buran Cirak Y, Yilmaz Yelvar GD, Durustkan Elbasi N. Effectiveness of 12-week inspiratory muscle training with manual therapy in patients with COPD: a randomized controlled study. Clin Respir J. 2022;16(4):317-28. doi: 10.1111/crj.13486. https://doi.org/10.1111/crj.13486...
(2022) |
Prospective, randomized, double-blinded, placebo-controlled study |
Male: 49 |
IMTG (30) |
Training time: 15min/day. |
IMTG showed improvement in MIP after 12 weeks when compared with CG. |
The studied group (395.1-467.2) did not present significant improvements in exercise tolerance when compared with the CG (386.7-430.2) in the 6MWT. |
The benefit of IMT in dyspnea was evaluated using the dyspnea scale, showing a decrease in dyspnea in both groups, but a more noticeable decrease in symptoms in IMTG. |
Female: 11 |
CG (30) |
Training frequency: every day. |
The MIP of the study participants before the intervention was ±62cmH2O*; after the intervention, the MIP was ±84cmH2O. |
Age: ≥62 |
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Total time of the intervention: 12 weeks |
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Device used: Threshold IMT. |
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Load adopted: 40% of the initial MIP. |
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CG: control group who received no intervention and was evaluated before and after 12 weeks. |
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