Inspiratory muscle training and its effect on indices of physiological and perceived stress during incremental walking exercise in normobaric hypoxia

This study evaluated the effects of inspiratory muscle training (IMT) on inspiratory muscle fatigue (IMF) and physiological and perceptual responses during trekking-specific exercise. An 8-week IMT program was completed by 21 males (age 32.4 ± 9.61 years, VO2peak 58.8 ± 6.75 mL/kg/min) randomised within matched pairs to either the IMT group (n = 11) or the placebo group [(P), n = 9]. Twice daily, participants completed 30 (IMT) or 60 (P) inspiratory efforts using a Powerbreathe initially set at a resistance of 50% (IMT) or used at 15% (P) of maximal inspiratory pressure (MIP) throughout. A loaded (12.5 kg) 39-minute incremental walking protocol (3–5 km/hour and 1–15% gradient) was completed in normobaric hypoxia (PIO2 = 110 mmHg, 3000 m) before and after training. MIP increased from 164 to 188 cmH2O (18%) and from 161 to 171 cmH2O (6%) in the IMT and P groups (P = 0.02). The 95% CI for IMT showed a significant improvement in MIP (5.21±43.33 cmH2O), but not for P. IMF during exercise (MIP) was*5%, showing no training effect for either IMT or P (P = 0.23). Rating of perceived exertion (RPE) was consistently reduced (*1) throughout exercise following training for IMT, but not for P (P = 0.03). The mean blood lactate concentration during exercise was significantly reduced by 0.26 and 0.15 mmol/L in IMT and P (P = 0.00), with no differences between groups (P = 0.34). Rating of dyspnoea during exercise decreased (*0.4) following IMT but increased (*0.3) following P (P = 0.01). IMT may attenuate the increased physiological and perceived exercise stress experienced during normobaric hypoxia, which may benefit moderate altitude expedition

Determinants of inspiratory muscle strength in healthy humans

We investigated 1) the relationship between the baseline and inspiratory muscle training (IMT) induced increase in maximal inspiratory pressure (PI,max) and 2) the relative contributions of the inspiratory chest wall muscles and the diaphragm (Poes/Pdi) to PI,max prior to and following-IMT. Experiment 1: PI,max was assessed during a Müeller manoeuvre before and after 4-wk IMT (n=30). Experiment 2: PI,max and the relative contribution of the inspiratory chest wall muscles to the diaphragm (Poes/Pdi) were assessed during a Müeller manoeuvre before and after 4-wk IMT (n=20). Experiment 1: PI,max increased 19% (P<0.01) post-IMT and was correlated with baseline PI,max (r=−0.373, P<0.05). Experiment 2: baseline PI,max was correlated with Poe/Pdi (r=0.582, P<0.05) and after IMT PI,max increased 22% and Poe/Pdi increased 5% (P<0.05). In conclusion, baseline PI,max and the contribution of the chest wall inspiratory muscles relative to the diaphragm affect, in part, baseline and IMT-induced ΔPI,max. Great care should be taken when designing future IMT studies to ensure parity in the between-subject baseline PI,max

Influence of prior activity (warm-up) and inspiratory muscle training upon between- and within-day reliability of maximal inspiratory pressure measurement

This is the post-print version of the article. The official published version can be obtained from the link below.BACKGROUND: A specific inspiratory muscle ‘warm-up’ (IWU) prior to assessment of maximal inspiratory mouth pressure (PImax) may reduce the number of measurements required to obtain reproducible, representative estimates of PImax. The influence of inspiratory muscle training (IMT) upon this phenomenon is unknown. OBJECTIVE: Compare the impact of an IWU on the between- and within-day reliability of PImax before and after IMT. METHOD: Eight participants were assessed on 4 separate occasions: 2 trials preceded IMT and 2 followed it. At each assessment, the highest of 3 initial efforts was recorded as the pre-IWU value (PI). The highest of 9 subsequent efforts that followed 2 sets of 30 breaths at 40% PI was recorded as PImax. Following 4 weeks of IMT, the trials were repeated. RESULTS: IWU increased PI by 11–17% (p ≤ 0.01), irrespective of IMT status. After IWU, 5–6 efforts were required to determine PImax, irrespective of IMT status. PImax was similar between the 2 trials before IMT and the 2 trials after IMT (p ≥ 0.05), and was 21% higher after IMT (p ≤ 0.01). The coefficient of variation was excellent before and after IWU, both before (1.9 and 0.6%, respectively) and after IMT (1.1 and 0.3%, respectively). Limits of agreement and sample sizes for effect sizes ≤10% were substantially smaller after IWU in all trials. CONCLUSIONS: (1) IWU enhances the between-day reliability of PImax measurement, and this is unaffected by IMT, and (2) judgements regarding acceptability in relation to PImax reliability should be made in relation to analytical goals and we present data to facilitate this

Inspiration for the Future: The Role of Inspiratory Muscle Training in Cystic Fibrosis.

Cystic fibrosis (CF) is an inherited, multi-system, life-limiting disease characterized by a progressive decline in lung function, which accounts for the majority of CF-related morbidity and mortality. Inspiratory muscle training (IMT) has been proposed as a rehabilitative strategy to treat respiratory impairments associated with CF. However, despite evidence of therapeutic benefits in healthy and other clinical populations, the routine application of IMT in CF can neither be supported nor refuted due to the paucity of methodologically rigorous research. Specifically, the interpretation of available studies regarding the efficacy of IMT in CF is hampered by methodological threats to internal and external validity. As such, it is important to highlight the inherent risk of bias that differences in patient characteristics, IMT protocols, and outcome measurements present when synthesizing this literature prior to making final clinical judgments. Future studies are required to identify the characteristics of individuals who may respond to IMT and determine whether the controlled application of IMT can elicit meaningful improvements in physiological and patient-centered clinical outcomes. Given the equivocal evidence regarding its efficacy, IMT should be utilized on a case-by-case basis with sound clinical reasoning, rather than simply dismissed, until a rigorous evidence-based consensus has been reached

Loading of trained inspiratory muscles speeds lactate recovery kinetics

Purpose: To investigate the effects of inspiratory muscle loading (ITL) and inspiratory muscle training (IMT) upon blood lactate concentration ([lacj]B)and acid-base balance following maximal incremental cycling. Methods: 18 subjects were divided into a control (n = 9) or IMT group (n = 9). Prior to and following a 6 wk intervention subjects completed two maximal incremental cycling tests followed by 20 min of recovery with (ITL) or without (passive recovery; PR) a constant inspiratory resistance (15 cmH2O). The IMT group performed 6 wk pressure threshold IMT at 50% maximal inspiratory mouth pressure (MIP). Throughout recovery, acid-base balance was quantified using the physicochemical approach by measuring the strong ion difference ([SID])=[Na+]+[K+]-[ Clj]+[ lacj]), the total concentration of weak acids ([Atot j]) and the partial pressure of carbon dioxide (PCO2). Results: Following the intervention MIP increased in the IMT group only (+34%). No differences in lactate clearance were observed between PR and ITL before the intervention in both groups and following the intervention in the control group. Following IMT, relative to PR, [lacj]B was reduced throughout ITL (min 2 to 20) by 0.66 ± 1.28 mmol·L-1 (P<0.05) and both the fast (lactate exchange) and slow (lactate clearance) velocity constants of the lactate recovery kinetics were increased (P<0.05). Relative to pre-IMT, ITL reduced plasma [H+] which was accounted for by an IMT-mediated increase in [SID] due almost exclusively to a 1.7 mmol·L-1 reduction in [lacj]B. Conclusions: Following maximal exercise ITL affected lactate recovery kinetics only after IMT. Our data support the notion that the inspiratory muscles are capable of lactate clearance which increases [SID] and reduces [H+]. These effects may facilitate subsequent bouts of high-intensity exercise

Evaluation of Carotid Arterial Intima-Media Thickness (IMT) and Its Relation to Clinical Parameters in Japanese Children

The aim of this study was to evaluate the carotid arterial intima-media thickness (IMT) and its relation to clinical parameters in Japanese children. Fifty-two healthy children (39 boys and 13 girls), aged 6-14 years, were enrolled in this cross-sectional investigation study. IMT of the common carotid artery was determined using ultrasonography. We also investigated anthropometric parameters, blood pressure (BP), lifestyles and blood examinations. The mean value of IMT was 0.4±0.1mm, which was lower than the normal value (1.0mm) in adults. IMT was positively correlated with age (r＝0.340) and height (r＝0.346) in boys, while it was positively correlated with body mass index (BMI) (r＝0.584) and diastolic BP (DBP) (r＝0.563) in girls. In addition, IMT was associated with sleeping hours and hours of watching television (TV) by using stepwise regression analysis. In conclusion, IMT increased with aging, and it was linked to some clinical parameters of atherosclerosis and lifestyles in children. Therefore, this reference data will be helpful for future assessment of age-related change in Japanese children in clinical practice, and IMT might be a good predictor of atherosclerosis in Japanese children

Intima-Media Thickness: Setting a Standard for a Completely Automated Method of Ultrasound Measurement

The intima - media thickness (IMT) of the common carotid artery is a widely used clinical marker of severe cardiovascular diseases. IMT is usually manually measured on longitudinal B-Mode ultrasound images. Many computer-based techniques for IMT measurement have been proposed to overcome the limits of manual segmentation. Most of these, however, require a certain degree of user interaction. In this paper we describe a new completely automated layers extraction (CALEXia) technique for the segmentation and IMT measurement of carotid wall in ultrasound images. CALEXia is based on an integrated approach consisting of feature extraction, line fitting, and classification that enables the automated tracing of the carotid adventitial walls. IMT is then measured by relying on a fuzzy K-means classifier. We tested CALEXia on a database of 200 images. We compared CALEXia performances to those of a previously developed methodology that was based on signal analysis (CULEXsa). Three trained operators manually segmented the images and the average profiles were considered as the ground truth. The average error from CALEXia for lumen - intima (LI) and media - adventitia (MA) interface tracings were 1.46 ± 1.51 pixel (0.091 ± 0.093 mm) and 0.40 ± 0.87 pixel (0.025 ± 0.055 mm), respectively. The corresponding errors for CULEXsa were 0.55 ± 0.51 pixels (0.035 ± 0.032 mm) and 0.59 ± 0.46 pixels (0.037 ± 0.029 mm). The IMT measurement error was equal to 0.87 ± 0.56 pixel (0.054 ± 0.035 mm) for CALEXia and 0.12 ± 0.14 pixel (0.01 ± 0.01 mm) for CULEXsa. Thus, CALEXia showed limited performance in segmenting the LI interface, but outperformed CULEXsa in the MA interface and in the number of images correctly processed (10 for CALEXia and 16 for CULEXsa). Based on two complementary strategies, we anticipate fusing them for further IMT improvement

Higher levels of osteoprotegerin and immune activation/immunosenescence markers are correlated with concomitant bone and endovascular damage in HIV-suppressed patients

HIV-infected patients appear to have a significantly greater risk of non-AIDS comorbidities such as osteoporosis and atherosclerosis. Subjects with osteoporosis are at a higher risk of developing cardiovascular disease than those with normal bone mass, therefore a possible relation between these two conditions can be hypothesized. In the setting of HIV infection, several factors might contribute to bone disease and endothelial dysfunction. The aim of our study was to evaluate the relationship between bone and cardiovascular disease and to investigate the role of traditional factors, T-cell phenotype and osteoprotegerin in HIV positive subjects on effective antiretroviral therapy. We included 94 HIV positive subjects on antiretroviral therapy with virological suppression and 41 healthy subjects matched for age and gender as a control group. Carotid-Intima Media Thickness (c-IMT) and bone mineral density (BMD) were performed by ultrasound and DEXA, respectively. CD4+/CD8+ T-cell activation, senescence and osteoprotegerin plasma levels were measured by flow-cytometry and ELISA, respectively. Among HIV positive patients, 56.4% had osteopenia/osteoporosis and 45.7% had pathological c-IMT (&gt;0.9mm). Subjects with pathological c-IMT and BMD exhibited higher CD4+ and CD8+ activated, CD8+ senescent and osteoprotegerin than subjects with normal c-IMT and BMD. HIV positive subjects with osteopenia/osteoporosis had higher c-IMT than subjects with normal BMD, and linear regression analysis showed a negative correlation between BMD and c-IMT. Several factors are implicated in the pathogenesis of non-AIDS comorbidities in HIV positive patients. Osteoprotegerin together with inflammation and immunosenescence in HIV positive patients could affect bone and vascular system and could be considered as a possible common link between these two diseases