Inspiratory muscle training in adults with chronic obstructive pulmonary disease: An update of a systematic review

Geddes, E. Lynne; O'Brien, Kelly; Reid, W. Darlene; Brooks, Dina; Crowe, Jean

doi:10.1016/j.rmed.2008.07.005

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Volume 102, Issue 12 , Pages 1715-1729, December 2008

Inspiratory muscle training in adults with chronic obstructive pulmonary disease: An update of a systematic review

E. Lynne Geddes
- School of Rehabilitation Science, Institute of Applied Health Science, Room 403, McMaster University, 1400 Main Street West, Hamilton, ON, Canada L8S 1C7
- Corresponding author. Tel.: +1 905 525 9140x27813; fax: +1 905 524 0069.
Kelly O'Brien
- Department of Physical Therapy, University of Toronto, 500 University Avenue, Room 160, Toronto, ON, Canada M5G 1V7
W. Darlene Reid
- Department of Physical Therapy, University of British Columbia, 617 – 828 W. 10th Avenue, Research Pavilion, VCHRI Vancouver, BC, Canada V5Z 1L8
Dina Brooks
- Department of Physical Therapy, University of Toronto, 500 University Avenue, Room 160, Toronto, ON, Canada M5G 1V7
Jean Crowe
- School of Rehabilitation Science, Institute of Applied Health Science, Room 403, McMaster University, 1400 Main Street West, Hamilton, ON, Canada L8S 1C7

Received 17 March 2008; accepted 8 July 2008. published online 19 August 2008.

Summary

The purpose was to update an original systematic review to determine the effect of inspiratory muscle training (IMT) on inspiratory muscle strength and endurance, exercise capacity, dyspnea and quality of life for adults with chronic obstructive pulmonary disease (COPD).

The original MEDLINE and CINAHL search to August 2003 was updated to January 2007 and EMBASE was searched from inception to January 2007. Randomized controlled trials, published in English, with adults with stable COPD, comparing IMT to sham IMT or no intervention, low versus high intensity IMT, and different modes of IMT were included.

Nineteen of 274 articles in the original search met the inclusion criteria. The updated search revealed 17 additional articles; 6 met the inclusion criteria, all of which compared targeted, threshold or normocapneic hyperventilation IMT to sham IMT. An update of the sub-group analysis comparing IMT versus sham IMT was performed with 10 studies from original review and 6 from the update.

Sixteen meta-analyses are reported. Results demonstrated significant improvements in inspiratory muscle strength (PI_max, PI_max % predicted, peak inspiratory flow rate), inspiratory muscle endurance (RMET, inspiratory threshold loading, MVV), exercise capacity (Ve_max, Borg Score for Respiratory Effort, 6MWT), Transitional Dyspnea Index (focal score, functional impairment, magnitude of task, magnitude of effort), and the Chronic Respiratory Disease Questionnaire (quality of life).

Results suggest that targeted, threshold or normocapneic hyperventilation IMT significantly increases inspiratory muscle strength and endurance, improves outcomes of exercise capacity and one measure of quality of life, and decreases dyspnea for adults with stable COPD.

Keywords: Respiratory muscles, Inspiratory muscle training, Breathing exercises, Lung diseases, obstructive, Chronic obstructive pulmonary disease, Pulmonary rehabilitation