Background: Aging is associated with decline in performance of various systems resulting in reduced exercise capacity, fatigue and reduced respiratory muscle functioning. Studies reported that respiratory muscle training is effective to increase respiratory muscle functioning in various populations but the reports are limited in community dwelling elderly population. Materials and methods: Thirty community dwelling elderly individuals fulfilling the eligibility criteria participated in a randomized controlled trial for four weeks of duration. They were assigned to Group A receiving respiratory muscle training along with aerobic training and Group B receiving only aerobic training. The outcome measures assessed were maximum voluntary ventilation, fatigue severity scale and 6 minute walk test distance; before and after four weeks of intervention. Results: Statistically significant improvement was seen in maximum voluntary ventilation, fatigue severity scale and 6 minute walk test distance with p<0.0001 in both the groups. Intergroup comparison showed greater improvement in the group A which received respiratory muscle training along with aerobic training. Conclusion: Respiratory muscle training along with aerobic training was more effective than aerobic training alone in improving respiratory muscle function, fatigue and exercise capacity in community dwelling elderly individuals after four weeks of intervention.
Keywords: Respiratory muscle training, aerobic training, community dwelling elderly

RATIONALE: Menopause is associated with changes in sex hormones, which affect immunity, inflammation, and osteoporosis and may impair lung function. Lung function decline has not previously been investigated in relation to menopause.
OBJECTIVES: To study whether lung function decline, assessed by FVC and FEV1, is accelerated in women who undergo menopause.
METHODS: The population-based longitudinal European Community Respiratory Health Survey provided serum samples, spirometry, and questionnaire data about respiratory and reproductive health from three study waves (n = 1,438). We measured follicle-stimulating hormone and luteinizing hormone and added information on menstrual patterns to determine menopausal status using latent class analysis. Associations with lung function decline were investigated using linear mixed effects models, adjusting for age, height, weight, pack-years, current smoking, age at completed full-time education, spirometer, and including study center as random effect.
MEASUREMENTS AND MAIN RESULTS: Menopausal status was associated with accelerated lung function decline. The adjusted mean FVC decline was increased by -10.2 ml/yr (95% confidence interval [CI], -13.1 to -7.2) in transitional women and -12.5 ml/yr (95% CI, -16.2 to -8.9) in post-menopausal women, compared with women menstruating regularly. The adjusted mean FEV1 decline increased by -3.8 ml/yr (95% CI, -6.3 to -2.9) in transitional women and -5.2 ml/yr (95% CI, -8.3 to -2.0) in post-menopausal women.
CONCLUSIONS: Lung function declined more rapidly among transitional and post-menopausal women, in particular for FVC, beyond the expected age change. Clinicians should be aware that respiratory health often deteriorates during reproductive aging.
KEYWORDS: latent class analysis; lung function decline; menopause; reproductive aging; sex hormones
PMID: 27907454 DOI: 10.1164/rccm.201605-0968OC

PURPOSE: Gas exchange abnormalities and inspiratory muscle dysfunction are common postoperative pulmonary complications after cardiac surgery. The aim of this study was to investigate the changes in the alveolar arterial oxygen gradients and inspiratory muscle power after preoperative inspiratory muscle training (IMT) followed by postoperative IMT and early mobilization after coronary artery bypass graft surgery.
METHODS: Patients were randomly assigned to the intervention group (n = 20) or the usual care group (n = 20). The intervention group received preoperative IMT by a threshold load inspiratory muscle trainer and education followed by postoperative IMT and early mobilization. The usual care group received preoperative education and postoperative routine physical therapy care. Alveolar-arterial oxygen gradients and oxygen saturation were measured before induction of anesthesia and postoperatively immediately after extubation, at 24 hours, 48 hours, and on day 8 postsurgery. Inspiratory muscle power was measured before surgery, after 48 hours, and on day 8.
RESULTS: Forty male patients underwent coronary artery bypass graft surgery. The intervention group showed significant (P < .05) improvement of alveolar arterial-oxygen gradients and inspiratory muscle power at all measurement points. The mean of inspiratory muscle power at discharge was significantly higher than at baseline but not statistically significantly different from the preoperative measurement.
CONCLUSION: Pre- and postoperative IMT by the threshold load inspiratory muscle trainer resulted in improvement of inspiratory muscle power, alveolar-arterial gradient, and oxygen saturation.
PMID: 28169983 DOI: 10.1097/HCR.0000000000000234

BACKGROUND: The purpose of this study (randomised controlled trial) was to assess the effects of an 8-week combined 'whole muscle' (resistance+aerobic) and inspiratory muscle training (IMT) on lung volume, inspiratory muscle strength (PImax) and cardiorespiratory fitness (VO2 peak) (primary outcomes), and dynamic muscle strength, body composition and quality of life in paediatric outpatients with CF (cystic fibrosis, secondary outcomes). We also determined the effects of a detraining period.
METHODS: Participants were randomly allocated with a block on gender to a control (standard therapy) or intervention group (initial n=10 (6 boys) in each group; age 10±1 and 11±1 years). The latter group performed a combined programme (IMT (2 sessions/day) and aerobic+strength exercises (3 days/week, in-hospital)) that was followed by a 4-week detraining period. All participants were evaluated at baseline, post-training and detraining.
RESULTS: Adherence to the training programme averaged 97.5%±1.7%. There was a significant interaction (group×time) effect for PImax, VO2peak and five-repetition maximum strength (leg-press, bench-press, seated-row) (all (p<0.001), and also for %fat (p<0.023) and %fat-free mass (p=0.001), with training exerting a significant beneficial effect only in the intervention group, which was maintained after detraining for PImax and leg-press.
CONCLUSION: The relatively short-term (8-week) training programme used here induced significant benefits in important health phenotypes of paediatric patients with CF. IMT is an easily applicable intervention that could be included, together with supervised exercise training in the standard care of these patients.
KEYWORDS: Aerobic fitness/Vo2 Max; Children; Children and exercise; Children's health and exercise
PMID: 23681502 DOI: 10.1136/bjsports-2012-091892

This study evaluated whether inspiratory muscle training (IMT) could increase inspiratory muscle strength and endurance and exercise performance in 11 patients with cystic fibrosis (CF) with moderately severe airflow limitation. The IMT consisted of breathing through an inspiratory resistance (IR) for 15 min twice daily for 4 wk, preceded or followed by a 4-wk control period. After IMT, there was an increase in inspiratory muscle strength measured by maximal inspiratory mouth pressure at functional residual capacity: 74 +/- 18 cmH2O before training to 81 +/- 12 cmH2O after training, mean +/- 1 SD, p less than 0.025, and in inspiratory muscle endurance measured by the maximal IR tolerated for 10 min. Limitation of performance in the progressive exercise test was related to increased airflow limitation and possibly to poor nutrition. Mean exercise performance during progressive or submaximal exercise testing did not change after training. It is concluded that this form of IMT improved inspiratory muscle strength and endurance, but had little effect on exercise performance in patients with CF.
PMID: 7149451 DOI: 10.1164/arrd.1982.126.5.855