title: Inspiratory muscle training in patients with chronic obstructive pulmonary disease: the state of the evidence.
abstract: OBJECTIVE
  The purpose of the present review was to assess the quality of evidence in the literature regarding the specific benefits of inspiratory muscle training (IMT) with an emphasis on training intensity and the relationships between changes in inspiratory muscle function and other clinical outcome measures.
  
  
  METHODS
  Articles were found by searching CINAHL, PubMed, Medline via First Search, and ProQuest databases. Articles used in the review were randomized trials of IMT vs. sham IMT or no intervention, published in English in a peer-reviewed journal, included patients with chronic obstructive pulmonary disease (COPD), and specified the intensity of training. The quality of the studies was evaluated by 2 independent reviewers using the methodological rigor scale described by Medlicott and Harris as well as Sackett's levels of evidence. Fifteen articles met the inclusion criteria and were used in this review.
  
  
  RESULTS
  Consistent improvements in maximal inspiratory pressures (ranging from -11 to -30 cm H(2)O) and inspiratory muscle endurance were found. Improvements in dyspnea and health-related quality of life were also observed. Inspiratory muscle training may result in improved exercise tolerance as measured using walking tests. High-intensity IMT resulted in improved training efficiency with respect to inspiratory muscle strength, but evidence of the effect of high-intensity IMT on other clinical outcomes is lacking.
  
  
  CONCLUSIONS
  Despite research spanning decades, there are numerous limitations in the literature regarding IMT. IMT appears to improve dyspnea, waking test distance, and health-related quality of life in individuals with COPD, but it is not clear whether this improvement is mediated through improved inspiratory muscle strength and endurance. This review discussed several considerations critical to the design of future trials.
authors.affiliation: Grand Valley State University, Physical Therapy Program, Grand Rapids, MI.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Shoemaker
authors.forename: Sarah
authors.initials: S
authors.lastname: Donker
authors.forename: Ashley
authors.initials: A
authors.lastname: Lapoe
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