title: Pre-operative inspiratory muscle training preserves postoperative inspiratory muscle strength following major abdominal surgery - a randomised pilot study.
abstract: BACKGROUND
  The aim of this pilot study was to assess the effect of pre-operative inspiratory muscle training (IMT) on respiratory variables in patients undergoing major abdominal surgery.
  
  
  METHODS
  Respiratory muscle strength (maximum inspiratory [MIP] and expiratory [MEP] mouth pressure) and pulmonary functions were measured at least 2 weeks before surgery in 80 patients awaiting major abdominal surgery. Patients were then allocated randomly to one of four groups (Group A, control; Group B, deep breathing exercises; Group C, incentive spirometry; Group D, specific IMT). Patients in groups B, C and D were asked to train twice daily, each session lasting 15 min, for at least 2 weeks up to the day before surgery. Outcome measurements were made immediately pre-operatively and postoperatively.
  
  
  RESULTS
  In groups A, B and C, MIP did not increase from baseline to pre-operative assessments. In group D, MIP increased from 51.5 cmH(2)O (median) pre-training to 68.5 cmH(2)O (median) post-training pre-operatively (P < 0.01). Postoperatively, groups A, B and C showed a fall in MIP from baseline (P < 0.01, P < 0.01) and P = 0.06, respectively). No such significant reduction in postoperative MIP was seen in group D (P = 0.36).
  
  
  CONCLUSIONS
  Pre-operative specific IMT improves MIP pre-operatively and preserves it postoperatively. Further studies are required to establish if this is associated with reduced pulmonary complications.
authors.affiliation: Department of General and Vascular Surgery, Cheltenham General Hospital, Cheltenham GL53 7AN, UK. sachin.kulkarni@glos.nhs.uk
authors.forename: S R
authors.initials: SR
authors.lastname: Kulkarni
authors.forename: E
authors.initials: E
authors.lastname: Fletcher
authors.forename: A K
authors.initials: AK
authors.lastname: McConnell
authors.forename: K R
authors.initials: KR
authors.lastname: Poskitt
authors.forename: M R
authors.initials: MR
authors.lastname: Whyman
mesh_terms: D000005:Abdomen / Q000601:surgery*; D000328:Adult; D000368:Aged; D001945:Breathing Exercises; D005541:Forced Expiratory Volume; D006801:Humans; D008875:Middle Aged; D053580:Muscle Strength; D010865:Pilot Projects; D011183:Postoperative Complications / Q000517:prevention & control; D011300:Preoperative Care / Q000379:methods*; D012129:Respiratory Function Tests / Q000379:methods; D012132:Respiratory Muscles / Q000502:physiology*; D016896:Treatment Outcome; D014797:Vital Capacity; D055815:Young Adult