title: Evaluation of the effectiveness of a home-based inspiratory muscle training programme in patients with chronic obstructive pulmonary disease using multiple inspiratory muscle tests.
abstract: OBJECTIVE
  To evaluate the effectiveness of a home-based inspiratory muscle training (IMT) programme using multiple inspiratory muscle tests.
  
  
  METHODS
  Sixty-eight patients (37 M) with moderate to severe chronic obstructive pulmonary disease (COPD) (Mean [SD], FEV1 36.1 [13.6]% pred.; FEV1/FVC 35.7 [11.2]%) were randomised into an experimental or control group and trained with a threshold loading device at intensity >30% maximum inspiratory pressure (PImax) or <15% PImax, respectively, for 7 weeks. Thirty-nine patients (23 M) completed the study. The following measures were assessed pre- and post-IMT: PImax, sniff inspiratory nasal pressure (SNIP), diaphragm contractility (Pdi,tw), incremental shuttle walk test (ISWT), respiratory muscle endurance (RME), chronic respiratory disease questionnaire (CRDQ), the hospital anxiety and depression scale (HADS) and the SF-36. Between-group changes were assessed using one-way analysis of variance (ANOVA).
  
  
  RESULTS
  PImax and perception of well-being improved significantly post-IMT [p = 0.04 and <0.05 in four domains, respectively]. This was not reflected in SNIP [p = 0.7], Pdi,tw [p = 0.8], RME [p = 0.9] or ISWT [p = 0.5].
  
  
  CONCLUSIONS
  A seven-week, community-based IMT programme, with realistic use of health-care resources, improves PImax and perception of well-being but a different design may be required for improvement in other measures. Multiple tests provide a more comprehensive evaluation of changes in muscle function post-IMT.
  
  
  CONCLUSIONS
  A seven-week, home-based inspiratory muscle training programme improves maximal inspiratory pressure and perception of well-being in patients with moderate to severe COPD but not sniff nasal inspiratory pressure or diaphragm contractility, respiratory muscle endurance and exercise capacity. Multiple tests are recommended for a more comprehensive assessment of changes in muscle function following inspiratory muscle training programmes. Therapists need to explore different community-based inspiratory muscle training regimes for COPD patients and identify the optimal exercise protocol that is likely to lead to improvements in diaphragm contractility and exercise capacity.
authors.affiliation: a Division of Asthma , Allergy and Lung Biology, King's College London , London , UK .|b Faculty of Health , Social Care and Education, Kingston and St. George's University , London , UK .
authors.forename: Dimitra
authors.initials: D
authors.lastname: Nikoletou
authors.affiliation: a Division of Asthma , Allergy and Lung Biology, King's College London , London , UK .|c NIHR Biomedical Research Unit for Advanced Lung Disease, Royal Brompton & Harefield NHS Foundation Trust and Imperial College London , London , UK .
authors.forename: William D-C
authors.initials: WD
authors.lastname: Man
authors.affiliation: a Division of Asthma , Allergy and Lung Biology, King's College London , London , UK .|d Department of Respiratory Medicine , University Hospital of North Staffordshire NHS Trust , London , UK , and.
authors.forename: Naveed
authors.initials: N
authors.lastname: Mustfa
authors.affiliation: e King's College Hospital NHS Trust , London , UK.
authors.forename: Julie
authors.initials: J
authors.lastname: Moore
authors.affiliation: a Division of Asthma , Allergy and Lung Biology, King's College London , London , UK .
authors.forename: Gerrard
authors.initials: G
authors.lastname: Rafferty
authors.affiliation: b Faculty of Health , Social Care and Education, Kingston and St. George's University , London , UK .
authors.forename: Robert L
authors.initials: RL
authors.lastname: Grant
authors.affiliation: a Division of Asthma , Allergy and Lung Biology, King's College London , London , UK .
authors.forename: Lorna
authors.initials: L
authors.lastname: Johnson
authors.affiliation: a Division of Asthma , Allergy and Lung Biology, King's College London , London , UK .
authors.forename: John
authors.initials: J
authors.lastname: Moxham
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D004311:Double-Blind Method; D005080:Exercise Test / Q000379:methods; D017079:Exercise Tolerance / Q000502:physiology; D005260:Female; D006304:Health Status; D006699:Home Care Services; D006801:Humans; D008297:Male; D008875:Middle Aged; D026741:Physical Therapy Modalities; D029424:Pulmonary Disease, Chronic Obstructive / Q000534:rehabilitation*; D012129:Respiratory Function Tests; D012132:Respiratory Muscles / Q000502:physiology*; D012138:Respiratory Therapy / Q000379:methods*; D016896:Treatment Outcome
keywords: COPD; home-based programme; inspiratory muscle training; randomised controlled trial; respiratory muscles