Beckerman M, Magadle R, Weiner M et al (2005) The effects of one year of specific inspiratory muscle training in patients with COPD. Chest, 128, 3177-82
www.chestjournal.org/cgi/content/full/128/5/3177
• IMT increases exercise capacity + quality of life, and reduces SOB + hospitalisation days.

Cahalin LP et al (1997) Inspiratory muscle training in patients with chronic heart failure awaiting cardiac transplantation. Phys Ther, 77, 830-8

Chang AT et al (2005) Case report: inspiratory muscle training in chronic critically ill patients. Physiother Res Internat, 10, 4, 222-6
www3.interscience.wiley.com/cgi-bin/abstract/112510356/ABSTRACT
• IMT after weaning can improve function following prolonged IPPV

Chatham K et al (2009) Suspected statin-induced respiratory muscle myopathy during long-term inspiratory muscle training in a patient with diaphragmatic paralysis Phys Ther, 89, 257-66
www.ptjournal.org/cgi/content/abstract/89/3/257
• high-intensity IMT improved inspiratory muscle performance, symptoms and functional status; improvements were lost after statins were started, but regained when statins were stopped.

Chatham K (2000) Individualised fixed load inspiratory muscle training responses in a patient with severe restrictive lung disease and an élite sportsman. Physiother, 86, 28-30

Chauhan (1992) Regular balloon inflation for patients with chronic bronchitis. BMJ, 304, 1668-69

Covey MK et al (2001) High-intensity inspiratory muscle training in patients with COPD and severely reduced function. J Cardiopulm Rehab, 21, 231-40
• IMT leads to reduced symptoms during exertion

Dronkers J (2008) Prevention of pulmonary complications after upper abdominal surgery by preoperative intensive inspiratory muscle training: a randomized controlled pilot study. Clin Rehab, 22, 2, 134-42.
cre.sagepub.com/cgi/content/abstract/22/2/134
• preoperative IMT ‘seems’ to reduce the incidence of atelectasis in patients having elective abdominal aortic aneurysm surgery.

Enright SJ et al (2006) Effect of high-intensity inspiratory muscle training on lung volumes, diaphragm thickness, and exercise capacity in subjects who are healthy. Phys Ther, 86, 345-54
www.ptjournal.org/cgi/content/abstract/86/3/345

Heidjira YF et al (1996) Nocturnal saturation improves by target-flow inspiratory muscle training in COPD. Am J Respir Crit Care Med, 153, 260-5
• training at 60% of max inspiratory pressure increases strength, endurance and nocturnal SaO2

Hill K, Jenkins S, Hillman DR, Eastwood PR (2004) Dyspnoea in COPD: can inspiratory muscle training help? Austr J Physiother, 50,169-80.
gateway.ut.ovid.com.ezproxy.bton.ac.uk:2048/gw2/ovidweb.cgi
• excellent explanation of the physiology of breathlessness
• evidence that specific loading of the respiratory muscles can reduce SOB

Hill K, Jenkins SC, Philippe DL et al (2006). High-intensity inspiratory muscle training in COPD. Eur Respir J, 27, 1119-28
erj.ersjournals.com/cgi/content/full/27/6/1119
• 8 weeks of IMT increased inspiratory muscle strength, inspiratory muscle endurance, SOB during ADL and reduces fatigue, with modest gains in functional exercise capacity.
training was for 20 min, three times a week for 8 weeks, i.e. could fit into rehab programme.

Hill K, Jenkins SC, Philippe DL Shepherd KL (2007) Comparison of incremental and constant load tests of inspiratory muscle endurance in COPD. Eur Respir J, 30, 3, 479-86
erj.ersjournals.com/cgi/content/full/30/3/479
• high-intensity IMT improved breathing pattern, increased inspiratory muscle endurance, leading to reduced fatigue, reduced SOB during ADL and increased 6-min walk distance.

Hulzebos EH (2006) Feasibility of preoperative inspiratory muscle training in patients undergoing coronary artery bypass surgery with a high risk of postoperative pulmonary complications: a randomized controlled pilot study. Clin Rehab, 20, 11, 949–59
cre.sagepub.com/cgi/content/abstract/20/11/949
• IMT before CABG prevented atelectasis

Hulzebos EH, Helders PJM, Favie NJ (2006) Preoperative intensive inspiratory muscle training to prevent postoperative pulmonary complications in high-risk patients undergoing CABG surgery: a randomized clinical trial. JAMA, 296, 15, 1851–57
jama.ama-assn.org/cgi/content/full/296/15/1851
• preoperative IMT reduced post-op complications and duration of postoperative hospitalisation in high-risk patients undergoing CABG

Klefbeck B et al (2003) Effect of inspiratory muscle training in patients with multiple sclerosis. Arch Phys Med Rehab, 84, 994-9
• IMT improves ease of inspiration, confidence and motivation to do further exercise in MS patients

McCool FD, Tzelepis GE (1995) Inspiratory muscle training in the patient with neuromuscular disease. Phys Ther, 75, 1006-14
• IMT shows benefit with neurological disease

Nield MA (1999) Inspiratory muscle training protocol using a pressure threshold device. Arch Phys Med Rehab, 80, 100-3

Ogiwara S, Miyachi T (2002) Effect of posture on ventilatory muscle strength. J Phys Ther Sci, 14, 1-5
www.jstage.jst.go.jp/article/jpts/14/1/1/_pdf
• training is most effective in the upright position

Preusser BA et al (1994) High vs low intensity inspiratory muscle interval training in patients with COPD. Chest, 106, 110-17
• no difference in outcome between high or low intensity IMT

Ramírez-Sarmiento A (2002) Inspiratory muscle training in patients with COPD, Am J Respir Crit Care Med, 166, 1491-7
• IMT induces functional improvement in the inspiratory muscles

Reid WD (2008) Effects of inspiratory muscle training in cystic fibrosis: a systematic review
Clin Rehab, 22, 10-11, 1003–13
cre.sagepub.com/cgi/content/abstract/22/10-11/1003
• weak evidence for the benefit of IMT in CF

Riera HS, Rubio TM, Ruiz FO et al (2001) Inspiratory muscle training in people with COPD. Chest, 120, 748-56
• IMT relieves SOB, increases walking capacity and increases quality of life in people with COPD

Rochester DF (1992) Nutritional repletion. Sem Respir Med, 13, 44
• IMT is ineffective unless nutrition is providing 1.5 x basal metabolic needs

Simms AM et al (2011) Development of a theory-based intervention to increase prescription of inspiratory muscle training by health professionals in the management of people with chronic obstructive pulmonary disease. Physiother Can, 63, 3, 315-23

Smeltzer SC et al (1996) Expiratory training in multiple sclerosis. Arch Phys Med Rehab, 77, 909-12
• expiration can be helped by expiratory muscle training in MS

Sutbeyaz ST (2010) Respiratory muscle training improves cardiopulmonary function and exercise tolerance in subjects with subacute stroke. Clin Rehabil, 24, 3, 240-50

Vergès S, Flore P, Nantermoz G (2009) Respiratory muscle training in athletes with spinal cord injury. Internat J Sports Med, 30, 526-32.
www.thieme-connect.com/ejournals/abstract/sportsmed/doi/10.1055/s-0029-1202336
• respiratory muscle training can reduce breathlessness in athletes with spinal cord injury.

Weiner (1992) Inspiratory muscle training combined with general exercise reconditioning in patients with COPD. Chest, 102, 1351-6
• IMT ¬increases exercise tolerance if added to exercise programme

Weiner P et al (1995) Inspiratory muscle training during treatment with corticosteroids. Chest, 107, 1041-4
• IMT can prevent muscle deterioration caused by steroids

Weiner, P, Berar-Yanay, N, Davidovich, A, et al (2000) The cumulative effect of long acting bronchodilators, exercise and inspiratory muscle training on the perception of dyspnea in patients with COPD. Chest, 118, 672-678
www.chestjournal.org/cgi/content/abstract/118/3/672?ijkey=872a9c12fdc7dc6ec08b1288cb805d61ebb61aac&keytype2=tf_ipsecsha
• following sequential periods of (a) long-active bronchodilator, (b) exercise and (c) inspiratory muscle training, COPD patients experienced a cumulative reduction in SOB, the most significant improvement being associated with IMT.

Weiner, P, Magadle, R, Beckerman, M, et al (2003) Specific expiratory muscle training in COPD. Chest, 124, 468-473
www.chestjournal.org/cgi/content/full/124/2/468?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&andorexactfulltext=and&searchid=1&FIRSTINDEX=0&sortspec=relevance&volume=124&firstpage=468&resourcetype=HWCIT
• expiratory muscles can be trained in patients with COPD, with improvement of both strength and endurance, leading to increased exercise performance and no change in breathlessness.

Weiner, P, Magadle, R, Beckerman, M, et al (2004) Maintenance of inspiratory muscle training in COPD patients: one year follow-up. Eur Respir J, 23, 61-65
• the benefits of 12-week’s IMT are lost gradually over one year without maintenance training.

Weiner P, Weiner M (2006) Inspiratory muscle training may increase peak inspiratory flow in COPD. Respiration; 73, 151-56
content.karger.com/ProdukteDB/produkte.asp?Aktion=ShowAbstract&ProduktNr=224278&Ausgabe=231710&ArtikelNr=88095







CABG = coronary artery bypass graft
CF = cystic fibrosis
IMT = inspiratory muscle training
SOB = shortness of breath