"Inspiratory muscle training programme
Patients will receive either high-intensity IMT (‘strength
training’=intervention group) or low-intensity placebo
IMT (‘endurance training’=placebo group). The training load in this study will be adjusted according to data
from a previously performed pilot study about a homebased, high-intensity IMT programme in patients with
COPD with inspiratory muscle weakness.28 Total daily
training time for both groups will be 21 min, consisting
of 6 cycles of 30 breaths (2 cycles, 3 times daily in the
intervention group or 3 cycles, 2 times daily in the
control group). There will be approximately 3.5 min of
resistive breathing during every cycle, each followed
by 1 min of resting. Patients will train 7 days/week, for
12 weeks using the Powerbreathe KH1 device
(POWERbreatheKH1, HaB International Ltd, Southam,
UK). This handheld device applies a variable resistance
provided by an electronically controlled valve (variable
flow resistive load). Loading is maintained at the same
relative intensity throughout the breath, by reducing the
absolute load to accommodate the pressure–volume relationship of the inspiratory muscles. The application of a
tapered load allows patients to get close to maximal
inspiration, even at high-training intensities (figure 1).
Figure 1 illustrates a comparison of a single breath
(training at an intensity of 60% Pi,max) using a conventional constant threshold loading device, with that of a
variable flow resistive loading device (POWERbreathe
KH1).28 It is apparent from this figure that, in contrast
to the threshold loading, the variable flow resistive load
overloads the inspiratory muscles at higher lung
volumes. Since one of the hypotheses that links
enhanced inspiratory muscle function to improvements
in exercise capacity is that IMT may allow the respiratory
system of patients with COPD to work more comfortably
Charususin N, Gosselink R, Decramer M, et al. BMJ Open 2013;3:e003101. doi:10.1136/bmjopen-2013-003101 3
Open Access
 on July 11, 2023 by guest. Protected by copyright. http://bmjopen.bmj.com/ BMJ Open: first published as 10.1136/bmjopen-2013-003101 on 5 August 2013. Downloaded from
at high lung volumes during exercise,22 we hypothesise
that this variable flow resistive IMT should be better
suited to reduce inspiratory effort (Pes/Pi,max) during
whole body exercise. Besides these hypothetically beneficial characteristics of the applied load, a further advantage of the electronic leading device is the ability to
store parameters of up to 40 IMT sessions. Continuous
registrations of pressure and flow at 500 Hz provide data
on the external work of breathing and enable us to
control quantity as well as quality of unsupervised training sessions. This is of special importance since 85% of
the training sessions during this RCT will be performed
by patients at their homes without supervision. The
device stores data on average mean pressure (cm H2O),
average mean power per breath (watt), average peak
flow per breath (L/s) and total work of breathing
during one session of 30 breaths ( joules). Patients will
be instructed to perform fast and forceful inspirations
and will be encouraged to achieve maximal inhalation
and exhalation with every breath. This breathing pattern
will be supported by acoustic signals from the loading
device.
The intervention group will start training at 40% of
their initial Pi,max. Intermediate measurements of Pi,max
will be performed every week. These Pi,max values will be
used to calculate the training load to be implemented
the following week. In other words, the training load in
each week will be increased continuously over time by
adjusting to at least 50% of the Pi,max value recorded in
the previous week. Rates of perceived inspiratory effort
on a modified CR10 Borg Scale (4–6 of 10) will also be
used to support decisions on training load increments.
The control group will train at an inspiratory load of
10% of their initial Pi,max. This training intensity will not
be changed during the study period. Each week, three
training sessions will be performed under supervision at
the outpatient clinic. During these supervised sessions,
the results of unsupervised sessions will be evaluated
and patients will receive instructions and feedback on
their training efforts. Resting periods will be given as
needed as long as the patients are able to complete the
full volume of training prescribed. Training intensity in
the intervention group will be adapted during these
supervised sessions.
When patients experience acute exacerbations or
respiratory infections, they will temporarily interrupt
their participation in the rehabilitation and IMT programme. Based on the guidance from the treating pulmonologist, they will, however, return to the programme
as quickly as possible. Periods of infections, exacerbations and hospitalisations will be registered and their
stay in the programme will be prolonged in order to
complete 12 weeks of IMT training programme." bu yazıdan bu yazıya benzer bir yazı çıkar Isınma Egzersizleri
Diyafragmatik solunum egzersizleri
5-10 dakika
Esneklik egzersizleri
Duvarda plank
'Core' Bölgesine yönelik egzersizler
Üst ekstremite hareketleri ile dinamik gövde aktivasyonu egzersizleri
Duvarda yana köprü
Duvarda köprü
Omuz flexiyonu
Omuz abdüksiyonu
60 saniye, 3 Set
60 saniye, 3 Set
60 saniye, 3 Set
8-12 tekrar, 2 Set
8-12 tekrar, 2 Set
Gövde rotasyonu
8-12 tekrar, 2 Set
Otur-kalk
Postural kontrol egzersizleri
Destekli tek ayak kaldırma
6 tekrar, 2 Set
30 saniye, 2 Set
Yürüme
Soğuma Egzersizleri
Esneklik Egzersizleri
30 saniye, 3 Set
5 dakika