The Effects of IMT on Exercise Capacity, Dyspnea and Lung Functions in LTx
Condition: Lung Transplant; Inspiratory Muscle Training
MeSH terms: Dyspnea; Respiratory Aspiration
Study type: Interventional

Summary: 
      Inspiratory Muscle Training (IMT), which is used to strengthen the respiratory muscles, is
      one of the techniques used in PR. It is mostly used in patients with chronic obstructive
      pulmonary disease, and has been shown to be beneficial for functionality and also for
      relieving dyspnea perception. It is reported in the guidelines that IMT has additional
      benefit for endurance in COPD patients. However, there are no studies related to its use and
      effectiveness in lung transplantation. In this study, we hoped to increase these known
      benefits by adding IMT to the standard Pulmonary Rehabilitation.

      There are two main objectives of this study:

        1. to examine the effect of respiratory muscle training on exercise capacity in lung
           transplantation candidates,

        2. to compare dyspnea perception and lung function changes between the IMT+PR group and the
           PR group.
    

Detailed description: 
      The patients in the lung transplantation waiting list were included the study. These patients
      were with severe lung disease requiring transplantation, and that the intervention was
      undertaken before any lung transplantation. The patients were eligible for inclusion if they
      have: a diagnosis of terminally severe lung disease, being listed for lung transplantation,
      medically stable, had no orthopedic or cardiac problems that would prevent them from
      exercising and had no transfer problem to the PR centre.

      Participants who meet the study inclusion criteria and complete the baseline assessments were
      randomly allocated into one of the two groups: namely Pulmonary Rehabilitation plus
      Inspiratory Muscle Training Group (IMT+PR) or Pulmonary Rehabilitation Group (PR) using a
      numbered series of 34 prefilled envelops specifying group assignment generated by a
      computer-based program.

      All patients underwent supervised PR program on 2 days per week for 3 months. Apart from
      that, they were asked to perform the home exercise program which was scheduled as 3 days per
      week and fill out the exercise follow-up form. The study group was provided with IMT in
      addition to the standard program.

      Statistical analysis was conducted using SPSS (version 15, USA). The Shapiro-Wilk statistic
      was used to test the normality of the distribution of all variables. Nonparametric tests were
      used in comparison, because the number of samples and the standard deviations of in-group
      chance (∆) were very large. The Wilcoxon Signed Rank Test was used to compare the pre- and
      post-treatment data of the groups, and the Mann-Whitney U test was used in the group-wise
      comparison. Nonparametric variables were expressed as median (minimum-maximum), and
      descriptive variables as percent. The chi-square test was used for categorical variables.
      Significance level was accepted as p <0.05 in all tests. We estimated that a sample size of
      19 patients for each group to have 80% power with 5% type 1 error level to detect a minimum
      clinically significant differences of 54 meters of the 6-min walk test with the highest
      standard deviation of the study parameters.
    

Intervention name(s): inspiratory muscle training; Pulmonary rehabilitation
Intervention type(s): Other; Other
Intervention description(s): Inspiratory Muscle Training was performed with an exercise tool (Powerbreath®) with a resistance range of 0-90. The training intensity was started with 30% of the Maximum Inspiratory Pressure (MIP) value obtained as a result of the mouth pressure measurement16, training was progressively increased from 30% to 60% considering that they were terminal-stage pulmonary disease patients. Patients were asked to perform IMT for 15 minutes, twice a day, 7 days a week, for 3 months.; Aerobic training:The aerobic exercise program consists of treadmill walking, cycle ergometer and arm ergometer training. Group exercises were performed in sets of 15 minutes each with three exercise modalities.
Strength training:It is recommended that resistance targets are set at loads equivalent to 20 to 40% of a 1-repetition maximum (1RM) maneuver and performed between 8 to 12 repetitions for 1 to 2 sets per session.
Home exercise programme:The program included breathing exercises (local expansion exercises, diaphragmatic breathing and pursed lip breathing), free walking, upper and lower extremity strengthening exercises with Thera-Band
Allocation: Randomized
Intervention model: Sequential Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: rehabilitation; exercise; maximal inspiratory pressure; 6-minute walk test