Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on sleep in brain health

LIVE: Thursday 2nd May 2024, 18:00-19:30 (CEST)

Quality sleep is essential for health. But what happens to our brains when sleep patterns are disturbed? Join our experts to explore the interplay between sleep disruption and neurological diseases, and the questions that you need to be asking your patients to help you prevent the harmful effects of sleep deprivation.
ADVANCED SEARCH
Log in
Top
Trials
Published in: Trials 1/2019

Open Access 01-12-2019 | Study protocol

Critical inspiratory pressure – a new methodology for evaluating and training the inspiratory musculature for recreational cyclists: study protocol for a randomized controlled trial

Authors: Patricia Rehder-Santos, Vinicius Minatel, Juliana Cristina Milan-Mattos, Étore De Favari Signini, Raphael Martins de Abreu, Carla Cristina Dato, Aparecida Maria Catai

Published in: Trials | Issue 1/2019

Login to get access

Abstract

Background

Inspiratory muscle training (IMT) has brought great benefits in terms of improving physical performance in healthy individuals. However, there is no consensus regarding the best training load, as in most cases the maximal inspiratory pressure (MIP) is used, mainly the intensity of 60% of MIP. Therefore, prescribing an IMT protocol that takes into account inspiratory muscle strength and endurance may bring additional benefits to the commonly used protocols, since respiratory muscles differ from other muscles because of their greater muscular resistance. Thus, IMT using critical inspiratory pressure (PThC) can be an alternative, as the calculation of PThC considers these characteristics. Therefore, the aim of this study is to propose a new IMT protocol to determine the best training load for recreational cyclists.

Methods

Thirty recreational cyclists (between 20 and 40 years old) will be randomized into three groups: sham (SG), PThC (CPG) and 60% of MIP, according to age and aerobic functional capacity. All participants will undergo the following evaluations: pulmonary function test (PFT), respiratory muscle strength test (RMS), cardiopulmonary exercise test (CPET), incremental inspiratory muscle endurance test (iIME) (maximal sustained respiratory pressure for 1 min (PThMAX)) and constant load test (CLT) (95%, 100% and 105% of PThMÁX) using a linear load inspiratory resistor (PowerBreathe K5). The PThC will be calculated from the inspiratory muscle endurance time (TLIM) and inspiratory loads of each CLT. The IMT will last 11 weeks (3 times/week and 55 min/session). The session will consist of 5-min warm-up (50% of the training load) and three sets of 15-min breaths (100% of the training load), with a 1-min interval between them. RMS, iIME, CLT and CPET will be performed beforehand, at week 5 and 9 (to adjust the training load) and after training. PFT will be performed before and after training. The data will be analyzed using specific statistical tests (parametric or non-parametric) according to the data distribution and their respective variances. A p value <0.05 will be considered statistically significant.

Discussions

It is expected that the results of this study will enable the training performed with PThC to be used by health professionals as a new tool to evaluate and prescribe IMT.

Trial registration

ClinicalTrials.gov, NCT02984189. Registered on 6 December 2016.
Appendix
Available only for authorised users
Literature
1.
Cahalin LP, Arena R, Guazzi M, Myers J, Cipriano G, Chiappa G, et al. Inspiratory muscle training in heart disease and heart failure: a review of the literature with a focus on method of training and outcomes. Expert Rev Cardiovasc Ther. 2013;11(2):161–77.CrossRefPubMed
2.
Cahalin LP, Arena RA. Breathing exercises and inspiratory muscle training in heart failure. Heart Fail Clin. 2015;11(1):149–72.CrossRefPubMed
3.
HajGhanbari B, Yamabayashi C, Buna TR, Coelho JD, Freedman KD, Morton TA, et al. Effects of respiratory muscle training on performance in athletes: a systematic review with meta-analyses. J Strength Cond Res. 2013;27(6):1643–63.CrossRefPubMed
4.
Edwards AM, Cooke CB. Oxygen uptake kinetics and maximal aerobic power are unaffected by inspiratory muscle training in healthy subjects where time to exhaustion is extended. Eur J Appl Physiol. 2004;93(1–2):139–44.CrossRefPubMed
5.
Gething AD, Williams M, Davies B. Inspiratory resistive loading improves cycling capacity: a placebo controlled trial. Br J Sports Med. 2004;38(6):730–6.CrossRefPubMed
6.
Sheel AW. Respiratory muscle training in healthy individuals: physiological rationale and implications for exercise performance. Sports Med. 2002;32(9):567–81.CrossRefPubMed
7.
Fairbarn M, Coutts K, Pardy R, McKenzie D. Improved respiratory muscle endurance of highly trained cyclists and the effects on maximal Exercise performance. Int J Sports Med. 1991;12(01):66–70.CrossRefPubMed
8.
Holm P, Sattler A, Fregosi RF. Endurance training of respiratory muscles improves cycling performance in fit young cyclists. BMC Physiol. 2004;4:9.CrossRefPubMed
9.
Jakovljevic DG, McConnell AK. Influence of different breathing frequencies on the severity of inspiratory muscle fatigue induced by high-intensity front crawl swimming. J Strength Cond Res. 2009;23(4):1169–74.CrossRefPubMed
10.
Johnson MA, Sharpe GR, Brown PI. Inspiratory muscle training improves cycling time-trial performance and anaerobic work capacity but not critical power. Eur J Appl Physiol. 2007;101(6):761–70.CrossRefPubMed
11.
Kilding AE, Brown S, McConnell AK. Inspiratory muscle training improves 100 and 200 m swimming performance. Eur J Appl Physiol. 2010;108(3):505–11.CrossRefPubMed
12.
Mickleborough TD, Nichols T, Lindley MR, Chatham K, Ionescu AA. Inspiratory flow resistive loading improves respiratory muscle function and endurance capacity in recreational runners: inspiratory muscle training and running. Scand J Med Sci Sports. 2009;20(3):458–68.CrossRefPubMed
13.
Sonetti DA, Wetter TJ, Pegelow DF, Dempsey JA. Effects of respiratory muscle training versus placebo on endurance exercise performance. Respir Physiol. 2001;127(2–3):185–99.CrossRefPubMed
14.
Wells GD, Plyley M, Thomas S, Goodman L, Duffin J. Effects of concurrent inspiratory and expiratory muscle training on respiratory and exercise performance in competitive swimmers. Eur J Appl Physiol. 2005;94(5–6):527–40.CrossRefPubMed
15.
Wylegala JA, Pendergast DR, Gosselin LE, Warkander DE, Lundgren CEG. Respiratory muscle training improves swimming endurance in divers. Eur J Appl Physiol. 2007;99(4):393–404.CrossRefPubMed
16.
Sturdy G, Hillman D, Green D, Jenkins S, Cecins N, Eastwood P. Feasibility of high-intensity, interval-based respiratory muscle training in COPD. Chest. 2003;123(1):142–50.CrossRefPubMed
17.
Hill K, Jenkins SC, Philippe DL, Shepherd KL, Hillman DR, Eastwood PR. Comparison of incremental and constant load tests of inspiratory muscle endurance in COPD. Eur Respir J. 2007;30(3):479–86.CrossRefPubMed
18.
Powers SK, Criswell D, Lieu F-K, Dodd S, Silverman H. Diaphragmatic fiber type specific adaptation to endurance exercise. Respir Physiol. 1992;89(2):195–207.CrossRefPubMed
19.
Janssens L, Brumagne S, McConnell AK, Raymaekers J, Goossens N, Gayan-Ramirez G, et al. The assessment of inspiratory muscle fatigue in healthy individuals: a systematic review. Respir Med. 2013;107(3):331–46.CrossRefPubMed
20.
Minatel V. Análise das respostas ventilatórias, metabólicas e do controle autonômico cardiovascular durante testes de resistência muscular inspiratória e de determinação da pressão inspiratória e de determinação da pressão inspiratória crítica. São Carlos: Universidade Federal de São Carlos; 2017. [cited 29 Nov 2018]. Available from: https://​repositorio.​ufscar.​br/​handle/​ufscar/​10705
21.
Monod H, Scherrer J. The work capacity of a synergic muscular group. Ergonomics. 1965;8(3):329–38.CrossRef
22.
23.
Jones AM, Vanhatalo A, Burnley M, Morton RH, Poole DC. Critical power: implications for determination of V˙O2max and exercise tolerance. Med Sci Sports Exerc. 2010;42(10):1876–90.CrossRefPubMed
24.
Moritani T, Nagata A, Devries HA, Muro M. Critical power as a measure of physical work capacity and anaerobic threshold. Ergonomics. 1981;24(5):339–50.CrossRefPubMed
25.
Vanhatalo A, Doust JH, Burnley M. Determination of critical power using a 3-min all-out cycling test. Med Sci Sports Exerc. 2007;39(3):548–55.CrossRefPubMed
26.
Dall’Ago P, Chiappa GRS, Guths H, Stein R, Ribeiro JP. Inspiratory muscle training in patients with heart failure and inspiratory muscle weakness: a randomized trial. J Am Coll Cardiol. 2006;47(4):757–63.CrossRefPubMed
27.
Eastwood PR, Hillman DR, Morton AR, Finucane KE. The effects of learning on the ventilatory responses to inspiratory threshold loading. Am J Respir Crit Care Med. 1998;158(4):1190–6.CrossRefPubMed
28.
Neves LMT, Karsten M, Neves VR, Beltrame T, Borghi-Silva A, Catai AM. Relationship between inspiratory muscle capacity and peak exercise tolerance in patients post-myocardial infarction. Heart Lung. New York, United States. 2012;41(2):137–45.CrossRef
29.
Neves LF, Reis MH, Plentz RDM, Matte DL, Coronel CC, Sbruzzi G. Expiratory and expiratory plus inspiratory muscle training improves respiratory muscle strength in subjects with COPD: systematic review. Respir Care. 2014;59(9):1381–8.CrossRefPubMed
30.
Chan A-W, Tetzlaff JM, Altman DG, Laupacis A, Gøtzsche PC, Krleža-Jerić K, et al. SPIRIT 2013 statement: defining standard protocol items for clinical trials. Rev Panam Salud Publica Pan Am J Public Health. 2015;38(6):506–14.
31.
AHA. Exercise testing and training of apparently healthy individuals: a handbook for physicians: Universidade de Michigan. Dallas: American Heart Association; 1972. p. 40.
32.
Garber CE, Blissmer B, Deschenes MR, Franklin BA, Lamonte MJ, Lee I-M, et al. Quantity and quality of exercise for developing and maintaining cardiorespiratory, musculoskeletal, and neuromotor fitness in Apparently healthy adults: guidance for prescribing exercise. Med Sci Sports Exerc. 2011;43(7):1334–59.CrossRefPubMed
33.
Hautmann H, Hefele S, Schotten K, Huber RM. Maximal inspiratory mouth pressures (PIMAX) in healthy subjects—what is the lower limit of normal? Respir Med. 2000;94(7):689–93.CrossRefPubMed
34.
Perseguini NM, de Medeiros Takahashi AC, Milan JC, dos Santos PR, Neves VFC, Borghi-Silva A, et al. Effect of hormone replacement therapy on cardiac autonomic modulation. Clin Auton Res. 2014;24(2):63–70.CrossRefPubMed
35.
36.
Souza RB. Pressões respiratórias estáticas Máximas. J Pneumol. 2002;28(3):155–64.
37.
Romer LM, McConnell AK. Inter-test reliability for non-invasive measures of respiratory muscle function in healthy humans. Eur J Appl Physiol. 2004;91(2–3):167–76.CrossRefPubMed
38.
Neder JA, Andreoni S, Lerario MC, Nery LE. Reference values for lung function tests: II. Maximal respiratory pressures and voluntary ventilation. Braz J Med Biol Res. 1999;32(6):719–27.CrossRefPubMed
39.
Balady GJ, Arena R, Sietsema K, Myers J, Coke L, Fletcher GF, et al. Clinician’s guide to cardiopulmonary exercise testing in adults: a scientific statement from the American Heart Association. Circulation. 2010;122(2):191–225.CrossRefPubMed
40.
Higa MN, Silva E, Neves VFC, Catai AM, Gallo L Jr, Silva de Sá MF. Comparison of anaerobic threshold determined by visual and mathematical methods in healthy women. Braz J Med Biol Res. 2007;40(4):501–8.CrossRefPubMed
41.
Dempsey JA, Sheel AW, St Croix CM, Morgan BJ. Respiratory influences on sympathetic vasomotor outflow in humans. Respir Physiol Neurobiol. 2002;130(1):3–20.CrossRefPubMed
42.
Wasserman K, editor. Principles of exercise testing and interpretation: including pathophysiology and clinical applications. 5th ed. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins; 2012. p. 572.
43.
Castello-Simões V, Minatel V, Karsten M, Simões RP, Perseguini NM, Milan JC, et al. Circulatory and ventilatory power: characterization in patients with coronary artery disease. Arq Bras Cardiol. 2015.
44.
American Thoracic Society/European Respiratory Society. ATS/ERS Statement on respiratory muscle testing. Am J Respir Crit Care Med. 2002;166(4):518–624.
45.
Pereira CA de C, Sato T, Rodrigues SC. Novos valores de referência para espirometria forçada em brasileiros adultos de raça branca. J Bras Pneumol. 2007;33(4):397-406.CrossRefPubMed
46.
Neves LMT, Karsten M, Neves VR, Beltrame T, Borghi-Silva A, Catai AM. Respiratory muscle endurance is limited by lower ventilatory efficiency in post-myocardial infarction patients. Braz J Phys Ther. 2014;18(1):1–8.CrossRefPubMed
47.
Shadgan B, Guenette JA, Sheel AW, Reid WD. Sternocleidomastoid muscle deoxygenation in response to incremental inspiratory threshold loading measured by near infrared spectroscopy. Respir Physiol Neurobiol. 2011;178(2):202–9.CrossRefPubMed
48.
Cohen J. Statistical power analysis for the behavioral sciences. 2nd ed. New York: Taylor & Francis Inc.; 1988.
49.
50.
Schulz KF, Altman DG, Moher D, for the CONSORT Group. CONSORT 2010 Statement: updated guidelines for reporting parallel group randomised trials. BMJ. 2010;340(mar23 1):c332.CrossRefPubMed
51.
Burd NA, Holwerda AM, Selby KC, West DWD, Staples AW, Cain NE, et al. Resistance exercise volume affects myofibrillar protein synthesis and anabolic signalling molecule phosphorylation in young men: resistance exercise volume and myofibrillar protein synthesis. J Physiol. 2010;588(16):3119–30.CrossRefPubMed
Metadata
Title
Critical inspiratory pressure – a new methodology for evaluating and training the inspiratory musculature for recreational cyclists: study protocol for a randomized controlled trial
Authors
Patricia Rehder-Santos
Vinicius Minatel
Juliana Cristina Milan-Mattos
Étore De Favari Signini
Raphael Martins de Abreu
Carla Cristina Dato
Aparecida Maria Catai
Publication date
01-12-2019
Publisher
BioMed Central
Published in
Trials / Issue 1/2019
Electronic ISSN: 1745-6215
DOI
https://doi.org/10.1186/s13063-019-3353-0

Other articles of this Issue 1/2019

Trials 1/2019 Go to the issue

Research

Comparative effectiveness of Chuna manual therapy versus conventional usual care for non-acute low back pain: a pilot randomized controlled trial

Study protocol

Remotely controlled mandibular positioning of oral appliance therapy during polysomnography and drug-induced sleep endoscopy compared with conventional subjective titration in patients with obstructive sleep apnea: protocol for a randomized crossover trial

Study protocol

A double-blinded, randomized placebo-controlled trial on the effect of traditional Chinese medicine formula Wuzi Yanzong pill on improving semen qualities in men with suboptimal parameters

Study protocol

Diabetic macular oedema and diode subthreshold micropulse laser (DIAMONDS): study protocol for a randomised controlled trial

Study protocol

Efficacy and safety of Hou Gu Mi Xi in patients with spleen qi deficiency syndrome who underwent radical gastrectomy for gastric cancer: protocol for a multicenter, randomized, double-blind, placebo-controlled trial

Study protocol

The trial to reduce antimicrobial use in nursing home residents with Alzheimer’s disease and other dementias: study protocol for a cluster randomized controlled trial