Inspiratory Muscle Training (IMT)

5-minute breathing workout lowers blood pressure by 12%

Dr. Cabral introduces inspiratory muscle strength training research from the University of Colorado showing that just 30 inhalations per day for five minutes can lower systolic blood pressure by 12% and improve brain function after six weeks.

"inspiratory or inspiratory muscle strength training. And so you're actually not training the muscles as you would think, like your chest and your bi's and your tri's and your glutes. So what you're doing though is strengthening the muscles of respiration or breathing. So what this device does, and it's very unique, it's very interesting, and they've spent a lot of money on this research."

IMST reduces blood pressure enough to eliminate need for medication

Cabral explains that 30 inhalations per day after six weeks reduced systolic blood pressure by 12%, potentially moving someone from 140/90 to 128/78, eliminating the need for blood pressure medication.

"Just 30 inhalations per day. We've seen it help people with sleep apnea, seen it help with also blood pressure. So 30 inhalations about five minutes after six weeks, systolic blood pressure, okay? So basically the top number when you're getting your blood pressure reading dropped by 12%."

IMST device works like breathing through a resistance thermometer

Cabral describes how the IMST device works mechanically, noting it trains inhalation against resistance. He expresses hope for future nasal versions since nose breathing brings in more oxygen than mouth breathing.

"Think about putting that in your mouth and what it does is it's sucking through that, sucking basically in the mouth, the air, and you are sucking back. So you're having to actually work on your breathing, right?"

Inspiratory Muscle Training: When the intervention is inspiratory muscle

When the intervention is inspiratory muscle training and the control is either sham training or no intervention, so when the intervention is not combined with a full pulmonary rehab or an aerobic exercise training program, then the evidence is quite clear that as a standalone intervention, IMT impro

"When the intervention is inspiratory muscle training and the control is either sham training or no intervention, so when the intervention is not combined with a full pulmonary rehab or an aerobic exercise training program, then the evidence is quite clear that as a standalone intervention, IMT improves respiratory muscle function, so strength and endurance."

Cochrane review of 55 RCTs supports IMT for COPD patients

A Cochrane review of 55 RCTs with 2,460 patients found that inspiratory muscle training improves outcomes for COPD patients when used as a standalone intervention. IMT uses targeted exercises and devices to increase the strength and endurance of breathing muscles.

"Inspiratory muscle training is a program that uses targeted exercises and devices to increase the strength and endurance of, you guessed it, the inspiratory muscles."

IMT alone helps but does not add benefit on top of full pulmonary rehab

When comparing pulmonary rehabilitation with or without IMT, the addition of IMT did not improve outcomes beyond standard rehab. This suggests IMT is most useful as a standalone option for patients who cannot do full pulmonary rehabilitation.

"However, when comparing pulmonary rehab with or without inspiratory muscle training, the addition of inspiratory muscle training wasn't shown to improve outcomes."

PPCs add over $25,000 per patient stay and multiply mortality rates

Professor Levett presents data showing that post-operative pulmonary complications are several times more common than cardiac complications and increase hospital costs by over $25,000 per patient stay.

"And having a single post-op pulmonary complication increases the financial cost of your inpatient stay by just over $25,000."

INSPIRE trial design with 2,500 patients across three arms

The INSPIRE trial is a three-arm pragmatic NHS RCT testing IMT vs sham vs usual care in 2,500 high-risk surgical patients. Patients perform 30 breaths twice daily at 50% of maximum tolerable load for 2-8 weeks preoperatively.

"And it's a three-arm trial, IMT versus sham IMT versus usual care."

Supervision converts 0% to 50% reduction in complications

The most striking finding is that supervision makes the difference between zero and 50% reduction in pulmonary complications. Once-weekly supervision appears sufficient, with load progression and technique evaluation being the key elements.

"Such that you got from a 50% reduction in pulmonary complications to no reduction in pulmonary complications if it wasn't supervised at all."

IMT is resistance training for respiratory muscles

Professor Levett explains that inspiratory muscle training is essentially exercise training for the diaphragm, intercostal muscles, and accessory muscles. In patients with cardiorespiratory disease, respiratory muscle deconditioning contributes to exercise limitation.

"You can really think of inspiratory muscle training as essentially exercise training for the respiratory muscles. By that I mean the diaphragm, the intercostal muscles and the accessory muscles."

30 breaths twice daily with progressive loading is the standard protocol

The standard IMT protocol uses 30 breaths twice daily at above 30% of maximum inspiratory pressure, with minimum two weeks for efficacy and plateau at 8-12 weeks. High-intensity training above 60% MIP produces faster improvements.

"And most of the studies that have looked at this technique in the vast majority of patient populations have used approximately 30 breaths twice a day. And the minimum period for efficacy appears to be around about two weeks."

Cochrane review shows 55% reduction in post-operative pulmonary complications

A 2013 Cochrane review of 12 trials in major abdominal and cardiac surgery found a 55% reduction in post-operative pulmonary complications with IMT, though these were small single-center trials.

"So there were 12 trials in major abdominal surgery and cardiac elective surgery. And you can see, probably more important than atelectasis, 55% reduction in post-op pulmonary complications."