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Background This systematic review aims to investigate the extent to which preoperative conditioning (PREHAB) improves physiologic function and whether it correlates with improved recovery after major surgery. Methods An electronic database search identified randomized controlled trials (RCTs) investigating the safety and efficacy of PREHAB. The outcomes studied were changes in cardiorespiratory physiologic function, clinical outcomes (including length of hospital stay and rates of postoperative complications), and measures of changes in functional capacity (physical and psychological). Results Eight low- to medium-quality RCTs were included in the final analysis. The patients were elderly (mean age >60 years), and the exercise programs were significantly varied. Adherence to PREHAB was low. Only one study found that PREHAB led to significant improvement in physiologic function correlating with improved clinical outcomes. Conclusion There are only limited data to suggest that PREHAB confers any measured physiologic improvement with subsequent clinical benefit. Further data are required to investigate the efficacy and safety of PREHAB in younger patients and to identify interventions that may help improve adherence to PREHAB.

This study aimed to investigate the effects of inspiratory muscle training (IMT) on inspiratory muscle strength, dyspnea, and quality of life (QOL) in COPD patients. A comprehensive search was undertaken on the Web of Science, Scopus, Embase, Cochrane, and PubMed databases, encompassing data published up to 31 March 2024. A meta-analysis was subsequently conducted to quantify the standardized mean difference (SMD) and 95% confidence interval (CI) for the effects of IMT in COPD patients. Sixteen studies met the inclusion criteria. IMT significantly improved inspiratory muscle strength (SMD, 0.86, p < 0.00001), dyspnea (SMD = −0.50, p < 0.00001), and QOL (SMD = 0.48, p = 0.0006). Subgroup analysis showed that <60% maximal inspiratory muscle pressure (PImax) IMT (inspiratory muscle strength, SMD = 1.22, p = 0.005; dyspnea, SMD = −0.92, p < 0.0001), IMT conducted for ≤20 min (inspiratory muscle strength, SMD = 0.97, p = 0.008; dyspnea, SMD = −0.63, p = 0.007; QOL, SMD = 1.66, p = 0.007), and IMT conducted >3 times per week (inspiratory muscle strength, SMD = 1.06, p < 0.00001; dyspnea, SMD = −0.54, p < 0.00001; QOL, SMD = 0.48, p = 0.0009) had greater effects. This meta-analysis provides clinicians with evidence supporting the recommendation that COPD patients engage in IMT at <60% PImax for more than 3 times per week, with each session lasting no more than 20 min, to improve inspiratory muscle strength, dyspnea, and QOL.

Objectives This study aimed to explore the correlation among inspiratory muscle strength, left atrial strain reservoir (LAsr), and functional capacity in patients with heart failure with preserved and mildly reduced ejection fractions (HFpEF and HFmrEF). Methods This cross‐sectional study enrolled 40 patients with HFpEF and HFmrEF. Regression analyses were conducted at both univariate and multivariate levels to explore the relationships between maximal inspiratory pressure (MIP), peak oxygen consumption (pVO2), six‐minute walk distance (6MWD), and LAsr. Results MIP significantly correlated with pVO2 (r = 0.400, p = 0.011) and 6MWD (r = 0.549, p < 0.001) in univariate analyses, with multivariable regression confirming its independent association with pVO2 (β = 0.07, 95% CI: 0.02–0.14, p = 0.044) and 6MWD (β = 1.14, 95% CI: 0.04–2.23, p = 0.043). While univariate analysis showed a meaningful correlation between MIP and LArs (r = 0.364, p = 0.021), this was not notable in the multivariable model (β = 0.09, 95% CI: −0.05–0.24, p = 0.181). Conclusions MIP is a significant predictor of exercise capacity in HFpEF and HFmrEF; however, its relationship with LAsr was influenced by confounding factors. It is essential to address inspiratory muscle weakness for effective management of patients with HFpEF and HFmrEF. Trial Registration This trial was registered in the Thai Clinical Trials Registry (https://www.thaiclinicaltrials.org/) under the trial ID TCTR20231121001. In patients with HFpEF and HFmrEF, maximal inspiratory pressure is independently associated with exercise capacity, including peak oxygen uptake and 6‐minute walk distance, as well as left atrial reservoir strain. These findings highlight inspiratory muscle strength as a relevant functional determinant of exercise intolerance, independent of age and conventional echocardiographic measures of cardiac function.

Repeated-sprint training in hypoxia (RSH) has been shown to boost team-sport players’ repeated-sprint ability (RSA). Whether players’ global inspiratory muscle (IM) and core muscle (CM) functions would be altered concomitantly with RSH was not reported. This study was designed to compare the concomitant alternations in players’ RSA and their IM and CM functions during a team-sport-specific intermittent exercise protocol (IEP) before and after the intervention. Twenty players were assigned into either RSH or control (CON) groups (n = 10 for each). RSH players participated in 5-wk RSH (15 sessions, 3 sets 5x5-s all-out treadmill sprints interspersed with 25-s passive recovery under the hypoxia of 13.5%) while CON players had no corresponding training. The changes in RSA between pre- and post-intervention, and the alterations in IM and CM functions that were revealed by maximum inspiratory mouth pressure (PImax) and sport-specific endurance plank test (SEPT) performance, respectively, between pre- and post-IEP and across pre- and post-intervention in the RSH group were compared with that of CON. Following the 5-wk RSH, players’ RSA improved significantly (>6%, p < 0.05) while PImax and SEPT performance did not alter (P > 0.05). Nevertheless, PImax which declined markedly in pre-intervention IEP (pre-IEP 155.4 ± 22.7 vs post-IEP 140.6 ± 22.8 cmH2O, p < 0.05) was alleviated significantly in post-intervention IEP (152.2 ± 27.4 vs 152.6 ± 31.8, p > 0.05), while the concomitant declined SEPT performance in the pre-intervention IEP (155 ± 24.6 vs 98.1 ± 21.7 s, p < 0.05) was retained post intervention (170.7 ± 38.1 vs 100.5 ± 33.4, p < 0.05). For the CON, all variables were unchanged (p > 0.05). Such findings suggest that 5-wk RSH could enhance players’ RSA but not global IM and CM functions. Nonetheless, the decline in PImax in pre-intervention IEP alleviated significantly post intervention led to a postulation that players’ IM endurance, rather than strength, might improve with the 5-wk RSH regimen, while the possible improved IM endurance did not advance the fatigue resistance of CM.

In addition to typical motor dysfunction, Parkinson's disease is also characterized by respiratory-related dysfunction. As a means of rehabilitation, respiratory muscle strength training (RMST) has been applied to restore Parkinson’s disease (PD) functions. However, the current clinical value of RMST in the application for PD has not been widely established. This article aims to review the research progress of the application of RMST in PD rehabilitation to provide new sight into respiratory-related impairments management in people with PD.

The aim of this study was to evaluate the hypotensive effect and optimal protocol of inspiratory muscle resistance training (IMST). Randomized controlled trials using IMST to lower blood pressure (BP) were retrieved from 12 databases as of July 2022. A meta‐analysis of BP and heart rate variability (HRV) was performed and a trial sequence analysis was performed using trial sequential analysis (TSA) software. Twelve articles ( n  = 386 participants) from five countries were included, with a mean quality score of 5.83. IMST achieved significant results in reducing systolic, diastolic, and mean arterial pressure (−7.93 [−12.08, −3.78]; −3.80 [−6.08, −1.53]; −4.90 [−13.76, 3.96]). Furthermore, TSA has shown that the findings for systolic and diastolic BP are conclusive. Finally, considerable variation remained between studies when analyzing HRV. The overall hypotensive effect of IMST was demonstrated by the TSA and was well tolerated in different populations. Of these, two interventions, high resistance or low resistance combined with slow breathing, showed the best efficacy under an 8‐week exercise intervention. In addition, the process of lowering BP by modulating sympathetic vagal activity has not been further confirmed in this study. Future long‐term interventions, especially those over 3 months, are needed to observe the prolonged antihypertensive effects and modulatory mechanisms; controlling for variables such as respiratory rate and executing more rigorous studies to further explore antihypertensive options.

Background: Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disease that affects motor neurons, resulting in muscle weakness, loss of function, and ultimately death due to respiratory failure. Due to the lethal prognosis of ALS, respiratory muscle training has been proposed as a potentially beneficial intervention. Objectives: To systematically review the efficacy of respiratory muscle training on lung function and respiratory muscle strength in ALS patients. Design: A systematic review and meta-analysis of randomized controlled trials. Data sources and methods: Articles published in PubMed, PEDro, Scopus, and Web of Science databases up to July 2024. The Preferred Reporting Items for Systematic reviews and Meta-Analyses 2020 statement guideline was followed. Included studies had (1) ALS patients, (2) respiratory muscle training, (3) physical exercise, usual care or no intervention were provided as a comparison group, (4) assessments of lung function, respiratory muscle strength, quality of life, survival, fatigue, and functional capacity outcome measures, and (5) a randomized controlled trial design. Methodological quality was analyzed using the PEDro scale, and risk of bias with the Cochrane Collaboration Risk of Bias Tool. Meta-analyses were performed with Review Manager software. Results: Five randomized controlled trials with 170 participants were included. The results showed that respiratory muscle training improved muscle strength, particularly maximum expiratory and inspiratory pressures. One study suggested inspiratory muscle training as a survival predictor in ALS patients. No significant effects were observed in forced vital capacity or quality of life. No adverse effects were reported. Conclusion: Respiratory muscle training improves ventilatory function, particularly respiratory muscle strength, in people with ALS. While evidence is limited, it shows promise as an adjuvant therapy to enhance quality of life and survival. It has been registered in the PROSPERO (CRD42024568235).

The benefits of inspiratory muscle training (IMT) have been demonstrated in patients with cardiovascular diseases (CVD); however, the optimal training intensity is not yet fully clarified. The purpose of this study was to review the impact of IMT intensity on respiratory muscle strength, functional and exercise capacity, pulmonary function, and quality of life in patients with CVD. This systematic review was carried out according to PRISMA statement and registered in the PROSPERO database (review protocol: CRD42023442378). Randomized controlled trials were retrieved on 3 July 2023 in the following electronic databases: Web of Science, PubMed, EMBASE, and SCOPUS. Studies were included if they assessed the impact of isolated IMT on CVD patients in comparison with sham, different intensities and/or intervention groups. Eight studies were included for final analysis; IMT consistently led to significantly greater improvements in inspiratory muscle strength compared to control (CON) groups. The intensity of IMT varied in the studies based on different percentages of maximal inspiratory pressure (MIP), ranging from 25% to 60% of MIP. The time of intervention ranged from 4 to 12 weeks. Despite this variability, the studies collectively suggested that IMT is beneficial for enhancing CVD patients’ conditions. However, the optimal intensity range for benefits appeared to vary, and no single intensity emerged as universally superior across all studies.

: Inspiratory muscle performance plays a crucial role in athletic demands, yet its associations with anthropometric and positional variables in American football remain underexplored. This study examined relationships between inspiratory metrics and key characteristics in Division I collegiate football players. : Eighty-five Division I collegiate football players (mean academic year in school: 2.87; height: 74.3 inches; weight: 108.13 kg; BMI: 30.21) underwent the Test of Incremental Respiratory Endurance (TIRE) to measure maximal inspiratory pressure (MIP), sustained maximal inspiratory pressure (SMIP), and inspiratory duration (ID). Bivariate and multivariate analyses assessed associations with height, weight, BMI, year in school, offense/defense status, and playing position. : Inspiratory performance showed limited associations with anthropometric variables, with only a weak correlation between height and ID. (ρ = 0.243, = 0.024). No significant differences were observed by year in school or position : Inspiratory performance appears largely independent of anthropometric and positional factors; future research should explore targeted respiratory training as a hypothesis rather than a confirmed benefit.

Breathing patterns play a crucial role in shooting performance; however, little is known about the respiratory muscle strength and pulmonary capacities that control these patterns. The present study aimed to examine the relationship between shooting performance, respiratory muscle strength, and pulmonary function and to determine differences in respiratory capacities according to the shooting performance categories in police cadets. One hundred sixty-seven police cadets were recruited to assess respiratory muscle strength, pulmonary function, and shooting performance in a well-controlled environment. Measurements included maximal inspiratory pressure (MIP), maximal expiratory pressure (MEP), forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC), slow vital capacity (SVC), maximal voluntary ventilation (MVV), and pistol shooting scores. The shooting score had a moderate positive correlation with MIP (ρ = 0.33) and MEP (ρ = 0.45). FVC (ρ = 0.25), FEV1 (ρ = 0.26), SVC (ρ = 0.26) (p < 0.001) and MVV (ρ = 0.21) (p < 0.05) were slightly correlated with shooting score. There were differences between shooting performance categories in MIP, MEP, FVC, FEV1, SVC, and MVV (p < 0.001, p < 0.05). The results imply that both strong respiratory muscles and optimal pulmonary function may be one of the necessary prerequisites for superior shooting performance in police.