Consult the medical resource doctors trust

UpToDate is one of the most respected medical information resources in the world, used by over 360,000 doctors and thousands of patients to find answers to medical questions.

  • Content written by a faculty of over 4,000 physicians from leading medical institutions
  • Unbiased: free of advertising or pharmaceutical funding
  • Evidence-based treatment recommendations
  • Continuously updated to incorporate new medical findings

Related articles included with a subscription

Preview Available
(subscription required for full access)

Respiratory muscle training and resting in COPD

INTRODUCTION

The respiratory muscles constitute a vital component of the respiratory pump. Their contraction during part of the breathing cycle changes the anatomic configuration of the thorax and displaces its components, so that air moves into and out of the gas exchanging portion of the lungs [1-3]. The importance of the respiratory musculature in chronic obstructive pulmonary disease (COPD) is underscored by diaphragmatic structural changes which render patients more resistant to fatigue, including an increased quantity of slow twitch fibers and slow isomers of myosin light chains, tropomyosin, and troponins [4].

The effect of training and resting the respiratory muscles in patients with chronic obstructive pulmonary disease (COPD) will be presented here. An overview of the management of stable COPD is discussed separately. (See "Management of stable chronic obstructive pulmonary disease".)

STRENGTH AND ENDURANCE TRAINING

Leith and Bradley first demonstrated in normal individuals that the respiratory muscles, like their skeletal muscle counterparts, could be specifically trained to improve strength or endurance [5]. Multiple studies have subsequently shown that a training response will occur if there is a sufficient stimulus.

Since reduced inspiratory muscle strength is evident in patients with COPD, considerable efforts have been made to define the role of respiratory muscle training in this setting. Theoretically, an increase in inspiratory muscle strength (and perhaps endurance) could result in improved respiratory muscle function.

Strength training — Training for strength is achieved by a high intensity, short duration stimulus, such as performance of inspiratory maneuvers against a closed glottis or shutter. An increase in maximal inspiratory pressures has been demonstrated when the respiratory muscles have been specifically trained for strength [6,7]. Respiratory muscle strength has also been shown to increase as a by-product of endurance training. It is therefore possible that some of the observed benefits reported after endurance training may be related to the associated increase in strength.
To continue reading this article you need to subscribe.

Read the rest of this article and others like it

The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use (click here) ©2010 UpToDate, Inc.
References Top
  1. Roussos, C, Macklem, PT. The respiratory muscles. N Engl J Med 1982; 307:786.
  2. Rochester, DF. The diaphragm: contractile properties and fatigue. J Clin Invest 1985; 75:1397.
  3. Celli, BR. Respiratory muscle function. Clin Chest Med 1986; 7:567.
  4. Levine, S, Kaiser, L, Leferovich, J, et al. Cellular adaptations in the diaphragm in chronic obstructive pulmonary disease. N Engl J Med 1997; 337:1799.
  5. Leith, DE, Bradley, M. Ventilatory muscle strength and endurance training. J Appl Physiol 1976; 4:508.
  6. Reid, WD, Warren, CP. Ventilatory muscle strength and endurance training in elderly subjects and patients with chronic airflow limitation: a pilot study. Physiol Canada 1984; 36:305.
  7. Larson, JL, Kim, MJ, Sharp, JT. Inspiratory muscle training with a pressure threshold breathing device in patients with chronic obstructive pulmonary disease. Am Rev Respir Dis 1988; 138:689.
  8. Harver, A, Mahler, D, Daubenspeck, J. Targeted inspiratory muscle training improves respiratory muscle function and reduces dyspnea in patients with chronic obstructive pulmonary disease. Ann Intern Med 1989; 111:117.
  9. Belman, M, Shadmehr, R. Targeted resistive ventilatory muscle training in chronic obstructive pulmonary disease. J Appl Physiol 1988; 65:2726.
  10. Noseda, A, Carpiaux, J, Vandeput, N, et al. Resistive inspiratory muscle training and exercise performance in COPD patients. A comparative study with conventional breathing retraining. Bull Eur Physiopathol Respir 1987; 23:457.
  11. Weiner, P, Azgad, Y, Ganam, R. Inspiratory muscle training combined with general exercise conditioning in patients with COPD. Chest 1992; 102:1351.
  12. Belman, M, Mittman, C. Ventilatory muscle training improves exercise capacity in chronic obstructive pulmonary disease patients. Am Rev Respir Dis 1980; 121:273.
  13. Wanke, T, Formanek, D, Lahrmann, H, et al. Effects of combined inspiratory muscle and cycle ergometer training on exercise performance in patients with COPD. Eur Respir J 1994; 7:2205.
  14. Lisboa, C, Munoz, V, Beroiza, T, et al. Inspiratory muscle training in chronic airflow limitation: comparison of two different training loads with a threshold device. Eur Respir J 1994; 7:1266.
  15. Ramirez-Sarmiento, A, Orozco-Levi, M, Guell, R, et al. Inspiratory muscle training in patients with chronic obstructive pulmonary disease: structural adaptation and physiologic outcomes. Am J Respir Crit Care Med 2002; 166:1491.
  16. Hill, K, Jenkins, SC, Philippe, DL, et al. High-intensity inspiratory muscle training in COPD. Eur Respir J 2006; 27:1119.
  17. Ries, AL, Moser, KM. Comparison of isocapneic hyperventilation and walking exercise training at home in pulmonary rehabilitation. Chest 1986; 90:285.
  18. Levine, S, Weiser, P, Gillen, J. Evaluation of a ventilatory muscle endurance training program in the rehabilitation of patients with chronic obstructive pulmonary disease. Am Rev Respir Dis 1986; 133:400.
  19. Koppers, RJ, Vos, PJ, Boot, CR, Folgering, HT. Exercise Performance Improves in Patients With COPD due to Respiratory Muscle Endurance Training. Chest 2006; 129:886.
  20. Weiner, P, Magadle, R, Beckerman, M, et al. Comparison of specific expiratory, inspiratory, and combined muscle training programs in COPD. Chest 2003; 124:1357.
  21. Celli, B, Lee, H, Criner, G, et al. Controlled trial of external negative pressure ventilation in patients with severe chronic airflow limitation. Am Rev Respir Dis 1989; 140:1251.
  22. Brochard, L, Isabey, D, Piquet, J, et al. Reversal of acute exacerbations of chronic obstructive lung disease by inspiratory assistance with a face mask. N Engl J Med 1990; 323:1523.
  23. Kramer, N, Meyer, T, Meharg, J, et al. Randomized prospective trial of non-invasive positive pressure ventilation in acute respiratory failure. Am J Respir Crit Care Med 1995; 151:1799.
  24. Bott, J, Caroll, P, Conway, J, et al. Randomized controlled trial of nasal ventilation in acute ventilatory failure due to obstructive lung disease. Lancet 1993; 341:1555.
  25. Brochard, L, Wysocki, M, Lofaso, F, et al. Face mask inspiratory positive airway pressure (IPAP) for acute exacerbation of chronic respiratory insufficiency . A randomized study. Am Rev Respir Dis 1993; 147:984.
  26. Hill, NS. Noninvasive ventilation for chronic obstructive pulmonary disease. Respir Care 2004; 49:72.
  27. Zibrak, J, Hill, NS, Federman, E, et al. Evaluation of intermittent long-term negative pressure ventilation in patients with severe chronic obstructive pulmonary disease. Am Rev Respir Dis 1988; 138:1515.
  28. Shapiro, SH Ernst, P, Gray-Donald, K, et al. Effect of negative pressure ventilation in severe chronic obstructive pulmonary disease. Lancet 1992; 340:1425.
  29. Strumpf, DA, Millman, RP, Carlisle, CC, et al. Nocturnal positive-pressure ventilation via nasal mask in patients with severe chronic obstructive pulmonary disease. Am Rev Respir Dis 1991; 144:1234.
  30. Casanova, C, Celli, BR, Tost, L, et al. Long-term controlled trial of nocturnal nasal positive pressure ventilation in patients with severe COPD. Chest 2000; 118:1582.
  31. Clini, E, Sturani, C, Rossi, A, et al. The Italian multicentre study on noninvasive ventilation in chronic obstructive pulmonary disease patients. Eur Respir J 2002; 20:529.
  32. Braun, N, Marino, W. Effect of daily intermittent rest of respiratory muscles in patients with severe chronic airflow limitation. Chest 1984; 85:59.
  33. Meecham, J, Paul, E, Jones, P, Wedzicha, A. Nasal pressure support ventilation plus oxygen compared with oxygen therapy alone in hypercapnic COPD. Am J Respir Crit Care Med 1995; 152:538.
white circle LOG IN
white circle DEMO