Search Results (114)

Background/Objectives: Chronic Obstructive Pulmonary Disease (COPD) is frequently associated with dyspnea, impaired health-related quality of life (HRQoL), and cognitive dysfunction. Although pulmonary rehabilitation (PR) is considered a core therapeutic strategy, its specific effects on cognitive function, dyspnea, and dysphonia remain unclear. This systematic review aimed to evaluate the impact of PR and respiratory or cognitive-focused rehabilitative interventions on dyspnea, quality of life, cognitive performance, and voice outcomes in adults with COPD. Methods: This review was conducted in accordance with PRISMA 2020 guidelines and registered in PROSPERO (CRD420251131325). A systematic search of PubMed, Scopus and Web of Science identified studies published between 2010 and 21 August 2025. Eligible designs included randomized and non-randomized controlled studies, cohort, and mixed-method studies involving adults with COPD undergoing rehabilitative interventions targeting dyspnea, cognition, dysphonia, or swallowing. Outcomes included cognitive measures, dyspnea scales, voice parameters, and HRQoL indices. Results: Twelve studies (n ≈ 810 participants) met inclusion criteria. Most PR and exercise-based programs showed improvements in global cognition and executive functions, particularly when combined with cognitive training or high-intensity exercise modalities. Dyspnea improved consistently following short- to medium-term PR or respiratory muscle training, whereas low-frequency long-term programs yielded limited benefit. HRQoL improved across structured PR programs, especially in multidimensional interventions. Only one study assessed dysphonia, reporting transient improvements in maximum phonation time following inspiratory muscle training. No included study evaluated dysphagia-related outcomes. Conclusions: PR and respiratory muscle training can enhance cognition, dyspnea, and HRQoL in COPD, although evidence for dysphonia remains scarce and dysphagia is entirely unaddressed. Future high-quality trials should adopt standardized outcome measures, include long-term follow-up, and integrate voice and swallowing assessments within PR pathways. Full article

Background: Amateur runners may benefit from combining respiratory muscle training (RMT) with resistance or aerobic modalities, but direct comparisons are scarce. This study compared different RMT-based combinations on pulmonary function, respiratory muscle strength, and whole-body exercise capacity. Methods: In this randomized four-arm trial, 48 amateur runners were allocated equally to stand-alone RMT, RMT plus upper-limb resistance (RMT + ULRT), RMT plus lower-limb resistance (RMT + LLRT), or RMT plus aerobic exercise (RMT + AET). All groups completed supervised sessions three times per week for six weeks. Pulmonary function (forced vital capacity [FVC], forced expiratory volume in one second [FEV₁], FEV₁/FVC), respiratory muscle strength (maximal inspiratory and expiratory pressures, MIP and MEP), and cardiopulmonary exercise test indices (peak oxygen uptake [VO₂peak], VE/VCO₂ slope) were assessed before and after training using standardized spirometry, mouth-pressure measurements, and treadmill cardiopulmonary exercise testing (CPET). Pre–post changes within groups and the overall between-group differences were evaluated using standard parametric methods. Results: All four interventions were associated with improvements in at least one respiratory or cardiopulmonary domain. FVC and FEV₁ tended to improve more in the resistance-combination groups, whereas the FEV₁/FVC ratio increased with RMT alone and when combined with resistance. MIP increased in the RMT, RMT + ULRT, and RMT + LLRT groups, and MEP increased across all groups. VO₂peak rose in every group, while the VE/VCO₂ slope improved only when RMT was combined with upper- or lower-limb resistance or aerobic exercise. Between-group differences in change scores were not statistically significant and did not clearly favor any single regimen. Conclusions: In amateur runners, six weeks of RMT-based programs are feasible and associated with domain-specific improvements in lung function, respiratory muscle strength, and exercise capacity. Because between-group differences in change scores were not statistically significant and the sample size was modest, these findings should be considered exploratory and may inform hypothesis generation regarding the use of different RMT combinations in future, larger trials. Full article

Background: 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. Methods: 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. Results: Inspiratory performance showed limited associations with anthropometric variables, with only a weak correlation between height and ID. (ρ = 0.243, p = 0.024). No significant differences were observed by year in school or position Conclusions: 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. Full article

Skeletal muscle dysfunction is a major systemic manifestation of COPD that shapes symptoms, exercise tolerance and mortality. Current evidence can be integrated within a Damage–Regeneration–Remodeling framework linking mechanics and biology to clinical phenotypes. Pulmonary hyperinflation and chest wall geometry chronically load the diaphragm and other respiratory muscles in COPD, whereas inactivity and exacerbation-related disuse underload locomotor muscles. Across muscle compartments, oxidative/nitrosative stress, activation of proteolytic pathways, mitochondrial and endoplasmic reticulum stress, microvascular limitations, neuromuscular junction instability, and myosteatosis degrade muscle quality. The diaphragm adapts with a fast-to-slow fiber shift, greater oxidative capacity, and sarcomere foreshortening, improving endurance, whereas limb muscles show atrophy, a glycolytic shift, reduced oxidative enzymes, extracellular matrix accrual, and fat infiltration. Translational levers that address these mechanisms include: (I) Reduce damage: bronchodilation, lung-volume reduction, oxygen, non-invasive ventilation, early mobilization, pulmonary rehabilitation, neuromuscular stimulation, and corticosteroid stewardship; (II) Enable regeneration: progressive resistance plus high-intensity/heavy-load endurance training; adequate protein and vitamin-D intake, and endocrine correction; and (III) Steer remodeling: increase physical activity (with/without coaching/telecoaching), functional assessment and CT or MRI monitoring, inspiratory-muscle training, and phenotype-guided adjuncts in selected cases. This framework clarifies why lung deflation strategies benefit inspiratory mechanics, whereas limb recovery requires behavioral and metabolic interventions layered onto systemic optimization. Full article

Background: The high-intensity demands of CrossFit induce respiratory muscle fatigue, potentially impairing performance via the metaboreflex. Respiratory muscle training (RMT) may mitigate this effect, but evidence in female athletes remains limited. Objective: We aimed to investigate the effects of RMT on sport-specific performance and maximal inspiratory pressure (PIMAX) in recreational female CrossFit practitioners. Design: We conducted a parallel-group randomized controlled trial. Setting: The study was conducted in a CrossFit-affiliated gym. Participants: We recruited twenty-nine recreational female practitioners (age: 30.3 ± 7.9 years) with ≥1 year of uninterrupted training who were free from respiratory diseases. Interventions: Participants were randomized to a CrossFit-only group (n = 14) or CrossFit + RMT group (n = 15). Both trained 5 days/week for 6 weeks; the RMT group additionally performed 30 inspiratory efforts at 50% of PIMAX, 5 days/week, with weekly load adjustment. Main Outcome Measures: Primary: Sport-specific performance (total repetitions in a 10-min AMRAP [As Many Rounds As Possible] test). Secondary: PIMAX (cmH₂O). Measurements were taken pre- and post-intervention. Results: Baseline performance and PIMAX were similar between groups. After 6 weeks, the CrossFit + RMT group improved in performance more (Δ = +10.5 ± 10.7 reps, p = 0.03, ηp² = 0.168) than the CrossFit-only group (Δ = +2.3 ± 8.1). PIMAX gains were also greater with RMT (Δ = +19.6 ± 8.4 cmH₂O, p = 0.043, ηp² = 0.148) vs. control (Δ = +10.1 ± 9.7). No adverse events occurred. Conclusions: Adding RMT to CrossFit training enhanced sport-specific performance and inspiratory strength in recreational female practitioners more than CrossFit alone. RMT appears to be a safe and effective complementary strategy for high-intensity functional training. Full article

Chronic obstructive pulmonary disease (COPD) and chronic heart failure (CHF) are pathologies that impact mortality and morbidity worldwide. These chronic diseases have multiple causes, and they share some common clinical symptoms, such as diaphragm dysfunction (DD) and cognitive decline (CD), which, in turn, increase the mortality and morbidity rates in patients with COPD and CHF. One of the causes of CD is impaired glymphatic system function, with an accumulation of proteins and metabolites in the central nervous system. The glymphatic system is a structure that has not yet been widely considered by researchers and clinicians. Three key factors stimulate the ongoing physiological function of the glymphatic system: autonomic balance, heart rate, and, most importantly, the diaphragm. All these factors are altered in patients with COPD and CHF. This article reviews the relationship between the importance of the diaphragm, the glymphatic system, and CD, focusing on inspiratory rehabilitation training (IMT). Based on the data reported in this narrative review, we can strongly speculate that a consistent regimen of IMT in patients can improve cognitive status, reducing the cascade of symptoms that follow the diagnosis of CD. Further research is needed to understand whether targeting the glymphatic system with IMT is an effective option for helping patients delay the onset of CD. Full article

Background and Objectives: Post-menopausal estrogen decline is considered a contributing factor to sarcopenia, and inspiratory muscle training (IMT) may provide benefits in this demographic. This study examined the impact of a four-week IMT program on diaphragm thickness, abdominal wall muscle thickness (AWMT; transversus abdominis, internal oblique, and external oblique), and liver fat percentage in healthy elderly women. Materials and Methods: Twenty-six women aged 60–80 years were randomly assigned to an IMT group (n = 13) or a control group (n = 13). The IMT group used the PowerBreathe^® Classic device at 40% of maximal inspiratory pressure (MIP), with weekly increments of 10%. Training was performed twice daily, five days per week, with 30 breathing cycles per session (60 per day). The control group maintained their usual routines. AWMT, diaphragm thickness (DT), and fatty liver density (FLD) were measured by a radiologist before and after the intervention. Results: After four weeks, the IMT group showed significant improvements in all parameters compared to controls. Mid-diaphragm thickness (MDT) increased by 11.44% (effect size (ES) = 0.358, p < 0.001) versus 0.76% in controls (p = 0.271). Posterior diaphragm thickness (PDT) improved by 7.48% (ES = 0.282, p < 0.001) versus 0.38% (p = 0.564). Right AWMT increased by 12.7% (ES = 0.492, p < 0.001) compared to 0.10% (p = 0.872), and left AWMT increased by 9.93% (ES = 0.395, p < 0.001) versus 2.64% (p = 0.014). FLD improved by 11.79% (ES = 0.959, p < 0.001) in the IMT group, while the control group showed no meaningful change (−0.13%, p = 0.847). Conclusions: A short-term IMT protocol significantly enhanced diaphragm and AWMT and reduced liver fat in elderly women. These findings support the use of IMT as a simple, non-invasive intervention to preserve musculoskeletal and metabolic health in aging populations. Full article

Background/Objectives: Pulmonary embolism (PE) is a life-threatening condition that frequently results in persistent exertional dyspnea, reduced exercise tolerance, and psychological distress, even after acute-phase management. Despite growing recognition of post-PE impairments, structured early rehabilitation remains underutilized. This narrative review aims to evaluate current evidence on the role, components, and outcomes of early rehabilitation strategies following acute PE. Methods: Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology, a comprehensive literature search was conducted across PubMed, Embase, Scopus, Web of Science, Google Scholar, and the Cochrane Library. Articles published between 2020 and 2025 were screened for relevance to early rehabilitation in PE patients. Inclusion criteria prioritized randomized controlled trials, prospective studies, meta-analyses, and systematic reviews. Study quality was assessed using Cochrane, Newcastle–Ottawa, and AMSTAR 2 tools. Results: Out of 306 records, 158 studies were included. Early pulmonary rehabilitation—including aerobic and resistance exercise, inspiratory muscle training, and psychological support—demonstrated improvements in functional capacity, dyspnea, and quality of life, without adverse effects. Supplementation with omega-3 fatty acids and vitamin D may further mitigate thromboembolic risk via anti-inflammatory pathways. However, evidence remains predominantly observational, with limited high-quality data addressing timing, dosage, and patient stratification. Conclusions: Early, individualized rehabilitation appears safe and potentially beneficial in improving recovery and limiting complications after acute PE. Nonetheless, the absence of robust randomized trials underscores the urgent need for hypothesis-driven research to establish standardized, evidence-based rehabilitation protocols and guidelines tailored to risk stratification and patient phenotype, so as not to prolong recovery time and keep survivors from becoming disabled. Full article

Background: Chronic obstructive pulmonary disease (COPD) is a progressive condition leading to declining lung function, dyspnea, and reduced quality of life. Pulmonary rehabilitation (PR) remains a cornerstone in COPD management; however, access remains limited, with less than 3% of eligible patients participating. Inspiratory muscle training (IMT), especially through novel methods like the Test of Incremental Respiratory Endurance (TIRE), offers a potential home-based alternative to traditional rehabilitation services. Despite growing interest, a key knowledge gap persists: few randomized trials have directly compared TIRE with threshold loading IMT over extended, largely unsupervised home-based periods while concurrently evaluating inspiratory muscle endurance and adherence. This randomized controlled trial aimed to evaluate the long-term efficacy of TIRE IMT compared to traditional threshold IMT and sham training in COPD patients. The study also assessed adherence to these home-based interventions, focusing on unsupervised periods without additional motivational support. Methods: A total of 52 COPD patients were randomly assigned to one of three groups: TIRE IMT, Threshold IMT, or Sham IMT. The study consisted of an 8-week supervised Phase I followed by a 24-week unsupervised Phase II. Training details: TIRE—session template set to 50% of the day’s maximal sustained effort; 6 levels × 6 inspirations (total 36) with preset inter-breath recoveries decreasing from 60 s to 10 s. Threshold IMT—spring-loaded valve set to 50% MIP (re-set at week 4); 36 inspirations completed within ≤30 min. Sham—valve set to minimal resistance (9 cmH₂O); 36 inspirations within ≤30 min. Primary outcomes included changes in maximal inspiratory pressure (MIP) and sustained maximal inspiratory pressure. Secondary outcomes focused on adherence rates and correlations with functional capacity. Results: Of the 52 participants, 36 completed the study. Participant details: TIRE n = 12 (mean age 60.9 ± 12.9 years), Threshold n = 12 (67.4 ± 6.9 years), Sham n = 12 (67.3 ± 8.7 years); overall 21/36 (58%) men; mean BMI 30.0 ± 7.5 kg/m². The TIRE IMT group demonstrated significantly greater improvements in MIP (31.7%) and SMIP compared to both the Threshold and Sham groups at 24 weeks (p < 0.05). Despite a decline in adherence during the unsupervised phase, the TIRE group maintained superior outcomes. No adverse events were reported during the intervention period. Conclusions: In this randomized trial, TIRE IMT was associated with greater improvements in inspiratory muscle performance than threshold and sham IMT. While adherence was higher in the TIRE group, it declined during the unsupervised phase. The clinical interpretation of these findings should consider the relatively wide confidence intervals and modest sample size. Nevertheless, the mean change in MIP in the TIRE arm exceeded a recently proposed minimal important difference for COPD, suggesting potential clinical relevance; however, no universally accepted minimal important difference exists yet for SMIP. Further adequately powered trials are warranted. Full article

Background: Living donor liver transplantation (LDLT) poses significant physiological challenges, especially during early postoperative recovery. While the long-term benefits of structured rehabilitation are well documented, data on short-term effects—particularly during the critical early inpatient phase—remain limited. This study aimed to evaluate the short-term impact of a structured exercise program on cardiopulmonary function, respiratory muscle strength, physical performance, oxidative stress markers, and quality of life in LDLT recipients. Methods: Four LDLT recipients (2 males, 2 females; mean age 48.00 ± 18.35 years) underwent a 4-week inpatient rehabilitation protocol. Weeks 1–2 involved conventional care, while weeks 3–4 included structured exercise consisting of early mobilization and inspiratory muscle training. Outcome measures included cardiopulmonary exercise testing (CPET), spirometry, maximal inspiratory and expiratory pressures (PImax, PEmax), 6 min walk distance (6MWD), lower limb muscle strength, Chronic Liver Disease Questionnaire (CLDQ), and serum oxidative stress markers (total antioxidant capacity [TAC] and malondialdehyde [MDA]). Results: All patients demonstrated postoperative declines in VO₂ peak, PImax, PEmax, and TAC. Structured exercise yielded clinically meaningful improvements in respiratory muscle strength, notably in female and younger participants. Two younger patients showed increased 6MWD; however, no patient regained preoperative VO₂ peak. TAC levels decreased following the intervention, and MDA levels remained stable in most cases. Conclusions: A two-week structured exercise program during early postoperative recovery may provide partial benefits in respiratory muscle strength and physical performance but is insufficient to restore full cardiopulmonary function in LDLT recipients. Longer rehabilitation periods may be necessary to achieve preoperative recovery levels. Full article

Background: Chronic heart failure (HF) is a systemic condition in which the heart is unable to meet the body’s peripheral demands, leading to both acute and chronic functional decline, accompanied by high morbidity and mortality rates. A non-pharmacological, non-surgical standard approach to managing HF is cardiovascular rehabilitation, which is widely endorsed by international cardiology societies. This typically includes aerobic and anaerobic physical activity involving the peripheral skeletal muscles. However, international guidelines often overlook the clinical significance of the diaphragm and the role of inspiratory muscle training (IMT) in rehabilitation. The diaphragm plays a critical role not only in respiratory and cardiac function but also in supporting limb movements and overall physical performance. In patients with HF, diaphragmatic dysfunction contributes significantly to the symptoms they experience. Conclusions: This review highlights the need for a greater emphasis on incorporating IMT into the standard rehabilitation protocols for patients with HF, given its potential to improve both respiratory function and overall physical capacity. Full article

Objective: To investigate the effect of an 8-week inspiratory muscle training (IMT) intervention on respiratory muscle strength and cardiovascular autonomic regulation in obese young men. Methods: The study included 36 obese young men who met the inclusion and exclusion criteria. Participants were randomly divided into two groups: the IG (inspiratory muscle training group, n = 17), which underwent high-intensity IMT intervention for 8 weeks, 5 times a week, and the CG (control group, n = 18), which was not given any additional intervention. Assessed parameters included maximum inspiratory pressure (MIP), maximum expiratory pressure (MEP), systolic blood pressure (SBP), diastolic blood pressure (DBP), and heart rate (HR), as well as heart rate variability metrics such as the standard deviation of normal-to-normal intervals (SDNN), root mean square of successive differences (RMSSD), standard deviation of successive differences (SDSD), low-frequency power component (LF), high-frequency power component (HF), and LF/HF ratio. These measurements were taken both at baseline and following the completion of the 8-week intervention period. Results: After 8 weeks of IMT, the MIP and MEP of the IG increased by 31.8% and 26.5%, respectively (p < 0.01). In addition, SBP, DBP, and HR decreased by 2.2%, 3.2%, and 2.1%, respectively (p < 0.01). In the HRV time domain, SDNN and RMSSD increased by 54.1% and 33.5%, respectively (p < 0.01), and there was no significant improvement in SDSD (p > 0.05); in the HRV frequency domain, LF decreased by 40.5%, HF increased by 59.4% (p < 0.01), and the LF/HF ratio decreased by 58.2% (p < 0.05). Conclusion: An 8-week 80%MIP IMT intervention significantly improves respiratory muscle strength and cardiovascular autonomic regulation in obese young men, suggesting that IMT is a promising non-pharmacological strategy for mitigating obesity-related cardiovascular risk. Full article

Respiratory muscle training (RMT) has been proposed as a supportive strategy for adults receiving invasive mechanical ventilation; however, the way RMT is prescribed—mode, intensity, frequency, and volume—remains highly heterogeneous. Objectives: This study aimed to describe the current evidence regarding the prescription of respiratory muscle strengthening in terms of frequency, intensity, method, and volume in adult patients under mechanical ventilation in intensive care units. Methods: A scoping review was conducted following the PRISMA-ScR guidelines based on searches in electronic databases including Scopus, SciELO, ScienceDirect, PubMed, LILACS, Springer, Web of Science, Google Scholar, PEDro, Dialnet, and Cochrane. Results: Seven studies met the established inclusion criteria and described prescription protocols for respiratory muscle strengthening in adult patients under mechanical ventilation in intensive care units. Conclusions: The most frequently reported protocol involved threshold load training at 40–50% of maximal inspiratory pressure, administered twice daily, every day of the week, with a volume of 30 repetitions. This intervention showed promising results in improving inspiratory muscle strength, with potential additional benefits in weaning success and pulmonary function. Full article

Background: Cystic fibrosis (CF) is a chronic genetic disease marked by progressive lung function decline and increased respiratory infections. Emerging evidence supports the role of physical exercise in improving lung function, aerobic capacity, and quality of life in pediatric CF patients. Methods: We reviewed randomized clinical trials and observational studies from the last ten years, sourced from PubMed and Google Scholar. Included studies involved children and adolescents (0–18 years) with CF and assessed physical exercise as a primary intervention to improve lung function, aerobic fitness, quality of life, or hospitalization rates. Results: Aerobic training, particularly when combined with strength training, improves cardiorespiratory fitness and muscle strength without compromising nutritional status. High-Intensity Interval Training and Inspiratory Muscle Training show potential but need further validation. Supervised, personalized exercise programs are key to promoting adherence and optimizing outcomes. Conclusions: Exercise-based interventions in pediatric CF should evolve toward personalized, technology-enhanced, and sustainable models. Integrating wearable devices, adapting programs to individual needs, and leveraging early parental involvement may enhance engagement and outcomes, especially in the era of CFTR modulator therapies. Full article

Aim: This study aimed to evaluate the effects of inspiratory muscle training on inspiratory muscle strength and cardiorespiratory performance in patients undergoing open heart surgery. Method: This study was conducted as a randomized controlled trial with two groups. Fifty-eight patients who underwent open heart surgery were randomly assigned to either the intervention group or the control group 29 in the control group and 29 in the intervention group. Patients in the intervention group participated in a physical therapy program combined with inspiratory muscle training using the Thammasat University (TU) Breath Trainer. Patients in the control group received only the standard physical therapy program. The maximum inspiratory pressure, maximum expiratory pressure and 6 min walk test distance were assessed both before surgery and prior to hospital discharge. Results: The intervention group had a significant increase in maximum inspiratory pressure (p < 0.001), maximum expiratory pressure (p < 0.001) and 6 min walk test distance (p = 0.013). The control group had a significant decrease in maximum inspiratory pressure (p < 0.001), maximum expiratory pressure (p = 0.002) and 6 min walk test distance (p < 0.001). Conclusions: Inspiratory muscle training can be performed using maximum pressure resistors, such as the TU-Breath Trainer device. This training has been shown to effectively improve inspiratory muscle strength and cardiorespiratory performance in patients undergoing open heart surgery, as well as reduce pulmonary complications and shorten the length of hospital stay. Full article