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Does Respiratory Muscle Training Improve Performance in High Level Athletes? Buna, Teryn; Coelho, Jonathan; Freedman, Kyle; Morton, Trevor; Palmer, Sheree; Toy, Melissa; Walsh, Cody 2010-07-31

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  Does respiratory muscle training improve performance in high level athletes?A Systematic Review and Meta-AnalysisRSPT 572Supervisor: Dr. Darlene Reid Teryn Buna, Jonathan Coelho, Kyle Freedman, Trevor Morton, Sheree Palmer, Melissa Toy, Cody WalshOutlineBackgroundObjectiveMethodsResultsDiscussion ConclusionsImplications  & Future DirectionsBackgroundOverviewCompetition drives top athletes to seek new ways to gain an edgeTop athletes thought to have plateaued their ability to improve:Muscular function							 PerformanceCardiovascular function   The role of inspiratory muscles (IM) have recently become a point of consideration in exercise performance research Respiratory System and Exercise PerformanceTraditionalUntrained, healthy respiratory system not a performance limiting factor 1, 3, 4Supported by no change in VO2max and lactate thresholds following IMT 2, 3Focus on O2 transport chainCurrentSystemic physiological changes secondary to inspiratory muscle fatigue (IMF)Respiratory System and Exercise PerformanceIMF occurs 2° to demands of work of breathing in 3-12Marathon running		RowingTriathlon			CyclingSwimming  Respiratory System and Exercise PerformanceIMF effect on performanceRating of perceived breathlessness (RPB) 3Rating of perceived effort (RPE) 15,16Metaboreflex phenomenon Redirection of blood flow from the periphery to fatiguing IM 13,14Can inspiratory muscle training (IMT) have an impact on performance?IMT and PerformanceDebate exists whether IMT can positively contribute to performance 3 areas of inconsistency:  Reliable and valid methods for measuring ‘performance’Variety of IMT protocols and training modalitiesTypes of athletic performance and level of competitionTlim vs. TTTime to limit of volitional exhaustion (Tlim) Time Trial(TT)Ability to detect small changes in performance ✔✖Constant testing environments✔✖Ability to mimic competition ✖✔ReliabilityPoor−Valid−✔3,15,25,31,32Other study measuresEffects:Measured by:1. Ergogenic properties on performance Primary performance outcomes     Time to limit of volitional exhaustion (Tlim)      Time Trial (TT) Secondary performance outcomes     RPB     RPE     VO2max     Lactate threshold2. Changes IM function PImax = IM strength MVV = IM enduranceIMT ProtocolsTypes of IMT modalities 25Voluntary Normocapnic Hyperpnea (VNH)Flow Resistive Loading (FRL) Pressure Threshold Loading (PTL)Type of IMT protocol chosen based on 25Type of adaptations desired Factors related to time, cost and ease of useNo current gold standardAthletic PopulationsStudies have examined four main types of athletesCyclists, rowers and running athletes may  TT with IMT 9,27,30Swimming may not be as sensitive to IMT 1Lack of consistent results between and within athletic disciplines IMT LiteratureOther literature on IMTSystematic Reviews of COPD and Cystic Fibrosis 45,47Favourable resultsIMT as an effective adjunct to general exercise3 narrative reviews of IMT in healthy and athletic populations 3,15,25 No systematic or statistical analysis Identified a need in the literature for a systematic review of IMT and performance in high level athletesObjectiveObjectiveTo conduct a thorough evaluation of the literature and attempt to answer the following questions pertaining to high level athletes: Primary ObjectiveDoes IMT improve performance ?Secondary ObjectivesDoes IMT improve IM function ?Which type of athletes or sports benefit most from IMT? MethodsPICO       PHealthy, high level athletes aged 18-40        IInspiratory muscle training: Voluntary Normocapnic Hyperpnea (VNH), Flow Resistive Loading (FRL), Pressure Threshold Loading (PTL)    CControl, sham    OPhysical performance: Tlim, TT, VO2max, Pulmonary function: PImax, MVV, FEV1Physiological measures: Lactate, RPE, RPBOperational DefinitionsInspiratory Muscle Training (IMT): an intervention that used either a VNH, FRL or PTL Healthy: fully able-bodied humans, non-injured and without chronic diseaseHigh level: an athlete competing at a varsity, national, international or professional level, OR has a VO2max level designated by Wilmore and Costill, 2005 VO2 max Search StrategySearch StrategyFollowing procedures performed by 2 independent reviewersArticle screeningTitle and abstract screeningScreening tool Inclusion/exclusion criteriaQuality assessmentPEDro scale + Oxford Level of Evidence + van TulderData abstraction Third party reviewer was used when requiredStudy InclusionArticles were included if: (1) Participants were high level, healthy athletes (mean age of 18-40 years) (2) Compared IMT to another comparison group(3) An RCT or crossover study design(4) Includes measures of respiratory muscle adaptation with reliable and valid outcome measures(5) EnglishIncluded Studies14 articles Note: Romer et al, 2002A and Romer et al, 2002B same study data SportsCyclingEndurance runningIntermittent sprint: Soccer, Rugby, Field Hockey, BasketballRowingSwimmingQuality AssessmentMeta-AnalysisRevMan 5.0.24 for meta-analyses48Randomized effects model: Does not assume a common treatment effect existsAllows for variation by assuming that effects follow a distribution across all studiesStandardized mean differences: Summary statistic when the studies assess the same outcome but measure it in variety of waysUsed to standardize to a uniform scale Express the size of the intervention effect relative to the variability observed Equivalent of ‘effect size’ in social science studies				Meta-AnalysisRevMan 5.0.24 48Heterogeneity: The extent to which the results of studies are consistentI2: assesses whether observed differences in results are compatible with chance aloneP <0.1 was considered significant for heterogeneity Meta-AnalysisAnalysis done on primary and secondary outcomesSport based sub-group analysis was performedCyclingEndurance RunningIntermittent Sprint (Soccer, Rugby, Field Hockey, Basketball)Rowing	SwimmingResultsPrimary Outcomes# studiesZ= / P = I2 = / P= Overall performance9Z = 3.55 P= <0.001 I2=24% P=0.23 Swimmers1Z = 0.61 P= 0.54 n/aIntermittent Sprint Sports3Z = 2.95 P= 0.003 I2= 0% P=0.61 Cyclists1Z =2.41 P= 0.02 n/aRowers3Z = 1.29 P= 0.20 I2=63% P=0.07 Endurance Runners1Z = 0.36 P= 0.72 n/aPrimary Outcomes# studiesZ= / P = I2 = / P= Overall performance9Z = 3.55 P= <0.001 I2=24% P=0.23 Swimmers1Z = 0.61 P= 0.54 n/aIntermittent Sprint Sports3Z = 2.95 P= 0.003 I2= 0% P=0.61 Cyclists1Z =2.41 P= 0.02 n/aRowers3Z = 1.29 P= 0.20 I2=63% P=0.07 Endurance Runners1Z = 0.36 P= 0.72 n/aSwimmingIntermittent Sprint SportsCyclingSpecial ForcesRowingOverall PerformanceFavours IMTFavours control/shamFigure 1: Meta-analysis results comparing targeted or threshold resistive IMT versus sham or control in whole body athletic performanceSecondary Outcomes# studies    /14Z= / P = I2 = / P=Lactate5 (3)Z= 0.50 P = 0.62 I² = 56% P = 0.04RPE3 (1)Z=1.58 P= 0.12 I2 = 0% P =0.39 RPB7 (1)Z=2.54 P=0.01I²=0% P=0.86VO2 max7 (1)Z= 1.01 P= 0.31I²=0% P= 0.31FEV19 (0)Z=0.53 P=0.59 I2 =0% P=0.97 MVV5(0)Z = 2.84 P=0.005 I2 = 0% P=0.45 Pimax- Resting12 (0)Z=4.34 P<0.001 I2 = 81% P< 0.001 - Post Performance4 (0)Z=12.57 P<0.001I2 = 73% P= 0.01 (#)  = the number of studies that mentioned the outcome but did not provide numerical dataSecondary Outcomes# studiesZ= / P = I2 = / P=Lactate5 (3)Z= 0.50 P = 0.62 I² = 56% P = 0.04RPE3 (1)Z=1.58 P= 0.12 I2 = 0% P =0.39 RPB7 (1)Z=2.54 P=0.01I²=0% P=0.86VO2 max7 (1)Z= 1.01 P= 0.31I²=0% P= 0.31FEV19 (0)Z=0.53 P=0.59 I2 =0% P=0.97 MVV5(0)Z = 2.84 P=0.005 I2 = 0% P=0.45 Pimax- Resting12 (0)Z=4.34 P<0.001 I2 = 81% P< 0.001 - Post Performance4 (0)Z=12.57 P<0.001I2 = 73% P= 0.01 DiscussionSummary of FindingsPrimary Outcome:Overall = Meta- analysis found that IMT does have an ergogenic effect on performanceSport based sub-group analysis revealed….Not all sports are equal!Intermittent sprint sports and cycling benefited from IMT performanceSwimming, rowing and endurance running were not found to benefitDiscussionSignificance of Primary OutcomesIMT could be used as an adjunct to regular training to enhance performance in high-level athletesOnly in certain sports disciplinesDiscussionSecondary OutcomesImprovements in PImax and MVV across all studiesImprovements in RPB across all studiesSignificanceHighly trained athletes are able to improve their IM functionAll protocols effective in eliciting training effectAttenuation of dyspnea is supported as a response to improvements in IM function DiscussionImprovement in performance with cycling and intermittent sprint sportsCorrelated withPImax and MVV Reduction in RPBDiscussionWhy does this not translate to rowing, swimming and endurance running performances?Rowing 9,52Dual function of IM = stabilization of the thorax + ventilation“Entrained” breathingDifferent ventilatory mechanics and IM physiological demands? Negate or confound IMT related improvements? DiscussionWhy does this not translate to rowing, swimming and endurance running performances?Swimming 3,33,50Respond with smaller  in PImax following IMT interventionsIM trained by water submersionSwimmer IM already near function plateauUnable to gain performance effects from IMTDiscussionWhy does this not translate to rowing, swimming and endurance running performances?Endurance Runners 51German Special Forces = Not elite athletes within a specific sporting discipline‘Generalist’ characteristics + non-specific performance testDiscussionWhy does this not translate to rowing, swimming and endurance running performances?Individual characteristicsEach athlete limited by different physiologic or psychologic factorsSome may be more limited by IM function than othersMix of responders and non-responders within a small sample could affect the effect sizeDiscussionIndividual characteristicsHighlights the need to consider the unique characteristics of each athlete prior to choosing a training interventionDiscussionOther secondary measuresFEV1VO2 maxBlood lactateRPEConsistent with the literatureFEV1 limited by airway diameter not IM strengthVO2 max does not respond to IMTBlood lactate postulated to decreaseMore recent studies have failed to support this argumentDiscussionLack of positive RPE findings contrasts current literatureData analyzed on end of test measuresRPE  post IMT for similar workouts during incremental testingFuture studies should examine exercise performance measures during fixed workload tasks vs. end-points of exercise performanceLimitationsSmall number of studies with sample sizesDefinition of “high-level” athletesData abstracted graphs via hand and ruler measurementsMcMahon (2002) removed from the analysis Data could not be reliably extracted from the graphAttempts to contact the author failedConclusionConclusionIMT improves performance in intermittent sprint and cycling NOT rowing, swimming or endurance runningWhere IM serve a dual function (rowing) or already stimulated with regular training (swimming) may not benefit vs. sports in which the sole function of the RM is ventilationHigh level athletes able to  IM function with IMTCan translate into performance improvementsLimited strength of claimImplicationsConsider IMT as a possible adjunct to regular athletic trainingIt is cheap and time effectiveMust consider the individual characteristicsMust consider type of athletic performanceFuture DirectionCall for more, higher quality studiesStudies should examine:Most effective IMT protocolsSpecific sportApply IMT in a non-research/field setting with a team/athletic group to determine feasibility and adherenceAcknowledgementsTHANK YOU!Dr. Darlene ReidMarc RoigDr. Bill SheelDr. Allison McConnellCharlotte BeckDean GuistiniDr. Theresa Lui-AmbroseDr. Lara BoydReferences1. Mickleborough TD, Stager JM, Chatham K, Lindley MR, Ionescu AA. Pulmonary adaptations to swim and inspiratory muscle training. Eur J Appl Physiol. 2008 Aug;103(6):635-46. 2. Edwards AM, Walker RE. Inspiratory muscle muscle training upon recovery time during high intensity, repetitive sprint activity. Int J Sports Med. 2002;23:353-60. 3. McConnell AK. Respiratory muscle training as an ergogenic aid. Journal of Exercise Science & Fitness. 2009;7(2):S18-S27. 4. Dempsey J, Gledhill N, Reddan W, Forster H, Hanson P, Claremont A. Pulmonary adaptation to exercise: Effects of exercise type and duration, chronic hypoxia and physical training. Ann N Y Acad Sci. 1977;301(1 The Marathon: Physiological, Medical, Epidemiological, and Psychological Studies):243-61. 5. Johnson B, Babcock M, Suman O, Dempsey J. Exercise-induced diaphragmatic fatigue in healthy humans. J Physiol (Lond ). 1993;460(1):385-405. 6. Mador MJ, Magalang UJ, Rodis A, Kufel TJ. Diaphragmatic fatigue after exercise in healthy human subjects. Am Rev Respir Dis. 1993 Dec;148(6 Pt 1):1571-5. 7. McConnell AK, Caine MP, Sharpe GR. Inspiratory muscle fatigue following running to volitional fatigue: The influence of baseline strength. Int J Sports Med. 1997;18(3):169-73. 8. Griffiths LA, McConnell AK. The influence of inspiratory and expiratory muscle training upon rowing performance. Eur J Appl Physiol. 2007 Mar;99(5):457-66. 9. Volianitis S, McConnell AK, Koutedakis Y, McNaughton L, Backx K, Jones DA. Inspiratory muscle training improves rowing performance. Med Sci Sports Exerc. 2001 05;33(5):803-9. 10. Romer LM, McConnell AK, Jones DA. Effects of inspiratory References11. Lomax ME, McConnell AK. Inspiratory muscle fatigue in swimmers after a single 200 m swim. J Sports Sci. 2003 08;21(8):659-64. 12. 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. European Respiratory Journal. 2007 Sep;30(3):479-86. 13. Legrand R, Marles A, Prieur F, Lazzari S, Blondel N, Mucci P. Related trends in locomotor and respiratory muscle oxygenation during exercise. Medicine & Science in Sports & Exercise. 2007 Jan;39(1):91-100. 14. Harms CA, Wetter TJ, McClaran SR, Pegelow DF, Nickele GA, Nelson WB, et al. Effects of respiratory muscle work on cardiac output and its distribution during maximal exercise. J Appl Physiol. 1998;85(2):609-18. 15. Sheel AW. Respiratory muscle training in healthy individuals: Physiological rationale and implications for exercise performance. Sports Med. 2002;32:567-81. 16. Romer LM, McConnell AK. Specificity and reversibility of inspiratory muscle training. Med Sci Sports Exerc. 2003 02;35(2):237-44. 17. Williams JS, Wongsathikun J, Boon SM, Acevedo EO. Inspiratory muscle training fails to improve endurance capacity in athletes. Med Sci Sports Exerc. 2002 07;34(7):1194-8. 18. Markov G, Spengler CM, Knopfli-Lenzin C, Stuessi C, Boutellier U. Respiratory muscle training increases cycling endurance without affecting cardiovascular responses to exercise. Eur J Appl Physiol. 2001 Aug;85(3-4):233-9. 19. McMahon ME, Boutellier U, Smith RM, Spengler CM. Hyperpnea training attenuates peripheral chemosensitivity and improves cycling endurance. J Exp Biol. 2002 Dec;205(Pt 24):3937-43. 20. Stuessi C, Spengler CM, Knopfli-Lenzin C, Markov G, Boutellier U. Respiratory muscle endurance training in humans increases cycling endurance without affecting blood gas concentrations. Eur J Appl Physiol. 2001 Jun;84(6):582-6. References21. Spengler CM, Roos M, Laube SM, Boutellier U. Decreased exercise blood lactate concentrations after respiratory endurance training in humans. Eur J Appl Physiol Occup Physiol. 1999 03;79(4):299-305. 22. Boutellier U, Buchel R, Kundert A, Spengler C. The respiratory system as an exercise limiting factor in normal trained subjects. Eur J Appl Physiol Occup Physiol. 1992;65:347-53. 23. Boutellier U. Respiratory muscle fitness and exercise endurance in healthy humans. Med Sci Sports Exerc. 1998 July;30(7):1169-72. 24. Inbar O, Weiner P, Azgad Y, Rotstein A, Weinstein Y. Specific inspiratory muscle training in well-trained endurance athletes. Med Sci Sports Exerc. 2000 Jul;32(7):1233-7. 25. McConnell AK, Romer LM. Respiratory muscle training in healthy humans: Resolving the controversy. Int J Sports Med. 2004 May;25(4):284-93. 26. Gething AD, Williams M, Davies B. Inspiratory resistive loading improves cycling capacity: A placebo controlled trial. Br J Sports Med. 2004 12;38(6):730-6. 27. Romer LM, McConnell AK, Jones DA. Effects of inspiratory muscle training on time-trial performance in trained cyclists. J Sports Sci. 2002 Jul;20(7):547-62. 28. Romer LM, McConnell AK, Jones DA. Inspiratory muscle fatigue in trained cyclists: Effects of inspiratory muscle training. Medicine & Science in Sports & Exercise. 2002 May;34(5):785-92. 29. Nicks CR, Morgan DW, Fuller DK, Caputo JL. The influence of respiratory muscle training upon intermittent exercise performance. Int J Sports Med. 2009 Jan;30(1):16-21. 30. Leddy JJ, Limprasertkul A, Patel S, Modlich F, Buyea C, Pendergast DR, et al. Isocapnic hyperpnea training improves performance in competitive male runners. Eur J Appl Physiol. 2007 APR;99(6):665-76. References31. Jeukendrup A, Saris WH, Brouns F, Kester AD. A new validated endurance performance test. Med Sci Sports Exerc. 1996 Feb;28(2):266-70. 32. Hopkins WG, Hawley JA, Burke LM. Design and analysis of research on sport performance enhancement. Med Sci Sports Exerc. 1999 Mar;31(3):472-85. 33. Clanton TL, Dixon GF, Drake J, Gadek JE. Effects of swim training on lung volumes and inspiratory muscle conditioning. J Appl Physiol. 1987 January 1;62(1):39-46. 34. Ray AD, Pendergast DR, Lundgren CE. Respiratory muscle training improves swimming endurance at depth. Undersea Hyperb Med. 2008 May-Jun;35(3):185-96. 35. 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 Aug;94(5-6):527-40. 36. Holm P, Sattler A, Fregosi RF. Endurance training of respiratory muscles improves cycling performance in fit young cyclists. BMC Physiology. 2004 May 6;4:9. 37. Guenette JA, Vogiatzis L, Zakynthinos S, Athanasopoulos D, Koskolou M, Golemati S, et al. Human respiratory muscle blood flow measured by near-infrared spectroscopy and indocyanine green. J Appl Physiol. 2008 04;104(4):1202-10. 38. Smith TBRJ, Hopkins WG, Taylor NAS. Respiratory responses of elite oarsmen, former oarsmen, and highly trained non-rowers during rowing, cycling and running. European Journal of Applied Physiology & Occupational Physiology. 1994 07;69(1):44-9. References39. Klusiewicz A, Borkowski L, Zdanowicz R, Boros P, Wesolowski S. The inspiratory muscle training in elite rowers. J Sports Med Phys Fitness. 2008 Sep;48(3):279-84. 40. Riganas CS, Vrabas IS, Christoulas K, Mandroukas K. Specific inspiratory muscle training does not improve performance or VO2max levels in well trained rowers. J Sports Med Phys Fitness. 2008 09;48(3):285-92. 41. Amonette WE, Dupler TL. The effects of respiratory muscle training on VO2max, the ventilatory threshold and pulmonary function. Journal of Exercise Physiology Online. 2002 05;5(2). 42. Watsford M, Spurrs R. The relationship between respiratory muscle strength and running performance in elite australian rules athletes. Journal of Science & Medicine in Sport. 2005;8(4):122-. 43. Tong TK, Fu FH, Chung PK, Eston R, Lu K, Quach B, et al. The effect of inspiratory muscle training on high-intensity, intermittent running performance to exhaustion. Appl Physiol Nutr Metab. 2008 Aug;33(4):671-81. 44. Edwards AM, Wells C, Butterly R. Concurrent inspiratory muscle and cardiovascular training differentially improves both perceptions of effort and 5000 m running performance compared with cardiovascular training alone. Br J Sports Med. 2008 10;42(10):523-7. 45. Geddes EL, O'Brien K, Brooks D, Reid WD, Crowe J. Does aerobic exercise training improve inspiratory muscle function in individuals with chronic obstructive pulmonary disease? A systematic review. CARDIOPULM PHYS THER J. 2007 12;18(4):3-13. . References46. O'Brien K, Geddes EL, Reid WD, Brooks D, Crowe J. Inspiratory muscle training compared with other rehabilitation interventions in chronic obstructive pulmonary disease: A systematic review update. Journal of Cardiopulmonary Rehabilitation & Prevention. 2008 Mar-Apr;28(2):128-41. 47. Reid WD, Geddes EL, O'Brien K, Brooks D, Crowe J. Effects of inspiratory muscle training in cystic fibrosis: A systematic review. Clin Rehabil. 2008 Oct-Nov;22(10-11):1003-13. 48. Cochrane handbook for systematic reviews of interventions version 5.0.2 [homepage on the Internet]. The Cochrane Collaboration. 2009 September 2009. Available from: www.cochrane-handbook.org49. Wilmore J.H. CDL. Physiology of sport and exercise. Champaign, IL: Human Kinetics Publishers; 2005. 50. Kilding AE, Brown S, McConnell AK. Inspiratory muscle training improves 100 and 200 m swimming performance. Eur J Appl Physiol. 2010 Feb;108(3):505-11. 51. Sperlich B, Fricke H, de Marees M, Linville JW, Mester J. Does respiratory muscle training increase physical performance? Mil Med. 2009 Sep;174(9):977-82. 52. Steinacker JM, Both M, Whipp BJ. Pulmonary mechanics and entrainment of respiration and stroke rate during rowing. Int J Sports Med. 1993 09;14:S15-s19. 53. McKardle W., Katch F., Katch V. Exercise physiology: Energy, nutrition, & human performance. 6th edition ed. United States: Lippincott Williams & Wilkins; 2007. 54. McConnell AK, Sharpe GR. The effect of inspiratory muscle training upon maximum lactate steady-state and blood lactate concentration. Eur J Appl Physiol. 2005 Jun;94(3):277-84. Questions?  Does respiratory muscle training improve performance in high level athletes? A Systematic Review and Meta-Analysis  RSPT 572 Supervisor: Dr. Darlene Reid Teryn Buna, Jonathan Coelho, Kyle Freedman, Trevor Morton, Sheree Palmer, Melissa Toy, Cody Walsh  Outline  Background  Objective  Methods  Results  Discussion  Conclusions  Implications & Future Directions  Background  Overview  Competition drives top athletes to seek new ways to gain  an edge   Top athletes thought to have plateaued their ability to  improve:   Muscular function   Performance  Cardiovascular function   The role of inspiratory muscles (IM) have recently become  a point of consideration in exercise performance research  Respiratory System and Exercise Performance  Traditional  Untrained, healthy respiratory system not a performance  limiting factor 1, 3, 4  Supported by no change in VO2max and lactate thresholds following IMT 2, 3  Focus on O2 transport chain   Current  Systemic physiological changes secondary to inspiratory  muscle fatigue (IMF)  Respiratory System and Exercise Performance  IMF occurs 2° to demands of work of breathing in 3-12  Marathon running  Rowing  Triathlon  Cycling  Swimming  Respiratory System and Exercise Performance  IMF effect on performance  Rating of perceived breathlessness (RPB) 3  Rating of perceived effort (RPE) 15,16  Metaboreflex phenomenon  Redirection of blood flow from the periphery to fatiguing IM 13,14   Can inspiratory muscle training (IMT) have an impact on  performance?  IMT and Performance  Debate exists whether IMT can positively contribute to  performance  3 areas of inconsistency: 1.  Reliable and valid methods for measuring ‘performance’  2.  Variety of IMT protocols and training modalities  3.  Types of athletic performance and level of competition  Tlim vs. TT Time to limit of volitional exhaustion (Tlim)  Time Trial (TT)  Ability to detect small changes in performance  ✔  ✔  Constant testing environments  ✔  ✔  Ability to mimic competition  c  ✔  Poor  −  −  ✔  Reliability Valid  3,15,25,31,  Other study measures Effects:  Measured by:  1. Ergogenic properties on performance  Primary performance outcomes • Time to limit of volitional exhaustion (Tlim) • Time Trial (TT) Secondary performance outcomes • RPB • RPE VO2max • • Lactate threshold  2. Changes IM function  • PImax = IM strength • MVV = IM endurance  IMT Protocols  Types of IMT modalities 25  Voluntary Normocapnic Hyperpnea (VNH)  Flow Resistive Loading (FRL)  Pressure Threshold Loading (PTL)   Type of IMT protocol chosen based on 25  Type of adaptations desired  Factors related to time, cost and ease of use  No current gold standard  Athletic Populations  Studies have examined four main types of athletes  Cyclists, rowers and running athletes may  TT with IMT 9,27,30   Swimming may not be as sensitive to IMT 1  Lack of consistent results between and within athletic disciplines  IMT Literature  Other literature on IMT  Systematic Reviews of COPD and Cystic Fibrosis 45,47  Favourable results  IMT as an effective adjunct to general exercise   3 narrative reviews of IMT in healthy and athletic  populations 3,15,25  No systematic or statistical analysis  Identified a need in the literature for a systematic review of IMT and performance in high level athletes  Objective  Objective To conduct a thorough evaluation of the literature and attempt to answer the following questions pertaining to high level athletes:  Primary Objective Does IMT improve performance ?  Secondary Objectives Does IMT improve IM function ? Which type of athletes or sports benefit most from IMT?  Methods  PICO P  Healthy, high level athletes aged 18-40  I  Inspiratory muscle training: Voluntary Normocapnic Hyperpnea (VNH), Flow Resistive Loading (FRL), Pressure Threshold Loading (PTL)  C  Control, sham  O  Physical performance: Tlim, TT, VO2max, Pulmonary function: PImax, MVV, FEV1 Physiological measures: Lactate, RPE, RPB  Operational Definitions Inspiratory Muscle Training (IMT): an intervention that used either a VNH, FRL or PTL Healthy: fully able-bodied humans, non-injured and without chronic disease High level: an athlete competing at a varsity, national, international or professional level, OR has a VO2max level designated by Wilmore and Costill, 2005  VO2 max  Search Strategy  Search Strategy  Following procedures performed by 2 independent reviewers  Article screening  Title and abstract screening  Screening tool  Inclusion/exclusion criteria   Quality assessment  PEDro scale +  Oxford Level of Evidence +  van Tulder  Data abstraction   Third party reviewer was used when required  Study Inclusion  Articles were included if:  (1) Participants were high level, healthy athletes (mean age of 18-40 years) (2) Compared IMT to another comparison group (3) An RCT or crossover study design (4) Includes measures of respiratory muscle adaptation with reliable and valid outcome measures (5) English  Included Studies  14 articles  Note: Romer et al, 2002A and Romer et al, 2002B same study  data  Sports  Cycling  Endurance running  Intermittent sprint: Soccer, Rugby, Field Hockey, Basketball  Rowing  Swimming  Quality Assessment  Meta-Analysis  RevMan 5.0.24 for meta-analyses48  Randomized effects model:  Does not assume a common treatment effect exists  Allows for variation by assuming that effects follow a distribution across all studies  Standardized mean differences: Summary statistic when the studies assess the same outcome but measure it in variety of ways  Used to standardize to a uniform scale  Express the size of the intervention effect relative to the variability observed  Equivalent of ‘effect size’ in social science studies  Meta-Analysis  RevMan 5.0.24 48  Heterogeneity: The extent to which the results of studies are  consistent  I2: assesses whether observed differences in results are  compatible with chance alone  P <0.1 was considered significant for heterogeneity  Meta-Analysis  Analysis done on primary and secondary outcomes  Sport based sub-group analysis was performed  Cycling  Endurance Running  Intermittent Sprint (Soccer, Rugby, Field Hockey,  Basketball)  Rowing  Swimming  Results  Primary Outcomes # studies  Z= / P =  I2 = / P=  Overall performance  9  Z = 3.55 P= <0.001  I2=24% P=0.23  Swimmers  1  Z = 0.61 P= 0.54  n/a  Intermittent Sprint Sports  3  Z = 2.95 P= 0.003  I2= 0% P=0.61  Cyclists  1  Z =2.41 P= 0.02  n/a  Rowers  3  Z = 1.29 P= 0.20  I2=63% P=0.07  Endurance Runners  1  Z = 0.36 P= 0.72  n/a  Primary Outcomes # studies  Z= / P =  I2 = / P=  Overall performance  9  Z = 3.55 P= <0.001  I2=24% P=0.23  Swimmers  1  Z = 0.61 P= 0.54  n/a  Intermittent Sprint Sports  3  Z = 2.95 P= 0.003  I2= 0% P=0.61  Cyclists  1  Z =2.41 P= 0.02  n/a  Rowers  3  Z = 1.29 P= 0.20  I2=63% P=0.07  Endurance Runners  1  Z = 0.36 P= 0.72  n/a  Swimming Intermittent Sprint Sports Cyclin g Rowing  Figure 1: Metaanalysis results comparing targeted or threshold resistive IMT versus sham or control in whole body athletic performance  Special Forces Overall Performance Favours IMT  Favours control/sham  Secondary Outcomes # studies /14  Z= / P =  I2 = / P=  Lactate  5 (3)  Z= 0.50 P = 0.62  I² = 56% P = 0.04  RPE  3 (1)  Z=1.58 P= 0.12  I2 = 0% P =0.39  RPB  7 (1)  Z=2.54 P=0.01  I²=0% P=0.86  VO2 max  7 (1)  Z= 1.01 P= 0.31  I²=0% P= 0.31  FEV1  9 (0)  Z=0.53 P=0.59  I2 =0% P=0.97  MVV  5(0)  Z = 2.84 P=0.005  I2 = 0% P=0.45  12 (0)  Z=4.34 P<0.001  I2 = 81% P< 0.001  4 (0)  Z=12.57 P<0.001  I2 = 73% P= 0.01  Pimax - Resting - Post Performance  (#) = the number of studies that mentioned the outcome but did not  Secondary Outcomes # studies  Z= / P =  I2 = / P=  Lactate  5 (3)  Z= 0.50 P = 0.62  I² = 56% P = 0.04  RPE  3 (1)  Z=1.58 P= 0.12  I2 = 0% P =0.39  RPB  7 (1)  Z=2.54 P=0.01  I²=0% P=0.86  VO2 max  7 (1)  Z= 1.01 P= 0.31  I²=0% P= 0.31  FEV1  9 (0)  Z=0.53 P=0.59  I2 =0% P=0.97  MVV  5(0)  Z = 2.84 P=0.005  I2 = 0% P=0.45  12 (0)  Z=4.34 P<0.001  I2 = 81% P< 0.001  4 (0)  Z=12.57 P<0.001  I2 = 73% P= 0.01  Pimax - Resting - Post Performance  Discussion  Summary of Findings  Primary Outcome:  Overall = Meta- analysis found that IMT does have an  ergogenic effect on performance  Sport based sub-group analysis revealed…. Not all sports are equal!  Intermittent sprint sports and cycling benefited from IMT  performance  Swimming, rowing and endurance running were not found to benefit  Discussion  Significance of Primary Outcomes  IMT could be used as an adjunct to regular training to  enhance performance in high-level athletes  Only in certain sports disciplines  Discussion  Secondary Outcomes  Improvements in PImax and MVV across all studies  Improvements in RPB across all studies   Significance  Highly trained athletes are able to improve their IM function  All protocols effective in eliciting training effect  Attenuation of dyspnea is supported as a response to  improvements in IM function  Discussion  Improvement in performance with cycling and  intermittent sprint sports  Correlated with  PImax and MVV  Reduction in RPB  Discussion Why does this not translate to rowing, swimming and endurance running performances?  Rowing 9,52  Dual function of IM = stabilization of the thorax + ventilation  “Entrained” breathing  Different ventilatory mechanics and IM physiological  demands  ? Negate or confound IMT related improvements?  Discussion Why does this not translate to rowing, swimming and endurance running performances?  Swimming 3,33,50  Respond with smaller  in PImax following IMT  interventions  IM trained by water submersion  Swimmer IM already near function plateau  Unable to gain performance effects from IMT  Discussion Why does this not translate to rowing, swimming and endurance running performances?  Endurance Runners 51  German Special Forces = Not elite athletes within a specific  sporting discipline  ‘Generalist’ characteristics + non-specific performance test  Discussion Why does this not translate to rowing, swimming and endurance running performances?  Individual characteristics  Each athlete limited by different physiologic or psychologic  factors  Some may be more limited by IM function than others  Mix of responders and non-responders within a small sample  could affect the effect size  Discussion  Individual characteristics  Highlights the need to consider the unique characteristics of  each athlete prior to choosing a training intervention  Discussion  Other secondary measures  FEV1  VO2 max  Blood lactate  RPE   Consistent with the literature  FEV1 limited by airway diameter not IM strength  VO2 max does not respond to IMT  Blood lactate postulated to decrease  More recent studies have failed to support this argument  Discussion  Lack of positive RPE findings contrasts current literature  Data analyzed on end of test measures  RPE  post IMT for similar workouts during incremental  testing  Future studies should examine exercise performance measures during fixed workload tasks vs. end-points of exercise performance  Limitations  Small number of studies with sample sizes  Definition of “high-level” athletes  Data abstracted graphs via hand and ruler measurements  McMahon (2002) removed from the analysis  Data could not be reliably extracted from the graph  Attempts to contact the author failed  Conclusion  Conclusion  IMT improves performance in intermittent sprint and  cycling NOT rowing, swimming or endurance running   Where IM serve a dual function (rowing) or already  stimulated with regular training (swimming) may not benefit vs. sports in which the sole function of the RM is ventilation   High level athletes able to  IM function with IMT  Can translate into performance improvements  Limited strength of claim  Implications  Consider IMT as a possible adjunct to regular athletic  training  It is cheap and time effective   Must consider the individual characteristics  Must consider type of athletic performance  Future Direction  Call for more, higher quality studies  Studies should examine:  Most effective IMT protocols  Specific sport   Apply IMT in a non-research/field setting with a  team/athletic group to determine feasibility and adherence  Acknowledgements THANK YOU! Dr. Darlene Reid Marc Roig Dr. Bill Sheel Dr. Allison McConnell Charlotte Beck Dean Guistini Dr. Theresa Lui-Ambrose Dr. Lara Boyd  References 1. Mickleborough TD, Stager JM, Chatham K, Lindley MR, Ionescu AA. Pulmonary adaptations to swim and inspiratory muscle training. Eur J Appl Physiol. 2008 Aug;103(6):635-46. 2. Edwards AM, Walker RE. Inspiratory muscle muscle training upon recovery time during high intensity, repetitive sprint activity. Int J Sports Med. 2002;23:353-60. 3. McConnell AK. Respiratory muscle training as an ergogenic aid. Journal of Exercise Science & Fitness. 2009;7(2):S18-S27. 4. Dempsey J, Gledhill N, Reddan W, Forster H, Hanson P, Claremont A. Pulmonary adaptation to exercise: Effects of exercise type and duration, chronic hypoxia and physical training. Ann N Y Acad Sci. 1977;301(1 The Marathon: Physiological, Medical, Epidemiological, and Psychological Studies):243-61. 5. Johnson B, Babcock M, Suman O, Dempsey J. Exercise-induced diaphragmatic fatigue in healthy humans. J Physiol (Lond ). 1993;460(1):385-405. 6. Mador MJ, Magalang UJ, Rodis A, Kufel TJ. Diaphragmatic fatigue after exercise in healthy human subjects. Am Rev Respir Dis. 1993 Dec;148(6 Pt 1):1571-5. 7. McConnell AK, Caine MP, Sharpe GR. Inspiratory muscle fatigue following running to volitional fatigue: The influence of baseline strength. Int J Sports Med. 1997;18(3):169-73. 8. Griffiths LA, McConnell AK. The influence of inspiratory and expiratory muscle training upon rowing performance. Eur J Appl Physiol. 2007 Mar;99(5):457-66. 9. Volianitis S, McConnell AK, Koutedakis Y, McNaughton L, Backx K, Jones DA. Inspiratory muscle training improves rowing performance. Med Sci Sports Exerc. 2001 05;33(5):803-9. 10. Romer LM, McConnell AK, Jones DA. Effects of inspiratory  References 11. Lomax ME, McConnell AK. Inspiratory muscle fatigue in swimmers after a single 200 m swim. J Sports Sci. 2003 08;21(8):659-64. 12. 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. European Respiratory Journal. 2007 Sep;30(3):479-86. 13. Legrand R, Marles A, Prieur F, Lazzari S, Blondel N, Mucci P. Related trends in locomotor and respiratory muscle oxygenation during exercise. Medicine & Science in Sports & Exercise. 2007 Jan;39(1):91-100. 14. Harms CA, Wetter TJ, McClaran SR, Pegelow DF, Nickele GA, Nelson WB, et al. Effects of respiratory muscle work on cardiac output and its distribution during maximal exercise. J Appl Physiol. 1998;85(2):609-18. 15. Sheel AW. Respiratory muscle training in healthy individuals: Physiological rationale and implications for exercise performance. Sports Med. 2002;32:567-81. 16. Romer LM, McConnell AK. Specificity and reversibility of inspiratory muscle training. Med Sci Sports Exerc. 2003 02;35(2):237-44. 17. Williams JS, Wongsathikun J, Boon SM, Acevedo EO. Inspiratory muscle training fails to improve endurance capacity in athletes. Med Sci Sports Exerc. 2002 07;34(7):1194-8. 18. Markov G, Spengler CM, Knopfli-Lenzin C, Stuessi C, Boutellier U. Respiratory muscle training increases cycling endurance without affecting cardiovascular responses to exercise. Eur J Appl Physiol. 2001 Aug;85(3-4):233-9. 19. McMahon ME, Boutellier U, Smith RM, Spengler CM. Hyperpnea training attenuates peripheral chemosensitivity and improves cycling endurance. J Exp Biol. 2002 Dec;205(Pt 24):3937-43. 20. Stuessi C, Spengler CM, Knopfli-Lenzin C, Markov G, Boutellier U. Respiratory muscle endurance training in humans increases cycling endurance without affecting blood gas concentrations. Eur J Appl Physiol. 2001 Jun;84(6):582-6.  References 21. Spengler CM, Roos M, Laube SM, Boutellier U. Decreased exercise blood lactate concentrations after respiratory endurance training in humans. Eur J Appl Physiol Occup Physiol. 1999 03;79(4):299-305. 22. Boutellier U, Buchel R, Kundert A, Spengler C. The respiratory system as an exercise limiting factor in normal trained subjects. Eur J Appl Physiol Occup Physiol. 1992;65:347-53. 23. Boutellier U. Respiratory muscle fitness and exercise endurance in healthy humans. Med Sci Sports Exerc. 1998 July;30(7):1169-72. 24. Inbar O, Weiner P, Azgad Y, Rotstein A, Weinstein Y. Specific inspiratory muscle training in well-trained endurance athletes. Med Sci Sports Exerc. 2000 Jul;32(7):1233-7. 25. McConnell AK, Romer LM. Respiratory muscle training in healthy humans: Resolving the controversy. Int J Sports Med. 2004 May;25(4):284-93. 26. Gething AD, Williams M, Davies B. Inspiratory resistive loading improves cycling capacity: A placebo controlled trial. Br J Sports Med. 2004 12;38(6):730-6. 27. Romer LM, McConnell AK, Jones DA. Effects of inspiratory muscle training on time-trial performance in trained cyclists. J Sports Sci. 2002 Jul;20(7):547-62. 28. Romer LM, McConnell AK, Jones DA. Inspiratory muscle fatigue in trained cyclists: Effects of inspiratory muscle training. Medicine & Science in Sports & Exercise. 2002 May;34(5):785-92. 29. Nicks CR, Morgan DW, Fuller DK, Caputo JL. The influence of respiratory muscle training upon intermittent exercise performance. Int J Sports Med. 2009 Jan;30(1):16-21. 30. Leddy JJ, Limprasertkul A, Patel S, Modlich F, Buyea C, Pendergast DR, et al. Isocapnic hyperpnea training improves performance in competitive male runners. Eur J Appl Physiol. 2007 APR;99(6):665-76.  References 31. Jeukendrup A, Saris WH, Brouns F, Kester AD. A new validated endurance performance test. Med Sci Sports Exerc. 1996 Feb;28(2):266-70. 32. Hopkins WG, Hawley JA, Burke LM. Design and analysis of research on sport performance enhancement. Med Sci Sports Exerc. 1999 Mar;31(3):472-85. 33. Clanton TL, Dixon GF, Drake J, Gadek JE. Effects of swim training on lung volumes and inspiratory muscle conditioning. J Appl Physiol. 1987 January 1;62(1):39-46. 34. Ray AD, Pendergast DR, Lundgren CE. Respiratory muscle training improves swimming endurance at depth. Undersea Hyperb Med. 2008 May-Jun;35(3):185-96. 35. 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 Aug;94(5-6):527-40. 36. Holm P, Sattler A, Fregosi RF. Endurance training of respiratory muscles improves cycling performance in fit young cyclists. BMC Physiology. 2004 May 6;4:9. 37. Guenette JA, Vogiatzis L, Zakynthinos S, Athanasopoulos D, Koskolou M, Golemati S, et al. Human respiratory muscle blood flow measured by near-infrared spectroscopy and indocyanine green. J Appl Physiol. 2008 04;104(4):1202-10. 38. Smith TBRJ, Hopkins WG, Taylor NAS. Respiratory responses of elite oarsmen, former oarsmen, and highly trained non-rowers during rowing, cycling and running. European Journal of Applied Physiology & Occupational Physiology. 1994 07;69(1):44-9.  References 39. Klusiewicz A, Borkowski L, Zdanowicz R, Boros P, Wesolowski S. The inspiratory muscle training in elite rowers. J Sports Med Phys Fitness. 2008 Sep;48(3):279-84. 40. Riganas CS, Vrabas IS, Christoulas K, Mandroukas K. Specific inspiratory muscle training does not improve performance or VO2max levels in well trained rowers. J Sports Med Phys Fitness. 2008 09;48(3):285-92. 41. Amonette WE, Dupler TL. The effects of respiratory muscle training on VO2max, the ventilatory threshold and pulmonary function. Journal of Exercise Physiology Online. 2002 05;5(2). 42. Watsford M, Spurrs R. The relationship between respiratory muscle strength and running performance in elite australian rules athletes. Journal of Science & Medicine in Sport. 2005;8(4):122-. 43. Tong TK, Fu FH, Chung PK, Eston R, Lu K, Quach B, et al. The effect of inspiratory muscle training on high-intensity, intermittent running performance to exhaustion. Appl Physiol Nutr Metab. 2008 Aug;33(4):671-81. 44. Edwards AM, Wells C, Butterly R. Concurrent inspiratory muscle and cardiovascular training differentially improves both perceptions of effort and 5000 m running performance compared with cardiovascular training alone. Br J Sports Med. 2008 10;42(10):523-7. 45. Geddes EL, O'Brien K, Brooks D, Reid WD, Crowe J. Does aerobic exercise training improve inspiratory muscle function in individuals with chronic obstructive pulmonary disease? A systematic review. CARDIOPULM PHYS THER J. 2007 12;18(4):3-13. .  References 46. O'Brien K, Geddes EL, Reid WD, Brooks D, Crowe J. Inspiratory muscle training compared with other rehabilitation interventions in chronic obstructive pulmonary disease: A systematic review update. Journal of Cardiopulmonary Rehabilitation & Prevention. 2008 MarApr;28(2):128-41. 47. Reid WD, Geddes EL, O'Brien K, Brooks D, Crowe J. Effects of inspiratory muscle training in cystic fibrosis: A systematic review. Clin Rehabil. 2008 Oct-Nov;22(10-11):1003-13. 48. Cochrane handbook for systematic reviews of interventions version 5.0.2 [homepage on the Internet]. The Cochrane Collaboration. 2009 September 2009. Available from: www.cochrane-handbook.org 49. Wilmore J.H. CDL. Physiology of sport and exercise. Champaign, IL: Human Kinetics Publishers; 2005. 50. Kilding AE, Brown S, McConnell AK. Inspiratory muscle training improves 100 and 200 m swimming performance. Eur J Appl Physiol. 2010 Feb;108(3):505-11. 51. Sperlich B, Fricke H, de Marees M, Linville JW, Mester J. Does respiratory muscle training increase physical performance? Mil Med. 2009 Sep;174(9):977-82. 52. Steinacker JM, Both M, Whipp BJ. Pulmonary mechanics and entrainment of respiration and stroke rate during rowing. Int J Sports Med. 1993 09;14:S15-s19. 53. McKardle W., Katch F., Katch V. Exercise physiology: Energy, nutrition, & human performance. 6th edition ed. United States: Lippincott Williams & Wilkins; 2007. 54. McConnell AK, Sharpe GR. The effect of inspiratory muscle training upon maximum lactate steady-state and blood lactate concentration. Eur J Appl Physiol. 2005 Jun;94(3):277-84.  Questions?  

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