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Inspiratory Muscle Training in Patients with Chronic Obstructive Pulmonary Disease

Structural Adaptation and Physiologic Outcomes

Servei de Pneumologia, Hospital del Mar; Grup de Recerca de Pneumologia, Unitat de Recerca Respiratòria i Ambiental; Institut Municipal d'Investigació Mèdica; Ciencies Experimentals i de la Salut–Universitat Pompeu Fabra; and Servei de Pneumologia, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain

Correspondence and requests for reprints should be addressed to Mauricio Orozco-Levi, M.D., Ph.D., Servei-Grup de Recerca de Pneumologia, Hospital del Mar-IMIM, Passeig Maritim 25, E-08003, Barcelona (Catalonia), Spain. E-mail: morozco{at}imim.es

The present study was aimed at evaluating the effects of a specific inspiratory muscle training protocol on the structure of inspiratory muscles in patients with chronic obstructive pulmonary disease. Fourteen patients (males, FEV₁, 24 ± 7% predicted) were randomized to either inspiratory muscle or sham training groups. Supervised breathing using a threshold inspiratory device was performed 30 minutes per day, five times a week, for 5 consecutive weeks. The inspiratory training group was subjected to inspiratory loading equivalent to 40 to 50% of their maximal inspiratory pressure. Biopsies from external intercostal muscles and vastus lateralis (control muscle) were taken before and after the training period. Muscle samples were processed for morphometric analyses using monoclonal antibodies against myosin heavy chain isoforms I and II. Increases in both the strength and endurance of the inspiratory muscles were observed in the inspiratory training group. This improvement was associated with increases in the proportion of type I fibers (by approximately 38%, p < 0.05) and in the size of type II fibers (by approximately 21%, p < 0.05) in the external intercostal muscles. No changes were observed in the control muscle. The study demonstrates that inspiratory training induces a specific functional improvement of the inspiratory muscles and adaptive changes in the structure of external intercostal muscles.

Key Words: chronic obstructive pulmonary disease • respiratory muscles • fiber structure • training

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