Immediate Respiratory Warm-Up Effect on Dynamic Inspiratory Muscle Strength in Cardiac Surgery Candidates
Abstract
Introduction: The strength of inspiratory muscles is one of the essential factors in preventing postoperative pulmonary complications (POPC). One of the new tools to safely measure the strength of the inspiratory muscles in heart patients dynamically and without breath holding is the strength-index (S-index). This study aims to evaluate the immediate effects of a respiratory warm-up (RWU) session on the S-index and other lung parameters in cardiac surgery candidates, a subject with limited existing research.
Materials and Methods: This study was conducted as a randomized controlled trial. Forty participants scheduled for heart surgeries were randomly assigned to either the study (RWU between two tests) or control (without RWU) groups. RWU consists of threshold loading inspiratory muscle training (TL-IMT) exercises at 30% of the S-index with 30 breathing cycles. Respiratory tests, including S-index, peak inspiratory flow (PIF) and vital capacity (VC), were assessed twice using an electronic respiratory device.
Results: Covariance analysis showed no significant difference in the average and best values of the S-index, PIF or VC indices at the second tests, between two groups (P>0.05), or in the independent t test and Mann-Whitney U test for the “rate of changes,” between two tests (P>0.05). Finally, intra-group changes, assessed with paired sample t test between two tests, were mostly non-significant for these indices (P>0.05), except for the best VC in the study group (P=0.03).
Conclusion: The study results suggest that a RWU session does not significantly impact cardiac surgery candidates’ S-index or other respiratory parameters. Thus, incorporating RWU before S-index testing may not be necessary.
Weissman C. Pulmonary Complications After Cardiac Surgery. Semin Cardiothorac Vasc Anesth. 2004; 8(3):185-211. [DOI:10.1177/108925320400800303]
Siafakas NM, Mitrouska I, Bouros D, Georgopoulos D. Surgery and the respiratory muscles. Thorax. 1999; 54(5):458-65. [DOI:10.1136/thx.54.5.458] [PMID]
Barros GF, Santos Cda S, Granado FB, Costa PT, Límaco RP, Gardenghi G. Respiratory muscle training in patients submitted to coronary arterial bypass graft. Brazilian Journal of Cardiovascular Surgery. 2010; 25(4):483-90. [DOI:10.1590/S0102-76382010000400011] [PMID]
Pourgharib Shahi MH, Mohammadnejad SF, Gohari Moghadam K, Borna S, Sharafi SE, Naderpour Z. Effects of pulmonary rehabilitation program on patients with chronic obstructive pulmonary disease. Journal of Modern Rehabilitation. 2022; 16(1):23-30. [DOI:10.18502/jmr.v16i1.8558]
Karanfil ET, Møller AM. Preoperative inspiratory muscle training prevents pulmonary complications after cardiac surgery-a systematic review. Danish Medical Journal. 2018; 65(3):A5450. [Link]
Naimi SS, Rahbar S, Asadi MR, Radinmehr H, Talimkhani A, Doosti-Irani A, et al. The immediate effects of aerobic exercise with and without external loads on blood glucose, cardiovascular, respiratory, and body temperature indices in type II Diabetic Patients. The Journal of Tehran University Heart Center. 2023; 18(1):39-45. [DOI:10.18502/jthc.v18i1.12580] [PMID]
Yáñez-Sepúlveda R, Verdugo-Marchese H, Duclos-Bastías D, Tuesta M, Alvear-Ordenes I. Effects of inspiratory muscle training on muscle oxygenation during vascular occlusion testing in trained healthy adult males. International Journal of Environmental Research and Public Health. 2022; 19(24):16766. [DOI:10.3390/ijerph192416766] [PMID]
McConnell AK, Romer LM. Respiratory muscle training in healthy humans: Resolving the controversy. International Journal of Sports Medicine. 2004; 25(4):284-93. [DOI:10.1055/s-2004-815827] [PMID]
Polkey M, Green M, Moxham J. Measurement of respiratory muscle strength. Thorax. 1995; 50(11):1131-5. [DOI:10.1136/thx.50.11.1131] [PMID]
Fortes JVS, Borges MGB, Marques MJS, Oliveira RL, Rocha LR, Castro É, et al. Effects of inspiratory muscle training using an electronic device on patients undergoing cardiac surgery: A randomized controlled trial. International Journal of Cardiovascular Sciences. 2020; 34(1):44-52. [DOI:10.36660/ijcs.20190093]
Mirenayat MS, Moradkhani A, Abedi M, Abedini A, Zahiri R, Karimzadeh S, et al. Role of inspiratory muscle training on pulmonary rehabilitation in patients with COVID-19: A pilot study. Tanaffos. 2022; 21(4):466-71. [PMID]
Areias GS, Santiago LR, Teixeira DS, Reis MS. Concurrent validity of the static and dynamic measures of inspiratory muscle strength: Comparison between maximal inspiratory pressure and s-index. Brazilian Journal of Cardiovascular Surgery. 2020; 35(4):459-64. [DOI:10.21470/1678-9741-2019-0269] [PMID]
Scharf SM, Woods BO, Brown R, Parisi A, Miller MM, Tow DE. Effects of the Mueller maneuver on global and regional left ventricular function in angina pectoris with or without previous myocardial infarction. The American Journal of Cardiology. 1987; 59(15):1305-9. [DOI:10.1016/0002-9149(87)90909-X] [PMID]
da Silva FMF, Cipriano G, Lima ACGB, Andrade JML, Nakano EY, Chiappa GR, et al. Maximal dynamic inspiratory pressure evaluation in heart failure: A comprehensive reliability and agreement study. Physical Therapy. 2020; 100(12):2246-53. [DOI:10.1093/ptj/pzaa165] [PMID]
Silva PE, de Carvalho KL, Frazão M, Maldaner V, Daniel CR, Gomes-Neto M. Assessment of maximum dynamic inspiratory pressure. Respiratory Care. 2018; 63(10):1231-8. [DOI:10.4187/respcare.06058] [PMID]
Volianitis S, McConnell AK, Jones DA. Assessment of maximum inspiratory pressureprior submaximal respiratory muscle activity (‘Warm-Up’) enhances maximum inspiratory activity and attenuates the learning effect of repeated measurement. Respiration. 2001; 68(1):22-7. [DOI:10.1159/000050458] [PMID]
Lee KB, Kim MK, Jeong JR, Lee WH. Reliability of an electronic inspiratory loading device for assessing pulmonary function in post-stroke patients. Medical Science Monitor: International Medical Journal of Experimental and Clinical Research. 2016; 22:191-6. [DOI:10.12659/MSM.895573] [PMID]
Minahan C, Sheehan B, Doutreband R, Kirkwood T, Reeves D, Cross T. Repeated-sprint cycling does not induce respiratory muscle fatigue in active adults: Measurements from the powerbreathe® inspiratory muscle trainer. Journal of Sports Science & Medicine. 2015; 14(1):233-8. [PMID]
Behnke BJ, Kindig CA, Musch TI, Sexton WL, Poole DC. Effects of prior contractions on muscle microvascular oxygen pressure at onset of subsequent contractions. The Journal of Physiology. 2002; 539(3):927-34. [DOI:10.1113/jphysiol.2001.013165] [PMID]
Hawkes EZ, Nowicky AV, McConnell AK. Diaphragm and intercostal surface EMG and muscle performance after acute inspiratory muscle loading. Respiratory Physiology & Neurobiology. 2007; 155(3):213-9. [DOI:10.1016/j.resp.2006.06.002] [PMID]
Koizumi J, Ohya T. Effects of high-intensity inspiratory muscle warm-up on inspiratory muscle strength and accessory inspiratory muscle activity. Respiratory Physiology & Neurobiology. 2023; 313:104069. [DOI:10.1016/j.resp.2023.104069] [PMID]
Arend M, Kivastik J, Mäestu J. Maximal inspiratory pressure is influenced by intensity of the warm-up protocol. Respiratory Physiology & Neurobiology. 2016; 230:11-5. [DOI:10.1016/j.resp.2016.05.002] [PMID]
Özdal M. Acute effects of inspiratory muscle warm-up on pulmonary function in healthy subjects. Respiratory Physiology & Neurobiology. 2016; 227:23-6. [DOI:10.1016/j.resp.2016.02.006] [PMID]
Savci S, Degirmenci B, Saglam M, Arikan H, Inal-Ince D, Turan HN, et al. Short-term effects of inspiratory muscle training in coronary artery bypass graft surgery: A randomized controlled trial. Scandinavian Cardiovascular Journal. 2011; 45(5):286-93. [DOI:10.3109/14017431.2011.595820] [PMID]
Cordeiro AL, de Melo TA, Neves D, Luna J, Esquivel MS, Guimarães AR, et al. Inspiratory muscle training and functional capacity in patients undergoing cardiac surgery. Brazilian Journal of Cardiovascular Surgery. 2016; 31(2):140-4.[DOI:10.5935/1678-9741.20160035] [PMID]
Cargnin C, Karsten M, Guaragna JCVDC, Dal Lago P. Inspiratory muscle training after heart valve replacement surgery improves inspiratory muscle strength, lung function, and functional capacity: A randomized controlled trial. Journal of Cardiopulmonary Rehabilitation and Prevention. 2019; 39(5):E1-E7. [DOI:10.1097/HCR.0000000000000409] [PMID]
Cheng CF, Tong TK, Kuo YC, Chen PH, Huang HW, Lee CL. Inspiratory muscle warm-up attenuates muscle deoxygenation during cycling exercise in women athletes. Respiratory Physiology & Neurobiology. 2013; 186(3):296-302. [DOI:10.1016/j.resp.2013.02.029] [PMID]
Brown PI, Johnson MA, Sharpe GR. Determinants of inspiratory muscle strength in healthy humans. Respiratory Physiology & Neurobiology. 2014; 196:50-5. [DOI:10.1016/j.resp.2014.02.014] [PMID]
Terzi N, Corne F, Mouadil A, Lofaso F, Normand H. Mouth and nasal inspiratory pressure: Learning effect and reproducibility in healthy adults. Respiration. 2010; 80(5):379-86. [DOI:10.1159/000254378] [PMID]
Issue | Vol 19 No 1 (2025) | |
Section | Research Article(s) | |
DOI | https://doi.org/10.18502/jmr.v19i1.17514 | |
Keywords | ||
Dynamic respiratory pressure Warm-up Cardiac disease |
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