Respiratory Muscle Training

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Introduction

Respiratory Muscle Training (RMT) can be defined as "a course of therapy consisting of a series of breathing exercises that aim to strengthen the bodies’ respiratory muscles making it easier for people to breathe".

RMT is normally aimed at people who suffer from asthma, bronchitis, emphysema and COPD. However, many people adopt RMT as part of their sports training as this training is designed to strengthen the muscles used for breathing. Studies have shown that regular RMT can increase a person’s endurance during cardiovascular exercise or sports activities such as running and cycling.

When a person is breathing normally, they typically use between 10 to 15 per cent of his or her total lung capacity. With RMT a person can typically increase the amount of lung capacity used. Deeper breathing uses a bit more energy but also allows more oxygen to enter the bloodstream with each breath while strengthening the breathing muscles. Strengthening inspiratory muscles by performing daily breathing exercises for at least six weeks significantly reduces the amount of oxygen these same breathing muscles require during exercise, resulting in more oxygen being available for other muscles.

The evidence

The historical evidence for RMT are presented here:

Responses to RMT

Things that change:

• effort related responses:
  • breathing effort
  • whole body effort
• metabolic related responses
  • respiratory muscle fatigue
  • breathing pattern
  • lactate turnover
  • heart rate
  • oxygen uptake kinetics

These do not change:

• maximal oxygen uptake
• maximum lactate threshold

Respiratory muscle respond to training stimuli in the same manner as the skeletal muscles i.e. by undergoing adaptations to their structure and function that are specific to the training stimulus.

• structural adaptations - changes in muscle fibre type, fibre cross-sectional area (hypertophy) and muscle thickness have been demonstrated. 
• functional adaptations - improvements in strength, speed, power, endurance performance, peak inspiratory flow, maximal inspiratory and expiratory pressures have been demonstrated.
  

There is evidence that RMT has many beneficial effects in healthy people and has been shown to improve althletic performance.  Results of studies clearly indicate that IMT produces statistically significant improvements in performance but EMT does not.

The range of pathological conditions in which RMT has been implemented ranges from the obvious (e.g. COPD) to the unexpected (e.g. Diabetes).  The evidence for the use of RMT in these conditions varies widely from conditions where RMT is supported by systematic reviews and meta-analyses (e.g. COPD) to those where there is only theoretical raionale.

How does it work - underlying mechanisms

1. optimisation of blood flow distribution
2. attenuation of central fatigue
3. reduced sense of respiratory and peripheral effort
   

Methods of RMT

Training principles

• Overload
• Specificity
• Reversibility

Forms of RMT

• Resistance training
  • inspiratory flow resistive loading (IFRL)
  • dynamic inspiratory flow resistive loading (dynamic IFRL)
  • inspiratory pressure threshold loading (IPTL)
  • expiratory pressure threshold loading  (EPTL)
  • concurrent IPTL and EPTL
• Endurance training

Implementing RMT

Practical issues

• posture
• optimising breathing technique
• diaphragm breathing
• breathing pattern
• secretions

Monitoring progress

assessment of respiratory muscle function

• maximal respiratory pressures
• sniff inspiratory pressure
• peak inspiratory flow rate
• inspiratory muscle endurance

evaluating clinical benefits

Getting Started

• protocol slection
• setting the training load
• repetition failure
• influence of daily activities and exacerbations
• training diaries

Ongoing program

• progression
• maintenance
• incorporating into rehabilitation
• warm up and cool down
• stretching

Resources

• Presentations from the RMT forum at the Centre for Sports Medicine and Human Performance at Brunel University

Recent Related Research (from Pubmed)

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References

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