The effects of inspiratory muscle warm-up prior to inspiratory muscle training during pulmonary rehabilitation in subjects with chronic obstructive pulmonary disease: a randomized trial

• Published in: Physiotherapy theory and practice Vol. 41; no. 1; pp. 1 - 11
• Main Authors: Aktan, Rıdvan, Özalevli, Sevgi, Yakut, Hazal, Özgen Alpaydin, Aylin
• Format: Journal Article
• Language: English
• Published: England Taylor & Francis Ltd 2025
• Subjects: Aged; Breathing Exercises - methods; Chronic obstructive pulmonary disease; Dyspnea; Dyspnea - physiopathology; Dyspnea - rehabilitation; Exercise; Exercise Tolerance; Female; Health status; Health surveys; Humans; Inhalation; Lung - physiopathology; Male; Medical research; Middle Aged; Muscle strength; Muscle Strength - physiology; Muscles; Pulmonary Disease, Chronic Obstructive - physiopathology; Pulmonary Disease, Chronic Obstructive - rehabilitation; Quality of Life; Rehabilitation; Respiratory Function Tests; Respiratory Muscles - physiopathology; Strength; Walk Test; Warm-Up Exercise; inspiratory muscle training; Chronic obstructive pulmonary disease; pulmonary rehabilitation
• DOI: 10.1080/09593985.2023.2301439
• ISSN: 0959-3985; 1532-5040

While a whole-body warm-up may not adequately prepare the inspiratory muscles for exercise, inspiratory warm-up is an effective approach in preparing the inspiratory muscles for exertion. To investigate the effects of inspiratory muscle warm-up performed prior to inspiratory muscle training (IMT) during pulmonary rehabilitation (PR) in patients with moderate-to-severe chronic obstructive pulmonary disease (COPD) and inspiratory muscle weakness. Pulmonary function tests, maximal inspiratory and expiratory pressures (MIP and MEP), 6-minute walk test distance (6MWD), modified Medical Research Council Dyspnea Scale(mMRC), St. George's respiratory questionnaire and the 36-item short-form health survey were evaluated. Both groups performed IMT during PR for 8 weeks. The warm-up group (n = 15), in addition to the standard IMT group (n = 15), performed an inspiratory muscle warm-up protocol before each IMT session. At the end of the 8-week intervention, improvements in dyspnea (mMRC in score, =0.033, effect size =0.76); exercise capacity (6MWD in meters, =0.001, effect size =1.30); pulmonary function [forced expiratory volume in 1 second (FEV ) in %predicted, =0.006, effect size =1.10]; and inspiratory muscle strength (MIP in cmH O, =0.001, effect siz e = 1.35) were significantly greater in the warm-up group. Moreover, there were significant improvements in health-related quality of life (HRQoL) sub-scores after the training in both groups ( <0.05). This study demonstrated improvements in both groups, surpassing or closely approaching the established minimal clinically important difference values for the respective outcomes. Performing a warm-up for inspiratory muscles before IMT boosts benefits for pulmonary function, inspiratory muscle strength, exercise capacity, dyspnea, and HRQoL in subjects with moderate-to-severe COPD and inspiratory muscle weakness.