Int J Sports Med 2004; 25(4): 284-293
DOI: 10.1055/s-2004-815827
Training & Testing

© Georg Thieme Verlag KG Stuttgart · New York

Respiratory Muscle Training in Healthy Humans: Resolving the Controversy

A. K. McConnell1 , L. M. Romer2
  • 1Department of Sport Sciences, Brunel University, Uxbridge, Middlesex, UK
  • 2John Rankin Laboratory of Pulmonary Medicine, Department of Population Health Sciences, University of Wisconsin, Madison, USA
Further Information

Publication History

Accepted after revision: July 31, 2003

Publication Date:
26 May 2004 (online)

Abstract

Specific respiratory muscle training offers the promise of improved exercise tolerance and athletic performance for a wide range of users. However, the literature addressing respiratory muscle training in healthy people remains controversial. Studies into the effect of respiratory muscle training upon whole body exercise performance have used at least one of the following modes of training: voluntary isocapnic hyperpnea, flow resistive loading, and pressure threshold loading. Each of these training modes has the potential to improve specific aspects of respiratory muscle function. Some studies have demonstrated significant improvements in either time to exhaustion or time trial performance, whilst others have demonstrated no effect. We present an overview of the literature that rationalizes its contradictory findings. Retrospective analysis of the literature suggests that methodological factors have played a crucial role in the outcome of respiratory muscle training studies. We conclude that in most well controlled and rigorously designed studies, utilizing appropriate outcome measures, respiratory muscle training has a positive influence upon exercise performance. The mechanisms by which respiratory muscle training improves exercise performance are unclear. Putative mechanisms include a delay of respiratory muscle fatigue, a redistribution of blood flow from respiratory to locomotor muscles, and a decrease in the perceptions of respiratory and limb discomfort.

References

  • 1 Babcock M A, Pegelow D F, Johnson B D, Dempsey J A. Aerobic fitness effects on exercise-induced low-frequency diaphragm fatigue.  J Appl Physiol. 1996;  81 2156-2164
  • 2 Bardsley P A, Bentley S, Hall H S, Singh S J, Evans D H, Morgan M D. Measurement of inspiratory muscle performance with incremental threshold loading: a comparison of two techniques.  Thorax. 1993;  48 354-359
  • 3 Belman M J, Gaesser G A. Ventilatory muscle training in the elderly.  J Appl Physiol. 1988;  64 899-905
  • 4 Belman M J, Shadmehr R. A target feedback device for ventilatory muscle training.  J Clin Monit. 1991;  7 42-48
  • 5 Boussana A, Matecki S, Galy O, Hue O, Ramonatxo M, Le Gallais D. The effect of exercise modality on respiratory muscle performance in triathletes.  Med Sci Sports Exerc. 2001;  33 2036-2043
  • 6 Boutellier U, Buchel R, Kundert A, Spengler C. The respiratory system as an exercise limiting factor in normal trained subjects.  Eur J Appl Physiol. 1992;  65 347-353
  • 7 Boutellier U, Piwko P. The respiratory system as an exercise limiting factor in normal sedentary subjects.  Eur J Appl Physiol. 1992;  64 145-152
  • 8 Caine M P, McConnell A K. Development and evaluation of a pressure threshold inspiratory muscle trainer for use in the context of sports performance.  J Sports Engineering. 2000;  3 149-159
  • 9 Chatham K, Baldwin J, Griffiths H, Summers L, Enright S. Inspiratory muscle training improves shuttle run performance in healthy subjects.  Physiotherapy. 1999;  85 676-683
  • 10 Chatham K, Baldwin J, Oliver W, Summers L, Griffiths H. Fixed load incremental respiratory muscle training: A pilot study.  Physiotherapy. 1996;  82 422-426
  • 11 Chen R C, Que C L, Yan S. Introduction to a new inspiratory threshold loading device.  Eur Respir J. 1998;  12 208-211
  • 12 Cibella F, Cuttitta G, Romano S, Grassi B, Bonsignore G, Milic-Emili J. Respiratory energetics during exercise at high altitude.  J Appl Physiol. 1999;  86 1785-1792
  • 13 Clanton T L, Dixon G, Drake J, Gadek J E. Inspiratory muscle conditioning using a threshold loading device.  Chest. 1995;  87 62-66
  • 14 Dempsey J A. JB Wolffe memorial lecture. Is the lung built for exercise?.  Med Sci Sports Exerc. 1986;  18 143-155
  • 15 El-Manshawi A, Killian K J, Summers E, Jones N L. Breathlessness during exercise with and without resistive loading.  J Appl Physiol. 1986;  61 896-905
  • 16 Fairbarn M S, Coutts K C, Pardy R L, McKenzie D C. Improved respiratory muscle endurance of highly trained cyclists and the effects on maximal exercise performance.  Int J Sports Med. 1991;  12 66-70
  • 17 Gandevia S C, Killian K J, Campbell E J. The effect of respiratory muscle fatigue on respiratory sensations.  Clin Sci (Colch). 1981;  60 463-466
  • 18 Hanel B, Secher N H. Maximal oxygen uptake and work capacity after inspiratory muscle training: a controlled study.  J Sports Sci. 1991;  9 43-52
  • 19 Hanson P, Claremont A, Dempsey J, Reddan W. Determinants and consequences of ventilatory responses to competitive endurance running.  J Appl Physiol. 1982;  52 615-623
  • 20 Hart N, Sylvester K, Ward S, Cramer D, Moxham J, Polkey M I. Evaluation of an inspiratory muscle trainer in healthy humans.  Respir Med. 2001;  95 526-531
  • 21 Inbar O, Weiner P, Azgad Y, Rotstein A, Weinstein Y. Specific inspiratory muscle training in well-trained endurance athletes.  Med Sci Sports Exerc. 2000;  32 1233-1237
  • 22 Johnson B D, Babcock M A, Suman O E, Dempsey J A. Exercise-induced diaphragmatic fatigue in healthy humans.  J Physiol (Lond). 1993;  460 385-405
  • 23 Johnson B D, Reddan W G, Seow K C, Dempsey J A. Mechanical constraints on exercise hyperpnea in a fit aging population.  Am Rev Respir Dis. 1991;  143 968-977
  • 24 Keens T G, Krastins I R, Wannamaker E M, Levison H, Crozier D N, Bryan A C. Ventilatory muscle endurance training in normal subjects and patients with cystic fibrosis.  Am Rev Respir Dis. 1977;  116 853-860
  • 25 Kohl J, Koller E A, Brandenberger M, Cardenas M, Boutellier U. Effect of exercise-induced hyperventilation on airway resistance and cycling endurance.  Eur J Appl Physiol. 1997;  75 305-311
  • 26 Leith D E, Bradley M. Ventilatory muscle strength and endurance training.  J Appl Physiol. 1976;  41 508-516
  • 27 Lenoir P, Jammes Y, Giry P, Rostain J C, Burnet H, Tomei C, Roussos C. Electromyographic study of respiratory muscles during human diving at 46 ATA.  Undersea Biomed Res. 1990;  17 121-137
  • 28 Leveritt M, Abernethy P J, Barry B K, Logan P A. Concurrent strength and endurance training. A review.  Sports Med. 1999;  28 413-427
  • 29 Markov G, Spengler C M, Knopfli-Lenzin C, Stuessi C, Boutellier U. Respiratory muscle training increases cycling endurance without affecting cardiovascular responses to exercise.  Eur J Appl Physiol. 2001;  85 233-239
  • 30 McClaran S R, Harms C A, Pegelow D F, Dempsey J A. Smaller lungs in women affect exercise hyperpnea.  J Appl Physiol. 1998;  84 1872-1881
  • 31 McConnell A K, Romer L M, Volianitis S, Donovan K J. Re: Evaluation of an inspiratory muscle trainer in healthy humans (Respir Med 2001; 95: 526 - 531).  Respir Med. 2002;  96 129-133
  • 32 McMahon M E, Boutellier U, Smith R M, Spengler C M. Hyperpnea training attenuates peripheral chemosensitivity and improves cycling endurance.  J Exp Biol. 2002;  205 3937-3943
  • 33 Morgan D W, Kohrt W M, Bates B J, Skinner J S. Effects of respiratory muscle endurance training on ventilatory and endurance performance of moderately trained cyclists.  Int J Sports Med. 1987;  8 88-93
  • 34 Powers S K, Coombes J, Demirel H. Exercise training-induced changes in respiratory muscles.  Sports Med. 1997;  24 120-131
  • 35 Ramirez-Sarmiento A, Orozco-Levi M, Guell R, Barreiro E, Hernandez N, Mota S, Sangenis M, Broquetas J M, Casan P, Gea J. Inspiratory muscle training in patients with chronic obstructive pulmonary disease: structural adaptation and physiologic outcomes.  Am J Respir Crit Care Med. 2002;  166 1491-1497
  • 36 Redline S, Gottfried S B, Altose M D. Effects of changes in inspiratory muscle strength on the sensation of respiratory force.  J Appl Physiol. 1991;  70 240-245
  • 37 Romer L M, Dempsey J A. The work of breathing during exercise: implications for performance. Aliverti A, Brusasco V, Macklem PT, Pedotti A Mechanics of Breathing: Pathophysiology, Diagnosis and Treatment. Milano, Italia; Springer-Verlag 2002: 11-24
  • 38 Romer L M, McConnell A K. Specificity and reversibility of inspiratory muscle training.  Med Sci Sports Exerc. 2003;  35 237-244
  • 39 Romer L M, McConnell A K, Jones D A. Effects of inspiratory muscle training upon recovery time during high intensity, repetitive sprint activity.  Int J Sports Med. 2002;  23 353-360
  • 40 Romer L M, McConnell A K, Jones D A. Effects of inspiratory muscle training upon time trial performance in trained cyclists.  J Sports Sci. 2002;  20 547-562
  • 41 Romer L M, McConnell A K, Jones D A. Inspiratory muscle fatigue in trained cyclists: effects of inspiratory muscle training.  Med Sci Sports Exerc. 2002;  34 785-792
  • 42 Smith K, Cook D, Guyatt G H, Madhavan J, Oxman A D. Respiratory muscle training in chronic airflow limitation: a meta-analysis.  Am Rev Respir Dis. 1992;  145 533-539
  • 43 Sonetti D A, Wetter T J, Pegelow D F, Dempsey J A. Effects of respiratory muscle training versus placebo on endurance exercise performance.  Respir Physiol. 2001;  127 185-199
  • 44 Spengler C M, Roos M, Laube S M, Boutellier U. Decreased exercise blood lactate concentrations after respiratory endurance training in humans.  Eur J Appl Physiol. 1999;  79 299-305
  • 45 Stuessi C, Spengler C M, 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;  84 582-586
  • 46 Suzuki S, Sato M, Okubo T. Expiratory muscle training and sensation of respiratory effort during exercise in normal subjects.  Thorax. 1995;  50 366-370
  • 47 Suzuki S, Yoshiike Y, Suzuki M, Akahori T, Hasegawa A, Okubo T. Inspiratory muscle training and respiratory sensation during treadmill exercise.  Chest. 1993;  104 197-202
  • 48 Volianitis S, McConnell A K, Koutedakis Y, McNaughton L, Backx K, Jones D A. Inspiratory muscle training improves rowing performance.  Med Sci Sports Exerc. 2001;  33 803-809
  • 49 Williams J S, Wongsathikun J, Boon S M, Acevedo E O. Inspiratory muscle training fails to improve endurance capacity in athletes.  Med Sci Sports Exerc. 2002;  34 1194-1198
  • 50 Wilson R C, Jones P W. Influence of prior ventilatory experience on the estimation of breathlessness during exercise.  Clin Sci (Colch). 1990;  78 149-153
  • 51 Winkler G, Zifko U, Nader A, Frank W, Zwick H, Toifl K, Wanke T. Dose-dependent effects of inspiratory muscle training in neuromuscular disorders.  Muscle Nerve. 2002;  23 1257-1260

Alison K. McConnell

Department of Sport Sciences · Brunel University

Uxbridge, Middlesex, UB8 3PH

UK

Phone: + 01895274000

Fax: + 0 18 95 81 63 41

Email: alison.mcconnell@brunel.ac.uk

    >