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Frequently asked questions

What is inspiratory muscle training?
Respiratory muscles can be trained in the same way as any other muscle in the body. This can be achieved in a number of ways, but the method that has proved to be the most convenient and effective is one using a device that imposes a resistance to inhalation using a special training device. Inspiratory muscle training devices such as the POWERbreathe® are effectively a "dumbbell for your diaphragm", allowing you to weight train your inspiratory muscles. This training increases inspiratory muscle strength, power and endurance, as well as athletic performance, in as little as six weeks.

What's different about Physiobreathe training?
Physiobreathe training comprises a two phase programme. The first phase is known as Foundation training and consists of 30 repetitions, twice daily at a moderate loading intensity using an inspiratory muscle trainer such as the POWERbreathe®. The second phase of the training incorporates functional training principles to optimise the translation of benefits to activities of daily living.

What is Foundation inspiratory muscle training?
This is the initial phase of Physiobreathe training (the first four to six weeks), during which the inspiratory muscles are trained in isolation using an inspiratory muscle trainer such as the POWERbreathe®. This phase lays down the foundation for functional respiratory muscle training, but also provides clinically proven benefits to exercise tolerance.

What are the benefits of Foundation inspiratory muscle training?
After the Foundation phase, improvements in inspiratory muscle function, exercise tolerance, dyspnoea and quality of life have been observed in a wide range of patients, as well as healthy people.

What's the best training regimen for Foundation inspiratory muscle training?
For the Foundation phase, a twice-daily regimen of 30 breaths at the 30 breath max (30RM) load has been shown to increase strength, power and endurance of the inspiratory muscles. The 30RM load is a moderate loading intensity and corresponds to 50-70% of inspiratory muscle strength. This is the 'tried and trusted' regimen that has been implemented in numerous scientific studies and found to be effective.

How long does a Physiobreathe Foundation training session take?
Foundation training (30 breaths, twice daily) takes less than 4 minutes per day.

What is functional inspiratory muscle training?
In functional respiratory muscle training, movement specific exercises are used to challenge the inspiratory muscles in their roles as both respiratory muscles and as the muscles responsible for postural control, core stabilisation and trunk rotation. This is the second phase of Physiobreathe training.

How do I ensure I get the best training results?
By following the guidance provided on the About section of this website, and by reading 'Respiratory muscle training: theory and practice'.

When will benefits become apparent?
Laboratory studies have shown statistically significant improvements in as little as four weeks in healthy people. In studies on patients, training interventions typically last 12 weeks, after which, statistically significant improvements have been observed.

Can training frequency be reduced after training for a while?
Laboratory studies have shown that improvements can be maintained by reducing training frequency by two thirds (to about twice per week) at the completion of the Foundation phase of training. If training stops completely at the end of the Foundation phase, research shows that after18 weeks, around one third of the improvement in inspiratory muscle strength is lost, and around two thirds of the improvement in endurance.

Patients often have an increased work of breathing - why do they need a specific workout for the inspiratory muscles?
The respiratory muscles adapt to the prevailing respiratory demand in a highly specific way. Patients normally have very sedentary lifestyles, requiring very modest levels of minute ventilation. The respiratory muscles therefore adapt to breathing with a small additional load at low levels of minute ventilation – an extreme endurance training stimulus. Because increasing ventilation provokes unpleasant sensations, patients avoid the intensity of respiratory muscle work that is required to maintain or increase the strength and power of the respiratory muscles. The result is a loss of respiratory pump power, and an inability to increase ventilation during physical activity without severe dyspnoea. By using resistance training principles, Physiobreathe training makes it possible to provide the necessary training overload to enhance the strength and power of the inspiratory muscles. This enables the pumping capacity of the lungs to be improved.

Does inspiratory muscle training work for everyone?
Improvements in exercise tolerance and breathing effort have been shown in people who differ as widely as Olympic athletes and frail patients with chronic lung disease. If one considers these to be the two extremes of human physical performance, then everyone lies somewhere on the continuum between them – accordingly, everyone has the potential to benefit from inspiratory muscle training.

Which disease conditions can respiratory muscle training help?
A comprehensive analysis of the published literature examining respiratory muscle training can be found in 'Respiratory muscle training: theory and practice'. Recent systematic reviews and meta-analyses support a beneficial influence of inspiratory muscle training in patients with chronic obstructive pulmonary disease and chronic heart failure, as well as healthy people. In addition, there is emerging evidence and/or a theoretical rationale for inspiratory muscle training in the following contexts:

  • Amyotrophic lateral sclerosis
  • Ankylosing spondylitis
  • Anorexia nervosa
  • Arthritis
  • Artificially ventilated patients
  • Asthma
  • Bronchiectasis
  • Cancer
  • Cerebral Palsy
  • Corticosteroid use (oral)
  • Cystic fibrosis
  • Diabetes (Type I and II)
  • Diaphragm paralysis
  • Muscular dystrophy
  • Hypothyroidism
  • Kyphscoliosis
  • Multiple sclerosis
  • Muscular dystrophies
  • Myasthenia gravis
  • Obesity
  • Obstructive sleep apnoea
  • Parkinson's disease
  • Post-Polio
  • Pregnancy
  • Pulmonary arterial hypertension
  • Renal failure
  • Sarcoidosis and interstitial lung disease
  • Senescence
  • Spinal cord injury
  • Surgical patients (thoracic and abdominal)
  • Ventilator-induced myopathy and failure to wean
  • Ventilatory failure (vulnerability to)
  • Vocal cord dysfunction and stridor

Are there any benefits to "warming-up" the inspiratory muscles?
Yes, research in healthy people shows that warming-up using a regimen of 30 repetitions at a load that's around 40% of the 30RM training load, increases performance by about half the amount that can be achieved with training alone. In fact, the benefits of training and warm-up appear to be additive. There is no evidence to suggest that patients will not respond in a similar manner.

Are there any risks associated with inspiratory muscle training?
There have been no reports of adverse events following inspiratory muscle training, but there is a theoretical risk of barotrauma-related events. Accordingly, caution should be exercised in the following situations –

  • A history of spontaneous pneumothorax (i.e., not due to traumatic injury)
  • A pneumothorax due to a traumatic injury that has not healed fully
  • A burst eardrum that has not healed fully, or any other condition of the eardrum

The sub-group of asthma patients with unstable asthma and abnormally low perception of dyspnoea are also unsuitable candidates for inspiratory muscle training. For more detailed information about contraindications please follow this link.

Can children undertake inspiratory muscle training?
Yes, provided that the structured breathing routine that the training requires can be comprehended, there is no reason for children not to undertake inspiratory muscle training. However, it's recommended that training be supervised by an adult in the under 16s.

How does respiratory muscle training work?
There are two main mechanisms: 1) exercise feels easier, so it's possible to exercise harder for the same effort; 2) training the inspiratory muscles delays or prevents the activation of a cardiovascular reflex that restricts blood flow to the exercising limbs (see About section of this website). Modification of this reflex means that blood flow and oxygen delivery to the limbs is preserved and performance is improved.

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Thanks to a unique partnership with PhysioTec, purchasers of "Respiratory Muscle Training: theory and practice" can build bespoke patient protocols, using Physiotecs online library of over 150 functional respiratory training exercises.
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About >

PhysioBREATHE training provides evidence-based guidance on respiratory muscle training for patients with a wide range of clinical conditions.
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The Book >

Respiratory Muscle Training: theory & practice is the world's first book to provide an "everything-you- need-to-know" guide to respiratory muscle training.
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The Author >

Professor Alison McConnell is the world's leading expert on respiratory muscle training and the creator of the market-leading POWERbreathe® inspiratory muscle trainers.
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Videos >

Access selected videos of functional respiratory training exercises from "Respiratory Muscle Training: theory and practice".
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