Respiratory muscle performance with stretch‐shortening cycle manoeuvres: maximal inspiratory pressure–flow curves

Aim: To test the hypothesis that the maximal inspiratory muscle (IM) performance, as assessed by the maximal IM pressure–flow relationship, is enhanced with the stretch‐shortening cycle (SSC). Methods: Maximal inspiratory flow–pressure curves were measured in 12 healthy volunteers (35 ± 6 years) during maximal single efforts through a range of graded resistors (4‐, 6‐, and 8‐mm diameter orifices), against an occluded airway, and with a minimal load (wide‐open resistor). Maximal inspiratory efforts were initiated at a volume near residual lung volume (RV). The subjects exhaled to RV using slow (S) or fast (F) manoeuvres. With the S manoeuvre, they exhaled slowly to RV and held the breath at RV for about 4 s prior to maximal inspiration. With the F manoeuvre, they exhaled rapidly to RV and immediately inhaled maximally without a post‐expiratory hold; a strategy designed to enhance inspiratory pressure via the SSC. Results: The maximal inspiratory pressure–flow relationship was linear with the S and F manoeuvres (r² = 0.88 for S and r² = 0.88 for F manoeuvre, P < 0.0005 in all subjects). With the F manoeuvre, the pressure–flow relationship shifted to the right in a parallel fashion and the calculated maximal power increased by approximately 10% (P < 0.05) over that calculated with the S manoeuvre. Conclusion: The maximal inspiratory pressure–flow capacity can be enhanced with SSC manoeuvres in a manner analogous to increases in the force–velocity relationship with SSC reported for skeletal muscles.     

Ventilatory responses to exercise training in obese adolescents

The aim of this study was to examine ventilatory responses to training in obese adolescents. We assessed body composition, pulmonary function and ventilatory responses (among which expiratory flow limitation and operational lung volumes) during progressive cycling exercise in 16 obese adolescents (OB) before and after 12 weeks of exercise training and in 16 normal-weight volunteers. As expected, obese adolescents' resting expiratory reserve volume was lower and inversely correlated with thoraco-abdominal fat mass (r=-0.74, p<0.0001). OB presented lower end expiratory (EELV) and end inspiratory lung volumes (EILV) at rest and during submaximal exercise, and modest expiratory flow limitation. After training, OB increased maximal aerobic performance (+19%) and maximal inspiratory pressure (93.7±31.4 vs 81.9±28.2cmH(2)O, +14%) despite lack of decrease in trunk fat and body weight. Furthermore, EELV and EILV were greater during submaximal exercise (+11% and +9% in EELV and EILV, respectively), expiratory flow limitation delayed but was not accompanied by increased V(T). However, submaximal exertional symptoms (dyspnea and leg discomfort) were significantly decreased (-71.3% and -70.7%, respectively). Our results suggest that exercise training can improve pulmonary function at rest (static inspiratory muscle strength) and exercise (greater operating lung volumes and delayed expiratory flow limitation) but these modifications did not entirely account for improved dyspnea and exercise performance in obese adolescents.     

Attenuated inspiratory muscle metaboreflex in endurance-trained individuals

The inspiratory metaboreflex is activated during loaded breathing to task failure and induces sympathetic activation and peripheral vasoconstriction that may limit exercise performance. Inspiratory muscle training appears to attenuate the inspiratory metaboreflex in healthy subjects. Since whole body aerobic exercise training improves breathing endurance and inspiratory muscle strength, we hypothesized that endurance-trained individuals would demonstrate a blunted inspiratory muscle metaboreflex in comparison to sedentary individuals. We studied 9 runners (23±0.7 years; maximal oxygen uptake [VO2 max] = 53 ± 4 ml kg(-1) min(-1)) and 9 sedentary healthy volunteers (24±0.7 years; VO2 max = 37 ±2 ml kg(-1) min(-1)). The inspiratory muscle metaboreflex was induced by breathing against an inspiratory load of 60% of maximal inspiratory pressure (MIP), with prolonged duty cycle. Arterial pressure, popliteal blood flow, and heart rate were measured throughout the protocol. Loaded breathing to task failure increased mean arterial pressure in both sedentary and endurance-trained individuals (96±3 to 100±4 mmHg and 101±3 to 110±5 mmHg). Popliteal blood flow decreased in sedentary but not in trained individuals (0.179±0.01 to 0.141±0.01 cm/s, and 0.211±0.02 to 0.214±0.02 cm/s). Similarly, popliteal vascular resistance increased in sedentary but not in trained individuals (559±35 to 757±56 mmHg s/cm, and 528±69 to 558±64 mmHg s/cm). These data demonstrate that endurance-trained individuals have an attenuated inspiratory muscle metaboreflex.     

Acute and chronic responses of the upper airway to inspiratory loading in healthy awake humans: an MRI study

We assessed upper airway responses to acute and chronic inspiratory loading. In Experiment I, 11 healthy subjects underwent T(2)-weighted magnetic resonance imaging (MRI) of upper airway dilator muscles (genioglossus and geniohyoid) before and up to 10 min after a single bout of pressure threshold inspiratory muscle training (IMT) at 60% maximal inspiratory mouth pressure (MIP). T(2) values for genioglossus and geniohyoid were increased versus control (p<0.001), suggesting that these airway dilator muscles are activated in response to acute IMT. In Experiment II, nine subjects underwent 2D-Flash sequence MRI of the upper airway during quiet breathing and while performing single inspirations against resistive loads (10%, 30% and 50% MIP); this procedure was repeated after 6 weeks of IMT. Lateral narrowing of the upper airway occurred at all loads, whilst anteroposterior narrowing occurred at the level of the laryngopharynx at loads > or =30% MIP. Changes in upper airway morphology and narrowing after IMT were undetectable using MRI.     

Unilateral arm strength training improves contralateral peak force and rate of force development

Neural adaptation following maximal strength training improves the ability to rapidly develop force. Unilateral strength training also leads to contralateral strength improvement, due to cross-over effects. However, adaptations in the rate of force development and peak force in the contralateral untrained arm after one-arm training have not been determined. Therefore, we aimed to detect contralateral effects of unilateral maximal strength training on rate of force development and peak force. Ten adult females enrolled in a 2-month strength training program focusing of maximal mobilization of force against near-maximal load in one arm, by attempting to move the given load as fast as possible. The other arm remained untrained. The training program did not induce any observable hypertrophy of any arms, as measured by anthropometry. Nevertheless, rate of force development improved in the trained arm during contractions against both submaximal and maximal loads by 40-60%. The untrained arm also improved rate of force development by the same magnitude. Peak force only improved during a maximal isometric contraction by 37% in the trained arm and 35% in the untrained arm. One repetition maximum improved by 79% in the trained arm and 9% in the untrained arm. Therefore, one-arm maximal strength training focusing on maximal mobilization of force increased rapid force development and one repetition maximal strength in the contralateral untrained arm. This suggests an increased central drive that also crosses over to the contralateral side.     

Effects of preoperative inspiratory muscle training in obese women undergoing open bariatric surgery: respiratory muscle strength, lung volumes, and diaphragmatic excursion

OBJECTIVE:

To determine whether preoperative inspiratory muscle training is able to attenuate the impact of surgical trauma on the respiratory muscle strength, in the lung volumes, and diaphragmatic excursion in obese women undergoing open bariatric surgery.

DESIGN:

Randomized controlled trial.

SETTING:

Meridional Hospital, Cariacica/ES, Brazil.

SUBJECTS:

Thirty-two obese women undergoing elective open bariatric surgery were randomly assigned to receive preoperative inspiratory muscle training (inspiratory muscle training group) or usual care (control group).

MAIN MEASURES:

Respiratory muscle strength (maximal static respiratory pressure – maximal inspiratory pressure and maximal expiratory pressure), lung volumes, and diaphragmatic excursion.

RESULTS:

After training, there was a significant increase only in the maximal inspiratory pressure in the inspiratory muscle training group. The maximal expiratory pressure, the lung volumes and the diaphragmatic excursion did not show any significant change with training. In the postoperative period there was a significant decrease in maximal inspiratory pressure in both the groups. However, there was a decrease of 28% in the inspiratory muscle training group, whereas it was 47% in the control group. The decrease in maximal expiratory pressure and in lung volumes in the postoperative period was similar between the groups. There was a significant reduction in the measures of diaphragmatic excursion in both the groups.

CONCLUSION:

The preoperative inspiratory muscle training increased the inspiratory muscle strength (maximal inspiratory pressure) and attenuated the negative postoperative effects of open bariatric surgery in obese women for this variable, though not influencing the lung volumes and the diaphragmatic excursion.     

Maximal activation of the human diaphragm but not inspiratory intercostal muscles during static inspiratory efforts

It is widely held that transdiaphragmatic pressure is a reliable index of the extent of central activation of the diaphragm but the maximal voluntary transdiaphragmatic pressure is lower during inspiratory than expulsive efforts. To determine whether the diaphragm is fully activated during the two manoeuvres supramaximal stimuli were delivered to both phrenic nerves during maximal efforts. No discernible twitch was evoked during 30-55% of attempted maximal efforts with either voluntary manoeuvre. Thus the difference in maximal transdiaphragmatic pressure between the manoeuvres must reflect changes in chest-wall geometry or mechanics rather than in the phrenic motor outflow. Inspiratory intercostal muscle activity was consistently submaximal during maximal inspiratory efforts.     

Changes in peak expiratory flow and respiratory strength during the menstrual cycle

This study evaluated the spirometry and respiratory static pressures in 17 young women, twice a week for three successive ovulatory menstrual cycles to determine if such variables changed across the menstrual, follicular, periovulatory, early-to-mid luteal and late luteal phases. The factors phases of menstrual cycle and individual cycles had no significant effect on the spirometry variables except for peak expiratory flow (PEF) and respiratory static pressures. Significant weak positive correlations were found between the progesterone:estradiol ratio and PEF and between estrogen and tidal volume (r = 0.37), inspiratory time (r = 0.22), expiratory time (r = 0.19), maximal inspiratory pressure (r = 0.25) and maximal expiratory pressure (r = 0.20) and for progesterone and maximal inspiratory pressure (r = 0.32) during the early-to-mid luteal phase. Although most parameters of the spirometry results did not change during the menstrual cycle, the correlations observed between sexual hormones and respiratory control variables suggest a positive influence of sexual female hormones controlling the thoracic pump muscles in the luteal phase.     

Influence of load and stretch shortening cycle on the kinematics, kinetics and muscle activation that occurs during explosive upper-body movements

Although explosive power in lower-body movements has been extensively studied, there is a paucity of research examining such movements in the upper body. This study aimed to investigate the influence of load and the stretch shortening cycle (SSC) on the kinematics, kinetics, and muscle activation that occurs during maximal effort throws. A total of 17 male subjects performed SSC and concentric only (CO) bench throws using loads of 15%, 30%, 45%, 60%, 75%, 90% and 100% of their previously determined one repetition maximum bench press. The displacement, velocity, acceleration, force and power output as well as the electromyogram (EMG) from pectoralis major, anterior deltoid, and triceps brachii were recorded for each throw. The results were compared using multivariate analysis of variance with repeated measures. A criterion alpha level of P?≤?0.05 was used. Similar force velocity power relationships were determined for this multijoint upper-body movement as has been found for isolated muscles, single joint movements, and vertical jumping. The highest power output was produced at the 30% [563 (104) W] and 45% [560 (86) W] loads during the SSC throws. Force output increased as a function of load; however, even the lighter loads resulted in considerable force due to the high accelerations produced. Average velocity, average and peak force, and average and peak power output were significantly higher for the SSC throws compared to the CO throws. However, peak velocity and height thrown were not potentiated by performing the pre-stretch because the duration and range of movement allowed the ability of the muscle to generate force at high shortening velocities to dominate the resulting throw. As such, explosive movements involving longer concentric actions than experienced during brief SSC movements may be limited by the ability of the muscle to produce force during fast contraction velocities.     

Pulmonary adaptations to swim and inspiratory muscle training

Because the anomalous respiratory characteristics of competitive swimmers have been suggested to be due to inspiratory muscle work, the respiratory muscle and pulmonary function of 30 competitively trained swimmers was assessed at the beginning and end of an intensive 12-week swim training (ST) program. Swimmers (n = 10) combined ST with either inspiratory muscle training (IMT) set at 80% sustained maximal inspiratory pressure (SMIP) with progressively increased work-rest ratios until task failure for 3-days per week (ST + IMT) or ST with sham-IMT (ST + SHAM-IMT, n = 10), or acted as controls (ST only, ST, n = 10). Measures of respiratory and pulmonary function were assessed at the beginning and end of the 12 week study period. There were no significant differences (P > 0.05) in respiratory and pulmonary function between groups (ST + IMT, ST + SHAM-IMT and ST) at baseline and at the end of the 12 week study period. However, within all groups significant increases (P < 0.05) were observed in a number of respiratory and pulmonary function variables at the end of the 12 week study, such as maximal inspiratory and expiratory pressure, inspiratory power output, forced vital capacity, forced expiratory and inspiratory volume in 1-s, total lung capacity and diffusion capacity of the lung. This study has demonstrated that there are no appreciable differences in terms of respiratory changes between elite swimmers undergoing a competitive ST program and those undergoing respiratory muscle training using the flow-resistive IMT device employed in the present study; as yet, the causal mechanisms involved are undefined.     

Interpretation of changes in spirographic and flow-volume variables after operative treatment in bilateral vocal cord paralysis

In 13 patients, who underwent a superolateralization of a vocal cord after bilateral vocal cord paralysis, we studied pre- and postoperatively spirometric dynamic and static lung volumes and variables from maximal expiratory and maximal inspiratory flow-volume (MEFV and MIFV) curves. The effects of surgical treatment on these variables have been established by comparing the statistical significance of the changes post- versus preoperative. A significant increase was found in the vital capacity and a significant decrease in the indices associated with the dynamic variability of the obstruction. The most significant changes were found in peak inspiratory flow and peak expiratory flow, and in the inspiratory defined dynamic estimates, as forced inspiratory volume in 1 second and maximal voluntary ventilation at a frequency of 30 c X min-1. Significant correlations, however, were found to exist only for the changes within the group of flow-volume indices and for those within the group of spirographic variables. This led us to the conclusion that for the diagnosis of this type of upper airway obstruction these measurements are additive, reflecting different aspects of airway mechanics.     

Comparison of muscle sympathetic nerve activity during exercise in dominant and nondominant forearm

Summary To determine whether or not muscle endurance training alters exercise-induced sympathetic nerve response, we recorded muscle sympathetic nerve activity (MSNA) microneurographically during forearm exercise and compared MSNA between dominant (D) and nondominant (ND) forearms of players of racket sports. Three kinds of forearm exercise were conducted on each side; static (SHG) and dynamic (DHG, at a rate of 1 Hz) handgrip exercise at a loading of 25°10 of maximal voluntary contraction until exhaustion, and 10-min submaximal dynamic handgrip (at a rate of 1 Hz) at an intensity of 0.9 W. Heart rate, ventilation and blood pressure were also monitored at rest and during SHG and DHG exercises. During the last minute of SHG exercise, MSNA burst rate had increased on average by 290 (SEM 46) % in D and 330 (SEM 46) % in ND, while during DHG it increased by 288 (SEM 38) % in D and 344 (SEM 36) % in ND, respectively. There were no significant differences in the MSNA responses between D and ND forearms in either exercise modes. Significant increases in heart rate, ventilation and blood pressure during the last minute of fatiguing SHG and DHG were observed, but there were no significant differences between the two forearms. During submaximal DHG, while MSNA increased significantly above control values in both D and ND, the MSNA response was less in D than that in ND forearm. The results would suggest that exercise-induced MSNA responsiveness is influenced little by muscle endurance training but the intensity of response may be due to the magnitude of metaboreceptor stimulation in the exercising muscle.     

Exercise mode affects muscle sympathetic nerve responsiveness

To compare the responses of remote sympathetic nerves to dynamic and static leg exercises, we recorded sympathetic nerve activity leading to skeletal muscle (MSNA) using a tungsten microelectrode during one-leg cycling at loads of 0, 25, and 50 W and during static leg extension (SLE) at 20% of maximal voluntary contraction. Oxygen uptake (Douglas bag method) and local fatigue sensation (LFS) of the working muscle were measured during cycling and SLE. MSNA decreased from the control value, respectively, by 25, 21, and 12% during cycling at loads of 0, 25, and 50 W. The differences from the control value were significant except during cycling at 50 W. On the contrary, MSNA increased from the control value by 83% during SLE. Oxygen uptake during 25 and 50 W leg cycling was greater than during SLE, whereas LFS was higher during SLE than during leg cycling at any load. The results indicate that the response of muscle sympathetic nerves to exercise does not exclusively reflect whole body metabolism, but is instead related to the local metabolic changes.     

Increases in inspiratory neural drive in response to rapid oscillating airflow braking forces (vibration)

OBJECTIVE: To investigate whether 10 breaths against a vibration stimulus elicits increments of spontaneous and maximal inspiratory mouth pressure (maxMP) and tidal mean inspiratory flow (iV(T)/T(I)) upon stimulus removal. METHODS: Twelve healthy subjects (8 female, 4 male; 22-50 years old), recruited from the University student body, completed 3 maximal inspirations before (pre) and after (post) 10 inspirations against resistive loading with a vibration-type stimulus (VIB; youbreathe, Exoscience Ltd., London, UK), pressure-matched resistive loading (RES) or resting breathing (CON; no load). The trials were presented in a random order. maxMP and involuntary tidal breathing were compared pre and post conditioning. RESULTS: Inspiratory neural drive increased only after VIB as evidenced by increased tidal and maxMP and mean inspiratory flow (iV(T)/T(I); p < 0.05). There was no effect of either resistance or control breathing on maximal maxMP or tidal responses. CONCLUSIONS: Ten conditioning breaths of VIB lead to increased maximal inspiratory mouth pressure and spontaneous mouth pressure and mean inspiratory flow possibly through a common mechanism of increased descending respiratory drive.     

Mechanical activity of mammalian heart muscle: variable onset, species differences, and the effect of caffeine.

The time course of the ability to shorten during contraction was measured using velocity of shortening of the contractile element corrected for length after quick releases to constant loads, in isolated papillary muscles of the cat, rabbit, dog, and rat. The ratios of time-to-peak shortening ability at preload (TTPA), to time-to-peak active force (TPF), were 0.30, 0.36, 0.32, and 0.70 in the cat, dog, rat and rabbit, respectively. When the pacing rate was increased from 12 to 60/min, peak force was augmented in the cat (36%) and rabbit (108%), while TPF decreased in the cat (by 30%) but not in the rabbit. Various inotropic interventions did not alter the ratio of TTPA/TPF in any species. However, caffeine (10mM) increased this ratio to that normally found in the rabbit, in which it was not altered. Afterloaded force-peak velocity relations of the cat, dog, and rat were curvilinear, but in the rabbit in the control state, and in the cat and dog in the presence of caffeine, these relationships tended to be linear. The differences in the time course of the ability to shorten among these mammalian species may be related to differences in excitation-contraction coupling.     

Diaphragm and intercostal surface EMG and muscle performance after acute inspiratory muscle loading

We examined the effect of an acute bout of submaximal non-fatiguing inspiratory loading (IL) on maximal inspiratory pressure (MIP), and on the activation of the diaphragm (DI) and intercostals (IC) using surface electromyography (sEMG). After baseline measurements, 12 healthy subjects performed two sets of 30 inspiratory efforts at a load equivalent to 40% of their initial MIP. MIP and maximal DI and IC sEMG activity were recorded after the first and second set of IL, and 15 min after task cessation. After IL, MIP reached (+/-S.E.M.) 111+/-4% (P=0.032) of baseline values, and during MIP, DI and IC root mean square (RMS) sEMG amplitude increased significantly above baseline (143+/-21%, P=0.039 and 137+/-33%, P=0.016, respectively). The significant increase in MIP and RMS amplitude after IL suggests that MIP efforts were initially submaximal, and that prior loading enabled full activation. The changes in DI and IC RMS amplitude may also reflect an improvement in the synergy between them during these maximal efforts.     

Respiratory muscle performance with stretch-shortening cycle manoeuvres: maximal inspiratory pressure-flow curves

AIM: To test the hypothesis that the maximal inspiratory muscle (IM) performance, as assessed by the maximal IM pressure-flow relationship, is enhanced with the stretch-shortening cycle (SSC). METHODS: Maximal inspiratory flow-pressure curves were measured in 12 healthy volunteers (35 +/- 6 years) during maximal single efforts through a range of graded resistors (4-, 6-, and 8-mm diameter orifices), against an occluded airway, and with a minimal load (wide-open resistor). Maximal inspiratory efforts were initiated at a volume near residual lung volume (RV). The subjects exhaled to RV using slow (S) or fast (F) manoeuvres. With the S manoeuvre, they exhaled slowly to RV and held the breath at RV for about 4 s prior to maximal inspiration. With the F manoeuvre, they exhaled rapidly to RV and immediately inhaled maximally without a post-expiratory hold; a strategy designed to enhance inspiratory pressure via the SSC. RESULTS: The maximal inspiratory pressure-flow relationship was linear with the S and F manoeuvres (r2 = 0.88 for S and r2 = 0.88 for F manoeuvre, P < 0.0005 in all subjects). With the F manoeuvre, the pressure-flow relationship shifted to the right in a parallel fashion and the calculated maximal power increased by approximately 10% (P < 0.05) over that calculated with the S manoeuvre. CONCLUSION: The maximal inspiratory pressure-flow capacity can be enhanced with SSC manoeuvres in a manner analogous to increases in the force-velocity relationship with SSC reported for skeletal muscles.     

Effects of aminophylline upon the exercise performance of patients with stable chronic airflow obstruction

To assess the effects of aminophylline upon the exercise performance of patients with chronic airflow obstruction (CAO), we performed ramp exercise tests (1 W/3 s) on six CAO subjects before and after intravenous aminophylline (6 mg X kg-1). The subjects had airflow obstruction (mean FEV1/FVC = 0.53) which did not improve following the inhalation of aerosolized isoetharine. After intravenous aminophylline, maximal oxygen uptake, maximal work rate and exercise duration increased (p less than 0.03) and the subjective dyspnea scores during exercise decreased (p less than 0.05). These changes were not accompanied by increases of FEV1 or peak expiratory flow rate, but maximal inspiratory pressure and peak inspiratory flow rate during exercise increased (p less than 0.05). These observations suggest that aminophylline acutely improves the maximal exercise performance of CAO subjects by mechanisms other than bronchodilation.     

Chest wall volume changes during inspiratory loaded breathing

We assessed the effect of inspiratory loaded breathing (ILB) on respiratory muscle strength and investigated the extent to which respiratory muscle fatigue is associated with chest wall volume changes during ILB. Twelve healthy subjects performed ILB at 76 ± 11% of maximal inspiratory mouth pressure (MIP) for 1h. MIP and breathing pattern during 3 min of normocapnic hyperpnea (NH) were measured before and after ILB. Breathing pattern and chest wall volume changes were assessed by optoelectronic plethysmography. After ILB, six subjects decreased MIP significantly (-16 ± 10%; p < 0.05), while the other six subjects did not (0 ± 7%, p = 0.916). Only subjects with decreased MIP after ILB lowered end-expiratory rib cage volume (volume at which inspiration is initiated) below resting values during ILB. During NH after ILB, tidal volume was smaller in subjects with decreased MIP (-19 ± 16%, p < 0.05), while it remained unchanged in the other group (-3 ± 11%, p = 0.463). These results suggest that respiratory muscle fatigue depends on the lung volume from which inspiratory efforts are made during ILB.     

Anatomical model of the human trunk for analysis of respiratory muscles mechanics

A realistic two-dimensional (2D) model of the human trunk was developed for quantitative analysis of the relative contribution to breathing mechanics of seven groups of respiratory muscles. Along with noninvasive measurements of electromyography (EMG) signals from respiratory muscles near the skin surface, it provides predictions for the forces generated by inner respiratory muscles as well as the instantaneous work of each muscle. The results revealed that inspiratory muscles reach their maximal force towards the end of inspiration, while expiratory muscles reach their maximal force at mid-expiration. Inspiratory muscles contributed to the work of breathing even at low efforts, while that of the expiratory muscles was observed only at relatively high efforts. The study clearly showed that the diaphragm muscle generates forces, which are of the same order as those generated by other inspiratory muscles, but performed 60-80% of the inspiratory work. The contribution of the external intercostal muscle to inspiration was not negligible, especially at high breathing efforts.