Canadian Respiratory Journal

Review Article

Inspiratory Muscle Rehabilitation Training in Pediatrics: What Is the Evidence?

Table 6

Inspiratory muscle rehabilitation training (IMRT) in children with obesity.


Citation	Study Design	Population	Intervention	Outcomes

LoMauro et al. 2016 [61]	Before-and-after trial	12–17-year-old children with obesity (BMI z > 2) enrolled in a multidisciplinary body weight reduction program	Duration: 3 weeks	Body weight reduction program with IMRT was associated with improved exercise performance (peak work rate increased by 26 W; = 0.003) and lung and chest wall volume recruitment (inspiratory capacity reduced by 290 ± 550 mL)
		(Mean BMI = 36 kg/cm²)	Frequency: 5 x/week	Dyspnea and leg discomfort during exercise were reduced
		N = 11 males	Intensity: 50–60% MVV	FVC improved by 4% predicted ( = 0.019)
			Volume: 12–18 min sessions, 25 inspirations, 1 session/d	During exercise, abdominal ribcage hyperinflation was delayed and led to
			Type: eucapnic hyperventilation	15% increased exercise capacity and reduced dyspnea at high workloads ( < 0.05) without ventilatory and metabolic changes
			Equipment: Spiro 141 Tiger®	MIP and MEP not reported
			All participants underwent a body weight reduction program including
			energy-restricted diet, psychological and nutritional counseling and aerobic physical activity

Salvadego et al. 2017 [59]	Non-randomized parallel group trial	15–19-year-old sedentary adolescents with a BMI >97^th percentile enrolled in a multidisciplinary body weight reduction program	Duration: 3 weeks	IMRT group had significantly greater PEF (∆PEF = 13% predicted [IMRT group] vs. 3% predicted [control group]), reduced oxygen cost of exercise and dyspnea ratings during exercise completed above the gas exchange threshold compared with the control group
		(mean BMI ≈ 39 kg/cm²)	Frequency: 5 x/week	MIP and MEP not reported
		N = 17 males	Intensity: 50–60% MVV
			Volume: 12–18 min sessions, 25 inspirations, 1 session/d
			Type: eucapnic hyperventilation
			Equipment: Spiro Tiger®
			(Control: No IMRT)
			All participants underwent a body weight reduction program including
			energy-restricted diet, psychological and nutritional counseling and aerobic physical activity

Alemayehu et al. 2018 [60]	RCT	15–18-year-old sedentary adolescents with a BMI >97^th percentile enrolled in a multidisciplinary body weight reduction program	Duration: 3 weeks	IMRT group had significantly greater improvement in time to exhaustion and peak exercise intensity during a treadmill test
		(Mean BMI = 40 kg/cm²)	Frequency: 5 x/week	IMRT had greater reduction in heart rate and oxygen cost of exercise below and above the gas exchange threshold and in dyspnea ratings above the gas exchange threshold
		N = 16 males	Intensity: 50–60% MVV	MIP and MEP not reported
			Volume: 12–18 min sessions, 25 inspirations, 1 session/d
			Type: eucapnic hyperventilation
			Equipment: Spiro Tiger®
			(Control: no IMRT)
			All participants underwent a body weight reduction program including
			energy-restricted diet, psychological and nutritional counseling and aerobic physical activity

Note. BMI–body mass index, MVV–maximal voluntary ventilation, FVC–forced vital capacity, and PEF–peak expiratory flow.