Respiratory Muscle Training in Institutionalized Elderly Population
Respiratory Muscle Training in Institutionalized Elderly Population
The global loss of muscle mass and strength associated with aging is a cause of functional
 impairment and disability, particularly in the frail elderly. Respiratory function can be
 severely compromised if there is a decrease of respiratory (RM) strength complicated by the
 presence of comorbidities and physical immobility.

 Previous studies have shown that the specific RM training is an effective method to increase
 RM strength, both in healthy people and patients. In this case, specific RM training may be
 regarded as a beneficial alternative to improve RM function, and thus prevent physical and
 clinical deterioration in this population.

 The hypothesis is that specific RM training would improve RM strength and endurance in the
 experimental groups vs. control who do not participate in RM training.

 Institutionalized elderly people with an inability to walk were randomly allocated to a
 control group, a Threshold group or a Pranayama group. Both experimental groups performed a
 supervised RM training, five days a week for six consecutive weeks. The maximum inspiratory
 and expiratory pressures (MIP and MEP) and the maximum voluntary ventilation (MVV) were
 assessed at four time points in each of three groups.
Studies have shown that general aerobic exercise training is accompanied by significant
 respiratory physiological benefits, including gains in RM strength and endurance (Larson, et
 al., 1999; Sheel, 2002; Watsford, et al., 2005; Lacasse et al., 2006). This benefit appears
 to be greater when general exercise conditioning is combined with specific RM training
 (Weiner, et al., 1992; Wanke, et al., 1994; Larson, et al., 1999; Hill y Eastwood, 2005;
 O'Brien, et al., 2008). However, many frail elderly are not able to perform general aerobic
 exercise, related or not to ADL, as it is mentioned above (e.g., institutionalized elderly
 with comorbidities, functional impairment and RM weakness). In this case, specific RM
 training may be used as a beneficial alternative to maintain or improve RM function (Watsford
 and Murphy, 2008), and thus prevent deterioration in this functionally impaired elderly.

 The most commonly used techniques of specific RM training are: a) isocapnic hyperpnoea (Leith
 and Bradley, 1976; Belman and Mittman, 1980), b) respiratory resistive loading (Pardy, et
 al., 1981; Sonne and Davis, 1982; Belman, et al., 1986), and c) respiratory threshold loading
 (Clanton, et al., 1985; Chen, et al., 1985; Martyn, et al., 1987; Larson, et al., 1988).
 Apart from these three well-known techniques, other less studied types of exercise such as
 the controlled breathing exercises of Yoga, Pranayama, may also be added to this list
 (Kulpati, et al., 1982; Manocha, et al., 2002; Donesky-Cueco, et al., 2009).
Inclusion Criteria:

 -  clinically stable residents, institutionalized at least 1 year;

 -  Barthel Index less than 95 points;

 -  inability to independently walk more than 10 meters or inability to effectively use a
 wheelchair;

 -  Mini-Mental Status Examination score of at least 20 points (i.e., subjects without
 moderate or severe cognitive deterioration).

 Exclusion Criteria:

 -  significant chronic cardiorespiratory diagnoses (e.g. moderate-severe COPD);

 -  an acute cardiorespiratory episode during the last 2 months prior to the study;

 -  neurological, muscular, or neuromuscular problems interfering with the capacity to
 engage in the tests and training protocols;

 -  active smokers or former smokers who had stopped smoking less than 5 years ago;

 -  a terminal disease.