Alison K. McConnell

Objective: To evaluate whether a slow and deep breathing (SDB) intervention is acceptable to pregnant women. Methods: The trial aims to recruit 67 pregnant women who have developed pregnancy-induced hypertension (clinicaltrials.gov: NCT04059822). SDB will be undertaken daily for 10 min using a video aid and women will self-monitor blood pressure (BP) daily. At 36-weeks gestation women will complete an online questionnaire. Adherence, recruitment rates, and acceptance of the intervention will be evaluated. Conclusion: The findings from this trial will evaluate if women accept SDB as a treatment method. Initial analysis will evaluate if BP and/or obstetric interventions reduce following SDB intervention.

Inspiratory muscle training applies a training stimulus directly to the inspiratory muscles and is distinct from whole‐body training. The potential benefits of inspiratory muscle training have yet to be explored in horses. The objectives were: 1) to develop an equine‐specific method of testing and training inspiratory muscles; 2) to assess tolerance and feasibility in a pilot study in a commercial Thoroughbred training establishment. Field study. A mask was used to interface commercial human inspiratory muscle training equipment. Ten horses undertook inspiratory muscle training once daily while stood in the stable approximately 5 days/week over a 9‐week period. Inspiratory muscle strength testing employed a continuous incremental inspiratory loading protocol alternating two loaded and two minimally loaded breaths until failure to tolerate the load occurred or the maximum 60 breaths were completed. The inspiratory muscle strength testing was undertaken twice; firstly in 10 horses with minimal acclimatisation and secondly in 8 horses experienced with the inspiratory muscle training programme. The ten horses undertook inspiratory muscle training for a median of 42 days, reaching a median peak training load of 32.5cmH₂O. One horse did not tolerate the mask with repeated snorting and was replaced. All horses completed the inspiratory muscle strength testing. The median peak value in Inspiratory Muscle Strength Testing Protocol 1 was 27cmH₂O and in Inspiratory Muscle Strength Testing Protocol 2 was 41cmH₂O. Two of 10 horses reached the maximum possible value in Inspiratory Muscle Strength Testing Protocol 1; therefore, the test was adapted to permit a higher maximum value, despite this 3/8 horses reached the maximum possible value in Inspiratory Muscle Strength Testing Protocol 2. Main limitations A small number of horses were assessed. The inspiratory muscle strength testing was refined during the study and requires additional refinement. Inspiratory muscle testing and training were feasible and tolerated in horses. Further research is required to understand whether the inspiratory muscle strength testing values obtained correlate with other physiological/performance outcomes. The potential benefits and/or adverse effects of inspiratory muscle training warrant further investigation.

Purpose: Prolonged workplace sitting can harm employee health. Sit-stand desks are a potential workplace health initiative that might reduce and break up the time office-based employees spend sitting in the workplace. However, little is known about the feasibility and acceptability of providing sit-stand desks. The paper aims to discuss this issue. Design/methodology/approach: The present study sought stakeholder employee views surrounding sit-stand desk implementation within two UK-based non-profit organisations with open-plan offices. This paper draws on qualitative semi-structured interviews with 26 stakeholder employees and 65 days of participant observations. Data were analysed using thematic analysis, and organisational cultural theory framed the study. Findings: Stakeholders employees’ positioning of sit-stand desks as a workplace health initiative reflected their perceptions of the relationship between sit-stand desk provision, employee health and organisational effectiveness. Perceptions were shaped by the nature and context of the organisation and by occupation-specific processes. Relatively fixed (e.g. organisational structure) and modifiable (e.g. selecting products compatible with the environment) factors were found to restrict and facilitate the perceived feasibility of implementing sit-stand desks. Practical implications: The findings offer several recommendations for workplaces to improve stakeholder employee attitudes towards sit-stand desk provision and to increase the ease and efficiency of implementation. Originality/value: Whilst extant literature has tended to examine hypothetical views related to sit-stand desk provision, this study consulted relevant stakeholders following, and regarding, the sit-stand desk implementation process.

To examine the effects of 8‐week unsupervised, home‐based inspiratory muscle training (IMT) on the balance and physical performance of healthy older adults. Fifty‐nine participants (74 ± 6 years) were assigned randomly in a double‐blinded fashion to either IMT or sham‐IMT, using a pressure threshold loading device. The IMT group performed 30‐breath twice daily at ~50% of maximal inspiratory pressure (MIP). The sham‐IMT group performed 60‐breaths once daily at ~15% MIP; training was home‐based and unsupervised, with adherence self‐reported through training diaries. Respiratory outcomes were assessed pre‐ and postintervention, including forced vital capacity, forced expiratory volume, peak inspiratory flow rate (PIFR), MIP, and inspiratory peak power. Balance and physical performance outcomes were measured using the shortened version of the Balance Evaluation System test (mini‐BEST), Biodex^® postural stability test, timed up and go, five sit‐to‐stand, isometric “sit‐up” and Biering–Sørensen tests. Between‐group effects were examined using two‐way repeated measures ANOVA, with Bonferroni correction. After 8‐week, the IMT group demonstrated greater improvements (P ≤ 0.05) in: PIFR (IMT = 0.9 ± 0.3 L sec⁻¹; sham‐IMT = 0.3 L sec⁻¹); mini‐BEST (IMT = 3.7 ± 1.3; sham‐IMT = 0.5 ± 0.9) and Biering–Sørensen (IMT = 62.9 ± 6.4 sec; sham‐IMT = 24.3 ± 1.4 sec) tests. The authors concluded that twice daily unsupervised, home‐based IMT is feasible and enhances inspiratory muscle function and balance for community‐dwelling older adults.

Background: This study aimed to investigate whether adjunctive inspiratory muscle training (IMT) can enhance the well-established benefits of pulmonary rehabilitation (PR) in patients with COPD.Methods: 219 patients with COPD (FEV₁: 42%±16% predicted) with inspiratory muscle weakness (PImax: 51±15 cm H₂O) were randomised into an intervention group (IMT+PR; n=110) or a control group (Sham-IMT+PR; n=109) in this double-blind, multicentre randomised controlled trial between February 2012 and October 2016 (ClinicalTrials.govNCT01397396). Improvement in 6 min walking distance (6MWD) was a priori defined as the primary outcome. Prespecified secondary outcomes included respiratory muscle function and endurance cycling time.Findings: No significant differences between the intervention group (n=89) and the control group (n=85) in improvements in 6MWD were observed (0.3 m, 95% CI −13 to 14, p=0.967). Patients who completed assessments in the intervention group achieved larger gains in inspiratory muscle strength (effect size: 1.07, p<0.001) and endurance (effect size: 0.79, p<0.001) than patients in the control group. 75 s additional improvement in endurance cycling time (95% CI 1 to 149, p=0.048) and significant reductions in Borg dyspnoea score at isotime during the cycling test (95% CI −1.5 to −0.01, p=0.049) were observed in the intervention group.Interpretation: Improvements in respiratory muscle function after adjunctive IMT did not translate into additional improvements in 6MWD (primary outcome). Additional gains in endurance time and reductions in symptoms of dyspnoea were observed during an endurance cycling test (secondary outcome)Trial registration number: NCT01397396; Results.

The addition of IMT to a PR programme for selected COPD patients changes breathing pattern during exercise http://ow.ly/WWrFT

Background: Most inspiratory muscle training (IMT) interventions in patients with chronic obstructive pulmonary disease (COPD) have been implemented as fully supervised daily training for 30 minutes with controlled training loads using mechanical threshold loading (MTL) devices. Recently, an electronic tapered flow resistive loading (TFRL) device was introduced that has a different loading profile and stores training data during IMT sessions.Objective: The aim of this study was to compare the efficacy of a brief, largely unsupervised IMT protocol conducted using either traditional MTL or TFRL on inspiratory muscle function in patients with COPD.Design: Twenty patients with inspiratory muscle weakness who were clinically stable and participating in a pulmonary rehabilitation program were randomly allocated to perform 8 weeks of either MTL IMT or TFRL IMT.Methods: Participants performed 2 daily home-based IMT sessions of 30 breaths (3–5 minutes per session) at the highest tolerable intensity, supported by twice-weekly supervised sessions. Adherence, progression of training intensity, increases in maximal inspiratory mouth pressure (Pimax), and endurance capacity of inspiratory muscles (Tlim) were evaluated.Results: More than 90% of IMT sessions were completed in both groups. The TFRL group tolerated higher loads during the final 3 weeks of the IMT program, with similar effort scores on the 10-Item Borg Category Ratio (CR-10) Scale, and achieved larger improvements in Pimax and Tlim than the MTL group.Limitations: A limitation of the study was the absence of a study arm involving a sham IMT intervention.Conclusions: The short and largely home-based IMT protocol significantly improved inspiratory muscle function in both groups and is an alternative to traditional IMT protocols in this population. Participants in the TFRL group tolerated higher training loads and achieved larger improvements in inspiratory muscle function than those in the MTL group.

A lack of physical activity and excessive sitting can contribute to poor physical health and wellbeing. The high percentage of the UK adult population in employment, and the prolonged sitting associated with desk-based office-work, make these workplaces an appropriate setting for interventions to reduce sedentary behaviour and increase physical activity. This pilot study aims to determine the effect of an office-based sit-stand workstation intervention, compared with usual desk use, on daily sitting, standing and physical activity, and to examine the factors that underlie sitting, standing and physical activity, within and outside, the workplace. A randomised control trial (RCT) comparing the effects of a sit-stand workstation only and a multi-component sit-stand workstation intervention, with usual desk-based working practice (no sit-stand workstation) will be conducted with office workers across two organisations, over a 12 month period (N = 30). The multicomponent intervention will comprise organisational, environmental and individual elements. Objective data will be collected at baseline, and after 2-weeks, 3-months, 6-months and 12-months of the intervention. Objective measures of sitting, standing, and physical activity will be made concurrently (ActivPAL3™ and ActiGraph (GT3X+)). Activity diaries, ethnographic participant observation, and interviews with participants and key organisational personnel will be used to elicit understanding of the influence of organisational culture on sitting, standing and physical activity behaviour in the workplace. This study will be the first long-term sit-stand workstation intervention study utilising an RCT design, and incorporating a comprehensive process evaluation. The study will generate an understanding of the factors that encourage and restrict successful implementation of sit-stand workstation interventions, and will help inform future occupational wellbeing policy and practice. Other strengths include the objective measurement of physical activity during both work and non-work hours. Clinicaltrials.gov identifier NCT02172599 , 22nd June 2014.

We have shown that individuals with recurrent nonspecific low back pain (LBP) and healthy individuals breathing against an inspiratory load decrease their reliance on back proprioceptive signals in upright standing. Because individuals with LBP show greater susceptibility to diaphragm fatigue, it is reasonable to hypothesize that LBP, diaphragm dysfunction, and proprioceptive use may be interrelated. The purpose of this study was to investigate whether inspiratory muscle training (IMT) affects proprioceptive use during postural control in individuals with LBP. Twenty-eight individuals with LBP were assigned randomly into a high-intensity IMT group (high IMT) and low-intensity IMT group (low IMT). The use of proprioception in upright standing was evaluated by measuring center of pressure displacement during local muscle vibration (ankle, back, and ankle–back). Secondary outcomes were inspiratory muscle strength, severity of LBP, and disability. After high IMT, individuals showed smaller responses to ankle muscle vibration, larger responses to back muscle vibration, higher inspiratory muscle strength, and reduced LBP severity (P < 0.05). These changes were not seen after low IMT (P > 0.05). No changes in disability were observed in either group (P > 0.05). After 8 wk of high IMT, individuals with LBP showed an increased reliance on back proprioceptive signals during postural control and improved inspiratory muscle strength and severity of LBP, not seen after low IMT. Hence, IMT may facilitate the proprioceptive involvement of the trunk in postural control in individuals with LBP and thus might be a useful rehabilitation tool for these patients.

Functional activities, such as the sit-to-stand-to-sit (STSTS) task, are often impaired in individuals with chronic obstructive pulmonary disease (COPD). The STSTS task places a high demand on the postural control system, which has been shown to be impaired in individuals with COPD. It remains unknown whether postural control deficits contribute to the decreased STSTS performance in individuals with COPD. Center of pressure displacement was determined in 18 individuals with COPD and 18 age/gender-matched controls during five consecutive STSTS movements with vision occluded. The total duration, as well as the duration of each sit, sit-to-stand, stand and stand-to-sit phase was recorded. Individuals with COPD needed significantly more time to perform five consecutive STSTS movements compared to healthy controls (19±6 vs. 13±4 seconds, respectively; p = 0.001). The COPD group exhibited a significantly longer stand phase (p = 0.028) and stand-to-sit phase (p = 0.001) compared to the control group. In contrast, the duration of the sit phase (p = 0.766) and sit-to-stand phase (p = 0.999) was not different between groups. Compared to healthy individuals, individuals with COPD needed significantly more time to complete those phases of the STSTS task that require the greatest postural control. These findings support the proposition that suboptimal postural control is an important contributor to the decreased STSTS performance in individuals with COPD.