Kinesiologia Slovenica, 18, 1, 53–64 (2012) Faculty of Sport, University of Ljubljana, ISSN 1318-2269 53

Jernej Kapus INSPIRATORY MUSCLE TRAINING INCREASES TIDAL

Anton Ušaj VOLUME DURING INCREMENTAL EXERCISE WITH
REDUCED BREATHING – A PILOT STUDY

VADBA ZA MOČ VDIŠNIH MIŠIC POVEČA DIHALNI

VOLUMEN MED VEČSTOPENJSKO OBREMENITVIJO Z
NIŽJO FREKVENCO DIHANJA – PILOTSKA RAZISKAVA
ABSTRACT IZVLEČEK
The purpose of this study was to investigate the Namen raziskave je bil ugotoviti učinek šest tedenske
influence of inspiratory muscle training (IMT) on tidal vadbe za moč vdišnih mišic na dihalni volumen med
volume (VT or inspiratory volume) during incremental večstopenjskim obremenilnim testom z nižjo frekvenco
exercise where breathing frequency is restricted. 21 dihanja. Enaindvajset merjencev (devet fantov in
healthy subjects (9 males, 12 females) were divided dvanajst deklet) je bilo razdeljenih v dve skupini:
into two groups: experimental (Group E) and control poskusno (skupina E) in referenčno (skupina C). Skupina
(Group C). Group E performed 30 dynamic inspiratory E je dvakrat dnevno vadila s 30 dinamičnimi vdihi in
efforts twice daily against a pressure-threshold load of izdihi s pomočjo dihalnega trenažerja, pri čemer je bil
~50% maximal inspiratory pressure. A spring-loaded upor vdiha približno 50% največjega vdišnega pritiska.
threshold inspiratory muscle trainer was used for this Skupina C opisane vadbe ni opravljala. Pred vadbo in po
IMT. Group C received no IMT. Prior to and following a njej sta obe skupini opravili večstopenjski obremenilni
6 week intervention both groups performed incremental test na kolesarskem ergometru z nižjo frekvenco
cycle ergometry until volitional exhaustion with dihanja. Le-ta je bila določena z 10 vdihi na minuto.
reduced breathing frequency (RBF), which was defined Skupina E je z vadbo povečala moč vdišnih mišic (+35
as 10 breaths per minute. After training, the inspiratory ± 16%; p<0.01) in dihalni volumen (+13 ± 14%; p<0.01)
muscle strength in Group E (+35 ± 16%; p<0.01) and med večstopenjskim obremenilnim testom z nižjo
submaximal and maximal VT was higher (+13 ± 14%; frekvenco dihanja. Slednje je omogočilo tudi daljše
p<0.01) during incremental cycle ergometry with RBF opravljanje tega testa (čas trajanja se je z vadbo podaljšal
compared with pre-training. The latter adaptation was za 17 ± 15%; p<0.01). Pri skupini C opisanih sprememb
the reason for the extended time to exhaustion (17 ± 15%; ni bilo. Glede na dobljene rezultate lahko zaključimo,
p<0.01) following training. VT and time to exhaustion da vadba za moč vdišnih mišic poveča dihalni volumen
were unchanged in Group C. It could be concluded that med večstopenjskim obremenilnim testom z nižjo
IMT increased VT during incremental exercise where frekvenco dihanja. Kljub vsemu pa verjamemo, da
breathing frequency was restricted. However, future nam bodo verodostojnejše in uporabnejše podatke dale
research is needed to establish the efficacy of this bodoče raziskave, ki bodo ugotovile učinek tovrstne
training as a supplement to regular exercise training vadbe kot dodatek običajni vadbi z nižjo frekvenco
with or without RBF. dihanja ali brez nje.
Keywords: inspiratory muscles, training, reduced Ključne besede: vdišne mišice, vadba, zmanjšano diha-
breathing, incremental exercise, swimming nje, večstopenjska obremenitev, plavanje
University of Ljubljana, Faculty of sport
Laboratory of biodinamics, Slovenia
Corresponding author:
Jernej Kapus, PhD
University of Ljubljana
Faculty of Sport
Gortanova 22
1000 Ljubljana, Slovenia
e-mail: [email protected]
54 Inspiratory muscle training Kinesiologia Slovenica, 18, 1, 53–64 (2012)

INTRODUCTION
Perhaps the best example in sport of where breathing frequency is naturally reduced is during
front crawl swimming. While performing the front crawl swimmers may use different breathing
patterns. They usually take a breath every second stroke cycle (Maglischo, 2003). However, they
can reduce their breathing frequency by taking a breath every fourth, fifth, sixth or eighth stroke
cycle. During such exercise, breathing (and specifically inspiration) must be coordinated with
stroke mechanics and as a result the tidal volume (VT or inspiratory volume) is elevated to com-
pensate for the reduced breathing frequency (RBF) (Dicker, Lofthus, Thornton, & Brooks, 1980).
However, as VT increases it requires progressively stronger inspiratory muscle force to expand
the lungs, which requires greater effort and results in breathing discomfort. Further, the time for
inhalation during swimming is quite short. Cardelli, Lerda, & Cholet (2000) demonstrated that
the duration of inhalation lasted less than 0.5 seconds during 800m front crawl swimming at a
lower velocity i.e. 1.28 m/s. Swimmers must therefore inhale quickly to ensure high lung volumes
during swimming with RBF. Therefore, it could be suggested that this breathing pattern during
swimming could pose a great challenge for the respiratory muscles. Indeed, it was recently shown
that a reduced breathing frequency induced a larger magnitude of inspiratory muscle fatigue
during 200m of maximal swimming (Jakoljevic & McConnell, 2009).

In the 1970s, Leith and Bradley (1976) demonstrated that the strength of respiratory muscles can
be improved by inspiratory muscle training (IMT). It is now well documented that IMT enhances
the performance of athletes across a range of endurance sports (Griffiths & McConnell, 2007;
Romer, McConnell, & Jones, 2002; Voliantis et al., 2001), as well as during repeated sprinting
(Romer, McConnell, & Jones, 2002). Recent evidence suggests that IMT has a small positive effect
on swimming performance in trained swimmers in events shorter than 400 m (Kilding, Brown, &
McConnell, 2010). Given the unique challenge for the respiratory muscles, it is surprising that so
far no studies have examined the influence of IMT on exercise with RBF. Therefore, the purpose
of this study was to investigate the influence of IMT on VT during incremental exercise where
breathing frequency is restricted. Considering suggestions from previous studies, we hypothesise
that IMT will increase VT during incremental exercise where breathing frequency is restricted.
Due to the technical limitations of measuring respiratory parameters during swimming, the
influence of IMT on subjects’ performance in reduced breathing conditions was investigated
during cycle ergometry in the present study. During such exercise the breathing frequency can
be modified and respiratory parameters measured with greater ease.

MATERIALS AND METHODS

Subjects

Nine males (age: 27 ± 3 years, height: 1.80 ± 0.07 m, body mass: 80 ± 13 kg) and twelve females
(age: 24 ± 1 years, height: 1.67 ± 0.03 m, body mass: 61 ± 5 kg)volunteered to participate in this
study. None of the subjects were smokers and none had any respiratory diseases. The subjects
were fully informed of the purpose and possible risks of the study before giving their written
consent to participate. The study was approved by the National Ethics Committee of the Republic
of Slovenia.
Kinesiologia Slovenica, 18, 1, 53–64 (2012) Inspiratory muscle training 55

Testing protocol
The subjects completed the following tests in the same order in pre- and post-training: 1) tests
of pulmonary function; 2) tests of respiratory muscle strength; and 3) an incremental cycle
ergometry with RBF. All testing took place in controlled environmental laboratory conditions
(21°C, 40–60% RH, 970–980 mbar) and at the same time of day. The subjects were asked to
maintain their usual eating habits and avoid consuming food 2 hours before the testing. Post-
training testing began 2 days after the last training session.

Pulmonary function. A pneumotachograph spirometer (Vicatest P2a, Mijnhardt, Netherlands)

was used to measure resting flow-volume profiles. The following variables were derived: vital
capacity (VC), forced vital capacity (FVC) and forced expiratory volume in one second (FEV1.0).
Pulmonary function measurements were made according to European Respiratory Society
recommendations (Miller et al., 2005).

Respiratory muscle strength was assessed by measuring the maximal inspiratory mouth pressure
(MIP) at residual volume and maximal expiratory mouth pressure (MEP) at total lung capacity.
Both parameters were measured using a portable hand-held mouth pressure meter (MicroRMP,
MicroMedical Ltd, Kent, UK) in the standing position. The assessment of maximal pressures
required a sharp, forceful effort maintained for a minimum of 2 s. All subjects became well
habituated with the procedure during two separate familiarisation sessions. They received
visual feed-back of the pressure achieved during each effort by viewing the digital display on
the hand-held device in order to maximise their inspiratory and expiratory effort. MIP and MEP
measurements were taken repeatedly until a stable baseline of each parameter was achieved. The
criteria for determining MIP and MEP stability was successive efforts within 5%. The highest
value recorded was included in the subsequent analysis.

Incremental exercise test with RBF was performed on an electromagnetically braked cycle ergom-
eter (Ergometrics 900, Ergoline, Windhagen, Germany) with a pedal cadence of 60 rpm. RBF was
defined as 10 breaths per minute and was regulated by a breathing metronome. The breathing
metronome was composed of a gas service solenoid valve (24 VDC, Jakša, Ljubljana, Slovenia)
and a semaphore with red and green lights. Both were controlled by micro-automation (Logo DC
12/24V, Siemens, Munich, Germany). The subjects were instructed to exhale and inhale during
a two second period of an open solenoid valve (the green semaphore light was switched on) and
to hold their breath, using almost all their lung capacity (holding their breath near total lung
capacity), for four seconds when the solenoid valve was closed (when the red semaphore light was
switched on) (Kapus, Ušaj, & Kapus, 2010; Sharp, Williams, & Bevan, 1991; Yamamoto, Mutoh,
Kobayashi, & Miyashita, 1987). Prior to testing and training, the subjects were familiarised with
cycling on the cycle ergometer and breathing in time with the metronome. The test began at an
intensity of 30 W and increased by 30 W every minute until volitional exhaustion.The subjects
breathed through a mouthpiece attached to apneumotachograph during each cycle ergometry
test. Expired air was sampled continuously by a metabolic cart (V-MAX29, SensorMedics Cor-
·
poration, Yorba Linda, USA) for a breath-by-breath determination of pulmonary ventilation(VE),
VT, end-tidal partial pressure of carbon dioxide (PETCO2), end-tidal partial pressure of oxygen
·
(PETO2), and oxygen uptake (VO2). The pneumotachograph and O2 and CO2 analysers were
calibrated with a standard three-litre syringe and precision reference gases, respectively. For
further statistical analysis the breath-by-breath data were averaged for each 10 second interval.
56 Inspiratory muscle training Kinesiologia Slovenica, 18, 1, 53–64 (2012)

Training protocol
The subjects were categorised according to gender and their baseline MIP measures and divided
into matched trios. Two subjects of each trio were assigned at random to the experimental group
(Group E) by an independent observer and the third to the control group (Group C). Descriptive
measures of the subjects and training groups are presented in Table 1.
Group E performed 30 dynamic inspiratory efforts twice daily for six weeks (84 training sessions)
against a pressure-threshold load of ~50% MIP. A spring-loaded threshold inspiratory muscle
trainer (POWERbreathe, Gaiam Ltd., Southham, UK) was used for this IMT. After the initial
setting of the training loads the subjects were instructed by an independent observer to increase
the load periodically once a week to a level that would permit them to only just complete 30
manoeuvres. The subjects initiated each inspiratory effort from the residual volume and strove
to maximise the tidal volume. This IMT protocol is known to be effective in eliciting an adaptive
response (Griffiths & McConnell, 2007; McConnell & Lomax, 2006; McConnell & Sharpe, 2005;
Romer, McConnell, & Jones, 2002; Voliantis et al., 2001). The subjects completed a training
diary throughout the study to record their adherence to the training. IMT had ceased 48 hours
before the post-training testing. Group C received no IMT. The subjects in both groups were
recreationally active, although they did not perform any intense exercise training during the
research period.

Statistical analyses
The results are presented as means and standard deviations. Intra-group differences between
the pre- and post-training values were calculated with a paired, two-tailed t-test. An analysis
of covariance (ANCOVA), with pre-training values as covariates and post-training values as
dependent variables, was used to test for differences between the groups resulting from differ-
ent training interventions. Statistical significance was accepted at the p≤0.05 level. Effect sizes
were calculated using Cohen’s d statistics to assess the magnitude of the treatment with 0.2
being deemed small, 0.5 medium and 0.8 large (Cohen, 1988). All statistical parameters were
calculated using the statistics package SPSS (version 15.0, SPSS Inc., Chicago, USA) and the
graphical statistics package Sigma Plot (version 9.0, Jandel & Tübingen, Germany).

RESULTS
Descriptive measures of the subjects and training groups are presented in Table 1.
Table 1. Descriptive characteristics of the subjects and training groups
Parameter All subjects Group E (N = 14; 6 M, 8 F) Group C (N = 7; 3 M, 4 F)
Age (yr) 25 ± 2 24 ± 1 27 ± 3
Height (cm) 173 ± 8 172 ± 8 174 ± 9
Body mass (kg) 69± 13 67 ± 9 74± 18
VC (l) 5.08± 1.08 5.03 ± 0.94 5.19± 1.41
FEV1.0 (l.s-1) 3.99± 0.74 3.98 ± 0.71 4.00 ± 0.86
MIP (cm H2O) 125± 22 122 ± 21 130± 26
MEP (cm H2O) 149± 30 142 ± 24 162±38
Values are means ± SD. VC, vital capacity; FVC, forced vital capacity; FEV1.0, forced expiratory volume in one second;
MIP, maximal inspiratory mouth pressure; MEP, maximal mouth expiratory pressure
Kinesiologia Slovenica, 18, 1, 53–64 (2012) Inspiratory muscle training 57

All subjects in Group E completed the prescribed training programme. Spirometry parameters
and parameters of respiratory muscle strength measured at the pre- and post-training testing
are shown in Table 2.
Table 2. Spirometry parameters and parameters of respiratory muscle strength pre- and post-
training
Parameter Group Pre-training Post-training
E 5.03 ±0.94 5.02 ±1.03
VC (l)
C 5.19±1.41 5.23±1.41
E 3.98 ± 0.71 4.06 ±0.74
FEV1.0 (l)
C 4.00 ± 0.86 3.98± 0.88
E 122 ±21 164 ±30 ††
MIP (cm H2O) **
C 130±26 133±32
E 142 ± 24 145 ±29
MEP (cm H2O)
C 162±38 166± 43
Values are means ± SD. VC, vital capacity; FEV1.0, forced expiratory volume in one second; MIP maximal inspiratory
pressure; MEP, maximal expiratory pressure.Significant training effect (paired T test): †† - p<0.01. Significant differ-
ences between groups after the training (ANCOVA): ** - p<0.01.

As shown in Table 2, MIP differed among the groups in response to the training period (p<0.01).
As expected,a higher value (p=0.01, d=1.68) was observed after training in Group E compared
with the pre-training values. By contrast, spirometry parameters and parameters of respiratory
muscle strength were unchanged in Group C. Time to exhaustion during incremental cycle
ergometry with RBF was extended with the IMT in group E (p<0.01, d=0.95), whereas this
parameter did not change in group C. Between-group differences in time to exhaustion were
also significant for the post-training comparisons (p<0.05; see Figure 1).

Figure 1. Time to exhaustion obtained during incremental cycle ergometry with reduced
breathing frequency pre- and post-training. Values are means ± SD. Significant training effect
(paired t-test): †† - p<0.01; significant differences between groups after the training (ANCOVA):
* - p<0.05.
58 Inspiratory muscle training Kinesiologia Slovenica, 18, 1, 53–64 (2012)

Table 3 shows the peak power output obtained at the pre- and post-training incremental tests.
Peak power output was defined as the highest work stage completed (i.e. the last work stage
thesubject actually sustained for one minute), and hence the power output obtained.
Table 3. Peak power output (W) obtained at the pre- and post-training incremental tests
Subject Group Pre-training Post-training
1 E 150 180
2 E 150 180
3 E 150 180
4 E 270 270
5 E 150 150
6 E 150 180
7 E 150 210
8 E 150 150
9 E 180 210
10 E 150 180
11 E 150 180
12 E 150 180
13 E 180 210
14 E 180 180
15 C 300 180
16 C 120 120
17 C 150 180
18 C 210 210
19 C 180 150
20 C 180 180
21 C 210 240

The lowest peak power output obtained at the pre- and post-training incremental tests was 150
W and 120 W, respectively, for Group E and Group C (Table 3). Therefore, the average data of
measured respiratory parameters to these work stages and maximal or minimal values during
the incremental test with RBF are presented in Figures 2 and 3, respectively, for Group E and
Group C.
Kinesiologia Slovenica, 18, 1, 53–64 (2012) Inspiratory muscle training 59

·
Figure 2. Respiratory parameters (VE, minute ventilation (a); V T, tidal volume (b); PETO2 end-
tidal partial pressure of oxygen (c); PETCO2, end-tidal partial pressure of carbon dioxide (d)) and
·
VO2, oxygen uptake (e)) obtained during the incremental test with RBF pre- (white squares and
columns) and post-training (black squares and columns) in Group E. Values are means ± SD.
Significant training effect (paired t-test): † - p<0.05 and †† - p<0.01.
60 Inspiratory muscle training Kinesiologia Slovenica, 18, 1, 53–64 (2012)

·
As shown in Figure 2, there were significant training changes in VE , VT,PETO2and PETCO2 (p
varied from 0.01 to 0.05) obtained at submaximal work stages during an incremental test with
· ·
RBF. In addition, maximal values of VE (p<0.01, d=0.75), VT (p<0.01, d=0.81) and VO2(p<0.05,
d=0.53) were also enhanced by the IMT in Group E. By contrast, respiratory parameters during
the incremental test with RBF did not change (neither in submaximal values nor at maximal
or minimal) throughout the training in Group C (Figure 3). Between-group differences in the
· ·
maximal values of VE and VO2were also significant for the post-training comparisons (p<0.05).

·
Figure 3. Respiratory parameters (VE, minute ventilation (a); VT, tidal volume (b); PETO2 end-
tidal partial pressure of oxygen (c); PETCO2, end-tidal partial pressure of carbon dioxide (d)) and
·
VO2, oxygen uptake (e)) obtained during the incremental test with RBF pre- (white squares and
columns) and post-training (grey squares and columns) in Group C. Values are means ± SD.
Kinesiologia Slovenica, 18, 1, 53–64 (2012) Inspiratory muscle training 61

DISCUSSION
This pilot study is the first to our knowledge to have investigated the influence of IMT on
VT during incremental exercise where breathing frequency is restricted. The data indicate that
IMT increased MIP (Table 2) and additionally V T during the RBF exercise (Figure 2b). The
later adaptation could be the reason for the significant improvement in time to exhaustion at
incremental cycle ergometry with RBF in Group E (17 ± 15%; Figure 1). On the basis of the large
effect sizes, it could be suggested that the training intervention per se was primarily responsible
for the increased mentioned variables.

The 35 ± 16% increase in MIP after six weeks of IMT (Figure 2) is in accordance with previous
IMT studies. However, the increase obtained in some studies was greater (from 45% to 64%
reported by Romer & McConnell, 2003; Voliantis et al., 2001) and lower in others (from 15% to
26% reported by Griffiths & McConnell, 2007; Inbar, Weiner, Azgad, Rotstein, & Weinstein, 2000;
Johnson, Sharpe, & Brown, 2007;Klusiewicz, Borkowski, Zdanowicz, Boros, & Wesolowski, 2008;
McConnell & Sharpe, 2005; Lomax, 2010). Established training principles appear to apply to IMT
(Romer and McConnell, 2003), thus these discrepancies may be related, in part, to inter-study
differences in the IMT mode, intensity and duration. However, since the scale of physiological
adaptation within a system depends on its baseline status (Åstrand & Rodahl, 1986), it seemed
that the training improvement is mainly related to the pre-training level of MIP. McConnell
(2011) suggested that changes in inspiratory muscle strength due to IMT could be attributed to
changes in diaphragm thickness. Indeed, it was shown that diaphragm thickness increased after
just four weeks of IMT, which confirmed the presence of rapid fibre growth (hypertrophy) in
response to loading (Downey et al., 2007).

It is well known that during endurance exercise the respiratory muscles perform significant
amounts of metabolic work. Indeed, Aaron, Seow, Johnson, & Dempsey (1992) showed that
during strenuous exercise respiratory muscles can command ~10%of total oxygen consumption
in moderately fit subjects and up to 15% in highly fit subjects. Taking this into account, previous
studies have tried to determine the effects of IMT on respiratory muscle functions and in addi-
tion on maximal aerobic capacity (Inbar, Weiner, Azgad, Rotstein, & Weinstein, 2000; Riganas,
Vrabas, Christoulas, & Mandroukas, 2008; Williams, Wongsathikun, Boon, & Acevedo, 2002),on
exercise performance (Forbes, Game, & Syrotuik, 2011; Kilding, Brown, & McConnell, 2010;
Voliantis et al. 2001; Williams, Wongsathikun, Boon, & Acevedo, 2002), and on post-exercise
inspiratory muscle fatigue (Romer, McConnell, & Jones, 2002). However, interestingly the impact
·
of IMT on breathing parameters such us VE, VT and breathing frequency during exercise has not
been examined yet. Hypoventilation is a well-documented phenomenon during exercise with
RBF. A reduction of approximately 48% in VE was demonstrated in previous studies in which
10 breaths per minute was used for the reduced breathing conditions (Kapus, Ušaj, & Kapus,
2010; Sharp, Williams, & Bevan, 1991; Yamamoto, Mutoh, Kobayashi, & Miyashita, 1987). A
similar reduction in VE was reported when swimmers reduced their breathing frequency during
swimming from the usual taking of a breath every second stroke cycle to taking a breath every
fifth (Dicker, Lofthus, Thornton, & Brooks, 1980) or sixth (Town & Wanness, 1990) stroke cycle.
·
As a reduction in VE is unlikely to benefit exercise performance, it follows that an increase in
·
VE would be advantageous. Due to the prescribed and unchanged breathing frequency in the
·
present study, an increase in VT was the only mechanism available for increasing VE (Figure 2a).
Indeed, our results indicate that IMT does increase VT during incremental exercise with RBF.
62 Inspiratory muscle training Kinesiologia Slovenica, 18, 1, 53–64 (2012)

Specifically, maximal values of VT increased by 13 ± 14% following the IMT (Figure 2b). Despite
breathing with large V T, a 2 second period of an opened valve was enough for the subjects’
expiration and for deep inspiration. The obtained improvement in VT as result of the IMT was less
than the 41% reported after training with RBF (Kapus, 2008). However, it should be emphasised
that increased VTwas obtained without any additional exercise or RBF training in the present
study.The higher VTat the post-training testing allowed the better regulation of blood gases, i.e.
it induced a higher submaximal PETO2 anda lower submaximal PETCO2 in comparison with the
pre-training testing (Figure 2). These measurements could indirectly show the level of O2 and CO2
in blood during rest and exercise (Williams and Babb, 1997). Previous studies demonstrated that
hypercapnia and/or hypoxia in blood could be the reasons for earlier fatigue during exercise with
RBF (Kapus, Ušaj, Kapus, & Štrumbelj, B., 2003; Sharp, Williams, & Bevan, 1991). Therefore, it
seemed that a higher VT (via better regulation of blood gases) enabled higher peak power output
during the post-training incremental exercise with RBF (Table 3). This adaptation was the reason
·
for the higher maximal values of VO2 during the post-training testing in comparison with the
pre-training testing (Figure 2).

Considering this, it could be suggested that IMT may offer some potential benefits (via increasing
VT) for a swimmer’s ability to swim with fewer breaths and to hold their breath for longer during
the underwater phases (flip turns, gliding, and underwater strokes). This could create an im-
portant biomechanical advantage for a swimmer’s performance (Chatard, Collomp, Maglischo,
& Maglischo, 1990; Kolmogorov & Duplisheva, 1992; Lerda, Cardelli, & Chollet, 2001; Pedersen
& Kjendlie, 2006).

Possible study limitations. The presented pilot study has some limitations and the results should
be interpreted in the context of its design. Firstly, because the subjects were not blinded for the
training intervention one may argue that this might have influenced our results. Although the
subjects were naive and were not informed about the potential effect of the IMT on exercise
performance with RBF, a placebo-controlled design should be used. Indeed, in most of the previ-
ous studies concerning the influences of IMT the experimental group and sham-training control
group were compared. Subjects were told that they were participating in a study to compare
the influence of strength (like Group E in the present study, which performed IMT) versus
endurance protocols (the placebo group, which also used the pressure threshold device, however,
performed 60 slow protracted inhalations against minimum pressure threshold once daily for six
weeks) (Inbar, Weiner, Azgad, Rotstein, & Weinstein, 2000; Kilding, Brown, & McConnell, 2010;
McConnell & Sharpe, 2005; Voliantis et al., 2001). Further, increased VT during the post-training
exercise with RBF could be the learning effect of the IMT. Indeed, at each training session
the subjects in Group E performed several rapid inhalations in which they strove to maximise
their VT. To avoid this effect, IMT should be added as an experimental group’s supplement to
training with RBF which would be otherwise performed by both groups, i.e. experimental and
control. Nonetheless, we find these preliminary data to be encouraging as part of the growing
literature supporting the use of IMT as a supplement to regular swimming training. Future
research is needed to establish the efficacy of this training in a randomised, controlled trial with
the experimental design suggested above.

It could be concluded that IMT increased V Tduring incremental exercise where breathing
frequency was restricted. However, further research is needed to establish the efficacy of this
training as a supplement to regular exercise training with or without RBF.
Kinesiologia Slovenica, 18, 1, 53–64 (2012) Inspiratory muscle training 63

ACKNOWLEDGMENTS
The research was supported by a grant from the Fundacija za šport, a foundation for financing
sport organisations in Slovenia (RR-11-608).

REFERENCES
Aaron, E. A., Seow, K. C., Johnson, B. D., & Dempsey, J. A. (1992). Oxygen cost of exercise hyperpnea:
Implications for performance. Journal of Applied Physiology, 72(5), 1818–1825.
Åstrand, P. O., & Rodahl, K. (1986). Textbook of Work Physiology: Physiological Bases of Exercise. Singapore:
McGraw-Hill Co.
Cardelli, C., Lerda, R., & Chollet, D. (2000). Analysis of breathing in the crawl as a function of skill and
stroke characteristics. Perceptual and Motor Skills, 90(3), 979–987.
Chatard, J. C., Collomp, C., Maglischo, E., & Maglischo, C. (1990). Swimming skill and stroking charac-
teristics of front crawl swimmers. International Journal of Sports Medicine,11(2), 156–161.
Cohen, J. (1988). Statistical Power Analysis for the Behavioural Sciences. Hillsdale: Lawrence Erlbaum
Associates.
Dicker, S. G., Lofthus, G. K., Thornton, N. W., & Brooks, G. A. (1980) Respiratory and heart rate responses
to tethered controlled frequency breathing swimming. Medicine and Science in Sport and Exercise,12(1),
20–23.
Downey, A. E., Chenoweth, L. M., Townsend, D. K., Ranum, J. D., Ferguson, C. S., & Harms, C. A. (2007).
Effects of inspiratory muscle training on exercise responses in normoxia and hypoxia. Respiratory Physiol-
ogy and Neurobiology, 156(2), 137–146.
Forbes, S., Game, A., & Syrotuik, D. (2011). The effect of inspiratory and expiratory respiratory muscle
training in rowers. Research in Sports Medicine,19(4), 217–230.
Griffits, L. A., & McConnell, A. K. (2007). The influence of inspiratory and expiratory muscle training
upon rowing performance. European Journal of Applied Physiology, 99(5), 457–466.
Inbar, O., Weiner, P., Azgad, Y., Rotstein, A., & Weinstein, Y. (2000). Specific inspiratory muscle training
in well-trained endurance athletes. Medicine and Science in Sports and Exercise, 32(7), 1233–1237.
Jakovljevic, D. G., & McConnell, A. K. (2009). Influence of different breathing frequencies on the severity
of inspiratory muscle fatigue induced by high-intensity front crawl swimming. Journal of Strength and
Conditioning Research, 23(4), 1169–1174.
Johnson, M. A., Sharpe, G. R., & Brown, P. I. (2007). Inspiratory muscle training improves cycling time-trial
performance and anaerobic work capacity but not critical power. European Journal of Applied Physiology,
101(6), 761–770.
Kapus, J. (2008). Učinki vzdržljivostne vadbe z nižjo frekvenco dihanja: doktorska disertacija [The influence
of training with reduced breathing frequency]. Unpublished doctoral dissertation, Ljubljana: Fakulteta
za šport.
Kapus, J., Ušaj, A., Kapus, V., & Štrumbelj, B. (2003). The influence of reduced breathing during intense
front crawl swimming on some respiratory and metabolic values in blood. Kinesiologia Slovenica, 9(1),
12–17.
Kapus, J., Ušaj, B., & Kapus, V. (2010). Some metabolic responses to reduced breathing frequency during
constant load exercise. Medicina Sportiva, 14(1), 13–18.
Kilding, A. E., Brown, S., & McConnell A. K. (2010). Inspiratory muscle training improves 100 and 200 m
swimming performance. European Journal of Applied Physiology, 108(3), 505–511.
64 Inspiratory muscle training Kinesiologia Slovenica, 18, 1, 53–64 (2012)

Klusiewicz, A., Borkowski, L., Zdanowicz, R., Boros, P., & Wesolowski, S. (2008). The inspiratory muscle
training in elite rowers. Journal of Sports Medicine and Physical Fitness, 48(3), 279–284.
Kolmogorov, S. V., & Duplisheva, A. (1992). Active drag, useful mechanical power output and hydro-
dynamic force coefficient in different genders and performance levels. Journal of Biomechanics, 25(3),
311–318.
Leith, D. E., & Bradley, M. (1976). Ventilatory muscle strength and endurance training. Journal of Applied
Physiology, 41(4), 508–516.
Lerda, R., Cardelli, C., & Chollet, D. (2001). Analysis of the interactions between breathing and arm actions
in the front crawl. Journal of Human Movement Studies, 40, 129–144.
Lomax, M. (2010). Inspiratory muscle training, altitude and arterial oxygen desaturation: A preliminary
investigation. Aviation, Space, and Environmental Medicine, 81(51), 1-4.
Maglischo, E. W. (2003). Swimming Fastest. Leeds: Human Kinetics.
McConnell, A. K. (2011). Breathe Strong, Perform Better. Leeds: Human Kinetics.
McConnell, A. K., & Lomax, M. (2006). The influence of inspiratory muscle work history and specific
inspiratory muscle training upon human limb muscle fatigue. Journal of Physiology, 577(1), 445–457.
McConnell, A. K., & Sharpe, G. R. (2005). The effects of inspiratory muscle training upon maximum lactate
steady-state and blood lactate concentration. European Journal of Applied Physiology, 94(3), 277–284.
Miller, M. R, Hankinson, J., Brusasco, V., Burgos, F., Casaburi, R., Coates, A., Crapo, R., Enright, P., van
der Grinten, C. P. M., Gustafsson, P., Jensen, R., Johnson, D. C., MacIntyre, N., McKay, R., Navajas, D.,
Pedersen, O. F., Pellegrino, R., Viegi, G., Wanger, J., & Force, A. E. T. (2005). Standardisation of spirometry.
European Respiratory Journal, 26(2), 319–338.
Sharp, R. L., Williams, D. J., & Bevan, L. (1991). Effects of controlled frequency breathing during exercise
on blood gases and acid-base balance. International Journal of Sports Medicine, 12(1), 62–65.
Pedersen, T., & Kjendlie, P. L. (2006). The effect of breathing action on velocity in front crawl swimming.
In J. P. Vilas-Boas, F. Alves, F., A. Marques (Eds.), Biomechanics and medicine in swimming 10 (pp. 75–77).
Porto: Portuguese Journal of Sport Sciences.
Riganas, C., Vrabas, S. I., Christoulas, K., & Mandroukas, K. (2008). Specific inspiratory muscle training
does not improve performance or Vo2max levels in well trained rowers. Journal of Sports Medicine and
Physical Fitness, 48(3), 285–292.
Romer, L. M., & McConnell, A. K. (2003). Specificity and reversibility of inspiratory muscle training.
Medicine and Science in Sports and Exercise, 35(2), 237–244.
Romer, L. M., McConnell, A. K., & Jones, D. A. (2002). Inspiratory muscle fatigue in trained cyclists: effects
of inspiratory muscle training. Medicine and Science in Sports and Exercise, 34(5), 785–792.
Town, G. P., & Vanness, J. M. (1990). Metabolic responses to controlled frequency breathing in competitive
swimmers. Medicine and Science in Sport and Exercise, 22(1), 112–116.
Volianitis, S., McConnell, A. K., Koutedakis Y., McNaughton, L., Backx, K., & Jones, D.A. (2001). Inspira-
tory muscle training improves rowing performance. Medicine and Science in Sports and Exercise, 33(5),
803–809.
Williams, J. S., & Babb, T. G. (1997). Differences between estimates and measured Paco2 during rest and
exercise in older subjects. Journal of Applied Physiology, 83(1), 312–316.
Williams, J. S., Wongsathikun, J., Boon, S. M., & Acevedo, E. O. (2002). Inspiratory muscle training fails to
improve endurance capacity in athletes. Medicine and Science in Sports and Exercise, 34(7), 1194–1198.
Yamamoto, Y., Mutoh, Y., Kobayashi, H., & Miyashita, M. (1987). Effects of reduced frequency breathing
on arterial hypoxemia during exercise. European Journal of Applied Physiology, 56(5), 522–527.