Comparison of balance changes after inspiratory muscle or Otago exercise training

Abstract

The inspiratory muscles contribute to balance via diaphragmatic contraction and by increasing intra-abdominal pressure. We have shown inspiratory muscle training (IMT) improves dynamic balance significantly with healthy community-dwellers. However, it is not known how the magnitude of balance improvements following IMT compares to that of an established balance program. This study compared the effects of 8-week of IMT for community-dwellers, to 8-week of the Otago exercise program (OEP) for care-residents, on balance and physical performance outcomes. Nineteen healthy community-dwellers (74 ± 4 years) were assigned to self-administered IMT. Eighteen, healthy care-residents (82 ± 4 years) were assigned to instructor-led OEP. The IMT involved 30 breaths twice-daily at ~50% of maximal inspiratory pressure (MIP). The OEP group undertook resistance and mobility exercises for ~60 minutes, twice-weekly. Balance and physical performance were assessed using the mini Balance Evaluation System Test (mini-BEST) and time up and go (TUG). After 8-week, both groups improved balance ability significantly (mini-BEST: IMT by 24 ± 34%; OEP by 34 ± 28%), with no between-group difference. Dynamic balance sub-tasks improved significantly more for the IMT group (P < 0.01), than the OEP group and vice versa for static balance sub-tasks (P = 0.01). The IMT group also improved MIP (by 66 ± 97%), peak inspiratory power (by 31 ± 12%) and TUG (by -11 ± 27%); whereas the OEP did not. IMT and OEP improved balance ability similarly, with IMT eliciting greater improvement in dynamic balance, whilst OEP improved static balance more than IMT. Unlike IMT, the OEP did not provide additional benefits in inspiratory muscle function and TUG performance. Our findings suggest that IMT offers a novel method of improving dynamic balance in older adults, which may be more relevant to function than static balance and potentially a useful adjunct to the OEP in frailty prevention.

Conflict of interest statement

This work was sponsored by Bournemouth University. FF, JG and TW declare no conflicts of interests. AM acknowledges a previous (now expired) beneficial interest in POWERbreathe® inspiratory muscle trainers, in the form of a share of royalty income to the University of Birmingham and a potential share of royalty income to Brunel University. In the past, AM has also provided consultancy services to POWERbreathe® International Ltd., but no longer does so. AM is named on two patents relating to POWERbreathe® products, including the device used in the present study, as well as being the author of two books on inspiratory muscle training. The patents are as follows: European Patent Office Patent No. EP2303417B1 - Dynamic inspiratory muscle training device; United States Patent No. 8 459 255 - Dynamic inspiratory muscle training device. The authors also declare that the results of the present study do not constitute an endorsement by American College of Sport Medicine and that the results are presented clearly, honestly, and without fabrication, falsification, or inappropriate data manipulation.

Figures

Fig 1. CONSORT flow diagram displaying participant pathways through the 8 week non-randomised comparison study.

IMT = inspiratory muscle training, OEP = Otago exercise program.

Fig 2

A. Peak power vs inspiratory mouth pressure PI (cmH2O). B. Inspiratory mouth pressure PI (cmH2O) vs inspiratory flow rate VI (l s-1). C. Inspiratory peak power (Watts) vs inspiratory flow rate VI (l s-1). Before (♦) and after ( ) 8 weeks of inspiratory muscle training (IMT) and Otago exercise program (OEP). Data are represented as mean ± percentage error.