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What Precautions and Contraindications Should Be Considered When Using Inspiratory Muscle Training?

Jessica DeMars, BSc.P.T.

March 15, 2024

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Question

What precautions and contraindications should be considered when using Inspiratory Muscle Training?

Answer

When considering IMT, it is crucial to be mindful of potential precautions and contraindications, many of which are rooted in the theoretical possibility of generating significant negative pressure swings during training. As individuals draw in a breath, the pressure changes can pose certain risks.

For instance, caution should be exercised if a person has a history of spontaneous pneumothorax or presents with large bullae on a chest x-ray. In such cases, creating intense pressure within the lungs may not be advisable. Similarly, individuals with severe osteoporosis and a history of rib fractures should approach IMT cautiously. The aggressive inhalation involved in the training process may pose risks, especially if individuals experience desaturation during its application. These considerations underscore the importance of tailoring IMT interventions based on an individual's specific medical history and condition.

In the realm of precautions, it is noteworthy to exercise caution with asthma patients who have very low symptom perception and experience frequent severe exacerbations. Additionally, individuals with an active cold, sinus or respiratory infection, or an eardrum issue should approach IMT with care, as the negative pressure generated during training may not be beneficial in these conditions.

When it comes to osteoporosis, it is not necessarily a contraindication but a precaution. In such cases, the approach to IMT may involve adjusting the load and repetitions. Opting for lower loads and longer repetitions could be a more prudent strategy, akin to modifying strength training in any other context. The key takeaway is the importance of tailoring the IMT approach based on individual characteristics and conditions, emphasizing a personalized and cautious prescription. This ensures that the potential benefits of IMT are realized while minimizing any associated risks.

This Ask the Expert is an edited excerpt from the course, Inspiratory Muscle Training: A Review of the Evidencepresented by Jessica DeMars, BSc.P.T.


jessica demars

Jessica DeMars, BSc.P.T.

Jessica graduated from the University of Alberta in 1998 with a Bachelor of Science Degree in Physical Therapy (with distinction). She practiced in a private setting and continued her education with numerous post-graduate courses.  In 2006, her focus shifted toward learning about the impact breathing has on health.  Since that time, she has attended numerous courses and gained in-depth knowledge in treating breathing pattern disorders and unexplained breathlessness. 

With the onset of the COVID-19 pandemic, Jessica quickly recognized that infections were resulting in debilitating ongoing symptoms for many and that this would have a major impact on the population.  She has worked to improve her knowledge of other post-infectious and complex illnesses, from which we take our learning for Long COVID.  She has become an ally and an advocate and has been a part of the Long COVID Physio board since its inception in 2021.  Jessica has developed several courses and webinars on Long COVID to assist with knowledge translation to allied health professionals, in addition to creating programming for those living with Long COVID.
 


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