Respiratory muscle training in individuals with spinal cord injury: effect of training intensity and -volume on improvements in respiratory muscle strength.

Abstract

Retrospective cohort study. To investigate the effect of training intensity and -volume on improvements in respiratory muscle strength in individuals with spinal cord injury (SCI). SCI rehabilitation center in Switzerland. Inpatients with SCI, lesion level C4-T12, who had at least 10 individualized inspiratory muscle training sessions with respiratory function measurements before and after the training period. Multiple regression analysis with natural logarithmic (ln) transformation of the outcome values was used to examine the effect of training intensity and -volume, lesion level and completeness, and baseline respiratory muscle strength on improvements in respiratory muscle strength. Overall, 67 individuals were analyzed. Variation in PI_max was explained by PI_max at baseline and training intensity. This adjusted effect size suggested a 7% (95% CI 2.8 to 11.6%) increase in PI_max per 10 units of increase in training intensity. Controlling for the variation in baseline PE_max, the effect of training intensity on PE_max was conditional on AIS (p < 0.021). While individuals with motor complete lesions showed a 6.8% (95% CI 2.1 to 11.7%) increase in PE_max per 10 units of increase in training intensity, the corresponding adjusted effect size in those with motor incomplete lesions was 0.1% (95% CI -4.3 to 4.5%). The full models explained 57 and 60% of the variance of lnPI_max and lnPE_max, respectively. The intensity of inspiratory muscle training was more relevant than training volume for the improvement of respiratory muscle strength in individuals with SCI. Thus, training intensity should be chosen as high as possible.