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Effects of Inspiratory Muscle Training and Yoga Breathing Exercises on Respiratory Muscle Function in Institutionalized Frail Older Adults: A Randomized Controlled Trial

Cebrià i Iranzo, Maria dels Àngels PT, PhD1,2; Arnall, David Alan PT, PhD3; Camacho, Celedonia Igual PT, PhD1,4; Tomás, José Manuel PhD5

Journal of Geriatric Physical Therapy: April/June 2014 - Volume 37 - Issue 2 - p 65–75
doi: 10.1519/JPT.0b013e31829938bb
Research Reports

Background: In older adults, respiratory function may be seriously compromised when a marked decrease of respiratory muscle (RM) strength coexists with comorbidity and activity limitation. Respiratory muscle training has been widely studied and recommended as a treatment option for people who are unable to participate in whole-body exercise training (WBET); however, the effects of inspiratory muscle training and yoga breathing exercises on RM function remain unknown, specifically in impaired older adults.

Purpose: To evaluate the effects of inspiratory threshold training (ITT) and yoga respiratory training (YRT) on RM function in institutionalized frail older adults.

Methods: Eighty-one residents (90% women; mean age, 85 years), who were unable to perform WBET (inability to independently walk more than 10 m), were randomly assigned to a control group or one of the 2 experimental groups (ITT or YRT). Experimental groups performed a supervised interval-based training protocol, either through threshold inspiratory muscle training device or yoga breathing exercises, which lasted 6 weeks (5 days per week). Outcome measures were collected at 4 time points (pretraining, intermediate, posttraining, and follow-up) and included the maximum respiratory pressures (maximum inspiratory pressure [MIP] and maximum expiratory pressure [MEP]) and the maximum voluntary ventilation (MVV).

Results: Seventy-one residents completed the study: control (n = 24); ITT (n = 23); YRT (n = 24). The treatment on had a significant effect on MIP YRT (F 6,204 = 6.755, P < .001, η2 = 0.166), MEP (F 6,204 = 4.257, P < .001, η2 = 0.111), and MVV (F 6,204 = 5.322, P < .001, η2 = 0.135). Analyses showed that the YRT group had a greater increase of RM strength (MIP and MEP) and endurance (MVV) than control and/or ITT groups.

Conclusion: Yoga respiratory training appears to be an effective and well-tolerated exercise regimen in frail older adults and may therefore be a useful alternative to ITT or no training, to improve RM function in older population, when WBET is not possible.

1Department of Physiotherapy, University of Valencia, Valencia, Spain.

2Cardiopulmonary Rehabilitation Service, University Hospital “La Fe,” Valencia, Spain.

3Physical Therapy Department, East Tennessee State University, Johnson City, Tenessee, USA.

4Musculoskeletal Rehabilitation Service, Clinic University Hospital of Valencia, Spain.

5Department of Behavioral Sciences Methodology, University of Valencia, Valencia, Spain.

Address correspondence to: Maria dels Àngels Cebrià i Iranzo, PT, PhD, Department of Physiotherapy, University of Valencia, C. Gascó Oliag, 5, 46010 Valencia, Spain (

Preliminary results reflected in this article have been presented at the 8th World Congress on Active Aging; August 13-17, 2012; Glasgow, Scotland.

The authors declare no conflicts of interest.

Copyright © 2014 the Section on Geriatrics of the American Physical Therapy Association
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