Patients with chronic heart failure exhibit significantly
reduced respiratory muscle strength and endurance.
These impairments are associated with numerous alterations
in respiratory muscle structure and function,
including a shift in muscle fibre phenotype, reduced
oxidative capacity, and altered intracellular calcium regulation.
There is now substantial evidence that selective
respiratory muscle training in patients withCHFincreases
respiratory muscle strength and overall aerobic capacity.
The majority of studies have used a regimen of inspiratory
muscle training against either a fixed or incremental
inspiratory load, expressed as a percentage of MIP.
The benefit of whole body aerobic and strength exercise
in CHF patients has been well documented and is now
implemented in many rehabilitation programes for these
patients.The recent trial ofWinkelmann et al. [46], demonstrating
that inspiratory muscle training in combination
with whole-body aerobic training was more beneficial
than aerobic training alone, should be repeated in a separate
CHF cohort. If the results are concordant, inspiratory
muscle training should be incorporated into existing rehabilitation
programes for patients with CHF.