Key result
High-intensity inspiratory muscle training boosts cardiac parasympathetic activity by ~26% in COPD patients.
Why the study?
The effects of eight-week inspiratory muscle training at the highest tolerable intensity on cardiovascular autonomic function in COPD remained untested.
Does eight-week high-intensity inspiratory muscle training improve cardiac autonomic function in patients with stable COPD?
RCT (n=39)
randomized
Does eight-week high-intensity inspiratory muscle training improve cardiac autonomic function in patients with stable COPD?
p-value: p=< 0.01
Eight weeks of high-intensity inspiratory muscle training significantly improves cardiac autonomic function, functional capacity, and health status in patients with stable COPD.
High-intensity inspiratory muscle training improves autonomic balance in stable COPD; extends low-intensity evidence to an 8-week RCT.
BACKGROUND: Cardiovascular autonomic dysfunction and respiratory muscle weakness have been detected in patients with COPD. Although low-intensity inspiratory muscle training over 12 weeks increases cardiac parasympathetic (vagal) activity, eight-week programmes at the highest tolerable intensity and their effects on cardiovascular autonomic function remain untested. METHODS: Thirty-nine stable COPD patients were randomized to inspiratory muscle training or control. Both received standard care, excluding pulmonary rehabilitation; the training group additionally performed 30 breaths twice daily at the highest tolerable intensity for eight weeks using a tapered flow resistive loading device. Assessments comprised pulmonary and respiratory muscle function, heart rate variability (HRV), blood pressure variability, baroreflex sensitivity, dyspnoea, 6-min walk distance and health status. Thirty-seven participants (training n = 18, control n = 19) completed the protocol. RESULTS: O (p < 0.001), and cardiac parasympathetic activity rose (high-frequency component of HRV: 36.99 ± 17.51% to 46.84 ± 15.33%, p < 0.01). Sympathetic index decreased (low-frequency component of HRV: 54.13 ± 21.40% to 40.73 ± 17.01%, p < 0.001), as did the low-frequency/high-frequency ratio (2.30 ± 2.39 to 1.10 ± 0.83, p < 0.01). Systolic blood pressure variability decreased significantly. Baroreflex sensitivity increased from 5.36 ± 3.15 to 7.18 ± 4.58 ms/mmHg but was not significant (p = 0.05). Six-minute walk distance improved from 347.47 ± 82.72 to 378.71 ± 80.09 m (p < 0.01), and health status improved (COPD Assessment Test 7.72 ± 3.36 to 3.61 ± 2.85; Clinical COPD Questionnaire 1.07 ± 0.52 to 0.48 ± 0.31; both p < 0.001). These training-group improvements significantly exceeded control; ANCOVA confirmed group effects after baseline adjustment. CONCLUSION: Eight-week highest tolerable intensity inspiratory muscle training enhances cardiovascular autonomic function in COPD through increased parasympathetic and reduced sympathetic activity, and improves functional capacity and health status.
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Suraprapapich et al. (2026) conducted an RCT in COPD (n=39). High-intensity inspiratory muscle training vs. Control (standard care) was evaluated on Cardiac parasympathetic activity (high-frequency component of HRV) (p=< 0.01). Eight-week high-intensity inspiratory muscle training in COPD patients significantly increased cardiac parasympathetic activity (HRV high-frequency component rose from 37.0% to 46.8%, p<0.01).
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