Valvular Heart Disease and the Importance of Inspiratory Muscle Training in Cardiovascular Rehabilitation

Q: What is the clinical evidence from this study?

Study design: Review. Population: Valvular heart disease (undergoing surgical or transcatheter valve repair or replacement). Intervention: Inspiratory muscle training (IMT) incorporated into cardiovascular rehabilitation.

Q: What does this research mean for the field?

Inspiratory muscle training should be routinely incorporated into cardiovascular rehabilitation programs to optimize functional recovery in patients undergoing surgical or transcatheter valvular interventions. Novelty: ClaimNovelty.SYNTHESIS. Consensus alignment: ConsensusAlignment.NEUTRAL.

Bruno Bordoni; Bruno Morabito; Luigi Pianese; Gianmarco Cannadoro; Allan R Escher

doi:10.7759/cureus.119102

November 4, 2026CureusOpen Access

Valvular Heart Disease and the Importance of Inspiratory Muscle Training in Cardiovascular Rehabilitation

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Key result

AIRC recommends inspiratory muscle training at 30-50% maximal pressure to aid valvular disease recovery.

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Why the study?

Cardiovascular rehabilitation guidelines specifically addressing valvular heart disease are lacking, and another gap concerns the use of inspiratory muscle training.

Does incorporating structured inspiratory muscle training into cardiovascular rehabilitation improve diaphragmatic recovery and functional capacity in patients with valvular heart disease undergoing surgical or transcatheter intervention?

Key Points

To examine the therapeutic value of integrating inspiratory muscle training into cardiovascular rehabilitation programmes for patients undergoing intervention for valvular heart disease.
Conducted a narrative review using PubMed searches spanning 2020 to August 2026, supplemented by foundational physiological publications from 1991 to 2017.
Synthesized current clinical perspectives and practice frameworks from the Italian Association for Cardiovascular Rehabilitation regarding pre-rehabilitation and post-intervention care.
Identified that severe symptomatic aortic stenosis carries an estimated mortality rate of 10% to 20% per year, and without intervention, mortality reaches 94% within five years of diagnosis.
Highlighted an absence of dedicated cardiovascular rehabilitation guidelines and inspiratory muscle training protocols specifically tailored to valvular heart disease.
Formulated expert hypotheses and parameterization recommendations from the Italian Association for Cardiovascular Rehabilitation to address functional recovery gaps following surgical or transcatheter interventions.

Structured PICO

Does incorporating structured inspiratory muscle training into cardiovascular rehabilitation improve diaphragmatic recovery and functional capacity in patients with valvular heart disease undergoing surgical or transcatheter intervention?

P

Population

Patients with valvular heart disease undergoing surgical or transcatheter valve replacement or repair who participate in cardiovascular rehabilitation programs.

I

Intervention

Inspiratory muscle training (IMT) integrated into cardiovascular rehabilitation (CR) for at least 1 month (ideally 3 months with a 1-week midway deload/taper phase), using split training 2-3 days/week: 30% of maximal inspiratory pressure (PImax) for 2-3 sets of 15 inhalations (90-second rest) in the afternoon before endurance training to target aerobic 'red fibres', and 50% PImax for 2-3 sets of 8-12 inhalations (3-minute rest) in the morning before anaerobic training to target anaerobic 'white fibres'.

O

Outcome

Diaphragmatic functional recovery, inspiratory muscle strength (maximal inspiratory pressure), functional exercise capacity (peak VO2, 6-minute walk test), and postoperative pulmonary recovery

This narrative review and position statement from the Italian Association for Cardiovascular Rehabilitation (AIRC) addresses a major guideline gap by proposing specific, fiber-targeted inspiratory muscle training parameters (≤50% PImax) to optimize post-procedural recovery in patients with valvular heart disease.

Limitations

The text is a narrative review and does not include any assessment of the strengths or weaknesses of research in the field, sample sizes, or risk of bias.
There is a lack of concrete data and standardized guidelines on rehabilitation and IMT parameters for patients with valvular heart disease.
Recommendations are based on existing literature on training and the diaphragm rather than direct experimental validation in this specific population.
Narrative review design that does not assess study strengths, weaknesses, sample sizes, or risk of bias
Scarcity of concrete data and inconsistencies in operational protocols for cardiovascular rehabilitation and IMT in valvular heart disease
Literature search limited to a single database (PubMed) and texts written in English
Proposed IMT parameters are non-mandatory suggestions based on physiological concepts that require experimental validation

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Implication

Offers AIRC guidance on inspiratory muscle training for valvular heart disease recovery; leaves open randomized confirmation before adoption.

Abstract

Valvular heart disease (VHD) is a major cause of global cardiovascular morbidity and mortality. Treatment is either surgical or transcatheter, as there is currently no conservative pharmacological approach. Cardiovascular rehabilitation (CR) is indicated before or after invasive medical interventions to facilitate the patient's functional recovery. While CR is common practice for many cardiovascular conditions, guidelines specifically addressing VHD are lacking. Another gap concerns the use of inspiratory muscle training (IMT). This narrative review discusses the importance of routinely incorporating IMT into CR programmes, offering hypotheses and recommendations for setting IMT parameters from the perspective of the Italian Association for Cardiovascular Rehabilitation (AIRC). Further research is needed to improve our understanding of rehabilitation and VHD.

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Cite This Study

Bordoni et al. (2026) conducted a review in Valvular heart disease (undergoing surgical or transcatheter valve repair or replacement). Inspiratory muscle training (IMT) incorporated into cardiovascular rehabilitation was evaluated. Inspiratory muscle training set at 30-50% of maximal inspiratory pressure for 1-3 months is recommended by the AIRC to support diaphragmatic recovery in valvular heart disease rehabilitation.

synapsesocial.com/papers/6aec9429fd1e54ad5327dc3f https://doi.org/10.7759/cureus.119102

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Valvular Heart Disease and the Importance of Inspiratory Muscle Training in Cardiovascular Rehabilitation

Figures

Key Points

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Valvular Heart Disease and the Importance of Inspiratory Muscle Training in Cardiovascular Rehabilitation

Figures

Key Points

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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