A Home-Based Nurse-Coached Inspiratory Muscle Training Study

The article under the study is A home-based nurse-coached inspiratory muscle training intervention in heart failure written by Cynthia A. Padula, Evelyn Yeaw and Saurabh Mistry. This study concerned itself with the effect of 3-month nurse-coached inspiratory muscles training program on dyspnea observed among people with heart failure.

Heart failure has become one of the most widespread problems in the USA. It is one of the main causes of hospitalization of over 5 million people. Although people may go through heart failure and live longer there are a lot of consequences of these diseases that worsen the quality of life and hamper to enjoying life completely. One of such consequences is dyspnea (Kleber, 1996). This research aims at providing methods of getting rid of dyspnea as the main consequence of heart failure.

More than that, dyspnea is observed not only connected to heart failure patients with the chronic obstructive pulmonary disease also have dyspnea (Stead, 2009). Nevertheless, the scope of the study is people with heart failure and the effects of inspiratory muscle training. The hypothesis of the work is that inspiratory muscle training improves the work of inspiratory muscles, decreases dyspnea and as a result increases the quality of life.

The research question may be formulated in the following words: “Is a home-based inventory muscles training intervention more effective in improving inventory muscles’ strength, dyspnea, self-efficacy for breathing, and health quality of life outcomes than an educational comparison group?”

Dyspnea is researched as a complex phenomenon influenced by a number of factors. It is traditionally explained by hemodynamic and neurohormonal models. As for the connection of heart failure to dyspnea, one of the consequences of heart failure is the reduction of skeletal muscle function and bulk that contribute to dyspnea. People with heart failure have weak inspiratory muscles that are reduced in strength, endurance and functional performance.

This research provides the method of inspiratory muscles training that help to strengthen weak muscles. The training device is a plastic cylinder with a scale of centimeters of water pressure, an airflow valve at one and pressure regulator. The patient breathes through the mouth clipping the nose and makes the pressure to open the airflow valve (Inspiratory muscle training, n.d.). The use of this training in chronic obstructive pulmonary disease has been researched while its practice by people with heart disease has not been observed completely. It becomes new for people with heart disease to use inspiratory muscles training.

The results of the eight studies have been used in the present research. Mancini, Henson, LaManca, Donchez and Levine made profound research in 1995 with the experiment on 14 patients with heart disease. The participants use inspiratory muscles training program for three months with 90-minute sessions thrice a week.

This training demonstrates good results and it testifies to the fact that it is very useful for people with heart disease. Nevertheless, these scientists do not research the clear effects of this training. They understand its positive effect without going into details. Research made by Cahalin, Semigran and Dec also is based on the experiment of the impact of inspiratory muscles training on the decrease of dyspnea.

There are a lot of other researches devoted to this subject namely Jownson, Cowley and Kinnear’s study of 1998, Weiner, Waizman, Magadle, Berar-Yanan and Pelled’s research made in 1999 and others. The results of these researches are used in the present study. Although all these researches have the same subject of the study their results vary as far as there are differences in frequency and duration of inspiratory muscles training.

Statistically the improvement of the work of inspiratory muscles has been demonstrated in all these works but effect sizes have not been reported that makes the present research urgent in the modern medical science. These researches are limited by lack of a control group. The present research aims at identifying the impact of inspiratory muscles training. This research expands the previously reported results using nurse-coached inspiratory muscles training at home.

The researches have used Self-Efficacy theory in their study. It has been used as the framework for the research under our consideration. Self-Efficacy theory is connected to people’s beliefs in their abilities and their motivation to make efforts improving their state of health (Self-Efficacy Theory, n.d.). There are three main ways of enhancing self-efficacy including performance accomplishment, vicarious experiences, verbal persuasion and enactive attainment.

These techniques are used to increase the patients’ self-efficacy. Except the primary aim of this study to find out the effects of inventory muscles training on the work of inventory muscles and dyspnea as the consequence of heart failure there is the secondary aim namely the impact of self-efficacy theory practice on the patients’ quality of life.

This research is structured according to two-group quasiexperimental design with random assignment to groups. The experimental group and the control group have been chosen by a coin toss. The control group has received a special patient education program. Both these groups have been treated in the same ways with the same frequency and duration. The data points are based on the results of previous researches, clinical knowledge, professional literature and principles of self-efficacy theory.

The measurements used in the research are as follows: dyspnea is measured with 0-10 scale where 0 – nothing at all and 10 – very, very strong. The main principle of the use of the Borg scale is the understanding of subjective symptoms and their relation to objective parameters. Self-efficacy with the relation to the study is measured as a 34-item measure with high reliability and excellent internal consistency.

The members of the group are aged from 32 to 95 years old with the middle age 74.7 years. 47% of the participants are male 87% of them are white and 13% – non-white. The participants of the group make activities that increase the work of their inspiratory muscles such as walking upstairs, hurrying, carrying, shopping, vacuuming, playing sports, moving furniture and others. The work of their inspiratory muscles is observed during these activities at the beginning of the experiment and after the use of inventory muscle training program.

As a result, there are positive effects of the use of the inventory muscle training program but its effect depends on many other factors such as age, gender, the diseases caused the dyspnea, the health quality of life, the level of self-efficacy and many others. All these factors are taken into account in the present research and it presents the real impact of inspiratory muscles training program on people with heart failure.

From the above said, we may conclude that primary aims of the research have been achieved while the secondary ones need to be researched deeper. Although it has been reported the influence of many activities on the work of inspiratory muscles and dyspnea the connections between the use of the inspiratory muscles training program and the quality of life are not presented in details.

As a result this study has provided evidence that home-coached inspiratory muscles training are effective in improving dyspnea and increasing the strength of inspiratory muscles but improving the quality of life and self-efficacy still remain questionable. These questions need a further detailed research. Nevertheless, this critique does not diminish the value of the present research as far as the primary aims have been achieved and it has become the first research providing such a detailed impact of inspiratory muscles training on people with heart failure.

This research is very valuable to the modern medicine. Numerous medical implications may be derived from this study. Professional medical workers as well as patients may find useful information in this research. Although inspiratory muscles training device is not widely practiced in the modern medicine this research testifies to its usefulness and inspires medical workers to use this device helping their patients to get rid of dyspnea. The variety of inspiratory muscles training devices are available nowadays and everyone may find them via the internet.

Reference List

Inspiratory muscle training. (n.d.). Web.

Kleber, F. (1996). Dyspnea in heart failure. Web.

Self-Efficacy Theory. (n.d.) Web.

Stead, E. (2009). Edema and Dyspnea of Heart failure. Web.