The importance of respiratory muscle training

for inspiratory and expiratory muscles

A white paper on concurrent respiratory muscle training (CRMT) from PowerLung, Inc.

The current body of clinical research work confirms the complex

mechanisms that are in place between the respiratory system and
the circulatory systems of the human body. This paper attempts to
capture that information in a form that addresses the scope of the
work and how it applies to the respiratory muscle training uniquely
provided by PowerLung products.
Twelve (12) sets of muscles are used in breathing. These muscle groups
are used for both inhale and exhale. Principles of strength training
in the literature show improved co-ordination and efficiency results
by training both agonist and antagonist muscle groups (Sale 1988).
Like other sets of muscles, the respiratory muscles can be trained for
improvement in strength, endurance or both. (Pardy, et al 1988)

Why do you need to train the breathing (respiratory) muscles if

you are an active person or athlete?
There is nothing wrong with you. You are breathing. You exercise regularly and you do cardio workouts, wind
sprints, and other aerobic activity. Doesnt this activity train the respiratory muscles? A growing number of clinical
studies are now proving that the bodys ability to exercise, particularly at high intensities, is significantly limited by
the performance of the respiratory system. It does so because during heavy exercise or when you are exercising with
maximal effort, four things occur.

The work of breathing is increased during exercise

and requires up to 15% of the total energy spent in high
intensity exercise. The harder the respiratory muscles
work, the less blood flows through the legs. This means
that the respiratory muscles take blood instead of it
being sent to the arms and legs. (St. Croix, et al, 2000;
Harms, et al, 2000) Therefore, anything that lessens the
respiratory muscle workload means more blood (which
contains oxygen, sugar for the muscles and gets rid of
lactate and carbon dioxide) can flow to the legs and arms
during intense exercise.

Respiratory Muscle Fatigue. The respiratory muscles

are subject to fatigue just like other muscles in the body
and this fatigue can reduce blood flow to the peripheral
muscles (Sheel, et al 2001). Recent research demonstrates
that a single 200-meter swim can cause significant
respiratory muscle fatigue as measured by maximal
inspiratory pressure. The impact of this on the athlete is
the impact on the ability to inhale adequately. The athlete
may perceive breathing is very difficult causing them to
work even harder to breathe and thus causing problems
related to the work of breathing.

Research clearly demonstrates that respiratory muscle

training improves both the strength AND endurance
capacity of the inspiratory AND expiratory muscles.

Respiratory muscle fatigue has been shown to negatively

affect the respiratory system demands to generate the
required amount of pressure necessary to provide for
adequate ventilation (Lomax and McConnell, 2003).

Physiological stress. Most well trained individuals

show significant physical stress during exercise. This
physiological stress can have detrimental effects on
oxygen uptake (Dempsey and Wagner, 1999).

The sensation of breathlessness. Breathing discomfort,

dyspnoea, may ultimately determine an individual
athletes exercise tolerance because it can prevent the
development of respiratory muscle fatigue (Altose et al.,
1985) because it limits an athletes ability to continue to
perform at the required intensity. When the sensation of
breathlessness and breathing discomfort occurs during
high intensity exercise it may be the ultimate exerciselimiting factor.

...the bodys ability to exercise is

The importance of this is best demonstrated by two

swimmers who are neck and neck at the end of the race
both dealing with the urge to breathe. The one who
breathes first usually loses. Decreases in the sensation of
breathlessness are associated with increases in swimming
speed during taper as documented by Wells, et al.

significantly limited by the performance

of the respiratory system...

The respiratory muscles can limit exercise

performance and endurance.
In a 2000 study, Prefaut, et al demonstrated that all of the above
conditions could result in the limitation of exercise performance.
Respiratory muscle training can be effective in addressing the
limitations of the respiratory system during exercise (recently
reviewed in Sheel (2002). Research in this area has demonstrated that
respiratory muscles, just like other skeletal muscles, adapt to specific
respiratory muscle training and to whole body exercise training
in relation to pulmonary function, respiratory muscle endurance,
and maximal strength. Studies have also shown improvements in
exercise endurance (Boutellier et al., 1992; Boutellier and Piwko,
1992; Boutellier, 1998; Spengler et al., 1999; Markov et al., 2001;
Stuessi et al., 2001 Research results indicate that specific respiratory
muscle training, in addition to normal exercise training, may reduce
sensitivity to chemoreceptors. It is believed this occurs because of
the repeated exposure to high levels of breathing present during
endurance exercise training (McMahon et al., 2002).

Because of the more active nature of inspiration in the breathing process,

most research has focused on the effects of inspiratory muscle training
only. Documentation suggests the expiratory muscles may not contribute
significantly to the work of breathing while an individual is at rest. The trend
to focus exclusively on inspiratory is changing because of recent research
findings. The findings show the expiratory muscles become actively involved
at high exercise intensities. Because high ventilation rates are required to
maintain exercise intensity and airway flow during this period becomes
turbulent more effort is required of the muscles used in exhalation. Recent
research by Derchak et al. (2002) shows that high-intensity contractions
of expiratory muscles to the point of task failure caused a time-dependent
sympatho-excitation and increases in mean arterial pressure. This suggests
that expiratory muscle fatigue may also result in constriction of blood vessel
in the limbs during exercise.
A principle in the strength training literature that training both agonist and
antagonist muscle groups results in improved neuromotor co-ordination
and movement efficiency (Sale, 1988) has not, until recently been applied
to the respiratory muscles and there has been no research on the effect of
concurrent inspiratory and expiratory muscle resistive training despite these
existing principles in the literature. In a recent study, Wells, et al, evaluated
the effect of concurrent inspiratory and expiratory muscle training (CRMT)
on pulmonary function and on the strength and endurance of the respiratory
muscles to apply the strength training literature to the respiratory muscles.
3

the importance of
including expiratory
muscles in a
respiratory muscle
training program.

conclusion
As the body of literature grows it continues to support the
benefits of respiratory muscle training for the athlete. Further,
the literature no longer suggests the benefits are restricted to
inspiratory muscles. Instead, as shown in this paper the research
substantiates the principles of training the inspiratory AND
expiratory muscles for strength, power and endurance can
provide the athlete with the same benefits this type of training

We built PowerLung to
solve a problem:
the ventilatory system
limits human performance.

provides to other skeletal muscles.

acknowledgement
PowerLung, Inc. gratefully acknowledges: Greg Wells, PhD, Hospital for Sick Kids, Toronto Canada for using PowerLung products in his research into Concurrent Respiratory Muscle Training (CRMT) and for sharing portions of his research with us for the purposes of this article. Dr.
Wells also graciously assisted us with this white paper by helping to maintain accuracy while delivering the message in less clinical terms than
presented in the research.

sources
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Altose, M., Cherniack, N. and Fishman, A. P. (1985). Respiratory sensations and

syspnea. J. Appl. Physiol. 58, 1051-1054.
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Prefaut, C., Durand, F., Mucci, P. and Caillaud, C. (2000). Exercise induced arterial
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