291

Design considerations for inspiratory muscle training

systems

M P Caine1 , T M Waller1 * and A Wilcox2

1
Wolfson School of Mechanical and Manufacturing Engineering, Loughborough University, Loughborough, UK
2
PDD Limited, London, UK

Abstract: Inspiratory muscle training can be used to strengthen the muscles employed when breathing
in. This has been shown to bene®t the exercise performance of a diverse group of users including elite
sports people. Unfortunately, existing training devices do not provide an optimum training stimulus.
The principal limitations of current devices are that they can only be used statically, i.e. not during
exercise, and that the load they provide does not re¯ect the force generating capacity of the targeted
muscle group. These limitations could be overcome if an ambulatory responsive loading technology
were developed. Ambulatory training would allow users to `wear’ the training device while
performing exercise, thereby ensuring that improvements to breathing are functionally relevant to
the particular demands of a given sport or task. Responsive loading would ensure that the load
applied to the inspiratory muscles is speci®c to the force-generating capacity of the inspiratory
muscles during exercise. The purpose of the present project was to explore the feasibility of
ambulatory responsive inspiratory muscle training. A series of potential design solutions were
identi®ed. This paper describes the design and development process undertaken and draws
conclusions regarding the feasibility of ambulatory responsive inspiratory muscle training.

Keywords: sport, pressure, breathing, ¯ow, control

1 INTRODUCTION 2 IDENTIFYING AN OPTIMAL LOADING

Recent studies of respiratory muscle training have lent
support to its ergogenic in¯uence upon time trial
performance [1], as well as on the time to the limit of
tolerance during moderate intensity exercise [2±4]. In
contrast, studies that have utilized either incremental
tests to the limit of tolerance [5, 6] or very strenuous
®xed-intensity tests [7±9] have failed to observe any
statistically signi®cant eVect upon performance. It is
clear that both respiratory and inspiratory muscle
training can improve exercise performance under certain
conditions. However, it is possible that exercise
performance could be improved further if a superior
training technology were available. There are a wide
range of commercially available devices, all of which
are suboptimal in their functionality. The present paper
describes the limitations of existing technologies and
explores novel means of overcoming these shortcomings.
Potential design solutions are de®ned and compared.
The MS was received on 31 July 2002 and was accepted after revision for
publication on 25 October 2002.
*Corresponding author: Wolfson School of Mechanicaland Manufacturing
Engineering, Loughborough University, Loughborough LE11 3TU, UK.
SC02202 # IMechE 2003 Downloaded from pib.sagepub.com at RYERSON UNIVProc.
PROFILE
It is important to consider the type of training most
suitable for the inspiratory muscles. Following speci®c
training, improvements in inspiratory muscle strength,
endurance and power can be achieved. However, in
terms of transferring these gains to improved exercise
performance, it is important to note that physiological
adaptations in response to physical training are highly
speci®c to the nature of the training activity [10].
During most forms of sustained exercise the individual
is required to achieve high ¯ow rates against modest
resistances for prolonged periods [11]. Thus, the chosen
technology should provide a stimulus speci®c to these
conditions.
Several investigators have described the pressure
volume pro®le across an inspiration. Ratnovsky et al.
[12] generated the data represented in Fig. 1. This is con-
sistent with the data reported by others and illustrates
the fact that a maximum force is generated at the start
of an inspiration with a reduction in force-generating
capacity being noted as the lungs ®ll. The decay pro®le
reported here has been used to de®ne the loading charac-
teristics of the training device concepts generated.
on AprilInstn
27, 2015
Mech. Engrs Vol. 217 Part B: J. Engineering Manufacture
292 M P CAINE, T M WALLER AND A WILCOX
Fig. 1 A representation of the data taken by Ratnovsky et al.
[12] showing the pressure±volume pro®le for the
inspiratory muscles (MIP, maximal inspiratory
pressure)
3 OVERVIEW OF EXISTING TECHNOLOGIES
Three principal training approaches have been utilized.
These include voluntary isocapnic hyperpnoea, pres-
sure-threshold loading and ¯ow-resistive loading.
3.1 Voluntary isocapnic hyperpnoea
This procedure requires the user to maintain elevated
minute ventilation for a prolonged period. Elaborate
apparatus are required to regulate both inspired and
expired gas concentrations primarily to ensure continued
isocapnic status.
3.2 Pressure-threshold loading
Pressure-threshold loading requires the user to overcome
a preset threshold load supplied by a mechanical
resistance (often a spring) in order to open a valve
system and thus to generate inspiratory ¯ow. This form
of training is characterized by the ability to set a ®xed
training load, which remains essentially constant across
the inspiration (Fig. 2). There have been many diVerent
designs using this concept with both laboratory and
commercial examples available (for a review, see refer-
ence [13]).
Fig. 2 Schematic diagram depicting the force-generating capacity of the inspiratory muscles and the loading
characteristics of pressure-threshold and ¯ow-resistive technologies
Proc. Instn Mech. Engrs Vol. 217 Part B: J. EngineeringDownloaded from pib.sagepub.com at RYERSON UNIV on April 27, 2015
Manufacture
3.3 Flow-resistive loading
Flow-resistive loading is achieved by breathing through a
restricted airway. This is usually achieved by sucking air
through a small ori®ce (several commercially available
variants exist). By altering the diameter of the ori®ce it
is possible to increase or decrease the resistance to
breathing. However, the training load is directly depen-
dent upon the breathing pattern employed by the subject
(see Fig. 2). As such it is not possible to quantify the
training load or to ensure a reproducible training
stimulus.
4 LIMITATIONS OF EXISTING TECHNOLOGIES
From Figs 1 and 2 it is clear that neither pressure-
threshold nor ¯ow-resistive devices provide a truly eVec-
tive loading pro®le compared with the force-generating
capabilities of the inspiratory muscles. The pro®le of
the ¯ow-resistive device shows that at the point where
the muscles’ force-generating capacity is greatest (at
residual volume), there is almost no load generation
taking place. The pressure-threshold devices are able to
provide high initial loads; however, the load remains
constant such that, as the force-generating capabilities
of the inspiratory muscles fall below that required for
the valve to stay open, it closes prematurely. The conse-
quence of this is that, depending on the initial load set-
up, a proportion of the muscle length will receive no
training stimulus.
5 IDENTIFYING AN OPTIMAL TRAINING
STIMULUS
With the emphasis placed towards training speci®city in
modern training techniques it appears that there is the
need for a new device employing a novel technology.
This device should:
(a) provide a loading pro®le that is independent of the
prevailing inspiratory ¯ow,
(b) provide a means of varying the inspiratory load,
SC02202 # IMechE 2003
 DESIGN CONSIDERATIONS FOR INSPIRATORY MUSCLE TRAINING SYSTEMS
(c) cater for a range of inspiratory ¯ows,
(d) provide a load that is proportional to the force-
generating capabilities of the inspiratory muscles
across an inspiration,
(e) permit ambulatory loading and sport speci®c train-
ing and
(f ) accommodate a range of inspiratory volumes.
6 DESIGN SPECIFICATION
The key technical challenge was to develop a valve system
capable of providing a predetermined loading pro®le
across the inspiratory cycle. Speci®cally the load needs
to decay from a maximum value at the start of inspiration
to a minimum value at the end of inspiration. The
approach taken was to generate alternative design solu-
tions that could be compared, ranked and subsequently
taken forwards into bench technology assemblies.
7 CONCEPT DESIGNS
Three main design concepts follow that ®t the set criteria.
A brief functional overview of each is provided with the
major advantages and disadvantages highlighted.
The above concepts rely on the changing position of a
fulcrum. As the fulcrum moves towards the spring, its
mechanical advantage is reduced, thus dropping the
force required to keep the valve open. A separate
physical system is required to control the rate at which
Fig. 3 Mechanical linkage solutions utilizing a moving fulcrum and rate control unit
SC02202 # IMechE 2003 Downloaded from pib.sagepub.com at RYERSON UNIVProc.
293
the fulcrum moves so that it can be synchronized with
the ®lling of the lungs. In the ®rst case a diaphragm
valve determines the rate of this decay. The size of an
aperture is varied so that the rate of ®lling of the chamber
matches the rate of ®lling of the lungs.
Advantages
1. No power requirements. The addition of batteries
dramatically increases the unit’s weight and size.
2. Simple adjustment. The user can increase the tension
in the spring via a simple interface.
Disadvantages
1. Many parts. This means an increased build cost.
2. Fixed pro®le. The decaying force pro®le may not be
appropriate for a varied population.
Further developments of devices of this type possess
similar constraints, namely how to apply the load over
diVerent lung volumes. The accompanying concept over-
comes this limitation by utilizing a powered motor acting
as a piston. This requires control, which is via a standard
circuit and processor connected to a personal computer.
Pressure and ¯ow sensors provide feedback to the device
so that the load can be quanti®ed and the rate of decay
de®ned.
Advantages
1. High repeatability. With the correct control set-up the
technology provides an accurate load pro®le.
on AprilInstn
27, 2015
Mech. Engrs Vol. 217 Part B: J. Engineering Manufacture
294
2. Part reduction compared with the mechanical solution.
The removal of fulcrums and levers allows simpli®ca-
tion of the mechanical parts so that assembly issues
are reduced.
Disadvantages
1. Increased weight due to power supply and motor. There
may be options to distribute this weight; however,
user discomfort is likely to increase.
2. Di
cult to achieve high-speed response. There may
be issues of lag in the system whereby the environ-
ment might change in advance of the load charac-
teristics.
The major di
culty predicted with this type of
technology is regarding the interface point between
that of the electrical and mechanical components. This
could incorporate gearing from the motor to the spring
tension adjuster. Coupled with this, suitable feedback is
required to control the system. The selection of signals
in terms of ¯ow and pressure will be important to the
success of the technology.
Figure 4 refers to a second set of concepts that are
based on high-speed actuators. This type of device
allows the inspiration to be broken down into a series
of data points whereby each point represents a speci®c
lung volume and pressure value. These data points can
be manipulated to provide any loading pro®le so that
the training stimulus is received by overcoming each of
these points in turn. The current breath characteristics
and more explicitly the inspired volume determine the
rate at which this occurs.
Advantages
1. There is no limit to applied load pro®les as the shape
is determined by the layout of the data points and not
by ®xed-component geometry.
2. Further part reduction is achieved so that only the
valve actuator and pressure±volume transducers
need be present at the user interface.
Fig. 4 High-speed valve utilizing an actuator and control system
Proc. Instn Mech. Engrs Vol. 217 Part B: J. EngineeringDownloaded from pib.sagepub.com at RYERSON UNIV on April 27, 2015
Manufacture
M P CAINE, T M WALLER AND A WILCOX
Disadvantages
1. As per the electrical piston solution, the unit requires
a power supply and control layout. It is, however,
feasible to move this away from the interface into a
belt for example.
2. The key limitation of this device is the selection of an
appropriate actuator. Because of its nature, the
movement is generally violent and loud, providing a
distraction to the user.
8 FEASIBILITY TESTING
Steps have been taken to assess the likely success of the
functionality provided by such a device. Proof-of-
principle rigs have been developed and tested for repeat-
ability and suitability according to the speci®cation.
From these the electrical actuator system was chosen
for further development. The main reasons for this
were the ¯exibility achieved with such a device and the
possibility of several con®gurations so that several diVer-
ent actuators could be tested. Initially the emphasis was
placed upon the selection of a suitable actuator. The
main requirements for this component were to provide
very quick response actuation while minimizing weight,
heat and noise. Several alternatives were considered
including solenoids, piezoelectric and electromagnetic
actuators. From these, recent successful developments
have been made with electromagnets. This is due to
their relative low cost, low voltage consumption and
physical size to power ratio. Using a data acquisition
(Biopac Systems Inc., Santa Barbara, California) control
channel output, the magnets can be controlled so that a
volume signal can be generated to close a valve. This is
closely followed by a subsequent pressure signal that
releases the valve. By repeating a series of these signals
at diVerent values the decaying pro®le can be produced.
Regardless of the data point resolution used to de®ne
the loading pro®le, the stimulus provided will be similar
to that of an oscillating valve. A recent feasibility study
SC02202 # IMechE 2003
 DESIGN CONSIDERATIONS FOR INSPIRATORY MUSCLE TRAINING SYSTEMS
has been completed to explore the eVects of an oscillating
system on breathing during exercise. Further publica-
tions will communicate the ®ndings.
9 DISCUSSION
A clear de®cit is apparent between the mechanical func-
tionality of the human respiratory system and the current
technology imposed to provide training. The design
speci®cation outlined identi®es these shortcomings and
highlights the areas that need to be approached so that
a suitable technology can be developed.
The solutions presented here ful®l the speci®cation to
varying degrees and overcome the limitations of existing
technologies. Further development is required particu-
larly to permit user evaluations.
ACKNOWLEDGEMENTS
The authors wish to thank Graham Lacy and Duncan
Young at PDD Limited, UK, for their design input.
Tom Waller is supported by an Engineering and Physical
Sciences Research Council studentship. Intellectual
property rights apply to the concepts and designs
presented.
REFERENCES
1 Volianitis, S., McConnell, A. K., Koutedakis, Y., McNaugh-
ton, L., Backx, K. and Jones, D. A. Inspiratory muscle
training improves rowing performance. Med. Sci. Sports
Exercise, 2001, 33(5), 803±809.
2 Boutellier, U., BuÈchel, R., Kundert, A. and Spengler, C. The
respiratory system as an exercise limiting factor in normal
trained subjects. Eur. J. Appl. Physiology, 1992, 65, 347±353.
SC02202 # IMechE 2003 Downloaded from pib.sagepub.com at RYERSON UNIVProc.
295
3 Boutellier, U. and Piwko, P. The respiratory system as an
exercise limiting factor in normal sedentary subjects. Eur.
J. Appl. Physiology, 1992, 64, 145±152.
4 Spengler, C. M., Roos, M., Laube, S. M. and Boutellier, U.
Decreased exercise blood lactate concentrations after
respiratory endurance training in humans. Eur. J. Appl.
Physiology, 1999, 79, 299±305.
5 Hart, N., Sylvester, K., Ward, S., Cramer, D., Moxham, J.
and Polkey, M. I. Evaluation of an inspiratory muscle
trainer in healthy humans. Respiratory Med., 2001, 95,
526±531.
6 Inbar, O., Weiner, P., Azgad, Y., Rotstein, A. and Wein-
stein, Y. Speci®c inspiratory muscle training in well-trained
endurance athletes. Med. Sci. Sports Exercise, 2000, 32(7),
1233±1237.
7 Morgan, D. W., Kohrt, W. M., Bates, B. J. and Skinner,
J. S. EVects of respiratory muscle ensurance training on
ventilatory and endurance performance of moderately
trained cyclists. Int. J. Sports Med., 1987, 8, 88±93.
8 Fairbarn, M. S., Coutts, K. C., Pardy, R. L. and McKenzie,
D. C. Improved respiratory muscle endurance of highly
trained cyclists and the eVects on maximal exercise
performance. Int. J. Sports Med., 1991, 12, 66±70.
9 Hanel, B. and Secher, N. H. Maximal oxygen uptake and
work capacity after inspiratory muscle training: a con-
trolled study. J. Sports Sci., 1991, 9, 43±52.
10 Wilmore, J. H. and Costill, D. L. Physiology of Sport
and Exercise, 2nd edition, 1999, pp. 301±302 (Human
Kinetics, Leeds).
11 Spengler, C. and Boutellier, U. Breathless legs? Consider
training your respiration. News Physiol. Sci., 2000, 15,
101±105.
12 Ratnovsky, A., Elad, D., Zaretsky, U. and Shiner, R. J. A
technique for global assessment of respiratory muscle
performance at diVerent lung volumes. Physiol. Measmts,
1999, 20, 37±51.
13 Caine, M. P. and McConnell, A. K. Development and
evaluation of a pressure-threshold inspiratory muscle
trainer for use in the context of sports performance.
Sports Engng, 2000, 3, 149±159.
on AprilInstn
27, 2015
Mech. Engrs Vol. 217 Part B: J. Engineering Manufacture