Respiratory Training for Heart Failure

(RETRO Trial)

Overseen By Daniel E. Forman, MD

Age: 65+

Sex: Any

Trial Phase: Academic

Sponsor: University of Pittsburgh

Disqualifiers: Dementia, Severe COPD, Anemia, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Approved in 3 Jurisdictions This treatment is already approved in other countries

Compensation: Varies

Number of Visits: Unknown

Duration: 12 weeks

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial explores a breathing exercise called Inspiratory Muscle Training (IMT) to determine if it improves physical and respiratory function in older adults with severe heart failure. Participants will divide into two groups: one will continue with usual care, while the other will add these breathing exercises to their routine. The goal is to assess whether this training can boost physical abilities, reduce fatigue, and enhance quality of life. The trial seeks individuals over 70 with advanced heart failure who have been on treatment for at least six weeks. As an unphased trial, it offers a unique opportunity to contribute to research that could improve care for others with similar conditions.

Will I have to stop taking my current medications?

The trial protocol does not specify whether you need to stop taking your current medications. However, it mentions that participants should be on optimal therapy according to heart failure guidelines, which suggests you may need to continue your current heart failure treatment.

What prior data suggests that inspiratory muscle training is safe for older adults with heart failure?

Research has shown that inspiratory muscle training (IMT) is generally safe for people with heart failure. Several studies have found that IMT can improve breathing and physical ability in these patients. For instance, one review found that IMT positively affected breathing health in heart failure patients without causing major issues. Another study noted that IMT safely boosts exercise ability, even for those who already feel tired and short of breath. Overall, this evidence suggests that IMT is well-tolerated and can be safely included in heart failure care. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about Inspiratory Muscle Training (IMT) for heart failure because it introduces a new way to strengthen the respiratory muscles. Unlike traditional heart failure treatments that focus on medications or surgical interventions, IMT is a form of exercise that specifically targets breathing muscles, potentially improving endurance and reducing breathlessness. This approach offers a non-drug option that could enhance the quality of life for patients with heart failure by boosting their ability to perform daily activities with less fatigue.

What evidence suggests that inspiratory muscle training is effective for heart failure?

Research shows that Inspiratory Muscle Training (IMT), which participants in this trial may receive, can help people with heart failure. Studies have found that IMT strengthens breathing muscles and enhances quality of life. It also reduces certain heart-related markers in the blood, indicating better heart health. Additionally, IMT improves blood flow to muscles, both at rest and during activity. These benefits suggest that IMT could enhance overall physical function and well-being in people with heart failure. ^{6 7 8 9 10}

Who Is on the Research Team?

Daniel Forman, MD

Principal Investigator

University of Pittsburgh

Are You a Good Fit for This Trial?

This trial is for adults aged 70 or older with heart failure who are receiving palliative care for end-stage management of their condition. Participants should be able to perform a home-based training regimen.

Inclusion Criteria

I am either male or female.

I am over 70 years old.

I am following the best heart failure treatment guidelines.

Exclusion Criteria

I have severe heart valve disease.

Patients living in an institutional setting (e.g., skilled nursing home) during the intended period of this study

Dementia

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Participants undergo a 12-week home-based Inspiratory Muscle Training (IMT) program

12 weeks

Weekly monitoring (virtual)

Follow-up

Participants are monitored for safety and effectiveness after treatment

4 weeks

What Are the Treatments Tested in This Trial?

Interventions

• Inspiratory Muscle Training (IMT)

Trial Overview The study is testing Inspiratory Muscle Training (IMT) compared to standard care, hypothesizing that IMT will improve physical and respiratory function, self-efficacy, fatigue levels, and overall quality of life over a 12-week period.

How Is the Trial Designed?

Group I: IMT Group: Inspiratory Muscle Training (IMT) Experimental Treatment 1 Intervention

IMT exercise sessions addition to standard of care.

Group II: Standard of Care Active Control 1 Intervention

Participants in the usual care group will be telephoned at 4 and 8 weeks, and AE/SAE will be reviewed.

Inspiratory Muscle Training (IMT) is already approved in European Union, United States, Canada for the following indications:

Approved in European Union as Inspiratory Muscle Training for:

• Heart Failure
• Chronic Obstructive Pulmonary Disease (COPD)
• Respiratory Muscle Weakness

Approved in United States as Inspiratory Muscle Training for:

• Heart Failure
• Respiratory Muscle Weakness
• Pulmonary Rehabilitation

Approved in Canada as Inspiratory Muscle Training for:

• Heart Failure
• Chronic Obstructive Pulmonary Disease (COPD)
• Respiratory Muscle Weakness

Who Is Running the Clinical Trial?

University of Pittsburgh

Lead Sponsor

Trials

1,820

Recruited

16,360,000+

The Pittsburgh Foundation

Collaborator

Trials

8

Recruited

470+

Published Research Related to This Trial

Isolated inspiratory muscle training (IMT) significantly improves inspiratory muscle strength, functional capacity (measured by the 6-Minute Walk Test), and quality of life in patients with heart failure, based on a systematic review of 14 studies.

IMT is particularly beneficial for patients with inspiratory muscle weakness, and higher training loads and longer intervention times lead to greater improvements, making it a valuable adjuvant therapy for those unable to participate in conventional rehabilitation.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Inspiratory Muscle Training in Patients With Heart Failure: What Is New? Systematic Review and Meta-Analysis. Azambuja, ACM., de Oliveira, LZ., Sbruzzi, G.[2021]

Inspiratory muscle training (IMT) combined with pulmonary rehabilitation (PR) did not show significant improvements in dyspnea, functional exercise capacity, or health-related quality of life in COPD patients, based on a review of 55 randomized controlled trials involving 4,467 participants.

However, IMT alone may lead to better outcomes in these areas, suggesting that while IMT can be beneficial, its effectiveness may be diminished when combined with PR.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Inspiratory muscle training, with or without concomitant pulmonary rehabilitation, for chronic obstructive pulmonary disease (COPD). Ammous, O., Feki, W., Lotfi, T., et al.[2023]

A study involving 40 critically ill patients showed that using an electronic device for inspiratory muscle training (IMT) was feasible, with 81% of planned sessions completed, indicating good adherence to the intervention.

The electronic IMT was found to be safe, with no major adverse events and only 10% minor adverse events that were transient and without clinical consequences, while over 85% of participants reported it as helpful for their recovery.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Feasibility, safety, and patient acceptability of electronic inspiratory muscle training in patients who require prolonged mechanical ventilation in the intensive care unit: A dual-centre observational study. Nickels, M., Erwin, K., McMurray, G., et al.[2023]

Inspiratory muscle training (IMT) significantly improved inspiratory strength and endurance in patients with chronic heart failure (CHF), as evidenced by increased maximum inspiratory pressure and sustained maximal inspiratory pressure after 10 weeks of training.

Patients undergoing IMT also experienced enhanced exercise capacity, reduced dyspnea, and improved quality of life, demonstrating the efficacy of this intervention in managing symptoms of CHF.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Inspiratory muscle training using an incremental endurance test alleviates dyspnea and improves functional status in patients with chronic heart failure. Laoutaris, I., Dritsas, A., Brown, MD., et al.[2019]

Inspiratory muscle training (IMT) significantly improves respiratory muscle strength, functional capacity, and reduces dyspnea in patients with stable heart failure, based on a review of 12 clinical trials.

Typical IMT protocols involved daily sessions lasting 20 to 30 minutes at an intensity greater than 30% of maximal inspiratory pressure, leading to moderate to large effect sizes in key outcomes like inspiratory pressure and walking distance.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Inspiratory muscle training in patients with heart failure: a systematic review. Lin, SJ., McElfresh, J., Hall, B., et al.[2021]

In a study of 25 male patients with chronic heart failure, adding inspiratory muscle training (IMT) to aerobic and resistance training significantly improved maximal inspiratory pressure, resting heart rate, heart rate reserve, and health-related quality of life compared to a control group that received sham IMT.

The results suggest that IMT can enhance the benefits of traditional exercise training in cardiac rehabilitation for patients with ischemic heart failure, indicating its potential as a valuable complementary therapy.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Effects of Addition of Inspiratory Muscle Training to Exercise-Based Cardiac Rehabilitation on Inspiratory Muscle Strength, Peak Oxygen Consumption, and Selected Hemodynamics in Chronic Heart Failure. Ahmad, AM., Hassan, MH.[2022]

A 4-week high-intensity inspiratory muscle training (hi-IMT) program significantly improved inspiratory muscle strength by 57.2% and endurance by 72.7% in patients with chronic heart failure, compared to much lower improvements in the control group.

The study, involving 22 patients, demonstrated that hi-IMT is a safe and feasible intervention with no adverse effects, highlighting its potential as an effective therapy for respiratory muscle dysfunction in chronic heart failure.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

High-intensity vs. sham inspiratory muscle training in patients with chronic heart failure: a prospective randomized trial. Marco, E., Ramírez-Sarmiento, AL., Coloma, A., et al.[2020]

Inspiratory muscle training (IMT) improves the strength and endurance of inspiratory muscles, reduces dyspnoea during daily activities, and enhances quality of life, but does not offer additional benefits when combined with standard pulmonary rehabilitation programs.

IMT is beneficial for patients who cannot engage in full exercise training, and it shows promise in pre-operative programs, suggesting it may be a useful intervention in specific contexts.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

[Inspiratory muscle training during pulmonary rehabilitation]. Beaumont, M., Le Tallec, F., Villiot-Danger, E.[2021]

Citations

1. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC3443467/

Inspiratory Muscle Training in Patients with Heart Failure INTRODUCTION. Chronic heart failure (CHF) is a clinical condition where the heart is unable to provide adequate tissue perfusion, especially to the vital organs ...

2. sciencedirect.com sciencedirect.com/science/article/abs/pii/S0914508725000164

The efficacy of inspiratory muscle training in improving ... Conclusion. IMT significantly improved respiratory muscle strength, QoL, and reduced cardiac biomarker levels in patients with both heart failure with preserved ...

3. journal-of-cardiology.com journal-of-cardiology.com/article/S0914-5087(25)00016-4/abstract

The efficacy of inspiratory muscle training in improving ... IMT significantly improved respiratory muscle strength, QoL, and reduced cardiac biomarker levels in patients with both heart failure with preserved ejection ...

4. jtd.amegroups.org jtd.amegroups.org/article/view/104650/html

Effect of inspiratory muscle training in patients with chronic ... Background: The effect of inspiratory muscle training (IMT) in chronic heart failure (CHF) patients remains unclear now.

5. journals.plos.org journals.plos.org/plosone/article?id=10.1371/journal.pone.0289287

The efficacy of inspiratory muscle training in patients with ... Inspiratory muscle training improves blood flow to resting and exercising limbs in patients with chronic heart failure. J Am Coll Cardiol. 2008; ...

6. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC9744751/

Effectiveness and safety of inspiratory muscle training in ... Inspiratory muscle training in patients with heart failure: what is new? systematic review and meta-analysis. Phys Ther. (2020) 100:2099–109 ...

7. sciencedirect.com sciencedirect.com/science/article/pii/S0735109705027841

Inspiratory Muscle Training in Patients With Heart Failure ... Most patients with chronic heart failure (CHF) are limited in their physical activity by fatigue and dyspnea, and it has been suggested that respiratory muscle ...

8. clinicaltrials.gov clinicaltrials.gov/study/NCT07108231

Inspiratory Muscle Training in Hospitalized Heart Failure ... ... safe intervention capable of improving the functional capacity of patients with heart failure. Despite the known benefits, to date there are ...

9. frontiersin.org frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2022.993846/full

Inspiratory muscle training in patients with heart failure Conclusion: IMT has a significant positive effect on respiratory status in patients with heart failure, but different dyspnoea and quality of ...

10. resmedjournal.com resmedjournal.com/article/S0954-6111(11)00163-6/fulltext

Effects of inspiratory muscle training in patients with heart ... A prospective, randomized controlled, double-blinded study. Thirty patients with heart failure (NYHA II-III, LVEF<40%) were included.