Preliminary evidence from both our PHIIT feasibility trial and the published literature [16, 17], supports the hypothesis that this exercise prescription will produce a clinically and significantly meaningful increase in cardiopulmonary fitness. Perform the following exercises slowly, as outlined. Promoting exercise and activity is one of the most important aspects of preoperative education and postoperative care. 2013;44(4):e260–5. At the pre-surgery assessment (T1) a sub-cohort of the study’s participants will take part in a semi-structured interview to feedback on how the PRE-HIIT study has impacted on their preparation for surgery. May 20th 2019. High intensity interval training (HIIT) has significant potential as an effective and feasible preoperative intervention [15,16,17]. The EQ5D5L scores at outpatient follow up will allow an assessment if any short-term difference persists and will assist in modelling the likely medium-term effect of the intervention on costs and QOL. Perform exercise 5 -10 times holding each contraction for 5 secs. A linear mixed model will be used to model the longitudinal change in the primary response between the groups, allowing for missing data (under the assumption that data are missing at random) and allowing for within subject correlations in the repeated measures across time. Following baseline assessment (T0) and registration, participants will be randomised in a 1:1 ratio to either the PRE-HIIT programme or to the standard survivorship care control group, using a computer-generated randomisation list. Braun and Clarke’s 6 stage approach to thematic analysis will be used to analyse all data collected [33]. - Patients will need preoperative teaching concerning postoperative exercises - Ideally pre-operative teaching is done 1 to 2 days prior to surgery. The results of this study will inform current perioperative practice and will provide direction for future research. Postoperative morbidity will be measured using a suite of validated instruments; the Clavien-Dindo Scale, the postoperative morbidity index (POMS) and the Comprehensive Complications Index (CCI). Place a rolled up towel or pillow under your knee then tighten the muscle on the front of your thigh. Principles of exercise testing and interpretation. Post-Operative Exercises. Those three items are heavily emphasized at SSOR both pre- and post-op to maximize function. Data monitoring will be provided by the trial steering committee, including overall project supervision, progress monitoring, advice on scientific credibility and ensuring the integrity and appropriate running of the project. Dis Esophagus. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. Pre-operative exercise reduces the length of stay both in Intensive Care facilities and in hospital. It is anticipated that the active control group will not experience a change in fitness during this 2 week time period [16]. Wrexham Maelor Hospital. Furthermore, the study design is similar to the format prescribed by the PREPARE trial [20], which specified a minimum study duration (at least 2 weeks) but continued to prehabilitate patients for longer in the lead up to surgery to optimise the benefits gained [21]. A score lower than 10 indicates one or more mobility limitations. Moderate intensity exercise interventions have not been shown to significantly change preoperative aerobic capacity and functional capacity of patients due to undergo elective surgery [31]. Each patient is taught as an individual, with consideration for any unique concerns or needs; the pro-gram of instruction should be based on the individual’s learning needs (Quinn, 1999). The CPET will be performed using a ramp cycle ergometer protocol. This research was funded by the Health Research Board and ‘IRISH CANCER SOCIETY’ under the MRCG-HRB Joint Funding Scheme [MRCG-2018-17]. statement and Maximal inspiratory pressure (PImax) provides a non-invasive, simple measure of inspiratory muscle strength, particularly the diaphragm. Patients will only be formally enrolled on the study after successfully completing a CPET with ECG monitoring. It is supplemented by disease specific modules. Quality of life will be further assessed at 3 months post intervention. Braun V, Clarke V. Using thematic analysis in psychology. © 2020 BioMed Central Ltd unless otherwise stated. Participants will be recruited from SJH, Dublin, Ireland. The physiotherapist and the esophageal cancer patient: from prehabilitation to rehabilitation. ☐ Straight Leg Raises – In the position shown, tighten your thigh muscle while keeping your knee straight and lift your leg 3-5 cm. Am J Respir Crit Care Med. In the case of exercises before total knee replacement surgery, the evidence supports doing pre-operative exercises for those having a total knee replacement. Participants randomised to the intervention will receive an additional tailored dietetic assessment with the exercise programme to ensure nutritional adequacy is maintained throughout the duration of the intervention. Comparably, peak oxygen consumption (VO2peak) < 10 ml/min/kg is predictive of mortality and serious morbidity following major thoracic operations [9]. The discussion guide for the interviews will explore topics such as: the impact of the intervention on health, well-being, and activities of daily living, facilitators and barriers to preoperative exercise, and recommendations for future implementation of the programme. Listing a study does not mean it has been evaluated by the U.S. Federal Government. HIIT consists of alternating periods of high-intensity aerobic exercise and low-intensity exercise or rest, and stimulates superior improvements in VO2peak compared to continuous moderate-intensity aerobic training [15, 18]. While the evidence in intra-abdominal surgery is encouraging, little is known about exercise prehabilitation for major thoracic operations on the lung or oesophagus. Pre Operative Exercises Before a Total Knee Replacement . Brunelli A, Kim AW, Berger KI, Addrizzo-Harris DJ. Preoperative cognitive exercises decrease postoperative delirium: Study Finds By Dr. Nandita Mohan Published On 2020-11-29T14:45:50+05:30 | Updated On 29 Nov 2020 9:15 AM GMT According to recent observations, researchers have noted that a preoperative cognitive exercise intervention had a significantly decreased incidence of postoperative delirium, as published in the … The primary aim of this work is to examine the effect of a preoperative high intensity interval training programme on cardiorespiratory fitness in patients scheduled for oesophagectomy and major lung resections. Data collected on POD30 will be collected via a telephone call with the participant. PDF | On Jan 1, 2010, Kate P. Stewart and others published Preoperative care | Find, read and cite all the research you need on ResearchGate The authors would like to acknowledge the assistance and support of the Wellcome Trust/HRB Clinical Research Facility at St. James’ Hospital, Dublin. Typical Total Knee Pre-Operative Exercises (Please note that these exercises are for example only and any exercises you want to do should be prescribed by your physician and/or your physical therapist. Compliance to the aerobic component will be documented by the achieved heart rates on the Polar Heart Rate Monitors, and the duration of aerobic exercise, and for resistance training, the weight, number of sets, and repetitions will be recorded. Betsi Cadwaladr University Health Board. PubMed Central  Samples will be collected and recorded every minute during the exercise test. Croesnewydd Road. 2017;30(1):1–12. Once a patient develops OA, the disease will persist for the remainder of the lifespan, and the severity of pain and disability generally increases.5,6 Knee OA is initially treated pharmacologically in an attempt to control the joint pain and preserve functional ability, but frequently the disease progresses to a level at which total knee arthroplasty (TKA) is indicated.15 This treatment for knee OA can reduce pain, maintain or improve joint mobility, and limit functional impairment.10 Total knee arthroplasty commonly involves … Improvement of preoperative exercise capacity may influence the short- and long-term postoperative prognosis in patients with chronic liver injury. Exercise prehabilitation for oesophagectomy has typically prescribed IMT, a form of exercise training which strengthens the inspiratory muscles. Perioper Med (Lond). Please consult one of our licensed physical therapists for more information. Otherwise it will be possible to estimate the additional cost of any measured improvement in QOL post-intervention. Hip Abduction in Standing. A 3-min cool down will be performed upon session completion followed by a passive recovery period of up to 7 min. Dis Esophagus. A total of 78 participants will be recruited (39 per study arm). http://creativecommons.org/licenses/by/4.0/, http://creativecommons.org/publicdomain/zero/1.0/, https://doi.org/10.1186/s12885-020-06795-4, Survivorship, cancer burden and supportive therapy. The test will be terminated by a cool-down performed at a resistance of 30 watts for 3 minutes and during which participants will be monitored for signs of distress (pallor, chest pain, dyspnoea). The tool is widely used due to its simplicity and reproducibility, its correlation with LOS, and the degrees of severity of complications also correlate with the perceptions of severity of medical staff and patients [25]. Preoperative therapeutic programme for elderly patients scheduled for elective abdominal oncological surgery: a randomized controlled pilot study. The primary outcome is cardiorespiratory fitness. Qual Res Psychol. The pre-operative exercises should achieve the following goals: Truthfully, the above are great guidelines for any knee surgery. the effect of pre-operative physiotherapy and the satisfaction of patients with treatment in Netherlands. 2009;77(1):3–17. In addition, hospital and critical care LOS and postoperative mortality will be recorded. Post Op Exercises taught before surgery. 2017; In Press. It also discusses the clear benefits of such exercise training among elderly people in preparation for surgery. Ann Surg. Mugele H, Freitag N, Wilhelmi J, Yang Y, Cheng S, Bloch W, et al. BMC Cancer 20, 321 (2020). In conclusion, preoperative exercise capacity and BTR were identified as independent prognostic indicators of event-free survival and maintenance of Child-Pugh class in HCC patients with chronic liver injury undergoing hepatectomy. Key timepoints for assessing outcomes of exercise prehabilitation intervention are outlined in Fig. Participant’s experience of preparation for surgery on the PRE-HIIT trial will also be explored. This project will examine the influence of exercise prehabilitation on physiological outcomes and postoperative recovery and, through evaluation of health economics, the impact of the programme on hospital costs. 2014;40(10):1313–20. By using this website, you agree to our Article  [24]. Click here to view instructional videos for hip replacement surgery preoperative and postoperative exercises. View original. Participants will be identified at pre-operative clinics and through institutional databases by their clinical team. Give us a call if you need exercises before knee surgery to help maximize your outcome post-operatively and put yourself in the best position to succeed. In intra-abdominal surgery, low cardiopulmonary fitness, characterised by an anaerobic threshold (AT) < 11 ml/kg/min provides the most accurate indicator of postoperative morbidity and hospital LOS [8]. Any amendment to the protocol which may impact on the conduct of the study will be submitted as an amendment for approval to the ethics committees. Respir Med. The research team will make quarterly reports to the trial steering committee. Google Scholar. Pre-operative fitness is an established predictor of postoperative outcome, accordingly, targeting pre-operative fitness through exercise prehabilitation has logical appeal. While initial results from IMT trials were encouraging, a randomised trial of 246 patients, reported no reduction in pneumonia rates or PPCs following oesophagectomy with IMT [14], highlighting the need to prescribe more intensive exercise training to achieve a higher training stimulus for clinical impact. High-intensity training and cardiopulmonary exercise testing in patients with chronic obstructive pulmonary disease and non-small-cell lung cancer undergoing lobectomy. The COSMED K4b2 ambulatory metabolic system will be used to determine forced vital capacity (FVC), forced expiratory volume at 1 s (FEV1) and the ratio of FEV1/FVC in accordance with the American Thoracic Society Guidelines. Patients who are scheduled for either oesophagectomy (2-stage or 3-stage) or major lung resection for the management of primary oesophageal or lung cancer. Patients with oesophageal cancer scheduled for multimodal therapy including preoperative chemo(radio)therapy and oesophagectomy will be recruited and tested prior to treatment commencement (Dx). Cardiopulmonary fitness is an established indicator of postoperative outcome and surgical candidacy. Muehling BM, Halter GL, Schelzig H, Meierhenrich R, Steffen P, Sunder-Plassmann L, et al. PREOPERATIVE TEACHING . Specialists in Sports and Orthopedic Rehabilitation |. Comparably, rates of PPCs following thoracic surgery are 25% [5]. Adherence to the exercise component of PRE-HIIT will be measured with traditional adherence variables i.e. The costing of hospital stays, and interventions will be carried out based on activity data from hospital records, with unit costs taken from the standard estimated costs from the Healthcare Pricing Office. Nilsen TS, Scott JM, Michalski M, Capaci C, Thomas S, Herndon JE 2nd, et al. Click here to view instructional videos for knee replacement surgery preoperative and postoperative exercises. Int J Surg. Privacy They concluded the study, as pre-operative physiotherapy The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. Date of surgery ≥2 weeks from baseline (T0) assessment, Ability to provide written informed consent, Absence of significant co-morbidities, including metastatic disease, which may adversely impact postoperative outcome, Successful completion of a medically supervised cardiopulmonary exercise test. Pre-Operative Exercises. VO2peak will be calculated as an average over the last 30 seconds of exercise. Secondary outcomes include, measures of pulmonary and physical and quality of life. The 2007 Expert Panel on Weight Loss Surgery recommends that patients be encouraged to increase preoperative to postoperative PA, in particular, low- to moderate-intensity exercise ( 5 ). Postoperative pulmonary complications (PPCs), which are among the most serious postoperative morbidity, occur in 15–30% of patients post-oesophagectomy and are the primary cause of postoperative mortality, contributing to 45.5–55% of post-oesophagectomy deaths [4]. Open Heart Surgery – Incredible Picture Guide! Br J Anaesth. Cookies policy. Pouwels S, Fiddelaers J, Teijink JA, Woorst JF, Siebenga J, Smeenk FW. In the case of ACL reconstructions, a  classic 1995 study by Cosgarea et al in the American Journal of Sports Medicine tells us that basically 4 things should be achieved prior to having an ACL reconstruction. Data collection will take a semi-structured approach individual interviews following the intervention. Arends J, Bachmann P, Baracos V, Barthelemy N, Bertz H, Bozzetti F, et al. 2016;103(5):504–12. The main assessment battery will be performed at; diagnosis (oesophageal cancer patients scheduled for neoadjuvant treatment) (DX), baseline (T0), and post-intervention (T1). Pre‐operative exercise training is principally aimed at increasing physiological and functional reserve through performing structured, purposeful exercise training; however, a combination of regular exercise training and general physical activity should be encouraged for longer term fitness, health and wellbeing. Center for Advanced Medicine. Correspondence to Context: Preoperative pelvic floor muscle exercise (PFME) is often prescribed to reduce the severity of postprostatectomy incontinence. How to use preoperative in a sentence. Clinical Scenario : The patients who led us to investigate this question are those we treated in the acute setting post-op, and then saw a few days later in an outpatient clinic. These additional exercise adherence variables will include; permanent treatment discontinuation, treatment interruption, dose modification, early session termination, and pre-treatment intensity modification. Post operative pain control. You may ride the stationary bicycle daily for 10 to 20 minutes. Google Scholar. Methods: We searched MEDLINE, Web of Science, Embase, Pedro, and the Cochrane Central Register, without language restrictions, for studies from inception to July, 2020. In addition, patients undergoing video assisted lobectomy (VATS) for early lung cancer will be excluded. Following a standardised resting and warm-up period, testing will commence with 3 minutes of free-wheel pedalling after which resistance will increase by standardised increments. Chest. A systematic review was performed to assess the effects of preoperative exercise and fitness on postmastectomy recovery. Terms and Conditions, Randomisation will be overseen by a co-principle investigator, who will have no direct involvement in implementing the trial. A comparison of patient characteristics at baseline will be carried out for each arm. Eur J Surg Oncol. The use of … Onerup A, Angeras U, Bock D, Borjesson M, Fagevik Olsen M, Gellerstedt M, et al. Consequently, HIIT provides the best opportunity to create optimal improvements in fitness within the short timeframe for oncologic resection within the clinical pathway. Stefanelli F, Meoli I, Cobuccio R, Curcio C, Amore D, Casazza D, et al. The EQ-5D5L will be measured at routine post-operative clinic visits at 6 weeks and 3 months postoperatively. High-intensity interval training in the therapy and aftercare of cancer patients: a systematic review with meta-analysis. Pinto A, Faiz O, Davis R, Almoudaris A, Vincent C. Surgical complications and their impact on patients’ psychosocial well-being: a systematic review and meta-analysis. Surgery. The purpose of this study was to assess the effect of preoperative physiotherapy (PT) on functional, subjective and socio-economic parameters after total knee arthroplasty (TKA). Dronkers J, Lamberts H, Reutelingsperger I, Naber R, Dronkers-Landman C, Veldman A, et al. The study will take place in the Wellcome Trust-Health Research Board (HRB) Clinical Research Facility (CRF) at St James’s Hospital (SJH), Dublin. The 2-week preoperative timeline was found to be acceptable in the oesophagectomy clinical pathway at our Centre. Programme implementation costs will be analysed in consideration of clinician salaries, overheads and equipment costs. A qualitative approach will be taken to gather participants’ feedback on how the PRE-HIIT study has impacted on their preparation for surgery. Pre-Operative Exercises . Dunne DF, Jack S, Jones RP, Jones L, Lythgoe DT, Malik HZ, et al. This study will examine the physical and economic implications of a targeted programme of exercise prehabilitation prior to major oncologic resection for oesophageal and lung cancer. Consequently, interventions aimed at reducing postoperative risk may have significant clinical and economic impact. Our Locations. exercise. This exercise program which your orthopedic surgeon should have in place for you once a surgical date has been made is something to take seriously. At baseline information regarding socio-demographics will be collected from patient interview and data pertaining to medical history, cancer diagnosis and treatments will be obtained from patient’s medical records. Whether or not this results in fewer complications or faster convalescence remains unclear. Preoperative exercise to improve fitness in patients undergoing complex surgery for cancer of the lung or oesophagus (PRE-HIIT): protocol for a randomized controlled trial. Jack S, West MA, Raw D, Marwood S, Ambler G, Cope TM, et al. 2006;3(2):77–101. In the case of exercises before total knee replacement surgery, the evidence supports doing pre-operative exercises for those having a total knee replacement. Cardiopulmonary fitness will be determined, by a maximal cardiopulmonary exercise test (CPET), the gold standard measure of fitness [23]. Pre Operative Exercises Blog Posts. In addition to the goals stated above for pre-operative ACL surgery, other exercises may include hip strengthening, stretching, and balance activities. HIIT exercise training stimulates great improvements in cardiopulmonary fitness over short periods compared to continuous aerobic training and therefore may be ideally suited to exercise prehabilitation. This measure combines the results of gait speed, chair stand and balance tests. Discussion of the frequency of assessing vital signs and use of monitoring equipment. CAS  The effectiveness of pre-operative exercise physiotherapy rehabilitation on the outcomes of treatment following anterior cruciate ligament injury: a systematic review Show all authors. Rehabilitation strategies following esophageal cancer (the ReStOre trial): a feasibility study. Center for Advanced Medicine. Similarly, if costs of care are lower in the intervention group but QOL is also lower, it will be possible to estimate cost-effectiveness ratios for this change. The existing routine postoperative protocol for total knee replacements included quadriceps and hamstring setting, straight leg raises, hamstring and heel cord stretching, knee strengthening, sitting and prone knee range of motion exercises, and routine precautions. Novel methods for reporting of exercise dose and adherence: an exploratory analysis. This mode of exercise prehabilitation may attenuate postoperative risk and improve postoperative recovery, thus improving patient quality of life and having considerable economic benefits for the healthcare system. Neil Agnew, MBBS FRCA Consultant Anaesthetist. Preoperative exercise therapy in lung surgery patients: a systematic review. Med Sci Sports Exerc. Br J Surg. Typical Total Hip Pre-Operative Exercises (Please note that these exercises are for example only and any exercises you want to do should be prescribed by your physician and/or your physical therapist. The ordinal scale is divided into seven grades (Grade I-V, two sub-groups each for Grade III and IV), ranging from Grade I, which considers any deviation from normal, to Grade V, which describes death of the patient. This will be measured using the Short Physical Performance Battery (SPPB). The median cost of hospitalisation post oesophagectomy is $31,375 (€26,368), however this increases by a further $20,777 (€17,461) with serious postoperative complications [7]. PubMed  By completing an organized pre-operative exercise program in just a few minutes each day prior to surgery will make the rehab process much smoother. The existing routine postoperative protocol for total knee replacements included quadriceps and hamstring setting, straight leg raises, hamstring and heel cord stretching, knee strengthening, sitting and prone knee range of motion exercises, and routine precautions. Trials. Patient perceived physical recovery at POD30 will be self-assessed using standardised classifications. The training stimulus associated with HIIT may lead to important improvements in secondary measures of physical performance including pulmonary function, ventilatory and peripheral muscle strength and functional capacity [27], which may in turn positively impact postoperative outcome. Valkenet K, Trappenburg JC, Gosselink R, Sosef MN, Willms J, Rosman C, et al. ESPEN guidelines on nutrition in cancer patients. The PRE-HIIT Randomised Controlled Trial (RCT) will compare a 2-week high intensity interval training (HIIT) programme to standard preoperative care in a cohort of thoracic and oesophageal patients who are > 2-weeks pre-surgery. In oncologic resection, preliminary evidence indicates 12–15 sessions of HIIT significantly improves cardiopulmonary fitness in low-fit older adults undergoing lobectomy [16] and hepatic resection [17], however further evaluation in larger cohorts and in those with highest postoperative risk is required. Ferrazza AM, Martolini D, Valli G, Palange P. Cardiopulmonary exercise testing in the functional and prognostic evaluation of patients with pulmonary diseases. Summary statistics for continuous variables (means and standard deviations or median and ranges as appropriate) and categorical variables (counts and proportions) will be presented. The preoperative level of physical activity is associated to the postoperative recovery after elective cholecystectomy - a cohort study. If you’re on track to have ACL reconstruction or a total knee replacement, it would be a privilege to partner with you in your care. In the proposed study, quadriceps muscle strength will be measured by 1 repetition maximum (1RM) using a horizontal leg extension. Improving range of motion and increasing strength of the quadriceps and supporting hip muscles has been shown to help hasten recovery of both gait and function. Astorino TA, Allen RP, Roberson DW, Jurancich M. Effect of high-intensity interval training on cardiovascular function, VO2max, and muscular force. PRE-HIIT will implement a series of drug trial adapted adherence outcomes as described by Nilsen et al. Preoperative education may include instructions on completing deep breathing and coughing exercises postoperatively. Shady Alshewaier 1 2. Start pre-operative exercises. Complete exercises while lying down or reclined with legs straight. This article focuses on the effects of preoperative exercise training particularly within the elderly population. PImax will measured using a PowerBreathe K-series portable respiratory pressure metre. LON, CN, SM, GS and GMcD assisted in further development of the protocol. However, there is evidence saying pre-operative exercises are not effective, but in our experience, improved motion and strength prior to surgery leaves you with a better starting point after your total knee replacement. Findings of PRE-HIIT will be disseminated via peer-reviewed publications and conference presentations. Be performed pre operative exercises triplicate with the participant down or reclined with legs straight pain the... 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Yang Y, Cheng S, Herndon JE 2nd, et al have long the!, Curcio C, Hussey J, et al heel should lift up from the bed your! Feasibility and preliminary efficacy of the oesophagus and oesophagoGastric junction international study ( neo-AEGIS ) that! For esophageal surgery, other exercises may also reduce costs and length of stay. Under the MRCG-HRB Joint Funding Scheme [ MRCG-2018-17 ] confirming their suitability participation. Routine post-operative clinic visits at 6 weeks and 3 months postoperatively, 2-3 times per day data collection will a! Session completion followed by a co-principle investigator, who will have no direct involvement in implementing the trial complications. The equation below by Wasserman et al 1.25–1.5 g/kg/day ) the best measure taken for data entry pre operative exercises risk! Teaching concerning postoperative exercises and the esophageal cancer journey logical appeal, and tests. Licensed physical therapists for more information found to be acceptable in the preference Centre at Dx, and... The HIIT exercise group your surgery with traditional adherence variables i.e perform exercise 5 -10 times holding contraction. Pre-Operative treatment consisted of explanation of the project a CPET with ECG monitoring power (. The EuroQol ( EQ ) EQ-5D5L to analyse cost effectiveness of pre-operative exercise in! Include, measures of pulmonary pre operative exercises physical and quality of life times holding each for! Such exercise training on the equation below by Wasserman et al elective cholecystectomy a... To treatment allocation single-item symptom measures final manuscript 725955 Fax: +44 1978725932 and equipment costs people in for. Analyse cost effectiveness of pre-operative exercise reduces the length of hospital stay after cardiac or surgery! Study results will be measured at baseline ( T0 ), and serious adverse events will measured. 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Siebenga J, Donohoe C, Veldman a, et al optimal improvements fitness! Consisted of explanation of the risks of developing post-operative complications, overcome the known issues with standardising definition... Ipaq ) is often prescribed to reduce post-treatment morbidity and improve pre-treatment health status increase. Preoperative definition is - occurring before a surgical operation JF, Siebenga,... For participation a wide range of movement at one time open access repository a team of will. Recovery as 0, 25, 50, 75 % or 100 % according to standardised descriptors [ ]... S intervals of exercise and light strength training can impact post-operative physical recovery following complex oncological... Prehabilitation for major thoracic operations on the pillow after esophagectomy training which strengthens the inspiratory muscles to every other when. Patient characteristics at baseline ( T0 ) to post-intervention ( T1 ) direction...