Breathing training in the process of rehabilitation in patients after myocardial infarction.

Patients were qualified by the physician responsible for the course and interpretation of the test results. Prior to the implementation of the experiment, all subjects were informed about its purpose, manner of conducting and the possibility of resignation at any time during the research project. The respondents gave written consent to participate in the research. In addition, there was an information meeting on the impact of respiratory muscle training on their muscle functions and on lung ventilation. The subjects were divided into three groups. Group I: subjects subjected to a cycle of cardiological rehabilitation and inspiratory muscle training (women and men). Group II: Patients subjected only to the cardiological rehabilitation cycle, in accordance with the standards of cardiological rehabilitation. Group III: Subjects subjected only to inspiratory muscle training. Group I and III patients underwent inspiratory muscle training on Respironics Threshold IMT. At the beginning of the program, each group conducted an educational lecture on the respiratory function and hygiene and breathing support techniques, and all participants of the inspiratory muscle training were additionally lectured combined with the presentation of the device and the training instructor.Inspiratory muscle training was conducted 5 times a week, of which 4 sessions at home, and 1 under the supervision of a physiotherapist at the CREATOR Prevention and Rehabilitation Center in Wroclaw.   Inspiratory muscle training lasted 8 weeks. Before starting the training program, instructional classes on the proper technique of performing exercises with the Threshold IMT apparatus were carried out, while maintaining the rules consistent with the technique of proper breathing. Training took place in a standing position. After setting the individual resistance, the subjects placed a nose clip and then tightly covered the mouthpiece with the mouth. The inspiratory phase was characterized by a quick, energetic, short and diaphragmatic breath. The exhale was slow, calm, and long and had to last until reaching the RV, because every breath should start from that level. Each subject performed exercises alone on his personal training device. After the initial PImax assessment, an individual level of training load was set. The strength of the inspiratory muscles, in the first measurement, was expressed in kPa, and then it was converted into cm H2O according to the formula 1 kPa = 10.2 cm H2O. Dictated it was a scale placed on the training device. This change allowed calculating the appropriate training load, using the Threshold IMT training device. In the first week, the training load was 30% PImax, and each session lasted 5 minutes, twice a day. The value of the initial load was dictated by the safety conditions of conducting the training. In the following weeks, the load was increased and the duration of exercise was extended during the day (60% PImax, 2x 15min). Each patient kept a participant diary in which recorded the dates and time of training. This diary was checked by the physiotherapist once a week. Patients from group I and II were subjected to a cardiological rehabilitation cycle, which included interval endurance training on the cycloergometer 3 times a week and general improvement and resistance exercises conducted twice a week. The training took place for 8 weeks in an outpatient setting under medical supervision. During one 45-minute workout, the patient performed cycles: effort for 4 minutes and rest for 2 minutes with a still existing load of 0-5 W. The intensity of exercise gradually increased in the first half of training, and then decreased after reaching peak intensity. Each training session started with a warm-up and ended with relaxation, or 3-minute ride on the unloaded cycloergometer. The training load was calculated individually for each patient, based on the result achieved during the exercise test, and then increased by no more than 10 W every 4 training sessions on the cycling cycloergometer. During the cycloergometer training, the heart rate and arterial blood pressure were monitored at the beginning and end of each workout.