Age-Related Frailty, Frailty Syndrome, Geriatric Health, Respiratory Muscle Weakness
Conditions
Keywords
Inspiratory Muscle Training, Diaphragm Ultrasound, Older Adults
Brief summary
This study aims to evaluate the effects of an 8-week inspiratory muscle training program on maximal inspiratory pressure and functional capacity in frail older adults aged 80 years and above. Frailty is associated with reduced physical capacity, declines in functional performance, impaired respiratory performance, and a higher risk of disability. Inspiratory muscle training is a simple, low-cost intervention that may improve breathing function, inspiratory muscle strength, and overall health in very old adults, but evidence in this age group remains limited. Participants will be randomly assigned to one of two groups: a high-load inspiratory muscle training group or a low-load sham training group. Both groups will use a threshold device and perform 30 breaths once per day, five days per week, for eight weeks. The experimental group will train with progressively increasing resistance (50% to 80% of maximal inspiratory pressure), while the sham group will use a minimal and non-progressive load (15% of maximal inspiratory pressure). All sessions will be supervised and monitored for safety. The main goal of the study is to determine whether inspiratory muscle training improves maximal inspiratory pressure (MIP), an established measure of global inspiratory muscle strength. Secondary outcomes include measures of functional capacity, reflecting the ability to perform physical tasks relevant to daily living in very old adults. These outcomes will allow the evaluation of the clinical relevance of improvements in inspiratory muscle strength in this population. Assessments will be performed before the intervention, immediately after the 8-week program, and again at one and three months after the end of the intervention to examine both immediate and short-term effects. This study may contribute valuable evidence regarding the safety, feasibility, and clinical benefits of inspiratory muscle training in frail very old adults, particularly its impact on inspiratory muscle strength and functional capacity, supporting its potential implementation in rehabilitation and geriatric care.
Interventions
DEVICEInspiratory Muscle Training
Participants perform 30 breaths once daily, 5 days per week for 8 weeks using a threshold inspiratory muscle training device. The load begins at 50% of maximal inspiratory pressure (MIP) and increases by 5 cmH#O weekly up to 80% of MIP. Sessions are supervised and oxygen saturation and heart rate are monitored.
Participants use the same device and schedule as the experimental group (30 breaths once daily, 5 days per week for 8 weeks) but with a constant load of 15% of maximal inspiratory pressure (MIP), with no weekly progression. This mimics the procedure while providing minimal physiological stimulus. Supervision and monitoring are identical to the experimental arm.
Sponsors
Universidad Francisco de Vitoria
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
DOUBLE (Subject, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
80 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Adults aged 80 years or older. * Clinical diagnosis of frailty, defined by a Short Physical Performance Battery (SPPB) score \< 9. * Ability to stand and walk with or without assistive devices. * Ability to understand and follow instructions for inspiratory muscle training. * Stable medical condition for at least 3 months prior to enrollment. * Capacity to provide informed consent or availability of a legal
Exclusion criteria
* Acute or unstable cardiovascular, respiratory, or metabolic conditions. * Severe cognitive impairment that prevents understanding the procedures. * Diagnosis of neuromuscular diseases affecting respiratory muscles (e.g., ALS, myopathies). * Severe or uncontrolled hypertension (≥180/110 mmHg). * Recent thoracic or abdominal surgery (\<3 months). * Severe musculoskeletal disorders limiting participation in training. * History of recurrent syncope, severe dizziness, or intolerance to respiratory maneuvers. * Any condition judged by the research team to compromise safety or participation.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Six-Minute Walk Test (6MWT) | Before-intervention; Immediately after intervention; 1-month after intervention; 3 months after intervention | Functional exercise capacity will be assessed using the Six-Minute Walk Test (6MWT). Participants will be instructed to walk at their fastest possible pace for six minutes along a 30-meter corridor, covering the greatest distance possible. The total distance walked (in meters) will be recorded. Participants will be continuously accompanied by the therapist and may use assistive devices and/or supplemental oxygen if required. |
| Maximal Inspiratory Pressure (MIP) | Before-intervention; Immediately after intervention; 1-month after intervention; 3 months after intervention | Maximal Inspiratory Pressure (MIP) will be measured using a calibrated handheld manometer following standardized respiratory assessment guidelines. Participants will be instructed to perform a maximal inspiratory effort from residual volume through the mouthpiece with their nose occluded. At least three maneuvers will be recorded, ensuring less than 10% variability between attempts. The highest reproducible value (cmH₂O) will be used for analysis. This measure reflects global inspiratory muscle strength and is widely validated in older and frail populations. |
| Timed Up and Go Test (TUG) | Before-intervention; Immediately after intervention; 1-month after intervention; 3 months after intervention | Functional mobility and fall risk will be evaluated using the Timed Up and Go (TUG) test. Participants will start seated in a chair with armrests. On command, they will stand up, walk 3 meters, turn around, return to the chair, and sit down. The total time to complete the task will be recorded in seconds. Interpretation criteria: \< 20 seconds: normal performance ≥ 20 seconds: increased risk of falls |
| Five Times Sit-to-Stand Test (5STS) | Before-intervention; Immediately after intervention; 1-month after intervention; 3 months after intervention | Lower limb functional strength will be assessed using the Five Times Sit-to-Stand Test (5STS). Participants will sit on a 43-45 cm high chair without armrests, with arms crossed over the chest, and will be instructed to stand up and sit down five times as quickly as possible. The total time to complete the test will be recorded in seconds. The minimal detectable change ranges from 3.6 to 4.2 seconds, and the minimal clinically important difference is 2.3 seconds. Age-related normative values will be considered for interpretation. |
| Upper Limb Muscle Strength (Handgrip Dynamometry) | Before-intervention; Immediately after intervention; 1-month after intervention; 3 months after intervention | Upper limb muscle strength will be assessed using handgrip dynamometry following the recommendations of the American Society of Hand Therapists. Participants will be seated with the shoulder in adduction and neutral rotation, the elbow flexed at 90°, the forearm in neutral position, and the wrist positioned between 0° and 30° of extension. Three maximal grip strength measurements will be obtained from the dominant hand, with 1 minute of rest between trials. The highest value will be selected for analysis. Handgrip strength will be measured using a JAMAR dynamometer (Lafayette Instrument, Lafayette, IN, USA). |
| Lower Limb Muscle Strength (Isometric Knee Extension Dynamometry) | Before-intervention; Immediately after intervention; 1-month after intervention; 3 months after intervention | Lower limb muscle strength will be assessed using isometric dynamometry to evaluate maximal voluntary contraction (MVC) of the knee extensors. The protocol described by Hung et al. will be followed. Participants will perform two maximal isometric contractions, each lasting 5 seconds, with 3 minutes of rest between contractions to allow phosphocreatine resynthesis. Participants will be seated at the edge of a physiotherapy table with the knee positioned at 90° of flexion. The dynamometer will be placed at the level of the malleoli to standardize the lever arm and ensure maximal isometric contraction. The peak force achieved during each contraction will be recorded and normalized to body weight, with results expressed in Newtons (N). Lower limb dynamometry will be performed using the ActiveForce 2 device (Activbody, San Diego, CA, USA). |
| Muscle Oxygenation | Before-intervention; Immediately after intervention; 1-month after intervention; 3 months after intervention | Muscle oxygen saturation (SmO₂) will be assessed using the Moxy Monitor (Fortiori Design LLC, Hutchinson, MN, USA), a wireless and portable device based on near-infrared spectroscopy (NIRS). The measurement protocol described by Contreras-Briceño et al. will be followed and will consist of a 180-second resting measurement, followed by continuous monitoring during the Six-Minute Walk Test (6MWT). Outcome values will correspond to the mean SmO₂ (%) recorded during the final 30 seconds of each phase. The sensor will be placed over the muscle belly of the vastus lateralis following standard NIRS placement recommendations. |
| Total Hemoglobin Concentration (THb) | Before-intervention; Immediately after intervention; 1-month after intervention; 3 months after intervention | Total hemoglobin concentration (THb) will be assessed using the same NIRS device (Moxy Monitor, Fortiori Design LLC, Hutchinson, MN, USA). Data acquisition and analysis will be performed using dedicated software (Moxy Software v1.5.5; Idiag, Fehraltorf, Switzerland). The same protocol will be applied: a 180-second resting measurement followed by continuous monitoring during the Six-Minute Walk Test (6MWT). Outcome values will correspond to the mean THb values recorded during the final 30 seconds of each phase. The sensor placement will be identical to that used for SmO₂ assessment (vastus lateralis). |
Contacts
Primary ContactSandra Sánchez Jorge, PhD
Outcome results
None listed