Diaphragm Recruitment Increases during a Bout of Targeted Inspiratory Muscle Training

Purpose The extent to which the diaphragm is targeted during a bout of inspiratory muscle training (IMT) is unknown. The purpose of this study was to characterize the relative activation patterns of the diaphragm and extradiaphragmatic inspiratory muscles during a bout of IMT and to determine whether diaphragmatic recruitment can be increased by giving subjects specific diaphragmatic breathing instructions (IMTdi). Methods Ten healthy men were instrumented with surface EMG electrodes on the sternocleidomastoid (EMG(scm)), scalenes (EMG(sca)), parasternal intercostals (EMG(pic)), and seventh intercostal space (EMG(7ic)). A multipair esophageal electrode catheter measured crural diaphragmatic EMG (EMG(di)) and transdiaphragmatic pressure (P-di). Trial 1 of IMT involved 25 dynamic inspiratory maneuvers at 40% of maximal inspiratory mouth pressure using a variable flow resistive loading device where subjects were free to choose their own inspiratory muscle recruitment strategy. Trial 2 involved the same procedures, but subjects were given specific instructions to actively recruit their diaphragm. Cervical magnetic stimulation of the phrenic nerves verified the absence of diaphragmatic fatigue before commencing the second trial. Results Compared with IMT, IMTdi resulted in a significant increase in EMG(di) (56 12 vs 73 +/- 10%max, P = 0.002) and P-di swings (39 +/- 14 vs 64 +/- 17 cm H2O, P < 0.0001) and a decrease in EMG(sca) (52 +/- 21 vs 36 +/- 22%max, P = 0.04). There was no difference in EMG(7ic) (26 +/- 19 vs 33 +/- 21%max, P = 0.36), EMG(pic) (31 +/- 24 vs 25 +/- 15%max, P = 0.22), and EMG(scm) (58 +/- 21 vs 45 +/- 24%max, P = 0.08) when comparing IMT versus IMTdi, respectively. Conclusions Simple diaphragmatic breathing instructions can significantly increase the recruitment of the diaphragm during IMT compared with a bout of IMT where individuals are free to choose their own inspiratory muscle recruitment strategy.