***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    ***EXAMPLES*** 
    Input: Background Esophageal resection is associated with a high incidence of postoperative pneumonia . Respiratory complications account for almost half of the readmissions to the critical care unit . Postoperative complications can result in prolonged hospital stay and consequently increase healthcare costs . In cardiac surgery a preoperative inspiratory muscle training program has shown to prevent postoperative pneumonia and reduce length of hospital stay . While in some surgical centers inspiratory muscle training is already used in the preoperative phase in patients undergoing esophageal resection , the added value of this intervention on the reduction of pulmonary complications has not yet been investigated in large surgical population s other than cardiac surgery in a r and omized and controlled study design . Methods / Design The effect of a preoperative inspiratory muscle training program on the incidence of postoperative pneumonia in patients undergoing esophageal resection will be studied in a single blind multicenter r and omized controlled trial ( the PREPARE study ) . In total 248 patients ( age > 18 years ) undergoing esophageal resection for esophageal cancer will be included in this study . They are r and omized to either usual care or usual care with an additional inspiratory muscle training intervention according to a high-intensity protocol which is performed with a tapered flow resistive inspiratory loading device . Patients have to complete 30 dynamic inspiratory efforts twice daily for 7 days a week until surgery with a minimum of 2 weeks . The starting training load will be aim ed to be 60 % of maximal inspiratory pressure and will be increased based on the rate of perceived exertion . The main study endpoint is the incidence of postoperative pneumonia . Secondary objectives are to evaluate the effect of preoperative inspiratory muscle training on length of hospital stay , duration of mechanical ventilation , incidence of other postoperative ( pulmonary ) complications , quality of life , and on postoperative respiratory muscle function and lung function . Discussion The PREPARE study is the first multicenter r and omized controlled trial to evaluate the hypothesis that preoperative inspiratory muscle training leads to decreased pulmonary complications in patients undergoing esophageal resection . Trial registration NCT01893008 BACKGROUND Aging results in a decline in the function of the respiratory muscles . Inspiratory muscle training is emerging as a possible intervention to attenuate the decline of respiratory muscles in the elderly . The aim of this study was to evaluate the efficacy of inspiratory muscle training on respiratory strength , diaphragm thickness , and diaphragmatic mobility in elderly women . METHODS This was a controlled , r and omized , and double-blind clinical trial , performed on 22 elderly women distributed in two groups , training ( TG ) and control ( CG ) . Over an 8-week period a moderate intensity inspiratory muscle training protocol was followed in the TG , while CG followed a sham protocol . In addition maximum expiratory and inspiratory pressure , mobility of the diaphragm and diaphragmatic thickness were evaluated by ultrasound . RESULTS After training , in TG maximal inspiratory pressure , maximal expiratory pressure , diaphragm thickness , and mobility increased by 37 % , 13 % , 11 % , and 9 % respectively , and their values were significantly higher than CG ( p < .005 , p = .013 , p = .001 , and p = .001 ) . CONCLUSION Inspiratory muscle training of moderate intensity improves respiratory muscle strength , diaphragm thickness , and diaphragm mobility in elderly women and it should be considered to minimize changes associated with senescence Our aim was to determine the minimal important difference ( MID ) for 6-min walk distance ( 6MWD ) and maximal cycle exercise capacity ( MCEC ) in patients with severe chronic obstructive pulmonary disease ( COPD ) . 1,218 patients enrolled in the National Emphysema Treatment Trial completed exercise tests before and after 4–6 weeks of pre-trial rehabilitation  , and 6 months after r and omisation to surgery or medical care .  The St George 's Respiratory Question naire ( domain and total scores ) and University of California San Diego Shortness  of Breath Question naire ( total score ) served as anchors for anchor-based MID estimates . In order to calculate distribution-based estimates , we used the st and ard error of measurement , Cohen 's effect size and the empirical rule effect size . Anchor-based estimates for the 6MWD were 18.9 m ( 95 % CI 18.1–20.1 m ) , 24.2 m ( 95 % CI 23.4–25.4 m ) , 24.6 m ( 95 % CI 23.4–25.7 m ) and 26.4 m ( 95 % CI 25.4–27.4 m ) , which were similar to distribution-based MID estimates of 25.7 , 26.8 and 30.6 m. For MCEC , anchor-based estimates for the MID were 2.2 W ( 95 % CI 2.0–2.4 W ) , 3.2 W ( 95 % CI 3.0–3.4 W ) , 3.2 W ( 95 % CI 3.0–3.4 W ) and 3.3 W ( 95 % CI 3.0–3.5 W ) , while distribution-based estimates were 5.3 and 5.5 W. We suggest a MID of 26±2 m for 6MWD and 4±1 W for MCEC for patients with severe COPD AIM To investigate the effects of inspiratory muscle training ( IMT ) on functional capacity and balance , respiratory and peripheral muscle strength , pulmonary function , dyspnea , fatigue , depression , and quality of life in heart failure patients . METHODS A prospect i ve , r and omized controlled , double-blinded study . Thirty patients with heart failure ( NYHA II-III , LVEF<40 % ) were included . Sixteen patients received IMT at 40 % of maximal inspiratory pressure ( MIP ) , and 14 patients received sham therapy ( 15 % of MIP ) for 6 weeks . Functional capacity and balance , respiratory muscle strength , quadriceps femoris muscle strength , pulmonary function , dyspnea , fatigue , quality of life , and depression were evaluated . RESULTS Functional capacity and balance , respiratory and peripheral muscle strength , dyspnea , depression were significantly improved in the treatment group compared with controls ; quality of life and fatigue were similarly improved within groups ( p < 0.05 ) . Functional capacity ( 418.59 ± 123.32 to 478.56 ± 131.58 m , p < 0.001 ) , respiratory ( MIP = 62.00 ± 33.57 to 97.13 ± 32.63 cmH(2)O , p < 0.001 ) and quadriceps femoris muscle strength ( 240.91 ± 106.08 to 301.82 ± 111.86 N , p < 0.001 ) , FEV(1)% , FVC% and PEF% , functional balance ( 52.73 ± 3.15 to 54.25 ± 2.34 , p < 0.001 ) , functional dyspnea ( 2.27 ± 0.88 to 1.07 ± 0.79 , p < 0.001 ) , depression ( 11.47 ± 7.50 to 3.20 ± 4.09 , p < 0.001 ) , quality of life , fatigue ( 42.73 ± 11.75 to 29.07 ± 13.96 , p < 0.001 ) were significantly improved in the treatment group . Respiratory muscle strength ( MIP = 78.64 ± 35.95 to 90.86 ± 30.23 cmH(2)O , p = 0.001 ) , FVC% , depression ( 14.36 ± 9.04 to 9.50 ± 10.42 , p = 0.011 ) , quality of life and fatigue ( 42.86 ± 12.67 to 32.93 ± 15.87 , p = 0.008 ) were significantly improved in the control group . CONCLUSION The IMT improves functional capacity and balance , respiratory and peripheral muscle strength ; decreases depression and dyspnea perception in patients with heart failure .  IMT should be included effectively in pulmonary rehabilitation programs Chronic renal failure can result in a variety of conditions leading to muscle weakness . We investigated inspiratory muscle ( IM ) performance and functional capacity in chronic renal failure before and after specific inspiratory muscle training ( SIMT ) .  9 men and 1 woman , ranging in age from 22 - 78 years , while on chronic hemodialysis received  SIMT 3 times a week , for 3 months , while 10 others received sham training .  Static inspiratory pressures , IM endurance and functional capacity were reduced in most subjects . Following SIMT , IM performance improved significantly and was associated with improved functional capacity , but not in the control group . We conclude that patients with chronic renal failure undergoing maintenance hemodialysis have reduced IM performance , and SIMT improves functional capacity BACKGROUND Exercise training increasingly is recommended as an important part of the management of cardiovascular disease . However , few studies have evaluated the effectiveness of exercise training in patients with chronic kidney disease ( CKD ) , and those that have included very selective population s. STUDY DESIGN Analysis of secondary outcomes of a r and omized controlled trial , with participants r and omly assigned to either lifestyle intervention or usual care ( control )  . SETTING & PARTICIPANTS Patients with CKD stages 3 to 4 and one or more uncontrolled cardiovascular risk factor were recruited from an outpatient clinic at a large tertiary hospital . INTERVENTION Lifestyle intervention included access to multidisciplinary care through a nurse practitioner-led CKD clinic , exercise training , and a lifestyle program . The exercise training was a 2-phased program in which participants received 8 weeks of supervised training before commencing 10 months of home-based training . OUTCOMES & MEASUREMENTS Efficacy , as assessed by metabolic equivalent tasks ( METs ) , 6-minute walk distance , Timed Get-Up- and -Go test , grip strength , and anthropomorphic measures ; adherence , as assessed by self-reported physical activity ; and safety , as assessed by reported serious adverse events , were recorded . RESULTS 83 patients were r and omly assigned and 72 patients completed follow-up testing ( intervention , n=36 ; control , n=36 ) . The intervention result ed in a significant improvement in METs ( pre , 7.2±3.3 ; post , 9.7±3.6 ) , 6-minute walk distance ( pre , 485±110 m ; post , 539±82 m ) , and body mass index ( pre , 32.5±6.7kg/m(2 ) ; post , 31.9±7.3kg/m(2 ) ) . Reported physical activity levels significantly increased in the intervention group at 6 months , but decreased at 12 months . There were no serious adverse events related to the exercise training . LIMITATIONS This study was not powered to evaluate the safety of exercise training on serious adverse events . CONCLUSIONS The findings from the present study suggest that an exercise program that includes a supervised and home-based training phase is effective , adhered to , and safe in patients with CKD Resistance respiratory muscle training ( RRMT ) increases respiratory muscle and swimming performance at depths down to 17 msw . It is unknown if RRMT improves swimming performance at greater depths and if the improvements are associated with a reduced work of breathing ( WOB ) , altered respiratory mechanics and /or improved respiratory muscle performance . Eight male subjects ( 30.3 ± 6.0 years ) were tested swimming underwater in a hyperbaric chamber at 37 m of depth against a pre-determined load ( 70 % $ $ \dot{V}_{{{\text{O } } _ { 2 } } } $ $ ) until exhausted . End expiratory lung volume ( EELV ) was determined by subtracting inspiratory capacity from total lung capacity throughout the swims . The mechanical WOB on the lung was calculated as the integrated product of the transpulmonary pressure and ventilatory flow . Maximal expiratory ( PEMAX ) and inspiratory pressures ( PIMAX ) were measured pre- and post-RRMT . RRMT was performed every 30 s against spring loaded inspiratory and expiratory valves 30 min/day , 5 days/week , for 4 weeks . RRMT increased PIMAX and PEMAX by 40 % ( 110 ± 11 cmH2O ( SD ) vs. 155 ± 22 , p < 0.001 ) and 30 % ( 148 ± 33 cmH2O vs. 192 ± 49 , p < 0.001 ) , respectively , respiratory endurance by 75 % ( 19.7 ± 15.4 min vs. 34.4 ± 27.3 , p = 0.010 ) , and swimming endurance by 87 % ( 26.4 ± 9.7 min vs. 49.4 ± 21.6 , p = 0.004 ) . The longer swimming time was associated with reduced $ $ \dot{V}_{\text{E } } $ $ and $ $ \dot{V}_{\text{A } } $ $ ( p < 0.001 
    Output:
    
Significant benefits in lung function and quality of life were also identified .
In patients with chronic renal failure on dialysis  , inspiratory muscle training with a fixed load significantly improves respiratory muscle strength , functional capacity , lung function and quality of life .
de Medeiros AIC , Fuzari HKB , Rattesa C , Br and ão DC , de Melo Marinho PÉ ( 2017 ) Inspiratory muscle training  improves respiratory muscle strength , functional capacity and quality of life in patients with chronic kidney disease : a systematic review .