***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 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: This study investigated the relationship between the intensity of an inspiratory muscle training programme and its effect on respiratory muscle strength , exercising heart rate , and ratings of perceived exertion .  A total of 66 subjects were r and omly assigned to one of three groups . One group trained at 100 % of maximum inspiratory pressure ( MIP ) for 6 weeks ( MAX , n=22 ) . A second group performed 6 weeks of inspiratory muscle training at 80 % of MIP ( SUB , n=21 ) and a third control group received no inspiratory training ( CON , n=23 ) . Both the MAX and SUB training groups improved MIP relative to the control group [ 32 ( 19 ) cmH2O , P=0.01 ; 37 ( 25 ) cmH2O , P=0.001 , respectively ] . A significant decrease in heart rate [ −6 ( 9 ) beats min−1 , P=0.02 ] and rating of perceived exertion [ −0.5 ( 1.4 ) , P=0.04 ] was observed for the MAX group only . It is concluded that 6 weeks of both MAX and SUB training were sufficient to improve inspiratory muscle strength . However , exercising heart rate and perceived exertion decreased with MAX training only Objective In patients with type 2 diabetes mellitus ( DM2 ) , it is hard to reach treatment objectives for blood pressure ( BP ) with classical treatment options . Recently , reducing breathing frequency has been advocated as a method to reduce BP . We examined if an electronic device such as Resperate , by reducing breathing frequency , would lead to BP reduction in a population of patients with DM2 and hypertension . Our secondary objective was to study the effect of this device on quality of life ( QOL ) . Methods A r and omized , single-blind , controlled trial was conducted over a period of 8 weeks to evaluate the effect of this therapy on BP and QOL . The control group listened to music and used no other therapeutic device .  BP and QOL changes were studied in 30 patients with DM2 and hypertension . Results There was no significant difference in change in BP between groups ; −7.5 [ 95 % confidence interval ( CI ) −12.7 , −2.3]/−1.0 ( 95 % CI −5.5 , 3.6 ) mmHg in the intervention group and −12.2 ( 95 % CI −17.4 , −7.0)/−5.5 ( 95 % CI −9.7 , −1.4 ) mmHg in the control group . Whether or not the target breathing frequency of 10 breaths/min was reached did not affect BP . There were no significant changes in QOL . Conclusions The effects of Resperate  on BP and QOL were not significantly different from those found in the control group . Furthermore , 40 % of patients did not reach the target breathing frequency , making this device less suitable for clinical practice in patients with DM2 Background Obstructive sleep apnoea ( OSA ) and obesity are interdependent chronic diseases sharing reduced exercise tolerance and high cardiovascular risk . Intervention A 3-month intervention with innovative training modalities would further improve functional capacity and cardiovascular health than usual cycle exercise training in already continuous positive airway pressure (CPAP)-treated obese patients with OSA . Methods Fifty three patients ( 35<body mass index ( BMI ) < 45 kg/m2 ) were r and omly allocated to exercise training on a cycle ergometer , either alone ( ERGO ) or with respiratory muscle training ( ERGO+RMT ) or non-invasive ventilation ( ERGO+NIV ) . Changes in 6 min walking distance ( primary outcome ) , aerobic capacity ( VO2peak ) , cardiovascular parameters , body composition and sleep quality were evaluated . Measurements and main results All training modalities increased 6 min walking distance without differences between groups ( P=0.97 ) . ERGO+NIV and ERGO+RMT led to significantly higher improvement in VO2peak compared with ERGO ( 3.1 ( 95 % CI 1.6 to 4.6 ) vs 2.3 ( 0.8 to 3.7 ) vs 0.5(−1.0 to 1.9 ) mL/min/kg , respectively , P=0.04 ) and ERGO+NIV significantly reduced self-measured blood pressure compared with ERGO+RMT and ERGO ( systolic : −9.5 ( 95 % CI −14.1 to −4.9 ) vs −13 ( −5.8 to 3.1 ) vs −0.7 ( −5.1 to 3.8 ) mm Hg , respectively , P=0.01 ) . Waist and neck circumferences were reduced after ERGO+NIV compared with ERGO+RMT and ERGO ( P=0.01 ) . Conclusions Combining RMT or NIV with cycling exercise training failed to provide further improvement in functional capacity as compared with cycling exercise training alone . However , the combination of NIV and exercise training demonstrated superiority for improving cardiometabolic risk factors in obese CPAP-treated patients with OAS . TRIAL REGISTRATION NUMBER Results , NCT01155271 Purpose Aging impairs the autonomic balance reducing the vagal and increasing the sympathetic components of heart rate variability ( HRV ) and this could be associated with a decline in physical capacity . Inspiratory muscle training ( IMT ) is a possible tool to attenuate this physical capacity decline in older women . The aim of this study was to investigate the influence of IMT in the older women on physical capacity and autonomic cardiac modulation at rest and post exercise . Methods 20 female participants 60–72 years old were r and omly allocated in two groups . One group underwent IMT set at 50 % of maximum inspiratory pressure ( MIP ) , every day for 4 weeks ( IMT-group ) . The placebo group performed the same training procedure but with a minimal resistance ( 5 % MIP ; PLA-group ) . Every week , the IMT load was readjusted and the HRV evaluated at rest . The six-minute walk test ( 6MWT ) was performed once pre and post IMT-intervention . The IMT-group and PLA-group performed the same test and intervention procedures . Results After a 5 weeks intervention , the MIP had significantly improved in the IMT-group but not in the PLA-group ( p < 0.01 ; es = 1.17 ) . The high frequency power of the HRV spectrum had already improved by the second week ( p < 0.01 ; es = 1.13 ) and remained elevated until the last week of intervention ( p < 0.01 ; es = 1.43 ) . The same positive results were described in 6MWT distance ( p = 0.04 ; es = 0.39 ) and the change ( ∆ ) of heart rate recovery ( HRR ) from 1 min ( p = 0.02 ; es = 0.68 ) . Conclusion IMT  increases HRV , improves 6MWT distance and HRR Background Hypertension is a complex chronic condition characterized by elevated arterial blood pressure . Management of hypertension includes non-pharmacologic strategies , which may include techniques that effectively reduce autonomic sympathetic activity . Respiratory exercises improve autonomic control over cardiovascular system and attenuate muscle metaboreflex . Because of these effects , respiratory exercises may be useful to lower blood pressure in subjects with hypertension . Methods / design This r and omized , double-blind clinical trial will test the efficacy of inspiratory muscle training in reducing blood pressure in adults with essential hypertension . Subjects are r and omly allocated to intervention or control groups . Intervention consists of inspiratory muscle training loaded with 40 % of maximum inspiratory pressure , readjusted weekly . Control sham intervention consists of unloaded exercises .  Systolic and diastolic blood pressures are co- primary endpoint measures assessed with 24 h ambulatory blood pressure monitoring . Secondary outcome measures include cardiovascular autonomic control , inspiratory muscle metaboreflex , cardiopulmonary capacity , and inspiratory muscle strength and endurance . Discussion Previously published work suggests that inspiratory muscle training reduces blood pressure in persons with hypertension , but the effectiveness of this intervention is yet to be established . We propose an adequately sized r and omized clinical trial to test this hypothesis rigorously . If an effect is found , this study will allow for the investigation of putative mechanisms to mediate this effect , including autonomic cardiovascular control and metaboreflex . Trial registration Clinical Trials.gov NCT02275377 . Registered on 30 September 2014 PURPOSE The purpose of this study was to evaluate the pressure-flow specificity of adaptations to inspiratory muscle training ( IMT ) , in addition to the temporal effects of detraining and reduced frequency of training upon these adaptations . METHODS Twenty-four healthy subjects were assigned r and omly to one of four groups ( A : low-flow-high-pressure IMT ; B : high-flow-low-pressure IMT ; C : intermediate flow-pressure IMT ; and D : no IMT ) . Subjects performed IMT 6 d.wk(-1 ) for 9 wk , and inspiratory muscle function was evaluated at baseline and every 3 wk . Groups A , B , and C were then assigned r and omly to either a maintenance group ( M ) ( IMT 2 d.wk(-1 ) ) or a detraining group ( DT ) ( no IMT ) . Inspiratory muscle function was reassessed at 9 and 18 wk post-IMT . RESULTS At 9 wk , group A exhibited the largest increase in pressure , B a large increase in flow , C more uniform increases in pressure and flow , and D no changes in pressure or flow . Maximum inspiratory muscle power increased in groups A , B , and C by 48 + /- 3 % , 25 + /- 3 % , and 64 + /- 3 % , respectively ( mean + /- SEM , P < or = 0.01 ) . Maximum rate of pressure development increased in groups A , B , and C by 59 + /- 1 % , 10 + /- 1 % , and 29 + /- 1 % , respectively ( P < or = 0.01 ) . A decrease in inspiratory muscle function was observed at 9 wk post-IMT in DT . Inspiratory muscle function plateaued between 9 and 18 wk but remained above pre-IMT values . Group M retained the improvements in inspiratory muscle function . CONCLUSION These data support the notion of pressure-flow specificity of IMT . Detraining result ed in small but significant reductions in inspiratory muscle function . Reducing training frequency by two thirds allowed for the maintenance of inspiratory muscle function up to 18 wk post-IMT Abstract Background . Slow breathing training ( SBT ) has been proposed as a new non-pharmacological treatment able to induce favorable effects in patients with chronic heart failure ( CHF ) . However , no information is available regarding its effects on orthostatic blood pressure ( BP ) changes in these patients , an issue of practical relevance given the reported BP-lowering effect of SBT . The aim of this study is to evaluate the influence of SBT on BP and whether SBT  induces orthostatic hypotension ( OH ) or changes in quality of life ( QoL ) in CHF patients . Methods . The analysis was performed as part of an ongoing crossover open trial aim ed at assessing the clinical effectiveness of SBT in treated patients with CHF . The patients underwent 10–12 weeks of SBT with the RESPeRATE device and 10–12 week follow-up under usual care . Patients were r and omly divided into two groups : group I began with SBT , followed by usual care ; group II began with usual care , followed by SBT . Patients undergoing SBT were asked to perform each day two separate 15 min sessions of device-guided SBT at a breathing frequency of 6 breaths/min . In all patients , before the enrollment and after each study phase , clinical data collection and BP measurements in sitting , supine and st and ing position were performed . OH was defined as a decrease of ≥ 20 mmHg in systolic blood pressure ( SBP ) or ≥ 10 mmHg in diastolic blood pressure ( DBP ) within 3 min of st and ing . QoL was assessed three times at the beginning , and after each phase of the study by the Minnesota Living with Heart Failure ( MLHF ) question naire . Results . Forty patients ( two equal groups ) completed the study , with the following baseline characteristics : 32 males/eight females , age 63.3 ± 13.4 years , 25 with ischemic CHF , 37 in New York Heart Association class II and three in class III , left ventricular ejection fraction 30.8 ± 6.7 % , mean BP 138.7 ± 16.5/83.1 ± 11.5 mmHg , 23 with arterial hypertension and four with a history of stroke . There were no significant differences between the groups in clinical characteristics , SBP and DBP at rest , while seated and before and after st and ing up . OH prevalence was low and did not change during the study ( 10 % vs 10 % ) . No significant difference in average SBP and DBP changes secondary to body position were found when comparing the two study phases . Decrease in MLHF score was observed in group I during SBT ( p = 0.002 ) , but not in group II . Conclusions . Our data indicate that SBT is safe , does not affect the prevalence of OH in CHF patients and shows a non-significant tendency to improve QoL. These results should be confirmed in a larger sample of patients to support the safety of SBT and its possible benefits as a novel component of cardiorespiratory rehabilitation programs in CHF STUDY OBJECTIVES New and effective strategies are needed to manage the autonomic and cardiovascular sequelae of obstructive sleep apnea ( OSA ) . We assessed the effect of daily inspiratory muscle strength training ( IMT ) on sleep and cardiovascular function in adult 
    Output:
    
Conclusion : IMT is an effective treatment for inspiratory muscle weakness in several population s and could be considered as a complementary treatment to improve the cardiovascular system , mainly HR and DBP .