***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: People with heart failure ( HF ) are living longer but with disabling dyspnea that erodes quality of life ( QOL ) . Decreased strength of inspiratory muscles ( IMs ) may contribute to dyspnea in HF , and inspiratory muscle training ( IMT ) has been shown to improve the strength of IMs . The purpose of this study was to determine the effects of a 3-month nurse-coached IMT program . B and ura 's Self-Efficacy Theory directed nursing interventions . This r and omized controlled trial employed an experimental group ( IMT ) and a control group ( education ) . Data were collected during six home visits . Outcome measures included maximal inspiratory pressure , perceived dyspnea , self-efficacy , and health-related QOL . Significant differences in PI(max ) , dyspnea , and respiratory rate were found . Implication s for further research and practice are discussed Background : It has been previously shown that the inspiratory muscles of patients with congestive heart failure ( CHF ) are weaker than those of normal persons . This weakness may contribute to the dyspnea and limit exercise capacity in these patients . The respiratory muscles can be trained for both strength and endurance Background In congestive heart failure ( CHF ) , the prognostic significance of impaired respiratory muscle strength has not been established . Methods and Results Maximal inspiratory pressure ( Pimax )  was prospect ively determined in 244 consecutive patients ( 207 men ) with CHF ( ischemic , n=75 ; idiopathic dilated cardiomyopathy , n=169 ; age , 54±11 years ; left ventricular ejection fraction [ LVEF ] , 22±10 % )  . Pimax was lower in the 244 patients with CHF than in 25 control subjects ( 7.6±3.3 versus 10.5±3.7 kPa;P = 0.001 ) . The 57 patients ( 23 % ) who died during follow-up ( 23±16 months ; range , 1 to 48 months ) had an even more reduced Pimax ( 6.3±3.2 versus 8.1±3.2 kPa in survivors;P = 0.001 ) . Kaplan-Meier survival curves differentiated between patients subdivided according to quartiles for Pimax ( P = 0.014 ) . Pimax was a strong risk predictor in both univariate ( P = 0.001 ) and multivariate Cox proportional hazard analyses ( P = 0.03 ) ; multivariate analyses also included NYHA functional class , LVEF , peak oxygen consumption ( peak ˙Vo2 ) , and norepinephrine plasma concentration . The areas under the receiver-operating characteristic curves for prediction of 1-year survival were comparable for Pimax and peak ˙Vo2 ( area under the curve [ AUC ] , 0.68 versus 0.73;P = 0.28 ) , and they improved with the triple combination of Pimax , peak ˙Vo2 , and LVEF ( AUC , 0.82;P = 0.004 compared with AUC of Pimax ) . Conclusions In patients with CHF  , inspiratory muscle strength is reduced and emerges as a novel , independent predictor of prognosis . Because testing for Pimax is simple in clinical practice , it might serve as an additional factor to improve risk stratification and patient selection for cardiac transplantation AIMS To assess whether a domiciliary programme of specific inspiratory muscle training in stable chronic heart failure results in improvements in exercise tolerance or quality of life . METHODS AND RESULTS We conducted a r and omized controlled trial of 8 weeks of inspiratory muscle training in 18 patients with stable chronic heart failure , using the Threshold trainer . Patients were r and omized either to a training group inspiring for 30 min daily at 30 % of maximum inspiratory mouth pressure , or to a control group of ' sham ' training at 15 % of maximum inspiratory mouth pressure .  Sixteen of the 18 patients completed the study .  Maximum inspiratory mouth pressure improved significantly in the training group compared with controls , by a mean ( SD ) of 25.4 ( 11.2 ) cmH2O ( P=0.04 ) . There were , however , no significant improvements in treadmill exercise time , corridor walk test time or quality of life scores in the trained group compared with controls . CONCLUSION Despite achieving a significant increase in inspiratory muscle strength , this trial of simple domiciliary inspiratory muscle training using threshold loading at 30 % of maximum inspiratory mouth pressure did not result in significant improvements in exercise tolerance or quality of life in patients with chronic heart failure Clinicians are increasingly using evidence from high- quality clinical research to guide clinical decision making . Recent articles in this journal have examined research evidence to assist in clinical decisions as diverse as the prescription of running shoes,1 exercise therapy in the treatment of chronic disease2 and the use of protective equipment to prevent concussion.3 The most valid information about the effectiveness of healthcare interventions is provided by r and omised controlled trials and systematic review s of r and omised controlled trials.4 The Physiotherapy Evidence Data base ( PEDro ; http://www.pedro.org.au ) provides easy access to r and omised controlled trials and systematic review s of physiotherapy interventions . PEDro also includes links to evidence -based clinical practice guidelines . October 2009 marked the 10th anniversary of the launch of PEDro . PEDro is freely available on the internet . The data base indexes citation details , author abstract s and , where available , links to full text for r and omised controlled trials , systematic review s and practice guidelines in physiotherapy . Although the PEDro data base is design ed primarily for health professionals , a subsite , called Physiotherapy Choices ( http://www.physiotherapychoices.org.au ) , provides information in lay terms directly to consumers of physiotherapy services . As of August 2009 , more than 15 000 records ( 12 408 trials , 2060 review s and 603 guidelines ) have been indexed on PEDro . Each record is coded according to the subdiscipline(s ) of physiotherapy it addresses . PEDro now includes 615 r and omised controlled trials and 102 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 BACKGROUND AND PURPOSE Persons with chronic heart failure ( HF ) have poor ventilatory muscle strength , and this weakness is associated with dyspnea . The purpose of this study was to examine the effects of inspiratory muscle training ( IMT ) on ventilatory muscle strength and dyspnea in patients with chronic HF . SUBJECTS Fourteen patients ( mean age [ + /-SD ] = 52 + /- 8.5 years ) with end-stage cardiomyopathy and chronic HF ( mean left ventricular ejection fraction = 23 % + /- 13 % and New York Heart Association class = 3.6 + /- 0.6 ) participated in the study . METHODS Inspiratory muscle training was performed at 20 % of maximal inspiratory pressure ( MIP ) for 5 to 15 minutes , three times a day , for 8 weeks . Dyspnea was evaluated at rest and during exercise . RESULTS Both MIP and maximal expiratory pressure ( MEP ) were greater after 2 weeks of IMT ( 51 + /- 21 to 63 + /- 23 cm H2O and 85 + /- 22 to 96 + /- 19 cm H2O , representing 24 % and 13 % improvement ) . Dyspnea scores at rest and during exercise decreased after 2 weeks ( 2.0 + /- 0.7 to 1.3 + /- 0.5 and 3.6 + /- 0.5 to 2.6 + /- 0.6 , representing 29 % and 28 % improvement ) and plateaued throughout the remainder of IMT . Baseline MEP was related to the percentage of change in MEP after IMT ( r = -.72 ) , and several measures of pulmonary function were related to the degree of improvement in dyspnea after IMT ( r = -.57 to -.82 ) and in MIP after IMT ( r = .71 ) . CONCLUSION AND DISCUSSION Improvements in MIP , MEP , and dyspnea were found after 2 weeks of IMT . Greater pulmonary function was associated with greater improvement in dyspnea and ventilatory muscle strength after IMT . These improvements may decrease the dependency and impairment associated with chronic HF BACKGROUND This small clinical trial tested the hypothesis that the addition of inspiratory muscle training ( IMT ) to aerobic exercise training ( AE ) results in further improvement in cardiorespiratory responses to exercise than those obtained with AE in patients with chronic heart failure ( CHF ) and inspiratory muscle weakness ( IMW ) . METHODS Twenty-four patients with CHF and IMW ( maximal inspiratory pressure < 70 % of predicted ) were r and omly assigned to a 12-week program of AE plus IMT ( AE + IMT , n = 12 ) or to AE alone ( AE , n = 12 ) . Before and after intervention , the following measures were obtained : maximal inspiratory muscle pressure ( PI(max ) ) , peak oxygen uptake ( Vo(2)peak ) , peak circulatory power , oxygen uptake efficiency slope , ventilatory efficiency , ventilatory oscillation , oxygen uptake kinetics during recovery ( T(1/2)Vo(2 ) ) , 6-minute walk test distance , and quality of life scores . RESULTS Compared to AE , AE + IMT result ed in additional significant improvement in PI(max ) ( 110 % vs 72 % ) , Vo(2)peak ( 40 % vs 21 % ) , circulatory power , oxygen uptake efficiency slope , ventilatory efficiency , ventilatory oscillation , and T(1/2)Vo(2 ) . Six-minute walk distance and quality of life scores improved similarly in the 2 groups . CONCLUSION This r and omized trial demonstrates that the addition of IMT to AE results in improvement in cardiorespiratory responses to exercise in selected patients with CHF and IMW . The clinical significance of these findings should be addressed by larger r and omized trials The present study was aim ed at evaluating the effects of a specific inspiratory muscle training protocol on the structure of inspiratory muscles in patients with chronic obstructive pulmonary disease . Fourteen patients ( males , FEV1 , 24 + /- 7 % predicted ) were r and omized to either inspiratory muscle or sham training groups . Supervised breathing using a threshold inspiratory device was performed 30 minutes per day , five times a week , for 5 consecutive weeks . The inspiratory training group was subjected to inspiratory loading 
    Output:
    
CHF with inspiratory muscle weakness showed greater gains in the 6-minute walk distance and peak oxygen consumption compared with those with normative maximal inspiratory pressure .
The results emphasize the importance of evaluating the inspiratory muscles to identify patients with CHF and inspiratory muscle weakness ; subgroup that showed better results after IMT