***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: Little information is available about the effects of inspiratory muscle training in patients with cystic fibrosis ( CF ) . In this study the effects of inspiratory-threshold loading in patients with CF on strength and endurance of the inspiratory muscles , pulmonary function , exercise capacity , dyspnoea and fatigue were evaluated . Sixteen patients were assigned to one of two groups using the minimization method : eight patients in the training group and eight patients in the control group . The training was performed using an inspiratory-threshold loading device . Patients were instructed to use the threshold trainer 20 min a day , 5 days a week for 6 weeks . Patients in the training group trained at inspiratory threshold loads up to 40 % of maximal static inspiratory pressure ( Pimax ) and patients in the control group got ' sham ' training at a load of 10 % of Pimax . No significant differences were found among the two groups in gender , age , weight , height , pulmonary function , exercise capacity , inspiratory-muscle strength and inspiratory-muscle endurance before starting the training programme . Mean ( SD ) age in the control group was 19 ( 5.5 ) years , mean ( SD ) age in the training group was 17 ( 5.2 ) years .  Mean FEV1 in both groups was 70 % predicted , mean inspiratory-muscle strength in both groups was above 100 % predicted . All patients except one , assigned to the training group , completed the programme . After 6 weeks of training , mean inspiratory-muscle endurance ( % Pimax ) in the control group increased from 50 % to 54 % ( P = 0.197 ) ; in the training group mean inspiratory muscle endurance ( % Pimax ) increased from 49 % to 66 % ( P = 0.003 ) . Statistical analysis showed that the change in inspiratory-muscle endurance ( % Pimax ) in the training group was significantly higher than in the control group ( P = 0.012 ) . After training , in the training group there was a tendency of improvement in Pimax with an increase from 105 to 123 % predicted , which just fell short of statistical significance ( P = 0.064 ) . After training no significant differences were found in changes from baseline in pulmonary function , exercise capacity , dyspnoea and fatigue . It is concluded that low-intensity inspiratory-threshold loading at 40 % of Pimax was sufficient to elicit an increased inspiratory-muscle endurance in patients with CF R and omized controlled clinical trials are conducted to determine whether differences of clinical importance exist between selected treatment regimens . When statistical analysis of the study data finds a P value greater than 5 % , it is convention to deem the assessed difference nonsignificant . Just because convention dictates that such study findings be termed nonsignificant , or negative , however , it does not necessarily follow that the study found nothing of clinical importance . Subject sample s used in controlled trials tend to be too small . The studies therefore lack the necessary power to detect real , and clinical ly worthwhile , differences in treatment . Freiman et al. found that only 30 % of a sample of 71 trials published in the New Engl and Journal of Medicine in 1978 - 79 with a P value greater than 10 % were large enough to have a 90 % chance of detecting even a 50 % difference in the effectiveness of the treatments being compared , and they found no improvement in a similar sample of trials published in 1988 . It is therefore wrong and unwise to interpret so many negative trials as providing evidence of the ineffectiveness of new treatments . One must instead seriously question whether the absence of evidence is a valid justification for inaction . Efforts must be made to look for quantification of an association rather than just a P value , especially when the risks under investigation are small . The authors cite a recent trial comparing octreotide and sclerotherapy in patients with variceal bleeding  , as well as the overview of clinical trials evaluating fibrinolytic treatment for preventing reinfa rct ion after acute myocardial infa rct ion as examples We evaluated the effects of specific inspiratory muscle training on simulated time-trial performance in trained cyclists . Using a double-blind , placebo-controlled design , 16 male cyclists ( VO 2max = 64 - 2 ml·kg -1 · min -1 ; mean - sx ¥ ) were assigned at r and om to either an experimental ( pressure-threshold inspiratory muscle training ) or sham-training control ( placebo ) group  . Pulmonary function , maximum dynamic inspiratory muscle function and the physiological and perceptual responses to maximal incremental cycling were assessed . Simulated time-trial performance ( 20 and 40 km ) was quantified as the time to complete pre-set amounts of work . Pulmonary function was unchanged after the intervention , but dynamic inspiratory muscle function improved in the inspiratory muscle training group ( P h 0.05 ) . After the intervention , the inspiratory muscle training group experienced a reduction in the perception of respiratory and peripheral effort ( Borg CR10 : 16 - 4 % and 18 - 4 % respectively ; compared with placebo , P h 0.01 ) and completed the simulated 20 and 40 km time-trials faster than the placebo group [ 66 - 30 and 115 - 38 s ( 3.8 - 1.7 % and 4.6 - 1.9 % ) faster respectively ; P = 0.025 and 0.009 ] . These results support evidence that specific inspiratory muscle training attenuates the perceptual response to maximal incremental exercise . Furthermore , they provide evidence of performance enhancements in competitive cyclists after inspiratory muscle training The purpose of this study was to quantify the intensity of breathlessness associated with exercise and respiratory resistive loading , with the specific purpose of isolating the quantitative contributions of inspiratory pressure , length , velocity , and frequency of inspiratory muscle shortening and duty cycle to breathlessness . The intensity of inspiratory pressure was quantified by measurement of estimated esophageal pressure ( Pes = pressure at the mouth plus lung pressure ) , the extent of shortening by tidal volume ( VT ) , and the velocity of shortening by inspiratory flow rate ( VI ) . Six normal subjects underwent five incremental ( 100 kpm X min-1 X min-1 ) exercise tests on a cycle ergometer to maximum capacity . The first and last test were unloaded and the intervening tests were performed with external added resistances of 33 , 57 , and 73 cm H2O X l-1 X s in r and om order . The resistances were selected to provide a range of pressures , tidal volumes , flow rates , and patterns of breathing . At rest and at the end of each minute during exercise the subjects estimated the intensity of breathlessness ( psi ) by selecting a number ranging from 0 to 10 ( Borg rating scale , 0 indicating no appreciable breathlessness and 10 the maximum tolerable sensation ) . Breathlessness was significantly and independently related to Pes ( P less than 0.0001 ) , VI ( P less than 0.0001 ) , frequency of breathing ( fb ) ( P less than 0.01 ) , and duty cycle [ ratio of inspiratory duration to total breath duration ( TI/TT ) ] ( P less than 0.01 ) : psi = 0.11 Pes + 0.61 VI + 1.99 TI/TT + 0.04 fb - 2.60 ( r = 0.83 ) . The results suggest that peak pressure ( tension ) , VI ( velocity of inspiratory muscle shortening ) , TI/TT , and fb contribute independently and collectively to breathlessness . The perception of respiratory muscle effort is ideally suited to subserve this sensation . The neurophysiological mechanism purported is a conscious awareness of the intensity of the outgoing motor comm and by means of corollary discharge within the central nervous system Background The purpose of this study ( r and omised controlled trial ) was to assess the effects of an 8-week combined ‘ whole muscle ’ ( resistance+aerobic ) and inspiratory muscle training ( IMT ) on lung volume , inspiratory muscle strength ( PImax ) and cardiorespiratory fitness ( VO2 peak ) ( primary outcomes ) , and dynamic muscle strength , body composition and quality of life in paediatric out patients with CF ( cystic fibrosis , secondary outcomes ) . We also determined the effects of a detraining period . Methods Participants were r and omly allocated with a block on gender to a control ( st and ard therapy ) or intervention group ( initial n=10 ( 6 boys ) in each group ; age 10±1 and 11±1 years ) . The latter group performed a combined programme ( IMT ( 2 sessions/day ) and aerobic+strength exercises ( 3 days/week , in-hospital ) ) that was followed by a 4-week detraining period . All participants were evaluated at baseline , post-training and detraining . Results Adherence to the training programme averaged 97.5%±1.7 % . There was a significant interaction ( group × time ) effect for PImax , VO2peak and five-repetition maximum strength ( leg-press , bench-press , seated-row ) ( all ( p<0.001 ) , and also for % fat ( p<0.023 ) and % fat-free mass ( p=0.001 ) , with training exerting a significant beneficial effect only in the intervention group , which was maintained after detraining for PImax and leg-press . Conclusion The relatively short-term ( 8-week ) training programme used here induced significant benefits in important health phenotypes of paediatric patients with CF . IMT is an easily applicable intervention that could be included , together with supervised exercise training in the st and ard care of these patients The aim of this study was to determine whether repeated maximum inspiratory vital capacity manoeuvres against a fixed resistance increased effective short-term sputum clearance in adults with cystic fibrosis ( CF ) . Twenty adults with CF were r and omised to receive , on alternate days , either st and ardised physiotherapy ( SP ) for 30 min , comprising postural drainage and the active cycle of breathing technique , or a series of resistive inspiratory manoeuvres ( RIM ) at 80 % of their maximum sustained inspiratory pressure developed between residual volume and total lung capacity during the first 4 days of the treatment of an exacerbation of respiratory symptoms . Expectorated sputum was collected during and for 30 min after each treatment and weighed . Total protein , immunoreactive interleukin (IL)‐8 and human neutrophil elastase ( HNE ) concentrations , and the amount of each component expectorated , were determined . Compared with SP , RIM increased sputum weight two-fold , independent of treatment order or day . The concentrations of protein , IL-8 and HNE in sputum were similar for both treatments , while the quantity expectorated was greater with RIM treatment . In conclusion , short-term resistive inspiratory manoeuvres treatment was more effective at clearing sputum and inflammatory mediators than st and ardised physiotherapy INTRODUCTION Chest physiotherapy ( CP ) is used in cystic fibrosis ( CF ) even if there is no robust scientific evidence of a beneficial effect . We investigated the effects of a training with a specific device ( SpiroTiger ) in a group of CF patients . This device , developed for respiratory training through maximal inspirations and espirations without hypocarbia , may improve respiratory function and mucus clearance . Patients where instructed and trained by a physiotherapist with individualized setting s of training parameters . METHODS Twenty-four patients were enrolled in an open-label 1 year observational study . Baseline and post intervention measurements were determined by lung function ( FVC , FEV1 , FEF 25 - 75 ) , patients ' opinions on physiotherapy ( question naires ) , need for antibiotic treatment ( clinical follow-up and records ) and perception of physical fitness ( question naires ) in the year before and in the year of intervention . Adherence to physiotherapy was monitored by means of a specific device software . RESULTS Increased lung function ( FEV1 p<0.01 ) , perception of physical fitness ( p<0.001 ) and a reduction in the need for intravenous antibiotic treatment ( p<0.001 ) were reported . Adherence to treatment was good/acceptable in 92 % of patients . CONCLUSIONS This study shows an association between training through a specific device and improved lung function . Further trials are needed to confirm this report BACKGROUND We investigated the effect of neuromuscular electrical stimulation ( NMES ) training prior to endurance training in patients with cystic fibrosis ( CF ) and severe pulmonary obstruction . METHODS Fourteen patients with CF ( FEV(1 ) = 35 % ± 11 % predicted ) were prospect ively r and omized to either a 6-week NMES training program ( n = 7 ) or a 6-week control period ( n = 7 ) both followed by ergocycle ( ERGO ) training ( 8 weeks ) ( NMES + ERGO and control + ERGO groups ) . Measurements were pulmonary function , mid-thigh circumference , quadriceps strength , 6-min walk distance , maximal exercise capacity on a cycloergometer , plasma biomarkers , insulin resistance ( homeostasis model assessment indexes ) , and quality of life ( CF question naire for adults and teenagers > 14 years of age [ CFQ14 + ] , Baseline Dyspnea Index-Transition Dyspnea Index ) . RESULTS NMES + ERGO training greatly improved mid-thigh circumference ( + 2.6 ± 0.9 cm vs - 0.4 ± 1.4 cm ) , quadriceps strength ( + 6 ± 5 kg vs - 2 ± 2 kg ) , and BMI ( + 0.6 ± 0.6 kg/m(2 ) vs - 0.5 ± 0.7 kg/m(2 ) ) compared with control + ERGO training ( P < .05 ) . No differences between groups were found in exercise-induced changes in 6-min walk distance and maximal exercise capacity . However , dyspnea after the 6-minute walk test , 
    Output:
    
We have not found any evidence to suggest that this treatment is either beneficial or not .