{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,10]],"date-time":"2026-11-10T00:45:29Z","timestamp":1794271529226,"version":"4.9.0"},"reference-count":31,"publisher":"BMJ","issue":"1","license":[{"start":{"date-parts":[[2023,1,27]],"date-time":"2023-01-27T00:00:00Z","timestamp":1674777600000},"content-version":"unspecified","delay-in-days":26,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100003810","name":"Hospital de Cl\u00ednicas de Porto Alegre","doi-asserted-by":"publisher","award":["N\/A"],"award-info":[{"award-number":["N\/A"]}],"id":[{"id":"10.13039\/501100003810","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Research Incentive Fund","award":["N\/A"],"award-info":[{"award-number":["N\/A"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2023,1,16]]},"published-print":{"date-parts":[[2023,1]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Patients with end-stage renal disease (ESRD) undergoing haemodialysis (HD) commonly present with a sedentary behaviour and reduced functional capacity, factors that can compromise their prognosis. Intradialytic inspiratory muscle training (IMT) can increase respiratory muscle strength and, consequently, improve functional capacity, besides being easy to apply, cheap and performed in a supervised setting. However, few studies show the effects of this type of training applied at different intensities in this population. This study aims to compare the effects of IMT at different intensities in adults with ESRD undergoing HD.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and analysis<\/jats:title>\n                    <jats:p>\n                      A randomised, double-blind, sham-controlled trial will be conducted on 36 subjects randomly allocated into three groups: IMT at intensities of 30% or 50% of maximal inspiratory pressure (intervention groups), or 10% of maximal inspiratory pressure (sham-IMT). All the interventions will be supervised and performed three times per week, for 12 weeks, totalling 36 sessions. The primary outcomes are the 6-minute walk test, diaphragm thickness and the response of VO\n                      <jats:sub>2<\/jats:sub>\n                      peak post-intervention. Respiratory muscle strength, 24-hour ambulatory blood pressure measurement and the Kidney Disease Quality of Life 36-item short form survey will be evaluated as secondary outcomes.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Ethics and dissemination<\/jats:title>\n                    <jats:p>This study has been approved by the Research Ethics Committee of the Hospital de Cl\u00ednicas de Porto Alegre (ID: 2020-0458). The results of this study will be disseminated by conference presentations and peer-reviewed journal.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration number<\/jats:title>\n                    <jats:p>\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"clintrialgov\" xlink:href=\"NCT04660383\">NCT04660383<\/jats:ext-link>\n                      .\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2022-066778","type":"journal-article","created":{"date-parts":[[2023,1,27]],"date-time":"2023-01-27T10:41:02Z","timestamp":1674816062000},"page":"e066778","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":5,"title":["Effects of intradialytic inspiratory muscle training at different intensities on diaphragm thickness and functional capacity: clinical trial protocol in patients undergoing haemodialysis"],"prefix":"10.1136","volume":"13","clinical-trial-number":[{"clinical-trial-number":"nct04660383","registry":"10.18810\/clinical-trials-gov"},{"clinical-trial-number":"nct04660383","registry":"10.18810\/clinical-trials-gov"}],"author":[{"given":"Marcelo de S","family":"Teixeira","sequence":"first","affiliation":[{"name":"Graduate Program in Cardiology and Cardiovascular Sciences, Hospital de Cl\u00ednicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil"},{"name":"Cardiology Exercise Research Group, Hospital de Cl\u00ednicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6929-8392","authenticated-orcid":false,"given":"Filipe","family":"Ferrari","sequence":"additional","affiliation":[{"name":"Graduate Program in Cardiology and Cardiovascular Sciences, Hospital de Cl\u00ednicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil"},{"name":"Cardiology Exercise Research Group, Hospital de Cl\u00ednicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thiago","family":"Dipp","sequence":"additional","affiliation":[{"name":"Graduate Program in Collective Health, Universidade do Vale do Rio dos Sinos, S\u00e3o Leopoldo, RS, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gabriel","family":"Carvalho","sequence":"additional","affiliation":[{"name":"Cardiology Exercise Research Group, Hospital de Cl\u00ednicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eduarda da S","family":"Bitencourt","sequence":"additional","affiliation":[{"name":"Cardiology Exercise Research Group, Hospital de Cl\u00ednicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marco","family":"Saffi","sequence":"additional","affiliation":[{"name":"Graduate Program in Cardiology and Cardiovascular Sciences, Hospital de Cl\u00ednicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil"},{"name":"Cardiology Exercise Research Group, Hospital de Cl\u00ednicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ricardo","family":"Stein","sequence":"additional","affiliation":[{"name":"Graduate Program in Cardiology and Cardiovascular Sciences, Hospital de Cl\u00ednicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil"},{"name":"Cardiology Exercise Research Group, Hospital de Cl\u00ednicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2023,1,27]]},"reference":[{"key":"2025121600065627000_13.1.e066778.1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa041031"},{"key":"2025121600065627000_13.1.e066778.2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.113.007106"},{"key":"2025121600065627000_13.1.e066778.3","doi-asserted-by":"publisher","DOI":"10.1093\/ndt\/gfq138"},{"key":"2025121600065627000_13.1.e066778.4","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0173159","article-title":"The role of the inspiratory muscle weakness in functional capacity in hemodialysis patients","volume":"12","author":"Figueiredo","year":"2017","journal-title":"PLoS One"},{"key":"2025121600065627000_13.1.e066778.5","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0209325","article-title":"Gradual reduction in exercise capacity in chronic kidney disease is associated with systemic oxygen delivery factors","volume":"13","author":"Wallin","year":"2018","journal-title":"PLoS One"},{"key":"2025121600065627000_13.1.e066778.6","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1016\/j.jphys.2018.11.008","article-title":"Combined training is the most effective training modality to improve aerobic capacity and blood pressure control in people requiring haemodialysis for end-stage renal disease: systematic review and network meta-analysis","volume":"65","author":"Scapini","year":"2019","journal-title":"J Physiother"},{"key":"2025121600065627000_13.1.e066778.7","doi-asserted-by":"publisher","DOI":"10.1053\/j.ackd.2009.08.009"},{"key":"2025121600065627000_13.1.e066778.8","doi-asserted-by":"crossref","unstructured":"Fernandes A de O , Sens Y , Xavier VB , et al . Functional and respiratory capacity of patients with chronic kidney disease undergoing cycle ergometer training during hemodialysis sessions: a randomized clinical trial. Int J Nephrol 2019.:7857824. doi:10.1155\/2019\/7857824","DOI":"10.1155\/2019\/7857824"},{"key":"2025121600065627000_13.1.e066778.9","doi-asserted-by":"crossref","DOI":"10.1186\/s12882-021-02618-1","article-title":"Clinical practice guideline exercise and lifestyle in chronic kidney disease","volume":"23","author":"Baker","year":"2022","journal-title":"BMC Nephrol"},{"key":"2025121600065627000_13.1.e066778.10","doi-asserted-by":"crossref","first-page":"251","DOI":"10.1007\/s40620-019-00687-y","article-title":"Intradialytic training in patients with end-stage renal disease: a systematic review and meta-analysis of randomized clinical trials assessing the effects of five different training interventions","volume":"33","author":"Ferrari","year":"2020","journal-title":"J Nephrol"},{"key":"2025121600065627000_13.1.e066778.11","doi-asserted-by":"crossref","first-page":"18470","DOI":"10.1038\/s41598-019-54953-x","article-title":"Effects of intradialytic exercise on cardiopulmonary capacity in chronic kidney disease: systematic review and meta-analysis of randomized clinical trials","volume":"9","author":"Andrade","year":"2019","journal-title":"Sci Rep"},{"key":"2025121600065627000_13.1.e066778.12","doi-asserted-by":"crossref","first-page":"424","DOI":"10.1589\/jpts.30.424","article-title":"Effects of inspiratory muscle training on pulmonary functions and muscle strength in sedentary hemodialysis patients","volume":"30","author":"El-Deen","year":"2018","journal-title":"J Phys Ther Sci"},{"key":"2025121600065627000_13.1.e066778.13","article-title":"Inspiratory muscle training for asthma","volume":"2013","author":"Silva","year":"2013","journal-title":"Cochrane Database Syst Rev"},{"key":"2025121600065627000_13.1.e066778.14","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2005.09.052"},{"key":"2025121600065627000_13.1.e066778.15","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2007.12.045"},{"key":"2025121600065627000_13.1.e066778.16","doi-asserted-by":"crossref","first-page":"768","DOI":"10.1016\/j.ahj.2009.09.005","article-title":"Addition of inspiratory muscle training to aerobic training improves cardiorespiratory responses to exercise in patients with heart failure and inspiratory muscle weakness","volume":"158","author":"Winkelmann","year":"2009","journal-title":"Am Heart J"},{"key":"2025121600065627000_13.1.e066778.17","doi-asserted-by":"crossref","first-page":"103","DOI":"10.1016\/j.rmed.2017.12.005","article-title":"Effects of respiratory muscle training on endothelium and oxidative stress biomarkers in hemodialysis patients: A randomized clinical trial","volume":"134","author":"Campos","year":"2018","journal-title":"Respir Med"},{"key":"2025121600065627000_13.1.e066778.18","doi-asserted-by":"publisher","DOI":"10.2165\/11536880-000000000-00000"},{"key":"2025121600065627000_13.1.e066778.19","doi-asserted-by":"crossref","first-page":"1560","DOI":"10.1152\/jappl.1989.67.4.1560","article-title":"Diaphragmatic thickness-lung volume relationship in vivo","volume":"67","author":"Wait","year":"1989","journal-title":"J Appl Physiol (1985)"},{"key":"2025121600065627000_13.1.e066778.20","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.167.2.211"},{"key":"2025121600065627000_13.1.e066778.21","doi-asserted-by":"publisher","DOI":"10.1681\/ASN.2018100994"},{"key":"2025121600065627000_13.1.e066778.22","doi-asserted-by":"crossref","DOI":"10.1186\/s12882-017-0569-7","article-title":"Changes in physical activity and risk of all-cause mortality in patients on maintence hemodialysis: a retrospective cohort study","volume":"18","author":"Shimoda","year":"2017","journal-title":"BMC Nephrol"},{"key":"2025121600065627000_13.1.e066778.23","doi-asserted-by":"crossref","first-page":"504","DOI":"10.1053\/j.jrn.2018.10.012","article-title":"Decline in the functional status and mortality in patients on hemodialysis: results from the japan dialysis outcome and practice patterns study","volume":"29","author":"Matsuzawa","year":"2019","journal-title":"J Ren Nutr"},{"key":"2025121600065627000_13.1.e066778.24","doi-asserted-by":"crossref","first-page":"1189","DOI":"10.1177\/0269215518760380","article-title":"Intradialytic exercise training modalities on physical functioning and health-related quality of life in patients undergoing maintenance hemodialysis: systematic review and meta-analysis","volume":"32","author":"Gomes Neto","year":"2018","journal-title":"Clin Rehabil"},{"key":"2025121600065627000_13.1.e066778.25","doi-asserted-by":"crossref","first-page":"2983","DOI":"10.1007\/s11255-022-03238-w","article-title":"The effect of a 6-month intradialytic exercise program on hemodialysis adequacy and body composition: a randomized controlled trial","volume":"54","author":"Vogiatzaki","year":"2022","journal-title":"Int Urol Nephrol"},{"key":"2025121600065627000_13.1.e066778.26","doi-asserted-by":"publisher","DOI":"10.1159\/000368722"},{"key":"2025121600065627000_13.1.e066778.27","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0200727","article-title":"Effects of the inspiratory muscle training and aerobic training on respiratory and functional parameters, inflammatory biomarkers, redox status and quality of life in hemodialysis patients: a randomized clinical trial","volume":"13","author":"Figueiredo","year":"2018","journal-title":"PLoS ONE"},{"key":"2025121600065627000_13.1.e066778.28","doi-asserted-by":"publisher","DOI":"10.3109\/0886022X.2012.745727"},{"key":"2025121600065627000_13.1.e066778.29","doi-asserted-by":"crossref","DOI":"10.1002\/pri.1879","article-title":"Effectiveness of inspiratory muscle training on respiratory fitness and breathlessness in chronic renal failure: A randomized control trial","volume":"26","author":"Yuenyongchaiwat","year":"2021","journal-title":"Physiother Res Int"},{"key":"2025121600065627000_13.1.e066778.30","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0267290","article-title":"Physical activity and exercise recommendations for people receiving dialysis: a scoping review","volume":"17","author":"Lambert","year":"2022","journal-title":"PLoS One"},{"key":"2025121600065627000_13.1.e066778.31","doi-asserted-by":"crossref","first-page":"280","DOI":"10.1016\/j.bjpt.2019.04.003","article-title":"Short period of high-intensity inspiratory muscle training improves inspiratory muscle strength in patients with chronic kidney disease on hemodialysis: a randomized controlled trial","volume":"24","author":"Dipp","year":"2020","journal-title":"Braz J Phys Ther"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2022-066778","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,16]],"date-time":"2025-12-16T08:07:07Z","timestamp":1765872427000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2022-066778"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,1]]},"references-count":31,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2023,1,27]]},"published-print":{"date-parts":[[2023,1]]}},"alternative-id":["10.1136\/bmjopen-2022-066778"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2022-066778","relation":{"has-part":[{"id-type":"doi","id":"https:\/\/doi.org\/10.1136\/bmjopen-2022-066778.supp2","asserted-by":"subject"},{"id-type":"doi","id":"https:\/\/doi.org\/10.1136\/bmjopen-2022-066778.supp1","asserted-by":"subject"}]},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,1]]}}}