{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T14:46:11Z","timestamp":1787237171008,"version":"build-2736575974"},"reference-count":31,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2025,5,27]],"date-time":"2025-05-27T00:00:00Z","timestamp":1748304000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100005790","name":"Thammasat University","doi-asserted-by":"publisher","award":["TUFT14\/2566"],"award-info":[{"award-number":["TUFT14\/2566"]}],"id":[{"id":"10.13039\/501100005790","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["ARM"],"abstract":"<jats:p>Aim: This study aimed to evaluate the effects of inspiratory muscle training on inspiratory muscle strength and cardiorespiratory performance in patients undergoing open heart surgery. Method: This study was conducted as a randomized controlled trial with two groups. Fifty-eight patients who underwent open heart surgery were randomly assigned to either the intervention group or the control group 29 in the control group and 29 in the intervention group. Patients in the intervention group participated in a physical therapy program combined with inspiratory muscle training using the Thammasat University (TU) Breath Trainer. Patients in the control group received only the standard physical therapy program. The maximum inspiratory pressure, maximum expiratory pressure and 6 min walk test distance were assessed both before surgery and prior to hospital discharge. Results: The intervention group had a significant increase in maximum inspiratory pressure (p &lt; 0.001), maximum expiratory pressure (p &lt; 0.001) and 6 min walk test distance (p = 0.013). The control group had a significant decrease in maximum inspiratory pressure (p &lt; 0.001), maximum expiratory pressure (p = 0.002) and 6 min walk test distance (p &lt; 0.001). Conclusions: Inspiratory muscle training can be performed using maximum pressure resistors, such as the TU-Breath Trainer device. This training has been shown to effectively improve inspiratory muscle strength and cardiorespiratory performance in patients undergoing open heart surgery, as well as reduce pulmonary complications and shorten the length of hospital stay.<\/jats:p>","DOI":"10.3390\/arm93030010","type":"journal-article","created":{"date-parts":[[2025,5,27]],"date-time":"2025-05-27T03:34:46Z","timestamp":1748316886000},"page":"10","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Inspiratory Muscle Training Improved Cardiorespiratory Performance in Patients Undergoing Open Heart Surgery: A Randomized Controlled Trial"],"prefix":"10.3390","volume":"93","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-2578-4126","authenticated-orcid":false,"given":"Chitima","family":"Kulchanarat","sequence":"first","affiliation":[{"name":"Department of Physical Therapy, Thammasat University Hospital, Pathum Thani 12120, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Suphannee","family":"Choeirod","sequence":"additional","affiliation":[{"name":"Department of Physical Therapy, Thammasat University Hospital, Pathum Thani 12120, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Supattra","family":"Thadatheerapat","sequence":"additional","affiliation":[{"name":"Department of Physical Therapy, Thammasat University Hospital, Pathum Thani 12120, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dusarkorn","family":"Piathip","sequence":"additional","affiliation":[{"name":"Cardiovascular Thoracic Intensive Care Unit (ICU CVT) Unit, Thammasat University Hospital, Pathum Thani 12120, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Opas","family":"Satdhabudha","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Thoracic Surgery, Department of Surgery, Thammasat University Hospital, Pathum Thani 12120, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kornanong","family":"Yuenyongchaiwat","sequence":"additional","affiliation":[{"name":"Department of Physiotherapy, Faculty of Allied Health Sciences, Thammasat University, Pathum Thani 12120, Thailand"},{"name":"Thammasat University Research Unit, Physical Therapy in Respiratory and Cardiovascular Systems, Thammasat University Pathum, Thani 12120, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,5,27]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1960","DOI":"10.21037\/jtd.2018.02.43","article-title":"Fifty years of coronary artery bypass grafting","volume":"10","author":"Melly","year":"2018","journal-title":"J. Thorac. Dis."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"2858","DOI":"10.1161\/CIRCULATIONAHA.105.165030","article-title":"Comparing On-Pump and off-pump coronary artery bypass grafting","volume":"111","author":"Sellke","year":"2005","journal-title":"Circulation"},{"key":"ref_3","first-page":"2610","article-title":"ACCF\/AHA Guideline for coronary artery bypass graft surgery: Executive Summary","volume":"124","author":"Hillis","year":"2011","journal-title":"Circulation"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"277","DOI":"10.1016\/S0003-4975(98)01207-7","article-title":"Arterial grafts for coronary artery bypass grafting: Biological characteristics, functional classification, and clinical choice","volume":"67","author":"He","year":"1999","journal-title":"Ann. Thorac. Surg."},{"key":"ref_5","first-page":"337","article-title":"Effect of cardiac surgery on respiratory muscle strength","volume":"14","author":"Naseer","year":"2019","journal-title":"J. Taibah Univ. Med. Sci."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"241","DOI":"10.1016\/J.EJCNURSE.2006.11.001","article-title":"Risk factors for postoperative pulmonary complications in coronary artery bypass graft surgery patients","volume":"6","author":"Jensen","year":"2007","journal-title":"Eur. J. Cardiovasc. Nurs."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"490","DOI":"10.1590\/S0102-76382009000500010","article-title":"Does the pain disturb the respiratory function after open heart surgery?","volume":"24","author":"Sasseron","year":"2009","journal-title":"Braz. J. Cardiovasc. Surg."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"227","DOI":"10.1051\/ject\/200537227","article-title":"General anesthesia in cardiac surgery: A review of drugs and practices","volume":"37","author":"Alwardt","year":"2005","journal-title":"J. Extracorpor. Technol."},{"key":"ref_9","first-page":"140","article-title":"Inspiratory muscle training and functional capacity in patients submitted to cardiac surgery","volume":"31","author":"Cordeiro","year":"2016","journal-title":"Braz. J. Cardiovasc. Surg."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"286","DOI":"10.3109\/14017431.2011.595820","article-title":"Short-term effects of inspiratory muscle training in coronary artery bypass graft surgery: A randomized controlled trial","volume":"45","author":"Savci","year":"2011","journal-title":"Scand. Cardiovasc. J."},{"key":"ref_11","first-page":"44","article-title":"Effects of inspiratory muscle training using an electronic device on patients undergoing cardiac surgery: A randomized controlled trial","volume":"34","author":"Fortes","year":"2020","journal-title":"Rev. Bras. Cir. Cardiovasc."},{"key":"ref_12","first-page":"89","article-title":"Effect of inspiratory muscle training on functional capacity in patients undergoing open heart surgery","volume":"36","author":"Songsorn","year":"2014","journal-title":"Thai J. Phys. Ther."},{"key":"ref_13","first-page":"40","article-title":"Analysis of a STEPs adapted protocol in Cardiac Rehabilitation in Phase Hospital","volume":"30","author":"Winkelmann","year":"2014","journal-title":"Braz. J. Cardiovasc."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1685","DOI":"10.1016\/j.apmr.2009.05.010","article-title":"Inspiratory muscle strength as a determinant of functional capacity early after coronary artery bypass graft surgery","volume":"90","author":"Stein","year":"2009","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"249","DOI":"10.1615\/CritRevPhysRehabilMed.2017021161","article-title":"Effect of threshold inspiratory muscle training on maximal inspiratory pressure and pulmonary gas exchange in patients undergoing coronary artery bypass graft surgery","volume":"28","author":"Elmarakby","year":"2016","journal-title":"Crit. Rev. Phys. Rehabil. Med."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"E19","DOI":"10.1097\/HCR.0000000000000431","article-title":"Effects of different rehabilitation protocols in inpatient cardiac rehabilitation after coronary artery bypass graft surgery","volume":"39","author":"Zanini","year":"2019","journal-title":"J. Cardiopulm. Rehabil. Prev."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"E1","DOI":"10.1097\/HCR.0000000000000409","article-title":"Inspiratory muscle training after heart valve replacement surgery improves inspiratory muscle strength, lung function, and functional capacity","volume":"39","author":"Cargnin","year":"2019","journal-title":"J. Cardiopulm. Rehabil. Prev."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"264","DOI":"10.5535\/arm.21027","article-title":"Effectiveness of inspiratory muscle training on respiratory muscle strength in patients undergoing cardiac surgeries: A Systematic Review with Meta-Analysis","volume":"45","author":"Dsouza","year":"2021","journal-title":"Ann. Rehabil. Med."},{"key":"ref_19","first-page":"562","article-title":"Respiratory physiotherapy in the pulmonary dysfunction after cardiac surgery","volume":"23","author":"Renault","year":"2008","journal-title":"Braz. J. Cardiovasc. Surg."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"518","DOI":"10.1164\/rccm.166.4.518","article-title":"Tests of respiratory muscle strength: ATS\/ERS Statement on respiratory muscle testing","volume":"166","author":"Green","year":"2002","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1225","DOI":"10.56899\/150.05.32","article-title":"Efficiency of the Respiratory Training Prototype for Application in Hemodialysis Patients: A Preliminary Study","volume":"150","author":"Yuenyongchaiwat","year":"2021","journal-title":"Philipp. J. Sci."},{"key":"ref_22","first-page":"21","article-title":"Development and application of a respiratory device on blood pressure in adults with high blood pressure","volume":"11","author":"Yuenyongchaiwat","year":"2019","journal-title":"Interv. Med. Appl. Sci."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1879","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":"ref_24","doi-asserted-by":"crossref","first-page":"19","DOI":"10.4103\/rcm.rcm_27_18","article-title":"Walking performance in the 6-min walk test and gait speed in patients undergoing open heart surgery: A preliminary cohort study","volume":"8","author":"Yuenyongchaiwat","year":"2019","journal-title":"Res. Cardiovasc. Med."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"129","DOI":"10.1016\/j.ijsu.2005.04.002","article-title":"The systemic inflammatory response syndrome and cardiopulmonary bypass","volume":"3","author":"Day","year":"2005","journal-title":"Int. J. Surg."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"380","DOI":"10.21037\/atm.2018.06.08","article-title":"Mechanical ventilation management during cardiothoracic surgery: An open challenge","volume":"6","author":"Bignami","year":"2018","journal-title":"Ann. Transl. Med."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"889","DOI":"10.1007\/s00408-020-00405-7","article-title":"Pulmonary Complications of Cardiac Surgery","volume":"198","author":"Tanner","year":"2020","journal-title":"Lung"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"91","DOI":"10.4103\/0972-5229.43676","article-title":"Incidence and management of diaphragmatic palsy in patients after cardiac surgery","volume":"12","author":"Mehta","year":"2008","journal-title":"Indian J. Crit. Care Med."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"201","DOI":"10.1097\/ACO.0000000000000045","article-title":"Predicting postoperative pulmonary complications: Implications for outcomes and costs","volume":"27","author":"Sabate","year":"2014","journal-title":"Curr. Opin. Anesthesiol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"16","DOI":"10.31083\/j.rcm2401016","article-title":"The Effects of inspiratory Muscle Training on patients undergoing Coronary Artery bypass graft surgery: A Systematic Review and Meta-Analysis","volume":"24","author":"Zhang","year":"2023","journal-title":"Rev. Cardiovasc. Med."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"224","DOI":"10.1590\/S0102-76382010000200015","article-title":"Changes in functional capacity of patients two years after coronary artery bypass grafting surgery","volume":"25","author":"Nery","year":"2010","journal-title":"Braz. J. Cardiovasc. Surg."}],"container-title":["Advances in Respiratory Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2543-6031\/93\/3\/10\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T17:41:03Z","timestamp":1760031663000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2543-6031\/93\/3\/10"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,5,27]]},"references-count":31,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2025,6]]}},"alternative-id":["arm93030010"],"URL":"https:\/\/doi.org\/10.3390\/arm93030010","relation":{},"ISSN":["2543-6031"],"issn-type":[{"value":"2543-6031","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,5,27]]}}}