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Revised Final Manuscript - Bernardino
Revised Final Manuscript - Bernardino
JUNE 2020
UNIVERSITY OF THE PHILIPPINES
Thesis Adviser:
Asst. Prof. Revin Aaron Santos
College of Human Kinetics
University of the Philippines Diliman
Thesis Reader:
Prof. Marla Frances T. Mallari, PhD
College of Human Kinetics
University of the Philippines Diliman
Date of Submission
18 June 2020
Thesis Classification:
F
This thesis is available to the public.
UNIVERSITY PERMISSION PAGE
I hereby grant the University of the Philippines a non-exclusive, worldwide, royalty-free license
to reproduce, publish and publicly distribute copies of this thesis or dissertation in whatever
form subject to the provisions of applicable laws, the provisions of the UP IPR policy and any
contractual obligations, as well as more specific permission marking on the Title Page.
_____________________________ ______________________________
Date MARLA FRANCES T. MALLARI, PhD
Chair, Department of Sports Science
_____________________________ ____________________________
Date FRANCIS CARLOS B. DIAZ, MSPE
Dean
Bernardino, D.
ABSTRACT
This literature synthesis and review examined the effects of Respiratory Muscle Fatigue (RMF)
researching the effects of RMF in asymptomatic subjects were collected. Data were then
tabulated and analyzed for common themes that were mutually shared by the studies. Results
show that RMF proves to be a potential threat to sport and exercise performance mainly through
effects such as a decrease in cardiac output and an increase in blood pressure and blood lactate,
which may significantly alter performance. In conclusion, RMF affects sport and exercise
performance, particularly the exercise tolerance and perceptions of exertion and breathlessness of
TABLE OF CONTENTS
INTRODUCTION……………………………………………………………………………….8
Background of the Study………………………………………………………………...8
Metaboreflex………………………………………………………………………….....11
Pressure……………………………………………………………………………..…...12
Summary………………………………………………………………………………...13
METHODOLOGY……………………………………………………………………………..14
Research Design………………………………………………………………………...14
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Performance…………………..18
Summary of
Findings…………………………………………………………………...21
Conclusion………………………………………………………………………………21
Limitation……………………………………………………………………………….21
Application……………………………………………………………………………...22
Recommendations………………………………………………………………………23
REFERENCES………………………………………………………………………………….24
APPENDIX
A Matrix of Collected
Literature……………………………………………………….29
Study……………………………………...37
Bernardino, D.
Chapter I
INTRODUCTION
Our lungs are passive structures that intake and expel air when respiratory muscles
coordinate and contract. These respiratory muscles include our diaphragm, which is the primary
muscle for respiration, some of our neck muscles, our intercostals, and our abdominal muscles
which aids the diaphragm and compresses the abdominal cavity. These respiratory muscles,
while possessing incredible energy characteristics (Welch et al., 2019), incur fatigue similar to
inconsequential to exercise and sport performance (McConnell, 2009). Although in the recent
years, the literature proving otherwise has been steadily growing, as new research has found
other mechanisms for respiratory muscle fatigue to impact sport performance. Additionally,
However, most of these studies have focused on the effects of training the respiratory
muscles. As such, the effects of respiratory muscle fatigue on sport performance have yet to be
fully investigated. Research on respiratory muscle fatigue should be given more importance to
establish whether it truly imposes a significant threat to exercise and to possibly develop an
Currently, companies have been trying to sell respiratory muscle training to the athletic
exerted, among others. While being backed up by scientific evidence for a considerable amount
of time since it launched, it has still yet to be included in many strength and conditioning
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programs by coaches. This might be because the significance of respiratory muscle fatigue to
exercise performance still has not been clearly established. A great volume of research has
studied the contributions of exercise to respiratory muscle fatigue, yet considerably few have
looked upon the inverse, i.e. the effects of respiratory muscle fatigue to exercise performance.
There is an apparent gap in the literature that still needs to be filled before respiratory muscle
healthy adults, and its subsequent effects to health and skill related components of physical
fitness that are relevant to sports performance. It investigates the role of respiratory muscle
fatigue to performance as it might have been previously overlooked and preemptively judged as
insignificant. The hypothesis is that sports and exercise performance are significantly deterred by
RMF.
1. find out how one may incur respiratory muscle fatigue during exercise.
4. elucidate the significance of respiratory muscle fatigue and relate its possible
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performance would provide a new perspective for improving athletes in those sports. The extent
of its performance consequences should also finally give coaches and athletes an idea of whether
to implement respiratory muscle training or not to their training plans. Furthermore, since it is
also relatively cost-friendly, respiratory muscle training would be a very accessible strategy for
use in improving the Filipino athlete. This study has the potential to add to the growing
It may also emphasize the importance of resistance training in athletes. A study has found
that resistance training also strengthens the respiratory muscles, and even more so than
endurance training alone (Hackett et. al, 2014). The findings of this study has the potential to add
perspective into the world of athletic training, particularly to the current value of respiratory
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Chapter II
Similar to any other muscle group in the body, respiratory muscles also incur fatigue
during exercise. In a study by Bye et al. (1984), diaphragmatic fatigue was recorded during
short-term high intensity cycling in active young men. In another study by Babcock et al. (1996),
aerobically trained individuals were shown to develop the same level of diaphragmatic fatigue
with less aerobically fit counterparts after a sustained high-intensity bout of exercise. The high-
aerobic fitness group completed a higher absolute workload, however, this also proves that elite
endurance athletes might still incur the same level of diaphragmatic fatigue as less trained
individuals if they both work at ≥85% V˙ O2max, the intensity wherein respiratory muscle
fatigue is known to occur (Welch et al., 2019). Moreover, these studies show that even though
the respiratory demands of exercise could be amply met by the respiratory system (Coast et al.,
1990), some form of fatigue might still occur in the muscles that facilitate breathing due to the
sports. Additionally, the loads placed upon the thoracic region during exercise is found to
accelerate respiratory muscle fatigue (RMF) due to the increased resistance against the
inspiratory muscles during breathing (Shei et al., 2017). These thoracic loads may be present in
sporting events such as climbing, wrestling, and swimming as well as in weight training
exercises.
Metaboreflex
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RMF has been proven to trigger a variety of physiological reactions that primarily affect
the cardiovascular system (Dempsey et al., 2006). These effects are potentially detrimental to
sports performance. The respiratory muscle metaboreflex is one that may significantly affect
fatiguing contractions of the respiratory muscles. Signals are then directed to the spine which
finally increases sympathetic vasoconstriction in the locomotor muscles (Dempsey et al., 2006).
It is similar to the blood shunting phenomenon one may experience by exercising immediately
after eating, caused by a competition for blood supply by the digestive and musculoskeletal
systems. In this case, the competitive relationship is occurring between the respiratory and the
musculoskeletal systems.
Blood pressure has also been documented to be affected by respiratory muscle fatigue. A
study by Katayama et al. in 2012 showed that exercising under inspiratory muscle load
significantly increased diastolic blood pressure compared to a control trial. It has been
hypothesized since then that it was caused by the sympathetic vasoconstriction that occurs due to
the respiratory muscle metaboreflex. Moreover, the study documented the elevated diastolic
blood pressure to remain for several minutes after the trial was done. Changes in systolic blood
In another study by Harms et al. (1998), unloading the respiratory muscles during
output when compared to a control trial, meaning respiratory muscle work reduces cardiac output
during exercise. This may again be attributed to the blood flow theft that occurs along with the
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respiratory muscle metaboreflex. The ~7% difference between cardiac output between the
respiratory muscle unloading trial and the control trial accounts for the decreased blood
requirements of the respiratory muscle during high-intensity exercise. Interestingly, when the
researchers increased the work of breathing through introducing inspiratory resistance, cardiac
output did not differ significantly between the increased work of breathing trial and the control
trial.
Respiratory muscle fatigue could also contribute to increases in blood lactate levels
sustained maximum voluntary ventilation (SMVV), blood lactate increased by 1.0 mmol/l (9.0
mg/100 ml) over resting values (Freedman et al., 1983). The increase in blood lactate levels were
a small but significant amount. This increase can only be attributed to the production of lactic
acid caused by the contractions of the respiratory muscles required to perform SMVV.
Summary
The current literature exposes how respiratory muscle fatigue may affect individuals
across various aerobic fitness levels. Additionally, this respiratory muscle fatigue might disturb
physiological phenomenon resulting from respiratory muscle fatigue is the respiratory muscle
metaboreflex, which causes sympathetic vasoconstriction to preserve regular blood supply in the
respiratory muscles during high-intensity exercise, where locomotor muscles might require blood
supply as well, thus competing with the respiratory muscles. This reaction may result to an
increase in diastolic blood pressure and a decrease in cardiac output. Finally, fatiguing
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contractions of the respiratory muscles also cause significant increases in blood lactate albeit
small.
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Chapter III
METHODOLOGY
Research Design
Resources gathered for the purpose of this paper were all retrieved from the online
databases Google, EBSCOhost, ResearchGate, and PubMed. The initial keywords used for the
search were “Respiratory Muscle Fatigue and Performance”. To thoroughly scan the databases
for sources, the keywords were broadened to only “Respiratory Muscle Fatigue”. Journal articles
were then inspected by title and abstract if they could prove useful in solving the research
question. Some articles were also found while investigating the citations of the previously
gathered journal articles. Relevant data were then tabulated for further analysis.
The search included scientific journals which had a title and an abstract pertaining to
fatigue in the respiratory muscles of humans and its effect to health and performance.
Experimental studies involving healthy participants were found to be appropriate for the purpose
of answering the research question and so were included to be examined for this review. Most of
the studies included have been published in the last 30 years, although one study published in the
year 1983 was included as its findings were found to still be significant to the present time. Upon
meeting these criteria, the full-texts of the journal articles were downloaded and scanned further
to select the final list of sources to be used for the purpose of this research. Furthermore, only
journal articles written in English or had an English version of the text were included. 17 journal
Full-text versions of the experimental journals were evaluated for their methodology:
whether their approach was valid and would produce results relevant to the purpose of this
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research. Journal articles were included if their methodologies involved either a control or
crossover method and investigated the effect of respiratory muscle work or fatigue on exercise
performance parameters. Studies involving respiratory muscle training within their methods have
been excluded as it is beyond the scope of this research. After validating the methodologies of
the experimental journals, the results sections were scanned to see if results produced would be
useful in answering the research question. Finally, discussion sections were read and studied as
well in order to gain insight on how the findings of the studies might help answer the research
question. 12 studies passed the selection process and were included to be further analyzed and
synthesized. A full summary of the relevant findings of these studies can be found at Appendix
A.
Respiratory Muscles. A muscle group which mainly includes the external and internal
Respiratory Muscle Fatigue (RMF). A type of fatigue that occurs in the respiratory muscles
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Chapter IV
All the experimental literature gathered had short-term interventions that lasted no more
than a week. The usual approach would be a crossover method wherein at least 2 days would be
dedicated to the experimental process: one day would serve as an intervention and another for
control. These experiments included ≤10 subjects only and was the design the majority of the
collected literature followed. A few experiments with more subjects available used a control
group to compare with an intervention group. Interventions would mostly comprise of techniques
inducing respiratory muscle fatigue during or before exercise to later on investigate its
corresponding effects.
Participants would range from sedentary to recreationally trained while a few studies
employed athletic populations. In all studies, all participants were ensured to be asymptomatic
and healthy, although some have not confirmed whether all participants did not participate in
smoking activities. In terms of gender, most participant samples were homogenous and
comprised of all males, although in cases where the group was heterogenous, it was still
predominantly male. Only one study by Nicks et al. in 2019 had a participant group of all female,
which was a collegiate football team. All subjects who participated were adults.
Additionally, most studies that were conducted and published were American and
European. Only 3 out of the 12 selected studies were Asian, all of which were produced in Japan.
Meanwhile, common instruments that were utilized were a respiratory muscle training
device (or a modified version of one), a spirometer, and a cycle ergometer. Some instruments
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that at least a couple of experiments mutually used were an EMG, a blood lactate analyzer, and
an ECG, mainly to evaluate the effects of the intervention i.e. the alteration of respiratory muscle
work done. Most of the studies included procedures that increased or decreased the work of
breathing of the participants before or during a cycle ergometer exercise of different intensities.
They would also be tested for physiological parameters for fatigue level and performance before
level at exhaustion when work of breathing is increased during exercise (Bye et al., 1983; Mador
& Acevedo, 1991; Wuthrich et al., 2013). When the opposite is done, such as decreasing the
work of breathing, a 10-20% increase in exercise time to exhaustion occurs. This may be
strongly tied to the respiratory muscle metaboreflex which alters cardiac output, and
consequently Oxygen delivery. These physiological disturbances take away essential substrates
from the locomotor muscles and into the respiratory muscles. Therefore, during conditions of
respiratory muscle fatigue, metabolite removal in the locomotor muscles is hampered, and so is
recovery. Locomotor muscle fatigue consequently accelerates and time to exhaustion shortens
leading to a decrease in overall exercise performance. Furthermore, the small but significant
increases in lactate accumulation in the respiratory muscles may contribute to the overall fatigue
Another known effect of respiratory muscle fatigue that may impair performance is an
increase in perceived exertion and breathlessness during exercise (Bye et al., 1983; Mador &
Acevedo, 1991, Sugiura et al., 2013; Wuthrich et al., 2013). This may also be an effect of the
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reduced Oxygen delivery to the muscles. A study by Drouin et al. in 2019 confirms the existence
of an Oxygen-Conforming Response, which suggests that the absence of Oxygen increases the
perception of effort during exercise. This reaction, coupled with the metabolite accumulation in
the locomotor muscles, might contribute to a greater perception of effort, and ultimately a
brought about by RMF alongside the increase in perceived exertion of effort causes additional
discomfort and may deter the exercise quality. These alterations in perception prove that RMF
may not only affect sport and exercise physiologically, but also psychologically.
Therefore, it can be expected that sports which require high-intensity endurance of short
to medium durations will experience a likely negative effect from RMF. Intermittent-sprint
work, may also suffer since Oxygen delivery, which is important to recovery during the low-
intensity bouts, is compromised. In both types of sports where the maintenance of force
Furthermore, water sports may incur additional RMF than sports on land. Since water
places external forces on the ribcage and consequently on the respiratory muscles, ultimately
causing more work. This additional work imposed by the water could accelerate RMF especially
(2013), which showed that swimmers have greater respiratory muscle strength than athletes
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It is also important to note that not only sport performances can be affected negatively,
but training as well. Respiratory muscle fatigue can affect training capacity similar to how it
affects sport performance. This cumulative reduction in training quality over time could lead to
undesired training adaptations. This could be a possible mechanism of how RMF could influence
sport performance outcomes. Figure 4.1 summarizes the mechanisms of RMF which may
Figure 4.1: Theoretical framework explaining how RMF might affect sports performance.
A study by Nicks & Mangum in 2008 suggests that respiratory muscle strength, measured
through maximal inspiratory pressure, may protect an individual from incurring respiratory
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muscle fatigue and its harmful effects. This supports the case for respiratory muscle training as a
possible method of attenuating the negative effects brought about by RMF. The mechanisms by
which respiratory muscle training could improve performance are further explained in Figure 4.2
(Welch et al., 2019). The potential of RMT as a training aid for sport and exercise performance
has yet to be fully realized, as the optimal protocol for implementing RMT in athletes is yet to be
determined (Karsten et al., 2019). The type of athlete that may find RMT most advantageous is
also yet unclear (HajGhanbari et al., 2013), although evidence has shown that running, cycling,
swimming, and rowing performance may improve through this type of training (Shei, 2018).
Intermittent-sprint type sports such as basketball (Chang et al., 2016) and football (Archiza et al.,
2017; Silva et al., 2019) have also been documented to benefit in some aspects of performance
following RMT.
Figure 4.2: Theoretical model of RMT influencing sports performance (Welch et al., 2019)
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Chapter V
Summary of Findings
Literature was searched and analyzed about how RMF might affect exercise performance.
Data investigating this issue were scanned and collected. Results were tabulated and further
analyzed and synthesized in order to answer the research question. Literature revealed several
effects that are caused by the occurrence of fatigue in the respiratory muscles. These include the
respiratory muscle metaboreflex, alterations in cardiac output and blood pressure, and small but
Conclusion
Respiratory muscle fatigue can influence the fitness of an individual mainly through the
respiratory muscle metaboreflex, which is a reflexive mechanism of the body during exercise to
preserve function of the respiratory muscles by redirecting the blood from locomotor muscles to
the respiratory muscles. This in turn causes alterations in blood supply and substrate delivery to
the locomotor muscles during exercise, possibly impeding recovery in those muscles. This
metaboreflex may also lead to heightened perceptions of effort and breathlessness, affecting the
drive of an individual to perform. In summary, respiratory muscle fatigue may potentially add on
the stresses incurred during sports, impairing several facets of performance, mainly recovery,
Limitations
All sources used for this review were accessed online. Current circumstances during the
production of this research prohibit searching potential sources in physical forms, i.e. library-
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based literature. Therefore, sources for the purpose of this research were limited to online
publications which have full-text versions readily accessible through the internet. Furthermore,
access to some potentially relevant journal articles were not freely available and so were not
included.
Additionally, the results collected were mostly from highly controlled experiments. Only
a single study was done in the field. Actual effects of RMF to performance outcomes in sport
that may be affected, e.g. time trial results, maintenance of peak force output, intermittent
Application
The findings of this research sheds light on the importance of respiratory muscle fatigue
in specific sport and exercise situations. Sport coaches may need to take into consideration the
implications respiratory muscle fatigue has in their respective types of sport. Alternatively,
coaches and athletes could consider respiratory muscle training as a cost efficient means to
attenuate the potential negative effects of respiratory muscle fatigue and improve their overall
performance.
Recommendations
Further research which tests the findings of this literature synthesis should be conducted
out on the field. The theoretical effects of RMF on more direct performance outcomes and in
more specific sport situations would raise the significance of RMF in athletes and coaches. A
respiratory muscle fatigue in intermittent sprint athletes, particularly on how RMF during
intermittent sprint bouts affects markers of performance such as speed and power maintenance.
The experiment could involve inducing RMF through making the participants undergo a
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respiratory muscle training bout to failure. The participants would then subsequently need to
perform a running-based anaerobic sprint test (RAST) to test if RMF affects their intermittent
sprint performance. This will allow intermittent sprint sport coaches to draw a more concrete
idea of how respiratory muscle fatigue affects their athlete. This will also elucidate the impact of
respiratory muscle fatigue in the short aerobic periods during this type of sport and how it affects
their overall recovery and performance. A detailed methodology for this type of study is further
explained in Appendix B.
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References:
Archiza, B., Andaku, D. K., Caruso, F. C. R., Bonjorno, J. C., Oliveira, C. R. D., Ricci, P. A., …
Babcock, M. A., Pegelow, D. F., Johnson, B. D., & Dempsey, J. A. (1996). Aerobic fitness
Bye, P. T., Esau, S. A., Walley, K. R., Macklem, P. T., & Pardy, R. L. (1984). Ventilatory
Chang, Y.-C., Lan, Y.-C., Tsai, M.-W., & Chou, L.-W. (2016). Effects of 3-week Respiratory
Coast, J. R., Clifford, P. S., Henrich, T. W., Stray-Gundersen, J., & Johnson, R. L. (1990).
199012000-00013
Dempsey, J. A., Romer, L., Rodman, J., Miller, J., & Smith, C. (2006). Consequences of
Dominelli, P. B., Archiza, B., Ramsook, A. H., Mitchell, R. A., Peters, C. M., Molgat-Seon, Y.,
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10.1113/ep086566
Drouin, P. J., Kohoko, Z. I. N., Mew, O. K., Lynn, M. J. T., Fenuta, A. M., & Tschakovsky, M.
Freedman, S., Cooke, N., & Moxham, J. (1983). Production of lactic acid by respiratory muscles.
Hackett, D. A., Johnson, N., & Chow, C. (2013). Respiratory muscle adaptations: a comparison
https://www.researchgate.net/publication/236181042
Hajghanbari, B., Yamabayashi, C., Buna, T. R., Coelho, J. D., Freedman, K. D., Morton, T. A.,
10.1519/jsc.0b013e318269f73f
Harms, C. A., Babcock, M. A., Mcclaran, S. R., Pegelow, D. F., Nickele, G. A., Nelson, W. B.,
& Dempsey, J. A. (1997). Respiratory muscle work compromises leg blood flow during
doi:10.1152/jappl.1997.82.5.1573
Harms, C. A., Wetter, T. J., Mcclaran, S. R., Pegelow, D. F., Nickele, G. A., Nelson, W. B., . . .
Dempsey, J. A. (1998). Effects Of Respiratory Muscle Work On Cardiac Output And Its
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Karsten, M., Ribeiro, G. S., Esquivel, M. S., & Matte, D. L. (2019). Maximizing the
Katayama, K., Iwamoto, E., Ishida, K., Koike, T., & Saito, M. (2012). Inspiratory muscle fatigue
Katayama, K., Goto, K., Shimizu, K., Saito, M., Ishida, K., Zhang, L., … Sheel, A. W. (2018).
Effect of increased inspiratory muscle work on blood flow to inactive and active limbs
Mador, M. J., & Acevedo, F. A. (1991). Effect of respiratory muscle fatigue on subsequent
doi:10.1152/jappl.1991.70.5.2059
Nicks, C. R., & Mangum, M. (2008). Influence of Baseline Respiratory Muscle Strength on
doi:10.1249/01.mss.0000323646.92095.56
Pessoa, I. M. S., Parreira, V. F., Fregonezi, G. A., Sheel, A. W., Chung, F., & Reid, W. D.
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Romer, L. M., & Polkey, M. I. (2008). Exercise-induced respiratory muscle fatigue: implications
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Shei, R.-J., Chapman, R. F., Gruber, A. H., & Mickleborough, T. D. (2017). Respiratory Effects
Shei, R.-J. (2018). Recent Advancements in Our Understanding of the Ergogenic Effect of
Silva, R. L. C., Hall, E., & Maior, A. S. (2019). Inspiratory muscle training improves
Sugiura, H., Sako, S., & Oshida, Y. (2013). Effect of Expiratory Muscle Fatigue on the
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Welch, J. F., Kipp, S., & Sheel, A. W. (2019). Respiratory muscles during exercise: Mechanics,
doi:10.1016/j.cophys.2019.04.023
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Wüthrich, T. U., Notter, D. A., & Spengler, C. M. (2013). Effect of inspiratory muscle fatigue on
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Zagatto, A. M., Beck, W. R., & Gobatto, C. A. (2009). Validity of the Running Anaerobic Sprint
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Appendix A
Journal articles that met the search criteria were gathered and tabulated here. Data from the articles that were collected include
titles, authors, dates of publication, problem statements, participant characteristics, instruments used, findings, and conclusions. 12
articles were included in total. The collective findings of these articles were used to formulate the results and discussion section.
Participant
Title, Author, and Date Problem Statement Instruments Finding Conclusion
Description
1.) Effect of increased Does increased Healthy young Custom designed Arm blood flow was reduced The respiratory
inspiratory muscle sympathetic men (n=10, 20 ± ergometer, while leg blood flow was muscle-induced
work on blood flow vasoconstriction 2 yrs), inspiratory preserved during mild leg metaboreflex affects
to inactive and active originating from the sedentary, non- threshold resistance exercise with inspiratory sympathetic blood
limbs respiratory smokers device resistance. flow redistribution
during submaximal musculature elicit a Brachial artery blood flow from active limbs.
dynamic exercise, reduction in blood (inactive
Katayama et al., 2018 flow to an inactive limb) was reduced, while femoral
limb in order to artery blood flow (active limb)
maintain blood flow to was maintained during
an active limb? submaximal leg exercise with
inspiratory resistance.
2.) Ventilatory muscles How does short-term 7 normal young EMG, Cycle Diaphragmatic fatigue occurs in Diaphragmatic fatigue
during exercise high-intensity exercise men age 26-36, ergometer short-term (~6mins) high intensity occurs in constant high
in air and oxygen in affect ventilatory recreationally exercise (80% max workload) at a intensity exercise.
normal men. Bye et muscle fatigue? active constant workload in young men Oxygen saturation of
al., 1984 (26-36yr) air affects onset of
diaphragmatic fatigue
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3.) Inspiratory muscle To elucidate the 8 healthy males. Inspiratory muscle Exercise with inspiratory load Inspiratory
fatigue increases influence of All were training device, induced changes in muscle muscle fatigue induces
sympathetic inspiratory muscle sedentary, mouth pressure sympathetic nerve activity and increases in muscle
vasomotor outflow fatigue nonsmokers, and meter, ergometer, diastolic blood pressure sympathetic vasomotor
and blood on muscle sympathetic with no history ECG outflow and blood
pressure during nerve activity of pressure during
submaximal exercise (MSNA) and blood cardiorespiratory dynamic leg exercise
Katayama et al., 2012 pressure diseases. at mild intensity.
(BP) response during
submaximal exercise.
4.) Respiratory muscle We hypothesized that 7 male cyclists Cycle ergometer, Significant correlations We conclude that Wb
work compromises during exercise at Ventilator existed (r 5 0.74–0.90; P , 0.05) normally incurred
leg blood flow maximal Oxygen between work of during maximal
during maximal consumption (V˙ breathing (Wb) and Q ˙ legs exercise causes
exercise, Harms et O2max), high (inverse), leg vascular resistance vasoconstriction
al., 1997 demand for respiratory (LVR), and leg V˙ O2 (V˙ O2 legs; in locomotor muscles
muscle blood flow (Q˙ inverse), and between LVR and and compromises
) would elicit norepinephrine spillover. locomotor
locomotor muscle Respiratory muscle loading and muscle perfusion and
vasoconstriction and unloading affected changes in V˙ O2 [in legs]
compromise limb Q vasoconstriction in leg muscles.
5.) Effect of Expiratory The aim of this study 9 healthy adult ECG, gas analyzer, The results showed that compared These results suggest
Muscle Fatigue on was to reveal the men (mean age spirometer, cycle with the CON-EX that during medium-
the effect of expiratory 21.0 ergometer condition, no change in VE, an intensity exercise,
Respiratory Response muscle fatigue (EMF) ± 0.5 years, increase in f, or a decrease in VT EMF modulates the
during Exercise, on respiratory mean body was observed under the medium- respiratory response by
Sugiura H. et. al. response under two height 171.2 ± intensity EMF-EX inducing shallow and
2013 different exercise 2.3 cm, mean condition, while high-intensity fast
conditions: exercise body exercise reduced VE and f breathing to increase
(EX) with EMF weight 64.8 ± without changing VT. ventilation volume.
(EMF-EX) and control 5.7 kg, mean
EX without body mass index
EMF (CON-EX). (BMI) 22.1 ±
1.8 kg/m2), who
did not smoke
and were not
athletes.
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6.) EFFECTS OF Does manipulating the Eight healthy oesophageal We found that when the WOB Our findings support
RESPIRATORY work of breathing subjects (n=5M, balloon catheters, was reduced during exercise, the theory of a
MUSCLE WORK (WOB) during high- n=3W), All resistors, respiratory muscle blood competitive
ON RESPIRATORY intensity exercise alter recreationally proportional assist flow decreased while locomotor relationship
AND LOCOMOTOR respiratory and active ventilation, near- muscle blood flow increased. between locomotor
BLOOD locomotor muscle infrared Conversely, when the and respiratory
FLOW DURING blood flow? spectoscopy WOB was increased, respiratory muscles during intense
EXERCISE, muscle blood flow increased exercise.
Dominelli et al., 2017 while locomotor muscle
blood flow decreased.
7.) Effect of respiratory The purpose of this Ten healthy Spirometer, After induction of fatigue, We conclude that
muscle fatigue on study was to subjects, seven pneumotachograph, exercise time was reduced induction of
subsequent exercise determine whether men and three breathing compared inspiratory
performance. Mador induction of women, apparatus. with control (P < 0.001). muscle fatigue can
& Acevedo, 1991 inspiratory muscle volunteered for During the last minute of impair subsequent
fatigue might impair this study. exercise, Oxygen consumption performance of
subsequent exercise and heart rate high-intensity exercise
performance were lower after induction of and alter the pattern of
fatigue than during control. breathing during
At exercise isotime, minute such exercise.
ventilation and the visual
analogue scale for respiratory
effort
were larger after induction of
fatigue than during control.
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8.) Production of lactic Do normal, 7 healthy male Spirometer, Blood With SMVV subjects sustained Maximal Ventilation
acid by respiratory asymptomatic subjects lactate analyser on average 68% of the and Respiratory
muscles. Freedman et individuals produce an predicted maximum breathing Loading induced
al., 1983 increase in systemic capacity and achieved final lactate significant increases in
blood lactate during concentrations of 1.9 mmol/l blood lactate albeit
breathing under (17X1 mg/100 ml), representing small.
respiratory load? an average increase of about 1*0
mmol/l (9.0 mg/100 ml) over
resting values.
There was a wide range between
individuals, from no increase at
all to 2-7 mmol/l,
despite similar levels of
ventilation.
Breathing against added loads
produced much smaller
changes in blood lactate.
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Bernardino, D.
9.) Effect of inspiratory Inspiratory muscle 14 healthy males magnetic nerve The time to exhaustion in the PF- Thus, prior-induced
muscle fatigue on fatigue (IMF) limits stimulation, cycle EX conditions was IMF
exercise exercise performance ergometer, visual significantly reduced by 14% reduces exercise
performance taking and can augment analog scale, compared with C-EX. performance, probably
into account the ventilatory custom inspiratory The reduction in Ptw and Qtw as a result of the
fatigue-induced drive, which could per pressure inducer was greater increased quadriceps
excess respiratory se impair performance after PF-EX (Ptw, 17.3±9.7%; muscle fatigue and
drive. Wuthrich et. al, due to greater Qtw, 32.0±10.8%) than after thus greater perception
2013 respiratory muscle MATCH-ISO (Ptw, 10.8±10.3%; of exertion
work. Using Qtw, 23.3±15.2%; P <0.05), independent of the
magnetic nerve which may explain the increased excess respiratory
stimulation to assess perception of exertion and drive when cycling
fatigue, we tested earlier task failure with prior- with fatigued
whether the IMF- induced IMF. inspiratory muscles.
induced decrease
in exercise
performance results
from increased
respiratory muscle
work alone and/or a
metaboreflex-
mediated increase in
quadriceps muscle
fatigue.
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Bernardino, D.
10.) Influence of Baseline The purpose of this 16 Female Portable mouth Average PImax and PEmax RMF occurs after
Respiratory Muscle study was to Collegiate pressure meter, values were 118.6 ± 8.0 and 128.3 intense exercise which
Strength determine the severity Athletes Yo-Yo Test ±28.1 cmH2O, respectively. includes intermittent-
on Respiratory of There was a significant drop in sprint sports
Muscle Fatigue inspiratory muscle both PImax (-15.4± 12.4%; p Respiratory muscle
Following fatigue (IMF) and =.000) and PEmax (-12.8 ± 9.7%, strength measured
Exhaustive expiratory muscle p = .000) following the through PImax may
Intermittent Exercise. fatigue (EMF) completion of the IRT. PImax and protect individual from
Nicks & Mangum, following exhaustive level of IMF were inversely RMF, although no
2008 intermittent exercise in related, significant differences
female athletes. The although not significantly (r = were found between
study also -.40; p = .061). high PImax and low
addressed the question PEmax and EMF were not PImax athletes.
of whether higher significantly related (r = .004; p
values of inspiratory =.494).
muscle RMF was compared between
strength (PImax) or participants (n = 4) exhibiting the
expiratory muscle highest PImax (HPI) to the lowest
strength (PEmax) (LPI, n= 4), (140.3 ± 8.8 cmH20
relate to the severity vs. 96.3 ± 13.6 cmH20). HPI
of respiratory muscle experienced a -20 ±16.1 cmH20 (-
fatigue (RMF) after 13.9 ± 11.3%) drop in PImax post
intermittent exercise. exercise compared to a
-25.5 ± 8.4 cmH20 (-27.7 ±
12.9%) drop in LPI.
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Bernardino, D.
11.) Aerobic fitness THIS STUDY WAS Twenty-four Bilateral Phrenic The supramaximal BPNS test High-fit subjects
effects on exercise- AIMED at subjects (20 men Nerve Stimulation showed a significant showed diaphragm
induced determining the effects and 4 women) (BPNS), reduction (P , 0.01) in the BPNS fatigue
low-frequency of Spirometer transdiaphragmatic pressure as a result of heavy
diaphragm fatigue, aerobic capacity or (Pdi) immediately after exercise endurance exercise but
Babcock et al., 1996 maximal Oxygen of 223.1 6 3.1% for the were also
consumption (V˙ high-fit group and 223.1 6 3.8% partially protected
O2max) (P . 0.05) for the fit group. from excessive fatigue,
on exercise-induced Recovery of the BPNS Pdi took despite high
diaphragm fatigue 60 min in both groups. ventilatory
The high-fit group exercised at a requirements
higher absolute workload, which This might be because
resulted in a higher CO2 their hyperventilatory
production (126%), a greater response
ventilatory demand (116%) to endurance exercise
throughout the exercise, and an was reduced, their
increased diaphragm force output diaphragm was
(128%) over the initial utilized less in
60% of the exercise period. providing the total
Thereafter, diaphragm force ventilatory response,
output declined, despite a rising and
minute ventilation, and it possibly their
was not different between most of diaphragm aerobic
the high-fit and fit subjects. capacity was greater.
36
Bernardino, D.
12.) Effects of respiratory Our present study Eight male 8 channel tape Stroke volume, CO, Respiratory muscle
muscle work on examined the effects cyclists recorder, PAV, and pulmonary Oxygen work normally
cardiac output of changes in [maximal catheter, blood-gas consumption (V˙ O2) were not expended
and its distribution the work of breathing Oxygen analyzer, pressure different (P . during maximal
during maximal on cardiac output consumption transducer, lactate 0.05) between control and loaded exercise has two
exercise. Harms et (CO) during maximal (V˙ O2max): 62 analyzer, cycle trials at V ˙ O2 max but were significant effects on
al., 1998 exercise. 6 5 ml·kg21 ergometer lower (28, 29, and 27%, the
·min21] respectively) than control with cardiovascular system:
inspiratory muscle unloading at V 1) up to 14–16% of the
˙ O2 max. CO is directed
to the respiratory
muscles; and 2) local
reflex vasoconstriction
significantly
compromises blood
flow to leg locomotor
muscles.
37
Bernardino, D.
Appendix B
Research Design
assigned into two groups. After accomplishing a specific warm-up, one group would perform a
running-based anaerobic sprint test (RAST) after respiratory muscle training (RMT) to failure
and the other would perform RAST after a placebo RMT. Each group would then crossover to
Participants
The target population for this research are athletes who participate in intermittent-sprint
type sports. The athletes who are accessible for the purpose of this research are collegiate
intermittent-sprint type athletes who are 18 to 24 years old. To ensure the quality of the results of
this study, at least 15 male participants who are learned with sprinting will be secured to
participate. Subjects are excluded if they incurred any orthopedic injuries in the past 6 months,
have any lung or cardiovascular disease, or are smokers. Furthermore, each will have to give
their informed consent before participating in this study. This study will follow the Declaration
of Helsinki.
Research Instruments
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Bernardino, D.
The running-based anaerobic sprint test has been proven reliable (r=0.88) and has been
validated to measure peak power (r=0.46), mean power (r=0.53), and fatigue index (r=0.63) and
can be used to predict anaerobic, short-distance performance (Zagatto et al., 2009). The test will
Respiratory muscle fatigue will be induced using PowerBreathe Plus, a breathing trainer
designed to improve the inspiratory muscles. The PowerBreathe Plus provides a threshold
resistance for the inspiratory muscles to overcome before allowing air to enter.
Procedure
Participants would be briefed to take an adequate amount of sleep prior to each testing
day and refrain from any food 2 hours prior to each testing period. During the test proper,
participants’ body weight in kilograms would be collected prior to the warm-up. Both groups
would then perform the same warm-up and a maximal 35m sprint to also familiarize with the
test. They would then rest for 3 minutes before doing RMT. The experimental group would then
attempt to breathe using the PowerBreathe Plus set at level 2.5 (~68.5 cmH2O) up to which they
cannot accomplish another breath, while the placebo group will attempt 10 breaths using the
same instrument set at level 0 (~23 cmH20). The values for the experimental group are derived
from an approximation of the 50% of their maximal inspiratory pressure using established norms
39
Bernardino, D.
(Pessoa et al., 2014). This protocol is the recommended protocol for RMT (HajGhanbari et al.,
2013). Both groups would then immediately start the RAST, in which they would sprint for 35
meters followed by a recovery period of 10 seconds to be repeated for a total of 6 sprints. The
time for each sprint as well as the RPE and RPB for each RAST will be collected. The sprint
time and body weight data will be used to calculate the peak power output, mean power, and
Analysis of Data
The hypothesis is that respiratory muscle fatigue will negatively influence the recovery
performance. This is derived from the theory of blood flow theft by the respiratory muscles from
the locomotor muscles due to the respiratory muscle induced metaboreflex. It can also stem from
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Bernardino, D.
Also, it has been found that aerobic fitness is positively correlated with repeated sprint-
ability (Thebault et al., 2011; Tomlin & Wenger, 2001), which might mean that if aerobic fitness
is compromised, repeated sprint-ability will be impaired. It can be postulated that the capability
of the respiratory muscles plays a role in this correlation, and thus, hampering that role may lead
to a decrease in the recovery capacity during the test. This might be another mechanism of how
A T-test will be used to determine if there exists a significant difference between the
measures from the two trials done. Sub-group analysis for each sport of the participants could
also be done to determine if their specific sports influence the scores and how significant its
effect may be. This is also to offset the differences of results in between each sport due to the
varying natures of each sporting event (e.g. movement patterns, environment, etc.).
Null Hypothesis:
Ho: The fatigue index of the experimental group is not significantly greater than the fatigue
41