The effectiveness of combining inspiratory muscle training with manual therapy and a therapeutic exercise program on maximum inspiratory pressure in adults with asthma: a randomized clinical trial

Objective: The objective of this study was to evaluate whether the addition of manual therapy and therapeutic exercise protocol to inspiratory muscle training was more effective in improving maximum inspiratory pressure than inspiratory muscle training in isolation. Design: This is a single-blinded, randomized controlled trial. Subjects: In total, 43 patients with asthma were included in this study. Interventions: The patients were allocated into one of the two groups: (1) inspiratory muscle training (n=21; 20-minute session) or (2) inspiratory muscle training (20-minute session) combined with a program of manual therapy (15-minute session) and therapeutic exercise (15-minute session; n=22). All participants received 12 sessions, two days/week, for six weeks and performed the domiciliary exercises protocol. Main measures: The main measures such as maximum inspiratory pressure, spirometric measures, forward head posture, and thoracic kyphosis were recorded at baseline and after the treatment. Results: For the per-protocol analysis, between-group differences at post-intervention were observed in maximum inspiratory pressure (19.77cmH(2)O (11.49-28.04), P<.05; F=22.436; P<.001; (2)(p)=0.371) and forward head posture (-1.25cm (-2.32 to -0.19), P<.05; F=5.662; P=.022; (2)(p)=0.13). The intention-to-treat analysis showed the same pattern of findings. Conclusion: The inspiratory muscle training combined with a manual therapy and therapeutic exercise program is more effective than its application in isolation for producing short-term maximum inspiratory pressure and forward head posture improvements in patients with asthma.