Does the choice of inspiratory muscle training modality affect respiratory and peripheral muscle function in chronic kidney disease?

PURPOSE: Chronic kidney disease (CKD) can impair respiratory, muscle, and functional capacity. This randomized controlled trial investigated the effects of fundamental and functional inspiratory muscle training (IMT) delivered via telerehabilitation in patients with non-dialysis CKD. METHODS: Sixty patients were randomized to fundamental IMT, functional IMT, or control groups. Thirty-eight participants completed the study and were analyzed: fundamental IMT (n = 13), functional IMT (n = 13), and control (n = 12). Maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP), strength index (S-Index), peak inspiratory flow (PIF), respiratory muscle endurance, diaphragmatic thickness and mobility, quadriceps muscle strength (QMS) and hand grip strength (HGS), trunk muscle endurance (partial sit-ups, prone, side, and pelvic bridge tests) and 6-minute walk test (6MWT) were assessed before and after 10 weeks. RESULTS: Compared with the control group, both intervention groups showed significant increases in MIP, MEP, S-Index, PIF, diaphragmatic mobility, QMS, HGS, trunk muscle endurance, and 6MWT distance (p < 0.05). Functional IMT resulted in greater improvements than fundamental IMT in respiratory muscle endurance, peripheral muscle strength, and trunk muscle function. Although 6MWT distance increased numerically more in the functional IMT group, the difference between the two IMT groups was not statistically significant (p > 0.05). CONCLUSION: Functional IMT delivered via telerehabilitation may provide additional benefits over fundamental IMT for inspiratory muscle endurance and musculoskeletal function in patients with non-dialysis CKD. Both IMT modalities improved functional capacity compared with control. These findings support the potential integration of functional IMT into telerehabilitation-based rehabilitation programs for CKD.