To overcome the problem of altered breathing strategy during resistive ventilatory muscle training (VMT), we used a single-orifice inspiratory resistance together with a target feedback device (TFD) in patients with chronic obstructive pulmonary disease (COPD). In a preliminary study (study A), we showed that the resistance plus TFD was effective in controlling breathing strategy. We subsequently used the resistor plus TFD in a 5-wk study (study B) of VMT in 17 COPD patients who were randomized into high-intensity (HI) and low-intensity (LI) training groups. Compared with the LI group, the HI group showed significant increases in static maximal inspiratory pressure (21.3 versus 5.0 cmH2O), maximal sustained ventilatory capacity (MSVC, 3.2 versus -0.1 l/min, sustained maximal mouth pressure (12.1 versus 0.6 cmH2O), mean mouth pressure (6.9 versus 3.9 cmH2O), peak inspiratory flow rate (12.3 versus 4.0 l/min), and maximal sustained work rate (12.2 versus 4.2 cmH2O/l/min). We conclude that targeted VMT with control of breathing strategy improves both ventilatory muscle strength and endurance.

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