• Potential indications

– Dyspnea at rest or with exertion

– Inspiratory muscle weakness (<70% of the predicted value)

– Pulmonary hypertension

• Potential contraindications

– Markedly elevated left ventricular end-diastolic volume and pressure

– Worsening heart failure signs and symptoms after IMT is initiated†

– Desaturation with IMT‡

– Paradoxical breathing pattern†

– Worsening inspiratory muscle performance†,§

– Persistent diaphragmatic/abdominal/thoracic/inspiratory accessory muscle discomfort†

^†Modify IMT prescription if observed.

^‡Consider providing supplemental oxygen if oxygen saturation is observed to decrease from resting levels.

^§Worsening inspiratory muscle performance defined as an inability to repeatedly achieve MIP, sustained MIP, inspiratory endurance or inspiratory duration achieved during previous IMT sessions.

IMT: Inspiratory muscle training; MIP: Maximal inspiratory pressure.