Using a 2-arm, RCT approach, the primary goal of the study is to evaluate the feasibility and preliminary efficacy of Inspiratory Muscle Strength Training (IMST) as a non-pharmacologic intervention to reduce cardiovascular and cognitive risks in older adults. Next, investigators will examine secondary effects of IMST on mood, sleep quality, systemic inflammation, and physical/motor function. Finally, investigators will assess participant adherence and acceptability ratings of using an 8-week home-based IMST protocol in a diverse older adult sample.
Ages 60-80
Converted telephone MoCA total score≥18
Presence of at least one dementia risk factor (e.g., MCI or subjective cognitive decline, hypertension [SBP >130 mmHg or on medication], sedentary lifestyle [<150 min/week], family history of dementia or self-reported APOE ε4 carrier, or mild sleep-disordered breathing; CAIDE total score [>5]
Capable of independently completing or requiring minimal assistance with inspiratory muscle strength training (IMST)
tMoCA <18, or diagnosis of neurodegenerative illness at the discretion of principal investigator (except MCI)
Current evidence of any major psychiatric disorder including psychosis (at the discretion of principal investigator), bipolar disorder, severe major depression (PHQ-9 > 20)
Unstable cardiovascular or pulmonary disease
Recent respiratory therapy or major medication changes
Parallel
Inspiratory Muscle Strength Training High-Resistance
DeviceInvestigators will use POWERbreathe® Electronic IMST devices and manually set them to 75% of an individual's IPpeak, depending on their randomization, to the high-resistance IMST group or very low-resistance IMST (sham) group. All participants will complete 30 training breaths per day at home for 8 weeks.
Inspiratory Muscle Strength Training Low-Resistance
DeviceInvestigators will use POWERbreathe® Electronic IMST devices and manually set them to 15% of an individual's IPpeak, depending on their randomization, to the high-resistance IMST group or very low-resistance IMST (sham) group. All participants will complete 30 training breaths per day at home for 8 weeks.
Change in systolic BP
Participants will demonstrate a change in systolic blood pressure (mmHg), assessed as the average of two seated measurements obtained following two consecutive 5-minute rest periods, from baseline to post-intervention.
Change in executive cognitive functioning
Participants will demonstrate a change in executive cognitive functioning, assessed using the Fluid Composite Score from the NIH Toolbox Cognition Battery. The Fluid Composite Score is derived from tasks assessing executive function, attention, working memory, episodic memory, and processing speed. Change in executive cognitive functioning will be evaluated as the difference in Fluid Composite Scores from baseline to post-intervention.
Change from Baseline in Mood Symptoms (Depression) at 8 Weeks
Participants will demonstrate a change in depression symptoms, assessed using the Patient Health Questionnaire-9 (PHQ-9) for depressive symptoms. Total scores of 5, 10, 15, and 20 represent cut off points for mild, moderate, moderately severe and severe depression. Change in symptoms will be evaluated as the difference in scores from baseline to 8 weeks, with higher scores indicating greater symptom severity.
Change from Baseline in Mood Symptoms (Anxiety) at 8 Weeks
Participants will demonstrate a change in anxiety symptoms, assessed using the Geriatric Anxiety Scale-10 (GAS) for anxiety symptoms. Total scores range from 0 to 30, with higher scores indicating greater symptom severity. Change in symptoms will be evaluated as the difference in scores from baseline to 8 weeks, with higher scores indicating greater severity.
Change from Baseline in Sleep Quality at 8 Weeks
Participants will demonstrate a change in sleep quality, measured using the Pittsburgh Sleep Quality Index (PSQI) and objective sleep measures collected via actigraphy (Fitbit) devices provided to participants. Change in sleep quality will be evaluated as the difference in PSQI global scores, with higher scores indicating poorer sleep quality, and sleep metrics compiled from actigraphy data from baseline to 8 weeks.
Change from Baseline in Inflammatory Markers (CRP, IL-6, TNF-α) at 8 Weeks
Participants will demonstrate a change in inflammatory markers, assessed from fasting blood samples. Serum concentrations of CRP, IL-6, and TNF-α will be measured using standardized laboratory analyses. Change in inflammatory markers will be evaluated from baseline to 8 weeks.
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Florida State University
Lead sponsor
National Institutes of Health (NIH)
Collaborator
