The Effect of Inspiratory Muscle Training in People With Gastroesophageal Reflux Disease

Background: Gastroesophageal reflux disease (GERD) is multifactorial and affects an increasing number of people. Its main cause is found in the antireflux valve mechanism of the gastroesophageal junction. This consists of two sphincters, the lower oesophageal and the diaphragmatic. The disease has been related to diaphragm dysfunction, either due to the de-coordination of the diaphragms' contractility or due to decreased strength. This study was designed to evaluate the effect of inspiratory muscle training on inspiratory strength in people with gastroesophageal reflux disease.

Objective: To evaluate the effect of a IMT program in maximal inspiratory pressure, maximal dynamic inspiratory pressure, gerd symptoms and quality of life in GERD patients.

Methods: Adults with diagnosed gastroesophageal reflux disease (n=30) or had a score of more than 8 on the Gastroesophageal Reflux Disease Questionnaire will be recruited from invitations that will be made through the social media. The volunteers who meet the inclusion criteria will be randomly allocated to two groups: (a) the experimental group (n = 15) that will receive 36 sessions inspiratory muscle training with tapered flow resistive loading at 40% of maximum inspiratory pressure. Each week there will be a gradual increase in resistance by 10% of the initial maximum inspiratory pressure. (b) Τhe control group (n = 15) that will receive 36 sessions inspiratory muscle training with a constant resistance load of 7cmH20 (sham group). Both groups will perform 3 sessions per week (1 set of 30 repetitions). Measurements will occur at three time points: before the initiation of treatment sessions (week 0), three months from the beginning of the trial (week 36) and 6 months after the end of the program. The main outcomes will be the maximal respiratory pressures (digital pressure manometer), maximal dynamic inspiratory pressure (tapered flow resistance device) with secondary outcomes the gerd symptoms (gerd-q questionnaire) and quality of life (Reflux Qual short form questionnaire).

Anticipated Results: IMT is expected to increased Mip, S-Index, improve Reflux Symptoms and quality of life, mitigate the impact of gerd in the participants' health and daily life compared to standard care.

Conclusion: This trial will provide novel insights into IMT's role in symptoms prevention for GERD patients, addressing a critical gap in holistic disease management.

• Maximum Dynamic Inspiratory Pressure s-index [Time frame: the start of the program (baseline-T1), immediately after the 3 months of the main exercise program (end of the main program-T2) and 6 months after (end of follow up-T3)]
• Gastroesophageal Reflux Disease Questionnaire [Time frame: Before the start of the program (baseline-T1), immediately after the 3 months of the main exercise program (end of the main program-T2) and 6 months after (end of follow up-T3).]
• Gastroesophageal Reflux Disease-Related Quality of Life Questionnaire [Time frame: Before the start of the program (baseline-T1), immediately after the 3 months of the main exercise program (end of the main program-T2) and 6 months after (end of follow up-T3).]