# Inspiratory Muscle Training to Improve Total Joint Arthroplasty Outcomes

> **NIH NIH R21** · UNIVERSITY OF FLORIDA · 2024 · $190,625

## Abstract

ABSTRACT
Total joint arthroplasty (TJA) surgeries are among the most common elective surgeries in the US and projected
to increase in frequency. Recent TJA clinical practices have effectively reduced post-operative hospital length of
stay, yet despite improvements in the efficiency of TJA care, the effects of TJA surgical procedures on pulmonary
and respiratory muscle function are less widely appreciated. Even during surgeries as short as TJA, the
administration of anesthesia, neuromuscular inactivity, and mechanical ventilation acutely deteriorate pulmonary
function and trigger rapid, significant proteolysis of the primary inspiratory muscle, the diaphragm. However,
conventional TJA preoperative care does not conventionally address these issues. Older adults, smokers, and
those with significant pre-existing lung disease, multiple medical comorbidities, or socioeconomic disadvantage
face the greatest risk for declines in post-operative pulmonary and respiratory neuromuscular function. Most
patients who utilize our urban safety-net academic medical center have at least one of these risk factors, which
can interfere with acute rehabilitation, increase the risk for post-operative pulmonary complications, and extend
hospital length of stay. Thus, we propose a clinical study of preoperative inspiratory muscle training (IMT) among
individuals with increased risk for pulmonary post-operative complications. Preoperative IMT has been shown to
counteract post-operative inspiratory weakness and reduce postoperative pulmonary complications following
prolonged cardiac surgeries, but its potential benefits have not been investigated in shorter surgeries such as
TJA, with expected brief post-operative hospitalizations.
The central hypothesis of this project is that preoperative IMT is feasible and will improve respiratory
strength, hasten the early postoperative respiratory recovery, and optimize functional mobility for
hospital discharge. Adults scheduled for TJA with pre-existing respiratory muscle or lung impairment will be
randomized to complete either: daily IMT in advance of surgery (dIMT), a single acute IMT session immediately
before surgery (aIMT), or usual surgical standard of care (SOC). Follow-up testing on the day of surgery and
during the acute post-operative hospitalization will identify the feasibility of IMT (Aim 1), distinguish IMT effects
on inspiratory and cough strength, (Aim 2), and evaluate patient readiness for discharge (Aim 3). This high risk,
proof-of-principle proposal will provide the first controlled evidence concerning disturbances in the regulatory
functions of breathing following TJA. Our plan is that data generated from this study will form the basis for future
mechanistic studies of IMT to restore breathing strength and further optimize early rehabilitation following TJA.

## Key facts

- **NIH application ID:** 10916497
- **Project number:** 5R21AG083667-02
- **Recipient organization:** UNIVERSITY OF FLORIDA
- **Principal Investigator:** Barbara K Smith
- **Activity code:** R21 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $190,625
- **Award type:** 5
- **Project period:** 2023-09-01 → 2026-08-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10916497

## Citation

> US National Institutes of Health, RePORTER application 10916497, Inspiratory Muscle Training to Improve Total Joint Arthroplasty Outcomes (5R21AG083667-02). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10916497. Licensed CC0.

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