The aim of this study is to investigate the effects of inspiratory muscle trainers on respiratory function, exercise capacity, pain intensity, and functional disability in patients with obesity and MLBP. If a significant improvement is found, IMT could be added to the guidelines for exercise prescriptions for obese patients with MLBP. Therefore, this study might provide evidence-based findings to guide clinical decision-making and empower clinicians and healthcare organizations to incorporate IMT into exercise prescription guidelines for obese patients with MLBP. By integrating IMT into guidelines, this study might enhance rehabilitation strategies for obese patients with MLBP.
Hypothesis
- Null Hypothesis: the addition of IMT to aerobic exercise does not result in significant differences in respiratory functions, exercise capacity, pain intensity, and functional disability in patients with obesity and mechanical low back pain.
- Alternative Hypothesis: the addition of IMT to aerobic exercise results in significant differences in respiratory functions, exercise capacity, pain intensity, and functional disability in patients with obesity and mechanical low back pain.
Objectives of the study:
- To assess the effects of PowerBreathIMT on pulmonary function tests and maximum inspiratory pressure in patients with obesity and mechanical low back pain.
- To assess the effects of PowerBreathIMT on exercise capacity, pain intensity and functional disability in patients with obesity and mechanical low back pain.
Expected Results The addition of IMT to aerobic exercise results in significant differences in respiratory functions, exercise capacity, pain intensity, and functional disability in patients with obesity and mechanical low back pain.
Material and methods:
o Study setting: The current study will be conducted at King Fahad Hospital of the University, Al Khobar, Saudi Arabia. All participants will be recruited from the orthopedic and neurological clinics after confirming their diagnosis (they suffer from mechanical low back pain & exclude the existence of other causes for back pain). All measurements will be done at the Pulmonary Function Test Lab in the previous week of our intervention and in the next week after the end of our intervention. Participants will practice the supervised sessions at the hospital three times per week for six weeks. During supervised sessions, all participants will follow a dietary regime and perform aerobic exercise and resistance training in addition to IMT training.
NB: Home program: All participants of both groups will also perform aerobic exercise and IMT training two sessions per week at home. The participants from both groups will receive detailed instructions to guide them in performing home sessions. A follow-up with them will be through WhatsApp and Zoom, and I will call them every other day to check their performance. The participants will also have logbooks to document aerobic exercise, resistance training, and IMT training at home and to document the adherence and completeness of the training program.
NB: Diet Program: All participants of both groups will follow an individualized diet program.
- Sample Size Calculation: Sample size was calculated by using data from a previous study that assessed the significant difference between two independent means (intervention and control groups) with a primary outcome measure of Vital Capacity from a Pulmonary Function Test (mean 1 = 4.28 and mean 2 = 4.07, sigma= 0.2) . The parameters used for the calculation included an alpha level of 0.05 and a power of 0.90. This link was used, which is a valid and reliable tool for calculating sample size when comparing two means. The sample size was 20 participants in each group to find out a significant difference with sufficient power. So, the total sample size will be 40. However, to account for a 20% attrition rate and dropouts, the sample size will be adjusted. The adjusted sample size will be calculated as a total of 48 participants, resulting in approximately 24 participants in each group.
- Ethical considerations: Ethical approval was obtained from the institutional review board of the Dean of Scientific Research at Imam Abdulrahman bin Faisal University. Moreover, approval from the Saudi Food and Drug Administration was obtained. Each patient will sign a consent form to authorize participation. They will be informed that their information and data will be confidential, and the collected data will be published in the future. The participants will be informed that participation is voluntary, and they can withdraw at any time without consequences.
- Recruitment and study population: Participants who meet the inclusion criteria will be recruited from orthopedic and neurologic clinics in the outpatient department of King Fahad Hospital of the University to participate in this study.
