RESEARCH ARTICLE Feasibility and Effectiveness of Pre-operative Inspiratory Muscle Training in Patients Undergoing Oesophagectomy: A Pilot Study Daniela S. Dettling 1 * , Marike van der Schaaf 1 , Rachel L.G.M. Blom 2 , Frans Nollet 1 , Olivier R.C. Busch 2 & Mark I. van Berge Henegouwen 2 1 Department of Rehabilitation, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands 2 Department of Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands Abstract Background. Patients undergoing oesophageal surgery have a high risk for post-operative complications including pulmonary infections. Recently, physical therapy has shifted from the post-operative to the pre-operative phase to diminish post-operative complications and to shorten hospital stay. The purpose of this pilot study was to investigate the feasibility and initial effectiveness of pre-operative inspiratory muscle training (IMT) on the incidence of pneumonia in patients undergoing oesophagectomy. Methods. A pragmatic non-randomized controlled trial was conducted among all patients who underwent an oesophagectomy between January 2009 and February 2010. Patients in the intervention group received IMT prior to surgery. Feasibility was assessed on the basis of the occur- rence of adverse effects during testing or training and patient satisfaction. Initial effectiveness on respiratory function was evaluated by maximal inspiratory pressure (MIP) and endurance, the incidence of post-operative pneumonia and length of hospital stay. Results. Eighty-three patients were included, of which 44 received pre-operative IMT. No adverse effects were observed. IMT was well tolerated and appreciated. In the intervention group, the median MIP and endurance improved significantly after IMT by 32% and 41%, respectively (p < 0.001). The incidence of post-operative pneumonia and the length of hospital stay were comparable for the intervention and the conventional care groups (pneumonia, 25% vs. 23% [p = 0.84]; hospitalization, 13.5 vs. 12 days [p = 0.08]). Conclusions. Pre- operative IMT is feasible in patients with oesophageal carcinoma and significantly improves respiratory muscle function. This, however, did not result in a reduction of post-operative pneumonia in patients undergoing oesophagectomy. Copyright © 2012 John Wiley & Sons, Ltd. Received 14 December 2011; Revised 22 February 2012; Accepted 26 February 2012 Keywords breathing exercises; cohort study; post-operative pulmonary complications *Correspondence Daniela Dettling, MSc, Department of Rehabilitation, Academic Medical Center, PO Box 22660, 1100 DD Amsterdam, The Netherlands. E-mail: d.s.dettling@amc.uva.nl Published online 10 April 2012 in Wiley Online Library (wileyonlinelibrary.com) DOI: 10.1002/pri.1524 Introduction Patients undergoing oesophageal resection for carcinoma are known to have a high risk for post-operative compli- cations. Pulmonary complications such as pneumonia and respiratory insufficiency are reported to occur from 25% up to 57% after oesophageal resection (Hulscher et al., 2002) and cause tremendous post-operative morbidity and extended hospital stay (Atkins et al., 2004; CBO, 2005). Physiotherapy in the peri-operative period of abdominal surgery aims to reduce post-operative pulmonary complications by deep breathing manoeuvres, 16 Physiother. Res. Int. 18 (2013) 16–26 © 2012 John Wiley & Sons, Ltd.