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Getting used to your Medic Plus
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Diagram 1: Adjusting the Medic Plus
Remove the Medic Plus and nose-clip from
the packaging. Holding the Medic Plus upright,
practise adjusting the training load: Rotate the load
adjustment knob clockwise to increase the training
load; rotate the load adjustment knob anticlockwise
to reduce the training load.
Notice that a numbered scale is visible on the side
of the Medic Plus. As the load adjustment knob is
rotated, the internal load-indicator sleeve will move
up or down, indicating your current training load on
this scale.
Diagram 2: Load 0
Now set the Medic Plus to load 0. At this load the
base of the internal white sleeve should be aligned
with the lowest load on the scale, as shown in the
diagram. Note: Do not attempt to reduce
the load below 0 as this may damage the
adjustment thread.
Diagram 3: Placing the Medic Plus in your
mouth. Make sure you are sitting or standing upright
and feel relaxed. Holding the Medic Plus by the
handle, place the mouthpiece in your mouth so that
your lips cover the outer shield to make a seal, and
the mouthpiece bite blocks are gripped between your
upper and lower teeth.
Internal load
indicator sleeve
Training with Medic Plus Training with Medic PlusGetting used to your Medic Plus
Guidance for patients
Please follow the instructions below unless instructed to do otherwise by your doctor. Before
commencing the exercises, please ensure that you have read the precautions section on page 4
of this manual
.
Finding your correct training load:
The recommended POWERbreathe RMT routine
is 30 breaths twice a day.* In order to get the
most from the training, these exercises should
be completed at a load that is as hard
as possible, without causing discomfort.
For the first day of training, set your
Medic Plus to load 0 (see Diagram 1 -
“Getting used to your Medic Plus”).
Some individuals may find the exercises
very challenging at this load. If you find you
are unable to complete 30 breaths at this
load, take a short rest then start again until
you have accumulated a total of 30 breaths.
If you found it difficult to complete 30 breaths
at load 0, continue to train at this load twice
a day for the first week.
If you found you could easily complete
30 breaths at load 0, the next day you should
set your Medic Plus to load 1. Complete the
exercises again. By this method, continue to
increase the training load by 1 setting each day,
until you are only just able to complete
30 breaths of training. Once you have reached
this point, continue to train at this load twice
a day for one week.
After one week of training with the Medic Plus
at the same load, increase the training load
by half a turn. Continue to train at this load for
a further week. From this point onwards you
should aim to increase the load by half a turn
each week.
For an example of a typical training diary
and to download/print blank diary pages,
to keep a record of your progress visit:
powerbreathe.com
Achieving good training technique:
When you inhale through your Medic Plus,
you should breathe in as deeply and as
quickly as possible. When you exhale,
breathe out slowly and gently until your
lungs are completely empty. Try to squeeze
out as much air as possible towards the
end of the breath to ensure your lungs are
completely empty. Pause until you feel the
urge to breathe in again before inhaling again
(Approx 3-4 secs).
You will notice that it becomes harder to
completely fill your lungs as you continue to
breathe during a training session. This is
because your breathing muscles are
becoming tired. If you can no longer take
a satisfying breath, take a short break
before continuing your training. If you find
you are unable to complete a breath early
in your training session, the load may be set
too high. In this case, simply decrease the
training load by half a turn, then continue
your training session. Note: Training should
feel challenging. At the end of the 30 breaths
training, you should aim to feel as if you
cannot continue further.
If you feel out of breath, light-headed or you
need to cough, take a short break. As soon
as you have recovered, continue the training
session until you have completed a total of
30 breaths. If you miss a training session,
simply complete the session as soon
as possible. If you miss it by more than
12 hours, ignore the missed session
and carry on with your next training
session as normal.
Maintaining your breathing:
After 4-6 weeks your breathing muscles
should have improved substantially and
you should feel less breathless during
activity. At this stage you will not need to
use your Medic Plus every day to maintain
your improved breathing. Training with
your Medic Plus just 3 times a week
should be sufficient to continue to enjoy a
better lifestyle.
“Low intensity training”– If you are
experiencing difficulties with the
training, you may wish to progress to a less
intense, longer training regimen that has
proven very effective for people who suffer
from respiratory conditions. If so, you could
consider trying the 15 minutes continuous
breathing on a low load setting (consult your
medical practitioner if in doubt).
* The 30 breath twice daily training regimen is a
high intensity training regimen that has been
found to be very effective in people who train to
improve their general fitness (Romer & McConnell,
2003). Though more intense, this regimen has the
great advantage of being much shorter than the
more traditional “Low intensity training” regimens
that have been used in clinical studies. Recent
evidence suggests that the benefits of low and
high intensity training are similar (Gosselink et al,
2010), so we recommend the regimen that is least
time consuming. However, if you are experiencing
difficulties with the high intensity training, please
refer to the section on “Low intensity training” on
the following page.
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Diagram 4: Inhaling through the Medic Plus.
Breathe out as far as you can then take a fast,
forceful breath in through the mouth. Take in
as much air as you can, as quickly as you can,
straightening your back and expanding your chest.
Diagram 5: Exhaling through the Medic Plus.
Now breathe out slowly and passively through your
mouth until your lungs are empty, letting the muscles
in your chest and shoulders relax. Pause until you
feel the urge to breathe again. Repeat this exercise
until you feel confident about breathing through the
Medic Plus. Note: do not pant – if you start to feel
light-headed, slow down and pause at the end of
your breath out.
Diagram 6: Using the nose-clip.
Now put the nose-clip on so that it pushes your
nostrils together, as shown in the diagram. Continue
to practise taking a forceful breath in then breathing
out slowly and fully. Note: the nose-clip will help you
to breathe through your mouth rather than your nose.
However, it is not essential and some people find it
more comfortable to train without the nose-clip.
If the lowest load setting “0” is too
heavy for you to start with, then
POWERbreathe Medic Plus allows you
to train without using the calibrated
load spring or the complete valve
assembly to train at the absolute
lowest load.
See pages 10 - 11, diagrams 1 - 6.
Medic Plus assembly Medic Plus assembly
Note: Whilst the POWERbreathe Medic Plus can
be disassembled further into its component parts
(with the exception of the main body) – This is not
recommended as small parts can easily be misplaced.
However, if your condition means that you need to start
at the absolute lowest load then you will need to follow
instructions as shown within diagrams 1 to 6.
If you need to train below load setting
“0” remove valve assembly and/or
spring as shown below:
Diagram 1: Gently pull to remove handle
cover. (When re-assembling handle cover
a gentle twist may be required to locate
the valve assembly into the load
adjustment knob.)
Diagram 3: To remove the calibrated spring
from the valve assembly gently peel back
and remove the rubber seal.
Diagram 5: Shows Medic Plus re-assembled
with the valve assembly in place but without the
calibrated spring.
Diagram 6: Shows the Medic Plus
re-assembled but without the complete valve
assembly and with the POWERbreathe breathing
indicator ball.
Diagram 4: Carefully remove the sleeve and
then remove the spring. Then replace the
sleeve before re-fitting the rubber seal.
Locator
Pin
Sleeve
Sleeve
Rubber Seal
Spring
General Assembly
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3
4
2
Diagram 2: Gently pull to remove valve
assembly Do Not Twist main body or
valve assembly as it is possible to
damage the locator pin indicated below.
To re-assemble, line up the locator pin with
the slot and relocate.
IMPORTANT
Please keep all the POWERbreathe Medic Plus components not being used
in a safe place, for use later on and for warranty purposes.
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Note: The load
adjustment knob
does not function
when spring is
not in use
Note: POWERbreathe
breathing indicator
ball helps to see
breathing actitvity
(Ball Not included - visit
powerbreathe.com
for details.)
Valve cover –
please do not
remove Mouthpiece –
push fit
Main body –
do not attempt to
disassemble this
component
Valve assembly – push fit
Handle cover – click fit
Load
adjustment knob
do not remove
Guidance for healthcare professionals
Guidance for healthcare professionals
Contraindications: Please read the precautions section on page 4 of this manual in order to
assess a patient’s suitability for respiratory muscle training (RMT).
Patients should be instructed in the proper
use of the POWERbreathe Medic Plus RMT
before commencing training. Please familiarise
yourself with the operation of the device prior
to assisting a patient in its correct use referring
to the sections “Getting used to your Medic
Plus” and “Training with Medic Plus - Guidance
for Patients”. Guidance on training with Medic
Plus is based on information published in
the European Respiratory Society’s ‘Breathe’
journal (McConnell et al, Inspiratory muscle
training in obstructive lung disease; how to
implement and what to expect. September.
vol 2(1),pp39-49, 2005). Visit our website to
download the full article.
Note: Some patients may be unable or
unwilling to use the mouthpiece. In this case,
the Medic Plus mouthpiece may be replaced
with a facemask attached to a Medic Plus
spacer, to allow training.
Setting the training load:
Clinical research indicates that inspiratory
muscle training (IMT) loads must exceed 30%
of the patient’s maximal inspiratory muscle
strength in order to be effective. There is
also evidence that heavier loads yield greater
improvements in inspiratory muscle strength.
If you have access to a means of measuring
inspiratory muscle strength such as a
POWERbreathe KH1 or KH2 device, you may set
the initial training load to 30-40% of Maximal
Inspiratory Pressure (MIP) using the conversion
table on pg16. The training load should then be
increased by half a turn each day for the next
7-10 days up to 60% of baseline MIP.
The patient should train at this load for
1 week. Thereafter, the training load should
be increased weekly to maintain the training
load at approximately 60% of the patient’s new
inspiratory muscle strength.
Note: at 60% MIP training will be strenuous
and it may take some time before the patient
is able to complete 30 breaths without taking
a break.
Teaching good training technique:
The first few days are the most challenging
for the patient who will require careful and
sensitive coaching, including the allowance
of short breaks. They should be encouraged
to tolerate the breathless sensation induced
by training, and to increase the training load
progressively. Typically, increases in load of
5-10% per week can be achieved.
It is advisable to encourage patients to train
across the full extent of their vital capacity in
order to train the full range of motion of the
inspiratory muscles. As the patient’s
inspiratory muscles fatigue, they may find it
hard to achieve higher lung volumes towards
the end of inspiration. At these higher lung
volumes the inspiratory muscles are weakest
and will be most prone to the effects of
fatigue. Patients should be warned to expect
this and should be discouraged from training
beyond the point where they are able to
achieve a ‘satisfying breath’.
Patients should also be encouraged to inhale
against the load as rapidly as possible in order
to maximally recruit their inspiratory muscles.
Patients should breathe with a combination
of diaphragmatic and chest wall movement in
order to utilise all of their inspiratory muscles
during training. Patients may require breaks
during a training session in order to cough,
or because they feel too breathless. It is
important that the duration of these is
minimised in order to maintain the training
stimulus, but this too must be handled
sensitively, and supported by an explanation of
why it is important to minimise the duration of
these enforced ‘rest’ periods.
Maintenance training:
After 4-6 weeks of training, the patient’s
inspiratory muscles should have improved
substantially and they should feel less
breathless during exercise. At this stage it is
not necessary to train with Medic Plus every
day in order to maintain improved breathing.
Training with Medic Plus three times a week
will be sufficient to maintain the training
effects.
POWERbreathe Medic Plus - Accessories
A range of accessories to help patients/users
with special needs are available, for example:
• Spacer
• Oxygen Mask Adapter
• Masks
• POWERbreathe Filters
For more information please visit:
powerbreathe.com
