Clinical Research Directory

Inclusion Criteria: 1. 18 years old or older 2. Able to provide consent and willing to participate in study procedures 3. Currently hospitalized awaiting advanced therapies (LVAD or heart transplant) 4. Diagnosed with NYHA class III or IV heart failure 5. Able to follow instructions including the use of the Borg Dyspnea scale 6. Physically able to independently hold and use the IMT 7. Patients will undergo screening with or without active PT orders. To be enrolled in the study, patient must have an active physical therapy order. . If no active order exists, one will be requested from medical team following the screening and prior to enrollment. 8. Participants must meet institutional criteria for participation in physical therapy and mobility activities prior to enrollment and before each IMT session. Medical stability may include: * Mean arterial pressure (MAP) ≥ 60 mmHg and ≤ 120 mmHg * Resting heart rate between 40 and 140 beats per minute * No evidence of active myocardial ischemia or unstable angina * No uncontrolled atrial or ventricular arrhythmias * No escalating vasopressor or inotropic support at time of intervention * Oxygen saturation ≥ 94% on current oxygen support * Respiratory rate between 8 and 35 breaths per minute * Ability to follow simple commands and participate in study procedures * No acute neurologic, respiratory, or hemodynamic deterioration requiring immediate escalation of care * Clearance by the treating medical team to participate in rehabilitation activities Exclusion Criteria: 1. Patients discharged from the hospital to await advanced therapies (LVAD or heart transplant) 2. Patients with an expectedpreoperative inpatient hospital stay of less than 10 days, based onreview of clinical status, treatment plan, and timing of expected surgery 3. Patients with acute pneumothorax 4. Presence of acute rib fracture(s) 5. Patients with acute cerebrovascular accident 6. Untreated hypertension, defined as systolic blood pressure consistently \>140 mmHg or diastolic blood pressure consistently \>90 mmHg in the absence of antihypertensive therapy. 7. Acute delirium 8. Perforated tympanic membrane 9. Hemodynamic instability 10. Abdominal surgery during present admission 11. Patients with planned multiple organ transplant (e.g. heart and kidney, heart and lung) 12. Patients currently requiring mechanical ventilatory support 13. A burst eardrum that has not fully healed, or any other condition of the eardrum 14. Patients with asthma who suffer from frequent severe exacerbations 15. Patients with marked elevated left ventricular end-diastolic volume and pressure 16. Patients with worsening heart failure signs and symptoms after IMT 17. If you have suffered from or are likely to suffer from costochondritis