Inspiratory Muscle Training in HFpEF

• ≥18 yrs of age
• Receiving SGLT2 inhibitors and spironolactone (and beta-blocker use for HFpEF patients with hypertension) for >3 months
• NYHA symptoms I-III
• Body mass index ≤40 kg/m2
• Currently non-smokers with \<20 pack year history
• Able to exercise (i.e. without significant orthopedic limitations or musculoskeletal disorders limiting their ability to exercise)

Exclusion Criteria:

• Sustained ventricular tachycardia and/or ventricular fibrillation within 21 days of visit 1
• Second or third degree heart block
• Body mass index >40 kg/m2
• Current smokers and/or smoking history >20 pack years
• Pregnant women (testing will be done by research team if requested)
• Glomerular filtration rate of \<30 mL/min/1.73m2 (initial screen via clinical record within the past 6 months and this will be assessed on Visit 1)
• Individuals who are not able to engage in exercise
• Uremia, history of allergy to iodides
• Peripheral artery disease
• Alanine transaminase and/or aspartate transaminase greater than 2 times the upper limit of normal (via clinical record within the past 6 months)
• Asthmatic patients with a low symptom perception and suffer frequency, severe exacerbations or with an abnormally low perception of dyspnea
• Ruptured eardrum or any other condition of the ear
• History of spontaneous pneumothorax or osteoporosis with a history of rib fractures
• History of lidocaine allergy.

For individuals agreeing to undergo dual energy x-ray absorptiometry (DEXA) scanning for measurement of body composition as part of their study visit, additional exclusion criteria apply: recently administered gastrointestinal contrast or radionuclides; severe degenerative changes or fracture deformity in measurement areas; or inability to attain correct position and/or remain motionless for the measurement period.