Pre-operative Inspiratory Muscle Strength Training in Total Joint Surgery

Inclusion Criteria: * 18 or older * History of current or previous tobacco use (including vaping containing nicotine products) * One or more risk factors for post operative pulmonary complications including history of current or previous tobacco use, a clinically diagnosed lung disease, shortness of breath with minimal exertion, FEV1 or FVC less than 80% than predicted or respiratory muscles strength below lower limit of normal for age and sex. * History of smoking related lung disease * Projected surgical time \> 30 minutes * Ability to follow instructions to complete IMT exercises * Ability to communicate adverse effects such as pain or fatigue or the need for assistance Exclusion Criteria: * American Society of Anesthesiologists physical status classification of 4 or greater . * Recent history of acute pneumonia or lower respiratory infection in the previous two weeks requiring acute corticosteroid or antibiotic medication, * Preoperative dependence on continuous supplemental oxygen dependence. * Preoperative dependence on positive pressure breathing support while awake and upright (night time CPAP permitted), * Diagnosis of a neurologic condition (i.e. MS, ALS, Parkinson's, stroke), * Participating in a pulmonary rehabilitation program * Severe obstructive pulmonary disease (Classification of Global Initiative for Chronic Obstructive Lung Disease (GOLD) 3 or higher, indicating FEV1\<50% predicted. * Patients with an infectious disease requiring isolation (i.e. COVID-19…