A Combined Inspiratory and Expiratory Muscle Training Program Improves Respiratory Muscle Strength and Fatigue in Multiple Sclerosis

Ray, Andrew D.; Udhoji, Supriya; Mashtare, Terry; Fisher, Nadine M.

doi:10.1016/j.apmr.2013.05.005

Cited by 46 publications

(44 citation statements)

References 29 publications

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“…The quasi-experimental trial of Ray et al 27 also showed increases in P Imax and P Emax for training groups (23.9 and 23 cm H 2 O, respectively), with initial values of 70 cm H 2 O for P Imax and 94 cm H 2 O for P Emax . 27 However, in the second study with grade B recommendations, no improvement was detected in the same outcomes at the end of a treatment carried out for 8 weeks at 5 days/week with 4 sets of 6 repetitions per day. 1 Unfortunately, very few studies had a large sample size in this systematic review.…”

Section: Respiratory Muscle Training In Patients With Msmentioning

confidence: 97%

Training of Respiratory Muscles in Patients With Multiple Sclerosis: A Systematic Review

2014

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BACKGROUND: The aim of this systematic review was to summarize the level of evidence and grades of recommendation regarding therapeutic respiratory muscle training interventions in patients with multiple sclerosis (MS). METHODS: We conducted a search using a number of electronic databases, and the limits of the search were studies published between 1993 and 2013. The selected documents were classified according to grades of recommendation of the Finnish Medical Society Duodecim. The methodological quality of 11 studies was assessed using the Physiotherapy Evidence Database (PEDro) scale. RESULTS: Fifteen trials (6 randomized controlled trials [RCTs], 2 non-RCTs, one quasi-experimental trial, 3 case studies, and 3 systematic reviews) showed clinical changes from pulmonary function outcomes for MS. The reviewed articles covered training protocols that were carried out for 10 weeks to 3 months at a frequency of 7 d/week with one or 2 daily sessions consisting of 3 sets of 10 or 15 repetitions per set at an intensity of 10 -60% of the subject's maximum expiratory pressure. It was observed that subjects who had minor scores in the Kurtzke Expanded Disability Status Scale showed changes in maximum inspiratory and expiratory pressures after respiratory muscle training. In future studies, it would be suitable to take into account both inspiratory and expiratory muscle training.

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Section: Respiratory Muscle Training In Patients With Msmentioning

confidence: 97%

Training of Respiratory Muscles in Patients With Multiple Sclerosis: A Systematic Review

2014

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“…Although recognizable respiratory muscle impairment has historically been associated with the later stage of MS, 5,6 individuals with mild MS also exhibit respiratory deficit even in the absence of obvious respiratory symptoms. 3,4 Expiratory muscle strength under the control of the abdominal and internal intercostal musculature deteriorates earlier during the disease progression than does inspiratory muscle strength controlled by the diaphragm and external intercostals.…”

Section: Ms and Respirationmentioning

confidence: 99%

Effects of expiratory muscle strength training on maximal respiratory pressure and swallow-related quality of life in individuals with multiple sclerosis

Silverman

Miller

Zhang

et al. 2017

Multiple Sclerosis Journal - Experimental, Translational and Cl

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BackgroundWeakening and dyscoordination of expiratory muscles in multiple sclerosis (MS) can impair respiratory and swallow function.ObjectiveThe objective of this paper is to test a novel expiratory muscle strength training (EMST) device on expiratory pressure, swallow function, and swallow-related quality-of-life (SWAL-QOL) in individuals with MS.MethodsParticipants with MS were randomized to a five-week breathing practice of either positive pressure load (EMST) or near-zero pressure (sham). We compared baseline to post-treatment data according to maximum expiratory pressure (MEP), abnormal airway penetration and aspiration (PAS), and SWAL-QOL.ResultsBoth groups improved in MEP (p < 0.001). Forty percent of the EMST group improved on PAS, and 15% worsened; conversely, 21.4% of the sham group worsened and 14.3% improved. There was no group difference in overall SWAL-QOL; but the EMST group had significantly greater gain versus sham on the Burden (p = 0.014) and Pharyngeal Swallow (p = 0.022) domains. Both groups improved in SWAL-QOL domains of Fear, Burden Mental Health, but only the EMST group improved in the SWAL-QOL and domains of Pharyngeal Swallow function, and Saliva management.ConclusionResults suggest that strengthening of expiratory muscles can occur with repetition of focused breathing practice in the absence of high resistance. Conversely, results from the PAS and SWAL-QOL domains suggest that the high resistance of the EMST was required in order to improve the functional safety (reduced penetration/aspiration) and coordination of swallowing, specifically pharyngeal function and saliva management.

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“…The domains of general health perception, vitality and mental health should be used with some caution [92]. Nonetheless, the instrument has been shown to be responsive to change over time [98] and in intervention studies [99,107]. It is recommended that a condition specific instrument should be incorporated where possible in research, as generic instruments may lack sensitivity for condition specific experiences of living with a neurodegenerative condition, for example, communication difficulties [94,95,106,108].…”

Section: • • Generic Instruments Short Form Health Survey (Sf-36)mentioning

confidence: 99%

“…The instrument has been widely used to assess patients with neurodegenerative disease including PD [95][96][97][98], MS [99,100] and stroke [101,102]. It has been largely reported that data collected with the SF-36 questionnaire are of good quality, reliable and that scoring of the subscale scores is appropriate.…”

Section: • • Generic Instruments Short Form Health Survey (Sf-36)mentioning

confidence: 99%

Outcome Measurement in Neurodegenerative Disease: Attributes, Applications & Interpretation

Kelly

Jenkinson

Morley

2015

Neurodegener. Dis. Manag.

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There has been a marked shift from clinically assessed to patient assessed outcomes of treatment in neurodegenerative conditions over recent decades. The use of patient-reported outcome measures (PROMs) provides a method with which researchers and clinicians can gain insightful and meaningful data on health status from the patients' perspective. It is imperative that high-quality PROMs are chosen based upon their measurement properties and their suitability for use in the intended clinical or research context. This review aims to give a brief overview of best practice standards for selecting PROMs, current instruments used in exemplar neurodegenerative conditions and their application in clinical trials and routine measurement.

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A Combined Inspiratory and Expiratory Muscle Training Program Improves Respiratory Muscle Strength and Fatigue in Multiple Sclerosis

Cited by 46 publications

References 29 publications

Training of Respiratory Muscles in Patients With Multiple Sclerosis: A Systematic Review

Training of Respiratory Muscles in Patients With Multiple Sclerosis: A Systematic Review

Effects of expiratory muscle strength training on maximal respiratory pressure and swallow-related quality of life in individuals with multiple sclerosis

Outcome Measurement in Neurodegenerative Disease: Attributes, Applications & Interpretation

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