Effects of Expiratory Muscle Training and Air Stacking on Peak Cough Flow in Individuals with Parkinson’s Disease

Reyes, Álvaro; Castillo, Adrián; Castillo, Javiera

doi:10.1007/s00408-019-00291-8

Cited by 20 publications

(25 citation statements)

References 20 publications

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“…Pre-post intervention studies (that had been excluded from the analyses) showed similar positive effects for either strength training (EMST and IMST) and other respiratory training techniques like air stacking, or deep breathing exercises (plus upper extremity exercises) and (global) postural training to improve respiratory function tests, swallowing safety and phonatory aspects. [24,[26][27][28][31][32][33][34][35][36][37] This confirms that the positive results are robust, but also indicates that more high-quality studies for both respiratory strength training and volume-oriented training techniques remain needed. The included studies all showed positive effects, but the magnitude of the effects was different.…”

Section: Discussionmentioning

confidence: 68%

“…A large effect was found for peak subglottic pressure Four CTs reported positive effects of EMST compared to control group. The Cohen's d effect size between EMST and control group was large for MEP (d = 1.07) moderate for voluntary PCF (d = 0.77) and small for reflex PCF (d = 0.32) [26]. An 88% increase was found on MEP for EMST-5DE compared to the control group [24].…”

Section: Expiratory Muscle Strength Trainingmentioning

confidence: 78%

“…First, differences might result from a lack of homogeneity of the training devices as two different devices were used for IMST [25,29] and two different devices for EMST [22,27]. Second, four out of the five included papers who used a respiratory function tests as outcome [24][25][26]29] describe to measure according to the statement of the American Thoracic Society (ATS) and European Respiratory Society (ERS) [38]. This procedure included the performance of respiratory function tests.…”

Section: Discussionmentioning

confidence: 99%

“…Breath-stacking and incentive spirometer techniques were found to directly increase tidal volume and minute ventilation measured by optoelectronic plethysomography [15]. EMST complemented by air stacking showed a large Cohen's d effect size compared with the control group on r-PCF (d = 1.34) and v-PCF (d = 1.00) [26]. Table 3 shows the quality assessments of the Cochrane risk of bias tool for the RCTs.…”

Section: Other Interventionsmentioning

confidence: 99%

“…The study of Haewon Byeon scored a serious risk of bias because the intervention protocol for the postural techniques and the measurement procedure of MEP were not described [28], limiting the reproducibility of this study. Reyes et al showed a serious risk of bias because there was no blinding for outcome assessment as the researchers were not blinded for group allocation [26]. Kuo et al showed a critical risk of bias because of a lack of randomization and reporting incomplete data of four of the thirteen participants [24].…”

Section: Quality Assessmentmentioning

confidence: 99%

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The Effects of Respiratory Training in Parkinson’s Disease: A Systematic Review

Dongen

Kalf

Wees³

et al. 2020

JPD

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Background: Signs of respiratory dysfunction can be present already early in the course of Parkinson’s disease (PD). Respiratory training could alleviate this, but its effectiveness is not well understood. Objective: The purpose of this systematic review is to review the efficacy of different respiratory training interventions in PD. Methods: A search strategy was performed in four databases: PubMed, Physiotherapy Evidence Database (PEDro), Cochrane Library, and Cumulative Index to Nursing and Allied Health Literature (CINAHL). Methodological quality of original full-text articles was assessed using the Cochrane Risk of Bias tool for randomized controlled trials (RCTs) and the Risk Of Bias In Non-randomized Studies of Interventions (ROBINS-I) tool for the controlled trials (CTs). Levels of evidence were rated by the Grading of Recommendation Assessment, Development and Evaluation (GRADE) approach. Results: Six papers reporting on four randomized controlled trials and another four controlled trials were included. Positive effects were reported for inspiratory muscle strength training (IMST), expiratory muscle strength training (EMST), air stacking, breath-stacking, incentive spirometry and postural training on respiratory muscle strength, swallowing safety, phonatory aspects and chest wall volumes. Best methodological quality was found for breath-stacking and incentive spirometry. Best levels of evidence were found for EMST, IMST and EMST plus air stacking. Conclusion: Respiratory training shows positive effects and should be considered when people with PD experience respiratory dysfunction. Future studies should focus on standardizing both training devices, instruments to measure outcomes and intervention protocols to further increase the level of evidence.

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Section: Discussionmentioning

confidence: 68%

Section: Expiratory Muscle Strength Trainingmentioning

confidence: 78%

Section: Discussionmentioning

confidence: 99%

Section: Other Interventionsmentioning

confidence: 99%

Section: Quality Assessmentmentioning

confidence: 99%

See 3 more Smart Citations

The Effects of Respiratory Training in Parkinson’s Disease: A Systematic Review

Dongen

Kalf

Wees³

et al. 2020

JPD

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Expiratory Muscle Strength Training in Patients with Parkinson's Disease: A Pilot Study of Mobile Monitoring Application

Srp

Korteová

Kliment

et al. 2021

Movement Disord Clin Pract

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Expiratory Muscle Strength Training in Multiple System Atrophy: A Pilot Study

Srp

Bartošová

Klempíř

et al. 2023

Movement Disord Clin Pract

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Background The effects of expiratory muscle strength training (EMST) has not yet been investigated in MSA patients. Objective The primary objective was to test the effects of EMST on expiratory muscle strength and voluntary peak cough flow (vPCF) in patients with multiple system atrophy (MSA). The secondary objective was to assess the suitability of the pulmonary dysfunction index as a tool for identifying MSA patients with expiratory muscle weakness and reduced voluntary peak cough flow. Methods This was an open label, non‐controlled study, with an 8‐week intensive home‐based EMST protocol. The outcome measures included: maximal expiratory pressure (MEP) and vPCF. The sensitivity and specificity of the index of pulmonary dysfunction in the respiratory diagnostic process were assessed using receiver operating characteristic (ROC) analysis. Results Fifteen MSA patients were enrolled in the study. Twelve MSA patients completed the training period. After the training period, MEP significantly increased (P = 0.006). Differences in vPCF were not significant (P = 0.845). ROC analysis indicated that the overall respiratory diagnostic accuracy of the index of pulmonary dysfunction had an outstanding capability to detect patients at risk of less effective coughing and an acceptable capability of detecting patients with decreased expiratory muscle strength. Conclusions These findings indicate non‐significant differences in vPCF after 8 weeks of EMST. The index of pulmonary dysfunction appears to be a promising prognostic screening tool for identifying altered cough efficacy in MSA patients. Test cut‐offs may be used to select an appropriate respiratory physiotherapy technique.

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Effects of Expiratory Muscle Training and Air Stacking on Peak Cough Flow in Individuals with Parkinson’s Disease

Cited by 20 publications

References 20 publications

The Effects of Respiratory Training in Parkinson’s Disease: A Systematic Review

The Effects of Respiratory Training in Parkinson’s Disease: A Systematic Review

Expiratory Muscle Strength Training in Patients with Parkinson's Disease: A Pilot Study of Mobile Monitoring Application

Expiratory Muscle Strength Training in Multiple System Atrophy: A Pilot Study

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