Should respiratory muscle training be part of the treatment of Parkinson’s disease? A systematic review of randomized controlled trials

Abstract

Objective: To determine the effectiveness of respiratory muscle training in persons with Parkinson’s disease. Data sources: PubMed/MEDLINE, EMBASE, Web of Science, Scopus and PEDro electronic databases were searched until 15 November 2019. Reference lists of included studies were hand-searched. Methods: Randomized controlled trials assessing the effects of respiratory muscle training programmes (both inspiratory and expiratory) in patients with Parkinson’s disease were included. Two reviewers independently identified eligible studies and extracted data. Method quality was appraised with the PEDro scale. Results: Five papers including three randomized controlled trials with a total of 111 patients were identified. Method appraisal showed a mean score of 5 in the PEDro scale. One study analysed inspiratory muscle training, one expiratory muscle training and two established a comparison between both of them. Statistically positive results were found in maximal inspiratory pressure ( P < 0.05 and d = 0.76), maximal expiratory pressure ( P < 0.01 and d = 1.40), perception of dyspnoea ( P < 0.01), swallowing function ( d = 0.55) and phonatory measures, without significant differences in spirometric indices. Conclusions: Respiratory muscle training may be an effective alternative for improving respiratory muscle strength, swallowing function and phonatory parameters in subjects with Parkinson’s disease. Nevertheless, the lack of primary studies about this type of training prevents obtaining robust evidence.

Respiratory Dysfunctions in Parkinson’s Disease Patients

“…A meta-analysis of the literature demonstrated that non-medical treatment methods in Parkinson’s disease provide statistically significant amelioration in respiratory strength measures and peak expiratory flow rates [ 28 ]. In a systematic review, Rodriguez et al concluded that respiratory muscle training might be helpful for enhancing the strength of the respiratory musculature, swallowing, and phonation capacity [ 29 ].…”

Nonpharmacological interventions for respiratory health in Parkinson’s disease: A systematic review and meta‐analysis

“…Adequate expiratory muscle strength is fundamental to vital capacity and effective cough generation [86, with expiratory pressures <80 cm H 2 0 in men and 60 cm H 2 O in women, suggestive of muscle weakness [87,88. This review now identifies expiratory muscle strength training as an effective nonpharmacological treatment to improve expiratory muscle strength in PD, where previous systematic reviews reported insufficient data to complete a meta‐analysis [85,89. Where evidence from other populations further identifies that exercise training at a moderate to vigorous aerobic intensity can affect improvements in expiratory muscle strength [78–80, no evidence of effect was identified in PD in the current review.…”

“…Expiratory muscle strength training is more dominant in the PD literature than inspiratory muscle training and is already recognised as an effective intervention for swallowing dysfunction and voice production in PD [85. Adequate expiratory muscle strength is fundamental to vital capacity and effective cough generation [86, with expiratory pressures <80 cm H 2 0 in men and 60 cm H 2 O in women, suggestive of muscle weakness [87,88.…”

Walking training augments the effects of expiratory muscle training in Parkinson's disease

“…There are studies in the literature showing that patients with Parkinson's disease have significant decreases in both inspiratory and expiratory respiratory muscle strength 2,4–6 . Inspiratory muscle weakness may cause many problems such as hypoxia, tachypnea, dyspnea, respiratory infections, and decreased functional capacity 4,5,15 . Expiratory muscle weakness, causing a reduction in effective cough and secretion retention, may lead to pneumonia and aspirations 4,5,15 …”