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

Abstract

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.

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

“…Several RCT studies reported approximately 20%–30% increases in MEP after six to 12 weeks of EMST training in individuals with MS. 9,10,19 We found a greater than 20% increase in MEP in our MS patients after five weeks of training, which is consistent with the published data.…”

“…7 Previous investigations have examined expiratory and inspiratory muscle strength training in MS patients regarding expiratory muscle strength training (EMST) benefits for maximum expiratory pressure (MEP) and speech, and the results were mixed. 4–10 One notable reason for different results could be that some studies used a device that featured progressive increase in resistance associated with practice performance, while others did not. Therefore, our first purpose was to use an EMST training device that could modulate training difficulty, according to practice performance, to evaluate effects of the EMST on respiratory function in individuals with MS.…”

Systematic Review of Inspiratory Muscle Training After Cerebrovascular Accident

“…It has been observed that respiratory muscle training can improve respiratory muscle strength (P I max ) and inspiratory muscle endurance (IME) in this population. These findings support the benefits found in subjects with multiple sclerosis 24 and COPD. 25 In addition, 3 cross-sectional studies were found [19][20][21] recommending the inclusion of respiratory muscle training in the PR program for subjects after stroke.…”

Abdominal Binding Improves Neuromuscular Efficiency of the Human Diaphragm during Exercise

“…It follows that non-disease specific interventions capable of increasing the pressure generating capacity of the diaphragm may have important clinical and pathophysiological implications. With the exception of inspiratory muscle training (Budweiser et al, 2006; Geddes et al, 2008; Moodie et al, 2011; Berlowitz and Tamplin, 2013; Smart et al, 2013; Martin-Valero et al, 2014) and the Ca 2+ sensitizing agent, Levosimendan (van Hees et al, 2009; Doorduin et al, 2012), few generalized interventions exist to improve the force generating capacity of the human diaphragm.…”