1. Breathing
Untrained
Trained
Support
Diaphragm
Healthy
Unhealthy

2. Intervention
Proof of Concept

3. Respiratory Muscle Strength Training Since about 1999PD
SCI MS
Children
Elderly
Spinal Muscle Atrophy
Bilateral Paralysis
ALS
Paradoxical VF
Dysfunction
Safety
COPD

4. Pressure, Flow, Voice

5. Intervention What is it? What is it not? Who can it be used with?
Outcomes: Case, Group, and Randomized trials
CoMorbidities
Protocol
Maintenance

6. Respiratory Muscle Strength Training (RMST)
The process of building strength within muscle groups
Two Types:
Inspiratory Muscle Strength Training (IMST)
Diaphragm
External intercostals
Expiratory muscle strength training (EMST)
Abdominals
Internal intercostals

7. Question: Which Direction?
Problem?
Purpose?
Desired Outcome?
MIP or MEP?

8. Overload & Specificity
Training must“overload” the system/muscle type
Low Load
Overload

9. Result: Adaptations Neural adaptations (6-8 weeks) Strength
Time
Neural adaptations (6-8 weeks)
Myogenic adaptations (+ 5 weeks)
Neural adaptations
Hypertrophy
Strength
Progress
(Modified from Sale, 1988)

10. Multiple Functions have Been Studied

11. What is a RMST? General “breathing exercisers”
Resistive trainers – is there a difference?
Pressure threshold trainers

12. EMST? Pressure‑threshold device
4 week program
5 days per week
25 breaths per day
Load set at 75% of MEP
Describe the program – how you use the device etc.
Calibrated deivce consisting of a mouthpiece with a one-way spring-loaded valve against adjustable spring. As long as the threshold pressure is maintained, as air flows through the device.
Does not allow for modification of flow rate.
Although it primary targ
et of this exercise is the expiratory muscles – other biomechanical events spedific to swallow have been observed.
Expiratory pressure threshold training:
Pressure‑threshold device
Calibrated, one way, spring-loaded valve
Not resistance training (physiological load calibrated and imposed)
Target muscles: expiratory (abdominals) and supralaryngeal

13. What is the setting?
Adjustable Valve
Mouthpiece
Loaded Spring

14. Provides specific, constant, pressure load (spring loaded valve 0-150 cm/H20)

15. Recommendations for Training (EMST)
Presentation Information
Recommendations for Training (EMST)
Twice daily exercise in all studies
Daily or every other day
Most studies used an overload principle
Specificity of training observed with some carry-over noted
5 weeks to 3 months of training resulted in increased respiratory muscle strength
The same exercise principles that are true of exercise with limb muscles are true of muscles of respiration.
CONFIDENTIAL 15

16. Time to Do Your Training

17. Time to Train Training manual included Video online Very simple to use
Very instrumental feeling