Expiratory muscle strength training in persons with multiple sclerosis having mild to moderate disability: effect on maximal expiratory pressure, pulmonary function, and maximal voluntary cough.
OBJECTIVE
To determine the effect of expiratory muscle strength training (EMST) on maximal expiratory strength, pulmonary function, and maximal voluntary cough in persons with multiple sclerosis (MS) having mild to moderate disability.


METHODS
Before-after trial.


METHODS
Assessments were completed in the privacy of the subject's home or exercise physiology laboratory.


METHODS
Seventeen persons with MS were age- and sex-matched to 14 healthy controls.


METHODS
Eight weeks of EMST and 4 weeks of detraining.


METHODS
Maximal respiratory pressures, pulmonary function, and maximal voluntary cough were assessed 3 times (pretraining, posttraining, detraining). Maximal expiratory pressure (MEP) was assessed weekly and training intensity adjusted based on the new measurement.


RESULTS
Subjects with MS had lower MEP, decreased pulmonary function, and weaker maximal voluntary cough at each assessment. EMST increased MEP and peak expiratory flow. However, improvement in maximal voluntary cough only occurred in subjects with a moderate level of disability when the MS group was subdivided into mild and moderate disability levels based on the Expanded Disability Status Scale.


CONCLUSIONS
EMST is a viable tool to enhance the strength of the respiratory muscles. However, further work is needed to determine the best parameters to assess change in cough following EMST.
Chiara
Toni
T
Brain Rehabilitation Research Center, Malcom Randall VA Medical Center, Gainesville, FL 32608, USA. toni.chiara@med.va.gov
Martin
A Daniel
AD
Davenport
Paul W
PW
Bolser
Donald C
DC
D000328:Adult; D000704:Analysis of Variance; D001945:Breathing Exercises; D016022:Case-Control Studies; D003371:Cough / Q000503:physiopathology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000503:physiopathology / Q000534:rehabilitation*; D018908:Muscle Weakness / Q000503:physiopathology / Q000534:rehabilitation*; D010366:Peak Expiratory Flow Rate / Q000502:physiology*; D010807:Physical Endurance / Q000502:physiology; D012129:Respiratory Function Tests; D015656:Respiratory Mechanics / Q000502:physiology; D012132:Respiratory Muscles / Q000503:physiopathology*; D016896:Treatment Outcome