Training of respiratory muscles in patients with multiple sclerosis: a systematic review.
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.
Department of Psychiatry and Physiotherapy, Faculty of Health Sciences, University of Málaga, Málaga, Spain. rovalemas@gmail.com.
Rocio
R
Martín-Valero
Faculty of Health Sciences. University of Málaga, Málaga, Spain.
Noelia
N
Zamora-Pascual
Department of Psychiatry and Physiotherapy, Faculty of Health Sciences, University of Málaga, Málaga, Spain.
Juan Antonio
JA
Armenta-Peinado
D001945:Breathing Exercises / Q000379:methods*; D006801:Humans; D009103:Multiple Sclerosis / Q000503:physiopathology / Q000534:rehabilitation*; D053580:Muscle Strength / Q000502:physiology*; D010807:Physical Endurance / Q000502:physiology*; D026741:Physical Therapy Modalities; D012132:Respiratory Muscles / Q000503:physiopathology*
breathing exercise; expiratory muscle strength training; inspiratory muscle training; multiple sclerosis; neuromuscular disorder; respiratory muscle training; threshold trainer