title: Deep breathing exercises with positive expiratory pressure in patients with multiple sclerosis - a randomized controlled trial.
abstract: BACKGROUND
  Breathing exercises with positive expiratory pressure are often recommended to patients with advanced neurological deficits, but the potential benefit in multiple sclerosis (MS) patients with mild and moderate symptoms has not yet been investigated in randomized controlled trials.
  
  
  OBJECTIVE
  To study the effects of 2 months of home-based breathing exercises for patients with mild to moderate MS on respiratory muscle strength, lung function, and subjective breathing and health status outcomes.
  
  
  METHODS
  Forty-eight patients with MS according to the revised McDonald criteria were enrolled in a randomized controlled trial. Patients performing breathing exercises (n = 23) were compared with a control group (n = 25) performing no breathing exercises. The breathing exercises were performed with a positive expiratory pressure device (10-15 cmH2O) and consisted of 30 slow deep breaths performed twice a day for 2 months. Respiratory muscle strength (maximal inspiratory and expiratory pressure at the mouth), spirometry, oxygenation, thoracic excursion, subjective perceptions of breathing and self-reported health status were evaluated before and after the intervention period.
  
  
  RESULTS
  Following the intervention, there was a significant difference between the breathing group and the control group regarding the relative change in lung function, favoring the breathing group (vital capacity: P < 0.043; forced vital capacity: P < 0.025). There were no other significant differences between the groups.
  
  
  CONCLUSIONS
  Breathing exercises may be beneficial in patients with mild to moderate stages of MS. However, the clinical significance needs to be clarified, and it remains to be seen whether a sustainable effect in delaying the development of respiratory dysfunction in MS can be obtained.
authors.affiliation: Faculty of Medicine and Health, Surgery, Örebro University, Örebro, Sweden. elisabeth.westerdahl@orebroll.se.
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Westerdahl
authors.affiliation: Faculty of Medicine and Health, Department of Neurology and Neurophysiology, Örebro University, Örebro, Sweden.
authors.forename: Anna
authors.initials: A
authors.lastname: Wittrin
authors.affiliation: Faculty of Medicine and Health, Department of Neurology and Neurophysiology, Örebro University, Örebro, Sweden.
authors.forename: Margareta
authors.initials: M
authors.lastname: Kånåhols
authors.affiliation: Faculty of Medicine and Health, Department of Neurology and Neurophysiology, Örebro University, Örebro, Sweden.
authors.forename: Martin
authors.initials: M
authors.lastname: Gunnarsson
authors.affiliation: Faculty of Medicine and Health, Medicine, Örebro University, Örebro, Sweden.
authors.forename: Ylva
authors.initials: Y
authors.lastname: Nilsagård
mesh_terms: D000328:Adult; D000368:Aged; D001945:Breathing Exercises / Q000295:instrumentation* / Q000379:methods*; D045853:Exhalation; D005260:Female; D005541:Forced Expiratory Volume; D006801:Humans; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000503:physiopathology / Q000628:therapy*; D012132:Respiratory Muscles / Q000503:physiopathology*; D057566:Self Report; D013147:Spirometry; D016896:Treatment Outcome
keywords: breathing exercises; multiple sclerosis; positive expiratory pressure; respiratory function tests