title: Respiratory training improved ventilatory function and respiratory muscle strength in patients with multiple sclerosis and lateral amyotrophic sclerosis: systematic review and meta-analysis.
abstract: BACKGROUND
  Among neurodegenerative diseases, multiple sclerosis (MS) and amyotrophic lateral sclerosis (ALS) have a high rate of respiratory disability.
  
  
  OBJECTIVE
  To analyze the effects of respiratory muscle training (RMT) on ventilatory function, muscle strength and functional capacity in patients with MS or ALS.
  
  
  METHODS
  A systematic review and meta-analysis of randomized controlled trials (RCTs) was performed. The sources were MEDLINE, PEDro, Cochrane CENTRAL, EMBASE, and LILACS, from inception to January 2015.
  The following were included: RCTs of patients with neurodegenerative diseases (MS or lateral ALS) who used the intervention as RMT (inspiratory/expiratory), comparison with controls who had not received RMT full time or were receiving training without load, and evaluations of ventilatory function (forced vital capacity - FVC, forced expiratory volume in one second - FEV1, maximum voluntary ventilation - MVV), respiratory muscle strength (maximal expiratory pressure/maximum inspiratory pressure - MEP/MIP) and functional capacity (6-minute walk test - 6MWT).
  
  
  RESULTS
  The review included nine papers, and a total of 194 patients. It was observed that RMT significantly increased at MIP (23.50cmH2O; 95% CI: 7.82 to 39.19), MEP (12.03cmH2O; 95% CI: 5.50 to 18.57) and FEV1 (0.27L; 95% CI: 0.12 to 0.42) compared to the control group, but did not differ in FVC (0.48L; 95% CI: -0.15 to 1.10) and distance in 6MWT (17.95m; 95% CI: -4.54 to 40.44).
  
  
  CONCLUSIONS
  RMT can be an adjunctive therapy in the rehabilitation of neurodegenerative diseases improving ventilatory function and respiratory strength.
authors.affiliation: Universidade Federal de Pelotas, Brazil; Instituto de Cardiologia do Rio Grande do Sul, Brazil.
authors.forename: Gustavo D
authors.initials: GD
authors.lastname: Ferreira
authors.affiliation: Instituto de Cardiologia do Rio Grande do Sul, Brazil.
authors.forename: Ana Cecília C
authors.initials: AC
authors.lastname: Costa
authors.affiliation: Instituto de Cardiologia do Rio Grande do Sul, Brazil; Universidade Federal de Ciências da Saúde de Porto Alegre, Brazil.
authors.forename: Rodrigo D M
authors.initials: RD
authors.lastname: Plentz
authors.affiliation: Instituto de Cardiologia do Rio Grande do Sul, Brazil.
authors.forename: Christian C
authors.initials: CC
authors.lastname: Coronel
authors.affiliation: Instituto de Cardiologia do Rio Grande do Sul, Brazil; Universidade Federal do Rio Grande do Sul, Brazil. Electronic address: graciele.sbruzzi@ufrgs.br.
authors.forename: Graciele
authors.initials: G
authors.lastname: Sbruzzi
mesh_terms: D000690:Amyotrophic Lateral Sclerosis / Q000503:physiopathology* / Q000534:rehabilitation*; D001945:Breathing Exercises; D004185:Disability Evaluation; D006801:Humans; D009103:Multiple Sclerosis / Q000503:physiopathology* / Q000534:rehabilitation*; D011788:Quality of Life; D012129:Respiratory Function Tests
keywords: Amyotrophic lateral sclerosis; Breathing exercises; Meta-analysis; Multiple sclerosis; Systematic review