BreathingUntrainedTrainedSupport

DiaphragmHealthy

Unhealthy

Intervention

Proof of Concept

Respiratory Muscle Strength TrainingSince about 1999

Bilateral Paralysis

Safety

Children

SCI

Spinal Muscle Atrophy

Paradoxical VFDysfunction

Elderly

PD

MS

ALS

COPD

Pressure, Flow, Voice

Intervention

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

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

Question: Which Direction?

1. Problem?

2. Purpose?

3. Desired Outcome?

4. MIP or MEP?

Overload & SpecificityTraining must“overload” the

system/muscle type

Low Load

Overload

Result:Adaptations

Time

• Neural adaptations (6-8 weeks)

• Myogenic adaptations (+ 5 weeks)

Neural adaptations

Hypertrophy

Strength

Progress

(Modified from Sale, 1988)

Multiple Functions have Been Studied

What is a RMST?

General “breathing exercisers”Resistive trainers – is there a difference?Pressure threshold trainers

EMST?

• 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

4 week program5 days per week

25 breaths per dayLoad set at 75% of MEP

What is the setting?

Adjustable Valve

Mouthpiece

Loaded Spring

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

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

Time to Do Your Training

Time to Train

Training manual included Video online Very simple to use Very instrumental feeling