Breathing Untrained Trained Support Diaphragm Healthy Unhealthy Intervention
Breathing Untrained Trained Support Diaphragm Healthy Unhealthy
Intervention l Proof of Concept
Respiratory Muscle Strength Training Since about 1999 SCI PD MS Children Elderly Spinal Muscle Atrophy Bilateral Paralysis Paradoxical VF Dysfunction ALS Safety COPD
Pressure, Flow, Voice
Intervention l l l l What is it? What is it not? Who can it be used with? Outcomes: Case, Group, and Randomized trials Co. Morbidities Protocol Maintenance
Respiratory Muscle Strength Training (RMST) l l The process of building strength within muscle groups Two Types: l l Inspiratory Muscle Strength Training (IMST) Diaphragm External intercostals Expiratory muscle strength training (EMST) l l Abdominals Internal intercostals
Question: Which Direction? 1. 2. 3. 4. Problem? Purpose? Desired Outcome? MIP or MEP?
Overload & Specificity l Training must“overload” the system/muscle type Low Load Overload
Result: Adaptations Progress Strength Hypertrophy Neural adaptations Time • Neural adaptations (6 -8 weeks) • Myogenic adaptations (+ 5 weeks) (Modified from Sale, 1988)
Multiple Functions have Been Studied
What is a RMST? General “breathing exercisers” l Resistive trainers – is there a difference? l Pressure threshold trainers l
EMST? 4 week program 5 days per week 25 breaths per day Load set at 75% of MEP • 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
What is the setting? Loaded Spring Mouthpiece Adjustable Valve
Provides specific, constant, pressure load (spring loaded valve 0 -150 cm/H 20)
Recommendations for Training (EMST) l Twice daily exercise in all studies l l l Daily or every other day Most studies used an overload principle Specificity of training observed with some carry -over noted l 5 weeks to 3 months of training resulted in increased respiratory muscle strength
Time to Do Your Training
Time to Train l l Training manual included Video online Very simple to use Very instrumental feeling
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