Functional outcomes associated with expiratory muscle strength training: narrative review

J Rehabil Res Dev. 2014;51(4):535-46. doi: 10.1682/JRRD.2013.03.0076.


This review presents the available evidence for the effects of expiratory muscle strength training (EMST) with the use of a pressure threshold device. The investigators used computerized database searches for studies reporting the outcomes of pressure threshold EMST published after 1994. A total of 24 selected articles presented outcomes related but not limited to respiratory function, such as speech, swallow, voice, and cough function in persons with neurologic conditions such as Parkinson disease, multiple sclerosis, and Lance-Adams syndrome; in persons with respiratory diseases, such as chronic obstructive pulmonary disease; and in healthy young adults and sedentary and active elderly. Several studies demonstrated promising outcomes of EMST as a non-task-specific training for airway protection in persons with dysphagia secondary to neuromuscular impairments; however, further research is needed to confirm and generalize the reported findings.

Keywords: COPD; cough air flow; dysphagia; dysphonia; dyspnea; exercise; expiratory; maximum expiratory pressure; muscle strength training; neuromuscular diseases; neuroplasticity; quality of life; respiration.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Breathing Exercises*
  • Cough / physiopathology
  • Deglutition / physiology
  • Exhalation / physiology*
  • Healthy Volunteers
  • Humans
  • Multiple Sclerosis / physiopathology
  • Multiple Sclerosis / rehabilitation
  • Muscle Strength / physiology*
  • Parkinson Disease / physiopathology
  • Parkinson Disease / rehabilitation
  • Pulmonary Disease, Chronic Obstructive / physiopathology
  • Pulmonary Disease, Chronic Obstructive / rehabilitation
  • Recovery of Function
  • Resistance Training*
  • Respiratory Muscles / physiopathology*
  • Speech / physiology
  • Treatment Outcome