Impact of expiratory strength training in amyotrophic lateral sclerosis: Results of a randomized, sham-controlled trial

Muscle Nerve. 2019 Jan;59(1):40-46. doi: 10.1002/mus.26292. Epub 2018 Nov 29.


Introduction: The purpose of this study was to determine the impact of an in-home expiratory muscle strength training (EMST) program on pulmonary, swallow, and cough function in individuals with amyotrophic lateral sclerosis (ALS).

Methods: EMST was tested in a prospective, single-center, double-blind, randomized, controlled trial of 48 ALS individuals who completed 8 weeks of either active EMST (n = 24) or sham EMST (n = 24). The primary outcome to assess treatment efficacy was change in maximum expiratory pressure (MEP). Secondary outcomes included: cough spirometry; swallowing; forced vital capacity; and scoring on the ALS Functional Rating Scale-Revised.

Results: Treatment was well tolerated with 96% of patients completing the protocol. Significant differences in group change scores were noted for MEP and Dynamic Imaging Grade of Swallowing Toxicity scores (P < 0.02). No differences were noted for other secondary measures.

Discussion: This respiratory training program was well-tolerated and led to improvements in respiratory and bulbar function in ALS. Muscle Nerve 59:40-46, 2019.

Keywords: EMST; amyotrophic lateral sclerosis; cough; exercise; expiratory muscle strength training; rehabilitation; swallowing.

Publication types

  • Randomized Controlled Trial
  • Research Support, N.I.H., Extramural

MeSH terms

  • Aged
  • Amyotrophic Lateral Sclerosis / rehabilitation*
  • Deglutition / physiology
  • Double-Blind Method
  • Female
  • Humans
  • Male
  • Middle Aged
  • Muscle Strength / physiology*
  • Prospective Studies
  • Resistance Training / methods*
  • Respiratory Muscles / physiology
  • Single-Blind Method
  • Spirometry