Patients with Parkinson’s Disease (PD) often develop respiratory weakness and lower lung capacities. This greatly diminishes quality of life, leading to difficulties with breathing, speaking, and swallowing.  Respiratory weakness can also lead to one of the most common causes of death in people with Parkinson’s Disease –aspiration pneumonia—especially in the late stages of the disease.

Individuals with PD can experience over 50% decreases in maximum inspiratory pressure and maximum expiratory pressure, which is essentially the force with which one can inhale or exhale, respectively (Sapienza et al. 2011).  Poor ability to inhale may be attributable to reduced respiratory muscle strength and increased chest wall rigidity (Sathyaprabha et al. 2005), which are two common characteristics of PD.

In short, living the best possible life with PD includes taking preventative measures to reduce PD’s impact on the respiratory system.  There are currently no standard protocols for respiratory therapy for people with PD, but research is beginning to show some promise for exercising the respiratory system –just like one should exercise the rest of the body.

Respiratory Muscle Training (RMT)

Research on techniques to improve respiratory health is in its infancy, but some studies have indicated that a technique called Respiratory Muscle Training (RMT) may significantly improve respiratory muscle strength (Jones and Busse, 2012).  RMT involves inhaling and/or exhaling against resistance through a device called a respiratory muscle trainer.

Research has shown that RMT can increase respiratory muscle strength (Sapienza et al. 2011 Reychler et al. 2016).  Put simply, RMT can improves one’s ability to cough, breathe, swallow and talk at normal volume.  This leads to the following improvements in quality of life:

• A good strong cough = clearing secretions and foreign objects from the airways
• Ease with swallowing=prevention of choking, aspiration (getting food into the airways) and subsequent infection and pneumonia that could develop.
• Talking with adequate volume= improved communication and social relationships.

Two forms of RMT have been examined: inspiratory muscle strength training (strength for inhaling) and expiratory muscle strength training (strength for exhaling).

In a study of 60 participants, half of which were randomly chosen to utilize a expiratory muscle strength trainer (EMST) for 4 weeks while the other group utilized a sham device, EMST was found to increase maximum expiratory pressure by 27%, improve swallowing function (Sapienza et al. 2011).  Other studies have also demonstrated that EMST can improve coughing and a reduction in incidence of aspiration (Troche et al. 2010; Pitts et al. 2009).  In short, EMST can make critical improvements in strength that protect lungs from aspiration and subsequent pulmonary complications.

Studies of inspiratory muscle strength training in people with PD are currently underway (Ferro et al. 2019).  However, a study that has been done on healthy adults over the age of 65 does demonstrates that (IMST) may have serious benefits in improving maximum inspiratory pressure (Reychler et al. 2016).  Over the course of a 4-week IMST program, 16 participants were able to increase their maximum inspiratory pressure by 38% (Reychler et al. 2016).  Over the course of the 4 weeks, participants performed 15 minutes of IMST maintaining a respiratory rate of 15-20 breaths per minute; each week of the program, the resistance on their training device was increased (Reychler et al. 2016).

A device on the market that allows one to perform RMT for inspiratory and expiratory muscles is THE BREATHER (click on image below to see in store and purchase):

To see a product demo video of THE BREATHER, click here.

Using such a device, improvements in respiratory muscle strength can seen in as little as 4 weeks, but it must be utilized at high frequency daily.  For instance, in the Sapienza et al. (2011) study, participants performed 5 sets of 5 repetitions of EMST exercise, on 5 days per week.  Although it takes dedication, improvement in respiratory muscle strength can be seen in a little as 4 weeks according to Sapienza et al. (2011).  Similarly, healthy geriatric patients had improved inspiratory muscle strength over the course of 4-weeks when practicing IMST for 15 minutes on 5 days per week (Reychler et al. 2016).

Can other people besides those with Parkinson’s Disease benefit from RMT?

In addition to benefitting those with Parkinson’s Disease, RMT can improve quality of life for those with other neurodegenerative conditions (i.e., ALS (Lou Gherig’s Disease), multiple sclerosis, Huntington’s Disease; Jones and Busse, 2012)—-and even athletes and musicians without neurodegenerative conditions.

Weber Physical Therapy and Wellness can get you started on an RMT program.  As an RMT patient, you can expect the following:

1. initial evaluation at which you will be trained in and provided with a home exercise program.
2. one visit with your therapist per week for 4-6 weeks to check in with your progress and to adjust your home exercise program.
3. Transition to self-guided home exercise program to continue on your own for maintenance and follow up with therapist only if needed.

If you have questions about this program and whether it may be right for you, please get in touch with Carolyn Weber via phone (505-412-8384) or email (cfweberpt@gmail.com).

References: 

Ferro et al. 2019.  Effects of inspiratory muscle training on respiratory muscle strength, lung function, functional capacity and cardiac autonomic function in Parkinson’s disease: randomized controlled clinical trial protocol. Physiotherapy Research Int. 24(3). Doi: 10.1002/pri.1777.

Jones and Busse. 2012. Management of respiratory problems in people with neurodegenerative conditions: a narrative review.  Physiotherapy. 98:1-12.

Pitts et al. 2009.  Impact of expiratory muscle strength training on voluntary cough and swallow function in Parkinson disease. Chest. 135(5): 1301-1308.

Reychler et al. 2016.  Randomized controlled trial of the effect of inspiratory muscle training and incentive spirometry on respiratory muscle strength, chest wall expansion and lung function in elderly adults.  Journal of the American Geriatrics Society.    Http://doi.org/10.1111/jgs.14097

Ribeiro et al.  2018. Breath stacking and incentive spirometry in Parkinson’s Disease: randomized crossover clinical trial.  Respiratory Physiology and Neurobiology. 255: 11-16.

Sapienza et al. 2011.  Respiratory strength training: concept and intervention outcomes. Seminars in speech and language. 32(11): 21-30.

Sathyaprabha et al. 2005.  Pulmonary functions in Parkinson’s Disease.  Indian Journal of Chest Disease Allied Sci. 47(4): 251-257.

Troche et al. 2010.  Aspiration and swallowing in Parkinson’s Disease and rehabilitation with EMST: the ASPIRE study. Neurology. 75(21): 1912-1919.