Expiratory Muscle Training Research Articles

Exercise tolerance and balance of inspiratory-to-expiratory muscle strength in relation to breathing timing in patients with chronic obstructive pulmonary disease

Rationale. Little is known about the applicability of respiratory muscle training based on exertional pathophysiological conditions in patients with chronic obstructive pulmonary disease (COPD). The aim of this study was to investigate the relationship between breathing timing and exertional responses, as well as whether exertional changes in the inspiratory duty cycle (Ti/Ttot) affect pathophysiological conditions, including respiratory muscles. Methods. Forty-five stable COPD patients (mean age: 71.2 years, severe and very severe COPD: 80%) were evaluated based on exertional cardiopulmonary function and respiratory muscle strength. To compare exertional responses and the balance of inspiratory-to-expiratory muscle strength, the patients were divided into two groups according to whether the Ti/Ttot increased (Ti/Ttot-increased group: resting Ti/Ttot ≤ peak Ti/Ttot, n = 21) or decreased during exercise (Ti/Ttot-decreased group: resting Ti/Ttot > peak Ti/Ttot, n = 24). Results. At peak exercise, the Ti/Ttot was positively correlated with minute ventilation (E), and oxygen uptake () in all patients. No significant differences were seen in breathing frequency, tidal volume, or E at peak exercise between the two groups. Compared with the Ti/Ttot-increased group, the Ti/Ttot-decreased group had significantly lower mean values of and ΔFO2 (the inspired minus expired oxygen concentration) at peak exercise, and significantly higher mean values of the absolute ratio of maximal inspiratory pressure/maximal expiratory pressure. Conclusions. The exertional change of breathing timing affected exercise tolerance and the balance of inspiratory-to-expiratory muscle strength; this finding might be helpful in making the contradictory choice of managing COPD patients with inspiratory or expiratory muscle training.

Changes in thickness of the transversus abdominis during the abdominal drawing-in manoeuvre and expiratory muscle training in elderly people.

[Purpose] It has been reported that exercises focusing upon the transversus abdominis (TrA) ameliorate low back pain (LBP). We investigated whether expiratory muscle training (EMT) can promote activity of the TrA to the same degree as the abdominal drawing-in manoeuvre (ADIM) in elderly individuals. [Subjects and Methods] Twenty-one elderly subjects (9 males, 12 females; mean age, 84.9 ± 6.6 years) without LBP symptoms were included. Using ultrasound imaging we measured changes in thickness of the lateral abdominal muscles, TrA, internal oblique muscle (IO), and external oblique muscle (EO) during ADIM and EMT. The load in EMT was set to 15% of maximal expiratory pressure. [Results] TrA showed a significant increase in muscle thickness during ADIM and EMT compared with at rest. A significant increase in muscle thickness was noted for EMT in comparison with ADIM. No significant differences were found for IO and EO. [Conclusion] In elderly people, EMT may be an effective alternative to ADIM for promoting activity of the TrA and can be used as an exercise to maintain TrA function.

Effects of expiratory muscle training on the frail elderly's respiratory function.

[Purpose] The present study examined the effects of expiratory muscle training on elderly day care service users, who had been classified into Care Grades 1 and 2 based on Japan’s long-term care insurance system. [Subjects and Methods] Intervention was provided for 29 Care Grade 1 or 2 day care service users. During intervention, expiratory muscle training was performed by slowly expiring using the abdominal muscles and a device after maximal inspiration. Each intervention session lasted for approximately 10 minutes, and 2 sessions were held weekly for 3 months to compare respiratory function test values before and after intervention. [Results] The results were favorable. The vital capacity (VC) and peak expiratory flow (PEF) significantly varied between before and after intervention. [Conclusion] Expiratory muscle training generally improved their respiratory function, particularly their VC and PEF that significantly varied between before and after intervention. As both of these items influence the cough capacity, they may be key to the prevention of aspiration pneumonia. Expiratory muscle training may also contribute to activities of daily living (ADL) and the quality of life, and it is expected to play an important role in rehabilitation as a field of preventive medicine.

Effects of Expiratory Muscle Training on Ventilatory Function and Respiratory Muscle Strength among Healthy Adult Women

Effects of Expiratory Muscle Training on Ventilatory Function and Respiratory Muscle Strength among Healthy Adult Women

Respiratory muscle training for multiple sclerosis.

Multiple sclerosis (MS) is a chronic disease of the central nervous system, affecting approximately 2.5 million people worldwide. People with MS may experience limitations in muscular strength and endurance - including the respiratory muscles, affecting functional performance and exercise capacity. Respiratory muscle weakness can also lead to diminished performance on coughing, which may result in (aspiration) pneumonia or even acute ventilatory failure, complications that frequently cause death in MS. Training of the respiratory muscles might improve respiratory function and cough efficacy. To assess the effects of respiratory muscle training versus any other type of training or no training for respiratory muscle function, pulmonary function and clinical outcomes in people with MS. We searched the Trials Register of the Cochrane Multiple Sclerosis and Rare Diseases of the Central Nervous System Group (3 February 2017), which contains trials from the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, CINAHL, LILACS and the trial registry databases ClinicalTrials.gov and WHO International Clinical Trials Registry Platform. Two authors independently screened records yielded by the search, handsearched reference lists of review articles and primary studies, checked trial registers for protocols, and contacted experts in the field to identify further published or unpublished trials. We included randomized controlled trials (RCTs) that investigated the efficacy of respiratory muscle training versus any control in people with MS. One reviewer extracted study characteristics and study data from included RCTs, and two other reviewers independently cross-checked all extracted data. Two review authors independently assessed risk of bias with the Cochrane 'Risk of bias' assessment tool. When at least two RCTs provided data for the same type of outcome, we performed meta-analyses. We assessed the certainty of the evidence according to the GRADE approach. We included six RCTs, comprising 195 participants with MS. Two RCTs investigated inspiratory muscle training with a threshold device; three RCTs, expiratory muscle training with a threshold device; and one RCT, regular breathing exercises. Eighteen participants (˜ 10%) dropped out; trials reported no serious adverse events.We pooled and analyzed data of 5 trials (N=137) for both inspiratory and expiratory muscle training, using a fixed-effect model for all but one outcome. Compared to no active control, meta-analysis showed that inspiratory muscle training resulted in no significant difference in maximal inspiratory pressure (mean difference (MD) 6.50 cmH2O, 95% confidence interval (CI) -7.39 to 20.38, P = 0.36, I2 = 0%) or maximal expiratory pressure (MD -8.22 cmH2O, 95% CI -26.20 to 9.77, P = 0.37, I2 = 0%), but there was a significant benefit on the predicted maximal inspiratory pressure (MD 20.92 cmH2O, 95% CI 6.03 to 35.81, P = 0.006, I2 = 18%). Meta-analysis with a random-effects model failed to show a significant difference in predicted maximal expiratory pressure (MD 5.86 cmH2O, 95% CI -10.63 to 22.35, P = 0.49, I2 = 55%). These studies did not report outcomes for health-related quality of life.Three RCTS compared expiratory muscle training versus no active control or sham training. Under a fixed-effect model, meta-analysis failed to show a significant difference between groups with regard to maximal expiratory pressure (MD 8.33 cmH2O, 95% CI -0.93 to 17.59, P = 0.18, I2 = 42%) or maximal inspiratory pressure (MD 3.54 cmH2O, 95% CI -5.04 to 12.12, P = 0.42, I2 = 41%). One trial assessed quality of life, finding no differences between groups.For all predetermined secondary outcomes, such as forced expiratory volume, forced vital capacity and peak flow pooling was not possible. However, two trials on inspiratory muscle training assessed fatigue using the Fatigue Severity Scale (range of scores 0-56 ), finding no difference between groups (MD, -0.28 points, 95% CI-0.95 to 0.39, P = 0.42, I2 = 0%). Due to the low number of studies included, we could not perform cumulative meta-analysis or subgroup analyses. It was not possible to perform a meta-analysis for adverse events, no serious adverse were mentioned in any of the included trials.The quality of evidence was low for all outcomes because of limitations in design and implementation as well as imprecision of results. This review provides low-quality evidence that resistive inspiratory muscle training with a resistive threshold device is moderately effective postintervention for improving predicted maximal inspiratory pressure in people with mild to moderate MS, whereas expiratory muscle training showed no significant effects. The sustainability of the favourable effect of inspiratory muscle training is unclear, as is the impact of the observed effects on quality of life.

The pulmonary effects of exspiratory muscle training in patients with heart failure of ischemic ethiology

Aim: To objectify the effect of at-home-performed expiratory muscle training (EMT) with a Threshold PEP® trainer on functional lung capacity, mouth occlusion pressures, chest expansion, dyspnea and fatigue in patients with systolic heart failure.

Effect of Static Abdominals Training and Incentive Spirometer in Improvement of Pulmonary Function and Abdominal Strength in Spinal Cord Injury Patients- A Comparative Study

Introduction: Following spinal cord injury, muscles below the level of injury develop variable degrees of disuse atrophy. Individuals with spinal cord injury (SCI) exhibit reduced lung volumes and flow rates as a result of respiratory muscle weakness. Many studies were done to strengthen diaphragm and abdominals using abdominal weights and dynamic curl up. Isolated training of abdominals using pressure biofeedback has been done by very few authors in patients with traumatic paraplegia. Methodology: Traumatic paraplegics between T9-T12 were randomly selected. The selected subjects were randomly assigned in to static abdominals and incentive spirometry group. 15 subjects in each group. Subjects in first group receives static abdominal exercise using pressure biofeedback in crook lying while other group practiced expiratory muscle training using incentive spirometer. Both groups receive conventional physiotherapy exercises. Training was given for 5 days a week for 6 weeks. Results: Result of the study suggested that both the static abdominals and incentive spirometry group had a significant improvement in pulmonary functions (FEV1, VC, MVV) and static abdominal strength in patients with traumatic paraplegia after treatment for 6 weeks. However, the incentive spirometry group showed greater change as compared to static abdominals. Conclusion: Incentive spirometery training brings about more improvement in pulmonary function than static abdominals while static abdominals using pressure biofeedback leads to increase in strength of abdominal muscles compares to incentive spirometry.

呼気筋トレーニングが随意的咳嗽力に及ぼす即時効果

呼気筋トレーニングが随意的咳嗽力に及ぼす即時効果

Benefits of interventions for respiratory secretion management in adult palliative care patients-a systematic review.

BackgroundRespiratory secretions impact negatively on palliative patients. Unfortunately, a gold standard therapy is not yet available. The purpose of this study was to identify which interventions are in use to control respiratory secretions in patients with chronic disease with a poor prognosis and verify their effects on outcomes relevant for palliative care patients.MethodsA systematic review of the literature with narrative summary was conducted. We searched eight electronic databases in April 6th, 2016. Citation-tracking and reference list searches were conducted. We included randomized controlled trials, crossover trials, observational and qualitative studies regarding interventions for respiratory secretion management in adult patients with chronic diseases that met inclusion criteria indicating short prognosis.ResultsSix randomized controlled trials, 11 observational studies, ten crossover trials and one qualitative study were found. Interventions included mechanical insufflation-exsufflation (MIE), expiratory muscle training, manually-assisted cough, tracheotomy, chest physiotherapy, suctioning, air stacking, electrical stimulation of abdominal muscles, nebulized saline, positive expiratory pressure masks, percussive ventilation, high frequency chest wall oscillations. The interventions with most promising benefits to patients in palliative care were manually-assisted cough and mechanical insufflation-exsufflation to promote expectoration and percussive ventilation to improve mucous clearance.ConclusionTherapies, such as manually assisted cough, mechanical insufflation-exsufflation and percussive ventilation, which aim to deal with respiratory secretion, were the most promising treatment for use in palliative care for specific diseases. Nevertheless, the evidence still needs to improve in order to identify which treatment is the best.Electronic supplementary materialThe online version of this article (doi:10.1186/s12904-016-0147-y) contains supplementary material, which is available to authorized users.

Spotlight on the August 18 Issue

#### Notable in Neurology This issue features articles discussing inspiratory and expiratory muscle training in subacute stroke and the effect of clopidogrel plus aspirin on functional outcome after TIA or minor stroke. Another article focuses on retinal pathology in Susac syndrome and its detection by spectral-domain optical coherence tomography. ### Antiepileptic drugs and intrauterine death: A prospective observational study from EURAP![Graphic][1]</img> The authors found no difference in risk of intrauterine death in pregnant women with epilepsy exposed to antiepileptic drug monotherapy. The most important … [1]: /embed/inline-graphic-1.gif

Inspiratory and expiratory muscle training in subacute stroke: A randomized clinical trial.

To assess the effectiveness, feasibility, and safety of short-term inspiratory and expiratory muscle training (IEMT) in subacute stroke patients. Within 2 weeks of stroke onset, 109 patients with a first ischemic stroke event were randomly assigned to the IEMT (n = 56) or sham IEMT (n = 53) study group. The IEMT consisted of 5 sets of 10 repetitions, twice a day, 5 days per week for 3 weeks, at a training workload equivalent to 30% of maximal respiratory pressures. Patients and researchers assessing outcome variables were blinded to the assigned study group. The main outcome was respiratory muscle strength assessed by maximal inspiratory and expiratory pressures (PImax, PEmax). Respiratory complications at 6 months were also recorded. Both groups improved respiratory muscle strength during the study. IEMT was associated with significantly improved %PImax and %PEmax: effect size d = 0.74 (95% confidence interval [CI] 0.28-1.20) and d = 0.56 (95% CI 0.11-1.02), respectively. No significant training effect was observed for peripheral muscle strength. Respiratory complications at 6 months occurred more frequently in the sham group (8 vs 2, p = 0.042), with an absolute risk reduction of 14%. The number needed to treat to prevent one lung infection event over a follow-up of 6 months was 7. No major adverse events or side effects were observed. IEMT induces significant improvement in inspiratory and expiratory muscle strength and could potentially offer an additional therapeutic tool aimed to reduce respiratory complications at 6 months in stroke patients. This study provides Class II evidence that short-term training may have the potential to improve respiratory muscle strength in patients with subacute stroke.

Effects of Expiratory Muscle Training and Pursed-Lips Breathing on Health Status and Dyspnea among Chronic Obstructive Pulmonary Disease Patients

The aim was to examine the effectiveness of expiratory muscle training and pursed-lips breathing on health status and dyspnea among patients with chronic obstructive pulmonary disease. A true experimental design was utilized. Setting: The study was carried out in the outpatient chest clinic at Assuit university hospital. Subjects: A purposeful sample of 127 diagnosed as COPD patients. They were randomly distributed to 4 subjects, classified into 3 study and one control group . Three tools : Tool 1: Structured interviewing questionnaire tool, Tool 11: ST George's Respiratory Questionnaire (SGRQ), Tool III: Assessment of the patients' condition includes the modified Borg scale and MRC breathlessness scale. Results: majority were male patients, more than 50 years old. There was significant improvement in total health status P= 0.001and shortness of breath among the study subjects than the control subjects’=0.01. Also, there was statistical significant improvement in the pulmonary function tests PEmax, PImax, paco2, Hco3 and Sao2in the study subjects than the control subjects’ P value (0.002, 0.005, 0.001, 0.001, 0.001) respectively. Conclusion: There was statistical significant improvement after implementation of the respiratory training in total health status score and Borg scale post Six Minute Walk Distance)6 MWD( among PLB and Both exercise subjects when compared with the EMT and control subjects after 8 weeks. Recommendation: Further researches is required to identify clearly the benefits of breathing exercises in breathless patients with COPD and treatments should be closely monitored for variations in response and modified accordingly.

Respiratory muscle training in children and adults with neuromuscular disease

Respiratory muscle training in children and adults with neuromuscular disease

The Effect of Different Respiratory Muscle Training Protocols on Health Outcomes in Patients with COPD

PURPOSE: Inspiratory muscle training (IMT) has been shown to improve dyspnoea, exercise tolerance and respiratory muscle strength in patients with chronic obstructive pulmonary disease (COPD), however the efficacy of expiratory muscle training (EMT) is equivocal. Respiratory muscle training (RMT) protocols are strenuous, therefore the purpose was to determine the effects of a modified IMT protocol or EMT protocol compared to standard IMT on respiratory health outcomes in patients with COPD. METHODS: 11 COPD patients enrolled in pulmonary rehabilitation completed a randomised controlled pilot trial involving either: eight breaths of IMT (IMT8), 30 breaths of IMT (IMT30) or 30 breaths of EMT (EMT30). RMT was performed twice daily, six days a week for six weeks, commencing at 25% of respiratory muscle strength and progressing by 5% per week up to 50% in the final week. Maximal inspiratory (PImax) and expiratory (PEmax) mouth pressures, Body mass index, airway Obstruction (FEV1), Dyspnoea (modified MRC scale) and Exercise capacity (6 minute walk test; 6MWD), for the calculation of BODE index, and anxiety and depression (hospital anxiety and depression scale; HADS) were recorded before and after the intervention. Data are presented as mean difference ± SD and percentage change while Cohen’s d were applied to determine small (≥0.2), moderate (≥0.5) and large (≥0.8) effect sizes. RESULTS: BODE index decreased in all groups (IMT8: 22% [d = -1.00], IMT30: 7% [d = -0.25] & EMT30: 36.5% [d = -1.08]), with IMT8 (-1.3 ± 1.3) and EMT30 (-1.3 ± 1.2) being the most meaningful. IMT8 & EMT30 were more effective in improving BODE index (d = 0.75 & d = 0.87, respectively) and reducing anxiety (d = -0.83 and d = -0.95, respectively) compared to IMT30. 6MWD increased in all groups: 17% in IMT8 (d = 0.85), 22% in IMT30 (d = 0.38) and 32% in EMT30 (d = 0.75). Both PImax (+15.4 ± 13.1 [d = 1.04] & 11.3 ± 21.4 cmH2O [d = 0.94] and PEmax (+4.0 ± 16.2 [d = 0.16] & 4.0 ± 13.5 cmH2O [d = 0.22]) increased following IMT8 and IMT30, respectively, whereas EMT30 had no positive effect on PImax/PEmax. Compliance was greater during IMT8 (98±2%) compared to IMT30 (85±14%; d = 1.33) and EMT30 (65±31%; d = 1.83). CONCLUSION: Both IMT protocols demonstrated similar improvements in respiratory muscle strength, however only IMT8 and EMT30 showed meaningful reductions in BODE index and HADS.

Effects of home-based exercise with expiratory muscle training on the prevention of falls and aspiration pneumonia in community-dwelling older adults

accessed from anywhere with minimal disruptions to their daily routine. A telerehabilitation project was initiated at our university hospital since 2012 using iPads onVirtual Personal Networks (VPN), called the e-MADO system (electronic Multidirectional Access andDelightful Opportunity-offering System). At the moment, the take-up rate for this option for family/patient consultation regarding their follow-up rehabilitation and monitoring is low with only 4 participants. The reason for this is unclear. Purpose: The aim of this study was to conduct a patient satisfaction survey to obtain feedback on the e-MADO system from these participants in order to understand the shortcomings and problemswith the e-MADO system so that improvements may be proposed and undertaken. Methods:A telephone interview was conducted to obtain feedback from the 4 participants in 5 main areas:

Respiratory Muscle Training Improves Dyspnea and Exercise Performance in Cancer Survivors

It is estimated that up to 70% of survivors experience dyspnea at some point in their recovery. Dyspnea is correlated with functional performance (6 minute walk test, 6MWT) and peak exercise (VO2PEAK), both of which predict survival in lung cancer. Respiratory muscle weakness represents one of the primary mechanisms contributing to exertional dyspnea and reduced exercise performance in cancer survivors. Respiratory muscle training (RMT) protocols have been used to reduce dyspnea in patients with non-malignant lung disease; however, no studies have explored respiratory muscle training to alleviate dyspnea in cancer survivors. PURPOSE: Implement a RMT program to reduce the sensation of dyspnea, as well as to improve exercise capacity, functional performance and QoL in breast and lung cancer survivors. METHODS: Eight participants who have completed all therapies (57.3 ± 6.8 years) performed RMT, 3 sets of 15 repetitions against spring loaded inspiratory and expiratory valves, 3 days/week, for 4 weeks. Pre- and Post-RRMT, subjects performed maximal expiratory (MEP) and inspiratory pressures (MIP), exercise tests (VO2Peak, sub-maximal cycling endurance at 70% of peak and 6MWT) and questionnaires related to dyspnea (Baseline Dyspnea Index) and quality of life (SF-36). RESULTS: Four breast and four lung cancer survivors completed the protocol (mean years ± SD from treatment = 4.1±3.0). At baseline, FVC and FEV1 were 80.3±18.5 and 77.2±18.2% of predicted. MIP and MEP were 51.8±20.0% and 94.8±19.2% of predicted. Post-RMT, MIP and MEP increased 26.5±21.2% and 40.1±32.7%, respectively (p<0.005). Time to peak (8.5±3.5 min vs. 10.1±3.2 min, p=0.015) and submaximal endurance (16.5±7.7 vs. 32.4±8.7 min, p=0.007) exercise and the distance covered in the 6MWT (414±91 m vs. 441±97 m, p=0.03) were all significantly longer. Finally, baseline dyspnea index (p=0.02) and quality of life (p=0.04) improved post-RMT. CONCLUSION: These results suggest that a progressive resistance inspiratory and expiratory respiratory muscle training program helps to improve respiratory muscle strength, the sensation of dyspnea, as well as exercise performance and QoL in cancer survivors.

Accelerometer-based gait analysis identifies frail older adults among the general Japanese population

and after intervention. On the other hand, there were no differencesC group in all measurements. Conclusion(s): This result showed that there were significant decrease of fall incidence and improvements of PCF by home-based exercisewith expiratorymuscle training. This study suggested that we should explore to prevent for fall and aspiration pneumonia in community-dwelling individuals. Implications: Effects of home-based exercise with expiratorymuscle trainingon the preventionof falls and aspiration pneumonia could broaden the vision of physical therapist’s potential in prevention of disease and health promotion.

Breathing exercises and inspiratory muscle training in heart failure.

Breathing exercises (BE) and inspiratory muscle training (IMT) have been demonstrated to improve ventilation and ventilation-to-perfusion matching, and to improve exercise, functional performance, and many pathophysiologic manifestations of heart failure (HF). This article provides an extensive review of BE and IMT in patients with HF and identifies several key areas in need of further investigation, including the role of expiratory muscle training, IMT targeted at various locations of inspiration (early, mid, or late inspiration), and alteration of the ratio of inspiratory time to total breath time, all of which have substantial potential to improve many pathophysiologic manifestations of HF.

Respiratory muscle training on pulmonary and swallowing function in patients with Huntington’s disease: a pilot randomised controlled trial

Objective: To examine the effects of 4-month of respiratory muscle training on pulmonary and swallowing function, exercise capacity and dyspnoea in manifest patients with Huntington’s disease. Design: A pilot randomised controlled trial. Setting: Home based training program. Participants: Eighteen manifest Huntington’s disease patients with a positive genetic test and clinically verified disease expression, were randomly assigned to control group (n=9) and training group (n=9). Intervention: Both groups received home-based inspiratory (5 sets of 5 repetitions) and expiratory (5 sets of 5 repetitions) muscle training 6 times a week for 4 months. The control group used a fixed resistance of 9 centimeters of water, and the training group used a progressively increased resistance from 30% to 75% of each patient’s maximum respiratory pressure. Main measures: Spirometric indices, maximum inspiratory pressure, maximum expiratory pressure, six minutes walk test, dyspnoea, water-swallowing test and swallow quality of life questionnaire were assessed before, at 2 and 4 months after training. Results: The magnitude of increases in maximum inspiratory (d=2.9) and expiratory pressures (d=1.5), forced vital capacity (d=0.8), forced expiratory volume in 1 second (d=0.9) and peak expiratory flow (d=0.8) was substantially greater for the training group in comparison to the control group. Changes in swallowing function, dyspnoea and exercise capacity were small (d≤0.5) for both groups without substantial differences between groups. Conclusions: A home-based respiratory muscle training program appeared to be beneficial to improve pulmonary function in manifest Huntington’s disease patients but provided small effects on swallowing function, dyspnoea and exercise capacity.

Does respiratory muscle training improve cough flow in acute stroke? Pilot randomized controlled trial.

Cough protects the lungs from aspiration. We investigated whether respiratory muscle training may improve respiratory muscle and cough function, and potentially reduce pneumonia risk in acute stroke. We conducted a single-blind randomized placebo-controlled trial in 82 patients with stroke (mean age, 64±14 years; 49 men) within 2 weeks of stroke onset. Participants were masked to treatment allocation and randomized to 4 weeks of daily expiratory (n=27), inspiratory (n=26), or sham training (n=25), using threshold resistance devices. Primary outcome was the change in peak expiratory cough flow of maximal voluntary cough. Intention-to-treat analyses were conducted using ANCOVA, adjusting for baseline prognostic covariates. There were significant improvements in the mean maximal inspiratory (14 cmH2O; P<0.0001) and expiratory (15 cmH2O; P<0.0001) mouth pressure and peak expiratory cough flow of voluntary cough (74 L/min; P=0.0002) between baseline and 28 days in all groups. Peak expiratory cough flow of capsaicin-induced reflex cough was unchanged. There were no between-group differences that could be attributed to respiratory muscle training. There were also no differences in the 90-day incidence of pneumonia between the groups (P=0.65). Respiratory muscle function and cough flow improve with time after acute stroke. Additional inspiratory or expiratory respiratory muscle training does not augment or expedite this improvement. http://www.controlled-trials.com. Unique identifier: ISRCTN40298220.