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Severely disabled multiple sclerosis patients can achieve the performance of healthy subjects after expiratory muscle strength training

  • Martin Srp
    Correspondence
    Corresponding author.
    Affiliations
    Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine and General University Hospital in Prague, Charles University, Katerinska 30, 128 21 Prague 2, Czech Republic
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  • Vaclav Capek
    Affiliations
    Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine and General University Hospital in Prague, Charles University, Katerinska 30, 128 21 Prague 2, Czech Republic
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  • Ota Gal
    Affiliations
    Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine and General University Hospital in Prague, Charles University, Katerinska 30, 128 21 Prague 2, Czech Republic
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  • Eva Kubala Havrdova
    Affiliations
    Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine and General University Hospital in Prague, Charles University, Katerinska 30, 128 21 Prague 2, Czech Republic
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  • Robert Jech
    Affiliations
    Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine and General University Hospital in Prague, Charles University, Katerinska 30, 128 21 Prague 2, Czech Republic
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  • Rebeka Korteova
    Affiliations
    Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine and General University Hospital in Prague, Charles University, Katerinska 30, 128 21 Prague 2, Czech Republic
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  • Klara Novotna
    Affiliations
    Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine and General University Hospital in Prague, Charles University, Katerinska 30, 128 21 Prague 2, Czech Republic
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  • Evzen Ruzicka
    Affiliations
    Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine and General University Hospital in Prague, Charles University, Katerinska 30, 128 21 Prague 2, Czech Republic
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  • Hana Ruzickova
    Affiliations
    Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine and General University Hospital in Prague, Charles University, Katerinska 30, 128 21 Prague 2, Czech Republic
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  • Barbora Srpova
    Affiliations
    Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine and General University Hospital in Prague, Charles University, Katerinska 30, 128 21 Prague 2, Czech Republic
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  • Martina Hoskovcova
    Affiliations
    Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine and General University Hospital in Prague, Charles University, Katerinska 30, 128 21 Prague 2, Czech Republic
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Published:August 05, 2021DOI:https://doi.org/10.1016/j.msard.2021.103187

      Highlights

      • EMST improves expiratory muscle strength and voluntary cough strength in severely disabled MS patients.
      • At post-training, MS patients achieved the performance of healthy subjects and retained it through post-detraining.
      • Detraining results suggests a need to establish a long-term maintenance program to sustain cough effectiveness gains following intensive training periods.

      Abstract

      Background

      The efficacy of expiratory muscle strength training (EMST) in patients with multiple sclerosis (MS) is controversial. The current study's primary objective was to test the effects of a progressive and intensive 12 week home based EMST program on expiratory muscle strength and voluntary cough strength. The secondary objective was to determine the retention of EMST benefits.

      Methods

      Thirty-five severely disabled MS patients (relapsing-remitting MS, n = 15; primary progressive MS, n = 5; secondary progressive MS, n = 15) with Expanded Disability Status Scale (EDSS) 5.0 − 7.0 were included in the study. Within 36 weeks, patients completed 12 weeks of a non-training period, 12 weeks of EMST and 12 weeks of a detraining period. Maximal expiratory pressure (PEmax) and voluntary peak cough flow (vPCF) were assessed 4 times: at week 0 (baseline), week 12 (pre-training), week 24 (post-training), and week 36 (post-detraining). MS patients included in the study were compared to age- and sex-matched healthy subjects. In the healthy controls, the PEmax and vPCF were assessed once to obtain normative data.

      Results

      Twenty-six patients completed the training period (mean age 52.7 ± 10.2, EDSS 5.9 ± 0.6) and were compared to 26 sex- and age-matched healthy subjects (mean age 53.5 ± 5.8). Patients with MS had a lower PEmax (p = 0.002) and vPCF (p = 0.022) at baseline than the healthy control group. In training period, the PEmax and vPCF increased (p = 0.0000; effect size: d = 0.94 and p = 0.0036; d = 0.57 respectively) in comparison with the non-training period (p = 0.0692; d = -0.36 and p = 0.5810; d = 0.11 respectively). Following the 12 weeks detraining period, the PEmax and vPCF declined but remained 16.7% and 5.5% respectively above the pre-training values. No differences were observed in the PEmax and vPCF between the MS group at the post-training and post-detraining timepoint and the healthy control group normative values.

      Conclusions

      EMST improves expiratory muscle strength and voluntary cough strength in severely disabled MS patients.

      Keywords

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