Expiratory Muscle Strength Training

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For secretion management issues, expiratory muscle strength training (EMST) has been shown to improve cough strength and swallowing.

Respiratory Muscle Strength Training

Respiratory muscle strength training can either be directed to the inspiratory or expiratory muscles.  Respiratory muscle strength training has clinical benefits including: improved dyspnea, peak cough flow, laryngeal function, QOL, vent weaning, speech, voice and swallow performance.  Expiratory muscle strength training focuses the expiratory muscles including the abdominal wall muscles and the internal and external oblique and intercostal muscles.  A primary goal of EMST is strengthening of the expiratory muscles by increasing the expiratory load during breathing exercises using either resistive or pressure threshold devices.  

For secretion management issues, expiratory muscle strength training (EMST) has been shown to improve cough strength and swallowing. During EMST training, there has been increased activation of the submental muscles.  Increased movement of the hyolaryngeal complex also occurred.  Both of these are important for airway protection (Troche, M, 2015).  EMST has shown improvements for individuals with neurologic conditions such as Parkinson disease, multiple sclerosis, and Lance-Adams syndrome; in those with respiratory diseases, such as chronic obstructive pulmonary disease; and in healthy young adults and sedentary and active elderly.

Expiratory Muscle Devices

There are many inspiratory and expiratory strength trainers on the market.  Protocols depend on the device used and the underlying disorder and should be tailored to each individual’s need.  

  • The Breather can be used for both inspiratory and expiratory respiratory muscle strength training.  
  • The Acapella combines positive expiratory pressure (PEP) training with vibrations to help mobilize secretions. The Green Acapella is for patients able to maintain an expiratory flow of greater than or equal to 15LPM for 3 seconds.  The Blue Acapella is for less resistance.  The frequency and flow resistance can be changed with the expiratory resistance dial. 
  • EMT-150

Resistive Devices

Pressure Threshold Devices


Troche, M.  Respiratory Muscle Strength Training for the Management of Airway Protective Deficits. Perspectives on Swallowing and Swallowing Disorders. 2015

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