Expiratory Muscle Strength Training (EMST)

Overview

What It Is Expiratory Muscle Strength Training uses a calibrated resistive device that you blow into, strengthening the muscles of forced expiration. Stronger expiratory muscles can improve cough effectiveness, airway protection, and sometimes voice and swallowing. Training is usually daily sets of repetitions for several weeks.

How It Works Like any strength training, repeated loaded practice increases muscle capacity. Better expiratory force improves cough and airway clearance, which can reduce aspiration risk. The training is peripheral (muscle) but supports safer swallowing and communication after neurological injury.

Conditions - Established / commonly used for: Parkinson’s disease and post-stroke impairments affecting cough and swallowing safety. - Also used for: other neurological conditions with weak cough or dysphagia. - Note: Moderate evidence supports improved expiratory strength and related airway-protection measures.

How it is administered

A clinician (often a speech-language pathologist) sets up and calibrates the device in clinic. Daily training is then completed independently at home with periodic reassessment.

The NPA Treatment Database lists this treatment in connection with 3 condition records. A database relationship does not establish effectiveness, safety, or suitability for an individual.

These controlled question pages reference this treatment through stored condition relationships.

Symptoms connected in the NPA database

The current record associates this treatment with the following symptom information. This is not a claim that the treatment will improve these symptoms.

Motor Control

Balance and coordination problems
difficulty walking
muscle stiffness/spasticity
Muscle weakness
One-sided weakness or paralysis
poor balance and coordination
reduced fine motor skills
slowed movements
stiffness/spasms
walking difficulty
weakness

Speech & Swallowing

Aphasia (trouble speaking or understanding)
difficulty swallowing
occasional swallowing challenges
occasional swallowing difficulty
slurred speech
word-finding difficulty

Practical information

Insurance coverage

Sometimes covered under speech therapy benefits.

Cost information

Device $50–$200; therapy varies.

Results and outcomes described in the source record

4–8 weeks of consistent training.

Side effects and risks

Low risk; temporary breathlessness possible.

Research context in the NPA database

This section reproduces the current database's research summary and detail. Structured citation metadata has not been supplied, so it should not be read as an independently verified literature review.

Research summary

Evidence Level: Moderate

What the research shows: Studies show that training the muscles used for forceful breathing can improve cough strength and, in some cases, swallowing safety after neurological injury or in Parkinson’s disease.

Key takeaway: A practical, device-based exercise that speech therapists often use to support airway protection.

Research detail

Overview Expiratory Muscle Strength Training uses a calibrated resistive device that the person blows into, thereby strengthening the muscles of forced expiration. Stronger expiratory muscles can improve cough effectiveness, airway protection, and, in some cases, voice and swallowing function. Training usually consists of daily sets of repetitions with a device set to a percentage of the individual’s maximum expiratory pressure. Protocols of four to eight weeks are common.

Evidence Base and Published Work • Randomized controlled trials demonstrate improved expiratory strength and related airway-protection measures (cough effectiveness, swallowing safety) in Parkinson’s disease and after stroke. • Reviews of respiratory muscle training in neurological populations support the approach. • Key published work includes: – RCTs demonstrating improved expiratory strength and related airway-protection measures in Parkinson’s and stroke. – Reviews of respiratory muscle training in neurological populations. – Temporary breathlessness can occur; overall risk is low. The device itself is relatively inexpensive and can be used at home after instruction.

Outcomes Outcomes most frequently described include improved cough strength and, in some cases, swallowing safety after neurological injury or in Parkinson’s disease. Evidence is moderate. The approach is practical and device-based.

Questions to ask a provider

1. Is expiratory muscle strength training appropriate for my swallowing, cough, or voice concerns? 2. How is the training device set (resistance level), and what is the recommended daily protocol? 3. How many weeks of consistent training are typically needed before strength and functional gains appear? 4. Will a speech-language pathologist supervise the program, and how often will I be reassessed? 5. Is the device and therapy covered by insurance for my diagnosis?

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