Individuals with severe multiple sclerosis (MS) may benefit from a long-term maintenance program involving expiratory muscle strength training (EMST), according to a study published in Multiple Sclerosis and Related Disorders.

While study participants with MS demonstrated lower maximal expiratory pressure (PEMAX) (P =.002) and voluntary peak cough flow (vPCF) (P =.022) at baseline than healthy controls, after 12 weeks of EMST, participants with severe MS achieved expiratory muscle strength (P =.0000) and voluntary cough strength (P =.0036) performances equivalent to those of the controls.

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Following the 12-week training period, the participants underwent another 12-week detraining period, after which the researchers analyzed the post-detraining retention of PEMAX and vPCF. After the detraining period, the investigators observed declines in PEMAX and vPCF; however, they noted that participants retained PEMAX at 16.7% and vPCF at 5.5% above pretraining levels.

Study Methods

The researchers enrolled 35 severely disabled patients with MS (15 with relapsing-remitting MS, 5 with primary progressive MS, and 15 with secondary progressive MS). The Expanded Disability Status Scale scores of the participants ranged from 5.0 to 7.0. Only 26 participants completed the entire training program and detraining period. The control group included 26 age- and sex-matched healthy individuals.

The investigators assessed primary outcomes measures (PEMAX and vPCF) in the participants with severe MS at 4 intervals, including week 0 (baseline), week 12 (pretraining), week 24 (post-training), and week 36 (post-detraining). They collected normative values for these outcomes in the healthy controls only once.

The authors suggested the need for a long-term EMST program to sustain the benefits of improved PEMAX and vPCF in patients with severe MS. They stated their study confirms that “EMST improves expiratory muscle strength and voluntary cough strength in severely disabled MS patients.”


Srp M, Capek V, Gal O, et al. Severely disabled multiple sclerosis patients can achieve the performance of healthy subjects after expiratory muscle strength training. Mult Scler Relat Disord. Published online August 5, 2021. doi:10.1016/j.msard.2021.103187