Skeletal muscles are reactors and adapters to stimuli that challenge them. That challenge can come in the form of free weight resistance, band resistance or learning a complex movement like throwing or running. The difference lies in what adaptations or responses occur when the stimulus is repeatedly attempted or applied. In the last decade or so, dysphagia (swallowing) researchers, have applied theories of exercise physiology to the swallowing and breathing muscles, which are also capable of adaptive changes in response to exercise.

Respiratory muscle trainers (RMT) are handheld devices developed over 30 years ago, and originally designed to provide PEP (positive expiratory pressure) or back pressure to the airways, thereby improving oxygen uptake and also helping to mobilize pulmonary secretions. Since many RMT devices are designed with variable resistance, they have also been used by patients with neuromuscular weakness as a tool for exercising and strengthening the breathing muscles.

Flow resistance or threshold resistance training, which is best?

There are now several different types of RMT devices sold directly to consumers, and the choice can sometime be difficult for therapists or physicians when making a recommendation to patients. Depending on the device design, an RMT device may provide training for the inspiratory, expiratory, or both inspiratory and expiratory muscle groups subjecting the muscles to an external load that is akin to lifting a weight. A pressure threshold device, using a spring loaded valve, provides a constant set pressure (resistance), to airflow, and you might think of it as similar to a weight machine in the gym. A flow resistance device has an orifice (opening) which changes in size by adjusting a dial , and since it is  dependent on the flow generated by the patient/user,  proper training or additional feedback for quantification of effort is beneficial. You might think of a resistance trainer as being similar to use of resistance bands for skeletal muscles. When using a flow resistance device one needs to generate constant velocity in order to complete the repetition or movement, and using a manometer for feedback can help you focus on sustaining the effort. It is also possible to manipulate sets and reps., depending on whether the goal is strength or endurance training.

For individuals with Parkinson’s disease, bradykinesia (stiffness) is a feature that contributes to muscle weakness and both inspiratory AND expiratory muscle weakness has been described in individuals with PD. Using an RMT device may help increase range of motion of ribcage muscles, help to normalize breathing patterns for persons experiencing respiratory muscle dyskinesia, and improve strength and use of the muscles for speech and swallowing

Dave the Band Man

                  The Band Man… Dave Schmitz at

One of my favorite exercise instructors is Dave; the Band Man. Dave is a physical therapist who developed a rather extensive training program using resistance bands. His mother also just happened to have Parkinson’s disease, so he understands as a therapist and a family member, the importance of coaching, consistency and convenience when expecting people to undertake any sort of exercise program.

His daily emails and videos are great tutorials for anyone wanting to understand how to incorporate resistance training into a strength and fitness program. He will be the first to admit, that resistance bands will not give the same strength gains as free weights, but, he also knows the numerous benefits of resistance band training that weights can’t offer, including: the ability to change movement patterns, change the speed of movement, change resistance on the fly, and build “usable muscle.

So, whether you are professional recommending respiratory muscle training to your patients, or a patient wanting to incorporate RMT into your daily exercise, focus on your exercise goals first, and then the particular device.

Device manufacturers have a responsibility for patient safety, but, they also have marketing and sales quotas to reach, and so they will always have a bias towards their product.  But, as healthcare professionals, we can help our patients by investigating the various RMT devices, using them ourselves, and making our recommendations based on a patient’s underlying medical diagnosis, their exercise interest and goals, their abilities, and learning needs.

If we move away from a “one size fits all mentality,” and explore all that various exercise approaches and RMT devices have to offer we will help ourselves and our patients develop a useful RMT gym with many benefits which include: improved pulmonary function, improved strength and endurance, and improved breath support for speech and swallowing.

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My MissionTo enlist individuals in their treatment, and help them express their personality & spirit through voice. To educate and empower.Mary Spremulli, MA, CCC-SLP, FITOUR Group Exercise Instructor