Respiratory muscle training (RMT) may not have been a part of your daily exercise in the past, but if you are someone with a diagnosis of Parkinson’s or related diagnosis, devoting a few minutes a day to RMT use may yield benefits for speech and swallowing.

Respiratory muscle trainers are hand- held devices designed to strengthen the muscles of breathing, which, like skeletal muscles, can become stronger in response to the increased effort or load provided by the resistance of the device. A device may be designed to focus on inhalation (IMST), exhalation (EMST), or a combination of both (cRMT). These portable devices are easy to use and beneficial for anyone interested in developing power and endurance of their breathing muscles.

Why Exercise the Respiratory Muscles?

In a previous blog post, I discussed some recent research that reported respiratory muscle weakness and an associated reduction in lung volumes in people with Parkinson’s disease.[i] Even early in the disease diagnosis, there may be evidence of inspiratory muscle weakness, which has implications for both speech and swallowing.

Interest in the role of respiratory muscle training for people with PD has grown among clinicians and researchers, and a systematic review of the research and efficacy of different respiratory training interventions in PD was the subject of a 2020 publication in the Journal of Parkinson’s disease.[ii] As is often the case in systematic reviews, there were methodological limitations identified in all the studies, but with that considered, the overall conclusion of this systematic review was that all respiratory training interventions device and some non-device interventions showed positive effects in people with PD, underlining that respiratory training should be considered as a possible treatment option for people with Parkinson’s.

Two main findings were that EMST significantly improves swallowing safety as measured by penetration-aspiration scores, phonation as measured by peak sound pressure level, and when combined with a non- device intervention (breath stacking) improves cough. IMST was found to improve phonatory aspects as measured by maximum phonation time and peak sound pressure.

The authors emphasized that strength training alone does not improve the decreased chest amplitudes due to bradykinesia, hypokinesia or akinesia. And, like gait training, where compensatory cueing strategies are employed consciously with a goal of improving step length, volume oriented respiratory training interventions performed consciously such as deep breathing (or, I would add, high effort voicing) may improve respiratory muscle excursion and control.


[ii] The Effects of Respiratory Training in Parkinson’s Disease: A Systematic Review. Journal of Parkinson’s Disease 10 (2020) 1315–1333DOI 10.3233/JPD-202223

Voice Aerobics® a Whole-Body Voice Exercise Program

Voice Aerobics® for Posture*Breathing*Voice


Voice Aerobics® was created in 1999, and at that time was designed to be used as an after-therapy program for persons with Parkinson’s disease who had completed formal speech therapy, including LSVT®. It was hypothesized that voice practice coupled with movement might lead to better awareness of breathing, posture, and voice use. The class was recorded on DVD in 2008 providing guided practice before, during or following formal speech therapy. Non-voice improvements in flexibility, increased range of motion and breathing have been reported by class participants. Try Voice Aerobics® yourself. You can rent it and download it for the weekend for as little as $4.99. Visit:

PWP Share Their Experiences with RMT Using the Breather®

Recently, several of my patients with PD who are also LOUD Crowd® members shared some of what they have experienced with using the Breather® a combined inspiratory-expiratory respiratory muscle training (cRMT) device. Visit:


My Mission: To 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 * Voice Aerobics® A Whole Body Approach to Voice Practice

Voice Aerobics the heART and Science of Voice Practice