Objective: This systematic review provides an overview investigating the effects of different respiratory training interventions in Parkinson’s disease (PD).

Background: Signs of respiratory dysfunction are already present early in PD but how to address respiratory dysfunction with respiratory training in PD is unclear.

Method: A literature search was performed in four databases: PubMed, PEDro, Cochrane Library and CINAHL. The search strategy was ‘Parkinson disease’ as the domain, ‘respiratory training’ as the determinant, and without limitations for outcome measures. Methodological quality of original full-text articles was assessed using the Cochrane Risk of Bias tool for randomized controlled trials (RCT’s) and the Risk Of Bias In Non-randomized Studies of Interventions tool for the non-randomized intervention studies.

Results: Four RCT’s and four non-randomized intervention studies were included. Most of these studies included persons with PD in Hoehn & Yahr stage I-III. Positive effects were found for all ten studies but high methodological quality was found for strength training in terms of Expiratory Muscle Strength Training (EMST) and volume-oriented training in terms of Breath stacking plus Incentive Spirometry. EMST significantly improved Maximal Expiratory Pressure (MEP) and swallowing safety. Breath stacking combined with Incentive Spirometry significantly improved Tidal Volume and Minute Ventilation. Other interventions with a higher risk of bias were Inspiratory Muscle Strength Training (IMST), air stacking and postural training. Other positive effects were reported for the outcomes vital capacity, swallowing safety, phonatory capacity and different optoelectronic plethysmography variables.

Conclusion: Respiratory strength training and techniques or exercises improving lung and chest wall expansions are both effective modalities of respiratory training in H&Y stages I-III.
More studies are needed to investigate the effects of respiratory training in a more advanced population of PD patients. Future studies should also pay more attention to well-designed studies in which training devices, instruments and protocols are more standardized. Although the pathophysiology underlying respiratory dysfunction is not fully understood, respiratory training improves respiratory dysfunction and should be considered when people with PD experience respiratory dysfunction.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/respiratory-training-in-parkinsons-disease-a-systematic-review/