The Acute Effects of a Single Session of Expiratory Muscle Strength Training on Blood Pressure, Heart Rate, and Oxygen Saturation in Healthy Adults

Abstract

Expiratory muscle strength training (EMST) is a rehabilitative program that has been tested for outcomes related to respiratory muscle strength, cough, swallow, and voice function in healthy young adult, elderly individuals, and in patients with progressive neurodegenerative disease. Because EMST has been used in patient care, the associated cardiovascular responses during EMST are of importance. This study investigated the changes in systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR), and oxygen saturation (SpO2) during one session of EMST in healthy, young adults as a preliminary study of device safety. Thirty-one participants completed a single session of 25 trials with the EMST device. Valsalva maneuvers were performed at the beginning and at the end of the EMST trials for task comparison. The SBP, DBP, HR, and SpO2 were recorded at the baseline and after completing the following tasks: a Valsalva maneuver, 12 trials using the EMST device, 13 trials using the EMST device, and 5 min of rest following the EMST session. A mixed linear model tested for changes across the six time points. The results indicated no significant change of SBP, DBP, HR, or SpO2 during or following the EMST trials or after performing the Valsalva maneuver. The results suggest that EMST does not elicit significant fluctuations of blood pressure, HR, and SpO2 in healthy young adults even when considering the effects of covariates on the outcomes measures.

Functional outcomes associated with expiratory muscle strength training: Narrative review

“…The secondary measures included a single EMST trial duration. No significant changes in BP, HR, and SpO 2 following the EMST trial were observed, which suggested that, although a high expiratory pressure is generated to open the valve within the device, the duration of that pressure generation is relatively short (1.25 s) and does not require a significant physical and respiratory effort even when the respiratory tasks are repeated [31]. Intrathoracic pressure was not assessed in this study; therefore, the respiratory effort could not be evaluated.…”

“…Such an interest has been recently expressed in regard to the EMST, particularly its application in treating patients with cardiovascular diseases. Laciuga et al tested acute cardiovascular responses to a single EMST session in a group of healthy, young participants [31]. For the purpose of this assessment, the investigators measured blood pressure (BP), heart rate (HR), and oxygen saturation (SpO 2 ) before the training session, immediately after the session, and after a 5 min rest.…”

“…Intrathoracic pressure was not assessed in this study; therefore, the respiratory effort could not be evaluated. Continuous measure of cardiac activity using electrocardiography would have provided more information regarding cardiovascular responses throughout the entire EMST session [31].…”

Dysphagia Management in Stroke Rehabilitation

“…Completion of breath-holding compensatory strategies (i.e., supraglottic swallow and super-supraglottic swallow) which involve a Valsalva maneuver has been shown to have negative cardiovascular effects in individuals with stroke [49]. Given these potential problems, the effects of EMST and the Valsalva maneuver on blood pressure, heart rate, and oxygen saturation levels were evaluated in healthy adults [72]. No significant changes in measures were observed suggesting that the shorter duration of pressure generation during EMST, about 1.25 s, does not induce negative cardiovascular changes.…”

“…In EMST, individuals blow into a one-way spring-loaded device calibrated to a specific percentage of maximum expiratory pressure until the valve opens with sufficient effort [65, 66, The effects of EMST may be similar to the Valsalva maneuver as it involves a build-up of intraoral and intrathoracic pressure [72]. Completion of breath-holding compensatory strategies (i.e., supraglottic swallow and super-supraglottic swallow) which involve a Valsalva maneuver has been shown to have negative cardiovascular effects in individuals with stroke [49].…”