MEP and swallowing safety data were collected using the same protocol completed in the RCT. We selected the 3 mo detraining interval based on (1) previous studies assessing detraining in similar muscle groups, (2) minimization of participant attrition, and (3) reduction in time swallowing treatment was withheld. The sample size of 10 was selected as a convenience sample given the preliminary nature of the research question regarding detraining and the unknown effects of "no training" or "suspended training" on swallowing safety in PD. Following completion of the experimental (active) arm of the aforementioned RCT ( n = 30 ), 10 consecutive participants were offered enrollment in a detraining phase of study (University of Florida Institutional Review Board 195–2005).
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Recently, a blinded, placebo-controlled randomized clinical trial (RCT) involving 60 participants with PD was completed, testing the effects of 4 wk of EMST on swallowing and cough function (see Troche et al. The current study examined changes in MEP and swallowing safety following 3 mo of EMST detraining in persons with PD with the long-term objective of identifying targets for the development of robust impairment-specific maintenance programs. Information related to detraining following swallowing intervention is especially relevant in PD, where patients often succumb to complications of dysphagia and resulting pulmonary sequelae. Moreover, there are no reports in the literature describing effects of detraining following any swallowing intervention. However, there are no published reports describing EMST detraining in persons with Parkinson disease (PD). The effects of EMST detraining are only documented for MEP and cough function in younger adults, older adults, and patients with multiple sclerosis (MS) with reports of no reduction to 10 percent reduction in MEP over 4 to 8 wk of detraining. Detraining is the partial or complete loss of positive adaptations gained from the use of exercise training programs, which begins the moment an exercise paradigm is stopped. The effects of 4 to 5 wk of intensive EMST training are well described, but less is understood about the changes resulting from the discontinuation of its training. EMST is efficacious for improving maximum expiratory pressure (MEP), cough effectiveness, and swallowing function. Key words: airway protection, aspiration, deglutition, detraining, dysphagia, expiratory muscle strength training, maximum expiratory pressure, Parkinson disease, swallowing, swallowing safety.Įxpiratory muscle strength training (EMST) with the EMST150 device (Aspire Products, LLC Gainesville, Florida) is a behavioral treatment paradigm used to increase expiratory and submental muscle force production. This preliminary study highlights the need for the design of maintenance programs to sustain function following intensive periods of training. Following the 3 mo detraining period, seven participants demonstrated no change in swallowing safety, one worsened, and two had improvements. No statistically significant changes were found in swallowing safety from post-EMST to postdetraining period. Following the 3 mo detraining period, MEP declined by 2% yet remained 17% above the baseline value. Participants demonstrated, on average, a 19% improvement in MEP from pre- to post-EMST. Measures of MEP and swallowing safety were made prior to beginning EMST (baseline), posttreatment (predetraining), and 3 mo postdetraining. Ten participants with PD underwent 3 mo of detraining following EMST. Moreover, there are no published reports describing detraining effects following any behavioral swallowing intervention. However, there are no published reports describing detraining effects following EMST in persons with PD.
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