Respiratory Muscle Training: A Missing Link in Post-Stroke Rehabilitation?
After a stroke, most people expect changes in movement, speech, and maybe memory, but one area that often gets overlooked is breathing. Yes, your breathing muscles. The diaphragm and the muscles in your chest can become weaker after a stroke.
If the diaphragm is weakened or less responsive, breathing becomes shallower and more effortful. Some people after stroke may:
- Get tired quickly, even with light activity
- Feel breathless more easily
- Have reduced ability to clear their lungs, which can increase the risk of infections like pneumonia
- Struggle with posture and trunk control due to a weakened core
All these issues are tied to the strength and endurance of your respiratory muscles.
But there is some good news: like other muscles, strengthening these muscles can make a meaningful difference. There’s reasonably strong evidence that training your breathing muscles, through something called respiratory muscle training (or RMT), can improve not only how well you breathe but also how far you can walk, how strong your core feels, and how much energy you have day to day.
What is Respiratory Muscle Training (RMT)?
RMT is a set of specific exercises that make your breathing muscles stronger and more efficient. It often involves using a handheld device that provides resistance while you breathe in (inspiratory muscle training or IMT), breathe out (expiratory muscle training or EMT), or both.
Think of it as “weight training” for your lungs and breathing muscles. The exercises are usually done for 20 to 40 minutes a day, several times per week, over 4 to 8 weeks.
Literature Summary
A group of researchers, Fabero-Garrido et al, recently conducted an analysis and summary of nine high-quality studies involving over 460 people who had experienced a stroke. Here are the major takeaways from their analysis:
1. Better Exercise Tolerance
People who did RMT were able to walk further and had better endurance. Even a simple walk test (like how far you can walk in 6 minutes) improved. This means that strengthening the breathing muscles can build endurance and help people stay more active and independent.
2. Stronger Breathing Muscles
Participants in these studies showed noticeable improvement in how strong and how long their breathing muscles could work before getting tired. This was especially true when both inspiratory and expiratory training were combined.
3. Improved Diaphragm Function
RMT helped to “bulk up” the diaphragm. The affected side of the diaphragm (the weaker one after a stroke) showed greater thickness and better movement during breathing, a sign that the muscle was becoming stronger and more effective.
4. Improved Lung Function
Peak expiratory flow (how fast you can blow air out) improved with training. This is important for clearing the lungs and preventing infections.
5. Short-Term Gains
The benefits of RMT were most noticeable at the end of the training program. However, the improvements weren’t always maintained long-term unless the training was continued. This suggests that ongoing practice might be needed to keep the gains.
Practical Tips: How to Get Started
If you’re interested in trying respiratory muscle training, here are some things to consider:
Talk to your physio
Not everyone after a stroke will benefit in the same way, and RMT is usually best done with professional guidance. Your ARC therapist can assess whether it’s suitable for you and recommend the right type of training.
Start early, if possible
The evidence suggests that people who begin RMT in the earlier stages after stroke (within the first 3 months) may see greater benefits. However, people in the chronic phase can still make gains, especially with the right intensity and consistency.
Use the right tools
RMT usually involves a small, affordable device that adds resistance to your breathing. Devices come in different styles—some for breathing in, some for breathing out, and some that do both. Your ARC therapist can help choose the right one for you.
Be consistent
Most of the studies showed improvements with training done 5 to 7 times a week, for at least 20 minutes per session, over 4 to 8 weeks. Like any exercise, regular practice leads to results.
Combine with other therapies
RMT works best when added to your existing stroke rehab program, not in place of it. Combining breathing exercises with walking practice, core strength training, or balance work can offer bigger improvements overall.
Who Can Benefit?
Respiratory muscle training may be especially helpful for:
- People who feel breathless during mild activity
- Those recovering from pneumonia or chest infections
- Stroke survivors who have low energy and poor endurance
- Anyone whose diaphragm function is reduced
- People who want to take an active role in their recovery
Even those who find it hard to exercise due to mobility or fatigue may find RMT an empowering way to build strength, one breath at a time.
Final Thoughts
Stroke recovery is about much more than walking and talking. Breathing—something we do automatically—can change after stroke and deserves attention. With targeted training, your breathing muscles can become stronger, supporting your overall rehabilitation and quality of life.
So if you’ve had a stroke and are feeling more tired, more breathless, or just want to build your stamina again, it might be time to think about training your lungs as well as your legs.
Talk to your ARC physio today about whether respiratory muscle training could be right for you.
Disclaimer: This blog is for educational purposes only and does not replace medical advice. Please consult with your health professional before starting any new treatment or exercise program.
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