Klaske van Sluis

Expiratory muscle strength training 121 Figure 7.3: Individual Maximum Expiratory Pressure (MEP) scores over time in cmH 2 O. 7.3.2 Objective and subjective outcome measures Results on pulmonary function, physical exertion, fatigue, and vocal functioning are presented in Table 7.3. We observed a non-linear increase in the manom- etry outcome MEP. During the first four training weeks mean MEP increased from 125.5 cmH 2 O to 174.8 cmH 2 O during the first 4 weeks (95% CI base- line 110.4–140.6, 4wk 152.8–196.8). After four weeks, MEP stabilized, with no evidence for differences in detraining between group 1 and group 2 (Fig- ure 7.3). Overall, MEP decreased slightly to a mean of 164.9 cmH 2 O (95% CI 141.8–189.0) at the end of the follow-up. Three of the nine participants achieved a MEP-score above 187.5 cmH 2 O during the first four training weeks. For those participants, training at 80% of the mean MEP was not possible from that moment onward, since the maximum setting of the EMST is 150 cmH 2 O. These participants continued their training on the maximum setting of the EMST150-device. The three participants who used no plug during train- ing showed increase of the MEP as well. We observed no effect on spirometry outcome PEF over time (Figure 7.4). Mean PEF values were 455.9L/min at baseline and 445.5L/min after four weeks (95%-CI:baseline 374.8–537.0, 4wk 356.0–535.0). In this sample, no effect of detraining was seen in PEF after reducing or stopping the training with a mean PEF value of 405.3 at wk 8 (95%-CI:318.8–492.0). No changes over time were found for self-reported pulmonary problems (CCQ), vocal functioning (VHI-10), fatigue (SFQ). No differences were found for outcomes in physical exertion (CPET, Borg scales). Objective assessment of vocal functioning showed no differences in MPT and vocal range in Hz. Ex- ception was dynamic range in dB, which increased from 26.4dB (95% CI 21.7 –