Most people think of swallowing therapy in terms of diet changes or tongue and throat exercises. What often goes unrecognized is the role that breathing plays in swallowing safety. The respiratory and swallowing systems share anatomical pathways, and when respiratory muscles are weak, airway protection suffers. This connection has drawn increasing attention to Respiratory Muscle Strength Training (RMST) as an evidence-based way to support patients with dysphagia.
Safe swallowing depends on precise timing between airway closure, laryngeal elevation and excursion, and epiglottic inversion. Airway protection depends on the ability to generate enough expiratory force for an effective cough if there is penetration or aspiration. If the respiratory system is compromised, patients may struggle to clear even small amounts of aspirated material, raising their risk of pneumonia. Research has shown that people with neurologic conditions such as Parkinson’s disease often present with both weakened respiratory pressures and higher aspiration risk, and targeted strengthening of the expiratory muscles can improve swallow safety (Frontiers in Aging Neuroscience).
How RMST Works
RMST uses handheld devices that provide resistance during inhalation or exhalation. The patient breathes against this load, which over time strengthens the respiratory muscles in much the same way that resistance training strengthens skeletal muscles. In dysphagia care, clinicians most often emphasize Expiratory Muscle Strength Training (EMST), since a strong cough is essential for airway clearance. Inspiratory training may also be introduced in patients who have difficulty initiating breath or maintaining endurance during meals.
A typical program involves structured, repeated breaths through a pressure-threshold device, with resistance set at a percentage of the patient’s maximum expiratory or inspiratory pressure. Over weeks of practice, the load is gradually increased as strength improves.
In a randomized trial, Troche and colleagues demonstrated that EMST improved swallow safety in patients with Parkinson’s disease, as measured by the Penetration-Aspiration Scale (American Speech-Language-Hearing Association Journals). Another study by Arnold et al. found that stroke survivors with dysphagia showed measurable gains in airway protection after combining inspiratory and expiratory training (PMC).
Beyond swallow outcomes, RMST has been shown to improve cough flow and respiratory pressures, both of which are critical for airway defense. For example, Pitts et al. documented stronger voluntary cough function after four weeks of EMST in Parkinson’s patients (Frontiers in Aging Neuroscience).
- Patients with neurological conditions such as Parkinson’s disease, amyotrophic lateral sclerosis (ALS), and post-stroke dysphagia have shown particular benefit from RMST. Survivors of head and neck cancer treatment, or individuals deconditioned after prolonged hospital stays, may also gain from this type of therapy. What these groups share is a need to strengthen the muscles that protect the airway, improve cough effectiveness, and sustain safer swallowing over time.
Bringing RMST Into Dysphagia Therapy
At Diagnostech FEES, RMST is considered as part of an integrated dysphagia rehabilitation plan. A FEES assessment can reveal whether reduced cough strength or poor airway clearance is contributing to aspiration risk. If so, RMST may be recommended alongside other targeted swallowing interventions. Clinicians typically monitor progress with repeat assessments of expiratory pressures and swallow safety, adjusting the program as patients improve.
- Respiratory Muscle Strength Training has emerged as a valuable complement to traditional dysphagia therapy. By targeting the muscles that underpin both breathing and swallowing, it helps patients defend their airway more effectively, reducing the risk of aspiration and its complications. With growing clinical evidence supporting its use, RMST is becoming an essential tool in the management of complex swallowing disorders.
If you are a clinician looking to integrate RMST into your dysphagia practice, or a facility seeking advanced bedside diagnostics and therapy options, Diagnostech FEES can help. Contact our team today to learn how we support safer swallowing and stronger outcomes for your patients.
