Combined Respiratory Training to Improve Pulmonary and Cough Function in Persons with ALS

Principal Investigator/Project Director

Lauren Tabor Gray

Colleges / Centers

Division of Clinical Operations


U.S. DOD - U.S. Army Medical Research Acquisition Activity (DODMRAA)

Start Date



Lay Abstract. All persons with amyotrophic lateral sclerosis (pALS) experience worsening of breathing and cough function as the disease progresses. Impairments in breathing and the inability to clear the airway contribute to respiratory infections, pneumonia, hospitalizations, and reduced quality of life. Currently, the use of prescription respiratory devices are recommended to maintain pulmonary health and reduce the risk of lung infections in pALS. However, these respiratory devices are typically prescribed reactively once significant impairment in function has already occurred. There are currently no effective, proactive interventions to help prevent deterioration of cough and breathing function in pALS. Therefore, identification of simple, accessible breathing exercises that can be performed immediately following ALS diagnosis is a priority to improve current clinical care for all pALS. We propose that the use of a combined respiratory strength training exercise program will improve breathing and cough function in pALS. Thirty-nine pALS with mild disease severity will complete lung volume recruitment and expiratory muscle strength training exercises daily for five weeks. Both lung volume recruitment and expiratory muscle strength training have been studied independently in pALS and shown to be safe, feasible, and effective in improving respiratory and cough measurements. The goal of this study is to combine these exercise regimens to improve two very important measures of respiratory function and airway clearance: forced vital capacity and peak cough flow. We will also assess how the exercise regimen impacts pALS-reported shortness of breath, exercise therapy burden and quality of life. The proposed combined respiratory training regimen represents an improvement from the current standard of care for the following reasons: 1. Training will be implemented early in the disease to capitalize on and maintain respiratory function and cough strength; 2. Training equipment is accessible, inexpensive and easy-touse; and 3. Training initiation does not require insurance approval or shipment of disposable replacement parts. The proposed study represents an opportunity to intervene proactively and empowers pALS with a tool to combat the loss of function early in the disease process. If successful, this combined training has the potential to improve the trajectory of decline in breathing and cough functions, ultimately prolonging survival in pALS.

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