Three important variables guide strength training: intensity, volume, and frequency. In an attempt to develop training guidelines based on existing studies, researchers in respiratory training modeled their guidelines off existing limb training research. Most respiratory training paradigms, for example, follow the limb strength training principle – that training is completed at 75-80% of the limb’s maximum strength. Some patients, however, may not be able to achieve 75-80% maximum expiratory pressure (MEP). In these instances, the medical professional guiding training should start the patient off at a comfortable level to allow the patient to complete 25 repetitions. Progress should be monitored weekly, and the training intensity level should be modified based on changes in strength. When it comes to training frequency, we recommended five sets of five repetitions be completed for 4-5 weeks. This guideline is also based on limb exercise research. When deciding on a patient’s respiratory training plan, the clinician should take stock of the individual’s needs and the therapeutic goal. If the goal is to increase endurance, then completing more repetitions at a lower intensity might be best. Alternatively, if the goal is to become stronger, then the intensity should be set at 75-80% of maximum expiratory strength, and the frequency should be at least five sets of five repetitions.

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