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Respiratory Muscle Training Improves Exercise Performance and Quality of Life in Cancer Survivors

A Pilot Study

Ray, Andrew D., PT, PhD1; Williams, Brian T., MS2; Mahoney, Martin C., MD, PhD3

doi: 10.1097/01.REO.0000000000000064

Background: Respiratory muscle weakness represents one of the potential mechanisms contributing to exertional dyspnea and reduced exercise performance in lung and breast cancer survivors.

Purpose/Objective: Pilot study of a respiratory muscle training (RMT) program to improve exercise capacity and quality of life (QOL) and reduce dyspnea in breast and lung cancer survivors.

Methods: Participants performed 3 sets of 15 repetitions against spring-loaded inspiratory and expiratory valves, 3 days per week, for 4 weeks, with weekly increases in resistance. Maximal expiratory (MEP) and inspiratory pressures (MIP), exercise tests (

O2peak, submaximal cycling endurance at 70% of peak, and Six-Minute Walk Test [6MWT]) along with questionnaires (Baseline Dyspnea Index and SF-36 [36-Item Short Form Health Survey]) were completed pre- and post-RMT.

Design: Single-arm pilot study.

Setting: University research and academic medical center.

Patients: Lung and breast cancer survivors with the presence of mild-to-moderate dyspnea symptoms not attributed to cardiopulmonary disease.

Results: Post-RMT, MIP and MEP increased 29% ± 21% and 34% ± 32%, respectively (P < .001). Submaximal endurance time (16.9 ± 7.4 minutes vs 31.4 ± 7.7 minutes, P = .001), the distance covered in the 6MWT (427 ± 84 m vs 471 ± 95 m, P = .005), dyspnea index (6.4 ± 1.0 vs 7.6 ± 1.3, P = .02), and QOL (total 85.3 ± 9.4 vs 97.8 ± 12.7, P = .014) were all significantly improved post-RMT.

Limitations: Limited sample size and short duration of follow-up.

Conclusions: These preliminary results support the continued investigation of a respiratory muscle-training program to improve respiratory muscle strength, exercise performance, and QOL, as well as to decrease dyspnea symptoms among cancer survivors.

1Assistant Professor, Department of Rehabilitation Science School of Public Health and Health Professions, University at Buffalo, Buffalo, NY

2Graduate Student, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY

3Professor of Oncology, Departments of Medicine & Health Behavior, Roswell Park Cancer Institute, Buffalo, NY

Correspondence: Andrew D. Ray, PT, PhD, Department of Rehabilitation Science, School of Public Health and Health Professions, University at Buffalo, 501 Kimball Tower, 3435 Main St, Buffalo, NY 14214 (

Grant Support: Funding for this project was supplied by the New York State Physical Therapy Association awarded to Dr Ray.

The authors declare no conflicts of interest.

©2017 (C) Academy of Oncologic Physical Therapy, APTA
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