Inspiratory Muscle Training in Individuals With Multiple Sclerosis

Multiple sclerosis (MS) is a chronic autoimmune disease affecting the central nervoussystem. Although the pathogenesis of the disease is not fully understood, genetic andenvironmental factors are thought to contribute to its development. Demyelinatingplaques, the primary pathological hallmark of MS, are most commonly found in the opticnerves, brainstem, spinal cord, and periventricular white matter. The clinicalmanifestations of the disease vary depending on the regions of the central nervous systemaffected and the extent of inflammation and axonal demyelination. Respiratory functionand respiratory muscle strength have been shown to be lower in individuals with MScompared with healthy individuals. The risk of death due to respiratory complications isapproximately 12 times higher in the MS population than in the general population, and47% of MS‐related deaths are attributed to respiratory complications. These findingshighlight the critical importance of early interventions targeting respiratory function.Although inspiratory muscle training (IMT) has been shown to improve respiratoryfunction, its effects on functional outcomes in individuals with MS have not beensufficiently investigated. However, these functional outcomes are important for improvingquality of life and optimizing rehabilitation in individuals with MS. Furthermore,because studies investigating IMT in individuals with MS are limited, the optimaltraining protocol in terms of training frequency, intensity, and duration has not yetbeen clearly established. Recent studies have demonstrated that high‐intensity intervalIMT is effective in improving respiratory function, respiratory muscle strength, andfunctional capacity in individuals with chronic obstructive pulmonary disease,bronchiectasis, and heart failure, and that it is well tolerated by patients. To the bestof our knowledge, no study has investigated the effects of this approach in individualswith MS.This study is designed as a randomized controlled trial. A total of 48 individualsdiagnosed with MS will be randomly assigned to one of three groups: high‐intensityinterval IMT, low‐intensity IMT, or conventional rehabilitation. The intervention periodwill last 8 weeks. All three groups will receive conventional rehabilitation consistingof aerobic and resistance exercises. In addition, the IMT groups will receive eitherhigh‐intensity interval IMT or low‐intensity IMT. The primary outcome measures of thestudy are respiratory muscle strength, pulmonary function, and cough strength. Secondaryoutcome measures include exercise capacity, lower extremity functional muscle strength,balance, fatigue, dysphagia severity, sleep quality, and quality of life.