Inspiratory Training in Amyotrophic Lateral Sclerosis - a phase III, multi-centre, double-blind, randomised-controlled trial

INTERVENTION: Inspiratory muscle training ‐ similar to resistance training of limb muscles except the target muscle group is the inspiratory muscles. Inspiratory muscle training involves inhaling through an threshold inspiratory muscle training device for 10 minutes, three times per day for 32 weeks. CONDITION: Amyotrophic lateral sclerosis Motor neuron disease PRIMARY OUTCOME: Sniff nasal inspiratory pressure. SECONDARY OUTCOME: 6 minute walk test Amyotrophic Lateral Sclerosis Functional Rating Scale‐revised Grip strength using a handheld Jamar dynamometer Health‐relatd quality of life (Short Form 36) Health‐related quality of life (Chronic Respiratory Questionnaire) Respiratory function (forced vital capacity, vital capacity, forced expiratory volume in one second) Survival INCLUSION CRITERIA: Definite, probable or possible amyotrophic lateral sclerosis according to the revised El Escorial criteria. Disease duration of less than 3 years & sniff nasal inspiratory pressure of equal to or greater than 40% predicted. OR disease duration of more than 3 years & sniff nasal inspiratory pressure less than 40% predicted.