Graduation date: 1995

Expiratory muscle strength training (EMST) is a resistance exercise targeting the expiratory musculature that has predominated rehabilitation research for cough and swallowing. While there have been consistent improvements in expiratory muscle strength with EMST, and promising findings in cough and swallowing, there remains a substantial gap in our understanding of the physiologic adaptations associated with training and how to optimize rehabilitative outcomes. This dissertation consists of two studies aimed at refining EMST protocols for cough and swallowing rehabilitation. Chapter 1 is an introduction that provides an overview of exercise prescription principles, outlines what is known related to exercise protocols and EMST outcome measures, and finally describes the current research gaps and dissertation aims. Chapter 2 focuses on quantifying the relationship between resistive load and ratings of perceived exertion (RPE) during EMST, examines variability in RPE in healthy adults, and compares RPE using two respiratory devices. In Chapter 3, we examine the impact of modifying exercise parameters on physiologic adaptations and RPE, while also beginning to establish links between EMST, cough, and swallowing by assessing task specificity. Chapter 4 synthesizes the research findings into the greater scientific literature, discusses the clinical implications of this work, outlines limitations, and suggests avenues for future research.