OBJECTIVE: To investigate the effects of respiratory muscle training (RMT) in patients with restrictive thoracic disorders and intermittent noninvasive positive-pressure ventilation (NPPV). DESIGN: Prospective randomized controlled trial. SETTING: Home-based RMT, with assessment in a primary care pulmonary center. PARTICIPANTS: Thirty patients with restrictive thoracic disorders; 28 patients completed the trial. INTERVENTION: Three months of RMT by isocapnic hyperpnea or sham training. MAIN OUTCOME MEASURES: Respiratory muscle strength and endurance, lung function, exercise performance, and health-related quality of life (HRQOL). RESULTS: After RMT, maximal inspiratory mouth pressure was increased (27.6% +/- 36.5%, p = 0.013). In patients who could perform cycle ergometer testing (n = 17), peak oxygen consumption (2.24 +/- 3.39 mL/kg/min versus -1.71 +/- 2.54 mL/kg/min, p = 0.014) and maximal work rate (9.4 +/- 14.8 W versus -5.1 +/- 10.8 W, p = 0.043) increased relative to a control group. Similar differences occurred regarding changes of HRQOL (physical performance, 3.3 +/- 11.4 score versus -6.6 +/- 9.0 score; p = 0.012) and time of ventilator use (-0.6 +/- 1.2 h/d versus 0.4 +/- 0.5 h/d, p = 0.010). Lung volumes, 12-second maximum voluntary ventilation, 6-minute walking distance, and blood gases were unchanged. CONCLUSIONS: In patients with restrictive thoracic disorders and NPPV, RMT improved inspiratory muscle strength. Exercise performance and HRQOL were improved when the 2 groups were compared. RMT was practicable and safe despite severe respiratory impairment. Further evaluation, including different training intensities and modalities, seems warranted.

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