OBJECTIVE: To explore the effectiveness of breathing-enhanced upper extremity exercises on the respiratory function of patients with multiple sclerosis. DESIGN: Randomized controlled study of six-week duration. SUBJECTS: Forty patients with multiple sclerosis (age 39.2 +/- 7 years; Kurtzke Expanded Disability Status Scale scores: 4.51 +/- 1.55) randomly divided into two groups. METHODS: The training group followed a six-week home training programme designed to strengthen accessory respiratory muscles. Controls performed no exercises. All subjects submitted to baseline and post-training tests of spirometry, respiratory muscle strength and 6-minute walking. They were also assessed with pulmonary dysfunction and exertion fatigue indices. RESULTS: Spirometry revealed clear improvement in forced expiratory volume in 1 second (FEV1) (+13%, p = 0.003) resulting in higher FEV1/FVC (forced vital capacity) (+8.5%, p = 0.03). Maximal inspiratory pressure (PImax) increased by +7.1% but not significantly. Maximal expiratory pressure (PEmax) and FVC were significantly higher (by +7.1%, p = 0.0066 and +4.8%, p = 0.036 respectively) with respect to baseline measures. Pulmonary dysfunction was reduced (-9%, p = 0.002) while 6-minute walking distance was longer (+16%, p = 0.029) at equal exertion fatigue level. CONCLUSIONS: The programme improved most pulmonary performance measures and had clinical significance. Its sustained application may prevent respiratory complications frequently observed in the later stages of multiple sclerosis.

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