OBJECTIVE: To evaluate whether inspiratory muscle training (IMT) improves inspiratory muscle strength, respiratory capacity, fatigue, and subjective perception of physical endurance in patients with advanced multiple sclerosis (MS). DESIGN: Randomized controlled trial. SETTING: Outpatient clinic in Sweden. PARTICIPANTS: Fifteen severely disabled patients with MS, randomized to a training or control group. INTERVENTION: Seven patients trained with a Threshold inspiratory muscle trainer, twice every other day, with 3 sets of 10 loaded inspirations (40% to 60% of patients' maximal inspiratory pressure (PImax)) over a 10-week period. MAIN OUTCOME MEASURES: Spirometry, Pimax, maximal expiratory pressure (PEmax), clinical assessments, and questionnaires on the patients' fatigue severity and physical endurance were evaluated. RESULTS: After training, the PImax (p < 0.008) and PEmax (p < 0.02) increased in the training group. The improvement in Pimax after 10 weeks of training was higher than the improvement in the control group (p < 0.01) and was maintained 1 month after the training period ended. The training affected neither respiratory function nor the patients' symptoms. CONCLUSIONS: IMT had a beneficial effect on inspiratory muscle strength in patients with MS and is recommended as a complement to ordinary physical training.

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