Accepted for/Published in: Journal of Medical Internet Research
Date Submitted: May 24, 2025
Date Accepted: Jan 18, 2026
Enhancing Adherence to Home-Based Expiratory Muscle Strength Training in Parkinson’s Disease: A Randomized Controlled Trial of an mHealth Intervention
ABSTRACT
Background:
Long-term adherence to home-based expiratory muscle strength training (EMST) in Parkinson’s disease (PD) is often suboptimal, reducing its therapeutic impact on airway protection.
Objective:
This randomized controlled trial evaluated whether the mHealth-assisted EMST with the SpiroGym app enhances adherence and clinical outcomes compared to conventional EMST, particularly in individuals at risk of non-adherence.
Methods:
In this single-center, phase II, randomized controlled trial, 75 individuals with PD were randomized to receive either conventional EMST or SpiroGym-assisted EMST. All participants underwent an 8-week semi-supervised intensive phase followed by a 16-week unsupervised maintenance phase. The primary outcome was EMST adherence during the maintenance phase in patients at risk of non-adherence. Secondary outcomes included changes in maximum expiratory pressure (MEP) and the Self-Efficacy for Home Exercise Program Scale (SEHEPS).
Results:
Among participants at risk for non-adherence (n=32), the SpiroGym group performed significantly more EMST repetitions during the maintenance phase compared to controls (mean: 1070 vs. 525; P=0.04, Cohen d=0.78). Adherence in the SpiroGym group remained consistently 20% above target, while it declined to 39% in controls. MEP improved significantly more in the experimental group from baseline to week 24 (+43.1 vs. +22.8 cmH₂O; P=0.02, Cohen d=0.73). Both groups improved on SEHEPS, but only the SpiroGym group exceeded the 12-point MDC₉₅, indicating meaningful self-efficacy gains.
Conclusions:
SpiroGym significantly enhanced long-term adherence in individuals at risk for non-adherence, supporting the utility of mHealth for home-based EMST. Moreover, the SpiroGym group achieved significantly greater improvements in MEP compared to the control group. Larger trials with objective swallowing or cough outcomes are warranted to confirm translatable clinical benefits. Clinical Trial: ClinicalTrials.gov NCT05728099; https://clinicaltrials.gov/study/NCT05728099
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