Innovations in Respiratory Muscle Training in Older Adults: Implications for PT and SLP Practice

Purpose: Weakness of the respiratory muscles is common in older adults and can affect breathing efficiency, walking, balance, swallowing, and voice. Respiratory muscle training (RMT) including inspiratory (IMT), expiratory (EMT), and combined approaches, have advanced from simple threshold devices to newer calibrated or technology-supported devices systems that offer real-time biofeedback, progressive resistance, and remote monitoring. This narrative review examines recent developments in RMT protocols and their clinical applications in physical therapy (PT) and speech-language pathology (SLP) practice with adults age 65 years and older. Methods: Peer reviewed articles published in PubMed, Google Scholar, and ASHA journals were searched from January 2022 through June 2025 to inform a narrative synthesis. Studies were included if they focused on adults age 65 years or older, used IMT, EMT, or combined RMT within PT or SLP practice, and incorporated technology-supported devices. Results: Across the 20 peer-reviewed studies synthesized, RMT, whether delivered with traditional mechanical threshold devices or newer technology-supported systems, was associated with improvements in inspiratory and expiratory pressures, cough strength, walking distance, balance, swallowing safety, voice measures, dyspnea, and quality of life in geriatric/frail, pulmonary, neurogenic, and voice-disordered populations. Technology-supported devices offering real-time biofeedback, progressive resistance, and remote monitoring did not consistently outperform traditional threshold devices when training parameters were comparable, but were associated with high reported adherence and may particularly benefit older adults with frailty or complex medical needs who require remote supervision. Devices such as POWERbreathe®, PrO 2 Fit™, EMST150, IMT/PEP systems, the Orygen Dual Valve, Resp-in-out, The Breather, and several Internet of Things–based platforms were associated with improvements in inspiratory and expiratory pressures, cough strength, walking distance, balance, swallowing safety, voice measures, dyspnea, and overall quality of life across a range of clinical groups. Technology-assisted programs demonstrated higher adherence. However, very old and severely frail populations remain underrepresented in current research, and long-term follow-up data are limited. Conclusion: Modern RMT devices and protocols enable individualized home-based treatment programs that use feedback to help older adults achieve benefits that extend past lung function improvement to enhance their mobility, airway protection, swallowing abilities, and communication skills. RMT provides a practical method for PT and SLP professionals to work together for better patient results in this specific population.