{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,17]],"date-time":"2026-10-17T03:00:39Z","timestamp":1792206039398,"version":"4.4.0"},"reference-count":50,"publisher":"JMIR Publications Inc.","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Med Internet Res"],"abstract":"Abstract<\/jats:title>\n \n Background<\/jats:title>\n Aspiration pneumonia is a leading cause of death in Parkinson disease (PD). Expiratory muscle strength training (EMST) is a promising intervention for respiratory and swallowing dysfunction. However, long-term EMST adherence is frequently poor in PD.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n \n This study aims to determine whether mobile health (mHealth)\u2013assisted EMST with the\n SpiroGym<\/jats:italic>\n app (Czech Technical University) improves long-term adherence and physiological outcomes versus conventional EMST among participants at risk for nonadherence.\n <\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n \n In this single-center, parallel, phase 2 randomized controlled trial, 75 individuals with PD were randomized 1:1 to conventional EMST (control; n=38) or the same protocol enhanced with the\n SpiroGym<\/jats:italic>\n app (experimental; n=37), using a simple computer-generated randomization sequence. The\n SpiroGym<\/jats:italic>\n is an mHealth app that provides real-time performance monitoring, direct visual feedback, and longitudinal progress tracking. All participants completed 8 weeks of semisupervised intensive EMST with biweekly in-person reassessments, followed by 16 weeks of unsupervised maintenance training. The primary outcome was adherence during weeks 8 to 24 among participants at risk for nonadherence, defined a priori at week 8 as Self-Efficacy for Home Exercise Program Scale (SEHEPS) less than 59. Because risk status was determined at week 8 and all participants subsequently entered the unsupervised phase, individuals not classified as at-risk were not excluded. Their data from week 8 onward were reported alongside the at-risk group. Secondary outcomes were changes in maximum expiratory pressure and SEHEPS.\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n No study-related adverse events occurred. Groups were well matched at baseline (control vs experimental: mean disease duration 7.0 (SD 5.7) vs 7.3 SD 4.7) y; mean Hoehn-Yahr 1.97 (SD 0.6) vs 2.0 (SD 0.5)). The mixed-effects model showed no significant 3-way interaction (group\u00d7interval\u00d7SEHEPS risk;\n P<\/jats:italic>\n =.14). At week 24, the at-risk category for the nonadherence cohort comprised 34 participants (control, n=17; experimental, n=17). In this at-risk cohort, the experimental group demonstrated a smaller decline in adherence during weeks 8 to 24 than controls (\n \u03b2<\/jats:italic>\n =496.9, 95% CI 130.7\u2010863.3;\n P<\/jats:italic>\n =.008), completing 1073 (95% CI 643\u20101502) expiratory maneuvers versus 525 (95% CI 358\u2010692). Maximum expiratory pressure increased in both groups from weeks 0 to 24, with larger gains in the experimental group (+43.1\n \n , 95% CI 32.4\u201053.8 cmH\n \u2082<\/jats:sub>\n O) than in controls (+22.8\n \n , 95% CI 13.8\u201031.8 cmH\n \u2082<\/jats:sub>\n O;\n P<\/jats:italic>\n =.006; Cohen\n d<\/jats:italic>\n =0.74). SEHEPS improved after intensive training in both groups, but only the experimental group exceeded the 12-point minimal detectable change at the 95% confidence limit.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n \n This is the first randomized controlled trial to integrate mHealth with EMST. Unlike prior studies in the EMST field, we focused on sustaining long-term exercise adherence.\n SpiroGym<\/jats:italic>\n -assisted EMST resulted in higher long-term adherence and greater gains in expiratory muscle strength than conventional EMST. In real-world PD care, assessing self-efficacy after the supervised EMST phase may help identify individuals who would benefit from digital support, making mHealth-assisted EMST a practical approach for maintaining exercise adherence.\n <\/jats:p>\n <\/jats:sec>","DOI":"10.2196\/78022","type":"journal-article","created":{"date-parts":[[2026,3,11]],"date-time":"2026-03-11T20:17:30Z","timestamp":1773260250000},"page":"e78022-e78022","source":"Crossref","is-referenced-by-count":2,"title":["Enhancing Adherence to Home-Based Expiratory Muscle Strength Training in Parkinson Disease: Randomized Controlled Trial of an mHealth 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