{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,28]],"date-time":"2026-03-28T03:57:45Z","timestamp":1774670265264,"version":"3.50.1"},"reference-count":56,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,9,25]],"date-time":"2025-09-25T00:00:00Z","timestamp":1758758400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Neurol."],"abstract":"Background<\/jats:title>Respiratory muscle training is a structured intervention designed to enhance respiratory muscle function, but robust evidence on its effects in myasthenia gravis remains limited. This systematic review evaluates the impact of respiratory muscle training on respiratory function and functional outcomes in patients with myasthenia gravis.<\/jats:p><\/jats:sec>Methods<\/jats:title>A comprehensive search of six databases was conducted without date restrictions until May 1, 2025, to identify studies meeting inclusion criteria: (1) myasthenia gravis patients aged \u226518\u202fyears, (2) respiratory muscle training involving inspiratory and expiratory muscle training, (3) outcomes on respiratory muscle strength, respiratory muscle endurance, pulmonary function tests, and functional outcome, (4) study designs like randomised controlled trials (RCTs), cohort studies, case\u2013control trials, and quasi-experimental studies. Two reviewers independently screened studies, extracted data, and assessed methodological quality and evidence level using appropriate tools. Due to limited RCTs and heterogeneity in participants, interventions, and outcomes, a descriptive synthesis was performed.<\/jats:p><\/jats:sec>Results<\/jats:title>Seven studies involving 223 participants (99 males and 124 females) with a mean age of 57.5\u202fyears were systematically reviewed, including two RCTs, one quasi-controlled study, one case\u2013control study, and three cohort studies, all of which demonstrated moderate-to-high methodological quality (evidence levels 2\u20134). Respiratory muscle training programs involved inspiratory-expiratory training and inspiratory-only training, with parameters varying widely: intensity ranged from 15 to 75% of maximal respiratory pressures or 50 to 60% of maximal voluntary ventilation, frequency spanned from 3 to 10 sessions weekly, sessions lasted 10 to 30\u202fmin, and total intervention periods extended from 4\u202fweeks to 12\u202fmonths. Devices included threshold and variable resistance trainers, all applied under supervised conditions alongside conventional myasthenia gravis medications. All five studies evaluating respiratory muscle endurance and functional outcomes reported statistically significant enhancements (p<\/jats:italic> &lt;\u202f0.05). Respiratory muscle strength and pulmonary function results were inconsistent. Maximal inspiratory pressure improved significantly in two of six studies (p<\/jats:italic> &lt;\u202f0.01), while maximal expiratory pressure improved in two of three studies (p<\/jats:italic> &lt;\u202f0.05). Among six studies measuring forced expiratory volume in 1\u202fs, three measuring forced vital capacity, and three measuring peak expiratory flow, only two studies reported significant improvements in forced expiratory volume in 1\u202fs and forced vital capacity (p<\/jats:italic> &lt;\u202f0.05), while others found no effects. Adverse events reported in three studies were attributed to comorbidities rather than interventions.<\/jats:p><\/jats:sec>Conclusion<\/jats:title>Respiratory muscle training can enhance respiratory muscle endurance and functional outcomes in patients with myasthenia gravis. However, evidence regarding its effects on respiratory muscle strength and pulmonary function remains inconsistent and is constrained by methodological limitations. Higher-quality trials are warranted to validate these findings and optimize intervention protocols.<\/jats:p><\/jats:sec>Systematic review registration<\/jats:title>CRD42024516112.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fneur.2025.1667400","type":"journal-article","created":{"date-parts":[[2025,9,25]],"date-time":"2025-09-25T04:17:35Z","timestamp":1758773855000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Effects of respiratory muscle training on respiratory function and functional outcomes in patients with myasthenia gravis: a systematic review"],"prefix":"10.3389","volume":"16","author":[{"given":"Zi-Ting","family":"Bi","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jing-Hua","family":"Xiao","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jing-Xue","family":"Wei","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lang","family":"Huang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ying-Dong","family":"Li","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yue-Mi","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jian","family":"Huang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chao-Song","family":"Luo","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jia-Mei","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yun-Shan","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2025,9,25]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"2570","DOI":"10.1056\/NEJMra1602678","article-title":"Myasthenia gravis","volume":"375","author":"Gilhus","year":"2016","journal-title":"N Engl J Med"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"137","DOI":"10.2217\/nmt-2018-0014","article-title":"Myasthenia gravis: the unmet needs of a paradigmatic autoimmune disease","volume":"8","author":"Modrego","year":"2018","journal-title":"Neurodegener Dis Manag"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"143","DOI":"10.1111\/nyas.13592","article-title":"Serological and experimental studies in different forms of myasthenia gravis","volume":"1413","author":"Vincent","year":"2018","journal-title":"Ann N Y Acad Sci"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"7","DOI":"10.25122\/jml-2020-0145","article-title":"The epidemiology of myasthenia gravis","volume":"14","author":"Bubuioc","year":"2021","journal-title":"J Med Life"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"46","DOI":"10.1186\/1471-2377-10-46","article-title":"A systematic review of population based epidemiological studies in myasthenia gravis","volume":"10","author":"Carr","year":"2010","journal-title":"BMC Neurol"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"e6808","DOI":"10.7759\/cureus.6808","article-title":"Myasthenia gravis with elderly onset at advanced age","volume":"12","author":"Hernandez Fustes","year":"2020","journal-title":"Cureus"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"100063","DOI":"10.1016\/j.lanwpc.2020.100063","article-title":"Incidence, mortality, and economic burden of myasthenia gravis in China: a nationwide population-based study","volume":"5","author":"Chen","year":"2020","journal-title":"Lancet Reg Health West Pac"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"71","DOI":"10.3390\/jfmk5040071","article-title":"Evidence-based practice in rehabilitation of myasthenia gravis. 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