Expiratory Muscle Strength Training (EMST): What it Is & Who Benefits

Expiratory Muscle Strength Training (EMST) is a type of respiratory muscle training that focuses on strengthening the muscles you use to breathe out.

Expiratory Muscle Strength Training (EMST): What It Is, How It Works, and Who It Helps

Expiratory Muscle Strength Training (EMST, or expiratory muscle training / EMT) is a type of respiratory muscle training that strengthens the muscles you use to breathe out. It can also improve other muscles, like some involved in swallowing.

It’s done using a small handheld device that provides resistance when you exhale -- a bit like weight training, but for your breathing muscles.

When we talk about “breathing muscles,” most people think of the diaphragm, but your expiratory muscles include your abdominal muscles, internal intercostals (between your ribs), and other core muscles that help push air out of your lungs.

These muscles are important for breathing, speaking, coughing, and protecting your airway during swallowing.

How EMST Works

An EMST device is a handheld device set to a certain resistance or difficulty level -- like a pin in a weight machine. Most EMT devices are pressure-threshold.

When you blow into it, nothing happens until you generate enough pressure to open the internal valve. This means your expiratory muscles must work harder than they do in everyday breathing.

Typical EMST involves:

Setting the device’s spring-loaded valve to a target resistance
Performing short, forceful exhalations into the device
Following a structured program, often 5 sets of 5 breaths per day, several days per week
Typically completing exercise based on a certain percentage of your strength at the time of testing

Why Strengthen the Expiratory Muscles?

Strong expiratory muscles can improve:

Cough effectiveness: crucial for clearing mucus and protecting against pneumonia
Speech & voice volume and clarity: especially for people with conditions that cause low voice volume
Airway protection during swallowing

Who Might Benefit from EMST

Research and clinical experience suggest EMST may help:

People with neurological conditions (like Parkinson disease, multiple sclerosis, stroke, ALS)
Individuals with certain types of swallowing difficulties (dysphagia)
Singers, musicians, and performers who rely on strong breath control & strong vocal quality

Is EMST Safe?

For most healthy people, EMST is safe when done correctly.

However, it may not be appropriate for:

People with uncontrolled high blood pressure
Those with certain cardiac conditions
Individuals who have recently had surgery or a medical event affecting the lungs or abdomen

It’s best to check with a qualified healthcare provider before starting EMST, especially if you have a medical condition.

Getting Started

Assessment first
A respiratory muscle strength test (measuring maximal expiratory pressure or MEP) helps set a safe, effective starting point.
Choose the right device
Popular devices include EMST150, EMST75 Lite, The Breather, and POWERbreathe. Each has different features and resistance ranges, and not all devices work the same way.
Follow a program
Many studies use a “5 sets of 5 breaths”, once a day, 5 days a week protocol, adjusted over time to continue building strength.
Track your progress
Reassessing every week or so helps ensure you’re working at the right intensity.

EMST vs. IMT

EMST trains the expiratory (breathing out) muscles
IMT trains the inspiratory (breathing in) muscles.
Some people do both, depending on their needs. Usually one modality is enough.

Bottom Line

EMST is a simple, portable, and research-supported way to strengthen the muscles you use to breathe out, speak, and cough.
Whether you’re recovering from illness, living with a chronic condition, or looking to boost performance, a tailored EMST program can be an effective part of your training or rehabilitation plan.

Learn more about EMST programs and devices here → https://breathehab.com/courses

Categories: : EMT, RMT basics