Enhancing Adherence to Home-Based Expiratory Muscle Strength Training in Parkinson Disease: Randomized Controlled Trial of an mHealth Intervention

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. SpiroGym-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.