Trial Outcomes & Findings for Vocal Warm-up and Respiratory Muscle Training (NCT NCT02102399)

NCT ID: NCT02102399

Last Updated: 2015-10-08

Results Overview

The voice handicap index (VHI) is a self-assessment questionnaire which quantifies the functional, physical and emotional impacts of a voice disorder on the quality of life. The VHI-10 is a reduced version and it consists of 10 questions about the severity of the voice problem perceived by the subject. It is presented as an ordinal scale (range 0-4) that indicates how frequently the subject has experienced the same situation (0 = never; 1 = almost never; 2 = sometimes; 3= almost always; 4 = always). Total VHI Score ranges from 0 (never) to 40 (always). Higher scores indicate greater voice handicap. Abnormal values \> 11.

• Recruitment status: COMPLETED
• Study phase: NA
• Target enrollment: 41 participants
• Primary outcome timeframe: Baseline, 6 weeks
• Results posted on: 2015-10-08

Participant Flow

The population sample was selected by convenience criteria. All the school's teachers were invited to participate and were selected according to eligibility criteria in the beginning of the study.

Participant milestones

Measure	Vocal Warm-up Vocal Warm up group performed 13 minutes of vocal warm-up exercises everyday before teaching over a course of 6 weeks, with one session exercise per day.	Respiratory Muscle Training Respiratory Muscle Training group performed 13 minutes of Respiratory Muscle Training everyday before teaching over a course of 6 weeks, with one session exercise per day.
Overall Study STARTED	20	21
Overall Study COMPLETED	14	17
Overall Study NOT COMPLETED	6	4

Reasons for withdrawal

Measure	Vocal Warm-up Vocal Warm up group performed 13 minutes of vocal warm-up exercises everyday before teaching over a course of 6 weeks, with one session exercise per day.	Respiratory Muscle Training Respiratory Muscle Training group performed 13 minutes of Respiratory Muscle Training everyday before teaching over a course of 6 weeks, with one session exercise per day.
Overall Study Withdrawal by Subject	6	4

Baseline Characteristics

Vocal Warm-up and Respiratory Muscle Training

Baseline characteristics by cohort

Measure	Vocal Warm-up n=14 Participants Vocal Warm up group was performed during 13 minutes of vocal warm-up exercises everyday before teaching over a course of 6 weeks, with one session exercise per day.	Respiratory Muscle Training n=17 Participants Respiratory Muscle Training group was performed during 13 minutes of Respiratory Muscle Training everyday before teaching over a course of 6 weeks, with one session exercise per day.	Total n=31 Participants Total of all reporting groups
Age, Continuous	45.8 years STANDARD_DEVIATION 8.1 • n=5 Participants	43.6 years STANDARD_DEVIATION 11.4 • n=7 Participants	44.6 years STANDARD_DEVIATION 9.9 • n=5 Participants
Sex: Female, Male Female	12 Participants n=5 Participants	12 Participants n=7 Participants	24 Participants n=5 Participants
Sex: Female, Male Male	2 Participants n=5 Participants	5 Participants n=7 Participants	7 Participants n=5 Participants

PRIMARY outcome

Timeframe: Baseline, 6 weeks

Population: Within-group analysis (pretest vs. posttest)

The voice handicap index (VHI) is a self-assessment questionnaire which quantifies the functional, physical and emotional impacts of a voice disorder on the quality of life. The VHI-10 is a reduced version and it consists of 10 questions about the severity of the voice problem perceived by the subject. It is presented as an ordinal scale (range 0-4) that indicates how frequently the subject has experienced the same situation (0 = never; 1 = almost never; 2 = sometimes; 3= almost always; 4 = always). Total VHI Score ranges from 0 (never) to 40 (always). Higher scores indicate greater voice handicap. Abnormal values > 11.

Outcome measures

Measure	Respiratory Muscle Training (Baseline) n=17 Participants Respiratory Muscle Training group performed 13 minutes of Respiratory Muscle Training everyday before teaching over a course of 6 weeks, with one session exercise per day.	Respiratory Muscle Training (Posttest) n=17 Participants Respiratory Muscle Training group performed 13 minutes of respiratory muscle training everyday before teaching over a course of 6 weeks, with one session exercise per day.
Voice Handicap Index (VHI-10)	20.44 units on a scale Standard Deviation 13.70	13.82 units on a scale Standard Deviation 10.86

PRIMARY outcome

Timeframe: Baseline, 6 weeks

Population: Within-group analysis (pretest vs. posttest)

The measurement of fundamental frequency directly reflects the rate of vibration of the vocal folds. The fundamental frequency term refers to the frequency of more occurrence of vocal fold vibration, featuring a certain production.

Outcome measures

Measure	Respiratory Muscle Training (Baseline) n=17 Participants Respiratory Muscle Training group performed 13 minutes of Respiratory Muscle Training everyday before teaching over a course of 6 weeks, with one session exercise per day.	Respiratory Muscle Training (Posttest) n=17 Participants Respiratory Muscle Training group performed 13 minutes of respiratory muscle training everyday before teaching over a course of 6 weeks, with one session exercise per day.
Acoustic Analysis (Fundamental Frequency)	191.87 Hertz (Hz) Standard Deviation 43.35	185.71 Hertz (Hz) Standard Deviation 33.70

PRIMARY outcome

Timeframe: Baseline, 6 weeks

Population: Within-group analysis (pretest vs. posttest)

Jitter is the perturbation cycle-to-cycle of the fundamental frequency. High levels of jitter are normally associated with pathological voice. The instability of the fundamental frequency can be attributed to changes in size, shape or firmness of the vocal folds.

Normal values must be < 0.6%.

Outcome measures

Measure	Respiratory Muscle Training (Baseline) n=17 Participants Respiratory Muscle Training group performed 13 minutes of Respiratory Muscle Training everyday before teaching over a course of 6 weeks, with one session exercise per day.	Respiratory Muscle Training (Posttest) n=17 Participants Respiratory Muscle Training group performed 13 minutes of respiratory muscle training everyday before teaching over a course of 6 weeks, with one session exercise per day.
Acoustic Analysis (Jitter)	0.19 percentage of jitter Standard Deviation 0.14	0.45 percentage of jitter Standard Deviation 0.94

PRIMARY outcome

Timeframe: Baseline, 6 weeks

Population: Within-group analysis (pretest vs. posttest)

The shimmer measures the amplitude's disturbance, e. g. how fast the amplitude changes on a sustained vowel for a few seconds. Shimmer high levels are normally associated with pathological voice. This can be attributed due to changes in size, shape or firmness of the vocal folds.

Normal values < 6.5%.

Outcome measures

Measure	Respiratory Muscle Training (Baseline) n=17 Participants Respiratory Muscle Training group performed 13 minutes of Respiratory Muscle Training everyday before teaching over a course of 6 weeks, with one session exercise per day.	Respiratory Muscle Training (Posttest) n=17 Participants Respiratory Muscle Training group performed 13 minutes of respiratory muscle training everyday before teaching over a course of 6 weeks, with one session exercise per day.
Acoustic Analysis (Shimmer)	2.77 percentage of shimmer Standard Deviation 0.94	4.19 percentage of shimmer Standard Deviation 2.60

PRIMARY outcome

Timeframe: Baseline, 6 weeks

Population: Within-group analysis (pretest vs. posttest)

Noise is the analysis of aperiodic components of the sound's signal. It is an important correlate of that the human ear considers voice disorders. Normal levels < 2.5 dB

Outcome measures

Measure	Respiratory Muscle Training (Baseline) n=17 Participants Respiratory Muscle Training group performed 13 minutes of Respiratory Muscle Training everyday before teaching over a course of 6 weeks, with one session exercise per day.	Respiratory Muscle Training (Posttest) n=17 Participants Respiratory Muscle Training group performed 13 minutes of respiratory muscle training everyday before teaching over a course of 6 weeks, with one session exercise per day.
Acoustic Analysis (Noise)	0.72 Decibel (dB) Standard Deviation 0.46	0.72 Decibel (dB) Standard Deviation 0.44

PRIMARY outcome

Timeframe: Baseline, 6 weeks

Population: Within-group analysis (pretest vs. posttest)

Glottal to Noise Excitation ratio (GNE) is an acoustic measurement to calculate the noise in a series of pulses produced by the oscillation of the vocal folds. This parameter is based on the hypothesis that resulting pulses of vocal fold collision generate a synchronous excitation of different frequency bands. Moreover, the noise produced by the vocal folds compressed generates uncorrelated excitations.

Normal levels > 0.5 dB

Outcome measures

Measure	Respiratory Muscle Training (Baseline) n=17 Participants Respiratory Muscle Training group performed 13 minutes of Respiratory Muscle Training everyday before teaching over a course of 6 weeks, with one session exercise per day.	Respiratory Muscle Training (Posttest) n=17 Participants Respiratory Muscle Training group performed 13 minutes of respiratory muscle training everyday before teaching over a course of 6 weeks, with one session exercise per day.
Acoustic Analysis (GNE)	0.88 Decibel (dB) Standard Deviation 0.11	0.88 Decibel (dB) Standard Deviation 0.11

PRIMARY outcome

Timeframe: Baseline, 6 weeks

Population: Within-group analysis (pretest vs. posttest)

The voice handicap index (VHI) is a self-assessment questionnaire which quantifies the functional, physical and emotional impacts of a voice disorder on the quality of life. The VHI-10 is a reduced version and it consists of 10 questions about the severity of the voice problem perceived by the subject. It is presented as an ordinal scale (range 0-4) that indicates how frequently the subject has experienced the same situation (0 = never; 1 = almost never; 2 = sometimes; 3= almost always; 4 = always). Total VHI Score ranges from 0 (never) to 40 (always). Higher scores indicate greater voice handicap. Abnormal values > 11.

Outcome measures

Measure	Respiratory Muscle Training (Baseline) n=14 Participants Respiratory Muscle Training group performed 13 minutes of Respiratory Muscle Training everyday before teaching over a course of 6 weeks, with one session exercise per day.	Respiratory Muscle Training (Posttest) n=14 Participants Respiratory Muscle Training group performed 13 minutes of respiratory muscle training everyday before teaching over a course of 6 weeks, with one session exercise per day.
Voice Handicap Index (VHI-10) 2	21.78 units on a scale Standard Deviation 17.44	13.04 units on a scale Standard Deviation 14.18

PRIMARY outcome

Timeframe: Baseline, 6 weeks

Population: Within-group analysis (pretest vs. posttest)

The measurement of fundamental frequency directly reflects the rate of vibration of the vocal folds. The fundamental frequency term refers to the frequency of more occurrence of vocal fold vibration, featuring a certain production.

Outcome measures

Measure	Respiratory Muscle Training (Baseline) n=14 Participants Respiratory Muscle Training group performed 13 minutes of Respiratory Muscle Training everyday before teaching over a course of 6 weeks, with one session exercise per day.	Respiratory Muscle Training (Posttest) n=14 Participants Respiratory Muscle Training group performed 13 minutes of respiratory muscle training everyday before teaching over a course of 6 weeks, with one session exercise per day.
Acoustic Analysis (Fundamental Frequency) 2	196.21 Hertz (Hz) Standard Deviation 34.47	186.25 Hertz (Hz) Standard Deviation 31.53

PRIMARY outcome

Timeframe: Baseline, 6 weeks

Population: Within-group analysis (pretest vs. posttest)

Jitter is the perturbation cycle-to-cycle of the fundamental frequency. High levels of jitter are normally associated with pathological voice. The instability of the fundamental frequency can be attributed to changes in size, shape or firmness of the vocal folds.

Normal values must be < 0.6%.

Outcome measures

Measure	Respiratory Muscle Training (Baseline) n=14 Participants Respiratory Muscle Training group performed 13 minutes of Respiratory Muscle Training everyday before teaching over a course of 6 weeks, with one session exercise per day.	Respiratory Muscle Training (Posttest) n=14 Participants Respiratory Muscle Training group performed 13 minutes of respiratory muscle training everyday before teaching over a course of 6 weeks, with one session exercise per day.
Acoustic Analysis (Jitter) 2	0.14 percentage of jitter Standard Deviation 0.11	0.10 percentage of jitter Standard Deviation 0.05

PRIMARY outcome

Timeframe: Baseline, 6 weeks

Population: Within-group analysis (pretest vs. posttest)

The shimmer measures the amplitude's disturbance, e. g. how fast the amplitude changes on a sustained vowel for a few seconds. Shimmer high levels are normally associated with pathological voice. This can be attributed due to changes in size, shape or firmness of the vocal folds.

Normal values < 6.5%.

Outcome measures

Measure	Respiratory Muscle Training (Baseline) n=14 Participants Respiratory Muscle Training group performed 13 minutes of Respiratory Muscle Training everyday before teaching over a course of 6 weeks, with one session exercise per day.	Respiratory Muscle Training (Posttest) n=14 Participants Respiratory Muscle Training group performed 13 minutes of respiratory muscle training everyday before teaching over a course of 6 weeks, with one session exercise per day.
Acoustic Analysis (Shimmer) 2	2.90 percentage of shimmer Standard Deviation 0.85	3.10 percentage of shimmer Standard Deviation 0.97

PRIMARY outcome

Timeframe: Baseline, 6 weeks

Population: Within-group analysis (pretest vs. posttest)

Noise is the analysis of aperiodic components of the sound's signal. It is an important correlate of that the human ear considers voice disorders. Normal levels < 2.5 dB

Outcome measures

Measure	Respiratory Muscle Training (Baseline) n=14 Participants Respiratory Muscle Training group performed 13 minutes of Respiratory Muscle Training everyday before teaching over a course of 6 weeks, with one session exercise per day.	Respiratory Muscle Training (Posttest) n=14 Participants Respiratory Muscle Training group performed 13 minutes of respiratory muscle training everyday before teaching over a course of 6 weeks, with one session exercise per day.
Acoustic Analysis (Noise) 2	0.69 Decibel (dB) Standard Deviation 0.50	0.68 Decibel (dB) Standard Deviation 0.50

PRIMARY outcome

Timeframe: Baseline, 6 weeks

Population: Within-group analysis (pretest vs. posttest)

Glottal to Noise Excitation ratio (GNE) is an acoustic measurement to calculate the noise in a series of pulses produced by the oscillation of the vocal folds. This parameter is based on the hypothesis that resulting pulses of vocal fold collision generate a synchronous excitation of different frequency bands. Moreover, the noise produced by the vocal folds compressed generates uncorrelated excitations.

Normal levels > 0.5 dB

Outcome measures

Measure	Respiratory Muscle Training (Baseline) n=14 Participants Respiratory Muscle Training group performed 13 minutes of Respiratory Muscle Training everyday before teaching over a course of 6 weeks, with one session exercise per day.	Respiratory Muscle Training (Posttest) n=14 Participants Respiratory Muscle Training group performed 13 minutes of respiratory muscle training everyday before teaching over a course of 6 weeks, with one session exercise per day.
Acoustic Analysis (GNE) 2	0.89 Decibel (dB) Standard Deviation 0.12	0.92 Decibel (dB) Standard Deviation 0.06

PRIMARY outcome

Timeframe: Baseline, 6 weeks

Population: Between-group analysis (mean difference posttest minus pretest)

The voice handicap index (VHI) is a self-assessment questionnaire which quantifies the functional, physical and emotional impacts of a voice disorder on the quality of life. The VHI-10 is a reduced version and it consists of 10 questions about the severity of the voice problem perceived by the subject. It is presented as an ordinal scale (range 0-4) that indicates how frequently the subject has experienced the same situation (0 = never; 1 = almost never; 2 = sometimes; 3= almost always; 4 = always). Total VHI Score ranges from 0 (never) to 40 (always). Higher scores indicate greater voice handicap. Abnormal values > 11.

Outcome measures

Measure	Respiratory Muscle Training (Baseline) n=14 Participants Respiratory Muscle Training group performed 13 minutes of Respiratory Muscle Training everyday before teaching over a course of 6 weeks, with one session exercise per day.	Respiratory Muscle Training (Posttest) n=17 Participants Respiratory Muscle Training group performed 13 minutes of respiratory muscle training everyday before teaching over a course of 6 weeks, with one session exercise per day.
Change in Voice Handicap Index (VHI-10)	-8.75 units on a scale Standard Deviation 10.13	-6.61 units on a scale Standard Deviation 6.84

PRIMARY outcome

Timeframe: Baseline, 6 weeks

Population: Between-group analysis (mean difference posttest minus pretest)

The measurement of fundamental frequency directly reflects the rate of vibration of the vocal folds. The fundamental frequency term refers to the frequency of more occurrence of vocal fold vibration, featuring a certain production.

Outcome measures

Measure	Respiratory Muscle Training (Baseline) n=14 Participants Respiratory Muscle Training group performed 13 minutes of Respiratory Muscle Training everyday before teaching over a course of 6 weeks, with one session exercise per day.	Respiratory Muscle Training (Posttest) n=17 Participants Respiratory Muscle Training group performed 13 minutes of respiratory muscle training everyday before teaching over a course of 6 weeks, with one session exercise per day.
Change in Fundamental Frequency	-9.96 Hertz (Hz) Standard Deviation 17.14	-6.15 Hertz (Hz) Standard Deviation 26.11

PRIMARY outcome

Timeframe: Baseline, 6 weeks

Population: Between-group analysis (mean difference posttest minus pretest)

Jitter is the perturbation cycle-to-cycle of the fundamental frequency. High levels of jitter are normally associated with pathological voice. The instability of the fundamental frequency can be attributed to changes in size, shape or firmness of the vocal folds.

Normal values must be < 0.6%.

Outcome measures

Measure	Respiratory Muscle Training (Baseline) n=14 Participants Respiratory Muscle Training group performed 13 minutes of Respiratory Muscle Training everyday before teaching over a course of 6 weeks, with one session exercise per day.	Respiratory Muscle Training (Posttest) n=17 Participants Respiratory Muscle Training group performed 13 minutes of respiratory muscle training everyday before teaching over a course of 6 weeks, with one session exercise per day.
Change in Jitter	-0.02 percentage of jitter Standard Deviation 0.10	0.25 percentage of jitter Standard Deviation 0.89

PRIMARY outcome

Timeframe: Baseline, 6 weeks

Shimmer measures the amplitude perturbations, e. g. how fast the amplitude changes on a sustained vowel for a few seconds. Shimmer high levels are normally associated with pathological voice. This can be attributed due to changes in size, shape or firmness of the vocal folds. Normal values < 6.5%

Outcome measures

Measure	Respiratory Muscle Training (Baseline) n=14 Participants Respiratory Muscle Training group performed 13 minutes of Respiratory Muscle Training everyday before teaching over a course of 6 weeks, with one session exercise per day.	Respiratory Muscle Training (Posttest) n=17 Participants Respiratory Muscle Training group performed 13 minutes of respiratory muscle training everyday before teaching over a course of 6 weeks, with one session exercise per day.
Change in Shimmer	0.20 percentage of shimmer Standard Deviation 0.89	1.41 percentage of shimmer Standard Deviation 2.30

PRIMARY outcome

Timeframe: Baseline, 6 weeks

Population: Between-group analysis (mean difference posttest minus pretest)

Noise is the analysis of aperiodic components of the sound's signal. It is an important correlate of that the human ear considers voice disorders. Normal levels < 2.5 dB

Outcome measures

Measure	Respiratory Muscle Training (Baseline) n=14 Participants Respiratory Muscle Training group performed 13 minutes of Respiratory Muscle Training everyday before teaching over a course of 6 weeks, with one session exercise per day.	Respiratory Muscle Training (Posttest) n=17 Participants Respiratory Muscle Training group performed 13 minutes of respiratory muscle training everyday before teaching over a course of 6 weeks, with one session exercise per day.
Change in Noise	-0.01 Decibel (dB) Standard Deviation 0.14	-0.004 Decibel (dB) Standard Deviation 0.67

PRIMARY outcome

Timeframe: Baseline, 6 weeks

Population: Between-group analysis (mean difference posttest minus pretest)

Glottal to Noise Excitation ratio (GNE) is an acoustic measurement to calculate the noise in a series of pulses produced by the oscillation of the vocal folds. This parameter is based on the hypothesis that resulting pulses of vocal fold collision generate a synchronous excitation of different frequency bands. Moreover, the noise produced by the vocal folds compressed generates uncorrelated excitations.

Normal levels > 0.5 dB

Outcome measures

Measure	Respiratory Muscle Training (Baseline) n=14 Participants Respiratory Muscle Training group performed 13 minutes of Respiratory Muscle Training everyday before teaching over a course of 6 weeks, with one session exercise per day.	Respiratory Muscle Training (Posttest) n=17 Participants Respiratory Muscle Training group performed 13 minutes of respiratory muscle training everyday before teaching over a course of 6 weeks, with one session exercise per day.
Change in GNE	0.02 Decibel (dB) Standard Deviation 0.13	0.001 Decibel (dB) Standard Deviation 0.67

SECONDARY outcome

Timeframe: After 6 weeks of intervention

Population: Between-group analysis

The post-treatment questionnaire was based on the original designed by Roy (2003) for assessing the teachers' perception of voice improvement and compliance with the intervention. Participants rated their extent of improvement on a 3-point Likert scale ("not at all/somewhat"; "moderate"; "a lot"). The questionnaire was applied only after the intervention. The answers were dichotomized in two categories ("moderate/a lot" and "not at all/somewhat"). The results were presented in frequency/percentage of subjects that answered "moderate/a lot" in each intervention.

Outcome measures

Measure	Respiratory Muscle Training (Baseline) n=14 Participants Respiratory Muscle Training group performed 13 minutes of Respiratory Muscle Training everyday before teaching over a course of 6 weeks, with one session exercise per day.	Respiratory Muscle Training (Posttest) n=17 Participants Respiratory Muscle Training group performed 13 minutes of respiratory muscle training everyday before teaching over a course of 6 weeks, with one session exercise per day.
Post-treatment Questionnaire (Voice Symptoms Improvement)	64.3 percentage of participants	11.8 percentage of participants

SECONDARY outcome

Timeframe: After 6 weeks of intervention

Population: Between-group analysis

The post-treatment questionnaire was based on the original designed by Roy (2003) for assessing the teachers' perception of voice improvement and compliance with the intervention. Participants rated their extent of improvement on a 3-point Likert scale ("not at all/somewhat"; "moderate"; "a lot"). The questionnaire was applied only after the intervention. The answers were dichotomized in two categories ("moderate/a lot" and "not at all/somewhat"). The results were presented in frequency/percentage of subjects that answered "moderate/a lot" in each intervention.

Outcome measures

Measure	Respiratory Muscle Training (Baseline) n=14 Participants Respiratory Muscle Training group performed 13 minutes of Respiratory Muscle Training everyday before teaching over a course of 6 weeks, with one session exercise per day.	Respiratory Muscle Training (Posttest) n=17 Participants Respiratory Muscle Training group performed 13 minutes of respiratory muscle training everyday before teaching over a course of 6 weeks, with one session exercise per day.
Post-treatment Questionnaire (Voice Clearer)	50 percentage of subjects	17.7 percentage of subjects

SECONDARY outcome

Timeframe: After 6 weeks of intervention

Population: Between-group analysis

The post-treatment questionnaire was based on the original designed by Roy (2003) for assessing the teachers' perception of voice improvement and compliance with the intervention. Participants rated their extent of improvement on a 3-point Likert scale ("not at all/somewhat"; "moderate"; "a lot"). The questionnaire was applied only after the intervention. The answers were dichotomized in two categories ("moderate/a lot" and "not at all/somewhat"). The results were presented in frequency/percentage of subjects that answered "moderate/a lot" in each intervention.

Outcome measures

Measure	Respiratory Muscle Training (Baseline) n=14 Participants Respiratory Muscle Training group performed 13 minutes of Respiratory Muscle Training everyday before teaching over a course of 6 weeks, with one session exercise per day.	Respiratory Muscle Training (Posttest) n=17 Participants Respiratory Muscle Training group performed 13 minutes of respiratory muscle training everyday before teaching over a course of 6 weeks, with one session exercise per day.
Post-treatment Questionnaire (Easier to Talk)	57.2 percentage of subjects	17.7 percentage of subjects

SECONDARY outcome

Timeframe: After 6 weeks of intervention

Population: Between-group analysis

The post-treatment questionnaire was based on the original designed by Roy (2003) for assessing the teachers' perception of voice improvement and compliance with the intervention. Participants rated their degree of compliance on a 3-point Likert scale ("not at all/somewhat"; "moderate"; "a lot"). The questionnaire was applied only after the intervention. The answers were dichotomized in two categories ("moderate/a lot" and "not at all/somewhat"). It was considered compliance the answers "moderate" and "a lot" in comparison of "not at all/somewhat", considered as no compliance. The results were presented in frequency/percentage of subjects in each intervention.

Outcome measures

Measure	Respiratory Muscle Training (Baseline) n=14 Participants Respiratory Muscle Training group performed 13 minutes of Respiratory Muscle Training everyday before teaching over a course of 6 weeks, with one session exercise per day.	Respiratory Muscle Training (Posttest) n=17 Participants Respiratory Muscle Training group performed 13 minutes of respiratory muscle training everyday before teaching over a course of 6 weeks, with one session exercise per day.
Post-treatment Questionnaire (Compliance With Intervention)	100 percentage of subjects	76.5 percentage of subjects

Adverse Events

Vocal Warm-up

Serious events: 0 serious events

Other events: 0 other events

Deaths: 0 deaths

Respiratory Muscle Training

Serious events: 0 serious events

Other events: 0 other events

Deaths: 0 deaths

Serious adverse events

Adverse event data not reported

Other adverse events

Adverse event data not reported

Additional Information

Lilian Paternostro

Federal University of Bahia

Phone: +55 (71) 8191-9730

Email: lilian_fono@hotmail.com

Results disclosure agreements

• Principal investigator is a sponsor employee
• Publication restrictions are in place