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Overall, EMST improved maximum expiratory pressure (15.95cmH2O; 95% CI 7.77 to 24.12; P less then 0.01) with no significant impact on cough flow (4.63L/minute; 95%CI -27.48 to 36.74; P=0.78), forced vital capacity (-0.16L; 95%CI -0.35 to 0.02; P=0.09) or forced expiratory volume in 1second (-0.09L; 95%CI -0.10 to -0.08; P less then 0.001) vs control or sham training. CONCLUSIONS Meta-analysis indicated a small significant increase in maximum expiratory pressure following EMST. Improvements in maximum expiratory pressure did not lead to i