Respiratory Physiotherapy using the Shaker by POWERbreathe

If you have a disease that results in sputum production, your physiotherapist will prescribe respiratory physiotherapy for you. Initially, this will involve the physio assessing you to identify the problem. As a result, management techniques and a treatment plan will be put in place. This will include airway clearance techniques, such as oscillating PEP. Different types of mucus clearance device use oscillating PEP, including the Shaker by POWERbreathe. Such devices combine the techniques of positive expiratory pressure (PEP) with oscillations. Your physio will refer to these as ‘oscillatory positive expiratory pressure’, or OPEP devices.
Respiratory Physiotherapy using the Shaker by POWERbreathe, by BreatheWellPhysio
Respiratory Physiotherapy using the Shaker by POWERbreathe, courtesy of Breathe Well Physio.

Shaker mucus clearance devices

The Shaker device will help to shift your bronchial secretions by combining PEP and oscillations. This combination will help you to expectorate the increasing amount of mucus you’re producing. By coughing out more mucus, you’re helping to prevent infections of your respiratory tract. It is also helpful if you have hay fever, which can make symptoms of asthma, such as coughing and wheezing, feel worse. Devices like the Shaker are easy-to-use without medical supervision, so you may decide to use it as an alternative, or additional, treatment to your prescribed medical respiratory physiotherapy. Although it works similarly to the older Acapella mucus clearance device, research reveals the Shaker to have better linearity at higher airflows. The same research also finds the pressure amplitude produced by the Shaker and Flutter mucus clearance device to be greater at low and high pressures. Finally, the same study shows a higher frequency of oscillation for the Shaker and Flutter at an intermediate pressure. This is all beneficial in helping you get the most from your therapy. The Shaker Classic, Shaker Deluxe and Shaker Medic Plus by POWERbreathe all mobilise mucus using oscillatory positive expiratory pressure (OPEP). An important point to note is that the Shaker devices are all gravity-dependent, as opposed to gravity-independent. This is worth bearing in mind as a 2018 study finds,
“the gravity-dependent devices were the ones to display close mechanical performances and produce optimal operational parameters at the simulated exhalation settings.”
By contrast, this same study finds that the two gravity-independent OPEP devices, the Acapella Choice and Aerobika, “probably require higher expiratory pressure to reach theoretical therapeutic effectiveness.”

Therapeutic effects of the Shaker

If you have a condition such as chronic bronchitis, cystic fibrosis, bronchiectasis or asthma, then you’ll be only too aware of the excessive amount of mucus you produce. You may also notice a change in the type of mucus you’re producing. Because of this, it’s no surprise that you’ll be having difficulty clearing the mucus, even after coughing. But this is where using the Shaker by POWERbreathe for respiratory physiotherapy can help you. The Shaker uses a stainless-steel ball, weighing 30g, to help clear bronchial secretions. It does this by ‘shaking’ and causing a vibration, or percussion, in your chest. This happens as you exhale through the mouthpiece. As you breathe out through the device, the 30g steel ball provides a resistance. This causes the ball to move and shake and makes it more difficult for you to breathe out. All this shaking and vibration loosens the mucus. After breathing out through it a few times, you’ll find you’ll need to huff, or cough, to expel the mucus. You can see this being demonstrated in the video above. After a few uses, you’ll begin to work out for yourself how long and how frequently you’ll need to use your Shaker device, as everyone is different. To further enhance the therapeutic effect of your Shaker airway clearance device, its mouthpiece is designed to allow you to use it in a sitting or lying position.

Respiratory physiotherapy techniques

In respiratory physiotherapy, no one technique fits all. A therapist must take into consideration the strength of their patient, the thickness of their mucus and where it is located. However, as a patient, the price may be a criterion for selecting the most suitable device. In this 2013 study, assessment of the Flutter, Acapella and Shaker shows all three mechanical behaviours to be reliable. However, the Shaker is likely to be the most cost-effective. This type of respiratory physiotherapy aims to help you clear excessive phlegm, sputum, mucus and catarrh. Consequently, breathing effort reduces and exercise tolerance improves, helping you return to a better quality of life. Young children benefit from respiratory physiotherapy too, but they will require something with a lighter resistance to exhale against. If you have children, you’ll know that you’ll also need to make their therapy more fun. Blowing games using the Flowball by POWERbreathe can help them to clear secretions.


You should always consult a doctor before starting any treatment if you’re concerned about any medical issue.

Phlegm in lungs – clear naturally with drug-free Shaker

You will usually find phlegm in the back of the throat or in the lungs. It is produced by the lower airways. Mucus on the other hand will normally be found in the mucous membranes inside the nose. It acts like a filter protecting your lungs as you inhale. To clear it you simply blow your nose. Phlegm however is thicker and more viscous. You usually only notice it when you cough it up. An excess of this secretion can be a symptom of a respiratory problem such as bronchitis.

Why you should cough up phlegm

Although unpleasant, you can safely swallow mucus. This is because your body can safely reabsorb it. Phlegm however must be expelled from the body. Advice from healthcare professionals is to cough it up. This is because it will contain virus and dead bacteria. As you cough it up you are helping your body to get rid of the infection.

What to do when phlegm is problematic

Secretions will be more of a problem at night. This is simply because of gravity. These secretions will feel heavy in your chest. This can bring on coughing. You can allieviate this by elevating your sleeping position. Simply prop yourself up more with a pillow. Coughing is actually your body’s natural way of expelling the phlegm. This will help you to get better.

Expel phlegm with drugs – or drug-free

Expectorants can be prescribed to help increase bronchial secretion. They are intended to help make it easier to cough it up. But expectorants are medicines. Shaker by POWERbreathe however is an effective drug-free alternative.

Expel phlegm naturally with the Shaker

The Shaker by POWERbreathe literally ‘shakes’ secretions in your chest to make them more mobile. The shaking breaks these secretions down and makes it easier for you to cough it up.

How the Shaker works

Inside the Shaker device is a weighted ball. As you breathe in through the device the ball rises and then falls again under its own weight. This happens quickly and feels like vibrations. This vibration and gentle resistance dislodges and thins phlegm. You’re then more able to expel it by coughing.

Who can use the Shaker

Because the Shaker is drug-free and easy-to-use, children and adults can use it. And because it shakes up phlegm, it is ideal for people with respiratory problems. These include Chronic Bronchitis, Bronchiectasis, Emphysema, Asthma and Cystic Fibrosis. There are however some precautions which you will find on the Shaker Classic, Shaker Deluxe and Shaker Plus product pages.

POWERbreathe Medic helps patients with breathing problems AND saves NHS money and resources

Health bosses announced back in October 2014 that the NHS in England needed extra money and an overhaul to services in order for patient care not to suffer.

When it comes to respiratory care the NHS could save both money and resources if they prescribed POWERbreathe Medic Respiratory Muscle Training (RMT) for patients with medical conditions such as COPD, Heart Failure, Asthma, Thoracic Surgery, Ventilator Weaning, Cystic Fibrosis and Neuromuscular Disease.

In a 2005 study of the benefits of a 12-month programme of POWERbreathe RMT, researchers observed significant reductions in the use of healthcare resources.1

POWERbreathe RMT for COPD

Accordingly to Professor Peter Calverley (Lung Report III. British Lung Foundation), in the average PCT serving 250,000 people, there would be 14,200 GP consultations per year for chronic obstructive pulmonary disease (COPD), and 9,600 inpatient bed days. Reducing length of hospital stay is an NHS productivity indicator.

POWERbreathe reduced hospital bed days by 29% and GP consultations by 23% compared with placebo (see table above).

POWERbreathe RMT for Asthma

In another study, Weiner et al2 observed an 86% reduction in hospitalisations/emergency room visits following respiratory muscle training in moderate/severe asthmatics (from 1.4 to 0.2 per 3 months per patient).

And in three separate studies, Weiner et al. observed an average 51% reduction in β2-agonist consumption (from 3.9 to 1.6 puffs per day)2,3,4 after respiratory muscle training, and in one study3, corticosteroid use decreased ~80%.

How POWERbreathe Medic could save NHS money & resources

In 2005 when this study was conducted, the total potential annual savings derived from POWERbreathe Medic prescription per average PCT due to reduced hospital bed days and medication consumption (not including savings due to reduction in GP consultations) were substantial.

The POWERbreathe Medic offers an evidence-based, drug-free treatment for patients with medical conditions such as COPD, Heart Failure, Asthma, Thoracic Surgery, Ventilator Weaning, Cystic Fibrosis and Neuromuscular Disease. It is the only Inspiratory Muscle Training device for RMT available for prescription that has been used in research into the benefits of IMT for a variety of medical conditions and prescribed by medical professionals as either a standalone intervention or as part of a rehabilitation programme.

For respiratory care professionals there is a POWERbreathe Medic Try-Before-You-Prescribe demonstration kit; an educational tool designed to help healthcare professionals and patients understand and experience the effect POWERbreathe Medic has on the respiratory muscles.

Since the approval of the POWERbreathe Medic for prescription in 2006, POWERbreathe has introduced the revolutionary, electronic POWERbreathe KH1, intended for use by healthcare professionals for respiratory muscle training and assessment in patients with dyspnoea, including patients with asthma, COPD, bronchitis, cystic fibrosis, emphysema, heart disease, neuromuscular disease, Parkinson’s disease and spinal injury.

The POWERbreathe KH1 is also suitable for use with disposable TrySafe filters and can be used bedside, on the ward, as part of a pulmonary program, or for single patient use at home under medical supervision.

Launched after the POWERbreathe Medic, following the latest technological advances in research and design, is the next generation POWERbreathe Medic: the POWERbreathe Medic Plus for patients to use at home, straight out of the box, with improved airflow dynamics and a more comfortable user experience. And for healthcare professionals (and their patients), is the new POWERbreathe KH2 with Breathe-Link Medic Live Feedback Software.


  1. Beckerman M, Magadle R, Weiner M, Weiner P. The effects of 1 year of specific inspiratory muscle training in patients with COPD. Chest. 2005 Nov;128(5):3177-82.
  2. Weiner P, Azgad Y, Ganam R, Weiner M. Inspiratory muscle training in patients with bronchial asthma. Chest. 1992;102(5):1357-61.
  3. Weiner P, Berar-Yanay N, Davidovich A, Magadle R, Weiner M. Specific inspiratory muscle training in patients with mild asthma with high consumption of inhaled beta(2)-agonists. Chest. 2000;117(3):722-7.
  4. Weiner P, Magadle R, Massarwa F, Beckerman M, Berar-Yanay N. Influence of gender and inspiratory muscle training on the perception of dyspnea in patients with asthma. Chest. 2002;122(1):197-201.

New CF Research Could Improve Treatments For Muscle Function

The research paper, Skeletal Muscle Oxidative Capacity in Patients with Cystic Fibrosis, published in Experimental Physiology in March 2015, has concluded that people suffering from Cystic Fibrosis have a lesser ability to uptake and use oxygen in their muscles, which leads to exercise intolerance.

This genetic disease affects the organs in people with Cystic Fibrosis (CF), primarily the lungs and digestive system, which become obstructed by excessive and thick mucus which makes breathing and digesting food difficult.

This research study found that those with CF have shown a limited ability to uptake and use oxygen in their muscles which then also gets more pronounced with age. This lack of oxygen can lead to a limited ability to exercise, and exercise is considered important for achieving a better quality of life, and prolonged life.

The researchers of this study used NIRS (Near Infrared Spectroscopy) as a method to evaluate skeletal muscle oxidative capacity in a group of patients with Cystic Fibrosis. They compared skeletal muscle oxidative capacity within a group of 13 patient aged 7-42 years with CF, and a control group of 16 healthy people aged 7-59 years. The NIRS device was placed on the middle of the thigh and a cuff, much like a blood pressure cuff, was placed on the upper thigh. The pressure cuff was then inflated on the thigh to measure muscle tissue oxygen response over time.

Read Skeletal Muscle Oxidative Capacity in Patients with Cystic Fibrosis >

Discover more about How POWERbreathe help improve exercise tolerance in people with CF >

How POWERbreathe could help improve exercise tolerance in people with CF

We recently came across an article that reported on how patients with Cystic Fibrosis (CF) have less exercise capacity than their peers, even though their lungs may be relatively healthy.

Studies by clinical exercise physiologist Dr. Ryan Harris (Georgia Prevention Institute) of the Medical College of Georgia at Georgia Regents University have shown that it’s actually leg fatigue as opposed to lung capacity that is the limiting factor when it comes to exercise capacity, and suggests that this could be as a result of insufficient levels of blood and oxygen reaching their exercising muscles.

Data from the studies suggested that if people with CF exercised more they could reduce other medical complications, improving their quality of life and longevity. Results from Dr. Harris and colleague Dr. McKie’s studies have indicated that during peak exercise the Cystic Fibrosis subjects consumed 14% less oxygen while their expelled air had higher oxygen levels, “indicating that their muscles were not as efficient at using it.”

This is where POWERbreathe Inspiratory Muscle Training (IMT) could help. In the study ‘Inspiratory muscle training enhances pulmonary O2 uptake kinetics and high-intensity exercise tolerance in humans’ the results indicated that “the enhanced exercise tolerance observed after IMT might be related, at least in part, to improved Vo(2) dynamics, presumably as a consequence of increased blood flow to the exercising limbs.” POWERbreathe was the actual Inspiratory Muscle Training device used in this study.

POWERbreathe IMT/RMT (Respiratory Muscle Training)

For people who experience breathing difficulties, such as those with Cystic Fibrosis, the POWERbreathe Medic, POWERbreathe Classic Level 1 (LR) and POWERbreathe Plus Level 1 (LR) have been selected by our CF customers as the most suitable. They all offer a Light Resistance (LR) and a variable load setting so that each individual is able to find the most appropriate setting for them.

One of our POWERbreathe users with CF has written a blog about how he incorporated his POWERbreathe training into his daily physiotherapy, and how he used it in conjunction with the Shaker Plus, a mucus clearance device. (He used the Shaker Plus for mucus clearance during physio and the POWERbreathe after his inhalers to help suck the particles further down.)

Drug-free mucus clearance devices by POWERbreathe

People with CF have to contend with glue-like mucus which acts like a magnet for bacteria, and it’s this mucus that clogs up organ function, including the function of the lungs. The Shaker Classic, Shaker Deluxe and Shaker Plus are all drug-free solutions for mobilising pulmonary secretions such as mucus, and they work by ‘shaking’ the mucus loose.

The original article that we referred to at the beginning of this blog can be found on Georgia Regents University & Health System News and this is one of the previous studies referred to in the article, ‘Impaired blood vessel function found in cystic fibrosis patients.’

We hope you found this blog helpful, but if there’s anything more you’d like to know then please leave a comment here or on the POWERbreathe Forum, on Facebook or Twitter as we’d be happy to help.

Benefits of combining inspiratory muscle with ‘whole muscle’ training in children with CF

The British Journal of Sports Medicine has just published details online (16th May) of a randomised trial that looked at assessing the effects of an 8-week combined ‘whole muscle’ (resistance + aerobic) and inspiratory muscle training on lung volume, inspiratory muscle strength and cardiorespiratory fitness, and dynamic muscle strength, body composition and quality of life in children with cystic fibrosis.

The trial concluded that the 8-week training programme induced significant benefits in important health phenotypes, and that inspiratory muscle training was an easily applicable intervention that could be included, along with supervised exercise training, in the standard care of these patients.

Here’s the Original Article, the Abstract for which can be found online at the British Journal of Sports Medicine.

Benefits of combining inspiratory muscle with ‘whole muscle’ training in children with cystic fibrosis: a randomised controlled trial


Elena Santana-Sosa1, Laura Gonzalez-Saiz1, Iris F Groeneveld2, José R Villa-Asensi3, María I Barrio Gómez de Aguero3, Steven J Fleck4, Luis M López-Mojares1, Margarita Pérez1, Alejandro Lucia1,5

Author Affiliations:

1 School of Doctorate Studies and Research, Universidad Europea de Madrid, Spain

2 Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands

3 Department of Pneumology, Hospital ‘Nino Jesus’ of Madrid, Madrid, Spain

4 Department of Health, Exercise Science and Sport Management, University of Wisconsin-Parkside, Kenosha, Wisconsin, USA

5 Instituto de Investigación i+12, Madrid, Spain

Correspondence to:

Dr Alejandro Lucia, Universidad Europea de Madrid, Villaviciosa de Odón, Madrid 28670, Spain;


The purpose of this study (randomised controlled trial) was to assess the effects of an 8-week combined ‘whole muscle’ (resistance+aerobic) and inspiratory muscle training (IMT) on lung volume, inspiratory muscle strength (PImax) and cardiorespiratory fitness (VO2 peak) (primary outcomes), and dynamic muscle strength, body composition and quality of life in paediatric outpatients with CF (cystic fibrosis, secondary outcomes). We also determined the effects of a detraining period.

Participants were randomly allocated with a block on gender to a control (standard therapy) or intervention group (initial n=10 (6 boys) in each group; age 10±1 and 11±1 years). The latter group performed a combined programme (IMT (2 sessions/day) and aerobic+strength exercises (3 days/week, in-hospital)) that was followed by a 4-week detraining period. All participants were evaluated at baseline, post-training and detraining.

Adherence to the training programme averaged 97.5%±1.7%. There was a significant interaction (group×time) effect for PImax, VO2peak and five-repetition maximum strength (leg-press, bench-press, seated-row) (all (p<0.001), and also for %fat (p<0.023) and %fat-free mass (p=0.001), with training exerting a significant beneficial effect only in the intervention group, which was maintained after detraining for PImax and leg-press.

The relatively short-term (8-week) training programme used here induced significant benefits in important health phenotypes of paediatric patients with CF. IMT is an easily applicable intervention that could be included, together with supervised exercise training in the standard care of these patients.

In another study, Improved Pulmonary Function and Exercise Tolerance With Inspiratory Muscle Conditioning in Children With Cystic Fibrosis, published in the Chest Journal (November 1993, Vol 104, No. 5) the effect of inspiratory muscle conditioning in children with cystic fibrosis was also documented, with findings indicating that the experimental group that trained at a high pressure load (> or = 29 cm H2O) showed significant increases in inspiratory muscle strength, vital capacity, total lung capacity, and exercise tolerance in comparison to the control group. The study suggested that IMT may provide some benefit to the young CF population with respect to functional status. “…the results are promising and may potentially be useful as an adjunct to well-established physical therapy regimens in this patient group.”

If you’re already using POWERbreathe to help with symptoms of cystic fibrosis, then please leave a comment here or on the POWERbreathe Forum as we’d love to hear from you. You can also read a POWERbreathe blog from Evan Scully who was diagnosed with CF at the age of just 6-months, about his first experience of using POWERbreathe.

Evan Scully, Scully Therapy Clinic – my first experience of POWERbreathe

At the age of 6 months, the Doctors diagnosed me with Cystic Fibrosis. CF is a hereditary disease of the lungs and pancreas, resulting in more mucus production and the inability to produce digestive enzymes. Not only do I produce more mucus, but it is also thicker. Therefore, it is harder to get the mucus up.

I was given a life expectancy of 10 years of age. My 10th birthday came, and the age was changed to 18. I’m 26 now, so I think the Doctors have given up guessing.

Having Cystic Fibrosis means doing airway clearance every single day. Christmas Day and Birthdays are days in which shouldn’t be ignored as it’s a clear reminder that your one year older, and that you are beating the odds even more.

So keeping on top of my CF remains one of the biggest parts of my life. Along with having CF, I also have Exercised Induced Asthma. One would think I should be bed ridden, but it’s just another hurdle that I have to jump, and clear.

As part of my airway clearance, I run. A lot. I run 10 times a week and anywhere between 70-100 miles a week. This comprised of two speed endurance sessions, a threshold run, a long run ( between 90mins to 2 hours), recovery runs, and of course a day off. I have to take precautions while doing the speed training, as my lungs can flair up. This means taking a steroidal inhaler beforehand.

I’m constantly looking for ways to help both my EIA and my CF. I heard about POWERbreathe roughly 5 years ago, and it was always something that interested me. So recently, I had a very bad attack of inflammation in my lungs which came out of the blue. It meant not being able to run. When I can’t run, I’m stuck with a catch 22 situation. I need to run to clear the mucus from my lungs, but if I was to run, my chest wouldn’t allow me because of the inflammation.

While sitting down, trying not to do too much, I remembered about the POWERbreathe. I thought what could be the harm in trying it out. As soon as it arrived, I had a go of it. I was surprised at how it worked the lungs from an inspiration and not expiration point of view. I’m a cynic when it comes to these types of “gadgets”, because there are a load of “gadgets” out there. From my first breath, I could actually feel my pulmonary muscles and diaphragm kicking into action.

A big part of my life is my work. I am a Sports Therapist and Acupuncturist. I run my own clinic called Scully Therapy Clinic. By treating Olympic athletes, I see quite a few who come into the clinic with either Asthma or Exercised Induced Asthma. I could safely recommend the athletes to use POWERbreathe as a tool to help their lungs become stronger. Stronger lungs equal faster times.

I have documented, and will continue to document how I am getting on with the POWERbreathe on my blog:


A huge thank you to Evan for sharing his first experience of using POWERbreathe for Cystic Fibrosis and we’ll look forward to sharing with you his continued experience.

If you’d like to show your support for Evan then please leave a comment here, and if you too are using POWERbreathe to help symptoms of Cystic Fibrosis then we would love to hear from you.