RMT is indicated for patients with a chronic obstructive lung disease with peak flow below 250 l/min - who display the will and ability to self-train.

1. Inform the patient carefully about relevant anatomy/physiology, the causes and effects of the disease and of its chronic nature. Give the patient the opportunity to ask questions. If the patient uses spray medicaments, their spray technique should be tested.

2. Fit a resistor in the blue (inspiration) nozzle.

Ask the patient to hold the mask tightly over their nose and mouth. Breathing should be regular, not forced.

With a hand on the epigastrium, the physiotherapist can check that the diaphragm is active during inspiration.

3. On expiration, the epigastrium is pulled inwards - whereby the position of the diaphragm is optimal for the subsequent inspiration.

A 3.5 to 4mm resistor, fitted in the white (expiration) nozzle, will facilitate this.

4. During the full training period the inspiration resistor (in the blue nozzle) should be sub-maximum. If the patient can use the RMT-set without effort for 2 minutes, the resistance should be increased by using an inspiration resistor with a smaller diameter.

In case of diaphragm failure, use of auxiliary respiratory muscles is allowable once or twice during a 2-minute training session.

Check the treatment results continously. Check the radius of action by stair walking, constitutional walking or by using an ergometric bicycle (with a stopwatch). A simple exercise programme to strengthen the foot & leg muscles and neck & shoulder regions should supplement RMT.

5. The patient must train with his RMT-set for five 2-minute periods - a total of 10 minutes, 3 times daily. The inspiratory resistance should be adjusted fortnightly for the initial 6 weeks and then on a monthly basis. The optimum treatment result ought to be reached after approximately 3 months. From then on the patient should be able to maintain the treatment result independently, with their own personal RMT-set.

6. Adapt the starting position of RMT to each patient individually.

Ensure the patient keeps their upper body upright so that free movement of the diaphragm is not unduly restricted.