Inspiratory muscle training

Practical note

Graded moderate: meta-analyses of randomised trials found a consistent, sizeable rise in maximal inspiratory pressure across sports; downgraded one level for risk of bias and imprecision from many small trials with differing protocols. The athlete meta-analysis found no effect on expiratory pressure or lung function markers.

Vegan note

No diet-specific evidence; the training uses no food or animal-derived product.

Sources

• Supports“IMT-linear improved maximal inspiratory pressure (MD -29.42 cmH2O [-35.65, -23.20]; p < 0.001), independent of sports modality.” (Abstract) Karsten M, Ribeiro GS, Esquivel MS, Matte DL. 2018. Physical Therapy in Sport. The effects of inspiratory muscle training with linear workload devices on the sports performance and cardiopulmonary function of athletes: A systematic review and meta-analysis. publisher copyright; metadata and short quotes only; Courtesy of the U.S. National Library of Medicine
• Supports“IMT significantly improved MIP (pre: -138 ± 45 vs. post: -160 ± 43 cmH2O, P < 0.01), whereas the SC intervention did not.” (Abstract) Ramsook AH, Molgat-Seon Y, Schaeffer MR, Wilkie SS, Camp PG, Reid WD, Romer LM, Guenette JA. 2017. Journal of Applied Physiology. Effects of inspiratory muscle training on respiratory muscle electromyography and dyspnea during exercise in healthy men. publisher copyright (American Physiological Society); metadata and short quotes only; Courtesy of the U.S. National Library of Medicine
• Supports“Inspiratory muscle strength and endurance improved in most studies, which in part, was dependent on the type of RMT employed.” (Abstract) HajGhanbari B, Yamabayashi C, Buna TR, Coelho JD, Freedman KD, Morton TA, Palmer SA, Toy MA, Walsh C, Sheel AW, Reid WD. 2013. Journal of Strength and Conditioning Research. Effects of respiratory muscle training on performance in athletes: a systematic review with meta-analyses. publisher copyright; metadata and short quotes only; Courtesy of the U.S. National Library of Medicine

Practical note

Graded low: three meta-analyses of randomised trials agree on a benefit, but the trials are small, protocols and performance tests differ, and blinding against sham is hard; downgraded for risk of bias, inconsistency and imprecision. Gains were not detected by conventional incremental tests.

Vegan note

No diet-specific evidence; the training uses no food or animal-derived product.

Sources

• Supports“RMT improves endurance exercise performance in healthy individuals with greater improvements in less fit individuals and in sports of longer durations.” (Abstract, conclusion) Illi SK, Held U, Frank I, Spengler CM. 2012. Sports Medicine. Effect of respiratory muscle training on exercise performance in healthy individuals: a systematic review and meta-analysis. publisher copyright; metadata and short quotes only; Courtesy of the U.S. National Library of Medicine
• Supports“It was observed that IMT-linear improves the sports performance (SMD 0.64 [0.35, 0.92]; p < 0.0001) with moderate effect size.” (Abstract) Karsten M, Ribeiro GS, Esquivel MS, Matte DL. 2018. Physical Therapy in Sport. The effects of inspiratory muscle training with linear workload devices on the sports performance and cardiopulmonary function of athletes: A systematic review and meta-analysis. publisher copyright; metadata and short quotes only; Courtesy of the U.S. National Library of Medicine
• Supports“Meta-analyses demonstrated a significant positive effect of RMT on sport performance outcomes of time trials, exercise endurance time, and repetitions on Yo-Yo tests.” (Abstract) HajGhanbari B, Yamabayashi C, Buna TR, Coelho JD, Freedman KD, Morton TA, Palmer SA, Toy MA, Walsh C, Sheel AW, Reid WD. 2013. Journal of Strength and Conditioning Research. Effects of respiratory muscle training on performance in athletes: a systematic review with meta-analyses. publisher copyright; metadata and short quotes only; Courtesy of the U.S. National Library of Medicine
• Context“Determination of the type of athlete that may benefit most from RMT was limited by small sample sizes, differing RMT protocols, and differences in outcome measures across studies.” (Abstract) HajGhanbari B, Yamabayashi C, Buna TR, Coelho JD, Freedman KD, Morton TA, Palmer SA, Toy MA, Walsh C, Sheel AW, Reid WD. 2013. Journal of Strength and Conditioning Research. Effects of respiratory muscle training on performance in athletes: a systematic review with meta-analyses. publisher copyright; metadata and short quotes only; Courtesy of the U.S. National Library of Medicine

Practical note

Graded moderate: a meta-analysis of 12 randomised trials (386 participants) with trial sequential analysis and no sign of publication bias, consistent with a double-blind sham-controlled trial; downgraded one level for imprecision and heterogeneity from small, short trials in mixed populations. The pooled mean arterial pressure estimate had a confidence interval crossing zero. The sham-controlled trial used 30 breaths a day, 6 days a week, at 75% of maximal inspiratory pressure for 6 weeks.

Vegan note

No diet-specific evidence; the training uses no food or animal-derived product.

Safety note

The sham-controlled trial in adults aged 50-79 reported the training as safe and well tolerated; trials were short, so long-term safety and effects beyond about 3 months are not established.

Sources

• Supports“IMST achieved significant results in reducing systolic, diastolic, and mean arterial pressure (-7.93 [-12.08, -3.78]; -3.80 [-6.08, -1.53]; -4.90 [-13.76, 3.96]).” (Abstract) Li W, Zhu X, Wang X, Liu H, Liu J, Xiao H, Dong L, Wang C, Wu Y. 2023. Journal of Clinical Hypertension. A hypotensive protocol of inspiratory muscle strength training: Systematic review and meta-analysis with trial sequential analysis. CC BY-NC-ND 4.0; credit Li et al., J Clin Hypertens 2023; short quotes only; Courtesy of the U.S. National Library of Medicine
• Supports“Casual systolic blood pressure decreased from 135±2 mm Hg to 126±3 mm Hg (P<0.01) with IMST, which was ≈75% sustained 6 weeks after IMST (P<0.01)” (Abstract) Craighead DH, Heinbockel TC, Freeberg KA, Rossman MJ, Jackman RA, Jankowski LR, Hamilton MN, Ziemba BP, Reisz JA, D'Alessandro A, Brewster LM, DeSouza CA, You Z, Chonchol M, Bailey EF, Seals DR. 2021. Journal of the American Heart Association. Time-Efficient Inspiratory Muscle Strength Training Lowers Blood Pressure and Improves Endothelial Function, NO Bioavailability, and Oxidative Stress in Midlife/Older Adults With Above-Normal Blood Pressure. CC BY-NC-ND 4.0; credit Craighead et al., J Am Heart Assoc 2021; short quotes only; Courtesy of the U.S. National Library of Medicine
• Context“There was significant heterogeneity between studies in this paper due to the different inclusion populations and intervention protocols” (Results, 3.4.4 Heterogeneity) Li W, Zhu X, Wang X, Liu H, Liu J, Xiao H, Dong L, Wang C, Wu Y. 2023. Journal of Clinical Hypertension. A hypotensive protocol of inspiratory muscle strength training: Systematic review and meta-analysis with trial sequential analysis. CC BY-NC-ND 4.0; credit Li et al., J Clin Hypertens 2023; short quotes only; Courtesy of the U.S. National Library of Medicine
• Context“IMST was safe, well tolerated, and had excellent adherence (≈95% of training sessions completed).” (Abstract) Craighead DH, Heinbockel TC, Freeberg KA, Rossman MJ, Jackman RA, Jankowski LR, Hamilton MN, Ziemba BP, Reisz JA, D'Alessandro A, Brewster LM, DeSouza CA, You Z, Chonchol M, Bailey EF, Seals DR. 2021. Journal of the American Heart Association. Time-Efficient Inspiratory Muscle Strength Training Lowers Blood Pressure and Improves Endothelial Function, NO Bioavailability, and Oxidative Stress in Midlife/Older Adults With Above-Normal Blood Pressure. CC BY-NC-ND 4.0; credit Craighead et al., J Am Heart Assoc 2021; short quotes only; Courtesy of the U.S. National Library of Medicine

Practical note

Graded low: the randomised trial found within-group reductions in breathlessness ratings but no between-group interaction against sham in 25 participants; downgraded for imprecision and indirectness (young men only). The 5-week trial used 30 inspiratory efforts twice a day.

Vegan note

No diet-specific evidence; the training uses no food or animal-derived product.

Sources

• Supports“IMT significantly reduced submaximal dyspnea intensity ratings but did not change EMG of any inspiratory muscles.” (Abstract, New and Noteworthy) Ramsook AH, Molgat-Seon Y, Schaeffer MR, Wilkie SS, Camp PG, Reid WD, Romer LM, Guenette JA. 2017. Journal of Applied Physiology. Effects of inspiratory muscle training on respiratory muscle electromyography and dyspnea during exercise in healthy men. publisher copyright (American Physiological Society); metadata and short quotes only; Courtesy of the U.S. National Library of Medicine
• Context“Dyspnea was significantly reduced at the highest equivalent work rate (pre: 7.6 ± 2.5 vs. post: 6.8 ± 2.9 Borg units, P < 0.05), but not in the SC group, with no between-group interaction effects.” (Abstract) Ramsook AH, Molgat-Seon Y, Schaeffer MR, Wilkie SS, Camp PG, Reid WD, Romer LM, Guenette JA. 2017. Journal of Applied Physiology. Effects of inspiratory muscle training on respiratory muscle electromyography and dyspnea during exercise in healthy men. publisher copyright (American Physiological Society); metadata and short quotes only; Courtesy of the U.S. National Library of Medicine

Practical note

Graded very low: two systematic reviews without pooled estimates for most outcomes, built on few small trials with mixed healthy and clinical populations; downgraded for risk of bias, imprecision and indirectness. Reviewed trials mostly ran 4 to 8 weeks at 50% to 75% of maximal inspiratory pressure.

Vegan note

No diet-specific evidence; the training uses no food or animal-derived product.

Sources

• Supports“improve cardiac autonomic control at rest and post-exercise, cerebrovascular response to orthostatic stress, static and dynamic balance, blood pressure control, endothelial function, and oxidative stress in older adults.” (Abstract) Mello ESF, Oliveira ALMB, Santanna TDC, Soares PPDS, Rodrigues GD. 2024. Archives of Gerontology and Geriatrics. Updates in inspiratory muscle training for older adults: A systematic review. publisher copyright; metadata and short quotes only; Courtesy of the U.S. National Library of Medicine
• Supports“There was a significant improvement in balance of the participants after treatment with IMT, however the effect on functional mobility was inconclusive.” (Abstract, results) Sheraz S, Ferraro FV, Siddiqui FA, Tariq H, Anthony Faghy M, Malik AN. 2023. Postgraduate Medicine. The effects of inspiratory muscle training on balance and functional mobility: a systematic review. publisher copyright; metadata and short quotes only; Courtesy of the U.S. National Library of Medicine
• Context“The benefits of IMT in cardiac autonomic and vascular functions are reversed after training cessation.” (Abstract) Mello ESF, Oliveira ALMB, Santanna TDC, Soares PPDS, Rodrigues GD. 2024. Archives of Gerontology and Geriatrics. Updates in inspiratory muscle training for older adults: A systematic review. publisher copyright; metadata and short quotes only; Courtesy of the U.S. National Library of Medicine