Inspiratory Muscle Training: Devices, Uses and Evidence

Check with a clinician first

Inspiratory muscle training (IMT) is exercise for the muscles you use to breathe in, using a hand-held device that adds resistance. It is a clinical and sports-science tool, not a relaxation practice. If you have a lung or heart condition, high blood pressure, recent surgery, or unexplained breathlessness, talk with your care team before starting, and never swap it for a prescribed medicine. If breathlessness is sudden or severe, call 911 (US) or your local emergency number. See when breathlessness needs medical care.

What it is

Cochrane describes IMT as training that aims to improve respiratory muscle strength and endurance. [1] Its inclusion rules left out trials that used resistive devices without controlling the breathing pattern. [1] Another review describes strength training with resistive or threshold devices. [2] Protocols varied significantly across trials. [1] Because of that, we do not give a training schedule or load here.

The same review also covers a second type, endurance (hyperpnoea) training. [2] We do not describe it, because deliberate sustained overbreathing is outside what this site teaches for self-directed practice.

What the research shows

1. COPD (Cochrane 2023, 55 trials)

   Mixed

   IMT may not improve breathlessness, exercise capacity or quality of life when added to pulmonary rehabilitation. [1] Used alone, it is likely to improve these outcomes, but only eight trials were at low risk of bias. [1]

2. Heart failure (meta-analysis, 17 trials)

   Promising but limited

   IMT improved quality of life, but the effect on 6-minute walk distance was not statistically significant. [3] Scales used to rate quality of life and breathlessness affected the result. [3]

3. Before heart or abdominal surgery (Cochrane, 12 trials, 695 people)

   Promising but limited

   Training before surgery was associated with fewer cases of atelectasis (partly collapsed lung) and pneumonia than usual care. [4] The authors warn of overestimation because of lack of blinding, small-study effects and publication bias. [4]

4. High blood pressure (meta-analysis, 8 trials, 215 people)

   Insufficient evidence (small trials)

   Reported lower systolic blood pressure, and the authors describe IMT as an auxiliary approach. [5]

5. Sleep apnea (13 trials)

   Mixed

   All had a high risk of bias; IMT may not beat sham for the apnea-hypopnea index, but probably helped systolic blood pressure and sleepiness. [6]

6. Neuromuscular disease (Cochrane, 11 studies, 250 people)

   Insufficient evidence

   Training may improve lung capacity and respiratory muscle strength in some conditions; results must be read very cautiously. [7]

7. Athletes (25 studies)

   Promising but limited

   Improved sports performance with a moderate effect size, but showed no effect on cardiopulmonary function. [8]

8. Healthy people (46 studies)

   Promising but limited

   Endurance performance improved, with bigger gains in less fit people than highly trained athletes. [2]

Reading the results

• Strength is not the same as benefit. In the COPD review, when IMT was added to rehabilitation, maximal inspiratory pressure rose by about 11 cmH2O [1] but fell short of the clinically important difference the authors set, [1] and breathlessness did not clearly improve. [1]
• Blinding. Participants in these trials know whether they are training, and the pre-surgery review identified inadequate blinding as its greatest concern. [4] Sham devices reduce this problem; the athlete review included 143 athletes using sham devices. [8]
• Who funded or ran the trials is not reported in the abstracts we read, so we cannot say whether device sellers were involved. Proper evidence not found on that question.
• Sports claims. Marketing for IMT devices often leans on performance gains. The reviews above support a modest average effect, not a guarantee, and not for every sport or fitness level. [8] [2]

Choosing devices and guidance

We do not name or rank devices. When a clinician recommends IMT, ask who sets the resistance, how progress is checked, and what signs mean you should stop. Consumer lung gadgets and wearables have accuracy limits; see wearables and health trackers. For breathing biofeedback tools, see breathing and muscle-tension biofeedback.

Related pages

• Breathing exercises for COPD and pulmonary rehabilitation
• Breathing exercises for lung health and recovery
• Slow breathing and blood pressure
• Breathing practices with heart conditions