Inspiratory Muscle Training (IMT) is increasingly recognised as a way to enhance functional capacity across clinical, ageing and performance contexts. However, its use is often approached in isolation within rehabilitation, exercise or athletic conditioning, limiting appreciation of its shared physiological basis. This symposium integrates physiological, clinical and applied sport science perspectives to show how strengthening the inspiratory muscles promotes functional resilience across the lifespan. The first presentation examines the dual respiratory–postural role of the diaphragm and its contribution to balance, trunk stability and mobility in older adults, highlighting IMT as a strategy to support autonomy and reduce fall risk. The second presentation focuses on clinical outcomes in chronic obstructive pulmonary disease and exercise-induced respiratory disorders, showing how IMT improves inspiratory muscle strength, ventilatory efficiency, dyspnoea and exercise tolerance. The final presentation bridges ageing and performance contexts, illustrating how IMT reduces respiratory muscle fatigue, lowers perceived exertion and supports sustainable physical engagement in active and athletic individuals. By positioning respiratory muscle function as a shared physiological foundation for independence in daily life and sustained performance under load, this session presents IMT as a scalable, accessible intervention that promotes lifelong functional resilience.
ECSS Paris 2023: IS-MH06
The diaphragm is widely recognised as the primary muscle of inspiration, yet extensive experimental and applied research demonstrates that it also plays a fundamental role in postural control. By modulating intra-abdominal pressure and coordinating with the abdominal and pelvic floor musculature, the diaphragm contributes to spinal stabilisation and anticipatory postural adjustments. This dual respiratory–postural function is governed by shared neural pathways at the level of the phrenic motoneurons, allowing the diaphragm to integrate respiratory demand with movement preparation. With ageing, declines in inspiratory muscle strength, trunk control, and neuromuscular coordination contribute to reduced mobility, increased fall risk, and loss of functional independence. Recognising the diaphragm as a bi-functional muscle is therefore essential for understanding age-related functional decline and identifying strategies to maintain autonomy. Building on physiological evidence of shared respiratory–postural control, recent intervention studies have examined whether strengthening the inspiratory muscles can support balance and mobility in older adults. A randomised, double-blind, placebo-controlled trial demonstrated that eight weeks of inspiratory muscle training (IMT) significantly improved inspiratory muscle power, dynamic balance, trunk endurance and confidence in daily movement in community-dwelling older adults. These findings were supported by research comparing IMT to the Otago Exercise Programme, where IMT elicited comparable overall improvements in balance, and greater gains in dynamic balance components most closely linked to gait adaptability. More recently, combining IMT with multimodal movement practices such as Tai Chi has demonstrated synergistic benefits for postural stability and movement efficiency, suggesting that respiratory-focused training can enhance motor control strategies beyond isolated muscular effects. Across studies, IMT has consistently increased maximal inspiratory pressure and improved markers of balance and mobility, effects that align with the diaphragm’s role in generating intra-abdominal pressure to stabilise the spine. Strengthening the inspiratory muscles appears to enhance central and peripheral neuromuscular coordination, supporting more efficient movement patterns and reducing the risk of falls. These outcomes position IMT as a scalable, low-cost and accessible intervention to promote active ageing and preserve functional autonomy. This mechanistic and functional foundation provides the rationale for examining how IMT improves clinical outcomes and daily function in chronic respiratory conditions, which will be the focus of the next presentation.
Read CV Francesco V FerraroECSS Paris 2023: IS-MH06
Inspiratory muscle training (IMT) is an effective strategy in chronic obstructive pulmonary disease (COPD) and exercise-induced respiratory disorders by improving respiratory pump function, reducing dyspnoea and enhancing functional capacity and quality of life. Evidence has grown, and its implications now extend beyond the management of chronic respiratory disease, with applications in populations with high ventilatory demands. In COPD, recent overviews of systematic reviews demonstrate that IMT significantly increases inspiratory pressure and functional performance, with clinically meaningful gains in six-minute walk distance and reductions in dyspnoea severity. Meta-analytic evidence indicates moderate-to-large effects on inspiratory muscle strength, alongside improvements in patient-reported outcomes. IMT appears particularly effective in individuals with baseline inspiratory muscle weakness, highlighting the importance of targeted assessment and individualised prescription. While the additive benefit of IMT within pulmonary rehabilitation remains under investigation, standalone interventions are supported by moderate-quality evidence. Mechanistically, the benefits of IMT arise from increased inspiratory muscle strength and power, reduced neural respiratory drive, improved ventilatory efficiency and decreased reliance on accessory musculature. These changes translate into reduced breathlessness, improved exercise tolerance and greater capacity for daily activities. The physiological rationale of these adaptations is not confined to clinical populations. Individuals engaging in regular physical activity or sport may experience respiratory muscle fatigue under high ventilatory loads. Conditioning the inspiratory muscles may attenuate this limitation by delaying the onset of respiratory muscle metaboreflex and reducing the sympathetic vasoconstrictor response that restricts blood flow to locomotor muscles during sustained effort. This translational dimension positions IMT as a bridging strategy between rehabilitation and performance practice. Protocols based on threshold loading at moderate intensity, performed multiple times per week with progressive adjustment, appear to produce consistent outcomes. Although evidence in exercise-induced respiratory disorders and athletic populations is still developing, the mechanistic foundations support its application to individuals who experience dyspnoea, ventilatory limitation or fatigue during exertion. In conclusion, IMT represents a clinically meaningful, scalable and accessible intervention for improving respiratory muscle function and functional capacity in COPD and related respiratory disorders, with emerging relevance for physically active and athletic individuals. These shared mechanisms and functional outcomes form the basis for considering IMT as a tool to promote resilience across the lifespan.
Read CV Guilherme Augusto de Freitas FregoneziECSS Paris 2023: IS-MH06
Inspiratory Muscle Training (IMT) has historically been implemented in clinical rehabilitation and in selected performance contexts, particularly in endurance sports. However, growing evidence indicates that strengthening the inspiratory musculature contributes to functional capacity across a wider range of populations, including healthy older adults, physically active individuals and athletes. These shared effects highlight a common physiological foundation: the diaphragm and accessory inspiratory muscles not only facilitate ventilation but also contribute to postural stabilisation, trunk control and movement efficiency. IMT therefore represents a single intervention with relevance across the continuum of ageing, daily physical activity and sport performance. In older adults, age-related declines in inspiratory muscle strength and neuromuscular coordination can reduce mobility and increase fatigue during everyday tasks such as walking, stair climbing or rising from a chair. IMT has been shown to increase maximal inspiratory pressure, inspiratory power and dynamic balance, improving gait adaptability, trunk stability and confidence in movement. These changes support autonomy, reduce fall risk and facilitate continued participation in meaningful activities—key outcomes in active ageing and preventive health strategies. In physically active adults and athletes, high ventilatory loads encountered during sustained or repeated effort may lead to respiratory muscle fatigue and increased perception of exertion. IMT can attenuate these limitations by improving ventilatory efficiency, reducing neural respiratory drive and delaying the onset of respiratory muscle metaboreflex. As a result, individuals may experience lower perceived exertion, improved tolerance to sustained workload and enhanced recovery between training sessions. Importantly, these effects extend beyond performance metrics alone; they contribute to consistency of participation, injury prevention and long-term athletic sustainability. The shared premise across these settings is resilience: the capacity to maintain effort, adapt to demand and recover effectively. Because the respiratory system is central to both metabolic homeostasis and postural stability, strengthening the inspiratory muscles supports movement quality and endurance at both low and high intensities of physical demand. IMT therefore offers a scalable, accessible and transferable strategy that can be integrated into preventive programmes for ageing adults, conditioning programmes for active individuals and performance and recovery plans for athletes. By recognising that the same physiological capacities underpin independence in daily life and sustained performance in sport, this presentation emphasises that health and performance are not opposing constructs, but expressions of the same functional capacity across different contexts.
Read CV Ainoa RoldanECSS Paris 2023: IS-MH06