Inspiratory Muscle Training In Elderly
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Published:
Dec 24, 2025
Keywords:
Inspiratory muscle training, aging, respiratory function, diaphragm
Main Article Content
Abstract
Introduction: The World Health Organization (WHO) defines an elderly individual as someone aged 65 years or older. With aging, the respiratory system undergoes structural and functional changes, leading to reduced pulmonary function, diminished exercise capacity, and increased susceptibility to respiratory diseases due to anatomical, physiological, and immunological alterations. Inspiratory muscle training (IMT) has been proposed as an intervention to counteract these age-related declines. Evidence suggests that IMT enhances inspiratory muscle strength, improves lung function, increases exercise tolerance and mobility, and promotes diaphragmatic hypertrophy in older adults. Thus, IMT may serve as a viable strategy to mitigate respiratory deterioration associated with aging.
Method: A literature search was conducted using PubMed, Google Scholar, and the Cochrane Library to identify original research articles on inspiratory muscle training in the elderly.
Results: IMT has been demonstrated to counteract physiological changes associated with aging, leading to improved respiratory function and overall physical performance.
Conclusion: Given its documented benefits, IMT represents a promising adjunctive or alternative training modality for older adults. This literature review further explores the implementation and effectiveness of IMT in the elderly population.
Keywords: Inspiratory muscle training, aging, respiratory function, diaphragm
Method: A literature search was conducted using PubMed, Google Scholar, and the Cochrane Library to identify original research articles on inspiratory muscle training in the elderly.
Results: IMT has been demonstrated to counteract physiological changes associated with aging, leading to improved respiratory function and overall physical performance.
Conclusion: Given its documented benefits, IMT represents a promising adjunctive or alternative training modality for older adults. This literature review further explores the implementation and effectiveness of IMT in the elderly population.
Keywords: Inspiratory muscle training, aging, respiratory function, diaphragm
Article Details
How to Cite
Tambunan, T. F. U., Kurnain, D. N., & Sianipar, H. R. P. (2025). Inspiratory Muscle Training In Elderly. Indonesian Journal of Physical Medicine and Rehabilitation, 14(2), 303 - 310. https://doi.org/10.36803/indojpmr.v14i2.469
Section
Literature Review
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References
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19. Human A, Corten L, Jelsma J, Morrow B. Inspiratory muscle training for children and adolescents with neuromuscular diseases: A systematic review. Neuromuscul Disord. 2017 Jun;27(6):503–17.
20. Shei RJ, Paris HL, Sogard AS, Mickleborough TD. Time to Move Beyond a “One-Size Fits All†Approach to Inspiratory Muscle Training. Front Physiol. 2022 Jan 10;12.
21. Caleffi Pereira M, Dacha S, Testelmans D, Gosselink R, Langer D. Assessing the effects of inspiratory muscle training in a patient with unilateral diaphragm dysfunction. Breathe (Sheff). 2019 Jun;15(2):e90–6.
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23. Alwohayeb NS, Alenazi BA, Albuainain FA, Alrayes MM. A Comparison between Two Types of Resistive Inspiratory Muscle Training Devices in Normal Subjects in Regards to Pulmonary Functions. International Journal of Physical Medicine & Rehabilitation. 2018;6(1):1–8.
24. McConnell A. Implementing respiratory muscle training. In: Respiratory Muscle Training: Theory and Practice. 1st ed. Churchill Livingstone; 2013.
25. McConnell AK, Romer LM, Weiner P. Inspiratory muscle training in obstructive lung disease. Breathe. 2005 Sep 1;2(1):38–49.
26. Wu W, Guan L, Zhang X, Li X, Yang Y, Guo B, et al. Effects of two types of equal-intensity inspiratory muscle training in stable patients with chronic obstructive pulmonary disease: A randomised controlled trial. Respir Med. 2017 Nov;132:84–91.
27. Morris NR, Hill K, Walsh J, Sabapathy S. Exercise & Sports Science Australia (ESSA) position statement on exercise and chronic obstructive pulmonary disease. J Sci Med Sport. 2021 Jan;24(1):52–9.
28. Shoemaker MJ, Donker S, LaPoe A. Inspiratory Muscle Training in Patients with Chronic Obstructive Pulmonary Disease: The State of the Evidence. Cardiopulm Phys Ther J. 2009 Sep;20(3):5–15.
29. Bissett B, Leditschke IA, Green M, Marzano V, Collins S, Van Haren F. Inspiratory muscle training for intensive care patients: A multidisciplinary practical guide for clinicians. Aust Crit Care. 2019 May;32(3):249–55.
30. Katsura M, Kuriyama A, Takeshima T, Fukuhara S, Furukawa TA. Preoperative inspiratory muscle training for postoperative pulmonary complications in adults undergoing cardiac and major abdominal surgery. Cochrane Database Syst Rev. 2015 Oct 5;2015(10):CD010356.
31. Azambuja A de CM, de Oliveira LZ, Sbruzzi G. Inspiratory Muscle Training in Patients With Heart Failure: What Is New? Systematic Review and Meta-Analysis. Phys Ther. 2020 Dec 7;100(12):2099–109.
32. Nield MA. Inspiratory muscle training protocol using a pressure threshold device: effect on dyspnea in chronic obstructive pulmonary disease. Arch Phys Med Rehabil. 1999 Jan;80(1):100–2.
33. Tounsi B, Acheche A, Lelard T, Tabka Z, Trabelsi Y, Ahmaidi S. Effects of specific inspiratory muscle training combined with whole-body endurance training program on balance in COPD patients: Randomized controlled trial. PLOS ONE. 2021 Sep 23;16(9):e0257595.
34. Rodrigues GD, Gurgel JL, Gonçalves TR, da Silva Soares PP. Inspiratory muscle training improves physical performance and cardiac autonomic modulation in older women. Eur J Appl Physiol. 2018 Jun;118(6):1143–52.
35. Mills DE, Johnson MA, Barnett YA, Smith WHT, Sharpe GR. The effects of inspiratory muscle training in older adults. Med Sci Sports Exerc. 2015 Apr;47(4):691–7.
36. Souza H, Rocha T, Pessoa M, Rattes C, Brandão D, Fregonezi G, et al. Effects of inspiratory muscle training in elderly women on respiratory muscle strength, diaphragm thickness and mobility. J Gerontol A Biol Sci Med Sci. 2014 Dec;69(12):1545–53.
37. Reychler G, Delacroix S, Dresse D, Pieters T, Liistro G. Randomized Controlled Trial of the Effect of Inspiratory Muscle Training and Incentive Spirometry on Respiratory Muscle Strength, Chest Wall Expansion, and Lung Function in Elderly Adults. J Am Geriatr Soc. 2016 May;64(5):1128–30.
38. Ferraro FV, Gavin JP, Wainwright T, McConnell A. The effects of 8 weeks of inspiratory muscle training on the balance of healthy older adults: a randomized, double-blind, placebo-controlled study. Physiol Rep. 2019 May;7(9):e14076.
39. Aznar-Lain S, Webster AL, Cañete S, San Juan AF, López Mojares LM, Pérez M, et al. Effects of inspiratory muscle training on exercise capacity and spontaneous physical activity in elderly subjects: a randomized controlled pilot trial. Int J Sports Med. 2007 Dec;28(12):1025–9.
40. Kaneko H, Suzuki A, Horie J. Effects of Cough Training and Inspiratory Muscle Training on Cough Strength in Older Adults: A Randomized Controlled Trial. Lung. 2022 Feb 1;200(1):49–57.
2. Lazarus NR, Harridge SDR. The Inherent Human Aging Process and the Facilitating Role of Exercise. Front Physiol. 2018;9:1135.
3. Lagunas-Rangel FA, Bermúdez-Cruz RM, Lagunas-Rangel FA, Bermúdez-Cruz RM. The Role of DNA Repair in Cellular Aging Process. In: DNA Repair- An Update. IntechOpen; 2019.
4. Xu W, Wong G, Hwang YY, Larbi A. The untwining of immunosenescence and aging. Semin Immunopathol. 2020 Oct;42(5):559–72.
5. Schneider JL, Rowe JH, Garcia-de-Alba C, Kim CF, Sharpe AH, Haigis MC. The aging lung: Physiology, disease, and immunity. Cell. 2021 Apr 15;184(8):1990–2019.
6. Brandenberger C, Mühlfeld C. Mechanisms of lung aging. Cell Tissue Res. 2017 Mar 1;367(3):469–80.
7. Manifield J, Winnard A, Hume E, Armstrong M, Baker K, Adams N, et al. Inspiratory muscle training for improving inspiratory muscle strength and functional capacity in older adults: a systematic review and meta-analysis. Age and Ageing. 2021 May 1;50(3):716–24.
8. Seixas MB, Almeida LB, Trevizan PF, Martinez DG, Laterza MC, Vanderlei LCM, et al. Effects of Inspiratory Muscle Training in Older Adults. Respiratory Care. 2020 Apr;65(4):535–44.
9. Cebrià I Iranzo MDÀ, Arnall DA, Igual Camacho C, Tomás JM, Meléndez JC. Physiotherapy intervention for preventing the respiratory muscle deterioration in institutionalized older women with functional impairment. Arch Bronconeumol. 2013 Jan;49(1):1–9.
10. Lalley PM. The aging respiratory system—Pulmonary structure, function and neural control. Respiratory Physiology & Neurobiology. 2013 Jul 1;187(3):199–210.
11. Skloot GS. The Effects of Aging on Lung Structure and Function. Clinics in Geriatric Medicine. 2017 Nov 1;33(4):447–57.
12. Torrelles JB, Restrepo BI, Bai Y, Ross C, Schlesinger LS, Turner J. The Impact of Aging on the Lung Alveolar Environment, Predetermining Susceptibility to Respiratory Infections. Front Aging. 2022 Jan 19;3.
13. Lee SH, Yim SJ, Kim HC. Aging of the respiratory system. KMJ. 2016 Feb 4;31(1):11–8.
14. Kim J, Sapienza CM. Implications of expiratory muscle strength training for rehabilitation of the elderly: Tutorial. J Rehabil Res Dev. 2005;42(2):211–24.
15. Greising SM, Ottenheijm CAC, O’Halloran KD, Barreiro E. Diaphragm plasticity in aging and disease: therapies for muscle weakness go from strength to strength. J Appl Physiol (1985). 2018 Aug 1;125(2):243–53.
16. Roman MA, Rossiter HB, Casaburi R. Exercise, ageing and the lung. European Respiratory Journal. 2016 Oct 31;48(5):1471–86.
17. Lowery EM, Brubaker AL, Kuhlmann E, Kovacs EJ. The aging lung. Clin Interv Aging. 2013;8:1489–96.
18. Bailey KL. Aging Diminishes Mucociliary Clearance of the Lung. Adv Geriatr Med Res. 2022;4(2):e220005.
19. Human A, Corten L, Jelsma J, Morrow B. Inspiratory muscle training for children and adolescents with neuromuscular diseases: A systematic review. Neuromuscul Disord. 2017 Jun;27(6):503–17.
20. Shei RJ, Paris HL, Sogard AS, Mickleborough TD. Time to Move Beyond a “One-Size Fits All†Approach to Inspiratory Muscle Training. Front Physiol. 2022 Jan 10;12.
21. Caleffi Pereira M, Dacha S, Testelmans D, Gosselink R, Langer D. Assessing the effects of inspiratory muscle training in a patient with unilateral diaphragm dysfunction. Breathe (Sheff). 2019 Jun;15(2):e90–6.
22. Wu W, Zhang X, Lin L, Ou Y, Li X, Guan L, et al. Transdiaphragmatic pressure and neural respiratory drive measured during inspiratory muscle training in stable patients with chronic obstructive pulmonary disease. Int J Chron Obstruct Pulmon Dis. 2017;12:773–81.
23. Alwohayeb NS, Alenazi BA, Albuainain FA, Alrayes MM. A Comparison between Two Types of Resistive Inspiratory Muscle Training Devices in Normal Subjects in Regards to Pulmonary Functions. International Journal of Physical Medicine & Rehabilitation. 2018;6(1):1–8.
24. McConnell A. Implementing respiratory muscle training. In: Respiratory Muscle Training: Theory and Practice. 1st ed. Churchill Livingstone; 2013.
25. McConnell AK, Romer LM, Weiner P. Inspiratory muscle training in obstructive lung disease. Breathe. 2005 Sep 1;2(1):38–49.
26. Wu W, Guan L, Zhang X, Li X, Yang Y, Guo B, et al. Effects of two types of equal-intensity inspiratory muscle training in stable patients with chronic obstructive pulmonary disease: A randomised controlled trial. Respir Med. 2017 Nov;132:84–91.
27. Morris NR, Hill K, Walsh J, Sabapathy S. Exercise & Sports Science Australia (ESSA) position statement on exercise and chronic obstructive pulmonary disease. J Sci Med Sport. 2021 Jan;24(1):52–9.
28. Shoemaker MJ, Donker S, LaPoe A. Inspiratory Muscle Training in Patients with Chronic Obstructive Pulmonary Disease: The State of the Evidence. Cardiopulm Phys Ther J. 2009 Sep;20(3):5–15.
29. Bissett B, Leditschke IA, Green M, Marzano V, Collins S, Van Haren F. Inspiratory muscle training for intensive care patients: A multidisciplinary practical guide for clinicians. Aust Crit Care. 2019 May;32(3):249–55.
30. Katsura M, Kuriyama A, Takeshima T, Fukuhara S, Furukawa TA. Preoperative inspiratory muscle training for postoperative pulmonary complications in adults undergoing cardiac and major abdominal surgery. Cochrane Database Syst Rev. 2015 Oct 5;2015(10):CD010356.
31. Azambuja A de CM, de Oliveira LZ, Sbruzzi G. Inspiratory Muscle Training in Patients With Heart Failure: What Is New? Systematic Review and Meta-Analysis. Phys Ther. 2020 Dec 7;100(12):2099–109.
32. Nield MA. Inspiratory muscle training protocol using a pressure threshold device: effect on dyspnea in chronic obstructive pulmonary disease. Arch Phys Med Rehabil. 1999 Jan;80(1):100–2.
33. Tounsi B, Acheche A, Lelard T, Tabka Z, Trabelsi Y, Ahmaidi S. Effects of specific inspiratory muscle training combined with whole-body endurance training program on balance in COPD patients: Randomized controlled trial. PLOS ONE. 2021 Sep 23;16(9):e0257595.
34. Rodrigues GD, Gurgel JL, Gonçalves TR, da Silva Soares PP. Inspiratory muscle training improves physical performance and cardiac autonomic modulation in older women. Eur J Appl Physiol. 2018 Jun;118(6):1143–52.
35. Mills DE, Johnson MA, Barnett YA, Smith WHT, Sharpe GR. The effects of inspiratory muscle training in older adults. Med Sci Sports Exerc. 2015 Apr;47(4):691–7.
36. Souza H, Rocha T, Pessoa M, Rattes C, Brandão D, Fregonezi G, et al. Effects of inspiratory muscle training in elderly women on respiratory muscle strength, diaphragm thickness and mobility. J Gerontol A Biol Sci Med Sci. 2014 Dec;69(12):1545–53.
37. Reychler G, Delacroix S, Dresse D, Pieters T, Liistro G. Randomized Controlled Trial of the Effect of Inspiratory Muscle Training and Incentive Spirometry on Respiratory Muscle Strength, Chest Wall Expansion, and Lung Function in Elderly Adults. J Am Geriatr Soc. 2016 May;64(5):1128–30.
38. Ferraro FV, Gavin JP, Wainwright T, McConnell A. The effects of 8 weeks of inspiratory muscle training on the balance of healthy older adults: a randomized, double-blind, placebo-controlled study. Physiol Rep. 2019 May;7(9):e14076.
39. Aznar-Lain S, Webster AL, Cañete S, San Juan AF, López Mojares LM, Pérez M, et al. Effects of inspiratory muscle training on exercise capacity and spontaneous physical activity in elderly subjects: a randomized controlled pilot trial. Int J Sports Med. 2007 Dec;28(12):1025–9.
40. Kaneko H, Suzuki A, Horie J. Effects of Cough Training and Inspiratory Muscle Training on Cough Strength in Older Adults: A Randomized Controlled Trial. Lung. 2022 Feb 1;200(1):49–57.