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The simultaneous inspiratory and aerobic exercise training (60\u201380% of maximal heart rate; 3\u00a0days\/weeks; 4\u00a0weeks) was performed in the W-SIMT group (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200914). The same aerobic (walking) exercise training protocol (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200913) without Inspiratory Muscle Training (IMT) was applied in the walking (aerobic) group. The W-SIMT group performed 30 consecutive inspirations with 2-min rest (2 sets) in 50% of Maximal Inspiratory Pressure (MIP) using an assistive inspiratory muscle training device simultaneously while walking. The diaphragm thickness and stiffness, pulmonary functions, MIP, Maximal Expiratory Pressure (MEP), sustained\u00a0inspiratory maximal pressure (P\n                      <jats:sub>max<\/jats:sub>\n                      ), and fatigue index were evaluated before and 4\u00a0weeks after the intervention.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      There was a significant effect of group\u2009\u00d7\u2009time interaction for MIP (cmH\u2082O and %, respectively) (F\u2009=\u200928.719,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001; F\u2009=\u200910.640,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.003), sum (Pmax) (F\u2009=\u20095.414,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.029), and fatigue index (F\u2009=\u20094.775,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.039), in favor of the W-SIMT group.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The distinctive combination of respiratory muscle training and aerobic exercise shows additional benefits enhancing particularly respiratory and anaerobic performance even over a short period. Further studies are needed to explore the long-term effects of W-SIMT.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial Registry<\/jats:title>\n                    <jats:p>Trial Registration Number: NCT06742372.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00421-025-05868-1","type":"journal-article","created":{"date-parts":[[2025,7,2]],"date-time":"2025-07-02T10:05:42Z","timestamp":1751450742000},"page":"3769-3783","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Effects of simultaneous aerobic and inspiratory muscle training on diaphragm function, respiratory muscle strength, endurance, and fatigue index: randomized-controlled trial"],"prefix":"10.1007","volume":"125","author":[{"given":"Zeliha","family":"\u00c7elik","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0467-7310","authenticated-orcid":false,"given":"Nevin A.","family":"G\u00fczel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6842-5978","authenticated-orcid":false,"given":"Seriyye","family":"Allahverdiyeva","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1690-2538","authenticated-orcid":false,"given":"Halit Nahit","family":"\u015eendur","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2878-6052","authenticated-orcid":false,"given":"Mahi Nur","family":"Cerit","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,7,2]]},"reference":[{"issue":"1","key":"5868_CR1","doi-asserted-by":"publisher","first-page":"44","DOI":"10.12965\/jer.1836518.259","volume":"15","author":"B Ak\u0131no\u011flu","year":"2019","unstructured":"Ak\u0131no\u011flu B, Kocahan T, \u00d6zkan T (2019) The relationship between peripheral muscle strength and respiratory function and respiratory muscle strength in athletes. 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