{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T13:49:45Z","timestamp":1787924985616,"version":"build-2784847793"},"reference-count":28,"publisher":"Human Kinetics","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,8,1]]},"abstract":"<jats:p><jats:italic><jats:bold>Context and Objectives<\/jats:bold>:<\/jats:italic> Respiratory muscle training (RMT) is considered an effective tool to improve cardiorespiratory limitations in athletes. The goals of this systematic review were to explore the role of RMT and its implementation within sport rehabilitation programs in para-athletes. <jats:italic><jats:bold>Evidence Acquisition<\/jats:bold>:<\/jats:italic> Several databases were searched until January 2024. Eligible studies were independently reviewed by 2 reviewers. Quality assessment was made using the PEDro scale and version 2 of the Cochrane Risk-of-Bias Tool for Randomized Trials. Eight studies (a total of 108 participants) were selected for the analysis. <jats:italic><jats:bold>Evidence Synthesis<\/jats:bold>:<\/jats:italic> Five studies preferred using resistive loading, while 2 studies used normocapnic hyperpnea, and 1 study used threshold inspiratory muscle training. Respiratory functions (respiratory muscle strength and endurance, spirometry measures) and exercise performance were assessed as the main outcomes. Significant increases in respiratory muscle strength were reported in 5 studies. Two studies observed improvement in respiratory muscle endurance and 3 studies reported increased exercise capacity. <jats:italic><jats:bold>Conclusions<\/jats:bold>:<\/jats:italic> This review suggests that although RMT can enhance respiratory muscle strength and endurance, it should not be considered the primary method for boosting the exercise performance of para-athletes. Additional research is necessary to explore the impact of various RMT techniques on different outcomes from the perspective of sport rehabilitation in para-athletes.<\/jats:p>","DOI":"10.1123\/jsr.2023-0301","type":"journal-article","created":{"date-parts":[[2024,7,12]],"date-time":"2024-07-12T18:34:32Z","timestamp":1720809272000},"page":"387-395","source":"Crossref","is-referenced-by-count":7,"title":["Respiratory Muscle Training in Para-Athletes: A Systematic Review on the Training Protocols and Effects on Reported Outcomes"],"prefix":"10.1123","volume":"33","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9878-256X","authenticated-orcid":true,"given":"Buket","family":"Akinci","sequence":"first","affiliation":[{"name":"Department of Physiotherapy and Rehabilitation (English), Faculty of Health Sciences, Biruni University, Istanbul, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9817-1021","authenticated-orcid":true,"given":"Cigdem","family":"Emirza Cilbir","sequence":"additional","affiliation":[{"name":"Department of Physiotherapy and Rehabilitation, Institute of Graduate Studies, Istanbul University-Cerrahpasa, Istanbul, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3335-2112","authenticated-orcid":true,"given":"Ahmet","family":"Kocyigit","sequence":"additional","affiliation":[{"name":"Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Zonguldak Bulent Ecevit University, Zonguldak, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0169-0707","authenticated-orcid":true,"given":"Goksen","family":"Kuran Aslan","sequence":"additional","affiliation":[{"name":"Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Istanbul University-Cerrahpasa, Istanbul, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"100","reference":[{"key":"r1","unstructured":"International Paralympic Committee. https:\/\/www.paralympic.org\/paralympic-games. Accessed 1 February, 2024."},{"issue":"6","key":"r2","series-title":"J Strength Cond Res","doi-asserted-by":"publisher","first-page":"1643","DOI":"10.1519\/JSC.0b013e318269f73f","article-title":"Effects of respiratory muscle training on performance in athletes: a systematic review with meta-analyses","volume":"27","author":"HajGhanbari B","year":"2013","unstructured":"HajGhanbari B, Yamabayashi C, Buna TR, et\u00a0al. Effects of respiratory muscle training on performance in athletes: a systematic review with meta-analyses. J Strength Cond Res. 2013;27(6):1643\u20131663. doi:10.1519\/JSC.0b013e318269f73f"},{"issue":"4","key":"r3","series-title":"Fisioterapia em Movimento","doi-asserted-by":"publisher","first-page":"821","DOI":"10.1590\/1980-5918.029.004.ao19","article-title":"Use of powerbreathe\u00ae in inspiratory muscle training for athletes: systematic review","volume":"29","author":"Nepomuceno J\u00fanior BRV","year":"2016","unstructured":"Nepomuceno J\u00fanior BRV, G\u00f3mez TB, Gomes Neto M. Use of powerbreathe\u00ae in inspiratory muscle training for athletes: systematic review. Fisioterapia em Movimento. 2016;29(4):821\u2013830. doi:10.1590\/1980-5918.029.004.ao19"},{"key":"r4","series-title":"Respiratory Muscle Training","first-page":"97","article-title":"Functional benefits of respiratory muscle training","author":"McConnell A","year":"2013","unstructured":"McConnell A. Functional benefits of respiratory muscle training. In McConnell A, ed.\u00a0Respiratory Muscle Training. Elseiver; 2013:97\u2013131."},{"key":"r5","series-title":"Phys Ther Sport","doi-asserted-by":"publisher","first-page":"92","DOI":"10.1016\/j.ptsp.2018.09.004","article-title":"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","volume":"34","author":"Karsten M","year":"2018","unstructured":"Karsten M, Ribeiro GS, Esquivel MS, Matte DL. 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. Phys Ther Sport. 2018;34:92\u2013104. doi:10.1016\/j.ptsp.2018.09.004"},{"issue":"8","key":"r6","series-title":"J Sport Rehabil","doi-asserted-by":"publisher","first-page":"1151","DOI":"10.1123\/jsr.2019-0231","article-title":"Inspiratory muscle training in rehabilitation of low back pain: a randomized controlled trial","volume":"29","author":"Ahmadnezhad L","year":"2020","unstructured":"Ahmadnezhad L, Yalfani A, Borujeni BG. Inspiratory muscle training in rehabilitation of low back pain: a randomized controlled trial. J Sport Rehabil. 2020;29(8):1151\u20131158. doi:10.1123\/jsr.2019-0231"},{"key":"r7","series-title":"Clin Biomech","doi-asserted-by":"publisher","first-page":"215","DOI":"10.1016\/j.clinbiomech.2019.09.006","article-title":"Reduction of postural sway in athletes with chronic low back pain through eight weeks of inspiratory muscle training: a randomized controlled trial","volume":"69","author":"Borujeni BG","year":"2019","unstructured":"Borujeni BG, Yalfani A. Reduction of postural sway in athletes with chronic low back pain through eight weeks of inspiratory muscle training: a randomized controlled trial. Clin Biomech. 2019;69:215\u2013220. doi:10.1016\/j.clinbiomech.2019.09.006"},{"issue":"9","key":"r8","series-title":"J Strength Cond Res","doi-asserted-by":"publisher","first-page":"2665","DOI":"10.1519\/JSC.0000000000002730","article-title":"Recent advancements in our understanding of the ergogenic effect of respiratory muscle training in healthy humans: a systematic review","volume":"32","author":"Shei RJ","year":"2018","unstructured":"Shei RJ. Recent advancements in our understanding of the ergogenic effect of respiratory muscle training in healthy humans: a systematic review. J Strength Cond Res. 2018;32(9):2665\u20132676. doi:10.1519\/JSC.0000000000002730"},{"issue":"14","key":"r9","series-title":"J Physiol","doi-asserted-by":"publisher","first-page":"3673","DOI":"10.1113\/JP277943","article-title":"Respiratory muscle training in athletes with cervical spinal cord injury: effects on cardiopulmonary function and exercise capacity","volume":"597","author":"Gee CM","year":"2019","unstructured":"Gee CM, Williams AM, Sheel AW, Eves ND, West CR. Respiratory muscle training in athletes with cervical spinal cord injury: effects on cardiopulmonary function and exercise capacity. J Physiol. 2019;597(14):3673\u20133685. doi:10.1113\/JP277943"},{"issue":"1","key":"r10","series-title":"Clin J Sport Med","doi-asserted-by":"publisher","first-page":"69","DOI":"10.1097\/JSM.0000000000000003","article-title":"An exploratory study of respiratory muscle endurance training in high lesion level paraplegic handbike athletes","volume":"24","author":"Fischer G","year":"2014","unstructured":"Fischer G, Tarperi C, George K, Ardig\u00f2 LP. An exploratory study of respiratory muscle endurance training in high lesion level paraplegic handbike athletes. Clin J Sport Med. 2014;24(1):69\u201375. doi:10.1097\/JSM.0000000000000003"},{"issue":"2","key":"r11","series-title":"Med Sci Sports Exerc","doi-asserted-by":"publisher","first-page":"323","DOI":"10.1249\/MSS.0b013e31822b7441","article-title":"Resting cardiopulmonary function in Paralympic athletes with cervical spinal cord injury","volume":"44","author":"West CR","year":"2012","unstructured":"West CR, Campbell IG, Shave RE, Romer LM. Resting cardiopulmonary function in Paralympic athletes with cervical spinal cord injury. Med Sci Sports Exerc. 2012;44(2):323\u2013329. doi:10.1249\/MSS.0b013e31822b7441"},{"issue":"1","key":"r12","series-title":"BMC Sports Sci Med Rehabil","doi-asserted-by":"publisher","DOI":"10.1186\/s13102-021-00369-y","article-title":"Wavelet coherence as a measure of trunk stabilizer muscle activation in wheelchair fencers","volume":"13","author":"B\u0142aszczyszyn M","year":"2021","unstructured":"B\u0142aszczyszyn M, Borysiuk Z, Piechota K, Kr\u0119cisz K, Zmarz\u0142y D. Wavelet coherence as a measure of trunk stabilizer muscle activation in wheelchair fencers. BMC Sports Sci Med Rehabil. 2021;13(1):140. doi:10.1186\/s13102-021-00369-y"},{"issue":"2","key":"r13","series-title":"PLoS One","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0192903","article-title":"Peak oxygen uptake in Paralympic sitting sports: a systematic literature review, meta-and pooled-data analysis","volume":"13","author":"Baumgart JK","year":"2018","unstructured":"Baumgart JK, Brurok B, Sandbakk \u00d8. Peak oxygen uptake in Paralympic sitting sports: a systematic literature review, meta-and pooled-data analysis. PLoS One. 2018;13(2):e0192903. doi:10.1371\/journal.pone.0192903"},{"issue":"1","key":"r14","series-title":"J Spinal Cord Med","doi-asserted-by":"publisher","first-page":"65","DOI":"10.1080\/10790268.2008.11753983","article-title":"Effects of respiratory resistance training with a concurrent flow device on wheelchair athletes","volume":"31","author":"Litchke LG","year":"2008","unstructured":"Litchke LG, Russian CJ, Lloyd LK, Schmidt EA, Price L, Walker JL. Effects of respiratory resistance training with a concurrent flow device on wheelchair athletes. J Spinal Cord Med. 2008;31(1):65\u201371. doi:10.1080\/10790268.2008.11753983"},{"issue":"1","key":"r15","series-title":"Ther Rec J","first-page":"51","article-title":"The effects of two types of concurrent respiratory resistance training devices on measures of physiological performance in wheelchair rugby athletes","volume":"44","author":"Litchke LG","year":"2011","unstructured":"Litchke LG, Russian CJ, Lloyd LK, Schmidt EA, Reardon R. The effects of two types of concurrent respiratory resistance training devices on measures of physiological performance in wheelchair rugby athletes. Ther Rec J. 2011;44(1):51\u201362."},{"issue":"2","key":"r16","series-title":"Int J Sports Physiol Perform","doi-asserted-by":"publisher","first-page":"238","DOI":"10.1123\/ijspp.2018-0979","article-title":"Effects of inspiratory muscle training with progressive loading on respiratory muscle function and sports performance in high-performance wheelchair basketball athletes: a randomized clinical trial","volume":"15","author":"Antonelli CBB","year":"2020","unstructured":"Antonelli CBB, Hartz CS, da Silva Santos S, Moreno MA. Effects of inspiratory muscle training with progressive loading on respiratory muscle function and sports performance in high-performance wheelchair basketball athletes: a randomized clinical trial. Int J Sports Physiol Perform. 2020;15(2):238\u2013242. doi:10.1123\/ijspp.2018-0979"},{"issue":"1","key":"r17","series-title":"Clin J Sport Med","doi-asserted-by":"publisher","first-page":"85","DOI":"10.1097\/JSM.0b013e318160c075","article-title":"Effects of respiratory muscle endurance training on wheelchair racing performance in athletes with paraplegia: a pilot study","volume":"18","author":"Mueller G","year":"2008","unstructured":"Mueller G, Perret C, Hopman MTE. Effects of respiratory muscle endurance training on wheelchair racing performance in athletes with paraplegia: a pilot study. Clin J Sport Med. 2008;18(1):85\u201388. doi:10.1097\/JSM.0b013e318160c075"},{"issue":"10","key":"r18","series-title":"Int J Environ Res Public Health","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph16101747","article-title":"Eight weeks of inspiratory muscle training improves pulmonary function in disabled swimmers\u2014a randomized trial","volume":"16","author":"Okrzymowska P","year":"2019","unstructured":"Okrzymowska P, Kurzaj M, Seidel W, Ro\u017cek-Piechura K. Eight weeks of inspiratory muscle training improves pulmonary function in disabled swimmers\u2014a randomized trial. Int J Environ Res Public Health. 2019;16(10):1747. doi:10.3390\/ijerph16101747"},{"issue":"9","key":"r19","series-title":"Br J Sports Med","doi-asserted-by":"publisher","first-page":"665","DOI":"10.1136\/bjsm.2008.049486","article-title":"Effects of inspiratory muscle training on respiratory function and repetitive sprint performance in wheelchair basketball players","volume":"44","author":"Goosey-Tolfrey V","year":"2010","unstructured":"Goosey-Tolfrey V, Foden E, Perret C, Degens H. Effects of inspiratory muscle training on respiratory function and repetitive sprint performance in wheelchair basketball players. Br J Sports Med. 2010;44(9):665\u2013668. doi:10.1136\/bjsm.2008.049486"},{"issue":"5","key":"r20","series-title":"Scand J Med Sci Sports","doi-asserted-by":"publisher","first-page":"764","DOI":"10.1111\/sms.12070","article-title":"Effects of inspiratory muscle training on exercise responses in Paralympic athletes with cervical spinal cord injury","volume":"24","author":"West CR","year":"2014","unstructured":"West CR, Taylor BJ, Campbell IG, Romer LM. Effects of inspiratory muscle training on exercise responses in Paralympic athletes with cervical spinal cord injury. Scand J Med Sci Sports. 2014;24(5):764\u2013772. doi:10.1111\/sms.12070"},{"issue":"4","key":"r21","series-title":"J Back Musculoskelet Rehabil","doi-asserted-by":"publisher","first-page":"655","DOI":"10.3233\/BMR-181452","article-title":"Respiratory muscle training in non-athletes and athletes with spinal cord injury: a systematic review of the effects on pulmonary function, respiratory muscle strength and endurance, and cardiorespiratory fitness based on the FITT principle of exercise prescription","volume":"33","author":"Lemos JR","year":"2020","unstructured":"Lemos JR, da Cunha FA, Lopes AJ, Guimaraes FS, do Amaral Vasconcellos FV, Dos Santos Vig\u00e1rio P. Respiratory muscle training in non-athletes and athletes with spinal cord injury: a systematic review of the effects on pulmonary function, respiratory muscle strength and endurance, and cardiorespiratory fitness based on the FITT principle of exercise prescription. J Back Musculoskelet Rehabil. 2020;33(4):655\u2013667. doi:10.3233\/BMR-181452"},{"issue":"12","key":"r22","series-title":"Am J Respir Crit Care Med","doi-asserted-by":"publisher","first-page":"1390","DOI":"10.1164\/rccm.200508-1211ST","article-title":"American thoracic society\/European respiratory Society statement on pulmonary rehabilitation","volume":"173","author":"Nici L","year":"2006","unstructured":"Nici L, Donner C, Wouters E, et\u00a0al. American thoracic society\/European respiratory Society statement on pulmonary rehabilitation. Am J Respir Crit Care Med. 2006;173(12):1390\u20131413. doi:10.1164\/rccm.200508-1211ST"},{"issue":"2","key":"r23","series-title":"Aust J Physiother","doi-asserted-by":"publisher","first-page":"129","DOI":"10.1016\/S0004-9514(09)70043-1","article-title":"The PEDro scale is a valid measure of the methodological quality of clinical trials: a demographic study","volume":"55","author":"De Morton NA","year":"2009","unstructured":"De Morton NA. The PEDro scale is a valid measure of the methodological quality of clinical trials: a demographic study. Aust J Physiother. 2009;55(2):129\u2013133. doi:10.1016\/S0004-9514(09)70043-1"},{"key":"r24","series-title":"BMJ","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.l4898","article-title":"RoB 2: a revised tool for assessing risk of bias in randomised trials","volume":"366","author":"Sterne JAC","year":"2019","unstructured":"Sterne JAC, Savovi\u0107 J, Page MJ, et\u00a0al. RoB 2: a revised tool for assessing risk of bias in randomised trials. BMJ. 2019;366:898. doi:10.1136\/bmj.l4898"},{"issue":"8","key":"r25","series-title":"Respir Care","doi-asserted-by":"publisher","first-page":"1189","DOI":"10.4187\/respcare.07098","article-title":"Inspiratory muscle training in COPD","volume":"65","author":"Figueiredo RIN","year":"2020","unstructured":"Figueiredo RIN, Azambuja AM, Cureau FV, Sbruzzi G. Inspiratory muscle training in COPD. Respir Care. 2020;65(8):1189\u20131201. doi:10.4187\/respcare.07098"},{"key":"r26","series-title":"Front Physiol","doi-asserted-by":"publisher","DOI":"10.3389\/fphys.2022.861582","article-title":"Strength and power-related measures in assessing core muscle performance in sport and rehabilitation","volume":"13","author":"Zemkov\u00e1 E","year":"2022","unstructured":"Zemkov\u00e1 E. Strength and power-related measures in assessing core muscle performance in sport and rehabilitation. Front Physiol. 2022;13:582. doi:10.3389\/fphys.2022.861582"},{"issue":"13","key":"r27","series-title":"Int J Environ Res Public Health","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph18136703","article-title":"Inspiratory muscle training program using the powerbreath\u00ae: does it have ergogenic potential for respiratory and\/or athletic performance? A systematic review with meta-analysis","volume":"18","author":"Fern\u00e1ndez-L\u00e1zaro D","year":"2021","unstructured":"Fern\u00e1ndez-L\u00e1zaro D, Gallego-Gallego D, Corchete LA, et\u00a0al. Inspiratory muscle training program using the powerbreath\u00ae: does it have ergogenic potential for respiratory and\/or athletic performance? A systematic review with meta-analysis. Int J Environ Res Public Health. 2021;18(13):6703. doi:10.3390\/ijerph18136703"},{"issue":"7","key":"r28","series-title":"Cochrane Database Syst Rev","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD008507","article-title":"Respiratory muscle training for cervical spinal cord injury","volume":"10","author":"Berlowitz DJ","year":"2013","unstructured":"Berlowitz DJ, Tamplin J. Respiratory muscle training for cervical spinal cord injury. Cochrane Database Syst Rev. 2013;10(7):507. doi:10.1002\/14651858.CD008507"}],"container-title":["Journal of Sport Rehabilitation"],"original-title":[],"link":[{"URL":"https:\/\/journals.humankinetics.com\/view\/journals\/jsr\/33\/6\/article-p387.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.humankinetics.com\/downloadpdf\/journals\/jsr\/33\/6\/article-p387.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/journals.humankinetics.com\/downloadpdf\/journals\/jsr\/33\/6\/article-p387.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,7,31]],"date-time":"2024-07-31T15:33:52Z","timestamp":1722440032000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.humankinetics.com\/view\/journals\/jsr\/33\/6\/article-p387.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,8,1]]},"references-count":28,"journal-issue":{"issue":"6"},"URL":"https:\/\/doi.org\/10.1123\/jsr.2023-0301","relation":{},"ISSN":["1056-6716","1543-3072"],"issn-type":[{"value":"1056-6716","type":"print"},{"value":"1543-3072","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,8,1]]}}}