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Prehabilitation may improve functional capacity, but evidence for its effect on inspiratory muscle strength in high-risk older adults remains limited. The main objective was to assess the change in maximal inspiratory pressure (MIP) in the preoperative period in high-risk patients receiving home-based tele-supervised prehabilitation compared to standard care.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This exploratory analysis included a subset of secondary outcome data from a prospective, two-arm, parallel-group randomised controlled trial conducted at a single university hospital in Switzerland. Patients aged\u2009\u2265\u200965 years awaiting elective cardiac or major non-cardiac surgery with a proven fitness deficit measured by cardiopulmonary exercise testing (CPET) were included. Participants randomized in the intervention arm received a multimodal, home-based tele-supervised prehabilitation programme over 2\u20134 weeks addressing deficits in physical fitness, nutrition, and anaemia, while controls received standard preoperative care.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Eighty eight participants were analysed (intervention\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200948; control\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200940). Patients in the intervention group showed improvement in MIP after the training period, whereas the control group demonstrated a decline (median change\u2009+\u200910.5 [0.00; 16.2] vs. \u2013 3.00 [-8.00; 1.50] cmH\u2082O;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). After adjustment for baseline MIP, the estimated between-group difference was 13.39 cmH\u2082O (95%CI 8.12\u201318.75;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Home-based tele-supervised IMT, delivered as part of a multimodal prehabilitation programme, improved maximal inspiratory pressure over the preoperative period in elderly high-risk surgical patients. The observed MIP decline in the control group suggests that the preoperative waiting period itself may carry a risk of functional deterioration in this population. Whether MIP improvements translate into reduced postoperative morbidity will be addressed by the primary outcome of the ongoing PREHABIL trial.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration<\/jats:title>\n                    <jats:p>ClinicalTrials.gov Identifier NCT04461301 (First Submitted: 02.07.2020, First Posted: 08.07.2020).<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12877-026-07944-3","type":"journal-article","created":{"date-parts":[[2026,7,7]],"date-time":"2026-07-07T13:54:44Z","timestamp":1783432484000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Inspiratory muscle training as part of multimodal prehabilitation improves maximal inspiratory pressure in elderly surgical patients: an exploratory secondary analysis of a randomised controlled trial"],"prefix":"10.1186","volume":"26","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-4684-6304","authenticated-orcid":false,"given":"Simone Wen-Shi","family":"Dueblin","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3704-6785","authenticated-orcid":false,"given":"Patrick Y.","family":"Wuethrich","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0544-7170","authenticated-orcid":false,"given":"Dominique","family":"Engel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9734-0682","authenticated-orcid":false,"given":"Prisca","family":"Eser","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1366-2949","authenticated-orcid":false,"given":"Christian M.","family":"Beilstein","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4541-3995","authenticated-orcid":false,"given":"Matthias","family":"Wilhelm","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4231-7837","authenticated-orcid":false,"given":"Thomas","family":"Vetsch","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,7,7]]},"reference":[{"key":"7944_CR1","doi-asserted-by":"publisher","unstructured":"Ruegsegger GN, Booth FW. 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Written informed consent was obtained for every participant before randomization into the trial.","order":2,"name":"Ethics","label":"Ethics approval and consent to participate","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Not applicable.","order":3,"name":"Ethics","label":"Consent for publication","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","label":"Competing interests","group":{"name":"EthicsHeading","label":"Declarations"}}],"article-number":"1237"}}