{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,10]],"date-time":"2026-11-10T02:50:23Z","timestamp":1794279023279,"version":"4.9.0"},"reference-count":42,"publisher":"MDPI AG","issue":"10","license":[{"start":{"date-parts":[[2025,10,2]],"date-time":"2025-10-02T00:00:00Z","timestamp":1759363200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.mdpi.com"],"crossmark-restriction":true},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: Post-menopausal estrogen decline is considered a contributing factor to sarcopenia, and inspiratory muscle training (IMT) may provide benefits in this demographic. This study examined the impact of a four-week IMT program on diaphragm thickness, abdominal wall muscle thickness (AWMT; transversus abdominis, internal oblique, and external oblique), and liver fat percentage in healthy elderly women. Materials and Methods: Twenty-six women aged 60\u201380 years were randomly assigned to an IMT group (n = 13) or a control group (n = 13). The IMT group used the PowerBreathe\u00ae Classic device at 40% of maximal inspiratory pressure (MIP), with weekly increments of 10%. Training was performed twice daily, five days per week, with 30 breathing cycles per session (60 per day). The control group maintained their usual routines. AWMT, diaphragm thickness (DT), and fatty liver density (FLD) were measured by a radiologist before and after the intervention. Results: After four weeks, the IMT group showed significant improvements in all parameters compared to controls. Mid-diaphragm thickness (MDT) increased by 11.44% (effect size (ES) = 0.358, p &lt; 0.001) versus 0.76% in controls (p = 0.271). Posterior diaphragm thickness (PDT) improved by 7.48% (ES = 0.282, p &lt; 0.001) versus 0.38% (p = 0.564). Right AWMT increased by 12.7% (ES = 0.492, p &lt; 0.001) compared to 0.10% (p = 0.872), and left AWMT increased by 9.93% (ES = 0.395, p &lt; 0.001) versus 2.64% (p = 0.014). FLD improved by 11.79% (ES = 0.959, p &lt; 0.001) in the IMT group, while the control group showed no meaningful change (\u22120.13%, p = 0.847). Conclusions: A short-term IMT protocol significantly enhanced diaphragm and AWMT and reduced liver fat in elderly women. These findings support the use of IMT as a simple, non-invasive intervention to preserve musculoskeletal and metabolic health in aging populations.<\/jats:p>","DOI":"10.3390\/medicina61101784","type":"journal-article","created":{"date-parts":[[2025,10,2]],"date-time":"2025-10-02T10:22:32Z","timestamp":1759400552000},"page":"1784","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Effect of Inspiratory Muscle Training on Diaphragm and Abdominal Wall Muscle Thickness with Fatty Liver Density in Elderly Women: A Randomized Controlled Trial"],"prefix":"10.3390","volume":"61","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1909-6754","authenticated-orcid":false,"given":"Eda","family":"G\u00f6k\u00e7elik","sequence":"first","affiliation":[{"name":"Faculty of Sport Sciences, Istanbul Ayd\u0131n University, Istanbul 34295, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2826-1566","authenticated-orcid":false,"given":"Co\u015fkun","family":"Y\u0131lmaz","sequence":"additional","affiliation":[{"name":"Kelkit Ayd\u0131n Do\u011fan Vocational School, G\u00fcm\u00fc\u015fhane University, G\u00fcm\u00fc\u015fhane 29600, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cemallettin","family":"Budak","sequence":"additional","affiliation":[{"name":"Faculty of Sport Sciences, Erzincan Binali Y\u0131ld\u0131r\u0131m University, Erzincan 24100, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hakan H\u00fcseyin","family":"Soylu","sequence":"additional","affiliation":[{"name":"Radiology Department, Kelkit District State Hospital, Gumushane Provincial Health Directorate, G\u00fcm\u00fc\u015fhane 29600, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Serdar","family":"Bayrakdaro\u011flu","sequence":"additional","affiliation":[{"name":"Faculty of Sports Sciences, G\u00fcm\u00fc\u015fhane University, G\u00fcm\u00fc\u015fhane 29100, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-2214-4667","authenticated-orcid":false,"given":"Halil \u0130brahim","family":"Ceylan","sequence":"additional","affiliation":[{"name":"Faculty of Sports Sciences, Atat\u00fcrk University, Erzurum 25100, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4615-6687","authenticated-orcid":false,"given":"Raul Ioan","family":"Muntean","sequence":"additional","affiliation":[{"name":"Faculty of Law and Social Sciences, University \u201c1 Decembrie 1918\u201d of Alba Iulia, 510009 Alba Iulia, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9912-9909","authenticated-orcid":false,"given":"Hamza","family":"K\u00fc\u00e7\u00fck","sequence":"additional","affiliation":[{"name":"Ya\u015far Do\u011fu Faculty of Sports Sciences, Ondokuz May\u0131s University, Samsun 55100, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3045-1211","authenticated-orcid":false,"given":"Levent","family":"Ceylan","sequence":"additional","affiliation":[{"name":"Faculty of Sport Sciences, Hitit University, \u00c7orum 19030, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,10,2]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1143","DOI":"10.1007\/s00421-018-3844-9","article-title":"Inspiratory muscle training improves physical performance and cardiac autonomic modulation in older women","volume":"118","author":"Rodrigues","year":"2018","journal-title":"Eur. J. Appl. Physiol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"e356","DOI":"10.6061\/clinics\/2018\/e356","article-title":"The influence of inspiratory muscle training combined with the Pilates method on lung function in elderly women: A randomized controlled trial","volume":"73","author":"Charkovski","year":"2018","journal-title":"Clinics"},{"key":"ref_3","first-page":"1467025","article-title":"Effects of Resistance Training on Immunoinflammatory Response, TNF-Alpha Gene Expression, and Body Composition in Elderly Women","volume":"2018","author":"Neto","year":"2018","journal-title":"J. Aging Res."},{"key":"ref_4","first-page":"544","article-title":"Exerc\u00edcio f\u00edsico como fator de preven\u00e7\u00e3o aos processos inflamat\u00f3rios decorrentes do envelhecimento","volume":"17","author":"Brito","year":"2011","journal-title":"Mot. Rev. Educ. F\u00edsica"},{"key":"ref_5","first-page":"78","article-title":"Fitness profiling in women soccer: Performance characteristics of elite Turkish women soccer players","volume":"21","author":"Can","year":"2019","journal-title":"Turk. J. Sport Exerc."},{"key":"ref_6","first-page":"320","article-title":"Physical exercise, inflammatory process and adaptive condition: An overview","volume":"13","author":"Macedo","year":"2011","journal-title":"Rev. Bras. Cineantropometria Desempenho Hum."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"707","DOI":"10.1007\/BF03262290","article-title":"Effect of respiratory muscle training on exercise performance in healthy individuals: A systematic review and meta-analysis","volume":"42","author":"Illi","year":"2012","journal-title":"Sports Med."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"28","DOI":"10.1016\/j.resp.2019.04.001","article-title":"Inspiratory muscle training improves pulmonary functions and respiratory muscle strength in healthy male smokers","volume":"264","author":"Bostanci","year":"2019","journal-title":"Respir. Physiol. Neurobiol."},{"key":"ref_9","doi-asserted-by":"crossref","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","year":"2013","journal-title":"J. Strength Cond. Res."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"76","DOI":"10.1016\/j.jvoice.2020.04.012","article-title":"Effect of respiratory muscle training on pitch range and sound duration in brass instrument players and singers","volume":"36","author":"Yilmaz","year":"2022","journal-title":"J. Voice"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"716","DOI":"10.1093\/ageing\/afaa221","article-title":"Inspiratory muscle training for improving inspiratory muscle strength and functional capacity in older adults: A systematic review and meta-analysis","volume":"50","author":"Manifield","year":"2020","journal-title":"Age Ageing"},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"McConnell, A. (2013). Respiratory Muscle Training: Theory and Practice, Elsevier Health Sciences.","DOI":"10.1016\/B978-0-7020-5020-6.00005-4"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"111357","DOI":"10.1016\/j.exger.2021.111357","article-title":"Time-dependent effects of inspiratory muscle training and detraining on cardiac autonomic control in older women","volume":"150","author":"Rodrigues","year":"2021","journal-title":"Exp. Gerontol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"e020980","DOI":"10.1161\/JAHA.121.020980","article-title":"Time-efficient inspiratory muscle strength training lowers blood pressure and improves endothelial function, NO bioavailability, and oxidative stress in midlife\/older adults with above-normal blood pressure","volume":"10","author":"Craighead","year":"2021","journal-title":"J. Am. Hear. Assoc."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"449","DOI":"10.1152\/japplphysiol.00024.2020","article-title":"Inspiratory muscle strength training lowers blood pressure and sympathetic activity in older adults with OSA: A randomized controlled pilot trial","volume":"129","author":"DeLucia","year":"2020","journal-title":"J. Appl. Physiol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"112058","DOI":"10.1016\/j.exger.2022.112058","article-title":"Respiratory training in older women: Unravelling central and peripheral hemodynamic slow oscillatory patterns","volume":"172","author":"Rodrigues","year":"2022","journal-title":"Exp. Gerontol."},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Rodrigues, G.D., Lago, P.D., and da Silva Soares, P.P. (2021). Inspiratory muscle training improves breathing pattern and sympatho-vagal balance but not spontaneous baroreflex sensitivity in older women. Respir. Physiol. Neurobiol., 290.","DOI":"10.1016\/j.resp.2021.103672"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"H1059","DOI":"10.1152\/ajpheart.00351.2023","article-title":"Time-efficient, high-resistance inspiratory muscle strength training increases cerebrovascular reactivity in midlife and older adults","volume":"325","author":"Freeberg","year":"2023","journal-title":"Am. J. Physiol. Circ. Physiol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"e14076","DOI":"10.14814\/phy2.14076","article-title":"The effects of 8 weeks of inspiratory muscle training on the balance of healthy older adults: A randomized, double-blind, placebo-controlled study","volume":"7","author":"Ferraro","year":"2019","journal-title":"Physiol. Rep."},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Rodrigues, G.D., Gurgel, J.L., dos Santos Galdino, I., da N\u00f3brega, A.C.L., and da Silva Soares, P.P. (2020). Respiratory pump contributions in cerebrovascular and postural control responses during orthostatic stress in older women. Respir. Physiol. Neurobiol., 275.","DOI":"10.1016\/j.resp.2020.103384"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1025","DOI":"10.1055\/s-2007-965077","article-title":"Effects of inspiratory muscle training on exercise capacity and spontaneous physical activity in elderly subjects: A randomized controlled pilot trial","volume":"28","author":"Webster","year":"2007","journal-title":"Int. J. Sports Med."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"518","DOI":"10.1016\/S0929-6646(11)60078-8","article-title":"Comparison of inspiratory muscle strength training effects between older subjects with and without chronic obstructive pulmonary disease","volume":"110","author":"Huang","year":"2011","journal-title":"J. Formos. Med. Assoc."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"105579","DOI":"10.1016\/j.archger.2024.105579","article-title":"Updates in inspiratory muscle training for older adults: A systematic review","volume":"127","author":"Oliveira","year":"2024","journal-title":"Arch. Gerontol. Geriatr."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"967","DOI":"10.1152\/jappl.2000.89.3.967","article-title":"Changes in intra-abdominal pressure during postural and respiratory activation of the human diaphragm","volume":"89","author":"Hodges","year":"2000","journal-title":"J. Appl. Physiol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"2377","DOI":"10.1007\/s11357-013-9517-z","article-title":"Association between ultrasound measurements of muscle thickness, pennation angle, echogenicity and skeletal muscle strength in the elderly","volume":"35","author":"Strasser","year":"2013","journal-title":"Age"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"457","DOI":"10.1186\/2193-1801-2-457","article-title":"Prediction of the muscle strength by the muscle thickness and hardness using ultrasound muscle hardness meter","volume":"2","author":"Muraki","year":"2013","journal-title":"SpringerPlus"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1545","DOI":"10.1093\/gerona\/glu182","article-title":"Effects of inspiratory muscle training in elderly women on respiratory muscle strength, diaphragm thickness and mobility","volume":"69","author":"Souza","year":"2014","journal-title":"J. Gerontol. Ser. A"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"345","DOI":"10.1093\/ptj\/86.3.345","article-title":"Effect of high-intensity inspiratory muscle training on lung volumes, diaphragm thickness, and exercise capacity in subjects who are healthy","volume":"86","author":"Enright","year":"2006","journal-title":"Phys. Ther."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"171","DOI":"10.1016\/S1836-9553(10)70022-9","article-title":"Inspiratory muscle training improves maximal inspiratory pressure and may assist weaning in older intubated patients: A randomised trial","volume":"56","author":"Cader","year":"2010","journal-title":"J. Physiother."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"418","DOI":"10.1016\/j.hrtlng.2018.04.010","article-title":"An investigation into the use of ultrasound as a surrogate measure of diaphragm function","volume":"47","author":"Holtzhausen","year":"2018","journal-title":"Hear. Lung"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"390","DOI":"10.1016\/j.jhep.2016.09.022","article-title":"Bi-directional analysis between fatty liver and cardiovascular disease risk factors","volume":"66","author":"Ma","year":"2017","journal-title":"J. Hepatol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"894","DOI":"10.1111\/j.1440-1746.2008.05420.x","article-title":"Liver fat is reproducibly measured using computed tomography in the Framingham Heart Study","volume":"23","author":"Speliotes","year":"2008","journal-title":"J. Gastroenterol. Hepatol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"225","DOI":"10.2478\/bhk-2023-0026","article-title":"POWERbreathe\u00ae S-Index Test\u2013guidelines and recommendations for practitioners","volume":"15","author":"Kowalski","year":"2023","journal-title":"Biomed. Hum. Kinet."},{"key":"ref_34","doi-asserted-by":"crossref","unstructured":"\u00c7elikel, B.E., Y\u0131lmaz, C., Demir, A., Sezer, S.Y., Ceylan, L., Ceylan, T., and Tan, \u00c7. (2025). Co Effects of inspiratory muscle training on 1RM performance and body composition in professional natural bodybuilders. Front. Physiol., 16.","DOI":"10.3389\/fphys.2025.1574439"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"107","DOI":"10.3102\/10769986006002107","article-title":"Distribution theory for glass\u2019s estimator of effect size and related estimators","volume":"6","author":"Hedges","year":"1981","journal-title":"J. Educ. Stat."},{"key":"ref_36","first-page":"196","article-title":"Effects of inspiratory muscle training on inspiratory muscle strength, diaphragm thickness, and exercise capacity in sarcopenic individuals","volume":"26","author":"Devran","year":"2024","journal-title":"Eurasian J. Pulmonol."},{"key":"ref_37","first-page":"541","article-title":"Sonographic response of diaphragmatic excursion to threshold inspiratory muscle trainer in elderly","volume":"85","author":"Rezkallah","year":"2017","journal-title":"Med. J. Cairo Univ."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"535","DOI":"10.4187\/respcare.06945","article-title":"Effects of inspiratory muscle training in older adults","volume":"65","author":"Seixas","year":"2020","journal-title":"Respir. Care"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"691","DOI":"10.1249\/MSS.0000000000000474","article-title":"The effects of inspiratory muscle training in older adults","volume":"47","author":"Mills","year":"2015","journal-title":"Med. Sci. Sports Exerc."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"245","DOI":"10.1123\/japa.16.3.245","article-title":"The effects of respiratory-muscle training on exercise in older women","volume":"16","author":"Watsford","year":"2008","journal-title":"J. Aging Phys. Act."},{"key":"ref_41","first-page":"e190157","article-title":"O efeito do treinamento muscular inspirat\u00f3rio em idosos sobre a qualidade de vida, resposta imune, for\u00e7a muscular inspirat\u00f3ria e de membros inferiores: Um ensaio cl\u00ednico randomizado","volume":"22","author":"Amaral","year":"2020","journal-title":"Rev. Bras. Geriatr. Gerontol."},{"key":"ref_42","doi-asserted-by":"crossref","unstructured":"Ladri\u00f1\u00e1n-Maestro, A., S\u00e1nchez-Infante, J., Mart\u00edn-Vera, D., and S\u00e1nchez-Sierra, A. (2024). Influence of an inspiratory muscle fatigue protocol on healthy youths on respiratory muscle strength and heart rate variability. A randomized controlled trial. Front. Physiol., 15.","DOI":"10.3389\/fphys.2024.1457019"}],"container-title":["Medicina"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1648-9144\/61\/10\/1784\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,4]],"date-time":"2025-10-04T04:24:58Z","timestamp":1759551898000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1648-9144\/61\/10\/1784"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10,2]]},"references-count":42,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2025,10]]}},"alternative-id":["medicina61101784"],"URL":"https:\/\/doi.org\/10.3390\/medicina61101784","relation":{},"ISSN":["1648-9144"],"issn-type":[{"value":"1648-9144","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10,2]]}}}