The Impact of Inspiratory Muscle Training on Diaphragm Thickness in Healthy Adults: A Systematic Review and Meta-Regression

TL;DR

This study finds that inspiratory muscle training increases diaphragm thickness in healthy adults, especially when using 50% of maximal inspiratory pressure.

Contribution

The study provides new evidence on how IMT affects diaphragm hypertrophy in healthy individuals, identifying baseline MIP as a key factor.

Findings

IMT significantly increased diaphragm thickness with a moderate effect size (Hedges’ g = 0.52).

Training at 50% maximal inspiratory pressure (MIP) produced a statistically significant effect.

Baseline MIP was the only factor significantly associated with diaphragm hypertrophy.

Abstract

Background and Objectives: The hypertrophic adaptation of the diaphragm to inspiratory muscle training (IMT) remains insufficiently characterized, particularly in healthy and athletic populations. To address this gap, we conducted a meta-analysis and meta-regression to evaluate the effects of IMT on diaphragm thickness and identify potential moderating factors. Materials and Methods: A systematic search was conducted across PubMed, MEDLINE, Embase, CINAHL, and SPORTDiscus as well as Google Scholar (gray literature) through November 2025. Eight studies involving 203 healthy participants met the inclusion criteria. A random-effects model was used to calculate pooled effect sizes and meta-regression estimates. Results: IMT produced a statistically significant moderate increase in diaphragm muscle thickness, with a standardized mean difference (SMD) of Hedges’ g = 0.52 (95% CI: 0.19 to 0.85; p < 0.05). Subgroup analyses indicated that IMT with 50% maximal inspiratory pressure (MIP) produces a statistically significant effect (p = 0.0069), whereas fitness status and age did not significantly influence outcomes (p = 0.589 and p = 0.126, respectively). Meta-regression analyses revealed that only baseline MIP value (β = 0.030; 95% CI: 0.009 to 0.050; p = 0.004) was associated with diaphragm hypertrophy. Conclusions: IMT with 50% of MIP elicits meaningful diaphragmatic hypertrophy in healthy individuals. This response appears independent of fitness status or age, but is significantly influenced by baseline inspiratory muscle strength (MIP). These findings support the utility of IMT in enhancing respiratory muscle morphology in health and performance contexts.

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