Building breath resilience: How Inspiratory Muscle Training might work for you

If you’ve started to feel like your breathing gives out before your body does, or if breathlessness is still causing you problems after you’ve worked on your breathing pattern, Inspiratory Muscle Training (IMT) might be the next step.

IMT focuses on strengthening the muscles you use to inhale, especially your diaphragm. It’s a targeted way to build endurance, improve breathing mechanics and help you feel more in control when you move.

So, what is IMT and when should it be used?

What is Inspiratory Muscle Training?

Your diaphragm is a muscle, just like your biceps or quadraceps. Muscle fibers need to be overloaded in order to have a training effect, and the respiratory muscles are no different. However it is more difficult to target the respiratory muscles as they cannot utilise equipment such as dumbells, or even body weight, to add a load to them. This is where inspiratory muscle training (IMT) devices come in.

IMT devices add a load, or resistance, to the breath in. During the breath in, the respiratory muscles contract and work against the load that is provided by the IMT device. This sensation can feel much like sucking a thick milkshake up a thin straw. This action encourages you to use your diaphragm against resistance in order to build strength.

When it’s strong, your diaphragm works more efficiently; when it’s under‑used, your smaller, weaker, upper chest and neck muscles compensate and you end up with less efficient, more tiring breaths that are unable to give you the lung volumes you need. This can lead to premature breathlessness, fatigue, and reduced performance and/or endurance during activity or sport.

Why the timing of IMT matters

IMT isn’t always the first step in resolving breathing issues. If you start IMT before your breathing mechanics are correct, you risk strengthening the wrong muscles - those neck or upper chest muscles that are already compensating, which will likely make your symptoms worse.

At the Breathing MOT, our specialist respiratory physiotherapists first focus on retraining your breathing pattern. This involves working on optimising your underlying breathing pattern ensuring diaphragm activation, lower rib cage movement, adequate thoracic range of movement, optimal alignment, nose vs mouth breathing, breath coordination... the list goes on. We then build resilience with IMT once the foundations of your breathing are solid and once it is safe to do so.

Here’s how it typically works:

• Assessment: We identify any breathing pattern abnormalities; looking at your overall pattern, joint mobility and muscle activation, as well as how well you engage your diaphragm when you breathe. We may conduct a baseline inspiratory muscle strength test to measure diaphragm function.

• Retraining: We help you switch from inefficient patterns (like chest/neck dominance, erratic gasps, hyperventilation patterns) to optimal breathing mechanics using your nose and lower chest, through our programme of breathing pattern re-training.

• IMT: We then introduce device‑based resistance in the form of IMT once the diaphragm is functioning appropriately and once it is safe to do so. We will schedule follow‑ups to monitor strength, symptoms (breathlessness, fatigue) and how your breathing pattern handles everyday or sport demands.

• Integration: You can then use strengthened diaphragm support during sport, exertion, or everyday tasks.

What the evidence says

There is a wealth of evidence supporting the use of IMT in various different conditions and scenarios. We have listed some we find most interesting below:

• Strengthens the inspiratory muscles and increases diaphragm thickness (McConnell et al 2006, 2004, 2005, 2011, 2013; Romer et all 2002, 2006; Volianitis et al 2001, Enright et al 2006).

• Decreased shortness of breath (Lisboa 1994, 1997; Copestake & McConnell 1995; McConnell et al 1998).

• Decreased inspiratory muscle fatigue (Jansens et al 2016).

• Less required blood flow to inspiratory muscles, delayed metaboreflex (McConnell et al 2005; Volianitis et al 2001) .

• At high levels of diaphragm fatigue during intense exercise, blood shifted back to core to prevent diaphragm from becoming overloaded / paralysed with lactate – therefore preventing a respiratory arrest.

• IMT has been shown to prevent this from happening (McConnell & Lomax 2006)

• Basic breathing pattern retraining also helps reduce the metaboreflex (Vickery 2007).

• Runners - Decrease in run time mile by 4% (or improved 800m by 6 secs) (Leddy et al 2007; Chang et al 2021).

• Cyclists - Decrease in 25km time trail by 2.6% (Johnson et al 2007).

• Swimmers - Decrease in 100m swim time by 1.5% (Kilding et al 2010).

• Improved heart rate variability (HRV) and blood pressure - Assumed to be due to improved autonomic nervous system tone favouring parasympathetic dominance. Lowering of HR and improved HRV.

  
  

How IMT can make a difference to you

Strong, efficient breathing muscles help you:

• Use less effort to breathe during activity.

• Avoid reverting to compensatory patterns when things get harder.

• Reduce symptoms like breathlessness or early fatigue during activity or sport.

• Support better posture and movement.

  
  

Is IMT right for you?

IMT might be especially worthwhile if you:

• Have a breathing pattern disorder and have completed initial retraining.

• Experience breathlessness on exertion, fatigue in sport or everyday tasks, or upper chest/neck breathing dominance.

• Want to improve performance (sport or day‑to‑day) by building endurance in your breathing system.

  
  

The important factor to remember is that IMT is a tool, not a cure. It’s powerful when used at the right stage, once your breathing mechanics are working well and you’re ready to build strength, endurance and resilience.

At The Breathing MOT we guide you through pattern correction first, then introduce IMT when it will make the biggest difference.

Book a consultation and find out if IMT could be the missing piece in your breathing journey. If you need any assistance with making a booking, please contact us on enquiries@airphysiotherapy.co.uk or 020 7971 1464.