Key result
IMST fails to attenuate peak exercise SBP versus sham in young adults with obesity.
Why the study?
It was unknown whether inspiratory muscle strength training attenuates systolic blood pressure indexed to lower body lean mass during peak exercise in adults with obesity.
Does inspiratory muscle strength training reduce peak exercise systolic blood pressure in younger adults with obesity?
RCT (n=14)
Does inspiratory muscle strength training reduce peak exercise systolic blood pressure in younger adults with obesity?
Absolute Event Rate: 0.8% vs 0.7%
p-value: p=≥0.62
Eight weeks of high-resistance inspiratory muscle strength training did not attenuate peak exercise systolic blood pressure in younger adults with obesity.
IMST does not blunt exaggerated exercise SBP responses in obesity; challenges recent hypotheses and leaves open alternative mechanisms for pressor control.
Adults with obesity have exaggerated exercise systolic blood pressure (SBP) responses. Exaggerated exercise SBP is an independent predictor of cardiovascular disease and mortality. However, absolute SBP values during exercise do not account for the specific metabolic demand achieved ([Formula: see text]O 2 ) or the amount of metabolically active tissue (i.e., lower body lean mass, LLM) driving the cardiovascular response. Recent evidence suggests that high-resistance inspiratory muscle strength training (IMST) attenuates submaximal exercise SBP, but it is unknown whether IMST attenuates SBP indexed to LLM during peak exercise. PURPOSE: To test the hypothesis that eight weeks of IMST would reduce SBP during peak exercise in younger adults with obesity. METHODS: We randomized 14 otherwise healthy adults (25[4] years) with obesity (body mass index [BMI] 30–40 kg/m 2 ) to daily training at 75% (IMST; n=8, 6 female) or 15% (SHAM; n=6, 4 female) of their maximal inspiratory pressure for eight weeks. Pre- and post-intervention, we assessed anthropometrics, body composition and LLM via dual-energy X-ray absorptiometry, and conducted a graded cardiopulmonary exercise test on a semi-recumbent cycle ergometer. SBP responses during exercise were indexed to metabolic demands (SBPpeak minus SBPrest divided by [Formula: see text]O 2 peak minus [Formula: see text]O 2 rest) and further indexed to LLM ([SBPpeak minus SBPrest divided by [Formula: see text]O 2 peak minus [Formula: see text]O 2 rest] divided by LLM). We assessed data normality with Shapiro-Wilk tests. We compared groups using Welch’s t-tests or mixed-effects analyses. Data are reported as mean ± SD, or median [IQR] for non-normally distributed data. RESULTS: Training compliance (IMST: 78±15% vs. SHAM: 91±9% p=0.07) did not differ between groups. Body mass did not change during the intervention (time: p=0.71). Changes (Δ) in maximal inspiratory pressure were greater with IMST (IMST: Δ41±23 vs. SHAM: Δ15±21, cmH 2 O, p=0.04). Resting SBP, [Formula: see text]O 2 peak, and LLM did not differ between time points or groups (time: p≥0.27, group: p≥0.14, interaction: p≥0.30 for all). SBP responses during exercise did not differ between time points or groups when expressed in absolute terms (pre-IMST: Δ85[41], post-IMST: Δ75[54], pre-SHAM: Δ91[44], post-SHAM: Δ70[31] mmHg), indexed to [Formula: see text]O 2 peak (pre-IMST: Δ3.6±1.0, post-IMST: Δ3.6±1.1, pre-SHAM: Δ4.1±1.6, post-SHAM: Δ3.8±1.4 mmHg/mL O 2 /kg body mass/min), or indexed to LLM (pre-IMST: Δ0.8±0.3, post-IMST: Δ0.8±0.3, pre-SHAM: Δ0.8±0.3, post-SHAM: Δ0.7±0.3 mmHg/mL O 2 /kg LLM/min) (time: p≥0.46, group: p≥0.58, interaction: p≥0.62 for all). CONCLUSION: These preliminary data suggest that IMST does not attenuate SBP responses during peak exercise among young adults with obesity, regardless of adjustment for metabolic demands or metabolically active tissue. This abstract was presented at the American Physiology Summit 2026 and is only available in HTML format. There is no downloadable file or PDF version. The Physiology editorial board was not involved in the peer review process.
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Hoch et al. (2026) conducted an RCT in Obesity (n=14). Inspiratory muscle strength training (IMST) vs. SHAM training at 15% of maximal inspiratory pressure was evaluated on Systolic blood pressure responses during exercise indexed to lower body lean mass (p=≥0.62). Inspiratory muscle strength training did not attenuate systolic blood pressure responses during peak exercise compared to sham among younger adults with obesity (interaction p≥0.62).
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