Acute effects of inspiratory muscle warm-up added to usual or sport-specific warm-up in trained and competitive athletes: a systematic review and meta-analysis

Background Inspiratory muscle warm-up (IMW) may acutely improve inspiratory muscle function. Whether it adds a performance benefit to an athlete’s usual warm-up is less clear. We evaluated the acute effects of adding IMW to usual or sport-specific warm-up in trained and competitive athletes. Methods PubMed, Embase, Web of Science Core Collection, Scopus, and SPORTDiscus were searched from inception to 20 April 2026 and updated on 14 September 2026. Eligible randomized studies evaluated a single session of IMW in trained or competitive athletes. Random-effects meta-analysis was used. Participant counts in crossover analyses counted each participant once. Risk of bias was assessed with RoB 2, and certainty with GRADE. Results Nineteen reports were included; 15 contributed to at least one quantitative synthesis. Primary add-on analysis favored IMW for immediate inspiratory muscle function (6 comparisons, 79 participants; Hedges’ g = 0.437, 95% CI 0.115 to 0.759; I² = 0.0%; moderate certainty). The primary performance analysis also favored IMW, with a small average effect (13 comparisons, 171 participants; Hedges’ g = 0.248, 95% CI 0.042 to 0.454; I² = 0.0%; low certainty). The effect on dyspnea or perceived breathing effort remained uncertain (3 comparisons, 30 participants; Hedges’ g = 0.125, 95% CI −0.602 to 0.852; I² = 0.0%; low certainty). Conclusions Adding IMW to usual or sport-specific warm-up probably improves immediate inspiratory muscle function and may provide a small average improvement in acute performance. The effect on dyspnea or perceived breathing effort remains uncertain. Systematic review registration https://www.crd.york.ac.uk/PROSPERO/view/CRD420261400752 , identifier CRD420261400752.