Effects of respiratory muscle training on respiratory function, functional outcomes, and pulmonary complications in patients with stroke: a systematic review and meta-analysis of randomized controlled trials
- 1Department of Cardiopulmonary Rehabilitation, Guangdong Provincial Work Injury Rehabilitation Hospital
Abstract
Objective: To systematically evaluate the effects of respiratory muscle training on respiratory function, functional outcomes, and pulmonary complications in patients with subacute stroke.
Method: We systematically searched PubMed, EMBASE, Cochrane Library, Web of Science, Scopus, and ClinicalTrials.gov up to August 12, 2026 for randomized controlled trials (RCTs). Pooled estimates were calculated using Hartung-Knapp-adjusted random-effects models. Two reviewers independently screened, extracted data, and assessed risk of bias (ROB2). Sensitivity and publication bias were evaluated via leave-one-out and trim-and-fill analyses.
Results: Eleven RCTs (Final analysis sample:737 patients) were included. Respiratory muscle training significantly improved six-minute walk distance (mean difference [MD] = 34.09 m, 95% confidence interval [CI] 9.71–58.47), forced expiratory volume in one second (MD = 0.32 L, 95% CI 0.16–0.49), forced vital capacity (MD = 0.31 L, 95% CI 0.20–0.41), maximum inspiratory pressure (MD = 14.16 cmH₂O, 95% CI 6.93–21.38), and Trunk Impairment Scale scores (MD = 2.27, 95% CI 1.12–3.43). Respiratory muscle training also reduced pneumonia incidence (risk ratio = 0.41, 95% CI 0.24–0.72). Heterogeneity was substantial for maximum inspiratory pressure (I ² = 89.9%), moderate-to-high for forced expiratory volume in one second (I ² = 62.4%), and moderate for Trunk Impairment Scale scores (I ² = 56.0%); forced vital capacity showed no heterogeneity (I ² = 0%). Sensitivity analyses indicated that the six-minute walk test and Trunk Impairment Scale findings were sensitive to individual trials, whereas forced expiratory volume in one second, forced vital capacity, and maximum inspiratory pressure estimates remained statistically significant after leave-one-out analyses. Egger’s test for maximum inspiratory pressure was not significant ( p = 0.097), but trim-and-fill analysis suggested potential missing studies for forced expiratory volume in one second, forced vital capacity, and maximum inspiratory pressure.
Conclusion: In patients with subacute stroke, respiratory muscle training is associated with improvements in respiratory function and functional outcomes and with a reduced risk of pneumonia. However, some pooled estimates were sensitive to individual trials and the evidence remains limited by heterogeneity, indicating a need for further large randomized trials.
Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/view/CRD420261482562 , Identifier, CRD420261482562.
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BibTeX
@article{guo2026effects,
title = {{Effects of respiratory muscle training on respiratory function, functional outcomes, and pulmonary complications in patients with stroke: a systematic review and meta-analysis of randomized controlled trials}},
author = {Ying Guo and Yanping Shang and Li Tian and Wen Li and Siwen Zhu and Jing Jia},
journal = {Frontiers in Neurology},
year = {2026},
month = oct,
doi = {10.3389/fneur.2026.1981476},
url = {https://www.frontiersin.org/articles/10.3389/fneur.2026.1981476/full},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Effects of respiratory muscle training on respiratory function, functional outcomes, and pulmonary complications in patients with stroke: a systematic review and meta-analysis of randomized controlled trials
AU - Ying Guo
AU - Yanping Shang
AU - Li Tian
AU - Wen Li
AU - Siwen Zhu
AU - Jing Jia
PY - 2026
DA - 2026/10/23
JO - Frontiers in Neurology
DO - 10.3389/fneur.2026.1981476
UR - https://www.frontiersin.org/articles/10.3389/fneur.2026.1981476/full
AB - Objective: To systematically evaluate the effects of respiratory muscle training on respiratory function, functional outcomes, and pulmonary complications in patients with subacute stroke. Method: We systematically searched PubMed, EMBASE, Cochrane Library, Web of Science, Scopus, and ClinicalTrials.gov up to August 12, 2026 for randomized controlled trials (RCTs). Pooled estimates were calculated using Hartung-Knapp-adjusted random-effects models. Two reviewers independently screened, extracted data, and assessed risk of bias (ROB2). Sensitivity and publication bias were evaluated via leave-one-out and trim-and-fill analyses. Results: Eleven RCTs (Final analysis sample:737 patients) were included. Respiratory muscle training significantly improved six-minute walk distance (mean difference [MD] = 34.09 m, 95% confidence interval [CI] 9.71–58.47), forced expiratory volume in one second (MD = 0.32 L, 95% CI 0.16–0.49), forced vital capacity (MD = 0.31 L, 95% CI 0.20–0.41), maximum inspiratory pressure (MD = 14.16 cmH₂O, 95% CI 6.93–21.38), and Trunk Impairment Scale scores (MD = 2.27, 95% CI 1.12–3.43). Respiratory muscle training also reduced pneumonia incidence (risk ratio = 0.41, 95% CI 0.24–0.72). Heterogeneity was substantial for maximum inspiratory pressure (I ² = 89.9%), moderate-to-high for forced expiratory volume in one second (I ² = 62.4%), and moderate for Trunk Impairment Scale scores (I ² = 56.0%); forced vital capacity showed no heterogeneity (I ² = 0%). Sensitivity analyses indicated that the six-minute walk test and Trunk Impairment Scale findings were sensitive to individual trials, whereas forced expiratory volume in one second, forced vital capacity, and maximum inspiratory pressure estimates remained statistically significant after leave-one-out analyses. Egger’s test for maximum inspiratory pressure was not significant ( p = 0.097), but trim-and-fill analysis suggested potential missing studies for forced expiratory volume in one second, forced vital capacity, and maximum inspiratory pressure. Conclusion: In patients with subacute stroke, respiratory muscle training is associated with improvements in respiratory function and functional outcomes and with a reduced risk of pneumonia. However, some pooled estimates were sensitive to individual trials and the evidence remains limited by heterogeneity, indicating a need for further large randomized trials. Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/view/CRD420261482562 , Identifier, CRD420261482562.
SN - 1664-2295
ER -