BACKGROUND: Up to 40% of patients undergoing oesophagectomy develop pneumonia. The aim of this study was to assess whether preoperative inspiratory muscle training (IMT) reduces the rate of pneumonia after oesophagectomy. METHODS: Patients with oesophageal cancer were randomized to a home-based IMT programme before surgery or usual care. IMT included the use of a flow-resistive inspiratory loading device, and patients were instructed to train twice a day at high intensity (more than 60% of maximum inspiratory muscle strength) for 2 weeks or longer until surgery. The primary outcome was postoperative pneumonia; secondary outcomes were inspiratory muscle function, lung function, postoperative complications, duration of mechanical ventilation, length of hospital stay and physical functioning. RESULTS: Postoperative pneumonia was diagnosed in 47 (39.2%) of 120 patients in the IMT group and in 43 (35.5%) of 121 patients in the control group (relative risk 1.10, 95% CI 0.79 to 1.53; p = 0.561). There was no statistically significant difference in postoperative outcomes between the groups. Mean (SD) maximal inspiratory muscle strength increased from 76.2 (26.4) to 89.0 (29.4) cmH2O (p < 0.001) in the intervention group and from 74.0 (30.2) to 80.0 (30.1) cmH2O in the control group (p < 0.001). Preoperative inspiratory muscle endurance increased from 4 min 14 s to 7 min 17 s in the intervention group (p < 0.001) and from 4 min 20 s to 5 min 5 s in the control group (p = 0.007). The increases were highest in the intervention group (p < 0.050). CONCLUSION: Despite an increase in preoperative inspiratory muscle function, home-based preoperative IMT did not lead to a decreased rate of pneumonia after oesophagectomy. REGISTRATION NUMBER: NCT01893008 (https://www.ClinicalTrials.gov).

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