BACKGROUND: While a whole-body warm-up may not adequately prepare the inspiratory muscles for exercise, inspiratory warm-up is an effective approach in preparing the inspiratory muscles for exertion. OBJECTIVES: To investigate the effects of inspiratory muscle warm-up performed prior to inspiratory muscle training (IMT) during pulmonary rehabilitation (PR) in patients with moderate-to-severe chronic obstructive pulmonary disease (COPD) and inspiratory muscle weakness. METHODS: Pulmonary function tests, maximal inspiratory and expiratory pressures (MIP and MEP), 6-minute walk test distance (6MWD), modified Medical Research Council Dyspnea Scale (mMRC), St. George's respiratory questionnaire and the 36-item short-form health survey were evaluated. Both groups performed IMT during PR for 8 weeks. The warm-up group (n = 15), in addition to the standard IMT group (n = 15), performed an inspiratory muscle warm-up protocol before each IMT session. RESULTS: At the end of the 8-week intervention, improvements in dyspnea (mMRC in score, p = 0.033, effect size 0.76); exercise capacity (6MWD in meters, p = 0.001, effect size 1.30); pulmonary function (forced expiratory volume in 1 second (FEV1) in %predicted, p = 0.006, effect size 1.10); and inspiratory muscle strength (MIP in cmH2O, p = 0.001, effect size 1.35) were significantly greater in the warm-up group. Moreover, there were significant improvements in health-related quality of life (HRQoL) sub-scores after the training in both groups (p < 0.05). CONCLUSIONS: This study demonstrated improvements in both groups, surpassing or closely approaching the established minimal clinically important difference values for the respective outcomes. Performing a warm-up for inspiratory muscles before IMT boosts benefits for pulmonary function, inspiratory muscle strength, exercise capacity, dyspnea, and HRQoL in subjects with moderate-to-severe COPD and inspiratory muscle weakness.

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