OBJECTIVE: This systematic review aimed to evaluate the effects of Inspiratory Muscle Training (IMT), either performed in isolation or combined with aerobic and resistance exercises, on exercise tolerance and respiratory function in patients with post-COVID-19 syndrome. METHODS: The review was conducted in accordance with PRISMA 2020 guidelines and registered in PROSPERO. Randomized controlled trials (RCTs) published in peer-reviewed journals investigating IMT in adults with post-COVID-19 syndrome were included. A comprehensive search was carried out in international electronic databases. Data extraction and risk of bias assessment (RoB 2.0) were performed independently by two reviewers. RESULTS: Six randomized controlled trials encompassing a total of 451 participants were included. The overall quality of evidence was considered moderate, mainly due to small sample sizes and heterogeneous protocols. Compared with control groups, IMT demonstrated significant improvements in inspiratory muscle strength, diaphragmatic thickness, and distance covered in the 6-min walk test (6MWT). However, no consistent differences were observed in maximal oxygen uptake (VO2max) or autonomic modulation. CONCLUSION: The findings suggest that IMT may enhance exercise tolerance and respiratory parameters in post-COVID-19 patients. Nevertheless, the available evidence remains limited and heterogeneous, underscoring the need for multicenter RCTs with standardized protocols and long-term follow-up to establish definitive clinical recommendations.

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