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Cancer survivor inspiratory muscle training: systematic review and Bayesian meta-analysis
  1. Aida Tórtola-Navarro1,
  2. Daniel Gallardo-Gómez2,
  3. Francisco Álvarez-Barbosa2 and
  4. Eduardo Salazar-Martínez3
  1. 1Health Sciencies Faculty, University Isabel I, Burgos, Spain
  2. 2Physical Education and Sport Department, University of Seville, Sevilla, Spain
  3. 3Physical Activity and Sports Department, CEU Cardenal Spínola, Sevilla, Spain
  1. Correspondence to Francisco Álvarez-Barbosa, Physical Education and Sport Department, University of Seville, Sevilla, 41013, Spain; falvarez5{at}


Background The long-term impact of cancer treatment is associated with respiratory dysfunction and physical fitness impairment. Although inspiratory muscle training (IMT) has been shown as an effective exercise therapy in cancer survivors, there is no evidence on the optimal dose, application moment nor specific population effects of this intervention. The main objective of this meta-analysis is to analyse the effects of IMT on pulmonary function, physical fitness and quality of life (QoL) in cancer survivors.

Methods This systematic review and meta-analysis was preregistered in the International Prospective Register of Systematic Reviews (PROSPERO) register and conducted according to the Preferred Reporting for Systematic Reviews and Meta-analysis statement. We used a Bayesian multilevel random-effects meta-analysis model to pool the data. Multilevel metaregression models were used to examine the conditional effects of our covariates. Convergence and model fit were evaluated through specific model parameters. Sensitivity analyses removing influential cases and using a frequentist approach were carried out.

Results Pooled data showed that IMT intervention is effective to improve pulmonary function (standardised mean difference=0.53, 95% credible interval 0.13 to 0.94, SE=0.19). However, IMT did not present statistically significant results on physical fitness and QoL. Metaregression analyses found that the type of cancer, the moment of application and the evaluation tool used had significant moderation effects on pulmonary function.

Conclusion IMT could be an important part in the management of side effects suffered by cancer survivors. Considering the current evidence, this intervention is highly recommended in patients diagnosed with oesophageal and lung cancers. IMT may provide superior benefits before the biological treatment and after the surgery.

PROSPERO registration number 304909.

  • Quality of life
  • Cancer
  • Respiratory conditions

Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

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Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

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  • Contributors Conception of the work was made by AT-N. Data collection was carried out by AT-N, ES-M and FÁ-B. Data analysis and interpretation was made by DG-G and FÁ-B. Critical revision of the article was made by ES-M. FÁ-B is responsible for the overall content as guarantor. The final approval of the version to be published was made by consensus by all authors.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.