Effects of Inspiratory Muscle Training Added to a Swimming Program in Children with Asthma

Background and Objectives: Asthma remains one of the most common chronic diseases in childhood, and despite advances in pharmacological management, its prevalence continues to rise globally. Physical activity, particularly swimming, has been proposed as a safe and beneficial form of exercise for asthmatic children due to the warm and humid environment that minimizes airway irritation. This study aimed to investigate the effects of adding inspiratory muscle training (IMT) to a structured swimming program on pulmonary function and asthma control in children with asthma. Materials and Methods: Thirty children with clinically diagnosed asthma, aged 8–11 years, were randomly assigned to either a swimming plus IMT group (n = 15) or a swimming-only control group (n = 15). Both groups participated in a 4-week supervised swimming program consisting of three 60-minute sessions per week. Inspiratory muscle training was integrated into the warm-up and cool-down phases for the experimental group. Pulmonary function parameters (FVC, FEV₁, FEV₁/FVC, PEF, MIP, MEP, MVV) and asthma control scores (Childhood Asthma Control Test [CACT]) were measured before and after the intervention. Statistical analyses were performed using repeated-measures ANOVA with significance set at p < 0.001. Results: Following the 4-week intervention, significant improvements were observed in all respiratory parameters and asthma control indices in both groups (p < 0.001). However, the swimming + IMT group showed substantially greater improvements in FEV₁ (↑46.4%), MIP (↑37.2%), MEP (↑42.6%), and CACT (↑69.5%) compared to the swimming-only group (FEV₁ ↑27.3%, MIP ↑10.3%, MEP ↑9.9%, CACT ↑30.1%). Effect sizes (Cohen’s d) were large across all primary outcomes, indicating a strong clinical impact of the combined intervention. Conclusions: The addition of inspiratory muscle training to a structured swimming program markedly enhances respiratory muscle strength, pulmonary function, and asthma control in children with mild-to-moderate asthma. These findings support incorporating IMT into aquatic exercise-based rehabilitation programs for pediatric asthma management.

背景与研究目的：哮喘仍是儿童最常见的慢性疾病之一，尽管药物治疗手段已取得进展，但其全球患病率仍持续上升。体力活动，尤其是游泳，因其温暖湿润的环境可最大程度减少气道刺激，被认为是哮喘儿童安全且有益的运动形式。本研究旨在探讨在结构化游泳方案中加入吸气肌训练（inspiratory muscle training, IMT）对哮喘儿童肺功能与哮喘控制的影响。
材料与方法：将30名临床确诊哮喘、年龄8~11岁的儿童随机分为游泳联合吸气肌训练组（n=15）与单纯游泳对照组（n=15）。两组均参与为期4周的监督式游泳课程，每周3次，每次时长60分钟。实验组在热身与放松阶段加入吸气肌训练。分别于干预前后测量肺功能参数（用力肺活量FVC、第一秒用力呼气容积FEV₁、FEV₁/FVC、峰值呼气流速PEF、最大吸气压MIP、最大呼气压MEP、最大自主通气量MVV）及哮喘控制评分（儿童哮喘控制测试[Childhood Asthma Control Test, CACT]）。统计分析采用重复测量方差分析，显著性阈值设定为p<0.001。
结果：经过4周的干预后，两组的所有呼吸参数与哮喘控制指标均出现显著改善（p<0.001）。但游泳联合IMT组的FEV₁（升高46.4%）、MIP（升高37.2%）、MEP（升高42.6%）及CACT（升高69.5%）的改善幅度显著优于单纯游泳组（FEV₁升高27.3%，MIP升高10.3%，MEP升高9.9%，CACT升高30.1%）。所有主要结局指标的效应量（Cohen’s d）均较大，表明联合干预具有显著的临床影响。
结论：在结构化游泳方案中加入吸气肌训练，可显著增强轻度至中度哮喘儿童的呼吸肌力量、肺功能与哮喘控制水平。本研究结果支持将IMT纳入基于水上运动的儿童哮喘康复管理方案。