--- title: "Evidence: high-resistance breath loading" description: "Six weeks of high-resistance inspiratory muscle training can lower blood pressure and improve blood vessel function in older adults." url: "https://magellanlongevity.com/study/s165.md" canonical: "https://magellanlongevity.com/study/s165.html" html: "https://magellanlongevity.com/study/s165.html" type: "study" study_key: "s165" journal: "J Am Heart Assoc" year: 2021 pmid: "34184544" doi: "10.1161/JAHA.121.020980" citations: 1 updated: 2026-09-02 author: "Gabriel Radu, DO" author_credentials: "Physiatrist (PM&R). NY medical license 275110. NPI 1376861765." publisher: "Magellan Longevity" content_format: "markdown" --- # Evidence: high-resistance breath loading [Home](https://magellanlongevity.com/) › [Research map](https://magellanlongevity.com/longevity-research-map.html) › Evidence: high-resistance breath loading **HTML version:** https://magellanlongevity.com/study/s165.html · **In the Magellan app:** https://magellanlongevity.com/#/study/s165 ## Citation | Field | Value | | --- | --- | | Journal | J Am Heart Assoc | | Year | 2021 | | PMID | [34184544](https://pubmed.ncbi.nlm.nih.gov/34184544/) | | DOI | [10.1161/JAHA.121.020980](https://doi.org/10.1161/JAHA.121.020980) | | Study key | s165 | ## Takeaway Six weeks of high-resistance inspiratory muscle training can lower blood pressure and improve blood vessel function in older adults. ## The question Does high-resistance inspiratory muscle strength training (IMST) improve blood pressure, endothelial function, and arterial stiffness in midlife/older adults with elevated systolic blood pressure? ## Hypothesis The study hypothesized that 6 weeks of high-resistance IMST would improve blood pressure, endothelial function, and arterial stiffness, and also investigated potential mechanisms and long-lasting effects. ## Methods A double-blind, randomized, sham-controlled trial was conducted with 36 midlife/older adults (aged 50-79 years) who had systolic blood pressure ≥120 mm Hg. Participants were randomized to either high-resistance IMST (75% maximal inspiratory pressure, n=18) or low-resistance sham training (15% maximal inspiratory pressure, n=18) for 30 breaths/day, 6 days/week for 6 weeks. Blood pressure, endothelial function (brachial artery flow-mediated dilation), and arterial stiffness were measured, along with markers of NO bioavailability, eNOS activation, reactive oxygen species, C-reactive protein, and circulating metabolites. ## Results High-resistance IMST significantly decreased casual systolic blood pressure from 135±2 mm Hg to 126±3 mm Hg, with approximately 75% of this reduction sustained 6 weeks post-training. Casual diastolic blood pressure also modestly decreased from 79±2 mm Hg to 77±2 mm Hg. Twenty-four hour systolic blood pressure was lower after IMST compared to sham training. Brachial artery flow-mediated dilation improved by approximately 45% with IMST. Serum from participants after IMST showed increased NO bioavailability, greater endothelial NO synthase activation, and lower reactive oxygen species bioactivity in cultured human umbilical vein endothelial cells. IMST also decreased C-reactive protein and altered select circulating metabolites. Sham training had no effect on blood pressure or endothelial function, and neither IMST nor sham training influenced arterial stiffness. ## Conclusion High-resistance IMST is a safe and highly adherable lifestyle intervention that effectively improves blood pressure and endothelial function in midlife/older adults with above-normal initial systolic blood pressure. ## Limitations The abstract does not explicitly state any limitations of the study. ## Verbatim from the abstract > Inspiratory muscle strength training lowers blood pressure and improves endothelial function ## Change in Casual Systolic Blood Pressure with IMST | Measure | Systolic Blood Pressure (mm Hg) | | --- | --- | | Before IMST | 135 | | After IMST | 126 | *Casual systolic blood pressure decreased from 135 mm Hg to 126 mm Hg after 6 weeks of high-resistance IMST.* ## Where this study is used on Magellan This paper is one of the citations behind the evidence grade on the pages below. Grades are assigned from the published research and are independent of affiliate commissions. | Compound or device | Evidence grade | Graded pages | | --- | --- | --- | | Inspiratory Muscle Strength Trainer | Moderate evidence | [Inspiratory Muscle Strength Trainer](https://magellanlongevity.com/p/165.md) | ## Reference 1. **Evidence: high-resistance breath loading** J Am Heart Assoc 2021 · [PMID 34184544](https://pubmed.ncbi.nlm.nih.gov/34184544/) · [DOI 10.1161/JAHA.121.020980](https://doi.org/10.1161/JAHA.121.020980) > Inspiratory muscle strength training lowers blood pressure and improves endothelial function ## Structured data ```json {"@context":"https://schema.org","@graph":[{"@type":"MedicalWebPage","@id":"https://magellanlongevity.com/study/s165.html#page","url":"https://magellanlongevity.com/study/s165.html","name":"Evidence: high-resistance breath loading","description":"Six weeks of high-resistance inspiratory muscle training can lower blood pressure and improve blood vessel function in older adults.","inLanguage":"en","isPartOf":{"@type":"WebSite","name":"Magellan Longevity","url":"https://magellanlongevity.com/"},"author":{"@type":"Person","name":"Gabriel Radu, DO","jobTitle":"Physiatrist (PM&R)","identifier":[{"@type":"PropertyValue","name":"NPI","value":"1376861765"},{"@type":"PropertyValue","name":"NY medical license","value":"275110"}]},"publisher":{"@type":"Organization","name":"Magellan Longevity","url":"https://magellanlongevity.com/"},"encoding":{"@type":"MediaObject","encodingFormat":"text/markdown","contentUrl":"https://magellanlongevity.com/study/s165.md"},"dateModified":"2026-09-02"},{"@type":"BreadcrumbList","itemListElement":[{"@type":"ListItem","position":1,"name":"Home","item":"https://magellanlongevity.com/"},{"@type":"ListItem","position":2,"name":"Research map","item":"https://magellanlongevity.com/longevity-research-map.html"},{"@type":"ListItem","position":3,"name":"Evidence: high-resistance breath loading","item":"https://magellanlongevity.com/study/s165.html"}]},{"@type":"ScholarlyArticle","@id":"https://magellanlongevity.com/study/s165.html#study","name":"Evidence: high-resistance breath loading","headline":"Evidence: high-resistance breath loading","datePublished":"2021","isPartOf":{"@type":"Periodical","name":"J Am Heart Assoc"},"identifier":"PMID:34184544","url":"https://pubmed.ncbi.nlm.nih.gov/34184544/","sameAs":"https://doi.org/10.1161/JAHA.121.020980","abstract":"Six weeks of high-resistance inspiratory muscle training can lower blood pressure and improve blood vessel function in older adults."}]} ``` ## Related on Magellan Longevity - [Inspiratory Muscle Strength Trainer](https://magellanlongevity.com/p/165.md) — product graded on this and related evidence - [Effects of inspiratory muscle training on blood pressure and sleep in obstructive sleep…](https://magellanlongevity.com/study/d36576599.md) - [Effects of high intensity inspiratory muscle training in patients with heart failure: a…](https://magellanlongevity.com/study/d37285766.md) - [Longevity research map](https://magellanlongevity.com/longevity-research-map.html) - [Evidence-based longevity supplements](https://magellanlongevity.com/longevity-supplements.md) ## Scope and disclosures Educational information, not medical advice. Nothing here is intended to diagnose, treat, cure, or prevent any disease. Talk to your physician before starting any supplement or device, especially if you are pregnant, nursing, or taking medication. Editorial firewall: evidence grades are assigned from the published research and are independent of any affiliate commission. As an Amazon Associate, Magellan Longevity earns from qualifying purchases. Reviewed for accuracy by a board-certified physician (DO).