Impact of Respiratory Muscle Training on Cognitive Functioning With a Focus on Executive Function Across the Lifespan: A Scoping Review

Purpose: Respiratory muscle training (RMT) has become a widely used interventional strategy in adults and now children as well. An initial focus was on improving respiratory muscle strength; however, current research supports additional improvements in cognition, perception of well-being, and health status in many chronic adult and emerging pediatric conditions such as those associated with heart failure, respiratory diseases, and neuromuscular diseases. The purpose of this review was to identify the current evidence describing the impact of RMT interventions on cognition in children and adults. Methods: The following databases were searched from 2000 to 2025: MEDLINE, EMBASE, CINAHL, Scopus, and CENTRAL. Article inclusion criteria consisted of participants from birth to adulthood, interventions related to RMT, and cognitive performance as an outcome. Articles were excluded if translation to English was impossible, and full access was not available. Results: Out of the 1031 initial articles, only 7 met all inclusion criteria. One study included pediatric subjects. Training approaches included pressure-threshold loading, flow-resistive loading, and voluntary isocapnic hyperventilation. One study conducted voluntary isocapnic hyperventilation, 4 studies included only inspiratory muscle training (IMT), no studies included only expiratory muscle training (EMT), and 2 studies included both IMT and EMT. Intervention and intensity varied across all studies without consistency in cognitive performance measurements. Across studies, cognitive outcomes were inconsistently defined, with limited focus on executive functioning. Most assessed global cognition, attention, or memory, whereas key executive domains (e.g., inhibition, flexibility, working memory) were rarely evaluated, limiting insight into RMT's impact on functional cognition. Conclusions: Although RMT shows promise—particularly high-intensity IMT—for enhancing cognition, current evidence is limited and highly variable. Standardized protocols and further studies, especially in pediatric populations, are needed.