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Key summary points: Aim: To evaluate inspiratory muscle function and the effect of a multicomponent exercise program including inspiratory muscle training during short-stay hospitalization. Findings: Inspiratory muscle impairment is very prevalent in the hospitalized elderly. Analysis of maximal inhibitory pressure revealed that those patients with inspiratory muscle weakness on admission showed the greatest improvement in inspiratory muscle strength. Message: These findings are especially relevant to identify those oldest-old patients who may benefit most from muscle inspiratory training during hospitalization for acute illness. Purpose: The impact of hospitalization for acute illness on inspiratory muscle strength in oldest-old patients is largely unknown, as are the potential benefits of exercise and inspiratory muscle training (IMT) during in-hospital stay. Design and methods: This was a sub-study of a randomized clinical trial that evaluated the efficiency of a multicomponent exercise program in preventing hospitalization-associated disability. Patients were randomized into control (CG) and intervention (IG) groups. The intervention included two daily sessions of supervised walking, squat, balance, and IMT. Baseline and discharge maximal inspiratory pressure (MIP) and inspiratory muscle weakness (IMW) were determined. The effect of the intervention on inspiratory muscle strength was assessed by analyzing (1) the differences between groups in baseline and discharge MIP and IMW, (2) the association, patient by patient, between baseline and discharge MIP, and the improvement index (MIP discharge/baseline) in patients with or without IMW. Results: In total, 174 patients were assessed (mean age of 87), 57 in CG and 117 in IG. Baseline MIP was lower than predicted in both sexes (women 29.7 vs 44.3; men 36.7 vs 62.5 cmH2O, P < 0.001, baseline vs predicted, respectively). More than 65% of patients showed IMW at admission. In women in IG, the mean MIP was higher at discharge than at admission (P = 0.003) and was the only variable that reached expected reference levels at discharge (Measured MIP 39.2 vs predicted MIP 45 cmH2O, P = 0.883). Patients with IMW on admission showed a statistically significant improvement in MIP after the intervention. Conclusion: IMW is very prevalent in oldest-old hospitalized with acute illness. Patients might benefit from a multicomponent exercise program including IMT, even during short-stay hospitalization. Clinical trial registration: ClinicalTrials.gov; No.: NTC03604640. May 3, 2018. [ABSTRACT FROM AUTHOR]