Purpose: The study aimed to verify the value of inspiratory muscle training (IMT) in the prevention of post-stroke sarcopenia, and to analyze the effects of IMT on the rehabilitation prognosis, including daily living activities, social regression, balance, and pneumonia, of stroke patients. Methods: A total of 367 patients with a first stroke event were randomly allocated to an experimental group (n =164) and a control group (n =165). Both groups received conventional neurological rehabilitation treatment, and the experimental group also received IMT. After eight weeks of treatment, the incidence of post-stroke sarcopenia and pneumonia were analyzed and compared. The maximum inspiratory pressure (MIP) was assessed using a respiratory resistance trainer, and the Modified Barthel Index (MBI) was used to assess activities of daily living (ADL). The ability to return to society was assessed using the modified Rankin Scale (mRS), the trunk impact scale (TIS) was used to evaluate trunk balance in both groups before and after treatment, and the differences in MIP, MBI, mRs, and TIS between the two groups were analyzed. Results: There were no significant differences in the baseline demographics between the two groups. After eight weeks of treatment, the incidence of post-stroke sarcopenia (P =0.004) and pneumonia (P =0.017) in the experimental group was lower than that in the control group. The trial group performed better than control group in MBI (P =0.02, effect size d =0.3), TIS (P < 0.001, effect size d =0.52), MIP (P < 0.001, effect size d =0.4) and mRS (P =0.001, effect size d =0.3) scores after intervention. Conclusion: Early inspiratory muscle training can effectively reduce the incidence of post-stroke sarcopenia and pneumonia and improve the rehabilitation prognosis of patients after stroke. (clinicaltrials.ChiCTR2200057067).