CARDIOVASCULAR RESPONSES FOLLOWING DIFFERENT TYPES OF BREATHING EXERCISES.
In physical therapy practice, breathing exercises have commonly been used to treat patients with respiratory problems to decrease the cost of oxygen consumption, increase respiratory efficiency, and increase endurance during physical activity. A report from Jones et al. and others (1-9) have demonstrated that diaphragm breathing (DB), pursed-lip breathing (PLB), and a combination of DB and PLB significantly lowered oxygen cost in patients with chronic obstructive pulmonary disease (COPD). Schein et. al (10) has shown that slow, regular breathing guided by a device called BIM (Breath with Interactive Music) significantly lowered the high blood pressure by approximately 10 to 15 mmHg. However, lack of conclusive information regarding the effects of traditional breathing exercises on cardiovascular response is evident. Therefore, the purpose of this study was to investigate the effects of different types of breathing exercises on blood pressure, heart rate, and respiration rate.
The study was performed on 45 healthy volunteer subjects ranging from 21-50 years of age according to our standard protocols unless otherwise indicated.
All subjects were screened for medical problems that would prevent their participation. All subjects included in this study their age ranged between 21-50 years old. The exclusion criteria implemented for those subjects that have a history of: (1) respiratory problems, (2) cardiovascular problem, (3) neurological problem, (4) metabolic syndrome, (5) those subjects who are currently on medication which that might affect heart rate, blood pressure and mental status, (6) those subjects who are pregnant, and (7) those who failed to answer questions in a consistent manner. All subjects voluntarily signed an informed consent document and confirmed that they understood the procedure of all tests and the risks that might be involved.
Subjects were randomly divided into three equal groups: control breathing (CR), shallow breathing (SB) and combined breathing (CB). Prior to the breathing exercise, all subjects were asked to rest for 5 minutes. Then blood pressure, heart rate, respiratory rate were recorded.
Subjects in the CR group sat on the chair quietly and took spontaneous breathing test for 15 minutes at their regular breathing pace following standard protocols.
Subjects in the SB group sat on the chair and took fast shallow breathing for 15 minutes. Subjects were allowed to rest at any time when they felt so short of breath.
Subjects in the CB group sat on the chair and performed CB for 15 minutes. CB was the combination of diaphragm breathing (DB) and pursed-lip breathing (PLB). DB occurred when there was a conscious appreciation of inspiring air to the lung bases with slight forward abdominal displacement and passive relaxed expiration. PLB consisted of each subject's normal pattern of inspiration, but expiration was performed by gently exhaling through "pursed" lips.
Blood pressure, heart rate, respiratory rate were recorded and saliva was analyzed for cortisol levels at the end of breathing exercise. The tolerance of stress as a measure of cortisol levels was conducted following standard laboratory procedures and as instructed by kits manual.
Statistical analysis between the groups was achieved using repeated ANOVA (P< 0.05 was considered as a judgment for statistical significant difference). Sigma Stat software was utilized for descriptive and test analysis. Slide write software was used to tabulate and construct the results.
As shown in Figure 1 the mean RR in C group before and after breathing exercises was 14.27 [+ or -] 2.84 and 14.53 [+ or -] 4.61, respectively. The mean RR in SB group before and after breathing exercises was 15.27 [+ or -] 3.26 and 17.47 [+ or -] 4.07, respectively. The mean RR in CB group was 14.33 [+ or -] 3.75 and 12.67 [+ or -] 2.50, respectively. SB had significantly increased RR (P<0.05) and CB had significantly decreased RR (P<0.05).
The mean systolic blood pressure in all groups before and after breathing exercise were demonstrated in Table
1. The results revealed that the mean systolic blood pressure slightly decreased among the control group after the breathing exercise, however, no significant difference noted in SB and CB groups compared to control.
The mean diastolic blood pressure in all groups before and after breathing exercise were demonstrated in Table
2. The results revealed similar trend to that observed in ventricular ejection (systolic) measurements.
The mean heart rate in all groups before and after breathing exercise were demonstrated in Table 3. The results revealed similar trend to that observed in blood pressure measurements. Overall results, there were no significant changes in systolic blood pressure, diastolic blood pressure and heart rate between pre and post breathing exercises among any of these groups (P>0.05).
In the present study, we investigated the direct effects of different traditional breathing patterns on blood pressure, heart rate and respiration rate. Compared with spontaneous breathing, combination of diaphragm breathing and pursed lip breathing (combined breathing) significantly decreased respiration rate, and shallow breathing significantly increased respiration rate. However, neither combined breathing nor shallow breathing affected blood pressure and heart rate significantly (P>0.05).
To the best of our knowledge this study is considered the first study to be reported in the literature in which assessed the effects of different traditional breathing pattern on blood pressure, heart rate and respiration rate in healthy adults without preexisting respiratory problems. Many form of breathing exercises are widely used as an intervention to reduce major disturbances such as dyspnea, short of breath, depression, anxiety, hypertension, angina, functional chest disorder, chronic obstructive pulmonary disease (COPD) and cardiac rehabilitation (3,4,5,7,9). In physical therapy rehabilitation traditional program, breathing exercises are commonly used to treat patients with respiratory problems (8). It was well documented that the common clinic symptoms of respiratory disorders are dyspnea and fatigue. Fatigue is usually induced due to the hypoxia in which resulting from different entities including: (i) an obstruction of the air ways, (ii) an increase in respiratory activities and (iii) lack of quality of breathing. Previous research reported by Breslin et.al (2) showed that an increase in fatigue severity lead to an increased disorder in pulmonary performance. Consequently, further reduced endurance for activity and resulting in sever fatigue conditions. Pharmacologically, there is still no effective cure for dyspnea and fatigue that have been scientifically documented. It is well known that pulmonary rehabilitation and respiratory exercises are actions usually taken to control the symptoms and to improve functional performance of life activities. A research conducted by Zakerimoghadam et.al (11) showed the change in respiratory pattern caused reduction of fatigue intensity in COPD patients. Patient with COPD has a high tendency to have a shallow, fast and insufficient breathing. Our results confirms that PLB exercise improved patient to diaphragm respiration pattern which is a slow, deep and relaxing breathing pattern. PLB and DB are the methods of choice of slow and deep breathing exercise. However there is no agreement which favors one over the other. This was the main reason CB pattern was selected in this study. This also could be attributed to a slow deep breathing exercise. The SB group was designed to simulate the breathing pattern of COPD and to explore the harmful effect of this breathing pattern. The results of the present study clearly demonstrated that combination DB and PLB significantly slowed the rate of respiration, indicating that CB can be an effective tool for the reduction of fatigue, dyspnea, anxiety, short of breath and increasing endurance for daily activity and improving quality of life. On the other hand, SB significantly increased the rate of respiration, indicating this type of breathing can increase pulmonary symptoms and further impair the quality of life of patients.
In addition to the management of dyspnea and fatigue, a slow and relaxed breathing exercise can be a choice of nonpharmacological invention of hypertension. Schein et.al (10) reported that slow, regular breathing guided by a device called BIM (Breath with Interactive Music) significantly lowers the high blood pressure by 10 to 15 mmHg. A recent view article made by Brandani et.al (1) showed that Yoga breathing exercise can decrease blood pressure by 4 to 21 mmHg. However, the results of the present study showed that there were no significant changes in HR and BP between pre and post measurements in any of the groups. The difference between previous studies (1,10) and our study is that our study only performed for a duration of 15 minutes of breathing excise in healthy subject without pulmonary problems and hypertension. Further study is needed to determine the long term beneficial effects of CB exercise on blood pressure, heart rate, and respiration rate in patient population.
Overall conclusion: a duration of 15 minutes of CB exercise significantly decreased the rate of respiration, suggesting CB can be a useful tool to reduce fatigue, dyspnea, anxiety and short of breath caused pulmonary disorders.
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Huang M, Dai XL, Pan Z, Fang Q, Adah F, Barnes L, and Benghuzzi H.
Department of Physical Therapy, School of Health Related Professions, University of Mississippi Medical Center, Jackson, MS, USA
Caption: Figure 1: the effect of different breathing exercise on respiration rate among the three different groups. See methods for more details.
Table 1. Quantitative measure of the mean [+ or -] SD systolic blood pressure (S-BB) in all groups before and after breathing exercise (n = 45). Groups S-BB at base time S-BB after test Control (C) 125.20 [+ or -] 20.64 121.20 [+ or -] 11.60 SB 117.73 [+ or -] 12.61 116.33 [+ or -] 13.06 CB 118.53 [+ or -] 11.94 117.87 [+ or -] 11.20 Groups Significant Difference Control (C) SB P>0.05 CB P>0.05 Table 2. Quantitative measure of the mean [+ or -] SD diastolic blood pressure (D-BB) in all groups before and after breathing exercise (n=45). Groups D-BB at base time D-BB after test Control (C) 78.40 [+ or -] 15.56 71.6 [+ or -] 7.40 SB 69.93 [+ or -] 8.19 68.27 [+ or -] 9.81 CB 76.13 [+ or -] 5.87 76.13 [+ or -] 5.87 Groups Significant Difference Control (C) SB P>0.05 CB P>0.05 Table 3. Quantitative measure of the mean [+ or -] SD heart rate (HR) in all groups before and after breathing exercise (n = 45). Groups HR at base time HR after test Control (C) 73.60 [+ or -] 15.99 76.20 [+ or -] 13.29 SB 68.40 [+ or -] 10.07 67.47 [+ or -] 12.30 CB 72.13 [+ or -] 10.40 72.13 [+ or -] 10.40 Groups Significant Difference Control (C) SB P>0.05 CB P>0.05
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|Author:||M., Huang; X.L., Dai; Z., Pan; Q, Fang; F., Adah; L., Barnes; H., Benghuzzi|
|Publication:||Journal of the Mississippi Academy of Sciences|
|Date:||Apr 1, 2018|
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