The effect of positioning and diaphragmatic breathing exercises on respiratory muscle activity in people with chronic obstructive pulmonary disease

Abstract

BackgroundBody positioning and diaphragmatic breathing may alter respiratory pattern and reduce dyspnoea in people with chronic obstructive pulmonary disease (COPD).ObjectivesTo determine the effect of positioning and diaphragmatic breathing on respiratory muscle activity in a convenience sample of people with COPD, using surface electromyography (sEMG).MethodsThis prospective descriptive study recorded sEMG measurements at baseline, after upright positioning, during diaphragmatic breathing and 5 minutes thereafter. Vital signs and levels of perceived dyspnoea were recorded at baseline and at the end of the study. Data were analysed using repeated measures ANOVAs with post hoc t-tests for dependent and independent variables.ResultsEighteen participants (13 male; mean ± standard deviation age 59.0 ± 7.9 years) were enrolled. Total diaphragmatic activity did not change with repositioning (p = 0.2), but activity increased from 7.3 ± 4.2 µV at baseline to 10.0 ± 3.3 µV during diaphragmatic breathing (p = 0.006) with a subsequent reduction from baseline to 6.1 ± 3.5 µV (p = 0.007) at the final measurement. There was no change in intercostal muscle activity at different time points (p = 0.8). No adverse events occurred. Nutritional status significantly affected diaphragmatic activity (p = 0.004), with participants with normal body mass index (BMI) showing the greatest response to both positioning and diaphragmatic breathing. There were no significant changes in vital signs, except for a reduction in systolic/diastolic blood pressure from 139.6 ± 18.7/80.4 ± 13.0 to 126.0 ± 15.1/75.2 ± 14.7 (p < 0.05).ConclusionA single session of diaphragmatic breathing transiently improved diaphragmatic muscle activity, with no associated reduction in dyspnoea.

Evidence for pulmonary rehabilitation in chronic respiratory diseases in sub-Saharan Africa: a systematic review

“…Of the remaining 14 articles, we further excluded one duplicate, 30 one with abstract only and no author contact details, 31 one nonresearch guideline 32 and five that did not meet inclusion criteria. [33][34][35][36][37] Study characteristics Of the six finally included, three studies were conducted in South Africa, [38][39][40] two in Uganda 41,42 and one in Nigeria, 43 and all were published between 2010 and 2018. The studies were focused on the feasibility and acceptability of PR programmes.…”

“…Forced expiratory volume in 1 sec (FEV 1 ) and forced expiratory volume (FVC) were common outcome measures for pulmonary function, while the 6-min walk test (6MWT) and the incremental shuttle walk test (ISWT) were used as outcome measures for exercise tolerance. Pulmonary function was reported in 5 studies, [38][39][40][41]43 of which 3 (including the 2 RCTs 37,38 ) demonstrated improvement after the programme, [38][39][40] 1 suggested a non-significant but potentially clinically important increase, 41 and 1 showed no significant change. 43 Exercise tolerance was reported in 4 studies, 38,39,41,43 of which 1 reported significant improvement, 43 1 reported a non-significant but potentially clinically important increase, 41 and 2 showed no significant change 38,39 (including an RCT 39 ).…”

Breathing exercises in people with COPD: A realist review

“…The outcomes of such interventions were often a combination of changes in subjective perceptions and objective measurements, of which dyspnoea was a complex subjective experience for participants, making the measurement of the characteristics and intensity relatively difficult for the practitioners (Borge et al., 2015; Morrow et al., 2016). Practitioners should weigh the pros and cons when choosing a measurement tool to understand and quantify the performance of these systems, such as the measurement environment, measurement equipment, reliability and ease of operation.…”

“…There may be a gap between the BEs that are performed when symptoms occur and those that are performed during training, which may cause the BE to fail to achieve the actual effects (Morrow et al., 2016; Roberts et al., 2017). Roberts et al.…”

“…There may be a gap between the BEs that are performed when symptoms occur and those that are performed during training, which may cause the BE to fail to achieve the actual effects (Morrow et al, 2016;Roberts et al, 2017). Roberts et al (2017) have indicated that the demonstration of PLB observed by COPD people during home visits was considered as an exercise at rest; however, the actual practice of PLB during acute dyspnoea has not been observed and may be different.…”