The Effects of Combination of Inspiratory Diaphragm Exercise and Exspiratory Pursed-lip Breathing Exercise on Pulmonary Functions of Stroke Patients

Abstract

Abstract.[Purpose] The purpose of this study was to examine the effects of a combination of inspiratory diaphragm exercise and expiratory pursed-lip breathing exercise on pulmonary functions and respiratory muscle activation of stroke patients. [Methods] Thirty stroke patients were randomly and equally allocated to an experimental group and a control group, and the intervention was conducted five times per week for four weeks. In each session, both groups received rehabilitative exercise treatment for 30 minutes, and a feedback breathing device exercise for 15 minutes. In addition, the experimental group performed a combination of inspiratory diaphragm breathing exercise and the expiratory pursed-lip breathing exercise for 15 minutes. Prior to and after the intervention, patients' pulmonary functions were measured using a spirometer. The pulmonary functions assessed were tests included FVC, FEV1, FVC/FEV1, PEF, VC, TV, IC, ERV, IRV.[Results] With respect to changes in the pulmonary functions of both groups after the intervention, the experimental group showed significant differences in FVC/FEV1, TV, and IC, but not in FVC, FEV1, PEF, VC, ERV, and IRV. The control group showed no significant differences. There were significant differences in FEV1, TV, and IC between the two groups, but no significant differences in FVC, PEF, FVC/FEV1, VC, ERV, and IRV after the experiment.[Conclusions] The experimental group, which conducted a combination of breathing machine exercise and the respiratory muscle strengthening exercise, saw their respiratory ability increase more significantly than the control group. The combination breathing exercise was found to improve pulmonary functions of stroke patients.

Efficacy of Interventions to Improve Respiratory Function After Stroke

“…The 17 included trials involved 616 participants and investigated the effects of 5 modalities of interventions delivered to improve respiratory function after stroke. Eleven trials compared experimental interventions versus no intervention, 14,16,[25][26][27][28][29][30][31][32][33] 3 compared to sham interventions, [34][35][36] and 3 of the studies compared 2 different modalities of respiratory interventions. [37][38][39] The characteristics of the included trials are summarized in Table 1.…”

“…Interventions. The experimental interventions were: aerobic exercises (2 trials), 37,39 breathing exercises (ie, breathing/chest expansion/diaphragmatic exercises) (4 trials), 16,26,30,33 postural exercises (1 trial), 32 respiratory muscle training (11 trials), 14,25,[27][28][29][30][31][33][34][35][36] , and the addition of electrical stimulation (2 trials). 14,38 Three trials included 2 interventions (2 experimental groups) and were included in 2 different comparisons.…”

“…13 These variables have been commonly used to reflect respiratory function and evaluate the effectiveness of various types of interventions in people with stroke. [14][15][16] Neuromuscular electrical stimulation, 14 transcranial magnetic stimulation, 15 breathing exercises (breathing/chest expansion/diaphragmatic exercises), 16 and respiratory muscle training 6 are examples of applied interventions, which have the potential to improve respiratory function. These interventions may increase the strength and endurance of the respiratory muscles, speed of contractions and power outputs, diaphragm thickness, and lung volumes and flows.…”

“…These interventions may increase the strength and endurance of the respiratory muscles, speed of contractions and power outputs, diaphragm thickness, and lung volumes and flows. 6,[14][15][16] Thus, the knowledge of the most effective interventions is fundamental for professionals because this information may help them integrate the best research evidence into their clinical practice. This, when associated with clinical expertise and client preferences, will produce appropriate and effective services.…”

“…3,6,19,20 The results indicated that respiratory muscle training resulted in increased strength of the inspiratory (7 cm H 2 O) 6,19 and expiratory (13 cm H 2 O) muscles 6 and improved lung function, such as FVC (2.0 L). 19 Although numerous randomized clinical trials [14][15][16] have investigated the effects of other interventions aimed at improving respiratory function in people with stroke, there were no systematic reviews found that summarized the current evidence. In addition, improvements in impairments related to respiratory function have the potential to reduce activity-related symptoms, such as dyspnea, and the benefits could be carried over to everyday activities, due to more efficient use of the respiratory muscles in activities of daily living.…”