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Catela D, Santos J, Oliveira J, Franco S, Mercê C. Heart Rate Variability, Blood Pressure and Peripheral Oxygen Saturation during Yoga Adham and Mahat Breathing Techniques without Retention in Adult Practitioners. J Funct Morphol Kinesiol 2024; 9:184. [PMID: 39449478 PMCID: PMC11503363 DOI: 10.3390/jfmk9040184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2024] [Revised: 10/01/2024] [Accepted: 10/01/2024] [Indexed: 10/26/2024] Open
Abstract
Background: Heart rate variability (HRV) is the change in time intervals between heart beats, reflecting the autonomic nervous system's ability to adapt to psychological and physiological demands. Slow breathing enhances parasympathetic activity, increasing HRV. Pranayama, a yoga breathing technique, affords the conscious regulation of respiration frequency. This study aimed to characterize HRV, blood pressure and peripheral oxygen saturation of basic yoga breathing slow techniques with regular yoga practitioners. Methods: In total, 45 yoga practitioners were included in the study (including 7 males, mean age of 54.04 ± 11.97 years) with varying levels of yoga experience (minimum 3 months, maximum 37 years). Participants performed three breathing conditions: baseline (control) and two yoga techniques (abdominal (adham) and complete (mahat)) breathing, each for 10 min in the supine position (i.e., savasana). For each condition, respiratory frequency, heart rate (HR), blood pressure and peripheral oxygen levels were collected. Results: The findings revealed that both abdominal and complete yoga breathing techniques promoted a decrease in respiratory frequency (p < 0.001, r = 0.61; p < 0.001, r = 0.61, respectively), and an increase in peripheral oxygen saturation (p < 0.001, r = 0.50; p < 0.001, r = 0.46, respectively), along with blood pressure decreases in all mean values, and a significant decrease in systolic pressure, considering all conditions (p = 0.034, W = 0.08). There were significant increases in standard deviation of HR during abdominal and complete yoga breathing techniques compared with the baseline (p = 0.003, r = 0.31; p < 0.001, r = 0.47, respectively), indicating enhanced parasympathetic activity. Moreover, the complete breathing technique exhibited the greatest variability in HRV measures, with several significant differences compared with abdominal breathing (standard deviation of HR, p < 0.001, r = 0.42; SD2, standard deviation of points perpendicular to the Poincaré parallel line, p < 0.003, r = 0.31; SD1/SD2, p < 0.003, r = 0.31), suggesting a more profound impact on autonomic modulation. Conclusions: simple, inexpensive and non-intrusive abdominal and complete yoga breathing techniques can effectively and momentarily enhance HRV and oxygen saturation in adults, mature adults and the elderly.
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Affiliation(s)
- David Catela
- Sport Sciences School of Rio Maior, Santarém Polytechnic University, Avenue Dr. Mário Soares No. 110, 2040-413 Rio Maior, Portugal; (S.F.); (C.M.)
- Quality Education-Life Quality Research Centre (CIEQV), Santarém Polytechnique University, Complex Andaluz, Apart 279, 2001-904 Santarém, Portugal;
- Sport Physical Activity and Health Research & Innovation Center (SPRINT), Santarém Polytechnic University, Complex Andaluz, Apart 279, 2001-904 Santarém, Portugal
| | - Júlia Santos
- Santarém Higher School of Health, Santarém Polytechnic University, Quinta do Mergulhão Senhora da Guia, 2005-075 Santarém, Portugal;
- Individual and Community Health-Life Quality Research Centre (CIEQV), Polytechnique University of Santarém, Complex Andaluz, Apart 279, 2001-904 Santarém, Portugal
| | - Joana Oliveira
- Quality Education-Life Quality Research Centre (CIEQV), Santarém Polytechnique University, Complex Andaluz, Apart 279, 2001-904 Santarém, Portugal;
- Portuguese Yoga Federation (FPY), Campo Emílio Infante da Câmara, 2000-014 Santarém, Portugal
| | - Susana Franco
- Sport Sciences School of Rio Maior, Santarém Polytechnic University, Avenue Dr. Mário Soares No. 110, 2040-413 Rio Maior, Portugal; (S.F.); (C.M.)
- Sport Physical Activity and Health Research & Innovation Center (SPRINT), Santarém Polytechnic University, Complex Andaluz, Apart 279, 2001-904 Santarém, Portugal
- Physical Activity and Health-Life Quality Research Centre (CIEQV), Polytechnique University of Santarém, Complex Andaluz, Apart 279, 2001-904 Santarém, Portugal
| | - Cristiana Mercê
- Sport Sciences School of Rio Maior, Santarém Polytechnic University, Avenue Dr. Mário Soares No. 110, 2040-413 Rio Maior, Portugal; (S.F.); (C.M.)
- Sport Physical Activity and Health Research & Innovation Center (SPRINT), Santarém Polytechnic University, Complex Andaluz, Apart 279, 2001-904 Santarém, Portugal
- Physical Activity and Health-Life Quality Research Centre (CIEQV), Polytechnique University of Santarém, Complex Andaluz, Apart 279, 2001-904 Santarém, Portugal
- Interdisciplinary Center for the Study of Human Performance (CIPER), Faculty of Human Kinetics, University of Lisbon, Cruz Quebrada-Dafundo, 1499-002 Lisboa, Portugal
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Eser P, Calamai P, Kalberer A, Stuetz L, Huber S, Kaesermann D, Guler S, Wilhelm M. Improved exercise ventilatory efficiency with nasal compared to oral breathing in cardiac patients. Front Physiol 2024; 15:1380562. [PMID: 39165283 PMCID: PMC11334221 DOI: 10.3389/fphys.2024.1380562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Accepted: 07/02/2024] [Indexed: 08/22/2024] Open
Abstract
Objectives: To assess whether nasal breathing improves exercise ventilatory efficiency in patients with heart failure (HF) or chronic coronary syndromes (CCS). Background: Exercise inefficient ventilation predicts disease progression and mortality in patients with cardiovascular diseases. In healthy people, improved ventilatory efficiency with nasal compared to oral breathing was found. Methods: Four study groups were recruited: Patients with HF, patients with CCS, old (age≥45 years) and young (age 20-40 years) healthy control subjects. After a 3-min warm-up, measurements of 5 min with once nasal and once oral breathing were performed in randomized order at 50% peak power on cycle ergometer. Ventilation and gas exchange parameters measured with spiroergometry were analysed by Wilcoxon paired-sample tests and linear mixed models adjusted for sex, height, weight and test order. Results: Groups comprised 15 HF, CCS, and young control and 12 old control. Ventilation/carbon dioxide production (V ˙ E/V ˙ CO2), ventilation (V ˙ E), breathing frequency (fR), and end-tidal oxygen partial pressure (PETO2) were significantly lower and tidal volume and end-tidal carbon dioxide partial pressure (PETCO2) significantly higher during nasal compared to oral breathing in all groups, with large effect sizes for most parameters. For patients with HF, medianV ˙ E/V ˙ CO2 was 35% lower, fR 26% lower, and PETCO2 10% higher with nasal compared to oral breathing, respectively. Exercise oscillatory ventilation (EOV) was present in 6 patients and markedly reduced with nasal breathing. Conclusion: Nasal breathing during submaximal exercise significantly improved ventilatory efficiency and abnormal breathing patterns (rapid shallow breathing and EOV) in 80% of our patients with HF and CCS.
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Affiliation(s)
- Prisca Eser
- Centre for Rehabilitation and Sports Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Pietro Calamai
- Centre for Rehabilitation and Sports Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Anja Kalberer
- Centre for Rehabilitation and Sports Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Laura Stuetz
- Centre for Rehabilitation and Sports Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Sarina Huber
- Centre for Rehabilitation and Sports Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Dominic Kaesermann
- Centre for Rehabilitation and Sports Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Sabina Guler
- Department for Pulmonary Medicine, Allergology and Clinical Immunology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Matthias Wilhelm
- Centre for Rehabilitation and Sports Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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Wang Z, Zhu Z, Sun Y, Wang T, Lu Y, Che W, Liu W, Xu Y. The Rehabilitation Efficacy of the Novel Metronomic Breathing Technique for Gerontic Patients After Percutaneous Coronary Intervention for Acute Myocardial Infarction-A Pilot Study. Clin Interv Aging 2024; 19:1029-1039. [PMID: 38863479 PMCID: PMC11166167 DOI: 10.2147/cia.s458675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Accepted: 05/21/2024] [Indexed: 06/13/2024] Open
Abstract
Background The respiratory rehabilitation technique is a crucial component of early cardiac recovery in geriatric patients with acute myocardial infarction (AMI). This study primarily investigated the effectiveness of a novel respiratory rehabilitation technique, metronomic breathing (MB), on geriatric patients after percutaneous coronary intervention for AMI and compliance with home-based rehabilitation compared to traditional respiratory rehabilitation. Methods From June 2022 to March 2023, 75 acute myocardial infarction (AMI) patients admitted to the Shanghai Tenth People's Hospital Cardiovascular Department were consecutively enrolled. Ultimately, 46 patients completed the follow-up in this study-26 in the MB group and 20 in the control group-who underwent the novel MB technique and conventional abdominal breathing training. The primary endpoint of the study was left ventricular function measured by noninvasive hemodynamics three months after discharge. The secondary endpoints were compliance and quality of life after three months of home rehabilitation. Results After the intervention, several cardiac functional parameters (SV, SVI, CO, CI, LCW, and LCWI), myocardial contractility parameters (VI), and systemic vascular resistance parameters (SVR and SVRI) were significantly greater in the MB group than in the preintervention group (P < 0.05). Furthermore, post-treatment, the MB group exhibited greater SV, SVI, CO, CI, and VI; lower SVR, SVRI, and SBP; and a lower readmission rate three months later than did the control group. The SF-36 scores after three months of MB intervention, PE, BP, GH, VT, SF, RE, and MH, were all significantly greater than those before treatment (P < 0.05). Moreover, the MB group displayed greater compliance with home-based cardiac rehabilitation (P < 0.05). Conclusion Compared to conventional respiratory rehabilitation training methods, short-term metronomic respiratory therapy is more effective for reducing systemic vascular resistance, enhancing left ventricular ejection function, enhancing quality of life, and increasing home-based rehabilitation compliance in geriatric patients following AMI with PCI.
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Affiliation(s)
- Zeyu Wang
- Department of Cardiology, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, 200072, People’s Republic of China
| | - Zhaoxin Zhu
- Department of Cardiology, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, 200072, People’s Republic of China
| | - Yifan Sun
- Department of Cardiology, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, 200072, People’s Republic of China
| | - Ting Wang
- Department of Cardiology, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, 200072, People’s Republic of China
| | - Yunlan Lu
- Department of Cardiology, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, 200072, People’s Republic of China
| | - Wenliang Che
- Department of Cardiology, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, 200072, People’s Republic of China
| | - Weijing Liu
- Department of Cardiology, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, 200072, People’s Republic of China
| | - Yawei Xu
- Department of Cardiology, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, 200072, People’s Republic of China
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Sokolovskiy S, Arroyo D, Hansma P. Can Pulse Rate Variability be Used to Monitor Compliance with a Breath Pacer? Appl Psychophysiol Biofeedback 2024; 49:233-240. [PMID: 38214800 PMCID: PMC11101548 DOI: 10.1007/s10484-023-09617-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/24/2023] [Indexed: 01/13/2024]
Abstract
Slow paced breathing has been demonstrated to provide significant health benefits for a person's health, and, during breathing sessions, it is desirable to monitor that a person is actually compliant with the breath pacer. We explore the potential use of pulse rate variability to monitor compliance with a breath pacer during meditation sessions. The study involved 6 human subjects each participating in 2-3 trials, where they are asked to follow or not to follow the breath pacer, where we collected data on how the magnitude of pulse rate variability changed. Two methods, logistic regression and a running standard deviation technique, were developed to detect non-compliance with the breath pacer based on pulse rate variability metrics. Results indicate that using pulse rate variability alone may not reliably detect non-compliance with the breath pacer. Both models exhibited limitations in terms of false positives and false negatives, with accuracy ranging from 67 to 65%. Existing methods involving visual, audio, and motion signals currently perform better for monitoring compliance with the breath pacer.
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Affiliation(s)
| | | | - Paul Hansma
- University of California, Santa Barbara, USA
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Eser P, Marcin T, Prescott E, Prins LF, Kolkman E, Bruins W, van der Velde AE, Gil CP, Iliou MC, Ardissino D, Zeymer U, Meindersma EP, Van’t Hof AWJ, de Kluiver EP, Wilhelm M. Breathing pattern and pulmonary gas exchange in elderly patients with and without left ventricular dysfunction-modification with exercise-based cardiac rehabilitation and prognostic value. Front Cardiovasc Med 2023; 10:1219589. [PMID: 37727302 PMCID: PMC10505741 DOI: 10.3389/fcvm.2023.1219589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 08/01/2023] [Indexed: 09/21/2023] Open
Abstract
Background Inefficient ventilation is an established prognostic marker in patients with heart failure. It is not known whether inefficient ventilation is also linked to poor prognosis in patients with left ventricular dysfunction (LVD) but without overt heart failure. Objectives To investigate whether inefficient ventilation in elderly patients with LVD is more common than in patients without LVD, whether it improves with exercise-based cardiac rehabilitation (exCR), and whether it is associated with major adverse cardiovascular events (MACE). Methods In this large multicentre observational longitudinal study, patients aged ≥65 years with acute or chronic coronary syndromes (ACS, CCS) without cardiac surgery who participated in a study on the effectiveness of exCR in seven European countries were included. Cardiopulmonary exercise testing (CPET) was performed before, at the termination of exCR, and at 12 months follow-up. Ventilation (VE), breathing frequency (BF), tidal volume (VT), and end-expiratory carbon dioxide pressure (PETCO2) were measured at rest, at the first ventilatory threshold, and at peak exercise. Ventilatory parameters were compared between patients with and without LVD (based on cardio-echography) and related to MACE at 12 month follow-up. Results In 818 patients, age was 72.5 ± 5.4 years, 21.9% were women, 79.8% had ACS, and 151 (18%) had LVD. Compared to noLVD, in LVD resting VE was increased by 8%, resting BF by 6%, peak VE, peak VT, and peak PETCO2 reduced by 6%, 8%, and 5%, respectively, and VE/VCO2 slope increased by 11%. From before to after exCR, resting VE decreased and peak PETCO2 increased significantly more in patients with compared to without LVD. In LVD, higher resting BF, higher nadir VE/VCO2, and lower peak PETCO2 at baseline were associated with MACE. Conclusions Similarly to patients with HF, in elderly patients with ischemic LVD, inefficient resting and exercise ventilation was associated with worse outcomes, and ExCR alleviated abnormal breathing patterns and gas exchange parameters.
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Affiliation(s)
- Prisca Eser
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Thimo Marcin
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Eva Prescott
- Department of Cardiology, Bispebjerg Frederiksberg University Hospital, Copenhagen, Denmark
| | | | | | | | | | - Carlos Peña Gil
- Department of Cardiology, Hospital Clínico Universitario de Santiago, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Marie-Christine Iliou
- Department of Cardiac Rehabilitation, Assistance Publique Hopitaux de Paris, Paris, France
| | - Diego Ardissino
- Department of Cardiology, Parma University Hospital, Parma, Italy
| | - Uwe Zeymer
- Klinikum Ludwigshafen and Institut für Herzinfarktforschung Ludwigshafen, Ludwigshafen, Germany
| | | | - Arnoud W. J. Van’t Hof
- Isala Heart Centre, Zwolle, Netherlands
- Department of Cardiology, Maastricht University Medical Center, Maastricht, Netherlands
- Department of Cardiology, Zuyderland Medical Center, Heerlen, Netherlands
| | | | - Matthias Wilhelm
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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When Agents Become Partners: A Review of the Role the Implicit Plays in the Interaction with Artificial Social Agents. MULTIMODAL TECHNOLOGIES AND INTERACTION 2020. [DOI: 10.3390/mti4040081] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The way we interact with computers has significantly changed over recent decades. However, interaction with computers still falls behind human to human interaction in terms of seamlessness, effortlessness, and satisfaction. We argue that simultaneously using verbal, nonverbal, explicit, implicit, intentional, and unintentional communication channels addresses these three aspects of the interaction process. To better understand what has been done in the field of Human Computer Interaction (HCI) in terms of incorporating the type channels mentioned above, we reviewed the literature on implicit nonverbal interaction with a specific emphasis on the interaction between humans on the one side, and robot and virtual humans on the other side. These Artificial Social Agents (ASA) are increasingly used as advanced tools for solving not only physical but also social tasks. In the literature review, we identify domains of interaction between humans and artificial social agents that have shown exponential growth over the years. The review highlights the value of incorporating implicit interaction capabilities in Human Agent Interaction (HAI) which we believe will lead to satisfying human and artificial social agent team performance. We conclude the article by presenting a case study of a system that harnesses subtle nonverbal, implicit interaction to increase the state of relaxation in users. This “Virtual Human Breathing Relaxation System” works on the principle of physiological synchronisation between a human and a virtual, computer-generated human. The active entrainment concept behind the relaxation system is generic and can be applied to other human agent interaction domains of implicit physiology-based interaction.
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Nicolò A, Massaroni C, Schena E, Sacchetti M. The Importance of Respiratory Rate Monitoring: From Healthcare to Sport and Exercise. SENSORS (BASEL, SWITZERLAND) 2020; 20:E6396. [PMID: 33182463 PMCID: PMC7665156 DOI: 10.3390/s20216396] [Citation(s) in RCA: 136] [Impact Index Per Article: 27.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 11/05/2020] [Accepted: 11/08/2020] [Indexed: 12/11/2022]
Abstract
Respiratory rate is a fundamental vital sign that is sensitive to different pathological conditions (e.g., adverse cardiac events, pneumonia, and clinical deterioration) and stressors, including emotional stress, cognitive load, heat, cold, physical effort, and exercise-induced fatigue. The sensitivity of respiratory rate to these conditions is superior compared to that of most of the other vital signs, and the abundance of suitable technological solutions measuring respiratory rate has important implications for healthcare, occupational settings, and sport. However, respiratory rate is still too often not routinely monitored in these fields of use. This review presents a multidisciplinary approach to respiratory monitoring, with the aim to improve the development and efficacy of respiratory monitoring services. We have identified thirteen monitoring goals where the use of the respiratory rate is invaluable, and for each of them we have described suitable sensors and techniques to monitor respiratory rate in specific measurement scenarios. We have also provided a physiological rationale corroborating the importance of respiratory rate monitoring and an original multidisciplinary framework for the development of respiratory monitoring services. This review is expected to advance the field of respiratory monitoring and favor synergies between different disciplines to accomplish this goal.
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Affiliation(s)
- Andrea Nicolò
- Department of Movement, Human and Health Sciences, University of Rome “Foro Italico”, 00135 Rome, Italy;
| | - Carlo Massaroni
- Unit of Measurements and Biomedical Instrumentation, Department of Engineering, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Rome, Italy; (C.M.); (E.S.)
| | - Emiliano Schena
- Unit of Measurements and Biomedical Instrumentation, Department of Engineering, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Rome, Italy; (C.M.); (E.S.)
| | - Massimo Sacchetti
- Department of Movement, Human and Health Sciences, University of Rome “Foro Italico”, 00135 Rome, Italy;
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Chen SM, Wang LY, Wu PJ, Liaw MY, Chen YL, Chen AN, Tsai TH, Hang CL, Lin MC. The Interrelationship between Ventilatory Inefficiency and Left Ventricular Ejection Fraction in Terms of Cardiovascular Outcomes in Heart Failure Outpatients. Diagnostics (Basel) 2020; 10:E469. [PMID: 32664450 PMCID: PMC7399946 DOI: 10.3390/diagnostics10070469] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 07/07/2020] [Accepted: 07/08/2020] [Indexed: 12/28/2022] Open
Abstract
The relationship between left ventricular ejection fraction (LVEF) and cardiovascular (CV) outcome is documented in patients with low LVEF. Ventilatory inefficiency is an important prognostic predictor. We hypothesized that the presence of ventilatory inefficiency influences the prognostic predictability of LVEF in heart failure (HF) outpatients. In total, 169 HF outpatients underwent the cardiopulmonary exercise test (CPET) and were followed up for a median of 9.25 years. Subjects were divided into five groups of similar size according to baseline LVEF (≤39%, 40-58%, 59-68%, 69-74%, and ≥75%). The primary endpoints were CV mortality and first HF hospitalization. The Cox proportional hazard model was used for simple and multiple regression analyses to evaluate the interrelationship between LVEF and ventilatory inefficiency (ventilatory equivalent for carbon dioxide (VE/VCO2) at anaerobic threshold (AT) >34.3, optimized cut-point). Only LVEF and VE/VCO2 at AT were significant predictors of major CV events. The lower LVEF subgroup (LVEF ≤ 39%) was associated with an increased risk of CV events, relative to the LVEF ≥75% subgroup, except for patients with ventilatory inefficiency (p = 0.400). In conclusion, ventilatory inefficiency influenced the prognostic predictability of LVEF in reduced LVEF outpatients. Ventilatory inefficiency can be used as a therapeutic target in HF management.
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Affiliation(s)
- Shyh-Ming Chen
- Section of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan; (P.-J.W.); (Y.-L.C.); (T.-H.T.); (C.-L.H.)
| | - Lin-Yi Wang
- Department of Physical Medicine and Rehabilitation, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan; (L.-Y.W.); (M.-Y.L.)
| | - Po-Jui Wu
- Section of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan; (P.-J.W.); (Y.-L.C.); (T.-H.T.); (C.-L.H.)
| | - Mei-Yun Liaw
- Department of Physical Medicine and Rehabilitation, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan; (L.-Y.W.); (M.-Y.L.)
| | - Yung-Lung Chen
- Section of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan; (P.-J.W.); (Y.-L.C.); (T.-H.T.); (C.-L.H.)
| | - An-Ni Chen
- Department of Physical Therapy, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 83301, Taiwan;
| | - Tzu-Hsien Tsai
- Section of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan; (P.-J.W.); (Y.-L.C.); (T.-H.T.); (C.-L.H.)
| | - Chi-Ling Hang
- Section of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan; (P.-J.W.); (Y.-L.C.); (T.-H.T.); (C.-L.H.)
| | - Meng-Chih Lin
- Section of Pulmonary and Critical Care Medicine, Department of Internal Medicine and Chang Gung University College of Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 83301, Taiwan;
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9
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Burrai F, Sanna GD, Moccia E, Morlando F, Cosentino ER, Bui V, Micheluzzi V, Borghi C, Parodi G. Beneficial Effects of Listening to Classical Music in Patients With Heart Failure: A Randomized Controlled Trial. J Card Fail 2019; 26:541-549. [PMID: 31877362 DOI: 10.1016/j.cardfail.2019.12.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 12/17/2019] [Accepted: 12/19/2019] [Indexed: 01/21/2023]
Abstract
BACKGROUND Practical recommendations on nonpharmacologic non-device/surgical interventions in patients with heart failure (HF) are well known. Although complementary treatments may have beneficial effects, there is no evidence that these on their own improve mortality, morbidity, or quality of life. We examined the effects of listening to recorded classical music on HF-specific quality of life (QOL), generic QOL, sleep quality, anxiety, depression, and cognitive state in patients with HF in the home-care setting. METHODS AND RESULTS Multicenter randomized controlled trial. One hundred fifty-nine patients with HF were randomized on a 1:1 basis in 2 groups: experimental (music) and control. Patients were evaluated after 30, 60, 90 days (experimental period) and at 6 months. Patients randomized to the music group listened to music from a large preselected playlist, at least 30 minutes per day, for 3 months on an MP3 player. Patients in the control group received standard care. HF-specific QOL, generic QOL, self-care, somatic perception of HF symptoms, sleep quality, anxiety and depression, and cognitive abilities were assessed throughout the use of specific scales. On average, patients in the music group showed greater improvements in terms of HF-specific QOL (P < .001), generic-QOL (P = .005), quality of sleep (P = .007), anxiety and depression levels (P < .001 for both), and cognitive performances (P = .003). CONCLUSIONS Listening to recorded classical music is a feasible, noninvasive, safe, and inexpensive intervention, able to improve QOL in patients with HF in the home-care setting.
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Affiliation(s)
- Francesco Burrai
- Educational and Research, ATS Sardegna-ASSL Sassari, 07100 Sassari, Italy
| | - Giuseppe D Sanna
- Clinical and Interventional Cardiology, Sassari University Hospital, 07100 Sassari, Italy.
| | - Eleonora Moccia
- Clinical and Interventional Cardiology, Sassari University Hospital, 07100 Sassari, Italy
| | | | - Eugenio R Cosentino
- Department of Internal Medicine, University of Bologna, 40138 Bologna, Italy
| | - Virna Bui
- Department of Internal Medicine, University of Bologna, 40138 Bologna, Italy
| | - Valentina Micheluzzi
- Clinical and Interventional Cardiology, Sassari University Hospital, 07100 Sassari, Italy
| | - Claudio Borghi
- Department of Internal Medicine, University of Bologna, 40138 Bologna, Italy
| | - Guido Parodi
- Clinical and Interventional Cardiology, Sassari University Hospital, 07100 Sassari, Italy
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10
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Wang MH, Yeh ML. Respiratory training interventions improve health status of heart failure patients: A systematic review and network meta-analysis of randomized controlled trials. World J Clin Cases 2019; 7:2760-2775. [PMID: 31616691 PMCID: PMC6789387 DOI: 10.12998/wjcc.v7.i18.2760] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 07/04/2019] [Accepted: 07/27/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Prior studies indicate that doing breathing exercises improves physical performance and quality of life (QoL) in heart failure patients. However, these effects remain unclear and contradictory.
AIM To determine the effects of machine-assisted and non-machine-assisted respiratory training on physical performance and QoL in heart failure patients.
METHODS This was a systematic review and network meta-analysis study. A literature search of electronic databases was conducted for randomized controlled trials (RCTs) on heart failure. Respiratory training interventions were grouped as seven categories: IMT_Pn (inspiratory muscle training without pressure or < 10% maximal inspiratory pressure, MIP), IMT_Pl (inspiratory muscle training with low pressure, 10%-15% MIP), IMT_Pm (inspiratory muscle training with medium pressure, 30%-40% MIP), IMT_Ph (inspiratory muscle training with high pressure, 60% MIP or MIP plus aerobics), Aerobics (aerobic exercise or weight training), Qi_Ex (tai chi, yoga, and breathing exercise), and none. The four outcomes were heart rate, peak oxygen uptake (VO2 peak), 6-min walking distance test (6MWT), and Minnesota Living with Heart Failure QoL. The random-effects model, side-splitting model, and the surface under the cumulative ranking curve (SUCRA) were used to test and analyze the data.
RESULTS A total of 1499 subjects from 31 RCT studies were included. IMT_Ph had the highest effect sizes for VO2 peak and 6MWT, IMT_Pm highest for QoL, and Qi_Ex highest for heart rate. Aerobics had the second highest for VO2 peak, Qi_Ex second highest for 6MWT, and IMT_Ph second highest for heart rate and QoL.
CONCLUSION This study supports that high- and medium-intensity machine-assisted training improves exercise capacity and QoL in hospital-based heart failure patients. After hospital discharge, non-machine-assisted training continuously improves cardiac function.
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Affiliation(s)
- Mei-Hua Wang
- School of Nursing, National Taipei University of Nursing and Health Sciences, Taipei 11219, Taiwan
| | - Mei-Ling Yeh
- School of Nursing, National Taipei University of Nursing and Health Sciences, Taipei 11219, Taiwan
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11
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Wang J, Guo S, Zeng M, Yu P, Mo W. Observation of the curative effect of device-guided rehabilitation on respiratory function in stable patients with chronic obstructive pulmonary disease. Medicine (Baltimore) 2019; 98:e14034. [PMID: 30813125 PMCID: PMC6408035 DOI: 10.1097/md.0000000000014034] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) is a serious lung disease for individuals in middle age and especially in old people. The study was aimed to observe the curative effect of device-guided rehabilitation on respiratory functions in stable COPD patients. METHODS Sixty-seven stable COPD patients were enrolled and assigned to the experiment group (n = 36) and the control group (n = 31). The conventional pulmonary rehabilitation treatments, including pursed lips breathing (PLB) and abdominal breathing training, were applied in the control group. Respiratory muscle training of the experiment group was performed using the respiratory endurance training device combined with traditional techniques. Both groups were assessed by 6-minute walk test (6MWT), COPD assessment test (CAT), body mass index, airflow obstruction, dyspnea, and exercise capacity (BODE) index. Besides, the pulmonary function (FVC%, FEVl%) were measured at 6 months before and after treatment. RESULTS After treatment, the 6MWT, CAT, BODE index were significantly increased compared with pre-treatment in both groups (P < .01), but not FVC% and FEVl%. Compared with the control group, the combination therapy in the experiment group could significantly improve the 6MWT (P = .0094), CAT (P = .0071) and BODE index (P = .0064) as well as the changes of 6MWT (P < .01), CAT (P < .01), and BODE index (P < .01) before and after treatment. CONCLUSIONS The traditional respiratory training combined with device-guided pulmonary rehabilitation can improve the respiratory muscle function and athletic ability in stable COPD patients.
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Affiliation(s)
- Jing Wang
- Taikang Yanyuan Rehabilitation Hospital, Beijing
| | - Shuai Guo
- Shanghai Key Laboratory of Intelligent Manufacturing and Robotics, Shanghai University, Shanghai
| | - Ming Zeng
- Rehabilitation Center, Jiaxing Second Hospital, The Second Affiliated Hospital of Jiaxing University, Jiaxing, Zhejiang Province
| | - Peng Yu
- Department of Pain Medicine, Kunming LIH Skycity Rehabilitation Hospital, Kunming, Yunnan Province
| | - Weiqiang Mo
- Respiratory Department, Jiaxing Second Hospital, The Second Affiliated Hospital of Jiaxing University, Jiaxing, Zhejiang Province, China
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12
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Lachowska K, Bellwon J, Moryś J, Gruchała M, Hering D. Slow breathing improves cardiovascular reactivity to mental stress and health-related quality of life in heart failure patients with reduced ejection fraction. Cardiol J 2019; 27:772-779. [PMID: 30697682 DOI: 10.5603/cj.a2019.0002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Revised: 12/31/2018] [Accepted: 01/03/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Previous studies have demonstrated therapeutic benefits of slow breathing (SLOWB) in chronic heart failure (HF) but its impact on cardiovascular reactivity in response to laboratory stressors remains unknown. METHODS Using device-guided breathing this study explored the acute and long-term effects of SLOWB on hemodynamic responses to handgrip, mental and cold pressor tests, and health-related quality of life (QoL) in stable HF patients with reduced ejection fraction (HFrEF) who had received all available optimal drug and device therapies. Blood pressure (BP) and heart rate (HR) were measured in 21 patients with HFrEF (23.9 ± 5.9%) at rest, during laboratory stressors, before and after acute SLOWB, and 12 weeks after SLOWB home training (30 min daily). Health-related QoL (MacNew questionaries) was assessed before and 12 weeks after SLOWB home training. RESULTS Resting BP significantly increased in response to three laboratory stressors. Pressor and cardiac changes during mental stress were greater than responses to the handgrip test (p < 0.05). Mental stress also produced a greater HR change than cold pressor test (p < 0.05). Both acute and long-term SLOWB significantly reduced BP and HR responses to mental stress (p < 0.05), but not to isometric and cold pressor tests. SLOWB improved scores of all domains of QoL (p < 0.05) at 12 weeks follow-up. CONCLUSIONS These findings demonstrate that SLOWB reduces acute and chronic effects of cardiovascular reactivity to mental stress and improves various aspects of health-related QoL in patients with severe HFrEF. Whether stress reduction and psychological changes achieved with SLOWB may translate to improved outcomes in HFrEF warrants further exploration.
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Affiliation(s)
- Kamila Lachowska
- Medical University of Gdansk, Poland, Debinki 7, 80-952 Gdansk, Poland
| | - Jerzy Bellwon
- Medical University of Gdansk, Poland, Debinki 7, 80-952 Gdansk, Poland
| | - Joanna Moryś
- Medical University of Gdansk, Poland, Debinki 7, 80-952 Gdansk, Poland
| | - Marcin Gruchała
- Medical University of Gdansk, Poland, Debinki 7, 80-952 Gdansk, Poland
| | - Dagmara Hering
- Medical University of Gdansk, Poland, Debinki 7, 80-952 Gdansk, Poland.
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13
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Long-term effects of device-guided slow breathing in stable heart failure patients with reduced ejection fraction. Clin Res Cardiol 2018; 108:48-60. [PMID: 29943271 PMCID: PMC6333716 DOI: 10.1007/s00392-018-1310-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Accepted: 06/19/2018] [Indexed: 12/13/2022]
Abstract
Background Slow breathing (SLOWB) alleviates symptoms of chronic heart failure (HF) but its long-term effects are unknown. We examined the acute and long-term impact of device-guided breathing on hemodynamics and prognostic parameters in HF patients with reduced ejection fraction (HFrEF). Methods and results Twenty-one patients with HFrEF (23.9 ± 5.8%, SD ± mean) on optimal medical therapy underwent blood pressure (BP), heart rate (HR), HR variability, 6-min walk test (6MWT), cardiopulmonary exercise testing (CPET), and echocardiography measurements before and 3 months after SLOWB home training (30 min daily). After 3 months, all patients were assigned to continue SLOWB (Group 1) or no-SLOWB (Group 2). All tests were repeated after 6 months. Acute SLOWB (18 ± 5 vs 8 ± 2 breaths/min, P < 0.001) had no influence on BP and HR but improved saturation (97 ± 2 vs 98 ± 2%, P = 0.01). Long-term SLOWB reduced office systolic BP (P < 0.001) but not central or ambulatory systolic BP. SLOWB reduced SDNN/RMSSD ratio (P < 0.05) after 3 months. One-way repeated measures of ANOVA revealed a significant increase in 6MWT and peak RER (respiratory exchange ratio) from baseline to 6-month follow-up in group 1 (P < 0.05) but not group 2 (P = 0.85 for 6MWT, P = 0.69 for RER). No significant changes in echocardiography were noted at follow-up. No HF worsening, rehospitalisation or death occurred in group 1 out to 6-month follow-up. Two hospitalizations for HF decompensation and two deaths ensued in group 2 between 3- and 6-month follow-up. Conclusions SLOWB training improves cardiorespiratory capacity and appears to slow the progression of HFrEF. Further long-term outcome studies are required to confirm the benefits of paced breathing in HFrEF.
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14
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Pastva AM, Walker JKL. Commentary: Central-acting therapeutics alleviate respiratory weakness caused by heart failure-induced ventilatory overdrive. Front Physiol 2018; 9:554. [PMID: 29875676 PMCID: PMC5975101 DOI: 10.3389/fphys.2018.00554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Accepted: 04/30/2018] [Indexed: 11/13/2022] Open
Affiliation(s)
- Amy M. Pastva
- Duke University School of Medicine, Duke University, Durham, NC, United States
| | - Julia K. L. Walker
- Duke University School of Medicine, Duke University, Durham, NC, United States
- Duke University School of Nursing, Duke University, Durham, NC, United States
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15
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Teng HC, Yeh ML, Wang MH. Walking with controlled breathing improves exercise tolerance, anxiety, and quality of life in heart failure patients: A randomized controlled trial. Eur J Cardiovasc Nurs 2018; 17:717-727. [PMID: 29775076 DOI: 10.1177/1474515118778453] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND Patients with heart failure experience not only impaired physical condition, but also their physical activity, moods, and quality of life may be diminished. AIMS The purpose of this study was to investigate the effects of 12-week walking with breathing program on physical activity tolerance considering time-dependent physiological factors and time-independent interoceptive awareness, as well as psychosocial factors. METHODS This randomized controlled trial recruited 90 heart failure patients and randomly assigned them. The walking with breathing group received the walking and breathing intervention for 12 weeks but the control group did not. Outcomes included activity tolerance measured by 6-minute walk distance, moods assessed by the Hospital Anxiety and Depression Scale, quality of life determined by the EuroQol 5-Dimensions, oxygen saturation by pulse oximetry, and interoceptive awareness by the Multidimensional Assessment of Interoceptive Awareness scale. Data were collected before the intervention at baseline and at Weeks 2, 4 and 12. RESULTS The results of the generalized estimating equation showed the 6-minute walk distance in the walking with breathing group was significantly different across time ( p<0.001) compared with the control group at baseline. Oxygen saturation by pulse oximetry ( p=0.04) and Trusting on the Multidimensional Assessment of Interoceptive Awareness scale ( p=0.001) significantly and positively correlated with results of the 6-minute walk distance. There were significant between-group differences at Week 12 in anxiety ( p=0.03) and quality of life ( p=0.02) but not depression ( p=0.06). CONCLUSIONS Walking with breathing improved heart failure patients' tolerance of physical activity, probably because of improved oxygen saturation and trusting interoceptive awareness. Walking with breathing also improved patients' anxiety and quality of life.
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Affiliation(s)
- Hsiu-Chin Teng
- 1 Department of Nursing, Cheng Hsin General Hospital, ROC
| | - Mei-Ling Yeh
- 2 Graduate Institute of Integration of Traditional Chinese Medicine with Western Nursing, National Taipei University of Nursing and Health Sciences, ROC
| | - Mei-Hua Wang
- 3 School of Nursing, National Taipei University of Nursing and Health Sciences, ROC
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16
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Inhibiting the Physiological Stress Effects of a Sustained Attention Task on Shoulder Muscle Activity. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15010115. [PMID: 29324693 PMCID: PMC5800214 DOI: 10.3390/ijerph15010115] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Revised: 01/08/2018] [Accepted: 01/08/2018] [Indexed: 11/29/2022]
Abstract
Objective: The objective of this study was to investigate if a breathing technique could counteract the effects of hyperventilation due to a sustained attention task on shoulder muscle activity. Background: The trend towards higher levels of automation in industry is increasing. Consequently, manufacturing operators often monitor automated process for long periods of their work shift. Prolonged monitoring work requires sustained attention, which is a cognitive process that humans are typically poor at and find stressful. As sustained attention becomes an increasing requirement of manufacturing operators’ job content, the resulting stress experienced could contribute to the onset of many health problems, including work related musculoskeletal disorders (WRMSDs). Methods: The SART attention test was completed by a group of participants before and after a breathing intervention exercise. The effects of the abdominal breathing intervention on breathing rate, upper trapezius muscle activity and end-tidal CO2 were evaluated. Results: The breathing intervention reduced the moderation effect of end-tidal CO2 on upper trapezius muscle activity. Conclusions: Abdominal breathing could be a useful technique in reducing the effects of sustained attention work on muscular activity. Application: This research can be applied to highly-automated manufacturing industries, where prolonged monitoring of work is widespread and could, in its role as a stressor, be a potential contributor to WRMSDs.
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17
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Agostoni P, Guazzi M. Exercise ventilatory inefficiency in heart failure: some fresh news into the roadmap of heart failure with preserved ejection fraction phenotyping. Eur J Heart Fail 2017; 19:1686-1689. [PMID: 28990273 DOI: 10.1002/ejhf.940] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Accepted: 06/13/2017] [Indexed: 12/28/2022] Open
Affiliation(s)
- Piergiuseppe Agostoni
- Cardiology Monzino Center, IRCCS, Milan, Italy.,Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, Milan, Italy
| | - Marco Guazzi
- University Cardiology Department, University of Milan, Department of Biomedical Sciences for Health, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
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18
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Lachowska K, Gruchała M, Narkiewicz K, Hering D. Sympathetic Activation in Chronic Heart Failure: Potential Benefits of Interventional Therapies. Curr Hypertens Rep 2017; 18:51. [PMID: 27193773 DOI: 10.1007/s11906-016-0660-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Heart failure (HF) is a major and growing public health problem. This condition is associated with poor prognosis, a high rate of mortality, frequent hospitalization and increasing costs to health care systems. Pharmacological approaches aimed at reducing morbidity and mortality in HF have primarily focused on inhibition of the renin-angiotensin-aldosterone system (RAAS) and the sympathetic nervous system (SNS), both of which have been associated with disease development, progression and adverse cardiovascular (CV) outcomes. The increasing number of hospitalizations for HF decompensation suggests the failure of available treatment options, indicating the necessity for alternative therapeutic approaches. Alongside pharmacological and cardiac resynchronization therapies in selected patients with arrhythmia, recent advancements in the management of HF have been directed at inhibiting relevant neurogenic pathways underlying disease development and progression. Initial evidence regarding the safety and effectiveness of interventional procedures suggests that HF patients may benefit from novel adjunctive therapies. Here we review the critical role of sympathetic activation in HF and the rationale for therapeutic interventions including device-based and interventional approaches aimed at restoring autonomic neural balance in this condition.
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Affiliation(s)
- Kamila Lachowska
- First Department of Cardiology, Medical University of Gdansk, Gdansk, Poland
| | - Marcin Gruchała
- First Department of Cardiology, Medical University of Gdansk, Gdansk, Poland
| | - Krzysztof Narkiewicz
- Department of Hypertension and Diabetology, Medical University of Gdansk, Gdansk, Poland
| | - Dagmara Hering
- Dobney Hypertension Centre, School of Medicine and Pharmacology-Royal Perth Hospital Unit, The University of Western Australia, Level 3 MRF Building, Rear 50 Murray Street, Perth, WA, 6000, MDBP: M570, Australia.
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19
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Matura LA, Fargo J, Fritz JS, Smith KA, Vaidya A, Pinder D, Archer-Chicko C, Palevsky HI, Pack AI, Sommers MS, Kawut SM. Slow-paced respiration therapy to treat symptoms in pulmonary arterial hypertension. Heart Lung 2016; 46:7-13. [PMID: 27884398 DOI: 10.1016/j.hrtlng.2016.11.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Revised: 11/02/2016] [Accepted: 11/07/2016] [Indexed: 01/23/2023]
Abstract
OBJECTIVE To determine the feasibility of using slow-paced respiration therapy to treat symptoms in women with pulmonary arterial hypertension (PAH). BACKGROUND People with PAH report increased dyspnea, fatigue and sleep disturbance that can impair health-related quality of life (HRQOL). METHODS Ten women with PAH received 8-weeks of daily, 15 min sessions using slow-paced respiration therapy via the RESPeRATE™ device. Participants had baseline and follow up assessments including plasma norepinephrine and interleukin-6 (IL-6), self-report questionnaires to measure dyspnea, fatigue, depressive symptoms, sleep and HRQOL along with 7-day actigraphy and sleep diaries. RESULTS The mean age was 50 years. Adherence to the intervention was 92%. There was decrease in median IL-6 levels [1.3 ± 0.5 to 1.1 ± 0.4, 95% CI (0.03-0.43)] over the study period. Sleep disturbance decreased, depressive symptoms decreased and HRQOL scores decreased (higher scores indicate worse HRQOL). CONCLUSIONS In this pilot study, slow-paced respiration therapy is feasible in patients with PAH and may improve symptoms and lower IL-6.
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Affiliation(s)
- Lea Ann Matura
- University of Pennsylvania, School of Nursing, Philadelphia, PA, USA.
| | | | - Jason S Fritz
- Perelman School of Medicine of the University of Pennsylvania, Pulmonary, Allergy and Critical Care, Philadelphia, PA, USA
| | - Kerri A Smith
- Perelman School of Medicine of the University of Pennsylvania, Pulmonary, Allergy and Critical Care, Philadelphia, PA, USA
| | - Anjali Vaidya
- Perelman School of Medicine of the University of Pennsylvania, Division of Cardiovascular Medicine, Philadelphia, PA, USA
| | - Diane Pinder
- Perelman School of Medicine of the University of Pennsylvania, Pulmonary, Allergy and Critical Care, Philadelphia, PA, USA
| | - Christine Archer-Chicko
- Perelman School of Medicine of the University of Pennsylvania, Pulmonary, Allergy and Critical Care, Philadelphia, PA, USA
| | - Harold I Palevsky
- Perelman School of Medicine of the University of Pennsylvania, Pulmonary, Allergy and Critical Care, Philadelphia, PA, USA
| | - Allan I Pack
- Center for Sleep and Respiratory Neurobiology, University of Pennsylvania, Philadelphia, PA, USA
| | - Marilyn S Sommers
- University of Pennsylvania, School of Nursing, Philadelphia, PA, USA
| | - Steven M Kawut
- Center for Clinical Epidemiology and Biostatistics, Department of Medicine, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA, USA
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20
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Ovadia-Blechman Z, Gavish B, Levy-Aharoni D, Shashar D, Aharonson V. The coupling between peripheral microcirculation and slow breathing. Med Eng Phys 2016; 39:49-56. [PMID: 27816391 DOI: 10.1016/j.medengphy.2016.10.009] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2016] [Revised: 10/14/2016] [Accepted: 10/23/2016] [Indexed: 12/14/2022]
Abstract
Vasomotion (rhythmic changes in arteriolar diameter) is believed to enhance tissue perfusion at low oxygenation levels. We hypothesized that slow breathing and vasomotion may correlate temporally ("coupling"), especially at low oxygenation levels. We paced down spontaneous breathing to about 5 or 6breaths/min in 14 healthy subjects using device-guided breathing (DGB), and continuously monitored respiration, transcutaneous oxygen pressure ("oxygenation"), and skin capillary blood flow ("microflow") using a laser Doppler flowmeter. The coupling was expressed by cross-correlation calculated in 1-min time windows. Our main results illustrated that: (1) coupling increased gradually upon slowing breathing down in a subgroup, in which initial oxygenation was lower than a threshold of 30mmHg (0.3±0.2 vs. 0.07±0.2, P<10-6); (2) during DGB changes in oxygenation elicited opposite (relative) changes in microflow, with 4-fold higher sensitivity for low initial oxygenation relative to high (regression slope -0.094±0.010mmHg-1 vs. -0.020±0.002mmHg-1, P<10-6); (3) at low initial oxygenation, we observed larger coupling and (relative) microflow changes in younger subjects, and greater oxygenation changes in females (P<10-6 for all); (4) pulse pressure changes from before to after DGB were reduced by increased oxygenation changes during DGB (-5.5±7.4mmHg, r=-0.73, P<0.001). In conclusion, the present methodology can provide the variation trend of respiration-vasomotion coupling during DGB that may characterize microcirculation behavior at tissue oxygenation below a measurable threshold. The potential association of these trends and thresholds with pathologies or specific conditions of the cardiopulmonary system, and the possible role played by the neural sympathetic activity in that coupling, deserve further studies.
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Affiliation(s)
- Zehava Ovadia-Blechman
- Medical Engineering Department, Afeka Tel Aviv Academic College of Engineering, 38 Mivtza Kadesh St., Tel Aviv 6910717, Israel.
| | | | - Danit Levy-Aharoni
- Medical Engineering Department, Afeka Tel Aviv Academic College of Engineering, 38 Mivtza Kadesh St., Tel Aviv 6910717, Israel
| | - David Shashar
- Research & Development Division, Sheba Medical Center, Tel-Hashomer, Israel
| | - Vered Aharonson
- Medical Engineering Department, Afeka Tel Aviv Academic College of Engineering, 38 Mivtza Kadesh St., Tel Aviv 6910717, Israel; School of Electrical and Information Engineering, University of the Witwatersrand, Johannesburg, South Africa
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21
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Seo Y, Yates B, LaFramboise L, Pozehl B, Norman JF, Hertzog M. A Home-Based Diaphragmatic Breathing Retraining in Rural Patients With Heart Failure. West J Nurs Res 2016; 38:270-91. [PMID: 25956151 DOI: 10.1177/0193945915584201] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Dyspnea limits physical activity and functional status in heart failure patients. This feasibility study examined effects of a diaphragmatic breathing retraining (DBR) intervention delivered over 8 weeks with follow-up at 5 months. The intervention group (n = 18) was trained at baseline and received four telephone calls. An attention control group (n = 18) received four telephone calls with general health information. Results from linear mixed model analysis with effect sizes (η(2)) showed dyspnea improved in both groups, with little difference between groups. Compared with attention alone, the intervention increased physical activity (calories expended; η(2) = .015) and functional status (η(2) = .013) across the 5-month follow-up and increased activity counts at 8 weeks (η(2) = .070). This intervention was feasible and demonstrated promising effects on activity and function but not by reducing dyspnea. Patients may have increased physical activity because of instructions to use DBR during activities of daily living. Further exploration of the intervention's underlying physiological effect is needed.
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Affiliation(s)
- Yaewon Seo
- University of Nebraska Medical Center, Omaha, USA
| | | | | | - Bunny Pozehl
- University of Nebraska Medical Center, Omaha, USA
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22
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A Randomized Controlled Trial of Listening to Recorded Music for Heart Failure Patients. Holist Nurs Pract 2016; 30:102-15. [DOI: 10.1097/hnp.0000000000000135] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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Drozdz T, Bilo G, Debicka-Dabrowska D, Klocek M, Malfatto G, Kielbasa G, Styczkiewicz K, Bednarek A, Czarnecka D, Parati G, Kawecka-Jaszcz K. Blood pressure changes in patients with chronic heart failure undergoing slow breathing training. Blood Press 2015; 25:4-10. [PMID: 26513698 DOI: 10.3109/08037051.2016.1099800] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Slow breathing training (SBT) has been proposed as a new non-pharmacological treatment able to induce favorable effects in patients with chronic heart failure (CHF). However, no information is available regarding its effects on orthostatic blood pressure (BP) changes in these patients, an issue of practical relevance given the reported BP-lowering effect of SBT. The aim of this study is to evaluate the influence of SBT on BP and whether SBT induces orthostatic hypotension (OH) or changes in quality of life (QoL) in CHF patients. METHODS The analysis was performed as part of an ongoing crossover open trial aimed at assessing the clinical effectiveness of SBT in treated patients with CHF. The patients underwent 10-12 weeks of SBT with the RESPeRATE device and 10-12 week follow-up under usual care. Patients were randomly divided into two groups: group I began with SBT, followed by usual care; group II began with usual care, followed by SBT. Patients undergoing SBT were asked to perform each day two separate 15 min sessions of device-guided SBT at a breathing frequency of 6 breaths/min. In all patients, before the enrollment and after each study phase, clinical data collection and BP measurements in sitting, supine and standing position were performed. OH was defined as a decrease of ≥ 20 mmHg in systolic blood pressure (SBP) or ≥ 10 mmHg in diastolic blood pressure (DBP) within 3 min of standing. QoL was assessed three times at the beginning, and after each phase of the study by the Minnesota Living with Heart Failure (MLHF) questionnaire. RESULTS Forty patients (two equal groups) completed the study, with the following baseline characteristics: 32 males/eight females, age 63.3 ± 13.4 years, 25 with ischemic CHF, 37 in New York Heart Association class II and three in class III, left ventricular ejection fraction 30.8 ± 6.7%, mean BP 138.7 ± 16.5/83.1 ± 11.5 mmHg, 23 with arterial hypertension and four with a history of stroke. There were no significant differences between the groups in clinical characteristics, SBP and DBP at rest, while seated and before and after standing up. OH prevalence was low and did not change during the study (10% vs 10%). No significant difference in average SBP and DBP changes secondary to body position were found when comparing the two study phases. Decrease in MLHF score was observed in group I during SBT (p = 0.002), but not in group II. CONCLUSIONS Our data indicate that SBT is safe, does not affect the prevalence of OH in CHF patients and shows a non-significant tendency to improve QoL. These results should be confirmed in a larger sample of patients to support the safety of SBT and its possible benefits as a novel component of cardiorespiratory rehabilitation programs in CHF.
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Affiliation(s)
- Tomasz Drozdz
- a Department of Cardiology, Interventional Cardiology and Hypertension , Jagiellonian University Medical College , Krakow , Poland
| | - Grzegorz Bilo
- b Department of Cardiovascular, Neural and Metabolic Sciences , San Luca Hospital, IRCCS Istituto Auxologico Italiano , Milan , Italy
| | - Dorota Debicka-Dabrowska
- a Department of Cardiology, Interventional Cardiology and Hypertension , Jagiellonian University Medical College , Krakow , Poland
| | - Marek Klocek
- a Department of Cardiology, Interventional Cardiology and Hypertension , Jagiellonian University Medical College , Krakow , Poland
| | - Gabriella Malfatto
- b Department of Cardiovascular, Neural and Metabolic Sciences , San Luca Hospital, IRCCS Istituto Auxologico Italiano , Milan , Italy
| | - Grzegorz Kielbasa
- a Department of Cardiology, Interventional Cardiology and Hypertension , Jagiellonian University Medical College , Krakow , Poland
| | - Katarzyna Styczkiewicz
- a Department of Cardiology, Interventional Cardiology and Hypertension , Jagiellonian University Medical College , Krakow , Poland
| | - Agnieszka Bednarek
- a Department of Cardiology, Interventional Cardiology and Hypertension , Jagiellonian University Medical College , Krakow , Poland
| | - Danuta Czarnecka
- a Department of Cardiology, Interventional Cardiology and Hypertension , Jagiellonian University Medical College , Krakow , Poland
| | - Gianfranco Parati
- b Department of Cardiovascular, Neural and Metabolic Sciences , San Luca Hospital, IRCCS Istituto Auxologico Italiano , Milan , Italy.,c Department of Health Sciences , University of Milano-Bicocca , Milan , Italy
| | - Kalina Kawecka-Jaszcz
- a Department of Cardiology, Interventional Cardiology and Hypertension , Jagiellonian University Medical College , Krakow , Poland
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24
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Abstract
Breathing exercises (BE) and inspiratory muscle training (IMT) have been demonstrated to improve ventilation and ventilation-to-perfusion matching, and to improve exercise, functional performance, and many pathophysiologic manifestations of heart failure (HF). This article provides an extensive review of BE and IMT in patients with HF and identifies several key areas in need of further investigation, including the role of expiratory muscle training, IMT targeted at various locations of inspiration (early, mid, or late inspiration), and alteration of the ratio of inspiratory time to total breath time, all of which have substantial potential to improve many pathophysiologic manifestations of HF.
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Affiliation(s)
- Lawrence P Cahalin
- Department of Physical Therapy, Leonard M. Miller School of Medicine, University of Miami, Miami, 5915 Ponce de Leon Boulevard, Coral Gables, FL 33146-2435, USA.
| | - Ross A Arena
- Department of Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago, 1919 West Taylor Street, Room 459, Chicago, IL 60612, USA
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25
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Achttien RJ, Staal JB, van der Voort S, Kemps HM, Koers H, Jongert MWA, Hendriks EJM. Exercise-based cardiac rehabilitation in patients with chronic heart failure: a Dutch practice guideline. Neth Heart J 2014; 23:6-17. [PMID: 25492106 PMCID: PMC4268216 DOI: 10.1007/s12471-014-0612-2] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Rationale To improve the quality of exercise-based cardiac rehabilitation (CR) in patients with chronic heart failure (CHF) a practice guideline from the Dutch Royal Society for Physiotherapy (KNGF) has been developed. Guideline development A systematic literature search was performed to formulate conclusions on the efficacy of exercise-based intervention during all CR phases in patients with CHF. Evidence was graded (1–4) according the Dutch evidence-based guideline development criteria. Clinical and research recommendations Recommendations for exercise-based CR were formulated covering the following topics: mobilisation and treatment of pulmonary symptoms (if necessary) during the clinical phase, aerobic exercise, strength training (inspiratory muscle training and peripheral muscle training) and relaxation therapy during the outpatient CR phase, and adoption and monitoring training after outpatient CR. Applicability and implementation issues This guideline provides the physiotherapist with an evidence-based instrument to assist in clinical decision-making regarding patients with CHF. The implementation of the guideline in clinical practice needs further evaluation. Conclusion This guideline outlines best practice standards for physiotherapists concerning exercise-based CR in CHF patients. Research is needed on strategies to improve monitoring and follow-up of the maintenance of a physical active lifestyle after supervised CR.
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Affiliation(s)
- R J Achttien
- Scientific Institute for Quality of Healthcare, Radboud University Nijmegen Medical Centre, Geert Grooteplein 21 6500, PO Box 9101, Nijmegen, HB, the Netherlands,
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26
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Abstract
Music therapy is a service that has become more prevalent as an adjunct to medical practice-as its evidence base expands and music therapists begin to join the cardiology team in every phase of care, from the most serious cases to those maintaining good heart health. Although applications of music medicine, primarily listening to short segments of music, are capable of stabilizing vital signs and managing symptoms in the short-term, music therapy interventions by a qualified practitioner are showing promise in establishing deeper and more lasting impact. On the basis of mind-body approaches, stress/coping models, the neuromatrix theory of pain, and entrainment, music therapy capitalizes on the ability of music to affect the autonomic nervous system. Although only a limited number of randomized controlled trials pinpoint the efficacy of specific music therapy interventions, qualitative research reveals some profound outcomes in certain individuals. A depth of understanding related to the experience of living with a cardiovascular disease can be gained through music therapy approaches such as nonverbal music psychotherapy and guided imagery and music. The multifaceted nature of musical responsiveness contributes to strong individual variability and must be taken into account in the development of research protocols for future music therapy and music medicine interventions. The extant research provides a foundation for exploring the many potential psychosocial, physiological, and spiritual outcomes of a music therapy service for cardiology patients.
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27
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Ekman I, Kjellström B, Falk K, Norman J, Swedberg K. Impact of device-guided slow breathing on symptoms of chronic heart failure: a randomized, controlled feasibility study. Eur J Heart Fail 2014; 13:1000-5. [DOI: 10.1093/eurjhf/hfr090] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Inger Ekman
- Institute of Health and Care Sciences, the Sahlgrenska Academy; University of Gothenburg; Sweden
- Centre for Person-centered Care, (GPCC); University of Gothenburg; Sweden
| | - Barbro Kjellström
- Department of Cardiology; the Karolinska institute; Stockholm Sweden
| | - Kristin Falk
- Institute of Health and Care Sciences, the Sahlgrenska Academy; University of Gothenburg; Sweden
| | - Jonna Norman
- Institute of Health and Care Sciences, the Sahlgrenska Academy; University of Gothenburg; Sweden
| | - Karl Swedberg
- Centre for Person-centered Care, (GPCC); University of Gothenburg; Sweden
- Department of Emergency and Cardiovascular Medicine, the Sahlgrenska Academy; University of Gothenburg; Sweden
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28
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Abstract
Neurophysiological studies may explain how breathing techniques normalize stress response, emotion regulation, and autonomic and neuroendocrine system function. Breath practices have been shown to reduce symptoms of stress, anxiety, insomnia, post-traumatic stress disorder, mass disasters, depression, and attention deficit disorder. Technology-assisted breathing interventions facilitate therapeutic breathing by using either static cues such as a breath pacer or real-time feedback based on physiological parameters such as heart rate variability. The empirical literature indicates that technology-assisted breathing can be beneficial in mental health treatment, though it may not be appropriate for all individuals. Initial in-person training and evaluation can improve results.
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29
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Vlemincx E, Van Diest I, Van den Bergh O. Imposing respiratory variability patterns. Appl Psychophysiol Biofeedback 2013; 37:153-60. [PMID: 22419514 DOI: 10.1007/s10484-012-9187-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
To ensure respiratory stability and flexibility, healthy breathing shows balanced variability consisting of considerable correlated variability (parameters of each breath are correlated to parameters of adjoining breaths) and some random variability. Sighing resets this balance when respiration lacks variability or becomes excessively irregular. The present study aimed to investigate the effect of imposed patterns of breathing variability on sighing and self-reported (dis)comfort. Spontaneous breathing was compared to imposed non-variable, correlated and random breathing. Results show that executing imposed breathing is difficult, demanding, and induces tension. Sigh occurrence following spontaneous and imposed breathing patterns could be predicted by self-reported discomfort and increased random variability. However, including non-variable, correlated and random breathing patterns only, the effects of self-reported discomfort on sigh occurrence override the effects of altered breathing variability.
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Affiliation(s)
- Elke Vlemincx
- Department of Psychology, Research Group on Health Psychology, University of Leuven, Leuven, Belgium.
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30
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Effects of slow deep breathing at high altitude on oxygen saturation, pulmonary and systemic hemodynamics. PLoS One 2012; 7:e49074. [PMID: 23152851 PMCID: PMC3495772 DOI: 10.1371/journal.pone.0049074] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2012] [Accepted: 10/03/2012] [Indexed: 11/18/2022] Open
Abstract
Slow deep breathing improves blood oxygenation (Sp(O2)) and affects hemodynamics in hypoxic patients. We investigated the ventilatory and hemodynamic effects of slow deep breathing in normal subjects at high altitude. We collected data in healthy lowlanders staying either at 4559 m for 2-3 days (Study A; N = 39) or at 5400 m for 12-16 days (Study B; N = 28). Study variables, including Sp(O2) and systemic and pulmonary arterial pressure, were assessed before, during and after 15 minutes of breathing at 6 breaths/min. At the end of slow breathing, an increase in Sp(O2) (Study A: from 80.2±7.7% to 89.5±8.2%; Study B: from 81.0±4.2% to 88.6±4.5; both p<0.001) and significant reductions in systemic and pulmonary arterial pressure occurred. This was associated with increased tidal volume and no changes in minute ventilation or pulmonary CO diffusion. Slow deep breathing improves ventilation efficiency for oxygen as shown by blood oxygenation increase, and it reduces systemic and pulmonary blood pressure at high altitude but does not change pulmonary gas diffusion.
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31
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Bertisch SM, Schomer A, Kelly EE, Baloa LA, Hueser LE, Pittman SD, Malhotra A. Device-guided paced respiration as an adjunctive therapy for hypertension in obstructive sleep apnea: a pilot feasibility study. Appl Psychophysiol Biofeedback 2011; 36:173-9. [PMID: 21523471 PMCID: PMC3428197 DOI: 10.1007/s10484-011-9158-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Data suggest that device-guided paced respiration (<10 breaths/min) may reduce blood pressure in hypertensive patients. We hypothesized that daily device-guided slow breathing may lower blood pressure in patients with hypertension and obstructive sleep apnea (OSA). In this one-arm pilot study, we enrolled 25 subjects with hypertension and OSA. Subjects were asked to perform device-guided paced respiration 30 min a day for 8 weeks. Our primary outcome was change in office systolic and diastolic blood pressures from baseline to 8 weeks. Twenty-four subjects completed the study. Mean baseline blood pressure was 140.0 ± 10.2 mmHg systolic and 82.7 ± 8.9 mmHg diastolic. Complete device data were available for 17 subjects. Mean device adherence was 81 ± 24% and 51% achieved a mean breath rate ≤10 breaths/min over 8 weeks. Three subjects had changes in their anti-hypertensive medications during the study. Among the remaining 21 subjects, mean difference in office blood pressure from baseline to 8 weeks was -9.6 ± 11.8 mmHg systolic (p ≤ 0.01) and -2.52 ± 8.9 mmHg diastolic (p = 0.21). Device-guided paced respiration may lower systolic blood pressure in patients with hypertension and OSA; however, our findings need to be confirmed with larger randomized controlled trials.
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Affiliation(s)
- Suzanne M Bertisch
- Division of General Medicine and Primary Care, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, 1309 Beacon Street, 2nd floor, Brookline, Boston, MA 02446, USA.
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32
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Liu GZ, Huang BY, Wang L. A wearable respiratory biofeedback system based on generalized body sensor network. Telemed J E Health 2011; 17:348-57. [PMID: 21545293 PMCID: PMC3109078 DOI: 10.1089/tmj.2010.0182] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2010] [Revised: 12/30/2010] [Accepted: 01/03/2011] [Indexed: 11/12/2022] Open
Abstract
Wearable medical devices have enabled unobtrusive monitoring of vital signs and emerging biofeedback services in a pervasive manner. This article describes a wearable respiratory biofeedback system based on a generalized body sensor network (BSN) platform. The compact BSN platform was tailored for the strong requirements of overall system optimizations. A waist-worn biofeedback device was designed using the BSN. Extensive bench tests have shown that the generalized BSN worked as intended. In-situ experiments with 22 subjects indicated that the biofeedback device was discreet, easy to wear, and capable of offering wearable respiratory trainings. Pilot studies on wearable training patterns and resultant heart rate variability suggested that paced respirations at abdominal level and with identical inhaling/exhaling ratio were more appropriate for decreasing sympathetic arousal and increasing parasympathetic activities.
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Affiliation(s)
- Guan-Zheng Liu
- Institute of Biomedical and Health Engineering, Chinese Academy of Sciences, Shenzhen, China
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33
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Harada D, Joho S, Oda Y, Hirai T, Asanoi H, Inoue H. Short term effect of adaptive servo-ventilation on muscle sympathetic nerve activity in patients with heart failure. Auton Neurosci 2010; 161:95-102. [PMID: 21195678 DOI: 10.1016/j.autneu.2010.12.001] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2010] [Revised: 11/29/2010] [Accepted: 12/01/2010] [Indexed: 12/26/2022]
Abstract
Chronic heart failure (HF) is characterized by sympathetic overactivation and periodic breathing. We examined whether adaptive servo-ventilation (ASV) exerts a sympathoinhibitory effect in patients with HF via normalizing respiratory pattern. Muscle sympathetic nerve activity (MSNA), heart rate, blood pressure, respiratory pattern and oxygen saturation were examined in 29 HF patients without obstructive sleep apnea (age, 61±15years; ejection fraction, 0.32±0.09; obstructive apnea index, <5/h) before (10 min), during (30 min) and after (10 min) the application of ASV. Periodic breathing was defined as a repeated oscillation of tidal volume with regularly recurring hyperpnea and hypopnea with a variation in tidal volume of greater than 25%. The severity of respiratory instability was determined using the coefficient of variation of tidal volume (CV-TV). Of 29 patients with HF, 11 had periodic breathing and 18 did not. There was a modest positive correlation between MSNA and CV-TV (n=29, p<0.05). ASV reduced respiratory rate, CV-TV and MSNA only in the group with periodic breathing (p<0.01). Change in MSNA significantly correlated with changes in respiratory rate, CV-TV and presence of periodic breathing. However, multivariate analyses revealed that respiratory rate and CV-TV were independent predictors of change in MSNA. ASV reduces MSNA by slowing respiratory rates and stabilizing respiratory patterns in patients with HF.
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Affiliation(s)
- Daisuke Harada
- Second Department of Internal Medicine, Toyama University Hospital, Toyama, Japan
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34
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Gavish B. Device-guided breathing in the home setting: Technology, performance and clinical outcomes. Biol Psychol 2010; 84:150-6. [DOI: 10.1016/j.biopsycho.2010.02.013] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2009] [Revised: 02/20/2010] [Accepted: 02/21/2010] [Indexed: 01/05/2023]
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35
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Complementary medicine for the management of chronic stress: superiority of active versus passive techniques. J Hypertens 2009; 27:2421-8. [DOI: 10.1097/hjh.0b013e3283312c24] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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36
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Effects of hypoxia on blood pressure regulation: interval hypoxic training as compared to obstructive sleep apnea – the other side of the coin? J Hypertens 2009; 27:1527-32. [DOI: 10.1097/hjh.0b013e3283300d6d] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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