Controlled Breathing Exercises Research Articles

A Systematic Review of Breathing Exercise Interventions: An Integrative Complementary Approach for Anxiety and Stress in Adult Populations.

Aim: Nurses are well-qualified to deliver integrative complementary therapy interventions, a holistic approach to assist individuals experiencing anxiety and stress. Self-regulated, controlled breathing exercises (a clinical approach) are reported to decrease anxiety and increase stress tolerance. The aim of this systematic review was to evaluate the effectiveness of breathing exercise interventions on the psychological and physiologic outcomes of anxiety and stress among adults and assess the state of the science in the post-COVID-19 population. Methods: A systematic review was conducted, and four scientific databases were searched: PubMed, CINAHL, EMBASE, and Web of Science. Inclusion criteria included: (1) peer-reviewed studies, (2) adults over 18, (3) breathing exercise interventions, and (4) anxiety or stress as outcomes. Results: Out of 309 studies identified, 19 were included. Twelve reported significant improvements in anxiety and nine reported significant improvements in stress following varying breathing exercise interventions (p < .05). No adverse events were reported. Conclusions: Breathing exercises were found to be effective in reducing anxiety and stress in adults, however, there continues to be limited evidence that includes large randomized controlled trials. Breathing exercises are a holistic care approach that can be safely implemented by nurses to decrease symptomatology among adults, including the post-COVID population.

Integrative Functions of the Hypothalamus: Linking Cognition, Emotion and Physiology for Well-being and Adaptability

Background The hypothalamus, a small yet crucial neuroanatomical structure, integrates external (e.g., environmental) and internal (e.g., physiological/hormonal) stimuli. This integration governs various physiological processes and influences cognitive, emotional, and behavioral outcomes. It serves as a functional bridge between the nervous and endocrine systems, maintaining homeostasis and coordinating bodily functions. Summary Recent advancements in the neurobiology of the hypothalamus have elucidated its functional map, establishing a causal relationship between its responses—such as respiration, sleep, and stress—and various physiological processes. The hypothalamus facilitates and coordinates these complex processes by processing diverse stimuli, enabling the body to maintain internal balance and respond effectively to external demands. This review delves into the hypothalamus’s intricate connections with cognition, emotion, and physiology, exploring how these interactions promote overall well-being and adaptability. Key Message Targeted external stimuli can modulate hypothalamic neuronal activities, impacting the physiological, cognitive, and emotional landscape. The review highlights non-invasive techniques, such as controlled breathing exercises, optimized sleep architecture, and stress management, as potential methods to enhance hypothalamic function. Ultimately, this comprehensive review underscores the multifaceted role of the hypothalamus in integrating signals, maintaining homeostasis, and influencing cognition, emotion, and physiology.

Acute effects of slow, controlled breathing exercises on arterial pressure and autonomic cardiac modulation in hypertensive patients

The aim of the present study was to evaluate the influence of slow, controlled breathing exercises (SCBE) on arterial pressure and autonomic cardiac modulation in hypertensive patients. 29 hypertensive patients were evaluation in two data collections (period between 1 to 3 days). In each evaluation, data were collected after 10 min of spontaneous breathing (between 12 and 20 breaths per minute – bpm) and 10 min of SCBE (12 bpm, in the rhythm of standardized verbal stimulus). The arterial pressure was evaluated by a multi-parameter monitor and the autonomic cardiac modulation by the rate variability technique. The SCBE reduced systolic arterial pressure (1st evaluation: -4.8 mmHg and 2nd evaluation: -4.3 mmHg), decreased sympathetic activity by 18% and modified autonomic modulation by about 50%. SCBE reduced both systolic arterial pressure and sympathetic activity and can be used in control arterial pressure of hypertensive patients.

Case Study: A Depiction of Blood Pressure Following Hatha Yoga Practice

Hatha Yoga, characterized by body posture formation techniques and controlled breathing exercises, seeks to maintain the body's natural equilibrium. Conversely, hypertension, marked by elevated blood pressure within the vascular system, is a persistent medical condition. Its prevalence increases with age, particularly in low and middle-income nations. This study explores the effect of Hatha Yoga exercises on blood pressure in elderly hypertensive patients at the Biaro Public Health Center in 2023. Employing a Quasi-Experimental One Group Pretest-Posttest Design, this research engaged a study population comprising individuals aged 45-59 years. Purposive sampling identified a sample of 12 participants. Over a 2-week period, data was collected utilizing an aneroid sphygmomanometer and observation sheets. Data analysis encompassed univariate and bivariate analyses, employing the paired t-test. The results revealed that the mean blood pressure in hypertensive patients prior to participating in Hatha Yoga was 155.50, whereas following the intervention, it reduced to 150.08. These outcomes indicated a substantial impact, as evidenced by a p-value of 0.030, surpassing the significance level α (0.05). In conclusion, Hatha Yoga exercises significantly influenced blood pressure in elderly hypertensive patients at the Biaro Public Health Center in 2023. Consequently, it is recommended that hypertensive elderly individuals incorporate regular and disciplined Hatha Yoga exercises into their routine to effectively manage their blood pressure.

Breathing Control Exercises Delivered in a Group Setting for Patients with Chronic Obstructive Pulmonary Disease: A Randomized Controlled Trial

Breathing control exercises are an important component of occupational therapy in patients with chronic obstructive pulmonary disease (COPD). Delivering these exercises in group settings may enhance their benefits. Therefore, this study assessed the effectiveness of breathing control exercises delivered in a group format to patients with severe COPD remitting from an acute pulmonary exacerbation. This randomized controlled trial of 6 weeks' duration compared the addition of breathing exercise sessions delivered in a group setting to a standard exercise inpatient rehabilitation program (usual care) versus usual care alone. The standard exercise program consisted of endurance and strength training and therapeutic patient education. The intervention group received, in addition to usual care, 20 sessions of 30 min duration of breathing control exercises in a group setting. The primary outcome was quality of life (Saint George's Respiratory Questionnaire). Secondary outcomes were the COPD assessment test, modified Borg scale, handgrip strength test, and five-time sit-to-stand test. Thirty-seven patients aged 69 ± 7 years were recruited. After the 6-week period, all outcomes significantly improved and exceeded the minimal clinically important difference in the intervention group only. Between-group changes were significant for each outcome. Conclusions: breathing control exercises in a group setting provide clinically relevant benefits in patients with severe COPD who are remitting from an acute pulmonary exacerbation.

Temperature Profile of Nasal Breathing for Respiration Monitoring in Ambulatory Settings

The nasal breathing parameters have shown promising applications in hyperventilation, Kussmaul breathing, sleep apnea, shortness of breath in COVID-19, bradypnea, sinus arrhythmia, and breathing pranayama. However, a wearable setup, which is affordable, esthetic, and accurate in real time during various physical activities, is not available currently. This article developed a novel, low-cost and wearable instrumented nasal temperature sensing (NTS) device for measuring various breathing parameters. The proposed device was tested during controlled breathing exercises in a seated position at three ambient temperature settings (18 °C, 28 °C, and 38 °C). The device was further tested for standing and walking at various speeds, including slow (1.5 km/h), medium (3.5 km/h), and fast (5.5 km/h). The NTS device is compared against a commercially available respiration belt (RB) (gold standard). The mean absolute error (MAE) (averaged across subjects and ambient temperature settings) was 0.09 ± 0.05 breaths per minute (bpm), 0.17 ± 0.10 bpm, and 0.13 ± 0.13 bpm for controlled breathing at 6, 12, and 18 bpm, respectively. The root mean square between the NTS device and RB across the subjects at the normal standing position was 1.13 ± 0.39 bpm. The results suggest that the proposed NTS device is accurate for real-time applications with the potential advantage of being robust enough to motion artifacts.

Pilot study of physiotherapist-led versus music therapist-led breathing control exercises for young adults living with breathing pattern disorder: a randomised controlled trial protocol

IntroductionBreathing pattern disorder (BPD) is an abnormal breathing pattern associated with biochemical, biomechanical and psychophysiological changes. While physiotherapy is often offered, limited evidence-based therapies for BPD are available. Music therapy-based...

Improving Respiratory Timing Estimation Using Quality Indexing and Electrocardiogram-Derived Respiration.

Numerous applications require accurate estimation of respiratory timings. Respiratory effort (RSP) measurement is a popular approach to accomplish this, especially when the tightness of the sensing belt around the chest can be ensured. In less controlled settings, however, belt looseness and artifacts from movement of the belt on the chest can corrupt the signal. This paper demonstrates that respiration quality indexing and outlier removal can help mitigate these issues, improving estimates of respiration rate (RR), inspiration time (Ti), and expiration time (Te)., In a sample of 15 healthy human participants undergoing a protocol of five controlled breathing exercises in four postures each, electrocardiogram (ECG) and RSP signals were collected. RSP signals were processed to extract breath-by-breath estimates of RR, Ti, and Te. These estimates were compared against ground truth spirometry-based estimates using Bland-Altman analysis. We find that incorporating quality indexing and outlier removal prior to feature extraction improves the 95% limits of agreement by 10-40%. We also find that by using ECG-derived respiration (EDR) during periods of RSP artifact, the data removal necessary for accurate respiratory timing estimation is significantly reduced ( for all postures). These findings encourage the use of quality assessment and EDR to enhance the robustness of RR, Ti, and Te estimation from RSP signals. Clinical Relevance- Detecting stimulus-induced or pathological changes in respiratory function can enhance our understanding and monitoring of respiratory health. Quality assessment and the use of EDR help accomplish this by enabling more accurate measurement of respiratory timings.

Silent Hypoxia in COVID-19 Pneumonia: State of Knowledge, Pathophysiology, Mechanisms, and Management.

Patients with COVID-19 often present with life-threatening hypoxemia without dyspnea or signs of respiratory distress. Termed silent or happy hypoxia, it has puzzled clinicians and challenged and defied our understanding of normal respiratory physiology. A range of host- and pathogen-related factors appears to contribute to its development, including SARS-CoV-2's ability to produce different COVID-19 phenotypes; induce endothelial damage and elicit a vascular distress response; invade cells of the central nervous system and disrupt normal interoception and response; and modulate transcription factors involved in hypoxic responses. Because hypoxemia in COVID-19 is associated with increased mortality risk and poorer survival, early detection and prompt treatment is essential to prevent potential complications. Interventions to prevent hypoxemia and improve oxygen delivery to the blood and the tissues include home pulse-oximetry monitoring, optimization of patient positioning, judicious use of supplemental oxygen, breathing control exercises, and timely and appropriate use of ventilatory modalities and adjuncts.

The effects of six-week slow, controlled breathing exercises on heart rate variability in physically active, healthy individuals

Background and Study Aim: Heart rate variability (HRV) provides information about sympathetic-parasympathetic balance. The effects of different types of physical exercises on HRV have been investigated so far. The purpose of the current study was to evaluate the chronic effects of six-week slow and controlled breathing exercise on HRV in physically active, healthy adults.&#x0D; Material and Methods: A total of 22 individuals (11 female, 11 male) participated in the study voluntarily. The experimental group (EG) attended to the breathing exercises for 15 minutes per day, three days a week for six weeks. Neither the EG nor the control group (CG) did join in any regular physical activity program during the study. Both groups participated in the HRV measurements before and after the six-week of process.&#x0D; Results: Only the EG showed statistically significant changes in some HRV parameters. The alterations observed in LF:HF ratio, HFnu, and LFnu parameters were to reflect the increase in parasympathetic activity. Although the changes in the other parameters of HRV such as SDNN, SDSD, RMSSD, TP, HF, LF, and VLF were also related to increased vagal activity, these alterations were not significant. However, no significant change was found in the CG.&#x0D; Conclusions: These results show that only the slow, controlled breathing exercises for six weeks could be used to improve parasympathetic activity in physically active individuals. A study could be designed where the duration is kept over 8 weeks, and the effects of physical exercises only, breathing exercises only, and physical + breathing exercises together on HRV are examined.

The effects of six-week slow, controlled breathing exercises on heart rate variability in physically active, healthy individuals

Background and Study Aim: Heart rate variability (HRV) provides information about sympathetic-parasympathetic balance. The effects of different types of physical exercises on HRV have been investigated so far. The purpose of the current study was to evaluate the chronic effects of six-week slow and controlled breathing exercise on HRV in physically active, healthy adults.&#x0D; Material and Methods: A total of 22 individuals (11 female, 11 male) participated in the study voluntarily. The experimental group (EG) attended to the breathing exercises for 15 minutes per day, three days a week for six weeks. Neither the EG nor the control group (CG) did join in any regular physical activity program during the study. Both groups participated in the HRV measurements before and after the six-week of process.&#x0D; Results: Only the EG showed statistically significant changes in some HRV parameters. The alterations observed in LF:HF ratio, HFnu, and LFnu parameters were to reflect the increase in parasympathetic activity. Although the changes in the other parameters of HRV such as SDNN, SDSD, RMSSD, TP, HF, LF, and VLF were also related to increased vagal activity, these alterations were not significant. However, no significant change was found in the CG.&#x0D; Conclusions: These results show that only the slow, controlled breathing exercises for six weeks could be used to improve parasympathetic activity in physically active individuals. A study could be designed where the duration is kept over 8 weeks, and the effects of physical exercises only, breathing exercises only, and physical + breathing exercises together on HRV are examined.

Inspiratory muscle training combined with pursed lip technique in women with chronic obstructive pulmonary disease: a case study

Objective. To improve pulmonary function, exercise capacity and quality of life of two women with Chronic Obstructive Pulmonary Disease (COPD). Material and Methods. Study of two clinical cases, both women. An intervention of 8 weeks was performed, in which the patients performed 3 weekly sessions, of which 1 was performed with supervision of the physiotherapist and 2 sessions were performed at home. The treatment sessions consisted of inspiratory muscle training with an inspiratory threshold and controlled breathing exercises with the pursed lip technique. Results. Quality of life of both women improved at the end of the study. In the woman with severe COPD, Maximal Inspiratory Pressure (MIP) and Maximal Expiratory Pressure (MEP) increased after the intervention. The Peak Expiratory Flow (PEF) improved in both cases, but not the rest of the spirometric values. Dyspnea improved in the woman with moderate COPD but not in the case of the one with severe COPD. Finally, the distance walked in the 6MWT improved in both cases. Conclusions. The training of the inspiratory muscles together with the pursed lip technique positively influences quality of life and exercise capacity of two women with COPD.

The Effect of Controlled Breathing Exercises on Anxiety and Arterial Oxygen Saturation in Chronic Obstructive Pulmonary Disease the Military Specialist Hospitals

The Effect of Controlled Breathing Exercises on Anxiety and Arterial Oxygen Saturation in Chronic Obstructive Pulmonary Disease the Military Specialist Hospitals

Adapted physical activity and cardiac coherence in hematologic patients (APACCHE): study protocol for a randomized controlled trial

BackgroundHematologic malignancies and their treatments are recognized for their significant long-term adverse effects on health-related quality of life. As a part of cancer treatment, physical exercise is known to improve physical functioning, but there are still questions regarding its impact on psychological and emotional functioning. Nonetheless, heart rate variability biofeedback (HRVB) is recognized for its positive effects on autonomic nervous system balance and emotional self-regulation. The Adapted Physical Activity and Cardiac Coherence in Hematologic Patients (APACCHE) protocol is a randomized, controlled superiority trial designed to evaluate the effects of HRBV training combined with an adaptive physical activity (APA) program compared to APA alone on the post-treatment quality of life of adult hematologic patients.MethodsSeventy patients aged 18–70 years, with various forms of hematological malignancies, in post-treatment remission within six months prior to beginning the study and who have been prescribed APA by a hematologist, will be randomly allocated in a 1:1 ratio to two 12-week treatment groups: HRVB + APA versus APA alone. APA sessions will consist of aerobic and resistance training for 1-h twice weekly. The HRVB training will consist of controlled breathing exercises with biofeedback of heart rate variability for 10 sessions and will include a daily home-based practice. The primary outcome will be to evaluate health-related quality of life (QLQ-C30, SF-36). The secondary outcomes will be to evaluate fatigue (MFI-20); anxiety and depression (HADS); clinical status with blood pressure, progression-free survival, overall survival, and body mass index; heart rate variability level and cardiac coherence score. All of these assessments will be evaluated initially (T1), 6 weeks after (T2), at the end of the 12 weeks (T3), and then at a 12-week post-intervention follow-up (T4).DiscussionTo our knowledge, this is the first protocol to investigate the additional value of HRVB on physical exercise. In addition, there has been no study previously published about HRVB in hematologic patients. We hypothesize that overall quality of life and psychological and physical functioning will be improved, potentially offering a better understanding of supportive cancer care in hematology and inferring new perspectives in psychophysiological research in cancer.Trial registrationCurrent randomized controlled trial was registered 29 November 2017 on Clinical Trials.gov (NCT number: NCT03356171).

Effect of Yogic Controlled Breathing Exercises on Cardiovascular Parameters

The study was conducted to evaluate the effect of pranayam (yogic controlled breathing exercises) &meditation on cardiovascular parameters in 1st year male medical students of GSVM Medical College,Kanpur. All the 60 students selected for the study were randomized into 3 groups of 20 students each:Group I–Anulom Vilom Pranayam, Group II–Kapalbhati Pranayam, Group III–Bhastrika Pranayam. Bloodpressure (systolic & diastolic) & pulse rate of all the students in each group were recorded at baseline & after3 months of training. Training programme included 10 min. meditation in padmasana followed by 5 min.practice of pranayam twice a day for 3 months. A significant (p< .001) decrease in pulse rate, systolic BP anddiastolic BP were observed after 3 months of training.. The relaxation & flexibility induced by meditation& pranayam help to stabilize the autonomic nervous system with a tendency towards parasympatheticdominance. So the meditation & pranayam should be encouraged to improve the performance ofcardiovascular system. Controlled pranayam breathing is also effective in improving the strength & tone ofmuscles involved in respiration.

Take a very Big Breath!

Controlled breathing exercises can help to provide focus and wellbeing for even very young children. Try this step-by-step guide to achieving the Big Breath, which can be both calming and energising.

The relationship between exercise capacity and different functional markers in pulmonary rehabilitation for COPD.

RationaleThe relationship of functional parameters such as lung mechanics, chest kinematics, metabolism and peripheral and respiratory muscle function with the level of exercise tolerance remains a controversial subject. While it has been previously shown that pulmonary rehabilitation is capable of improving exercise tolerance in patients afflicted by COPD, as expressed by values of 6-minute walking test (6MWT), the degree of contribution to this change by each of the aforementioned parameters remains unclear.AimsTo investigate the correlation between changes in exercise capacity and other functional markers following pulmonary rehabilitation in COPD and to determine which parameters are more closely related to improvements of exercise tolerance.Materials and methodsThree hundred and twenty-seven patients with COPD (with average, 95% CI for forced expiratory volume in the first second [FEV1]: 45% [25%–83%] predicted, age: 64 [48–80] years, and BMI: 27 [13.5–40.4] kg/m2) participated in this study. Thirty percent of the patients had pulmonary hypertension as comorbidity. Patients underwent a pulmonary rehabilitation program with 20–30 minutes sessions two to three times per day for 4 weeks. The program was composed of chest wall-stretching, controlled breathing exercises, and a personalized training schedule for cycling and treadmill use. Measurements of 6MWT, lung function, chest wall expansion, grip strength, maximal inspiratory pressure, and breath holding time were taken. The Body mass index, airflow Obstruction, Dyspnea and Exercise capacity (BODE-index), body mass index [BMI], FEV1, 6MWT, modified Medical Research Dyspnea Scale score, and an alternative scale score (for BMI, FEV1, 6MWT, and COPD Assessment Test) were calculated.ResultsRehabilitation resulted in a generalized improvement in 6MWT among patients (average: 360 [95% CI: 178–543 m] vs average: 420 [95% CI: 238–601 m], p<0.05). Improvements in exercise tolerance were found to be most closely associated with changes in composite BODE-index (R2=−0.6), Alternative Scale (R2=−0.56), dyspnea score (modified Medical Research Dyspnea Scale R2=−0.54), and health status (COPD Assessment Test R2=−0.4, p<0.05). In addition, improvements in exercise tolerance were found to moderately correlate with improvements in inspiratory vital capacity (IVC, R2=0.34, p<0.05). Post-rehabilitation changes in IVC displayed a connection with grip strength (R2=0.6) and chest expansion (R2=0.48).ConclusionEnhancements in exercise tolerance had correlation with changes in IVC, BODE-index, and the new Alternative Scale. However, comprehensive assessment needs to include considerations of chest kinematics and peripheral and respiratory muscle function as well.

Effect of Pranayama on respiratory endurance in young adults

Background: Pranayama is an integral part of Yoga with proven health benefits. Pranayama involves controlled breathing exercises and isometric contraction of respiratory muscles which have a major role in strengthening the respiratory muscles and improving respiratory endurance. Aims and Objectives: The present study was undertaken to find out whether the practice of Pranayama regularly for a significant duration increases respiratory endurance. Materials and Methods: Maximum respiratory pressures (maximum expiratory pressure [MEP] and maximum inspiratory pressure [MIP]), breath holding time after expiration (BHTe) and after inspiration (breath holding time after inspiration [BHTi]) were recorded and 40 mmHg test was performed in 53 subjects before start of study and after 12 weeks of Pranayama practice. The descriptive statistics were used, i.e. mean and standard deviation for describing the parameters. Paired t-test was used to compare the MEP, MIP, BHTe, BHTi, and 40 mmHg test results before and after study. P < 0.05 was considered statistically significant. Results: There was a significant increase in MEP and MIP by 37% and 26%, respectively (Z = 28.19, P < 0.001 for MEP and Z = 19.06, P < 0.001 for MIP). BHTe and BHTi also showed statistically significant increase by 38% and 46%, respectively (Z = 32.24, P < 0.001 for BHTe and Z = 32.33, P < 0.001 for BHTi). 40 mmHg test showed a 50% increase after 12 weeks training. Conclusion: The current study indicates that practice of Pranayama regularly increases the strength of respiratory muscles and improves respiratory endurance.

Prevalence and pattern of usage of complementary and alternative medicine among south Indian asthma patients in a tertiary care hospital

ObjectivesThe study aimed to investigate the prevalence of CAM users among asthmatic patients in a tertiary care South Indian hospital. MethodsProspective, cross sectional study was conducted in 394 asthmatic patients. Results30.4% of the patients used CAM therapies. The most commonly used CAM treatment was herbal medicine followed by pranayama (controlled breathing exercises). Most of the CAM users were found to be in lower middle class. The baseline characteristics of the CAM users and the non CAM users were found to be similar except for education and socioeconomic status (p < .008). Among the CAM users, none of the patients disclosed about their CAM treatment to their pulmonologists. ConclusionPatients must be educated about CAM therapies and they must be advised to discuss all their treatment related issues with treating clinicians. Healthcare professionals should be familiar with the merits and demerits of using CAM therapy so that they could provide proper guidance to their patients.

Physiological coherence in healthy volunteers during laboratory-induced stress and controlled breathing.

Physiological coherence has been related with a general sense of well-being and improvements in health and physical, social, and cognitive performance. The aim of this study was to evaluate the relationship between acute stress, controlled breathing, and physiological coherence, and the degree of body systems synchronization during a coherence-generation exercise. Thirty-four university employees were evaluated during a 20-min test consisting of four stages of 5-min duration each, during which basal measurements were obtained (Stage 1), acute stress was induced using validated mental stressors (Stroop test and mental arithmetic task, during Stage 2 and 3, respectively), and coherence states were generated using a controlled breathing technique (Stage 4). Physiological coherence and cardiorespiratory synchronization were assessed during each stage from heart rate variability, pulse transit time, and respiration. Coherence measurements derived from the three analyzed variables increased during controlled respiration. Moreover, signals synchronized during the controlled breathing stage, implying a cardiorespiratory synchronization was achieved by most participants. Hence, physiological coherence and cardiopulmonary synchronization, which could lead to improvements in health and better life quality, can be achieved using slow, controlled breathing exercises. Meanwhile, coherence measured during basal state and stressful situations did not show relevant differences using heart rate variability and pulse transit time. More studies are needed to evaluate the ability of coherence ratio to reflect acute stress.