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Hasuo H, Mori K, Matsuoka H, Sakuma H, Ishikawa H. An Estimation Formula for Resonance Frequency Using Sex and Height for Healthy Individuals and Patients with Incurable Cancers. Appl Psychophysiol Biofeedback 2024; 49:125-132. [PMID: 37702816 PMCID: PMC10869367 DOI: 10.1007/s10484-023-09602-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/25/2023] [Indexed: 09/14/2023]
Abstract
Resonance frequency breathing is a technique that involves breathing that maximizes heart rate variability. It is specific to individuals and is determined through a procedure taking approximately 30 min, using a procedure that is often best carried out at specialized medical institutions. This is a physical and time-consuming burden because of hospital visits and measurements, particularly for patients with cancer. Therefore it would be beneficial if a procedure can be found to determine resonance frequency from the patient's physical characteristics, without the need for special assessment procedures. This exploratory cross-sectional study examined the correlation between individual characteristics and resonance frequency in healthy volunteers. Multiple regression analysis was performed with the measured resonance frequency as the target variable and individual characteristic parameters as explanatory variables. The study aims to build an estimation formula for resonance frequency with some of these parameters and assess its validity. In addition, the validity of the formula's applicability to patients with incurable cancers is assessed. A total of 122 healthy volunteers and 32 patients with incurable cancers were recruited as participants. The median resonance frequency of 154 participants was six breaths per min. Sex and height were selected as explanatory variables associated with the measured resonance frequency in the volunteers. The estimation formula for resonance frequency using individual characteristics was 17.90-0.07 × height for men and 15.88-0.06 × height for women. Adjusted R-squared values were 0.55 for men and 0.47 for women. When the measured resonance frequency in patients with incurable cancers was six breaths per minute or less, the resonance frequency estimated by this formula was slightly larger than the measured ones. Information on individual characteristics, such as sex and height, which can be easily obtained, was useful to construct an estimation formula for resonance frequency.
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Affiliation(s)
- Hideaki Hasuo
- Department of Psychosomatic Medicine, Kansai Medical University, Shinmachi 2-5-1, Hirakata, Osaka, 573-1090, Japan.
| | - Keita Mori
- Clinical Research Support Center, Shizuoka Cancer Center, Shizuoka, Japan
| | - Hiromichi Matsuoka
- Department of Psycho-Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Hiroko Sakuma
- Department of Psychosomatic Medicine, Kansai Medical University, Shinmachi 2-5-1, Hirakata, Osaka, 573-1090, Japan
| | - Hideki Ishikawa
- Department of Molecular-Targeting Prevention, Kyoto Prefectural University of Medicine, Kyoto, Japan
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2
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Yuenyongchaiwat K, Changsri K, Harnmanop S, Namdaeng P, Aiemthaisong M, Pongpanit K, Pariyatkaraphan T. Effects of slow breathing training on hemodynamic changes, cardiac autonomic function and neuroendocrine response in people with high blood pressure: A randomized control trial. J Bodyw Mov Ther 2024; 37:136-141. [PMID: 38432795 DOI: 10.1016/j.jbmt.2023.11.042] [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] [Received: 11/28/2021] [Revised: 09/10/2023] [Accepted: 11/24/2023] [Indexed: 03/05/2024]
Abstract
BACKGROUND High blood pressure (BP) is a non-communicable disease that is a risk factor for cardiovascular disease and is the leading cause of mortality and morbidity worldwide. High BP can be managed by both pharmacological and non-pharmacological interventions. Non-pharmacological treatment, such as slow-breathing training (SBT), has been shown to reduce BP. However, there are few studies on the effect of SBT on both cardiac activation and oxidative stress in people with high BP. OBJECTIVES To explore the effect of SBT on cardiac autonomic function (i.e., heart rate variability: HRV) and neuroendocrine response (i.e., salivary cortisol). METHODS One hundred people (including 89 women) with high BP were randomly assigned to either a control (n = 50) or intervention group (n = 50). The intervention program was conducted for 30 min per day, for 5 days per week, for 4 weeks, with a total of 20 sessions of the SBT at the rate of 10 times per minute, whereas the control group was required to continue with their daily routine. HRV, BP, and salivary cortisol were measured before and after the intervention program. A two-way mixed ANOVA was performed for within-group and between-group comparisons over time. RESULTS Of the 100 participants, 71 individuals completed the study. The participants in the intervention group had a lower BP and salivary cortisol levels compared to those in the control group (p < .05). Further, those participants showed an increase in the standard deviation of normal R-R intervals after the 4-week intervention program (p < .05). CONCLUSION This study provided evidence demonstrating the effect of SBT on cardiac autonomic and stress reactivity, which has important implications for health promotion in people with high BP. CLINICAL TRIAL REGISTRATION NUMBER TCTR20180302008.
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Affiliation(s)
- Kornanong Yuenyongchaiwat
- Physiotherapy Department, Faculty of Allied Health Sciences, Thammasat University, Pathumtani, Thailand; Thammasat University Research Unit for Physical Therapy in Respiratory and Cardiovascular Systems, Thammasat University, Pathumthani, Thailand.
| | - Khaimuk Changsri
- Medical Technology Department, Faculty of Allied Health Sciences, Thammasat University, Pathumtani, Thailand
| | - Somrudee Harnmanop
- Physiotherapy Department, Faculty of Allied Health Sciences, Thammasat University, Pathumtani, Thailand
| | - Phuwarin Namdaeng
- Physiotherapy Department, Faculty of Allied Health Sciences, Thammasat University, Pathumtani, Thailand
| | - Mayuree Aiemthaisong
- Physiotherapy Department, Faculty of Allied Health Sciences, Thammasat University, Pathumtani, Thailand
| | - Karan Pongpanit
- Physiotherapy Department, Faculty of Allied Health Sciences, Thammasat University, Pathumtani, Thailand
| | - Thanawat Pariyatkaraphan
- Physical Therapy Unit, Hospital for Tropical Diseases, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
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Dillard CC, Martaindale H, Hunter SD, McAllister MJ. Slow Breathing Reduces Biomarkers of Stress in Response to a Virtual Reality Active Shooter Training Drill. Healthcare (Basel) 2023; 11:2351. [PMID: 37628548 PMCID: PMC10454504 DOI: 10.3390/healthcare11162351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 08/08/2023] [Accepted: 08/19/2023] [Indexed: 08/27/2023] Open
Abstract
Tactical occupations regularly encounter life-threatening situations while on duty. Although these occupations are often trained to utilize slow breathing (SB) during intense stress, there is no evidence supporting the effects on markers of stress in response to a virtual reality active shooter training drill (VR-ASD). The purpose of the study was to determine the impact of acute SB on biomarkers of stress in response to a VR-ASD. Seventy-nine (n = 79) subjects performed either slow breathing method 1 (SB1), slow breathing method 2 (SB2), or normal breathing (control) for five minutes, both pre- and post-VR-ASD. Saliva samples were analyzed for stress markers, including α-amylase (sAA) and secretory immunoglobulin-A (SIgA). Both methods of SB resulted in significantly lower sAA concentrations at 5 (p < 0.001) and 30 min post-VR-ASD (SB1: p = 0.008; SB2: p < 0.001) compared to the control. In the control condition, the sAA concentrations were significantly elevated 5 min post-VR-ASD (p < 0.001) but did not change across time in SB1 or SB2 (p > 0.05). Thus, both SB1 and SB2 reduced the sAA response and resulted in lower concentrations post-VR-ASD. This study was pre-registered as a clinical trial ("Impact of Breathing Interventions on Stress Markers"; NCT05825846).
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Affiliation(s)
- Courtney C. Dillard
- Metabolic & Applied Physiology Lab, Texas State University, San Marcos, TX 78666, USA
| | | | - Stacy D. Hunter
- Metabolic & Applied Physiology Lab, Texas State University, San Marcos, TX 78666, USA
| | - Matthew J. McAllister
- Metabolic & Applied Physiology Lab, Texas State University, San Marcos, TX 78666, USA
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Albertus-Cámara I, Rochel-Vera C, Lomas-Albaladejo JL, Ferrer-López V, Martínez-González-Moro I. Ventilatory Pattern Influences Tolerance to Normobaric Hypoxia in Healthy Adults. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4935. [PMID: 36981844 PMCID: PMC10049086 DOI: 10.3390/ijerph20064935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 03/02/2023] [Accepted: 03/09/2023] [Indexed: 06/18/2023]
Abstract
INTRODUCTION Tolerance to breathing in conditions with a decreased oxygen ratio is subject-specific. A normobaric hypoxia tolerance test (NHTT) is performed to assess the ability of each individual, as this may be influenced by genetic or personal factors such as age or gender. The aim of this study is to test the influence of deep breathing on hypoxia tolerance time. MATERIAL AND METHODS A total of 45 subjects (21 parachutists and 24 students) performed two NHTTs at 5050 m altitude (iAltitude). Arterial (SatO2) and muscle (SmO2) oxygen saturation were monitored with the Humon Hex® device. The first NHTT was performed with free breathing, without any instructions; and the second NHTT was performed with wide, slow, diaphragmatic breathing. The NHTT was terminated at the end of 10 min or when a value of less than 83% was obtained. RESULTS The first NHTT was completed by 38.1% of parachutist and 33.3% of students while the second NHTT was completed by 85.7% and 75%, respectively. In the second NHTT, both parachutists and students had a significantly (p = 0.001) longer duration compared to the first NHTT. SmO2 and SatO2 values also increased significantly (p < 0.001) in both groups (p < 0.05). CONCLUSION Performing controlled diaphragmatic breathing is successful in increasing hypoxia tolerance time and/or SatO2 values.
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Four Sessions of Combining Wearable Devices and Heart Rate Variability (HRV) Biofeedback are Needed to Increase HRV Indices and Decrease Breathing Rates. Appl Psychophysiol Biofeedback 2023; 48:83-95. [PMID: 36350478 DOI: 10.1007/s10484-022-09567-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/23/2022] [Indexed: 11/11/2022]
Abstract
Heart rate variability biofeedback (HRVB) is a behavioral intervention that uses resonance frequency breathing to synchronize the heart rate and breathing patterns. This study aimed to explore how many sessions of wearable HRVB devices are needed to increase the HRV index and decrease breathing rates and to compare the HRVB protocol with other psychological intervention programs in HRV indices and breathing rates. Sixty-four participants were randomly assigned to either the HRVB or relaxation training (RT) group. Both groups received interbeat intervals (IBIs) and breathing rates measurement at the pre-training baseline, during training, and post-training baseline from weeks 1 to 4. IBIs were transformed into HRV indices as the index of the autonomic nervous system. The Group × Week interaction effects significantly in HRV indices and breathing rates. The between-group comparison found a significant increase in HRV indices and decreased breathing rates in the HRVB group than in the RT group at week 4. The within-session comparison in the HRVB group revealed significantly increased HRV indices and decreased breathing rates at weeks 3 and 4 than at weeks 1 and 2. There was a significant increase in HRV indices and a decrease in breathing rates at mid- and post-training than pre-training in the HRVB group. Therefore, 4 weeks of HRVB combined with a wearable device are needed in increasing HRV indices and decrease breathing rates compared to the relaxation training. Three weeks of HRVB training are the minimum requirement for increasing HRV indices and reducing breathing rates compared to the first week of HRVB.
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Respiratory patterns and baroreflex function in heart failure. Sci Rep 2023; 13:2220. [PMID: 36755066 PMCID: PMC9908869 DOI: 10.1038/s41598-023-29271-y] [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: 07/13/2022] [Accepted: 02/01/2023] [Indexed: 02/10/2023] Open
Abstract
Little is known on the effects of respiratory patterns on baroreflex function in heart failure (HF). Patients with HF (n = 30, age 61.6 ± 10 years, mean ± SD) and healthy controls (CNT, n = 10, age 58.9 ± 5.6 years) having their R-R interval (RRI, EKG), systolic arterial blood pressure (SBP, Finapres) and respiratory signal (RSP, Respitrace) monitored, were subjected to three recording sessions: free-breathing, fast- (≥ 12 bpm) and slow- (6 bpm) paced breathing. Baroreflex sensitivity (BRS) and power spectra of RRI, SBP, and RSP signals were calculated. During free-breathing, compared to CNT, HF patients showed a significantly greater modulation of respiratory volumes in the very-low-frequency (< 0.04 Hz) range and their BRS was not significantly different from that of CNT. During fast-paced breathing, when very-low-frequency modulations of respiration were reduced, BRS of HF patients was significantly lower than that of CNT and lower than during free breathing. During slow-paced breathing, BRS became again significantly higher than during fast breathing. In conclusion: (1) in free-breathing HF patients is present a greater modulation of respiratory volumes in the very-low-frequency range; (2) in HF patients modulation of respiration in the very-low and low frequency (around 0.1 Hz) ranges contributes to preserve baroreflex-mediated control of heart rate.
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Heart Rate Variability: A Measure of Cardiovascular Health and Possible Therapeutic Target in Dysautonomic Mental and Neurological Disorders. Appl Psychophysiol Biofeedback 2022; 47:273-287. [DOI: 10.1007/s10484-022-09572-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/04/2022] [Indexed: 11/24/2022]
Abstract
AbstractMental illness such as depression and anxiety as well as cerebrovascular disease are linked to impairment of neurocardiac function mediated by changes to the autonomic nervous system with increased sympathetic and decreased parasympathetic activity. Autonomic neurocardiac function can be evaluated by computing heart rate variability (HRV). Over the past decades, research has demonstrated the diagnostic value of HRV as independent predictor of cardiovascular mortality and as disease marker in progressive autonomic nervous system disorders such as Parkinson’s disease. Here we summarize our studies on HRV and its therapeutic modulation in the context of psychopharmacology as well as psychiatric and neurological disorders to honor the life of Professor Evgeny Vaschillo, the true pioneer of HRV research who sadly passed away on November 21st, 2020.
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Vermeylen S, Honinx E, Broes S, Vandenhoudt H, De Witte NAJ. Evaluation of a tactile breath pacer for sleep problems: A mixed method pilot study. Front Digit Health 2022; 4:908159. [PMID: 36274653 PMCID: PMC9581241 DOI: 10.3389/fdgth.2022.908159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 09/12/2022] [Indexed: 11/07/2022] Open
Abstract
Sleep problems, like insomnia, are a prevalent condition associated with major health risks. Prevention and treatment of sleep problems are thus essential to preserve physical and mental health. Previous work supports the effectiveness of breathing guidance for sleep problems and recommends breathing exercises as an effective intervention for insomnia. While new technologies can support breathing guidance, such novel devices should be assessed for effectiveness and usability to facilitate implementation and continued use. The current pilot study investigates the acceptability and usability of a mobile tactile breathing device and explores its potential impact on subjective sleep quality. In this mixed-method pilot study, 39 participants tested the breathing device for one month in naturalistic circumstances. We collected their experiences, subjective sleep quality, and feedback regarding the usability of the device and the accompanying app through a survey in a pre-post design. The results show that the breathing device is an acceptable solution for sleep problems and participants particularly appreciate the standalone function and design. Nevertheless, important points of attention, such as the size of the device, were also identified. Explorative analyses suggest that subjective sleep quality improved after using the device and accompanying app. The current study supports the usability and acceptability of a tactile breath pacer and provides preliminary evidence supporting a positive impact of the technology on the sleep quality of participants. Recommendations for developers of breathing technologies and eHealth are devised based on the findings.
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Affiliation(s)
- Sascha Vermeylen
- LiCalab, Thomas More University of Applied Sciences, Geel, Belgium
| | | | | | | | - Nele A. J. De Witte
- LiCalab, Thomas More University of Applied Sciences, Geel, Belgium,Correspondence: Nele A. J. De Witte
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Effects of Exercise Training on the Autonomic Nervous System with a Focus on Anti-Inflammatory and Antioxidants Effects. Antioxidants (Basel) 2022; 11:antiox11020350. [PMID: 35204231 PMCID: PMC8868289 DOI: 10.3390/antiox11020350] [Citation(s) in RCA: 41] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 02/04/2022] [Accepted: 02/07/2022] [Indexed: 02/01/2023] Open
Abstract
Studies show that the autonomic nervous system (ANS) has an important impact on health in general. In response to environmental demands, homeostatic processes are often compromised, therefore determining an increase in the sympathetic nervous system (SNS)’s functions and a decrease in the parasympathetic nervous system (PNS)’s functions. In modern societies, chronic stress associated with an unhealthy lifestyle contributes to ANS dysfunction. In this review, we provide a brief introduction to the ANS network, its connections to the HPA axis and its stress responses and give an overview of the critical implications of ANS in health and disease—focused specifically on the immune system, cardiovascular, oxidative stress and metabolic dysregulation. The hypothalamic–pituitary–adrenal axis (HPA), the SNS and more recently the PNS have been identified as regulating the immune system. The HPA axis and PNS have anti-inflammatory effects and the SNS has been shown to have both pro- and anti-inflammatory effects. The positive impact of physical exercise (PE) is well known and has been studied by many researchers, but its negative impact has been less studied. Depending on the type, duration and individual characteristics of the person doing the exercise (age, gender, disease status, etc.), PE can be considered a physiological stressor. The negative impact of PE seems to be connected with the oxidative stress induced by effort.
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Sevoz-Couche C, Laborde S. Heart rate variability and slow-paced breathing:when coherence meets resonance. Neurosci Biobehav Rev 2022; 135:104576. [DOI: 10.1016/j.neubiorev.2022.104576] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 02/07/2022] [Accepted: 02/09/2022] [Indexed: 01/08/2023]
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Influencing Cardiovascular Outcomes through Heart Rate Variability Modulation: A Systematic Review. Diagnostics (Basel) 2021; 11:diagnostics11122198. [PMID: 34943435 PMCID: PMC8700170 DOI: 10.3390/diagnostics11122198] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 11/22/2021] [Accepted: 11/23/2021] [Indexed: 01/08/2023] Open
Abstract
Psychological stress is a well-established risk factor for cardiovascular disease (CVD). Heart rate variability (HRV)-biofeedback could significantly reduce stress levels and improve autonomic nervous system function and cardiovascular endpoints. We aimed to systematically review the literature to investigate the impact of HRV modulation through HRV-biofeedback on clinical outcomes in patients with CVD. A literature search was performed in the following databases: MEDLINE (PubMed), Embase, and Cochrane from the inception until 1 October 2021. Patients in the HRV-biofeedback group had significantly lower rates of all-cause readmissions than patients who received psychological education (respectively, p = 0.028 and p = 0.001). Heart failure following HRV-biofeedback displayed an inverse association with stress and depression (respectively, p = 0.022 and p = 0.033). When stratified according to left ventricular ejection fraction (LVEF), patients with LVEF ≥ 31% showed improved values of the 6 min walk test after HRV-biofeedback interventions (p = 0.05). A reduction in systolic and diastolic blood pressure associated with HRV-biofeedback was observed (p < 0.01) in pre-hypertensive patients. HRV-biofeedback had beneficial effects on different cardiovascular diseases documented in clinical trials, such as arterial hypertension, heart failure, and coronary artery disease. A standard breathing protocol should be applied in future studies to obtain equivalent results and outcomes. However, data regarding mortality in patients with coronary artery disease are scarce and need further research.
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Angiotensin II and the Cardiac Parasympathetic Nervous System in Hypertension. Int J Mol Sci 2021; 22:ijms222212305. [PMID: 34830184 PMCID: PMC8624735 DOI: 10.3390/ijms222212305] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Revised: 11/09/2021] [Accepted: 11/10/2021] [Indexed: 01/08/2023] Open
Abstract
The renin-angiotensin-aldosterone system (RAAS) impacts cardiovascular homeostasis via direct actions on peripheral blood vessels and via modulation of the autonomic nervous system. To date, research has primarily focused on the actions of the RAAS on the sympathetic nervous system. Here, we review the critical role of the RAAS on parasympathetic nerve function during normal physiology and its role in cardiovascular disease, focusing on hypertension. Angiotensin (Ang) II receptors are present throughout the parasympathetic nerves and can modulate vagal activity via actions at the level of the nerve endings as well as via the circumventricular organs and as a neuromodulator acting within brain regions. There is tonic inhibition of cardiac vagal tone by endogenous Ang II. We review the actions of Ang II via peripheral nerve endings as well as via central actions on brain regions. We review the evidence that Ang II modulates arterial baroreflex function and examine the pathways via which Ang II can modulate baroreflex control of cardiac vagal drive. Although there is evidence that Ang II can modulate parasympathetic activity and has the potential to contribute to impaired baseline levels and impaired baroreflex control during hypertension, the exact central regions where Ang II acts need further investigation. The beneficial actions of angiotensin receptor blockers in hypertension may be mediated in part via actions on the parasympathetic nervous system. We highlight important unknown questions about the interaction between the RAAS and the parasympathetic nervous system and conclude that this remains an important area where future research is needed.
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Laborde S, Allen MS, Borges U, Iskra M, Zammit N, You M, Hosang T, Mosley E, Dosseville F. Psychophysiological effects of slow-paced breathing at six cycles per minute with or without heart rate variability biofeedback. Psychophysiology 2021; 59:e13952. [PMID: 34633670 DOI: 10.1111/psyp.13952] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Revised: 08/06/2021] [Accepted: 09/13/2021] [Indexed: 12/20/2022]
Abstract
Heart rate variability (HRV) biofeedback, referring to slow-paced breathing (SPB) realized while visualizing a heart rate, HRV, and/or respiratory signal, has become an adjunct treatment for a large range of psychologic and medical conditions. However, the underlying mechanisms explaining the effectiveness of HRV biofeedback still need to be uncovered. This study aimed to disentangle the specific effects of HRV biofeedback from the effects of SPB realized alone. In total, 112 participants took part in the study. The parameters assessed were emotional (valence, arousal, and control) and perceived stress intensity as self-report variables and the root mean square of the successive differences (RMSSD) as a physiologic variable. A main effect of condition was found for emotional valence only, valence being more positive overall in the SPB-HRVB condition. A main effect of time was observed for all dependent variables. However, no main effects for the condition or time x condition interaction effects were observed. Results showed that for PRE and POST comparisons (referring, respectively, to before and after SPB), both SPB-HRVB and SPB-NoHRVB conditions resulted in a more negative emotional valence, lower emotional arousal, higher emotional control, and higher RMSSD. Future research might investigate psychophysiological differences between SPB-HRVB and SPB-NoHRVB across different time periods (e.g., long-term interventions), and in response to diverse psychophysiological stressors.
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Affiliation(s)
- Sylvain Laborde
- Department of Performance Psychology, Institute of Psychology, German Sport University Cologne, Cologne, Germany.,Normandie Université, UFR STAPS, EA 4260 CESAMS, Caen, France
| | - Mark S Allen
- School of Psychology, University of Wollongong, Wollongong, New South Wales, Australia
| | - Uirassu Borges
- Department of Performance Psychology, Institute of Psychology, German Sport University Cologne, Cologne, Germany.,Department of Health & Social Psychology, Institute of Psychology, German Sport University Cologne, Cologne, Germany
| | - Maša Iskra
- Department of Performance Psychology, Institute of Psychology, German Sport University Cologne, Cologne, Germany
| | - Nina Zammit
- Department of Performance Psychology, Institute of Psychology, German Sport University Cologne, Cologne, Germany
| | - Min You
- Normandie Université, UFR Psychologie, EA3918 CERREV, Caen, France
| | - Thomas Hosang
- Experimental Psychology Unit, Helmut Schmidt University/University of the Federal Armed Forces, Hamburg, Germany
| | - Emma Mosley
- Department of Sport Science and Performance, School of Sport, Health and Social Science, Solent University Southampton, Southampton, UK
| | - Fabrice Dosseville
- Normandie Université, UMR-S 1075 COMETE, Caen, France.,INSERM, UMR-S 1075 COMETE, Caen, France
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Hasuo H, Ishikawa H, Matsuoka H. Relationship between the number of breaths that maximizes heart rate variability and height in patients with incurable cancers. Complement Ther Med 2021; 63:102780. [PMID: 34624493 DOI: 10.1016/j.ctim.2021.102780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 10/02/2021] [Accepted: 10/04/2021] [Indexed: 10/20/2022] Open
Abstract
INTRODUCTION Resonant frequency breathing is a coping skill used for relaxation. A resonant frequency varies from person to person and is only investigated by specialized medical institutions. METHODS The relationships between patients' resonant frequencies and age, sex, height, and body weight were assessed using an analysis of variance. RESULTS The average resonant frequency among the 50 patients with incurable cancers was 6.05 breaths per minute. There was a significant difference in height between the resonant frequencies of 5, 5.5, 6, 6.5, and 7 breaths per minute (p < 0.001). CONCLUSION Resonant frequency may be correlated with height in patients with incurable cancers. TRIAL REGISTRATION UMIN000029820. Registered on November 4, 2017.
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Affiliation(s)
- Hideaki Hasuo
- Department of Psychosomatic Medicine, Kansai Medical University, Osaka, Japan.
| | - Hideki Ishikawa
- Department of Molecular-Targeting Cancer Prevention, Kyoto Prefectural University of Medicine, Kyoto, Japan.
| | - Hiromichi Matsuoka
- Department of Psycho-Oncology, National Cancer Center Hospital, Tokyo, Japan.
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Müller J, Lichtblau M, Saxer S, Calendo LR, Carta AF, Schneider SR, Berlier C, Furian M, Bloch KE, Schwarz EI, Ulrich S. Effect of Breathing Oxygen-Enriched Air on Exercise Performance in Patients With Pulmonary Hypertension Due to Heart Failure With Preserved Ejection Fraction: A Randomized, Placebo-Controlled, Crossover Trial. Front Med (Lausanne) 2021; 8:692029. [PMID: 34395475 PMCID: PMC8357069 DOI: 10.3389/fmed.2021.692029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 06/24/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: To evaluate the effects of breathing oxygen-enriched air (oxygen) on exercise performance in patients with pulmonary hypertension due to heart failure with preserved ejection fraction (PH-HFpEF). Methods: Ten patients with PH-HFpEF (five women, age 60 ± 9 y, mPAP 37 ± 14 mmHg, PAWP 18 ± 2 mmHg, PVR 3 ± 3 WU, resting SpO2 98 ± 2%) performed two-cycle incremental exercise tests (IET) and two constant-work-rate exercise test (CWRET) at 75% maximal work-rate (Wmax), each with ambient air (FiO2 0.21) and oxygen (FiO2 0.5) in a randomized, single-blinded, cross-over design. The main outcomes were the change in Wmax (IET) and cycling time (CWRET) with oxygen vs. air. Blood gases at rest and end-exercise, dyspnea by Borg CR10 score at end-exercise; continuous SpO2, minute ventilation (V'E), carbon dioxide output (V'CO2), and cerebral and quadricep muscle tissue oxygenation (CTO and QMTO) were measured. Results: With oxygen vs. air, Wmax (IET) increased from 94 ± 36 to 99 ± 36 W, mean difference (95% CI) 5.4 (0.9–9.8) W, p = 0.025, and cycling time (CWRET) from 532 ± 203 to 680 ± 76 s, +148 (31.8–264) s, p = 0.018. At end-exercise with oxygen, Borg dyspnea score and V'E/V'CO2 were lower, whereas PaO2 and end-tidal PaCO2 were higher. Other parameters were unchanged. Conclusion: Patients with PH-HFpEF not revealing resting hypoxemia significantly improved their exercise performance while breathing oxygen-enriched air along with less subjective dyspnea sensation, a better blood oxygenation, and an enhanced ventilatory efficiency. Future studies should investigate whether prolonged training with supplemental oxygen would increase the training effect and, potentially, daily activity for PH-HFpEF patients. Clinical Trial Registration: [clinicaltrials.gov], identifier [NCT04157660].
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Affiliation(s)
- Julian Müller
- Pulmonary Clinic, University Hospital Zürich, Zürich, Switzerland.,Faculty of Medicine, University of Zürich, Zürich, Switzerland
| | - Mona Lichtblau
- Pulmonary Clinic, University Hospital Zürich, Zürich, Switzerland.,Faculty of Medicine, University of Zürich, Zürich, Switzerland
| | - Stéphanie Saxer
- Pulmonary Clinic, University Hospital Zürich, Zürich, Switzerland.,Faculty of Medicine, University of Zürich, Zürich, Switzerland
| | - Luigi-Riccardo Calendo
- Pulmonary Clinic, University Hospital Zürich, Zürich, Switzerland.,Faculty of Medicine, University of Zürich, Zürich, Switzerland
| | - Arcangelo F Carta
- Pulmonary Clinic, University Hospital Zürich, Zürich, Switzerland.,Faculty of Medicine, University of Zürich, Zürich, Switzerland
| | - Simon R Schneider
- Pulmonary Clinic, University Hospital Zürich, Zürich, Switzerland.,Faculty of Medicine, University of Zürich, Zürich, Switzerland
| | - Charlotte Berlier
- Pulmonary Clinic, University Hospital Zürich, Zürich, Switzerland.,Faculty of Medicine, University of Zürich, Zürich, Switzerland
| | - Michael Furian
- Pulmonary Clinic, University Hospital Zürich, Zürich, Switzerland.,Faculty of Medicine, University of Zürich, Zürich, Switzerland
| | - Konrad E Bloch
- Pulmonary Clinic, University Hospital Zürich, Zürich, Switzerland.,Faculty of Medicine, University of Zürich, Zürich, Switzerland.,Centre for Integrative Human Physiology, University of Zürich, Zürich, Switzerland
| | - Esther I Schwarz
- Pulmonary Clinic, University Hospital Zürich, Zürich, Switzerland.,Faculty of Medicine, University of Zürich, Zürich, Switzerland
| | - Silvia Ulrich
- Pulmonary Clinic, University Hospital Zürich, Zürich, Switzerland.,Faculty of Medicine, University of Zürich, Zürich, Switzerland.,Centre for Integrative Human Physiology, University of Zürich, Zürich, Switzerland
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16
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Anasuya B, Deepak KK, Jaryal AK, Narang R. Effect of slow breathing on autonomic tone & baroreflex sensitivity in yoga practitioners. Indian J Med Res 2021; 152:638-647. [PMID: 34145104 PMCID: PMC8224157 DOI: 10.4103/ijmr.ijmr_559_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background & objectives: Slow breathing increases parasympathetic activity and baroreflex sensitivity (BRS) in healthy individuals, also similarly observed in yoga practitioners. Pranayama which is an important component of yoga when practiced at a slow pace was at a respiratory frequency of around 0.1 Hz (6 breaths/min). Therefore, it was hypothesized that yoga practitioners might have adapted to slow breathing. This study was aimed to decipher the role of yoga on cardiovascular variability during slow breathing (0.1 Hz) in yoga practitioners. Methods: A cross-sectional study was undertaken in naïve-to-yoga individuals (n=40) and yoga practitioners (n=40) with an average age of 31.08 ± 7.31 and 29.93 ± 7.57 yr, respectively. The analysis of heart rate variability, blood pressure variability (BPV) and BRS during spontaneous and slow breathing was compared between the two groups. Results: During slow breathing, the heart rate (P<0.01) was lower, respiratory rate interval (P<0.05) and pNN50 per cent (P=0.01) were higher, mean systolic BP (SBP) (P<0.05) and SDSD (Standard deviation of successive beat to beat systolic blood pressure differences) (P<0.01) of SBP variability were lower with sequence BRS (P<0.001) and α low frequency (P<0.01) and α high frequency (P<0.001) of spectral BRS were higher in yoga practitioners. Interpretation & conclusions: The present study indicated higher parasympathetic activity and BRS with lower SBP variability at rest and during slow breathing in yoga practitioners compared to naive group. Findings indicate that the short-term practice of slow breathing complements the augmented parasympathetic activity and BRS in the yoga group.
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Affiliation(s)
- Boligarla Anasuya
- Department of Physiology, Cardiothoracic Sciences Center, All India Institute of Medical Sciences, New Delhi, India
| | - Kishore Kumar Deepak
- Department of Physiology, Cardiothoracic Sciences Center, All India Institute of Medical Sciences, New Delhi, India
| | - Ashok Kumar Jaryal
- Department of Physiology, Cardiothoracic Sciences Center, All India Institute of Medical Sciences, New Delhi, India
| | - Rajiv Narang
- Department of Cardiology, Cardiothoracic Sciences Center, All India Institute of Medical Sciences, New Delhi, India
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17
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Szulczewski MT. Transcutaneous Auricular Vagus Nerve Stimulation Combined With Slow Breathing: Speculations on Potential Applications and Technical Considerations. Neuromodulation 2021; 25:380-394. [PMID: 35396070 DOI: 10.1111/ner.13458] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Revised: 04/02/2021] [Accepted: 04/26/2021] [Indexed: 12/20/2022]
Abstract
OBJECTIVES Transcutaneous auricular vagus nerve stimulation (taVNS) is a relatively novel noninvasive neurostimulation method that is believed to mimic the effects of invasive cervical VNS. It has recently been suggested that the effectiveness of taVNS can be enhanced by combining it with controlled slow breathing. Slow breathing modulates the activity of the vagus nerve and is used in behavioral medicine to decrease psychophysiological arousal. Based on studies that examine the effects of taVNS and slow breathing separately, this article speculates on some of the conditions in which this combination treatment may prove effective. Furthermore, based on findings from studies on the optimization of taVNS and slow breathing, this article provides guidance on how to combine taVNS with slow breathing. MATERIALS AND METHODS A nonsystematic review. RESULTS Both taVNS and slow breathing are considered promising add-on therapeutic approaches for anxiety and depressive disorders, chronic pain, cardiovascular diseases, and insomnia. Therefore, taVNS combined with slow breathing may produce additive or even synergistic beneficial effects in these conditions. Studies on respiratory-gated taVNS during spontaneous breathing suggest that taVNS should be delivered during expiration. Therefore, this article proposes to use taVNS as a breathing pacer to indicate when and for how long to exhale during slow breathing exercises. CONCLUSIONS Combining taVNS with slow breathing seems to be a promising hybrid neurostimulation and behavioral intervention.
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18
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Miguel JP, Dias ADC, Bettini NR, Sousa SABAD, Durão MPL, Oliveira LVDC, Monedeiro F, Ramalho LNZ, Branco LGS, Sabino JPJ, Durand MDT. Cigarette smoke exposure causes systemic and autonomic cardiocirculatory changes in rats depending on the daily exposure dose. Life Sci 2021; 277:119498. [PMID: 33864817 DOI: 10.1016/j.lfs.2021.119498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Revised: 03/29/2021] [Accepted: 03/31/2021] [Indexed: 11/15/2022]
Abstract
AIMS To evaluate the systemic changes and autonomic cardiocirculatory control of awaken rats chronically exposed to the cigarette smoke (CS) of 1 or 2 cigarettes/day. MAIN METHODS Rats were exposed to clean air (control) or cigarette smoke of 1 (CS1) or 2 (CS2) cigarettes/animal/day for 30 days. Then, arterial pressure (AP) and heart rate (HR) were recorded in conscious rats to assess spontaneous baroreflex sensitivity and HR and AP variabilities. Evoked baroreflex and cardiac autonomic tone were evaluated by vasoactive drugs and autonomic blockers, respectively. In another group, ventilatory and cardiovascular parameters were recorded under hypoxia and hypercapnia stimulus. At the end of protocols, heart, lung, kidneys and liver were collected for histological analysis. KEY FINDINGS Rats exposed to CS showed morphological changes, being more evident in the CS2 group. Also, less weight gain and cardiac hypertrophy were prominent in CS2 rats. Basal AP and HR, spontaneous baroreflex sensitivity and cardiovascular variabilities were similar among groups. CS exposure progressively blunted the bradycardia response to phenylephrine (-2.2 ± 0.1 vs. -1.7 ± 0.2 vs. -1.5 ± 0.2) while the tachycardia response to sodium nitroprusside was slightly increased compared to control. Vagal tone was not affected by CS, but CS2 rats exhibited higher sympathetic tone (-25 ± 4 vs. -28 ± 4 vs. -56 ± 9) and lower intrinsic HR (411 ± 4 vs. 420 ± 8 vs. 390 ± 6). Exposure to CS of 2 cigarettes also exacerbated the reflex cardiovascular and ventilatory responses to hypoxia and hypercapnia. SIGNIFICANCE CS exposure for 30 days promoted systemic changes and autonomic cardiocirculatory dysfunction in rats depending on the daily exposure dose.
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Affiliation(s)
- João Paulo Miguel
- Medical School, University of Ribeirão Preto, Ribeirão Preto, SP, Brazil
| | | | | | | | | | - Lucas Vaz de Castro Oliveira
- Department of Biophysics and Physiology, Postgraduate Program in Pharmaceutical Sciences, Federal University of Piaui, Teresina, PI, Brazil
| | - Fernanda Monedeiro
- Department of Chemistry, Physiology and Basic Pathology, University of São Paulo, Ribeirão Preto, SP, Brazil
| | | | - Luiz Guilherme S Branco
- Department of Morphology, Physiology and Basic Pathology, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - João Paulo Jacob Sabino
- Department of Biophysics and Physiology, Postgraduate Program in Pharmaceutical Sciences, Federal University of Piaui, Teresina, PI, Brazil
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19
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Effects of Buddhist walking meditation on exercise capacity and quality of life of patients with chronic heart failure: A randomized controlled trial. Heart Lung 2021; 50:363-368. [PMID: 33618146 DOI: 10.1016/j.hrtlng.2021.02.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 02/03/2021] [Accepted: 02/04/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND Buddhist walking meditation (BWM) is widely practiced in many countries. However, there is a lack of evidence relating to its effectiveness for patients with heart failure (HF). PURPOSE To determine the effects of a six-week BWM program on exercise capacity, quality of life, and hemodynamic response in patients with chronic HF. METHODS Patients with HF were randomly assigned to a BWM program or an aerobic exercise program. Each group trained at least three times a week during the six-week study period. The outcome measures included exercise capacity (six-minute walk test), disease-specific quality of life (Minnesota Living with Heart Failure Questionnaire), and hemodynamic response (blood pressure and heart rate) immediately after the six weeks of training. RESULTS The study enrolled 48 patients with a mean age of 65 years and a New York Heart Association functional class of II and III. At baseline, there were no significant differences in their clinical and demographic characteristics or the outcome measures. Although six patients withdrew, all participants were included in the intention-to-treat analysis. There was no statistically significant increase in the functional capacity of the BWM group; however, there was a significant improvement for the aerobic group. With both groups, there was no significant improvement in quality of life or most hemodynamic responses. CONCLUSIONS The six-week BWM program did not improve the functional capacity, quality of life, or hemodynamic characteristics of the HF patients, compared with the values of the patients in the aerobic exercise program.
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20
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Weng HY, Feldman JL, Leggio L, Napadow V, Park J, Price CJ. Interventions and Manipulations of Interoception. Trends Neurosci 2021; 44:52-62. [PMID: 33378657 PMCID: PMC7805576 DOI: 10.1016/j.tins.2020.09.010] [Citation(s) in RCA: 65] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 08/22/2020] [Accepted: 09/27/2020] [Indexed: 12/15/2022]
Abstract
Interoceptive pathways may be manipulated at various levels to develop interventions to improve symptoms in a range of disorders. Primarily through the lens of the respiratory system, we outline various pathways that can be manipulated at neural, behavioral, and psychological levels to change the representation of and attention to interoceptive signals, which can alter interconnected physiological systems and improve functioning and adaptive behavior. Interventions can alter interoception via neuromodulation of the vagus nerve, slow breathing to change respiratory rate and depth, or awareness processes such as mindfulness-based interventions. Aspects of this framework may be applied to other physiological systems and future research may integrate interventions across multiple levels of manipulation or bodily systems.
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Affiliation(s)
- Helen Y Weng
- Osher Center for Integrative Medicine, University of California, San Francisco, San Francisco, CA, USA; Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, USA.
| | - Jack L Feldman
- Department of Neurobiology, David Geffen School of Medicine, Center for Health Sciences, University of California at Los Angeles, Los Angeles, CA, USA
| | - Lorenzo Leggio
- Clinical Psychoneuroendocrinology and Neuropsychopharmacology Section, Translational Addiction Medicine Branch, National Institute on Drug Abuse Intramural Research Program and National Institute on Alcohol Abuse and Alcoholism Division of Intramural Clinical and Biological Research, National Institutes of Health, Baltimore and Bethesda, MD, USA; Medication Development Program, National Institute on Drug Abuse Intramural Research Program, National Institutes of Health, Baltimore, MD, USA; Center for Alcohol and Addiction Studies, Department of Behavioral and Social Sciences, Brown University, Providence, RI, USA
| | - Vitaly Napadow
- Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA, USA; Department of Anesthesiology, Brigham and Women's Hospital, Boston, MA, USA
| | - Jeanie Park
- Renal Division, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA; Research Service Line, Department of Veterans Affairs Medical Center, Decatur, GA, USA
| | - Cynthia J Price
- School of Nursing, University of Washington, Seattle, WA, USA; Osher Center for Integrative Medicine, University of Washington, Seattle, WA, USA
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21
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Bachler M, Sehnert W, Mikisek I, Wassertheurer S, Mengden T. Non-invasive quantification of the effect of device-guided slow breathing with direct feedback to the patient to reduce blood pressure. Physiol Meas 2020; 41:104002. [PMID: 33164912 DOI: 10.1088/1361-6579/abb320] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Slow breathing is a relaxation exercise recommended for lowering blood pressure (BP). Biofeedback may improve patient adherence and enhance BP lowering effects. Since the pulse arrival time (PAT) is inversely proportional to BP, it can be used to estimate BP changes. APPROACH In this pilot study, 30 patients (age 62.9 (SD 7.7) years, 11 F/19 M, Sys. BP 133.0 (SD 17.1) mmHg, Dia. BP 83.8 (SD 10.6) mmHg) performed a device-guided slow breathing exercise. PAT was measured by ECG and plethysmography and immediately presented to the patient, and respiratory sinus arrhythmia (RSA) was calculated retrospectively to measure the adherence to the instructed respiratory rate. MAIN RESULTS Respiratory rate was 13.6 (SD 1.9) bpm at baseline and 5.4 (SD 1.0) bpm during guided breathing. PAT continuously and progressively increased from 231.5 (SD 20.3) to 237.3 (SD 18.5) ms (p [Formula: see text] 0.001). The median deviation of RSA from the guided respiratory rate was 0.06 (IQR 0.19) bpm. In three patients, a deviation of > 0.20 bpm was detected, and two of them showed no increase in PAT. In total, 25 patients responded with increase in PAT. SIGNIFICANCE In this pilot study we have shown that biofeedback of PAT and RSA are feasible and can further improve motivation and adherence. Furthermore, we have shown that the exercise increased PAT, which indicates a reduction in BP. Due to its ease of use, this method is ideal for home use and self-monitoring.
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Affiliation(s)
- Martin Bachler
- AIT Austrian Institute of Technology, Center for Health & Bioresources, Vienna, Austria
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22
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Larson M, Chantigian DP, Asirvatham-Jeyaraj N, Van de Winckel A, Keller-Ross ML. Slow-Paced Breathing and Autonomic Function in People Post-stroke. Front Physiol 2020; 11:573325. [PMID: 33192570 PMCID: PMC7662434 DOI: 10.3389/fphys.2020.573325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 09/28/2020] [Indexed: 11/14/2022] Open
Abstract
Purpose: To determine if acute slow breathing at 6 breaths/min would improve baroreflex sensitivity (BRS) and heart rate variability (HRV), and lower blood pressure (BP) in adults after stroke. Methods: Twelve individuals completed two randomized study visits where they performed a 15-min bout of breathing exercises at 6 breaths/min (slow) and at 12 breaths/min (control). Continuous BP and heart rate (HR) were measured throughout, and BRS, BRS response to elevations in blood pressure (BRSup), BRS response to depressions in blood pressure (BRSdown), and HRV were calculated and analyzed before (pre), during, and after (post) breathing exercises. Results: BRS increased from pre to post slow breathing by 10% (p = 0.012), whereas BRSup increased from pre to during slow breathing by 30% (p = 0.04). BRSdown increased from pre to post breathing for both breathing conditions (p < 0.05). HR (control: Δ - 4 ± 4; slow: Δ - 3 ± 4 beats/min, time, p < 0.01) and systolic BP (control: Δ - 0.5 ± 5; slow: Δ - 6.3 ± 8 mmHg, time, p < 0.01) decreased after both breathing conditions. Total power, low frequency power, and standard deviation of normal inter-beat intervals (SDNN) increased during the 6-breaths/min condition (condition × time, p < 0.001), whereas high frequency increased during both breathing conditions (time effect, p = 0.009). Conclusions: This study demonstrated that in people post-stroke, slow breathing may increase BRS, particularly BRSup, more than a typical breathing space; however, paced breathing at either a slow or typical breathing rate appears to be beneficial for acutely decreasing systolic BP and HR and increasing HRV.
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Affiliation(s)
- Mia Larson
- Division of Rehabilitation Science, Department of Rehabilitation Medicine, Medical School, University of Minnesota, Minneapolis, MN, United States
| | - Daniel P. Chantigian
- Division of Rehabilitation Science, Department of Rehabilitation Medicine, Medical School, University of Minnesota, Minneapolis, MN, United States
| | - Ninitha Asirvatham-Jeyaraj
- Indian Institute of Science, Bangalore, India
- Division of Physical Therapy, Department of Rehabilitation Medicine, Medical School, University of Minnesota, Minneapolis, MN, United States
| | - Ann Van de Winckel
- Division of Rehabilitation Science, Department of Rehabilitation Medicine, Medical School, University of Minnesota, Minneapolis, MN, United States
- Division of Physical Therapy, Department of Rehabilitation Medicine, Medical School, University of Minnesota, Minneapolis, MN, United States
| | - Manda L. Keller-Ross
- Division of Rehabilitation Science, Department of Rehabilitation Medicine, Medical School, University of Minnesota, Minneapolis, MN, United States
- Division of Physical Therapy, Department of Rehabilitation Medicine, Medical School, University of Minnesota, Minneapolis, MN, United States
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23
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Gholamrezaei A, Van Diest I, Aziz Q, Vlaeyen JWS, Van Oudenhove L. Psychophysiological responses to various slow, deep breathing techniques. Psychophysiology 2020; 58:e13712. [PMID: 33111377 DOI: 10.1111/psyp.13712] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 10/03/2020] [Accepted: 10/04/2020] [Indexed: 02/02/2023]
Abstract
Deep breathing exercises are commonly used for several health conditions including pain and hypertension. Various techniques are available to practice deep breathing, whereas possible differential psychophysiological effects have not been investigated. We compared four deep breathing techniques and examined outcomes in blood pressure variability, respiratory sinus arrhythmia, baroreflex function, and emotional state. Healthy adult volunteers performed pursed-lips breathing, left and right unilateral nostril breathing, and deep breathing with an inspiratory threshold load (loaded breathing), all at a frequency of 0.1 Hz (i.e., controlled breathing) and for three minutes each. Results showed that blood pressure variability was higher during loaded breathing versus other conditions and higher during pursed-lips breathing versus left and right unilateral nostril breathing. Respiratory sinus arrhythmia was higher during loaded breathing versus other conditions and higher during pursed-lips breathing versus left unilateral nostril breathing. The effect of breathing condition on respiratory sinus arrhythmia was mediated by alterations in blood pressure variability. There was no difference between the breathing conditions in baroreflex sensitivity or effectiveness. Participants rated pursed-lips breathing as more calming and pleasant and with more sense of control (vs. other conditions). Overall, among the four tested deep breathing techniques, loaded breathing was associated with enhanced cardiovascular effects and pursed-lips breathing with better emotional responses, while also enhancing cardiovascular effects (albeit less than loaded breathing). These findings can be informative in applying deep breathing techniques as self-management interventions for health conditions, in which baroreceptors stimulation and autonomic and emotional modulations can be beneficial, such as pain and hypertension.
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Affiliation(s)
- Ali Gholamrezaei
- Research Group Health Psychology, Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium.,Laboratory for Brain-Gut Axis Studies, Translational Research Center for Gastrointestinal Disorders, Department of Chronic Diseases, Metabolism and Ageing, KU Leuven, Leuven, Belgium
| | - Ilse Van Diest
- Research Group Health Psychology, Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium
| | - Qasim Aziz
- Centre for Neuroscience, Surgery and Trauma, Blizard Institute, Wingate Institute of Neurogastroeneterology, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Johan W S Vlaeyen
- Research Group Health Psychology, Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium.,Experimental Health Psychology, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Lukas Van Oudenhove
- Laboratory for Brain-Gut Axis Studies, Translational Research Center for Gastrointestinal Disorders, Department of Chronic Diseases, Metabolism and Ageing, KU Leuven, Leuven, Belgium
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24
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Petersen CL, Görges M, Todorova E, West NC, Newlove T, Ansermino JM. Feasibility of Using a Single Heart Rate-Based Measure for Real-time Feedback in a Voluntary Deep Breathing App for Children: Data Collection and Algorithm Development. JMIR Perioper Med 2020; 3:e16639. [PMID: 33393917 PMCID: PMC7709837 DOI: 10.2196/16639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 03/04/2020] [Accepted: 08/13/2020] [Indexed: 11/26/2022] Open
Abstract
Background Deep diaphragmatic breathing, also called belly breathing, is a popular behavioral intervention that helps children cope with anxiety, stress, and their experience of pain. Combining physiological monitoring with accessible mobile technology can motivate children to comply with this intervention through biofeedback and gaming. These innovative technologies have the potential to improve patient experience and compliance with strategies that reduce anxiety, change the experience of pain, and enhance self-regulation during distressing medical procedures. Objective The aim of this paper was to describe a simple biofeedback method for quantifying breathing compliance in a mobile smartphone app. Methods A smartphone app was developed that combined pulse oximetry with an animated protocol for paced deep breathing. We collected photoplethysmogram data during spontaneous and subsequently paced deep breathing in children. Two measures, synchronized respiratory sinus arrhythmia (RSAsync) and the corresponding relative synchronized inspiration/expiration heart rate ratio (HR-I:Esync), were extracted from the photoplethysmogram. Results Data collected from 80 children aged 5-17 years showed a positive RSAsync effect in all participants during paced deep breathing, with a median (IQR; range) HR-I:Esync ratio of 1.26 (1.16-1.35; 1.01-1.60) during paced deep breathing compared to 0.98 (0.96-1.02; 0.82-1.18) during spontaneous breathing (median difference 0.25, 95% CI 0.23-0.30; P<.001). The measured HR-I:Esync values appeared to be independent of age. Conclusions An HR-I:Esync level of 1.1 was identified as an age-independent threshold for programming the breathing pattern for optimal compliance in biofeedback.
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Affiliation(s)
- Christian L Petersen
- Department of Anesthesiology, Pharmacology & Therapeutics, The University of British Columbia, Vancouver, BC, Canada
| | - Matthias Görges
- Department of Anesthesiology, Pharmacology & Therapeutics, The University of British Columbia, Vancouver, BC, Canada.,Research Institute, BC Children's Hospital, Vancouver, BC, Canada
| | - Evgenia Todorova
- Department of Psychology, The University of British Columbia, Vancouver, BC, Canada.,Department of Psychology, BC Children's Hospital, Vancouver, BC, Canada
| | - Nicholas C West
- Department of Anesthesiology, Pharmacology & Therapeutics, The University of British Columbia, Vancouver, BC, Canada
| | - Theresa Newlove
- Department of Psychology, The University of British Columbia, Vancouver, BC, Canada.,Department of Psychology, BC Children's Hospital, Vancouver, BC, Canada
| | - J Mark Ansermino
- Department of Anesthesiology, Pharmacology & Therapeutics, The University of British Columbia, Vancouver, BC, Canada.,Research Institute, BC Children's Hospital, Vancouver, BC, Canada
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25
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Hasuo H, Kanbara K, Shizuma H, Morita Y, Fukunaga M. Short-term efficacy of home-based heart rate variability biofeedback on sleep disturbance in patients with incurable cancer: a randomised open-label study. BMJ Support Palliat Care 2020; 13:190-198. [PMID: 32958502 DOI: 10.1136/bmjspcare-2020-002324] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 07/01/2020] [Accepted: 08/03/2020] [Indexed: 11/04/2022]
Abstract
OBJECTIVES Early palliative care reportedly contributes to the quality of life by improving coping skills in patients with cancer. The aims of the study are to (1) Build a self-coping system that makes it possible to perform a session of home-based heart rate variability biofeedback (HRV-BF) with resonant breathing in patients with sleep disturbance and to acquire its techniques early on, and (2) Examine its short-term efficacy and feasibility. METHODS A randomised, open-label, comparative study was conducted in the presence or absence of home-based HRV-BF with resonant breathing using a portable HRV-BF device prior to bedtime. The participants were 50 patients with incurable cancer with sleep disturbance who underwent a hospital practice of HRV-BF with resonant breathing. The primary end point was the rate of change in sleep efficiency for 10-14 days. The Japanese version of the Pittsburgh Sleep Quality Index (subjective indicator) and actigraphy sleep parameters (objective indicators) were used for sleep assessments. RESULTS The completion rate and implementation rate in the home-based HRV-BF group (n=25) were 96.0% and 91.4%, respectively. This group showed a significant improvement in sleep efficiency, sleep duration and the low-frequency component of HRV. Sleep latency worsened in this group, but a significant difference was not observed. CONCLUSIONS A home practice of HRV-BF with resonant breathing made it possible to acquire its techniques early on and improve sleep and autonomic function; therefore, our study showed high short-term efficacy and feasibility required for a self-coping system.
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Affiliation(s)
- Hideaki Hasuo
- Psychosomatic Medicine, Kansai Medical University, Hirakata, Osaka, Japan
| | - Kenji Kanbara
- Psychosomatic Medicine, Kansai Medical University, Hirakata, Osaka, Japan
| | - Hisaharu Shizuma
- Psychosomatic Medicine, Kansai Medical University, Hirakata, Osaka, Japan
| | - Yukihiro Morita
- Psychosomatic Medicine, Kansai Medical University, Hirakata, Osaka, Japan
| | - Mikihiko Fukunaga
- Psychosomatic Medicine, Kansai Medical University, Hirakata, Osaka, Japan
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Tanriverdi A, Kahraman BO, Ozsoy I, Ozpelit E, Savci S. Acute effects of inspiratory muscle training at different intensities in healthy young people. Ir J Med Sci 2020; 190:577-585. [PMID: 32851483 DOI: 10.1007/s11845-020-02353-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 08/22/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Understanding the acute effects of inspiratory muscle training (IMT) at different intensities on the autonomic nervous system, arterial stiffness, and blood pressure in healthy young people will be important in the constitution of appropriate IMT prescriptions. AIMS To investigate the acute effects of IMT at different intensities on autonomic function, arterial stiffness, and blood pressure in healthy young people METHODS: Thirty-six healthy participants were enrolled in this crossover study. All participants randomly performed IMT sessions, which consisted of diaphragmatic breathing exercise (DBE), 10%, 30%, and 60% of maximal inspiratory pressure (MIP) on consecutive days. Autonomic function and arterial stiffness were assessed by measuring heart rate variability (HRV) and aortic pulse wave velocity (AoPWV), respectively. HRV, AoPWV, and blood pressure were recorded before and immediately after each IMT session. RESULTS There was no significant difference in the baseline measurements between IMT sessions (p > 0.05). Heart rate (HR) significantly decreased after DBE and IMT at 10% of MIP (p < 0.05). All time domain parameters of HRV significantly improved after DBE compared with the baseline (p < 0.05). There was no difference in the frequency domain of HRV after the IMT sessions (p > 0.05). AoPWV significantly increased after IMT at 60% of MIP (p < 0.05). Mean arterial pressure significantly changed after DBE and IMT at 60% of MIP (p < 0.05). CONCLUSIONS A single session of DBE positively affects autonomic function and blood pressure, while IMT at 60% of MIP increases arterial stiffness. The different intensities of IMT have various impacts on autonomic function, arterial stiffness, and blood pressure. TRIAL REGISTRATION NCT03788356.
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Affiliation(s)
- Aylin Tanriverdi
- Graduate School of Health Sciences, Dokuz Eylül University, Izmir, Turkey. .,School of Physical Therapy and Rehabilitation, Dokuz Eylül University, Izmir, Turkey.
| | - Buse Ozcan Kahraman
- School of Physical Therapy and Rehabilitation, Dokuz Eylül University, Izmir, Turkey
| | - Ismail Ozsoy
- School of Physical Therapy and Rehabilitation, Selcuk University, Konya, Turkey
| | - Ebru Ozpelit
- Department of Cardiology, Faculty of Medicine, Dokuz Eylül University, Izmir, Turkey
| | - Sema Savci
- School of Physical Therapy and Rehabilitation, Dokuz Eylül University, Izmir, Turkey
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The Effectiveness of Combat Tactical Breathing as Compared with Prolonged Exhalation. Appl Psychophysiol Biofeedback 2020; 46:19-28. [PMID: 32757097 DOI: 10.1007/s10484-020-09485-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Tactical breathing (TB) is used by military and law enforcement personnel to reduce stress and maintain psychomotor and cognitive performance in dangerous situations (Grossman and Christensen, in On combat: the psychology and physiology of deadly conflict in war and in peace, PPCT Research Publications, Belleville, 2008). So far, empirical evidence on the effectiveness of TB is limited and there are breathing techniques that are easier to learn and to apply. This study compared the effectiveness of tactical breathing and prolonged exhalation (ProlEx) under laboratory conditions. Thirty healthy participants performed a Stroop interference task under time pressure and noise distraction. Time pressure was induced with short inter-trial intervals of 350 ms and short trial durations of 1500 ms. Acoustic distraction was realised with white noise with intensity increasing from 77 to 89 dB SPL over the course of an experimental block. In a counterbalanced repeated-measures design, participants used either TB or ProlEx to reduce the induced psychological and physiological arousal. Stress reactions were assessed on the subjective level (Steyer et al., in Multidimensional mood questionnaire (MDMQ), Hogrefe, Göttingen, 1997) and on the physiological level (heart rate, heart rate variability, electrodermal activity). Results showed no significant differences between breathing techniques on the subjective level. While participants showed a lower physiological arousal in the TB condition, better performance was achieved in the ProlEx condition. Results indicate that TB may be superior in passive coping conditions, while ProlEx is more effective when active coping is required.
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Courtois I, Gholamrezaei A, Jafari H, Lautenbacher S, Van Diest I, Van Oudenhove L, Vlaeyen JW. Respiratory Hypoalgesia? The Effect of Slow Deep Breathing on Electrocutaneous, Thermal, and Mechanical Pain. THE JOURNAL OF PAIN 2020; 21:616-632. [DOI: 10.1016/j.jpain.2019.10.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Revised: 08/23/2019] [Accepted: 10/17/2019] [Indexed: 02/06/2023]
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Yuenyongchaiwat K, Thanawattano C, Buranapuntalug S, Pongpanit K, Saengkrut P. Development and application of a respiratory device on blood pressure in adults with high blood pressure. Interv Med Appl Sci 2020; 11:21-26. [PMID: 32148900 PMCID: PMC7044573 DOI: 10.1556/1646.10.2018.34] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Purpose The purpose of this study is to develop a prototype of a novel respiratory device that we validated and assessed clinically and examined the effect of prototype of respiratory device on blood pressure (BP). Methods Prototype of respiratory device (TU-Breath Training) was designed with pressure cuff and application software was created. The immediate effect of resisted breathing was determined in 20 adults with high BP (systolic BP ≥ 130 mmHg and diastolic BP ≥ 90 mmHg). A crossover study was designed. A total of 20 eligible participants were asked to sit quietly for 10 min. Heart rate (HR), BP, and oxygen saturation (SpO2) were measured and recorded. After the resting period, all participants were randomized and counterbalanced for undergoing the set of inspiratory muscle training by TU-Breath Training and control group. A set of respiratory training were composed of 10 times per set for three sets, while the control group was asked to sit for 10 min. Results After inspiratory training, both the systolic and diastolic BP decreased significantly. Compared with control group, using TU-Breath Training decreased systolic BP (−7.00 ± 5.93 mmHg) and diastolic BP (−5.95 ± 8.88 mmHg), but did not show differences in HR and SpO2. Conclusion The study indicated that in high-BP participants, the prototype of respiratory device (TU-Breath Training) elicits decreased BP.
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Affiliation(s)
- Kornanong Yuenyongchaiwat
- Faculty of Allied Health Sciences, Department of Physiotherapy, Thammasat University, Pathum Thani, Thailand
| | - Chusak Thanawattano
- Department of Biomedical Signal Processing Lab, National Electronics and Computer Technology Center (NECTEC), Pathum Thani, Thailand
| | - Sasipa Buranapuntalug
- Faculty of Allied Health Sciences, Department of Physiotherapy, Thammasat University, Pathum Thani, Thailand
| | - Khajonsak Pongpanit
- Faculty of Allied Health Sciences, Department of Physiotherapy, Thammasat University, Pathum Thani, Thailand
| | - Patcharin Saengkrut
- Faculty of Allied Health Sciences, Department of Physiotherapy, Thammasat University, Pathum Thani, Thailand
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Hasuo H, Kanbara K, Fukunaga M. Effect of Heart Rate Variability Biofeedback Sessions With Resonant Frequency Breathing on Sleep: A Pilot Study Among Family Caregivers of Patients With Cancer. Front Med (Lausanne) 2020; 7:61. [PMID: 32158764 PMCID: PMC7052296 DOI: 10.3389/fmed.2020.00061] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Accepted: 02/11/2020] [Indexed: 11/28/2022] Open
Abstract
Heart rate variability biofeedback (HRV-BF) is used as a skill in psychosomatic medicine, but is not yet established in the field of sleep. The present study aimed to evaluate the effect of HRV-BF with resonant frequency breathing (RFB) on sleep performed once every 2 weeks and the usefulness of practice of RFB using a portable device at home before bedtime. Participants were 69 family caregivers of patients with cancer that felt burdened by nursing care. We conducted a randomized controlled trial with an HRV-BF+Home practice group and an HRV-BF group. HRV-BF with RFB was administered to both groups at our medical institution for up to 30 min on the experiment days. Home practice involved RFB using a portable device, which was performed at home each day within 20 min before bedtime. Evaluation items were: change ratio of total score of the Pittsburgh Sleep Quality Index (PSQI) at 28 days after the trial started. In total, 52.2% of participants had insomnia. The two HRV-BF groups had decreased PSQI total scores, which indicated an improvement in PSQI total score near 5.5 on Day 28. The two HRV-BF groups had significantly increased HRV scores on Day 28, and there was correlation between the variation of PSQI total score and the variation of HRV score. The quality of sleep assessed by PSQI scores in the HRV-BF+Home practice group was significantly improved compared with the HRV-BF group on Day 28 (p = 0.001). This suggests HRV-BF may be a useful skill for enhancing sleep among family caregivers of patients with cancer, as well as supporting their autonomic nervous function. Additional actual regular practice of RFB (using a portable device at home before bedtime) may further enhance the effect.
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Affiliation(s)
- Hideaki Hasuo
- Department of Psychosomatic Medicine, Kansai Medical University, Osaka, Japan
| | - Kenji Kanbara
- Department of Psychosomatic Medicine, Kansai Medical University, Osaka, Japan
| | - Mikihiko Fukunaga
- Department of Psychosomatic Medicine, Kansai Medical University, Osaka, Japan
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Hasler ED, Saxer S, Schneider SR, Furian M, Lichtblau M, Schwarz EI, Bloch KE, Ulrich S. Effect of Breathing Oxygen-Enriched Air on Exercise Performance in Patients with Chronic Obstructive Pulmonary Disease: Randomized, Placebo-Controlled, Cross-Over Trial. Respiration 2020; 99:213-224. [PMID: 32050198 DOI: 10.1159/000505819] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 01/06/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Patients with chronic obstructive pulmonary disease (COPD) experience dyspnea and hypoxemia during exercise. OBJECTIVE The aim of this study was to evaluate the effects of breathing oxygen-enriched air on exercise performance and associated physiological changes in patients with COPD. METHODS In a randomized, placebo-controlled, single-blind, cross-over trial, 20 patients with COPD (11 women, age 65 ± 6 years, FEV1 64 ± 19% pred., resting SpO2 ≥90%) performed 4 cycle ergospirometries to exhaustion using an incremental exercise test (IET) and a constant work rate (at 75% maximal workload with air) exercise test (CWRET), each with ambient (FiO2 0.21) and oxygen-enriched (FiO2 0.5) air. The main outcomes were the change in maximal workload in the IET and the change in exercise duration in the CWRET with oxygen versus air. Electrocardiogram, pulmonary gas exchange, thoracic volumes by inductance plethysmography, arterial blood gases, and cerebral and quadriceps muscle tissue oxygenation (CTO and MTO) were additionally measured. RESULTS In the IET, maximal workload increased from 96 ± 21 to 104 ± 28 W with oxygen. In the CWRET, exercise duration increased from 605 ± 274 to 963 ± 444 s with oxygen. At end-exercise with oxygen, CTO, MTO, PaO2, and PaCO2 were increased, while V'E/V'CO2 was reduced and thoracic volumes were similar. At the corresponding time to end of exercise with ambient air, oxygen decreased heart rate, respiratory rate, minute ventilation, and V'E/V'CO2, while oxygenation was increased. CONCLUSION In COPD patients without resting hypoxemia, breathing oxygen-enriched air improves exercise performance. This relates to a higher arterial oxygen saturation promoting oxygen availability to muscle and cerebral tissue and an enhanced ventilatory efficiency. COPD patients may benefit from oxygen therapy during exercise training.
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Affiliation(s)
| | - Stéphanie Saxer
- Pulmonary Clinic, University Hospital Zurich, Zurich, Switzerland
| | | | - Michael Furian
- Pulmonary Clinic, University Hospital Zurich, Zurich, Switzerland
| | - Mona Lichtblau
- Pulmonary Clinic, University Hospital Zurich, Zurich, Switzerland
| | | | - Konrad E Bloch
- Pulmonary Clinic, University Hospital Zurich and Centre for Integrative Human Physiology, University of Zurich, Zurich, Switzerland
| | - Silvia Ulrich
- Pulmonary Clinic, University Hospital Zurich and Centre for Integrative Human Physiology, University of Zurich, Zurich, Switzerland,
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Takeda K, Iwai M, Tanabe S, Koyama S, Hamauzu Y, Kumazawa N, Sakurai H, Kanada Y. The effects of combined static and dynamic stretching of anti-gravitational muscles on body flexibility and standing balance: A preliminary study of healthy young participants. J Bodyw Mov Ther 2020; 24:221-227. [PMID: 31987548 DOI: 10.1016/j.jbmt.2019.05.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Accepted: 05/09/2019] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Falling is a leading cause of injury-related death. Previous studies reported that an impairment of standing balance is one of the causative factors associated with falling. The combined use of static and dynamic stretching has been reported as a treatment method for improving standing balance. As one of the combined methods, stretching based on Mézières' concept, which has an efficacy on the improvement of body flexibility, has been used. However, it is not fully clear whether stretching based on Mézières' concept can improve standing balance. This study aimed to examine the effects of combined method of static and dynamic stretching of anti-gravitational muscles based on Mézières' concept on body flexibility and standing balance. METHODS This study employed a quasi-randomized controlled trial design. Thirteen subjects were assigned randomly to one of two groups: stretching or control. A sit and reach test (SRT), functional reach test (FRT), and total trajectory length of center of pressure (COP) during static standing were assessed at pre- and post-intervention. An independent t-test was used to compare the rate of improvement between both groups at each assessment. RESULTS The stretching group demonstrated a significantly larger rate of improvement in the total trajectory length of COP compared to the control group. In the SRT and FRT, the stretching group showed a trend toward improvement compared to the control group, but did not achieve statistical significance. CONCLUSIONS The combined use of static and dynamic stretching of anti-gravitational muscles might have the potential to improve the standing balance.
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Affiliation(s)
- Kazuya Takeda
- Department of Rehabilitation, Kawamura Hospital, Gifu, Japan
| | - Masanobu Iwai
- Department of Rehabilitation, Kawamura Hospital, Gifu, Japan; Graduate School of Health Sciences, Fujita Health University, Toyoake, Japan
| | - Shigeo Tanabe
- Faculty of Rehabilitation, School of Health Sciences, Fujita Health University, Toyoake, Japan.
| | - Soichiro Koyama
- Faculty of Rehabilitation, School of Health Sciences, Fujita Health University, Toyoake, Japan
| | - Yui Hamauzu
- Graduate School of Health Sciences, Fujita Health University, Toyoake, Japan
| | - Nobuhiro Kumazawa
- Faculty of Rehabilitation, School of Health Sciences, Fujita Health University, Toyoake, Japan
| | - Hiroaki Sakurai
- Faculty of Rehabilitation, School of Health Sciences, Fujita Health University, Toyoake, Japan
| | - Yoshikiyo Kanada
- Faculty of Rehabilitation, School of Health Sciences, Fujita Health University, Toyoake, Japan
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Noble DJ, Hochman S. Hypothesis: Pulmonary Afferent Activity Patterns During Slow, Deep Breathing Contribute to the Neural Induction of Physiological Relaxation. Front Physiol 2019; 10:1176. [PMID: 31572221 PMCID: PMC6753868 DOI: 10.3389/fphys.2019.01176] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Accepted: 08/30/2019] [Indexed: 12/26/2022] Open
Abstract
Control of respiration provides a powerful voluntary portal to entrain and modulate central autonomic networks. Slowing and deepening breathing as a relaxation technique has shown promise in a variety of cardiorespiratory and stress-related disorders, but few studies have investigated the physiological mechanisms conferring its benefits. Recent evidence suggests that breathing at a frequency near 0.1 Hz (6 breaths per minute) promotes behavioral relaxation and baroreflex resonance effects that maximize heart rate variability. Breathing around this frequency appears to elicit resonant and coherent features in neuro-mechanical interactions that optimize physiological function. Here we explore the neurophysiology of slow, deep breathing and propose that coincident features of respiratory and baroreceptor afferent activity cycling at 0.1 Hz entrain central autonomic networks. An important role is assigned to the preferential recruitment of slowly-adapting pulmonary afferents (SARs) during prolonged inhalations. These afferents project to discrete areas in the brainstem within the nucleus of the solitary tract (NTS) and initiate inhibitory actions on downstream targets. Conversely, deep exhalations terminate SAR activity and activate arterial baroreceptors via increases in blood pressure to stimulate, through NTS projections, parasympathetic outflow to the heart. Reciprocal SAR and baroreceptor afferent-evoked actions combine to enhance sympathetic activity during inhalation and parasympathetic activity during exhalation, respectively. This leads to pronounced heart rate variability in phase with the respiratory cycle (respiratory sinus arrhythmia) and improved ventilation-perfusion matching. NTS relay neurons project extensively to areas of the central autonomic network to encode important features of the breathing pattern that may modulate anxiety, arousal, and attention. In our model, pronounced respiratory rhythms during slow, deep breathing also support expression of slow cortical rhythms to induce a functional state of alert relaxation, and, via nasal respiration-based actions on olfactory signaling, recruit hippocampal pathways to boost memory consolidation. Collectively, we assert that the neurophysiological processes recruited during slow, deep breathing enhance the cognitive and behavioral therapeutic outcomes obtained through various mind-body practices. Future studies are required to better understand the physio-behavioral processes involved, including in animal models that control for confounding factors such as expectancy biases.
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Affiliation(s)
- Donald J Noble
- Department of Physiology, Emory University School of Medicine, Atlanta, GA, United States
| | - Shawn Hochman
- Department of Physiology, Emory University School of Medicine, Atlanta, GA, United States
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Abstract
Cardiovascular ageing and the atherosclerotic process begin very early in life, most likely in utero. They progress over decades of exposure to suboptimal or abnormal metabolic and hormonal risk factors, eventually culminating in very common, costly, and mostly preventable target-organ pathologies, including coronary heart disease, stroke, heart failure, aortic aneurysm, peripheral artery disease, and vascular dementia. In this Review, we discuss findings from preclinical and clinical studies showing that calorie restriction (CR), intermittent fasting, and adjusted diurnal rhythm of feeding, with adequate intake of specific macronutrients and micronutrients, are powerful interventions not only for the prevention of cardiovascular disease but also for slowing the accumulation of molecular damage leading to cardiometabolic dysfunction. Furthermore, we discuss the mechanisms through which a number of other nondietary interventions, such as regular physical activity, mindfulness-based stress-reduction exercises, and some CR-mimetic drugs that target pro-ageing pathways, can potentiate the beneficial effects of a healthy diet in promoting cardiometabolic health.
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35
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Gholamrezaei A, Van Diest I, Aziz Q, Vlaeyen JWS, Van Oudenhove L. Influence of inspiratory threshold load on cardiovascular responses to controlled breathing at 0.1 Hz. Psychophysiology 2019; 56:e13447. [DOI: 10.1111/psyp.13447] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 06/05/2019] [Accepted: 07/06/2019] [Indexed: 12/21/2022]
Affiliation(s)
- Ali Gholamrezaei
- Laboratory for Brain‐Gut Axis Studies (LaBGAS), Translational Research Center for Gastrointestinal Disorders (TARGID), Department of Chronic Diseases, Metabolism and Ageing University of Leuven Leuven Belgium
- Health Psychology Research Group, Faculty of Psychology and Educational Sciences University of Leuven Leuven Belgium
| | - Ilse Van Diest
- Health Psychology Research Group, Faculty of Psychology and Educational Sciences University of Leuven Leuven Belgium
| | - Qasim Aziz
- Centre for Neuroscience and Trauma Blizard Institute, Wingate Institute of Neurogastroeneterology, Queen Mary University of London London UK
| | - Johan W. S. Vlaeyen
- Health Psychology Research Group, Faculty of Psychology and Educational Sciences University of Leuven Leuven Belgium
| | - Lukas Van Oudenhove
- Laboratory for Brain‐Gut Axis Studies (LaBGAS), Translational Research Center for Gastrointestinal Disorders (TARGID), Department of Chronic Diseases, Metabolism and Ageing University of Leuven Leuven Belgium
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Cramer H, Haller H, Klose P, Ward L, Chung VC, Lauche R. The risks and benefits of yoga for patients with chronic obstructive pulmonary disease: a systematic review and meta-analysis. Clin Rehabil 2019; 33:1847-1862. [PMID: 31353959 DOI: 10.1177/0269215519860551] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
OBJECTIVES To determine the effectiveness and safety of yoga interventions on disease symptoms, quality of life and function in patients diagnosed with chronic obstructive pulmonary disease (COPD). DATA SOURCES Medline/PubMed, Scopus, and CENTRAL (Cochrane Central Register of Controlled Trials) were searched through 6 June 2019. REVIEW METHODS Randomized controlled trials assessing the effects of yoga on quality of life, dyspnea, exercise capacity, and pulmonary function (FEV1) in patients with COPD were included. Safety was defined as secondary outcome. Mean differences (MD) and standardized mean differences (SMD) with 95% confidence intervals (CIs) were computed. Risk of bias was assessed using the Cochrane tool. RESULTS Eleven randomized controlled trials with a total of 586 patients were included. Meta-analysis revealed evidence for effects of yoga compared to no treatment on quality of life on the COPD Assessment Test (MD = 3.81; 95% CI = 0.97 to 6.65; P = 0.009, I2 = 70%), exercise capacity assessed by the 6-minute walk test (MD = 25.53 m; 95% CI = 12.16 m to 38.90 m; P = 0.001, I2 = 0%), and pulmonary function assessed by FEV1 predicted (MD = 3.95%; 95% CI = 2.74% to 5.17%; P < 0.001, I2 = 0%). Only the effects on exercise capacity and pulmonary function were robust against methodological bias. Effects were only present in breathing-focused yoga interventions but not in interventions including yoga postures. Adverse events were reported infrequently. CONCLUSION This meta-analysis found robust effects of yoga on exercise capacity and pulmonary function in patients with COPD. Yoga, specifically yoga breathing techniques, can be an effective adjunct intervention for patients with COPD. Yoga's safety needs to be assessed in more depth in future studies.
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Affiliation(s)
- Holger Cramer
- Department of Internal and Integrative Medicine, Kliniken Essen-Mitte, Faculty of Medicine, University of Duisburg-Essen, Essen, Germany.,Australian Research Centre in Complementary and Integrative Medicine (ARCCIM), Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Heidemarie Haller
- Department of Internal and Integrative Medicine, Kliniken Essen-Mitte, Faculty of Medicine, University of Duisburg-Essen, Essen, Germany
| | - Petra Klose
- Department of Internal and Integrative Medicine, Kliniken Essen-Mitte, Faculty of Medicine, University of Duisburg-Essen, Essen, Germany
| | - Lesley Ward
- Australian Research Centre in Complementary and Integrative Medicine (ARCCIM), Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia.,Centre for Rehabilitation Research in Oxford (RRIO), Nuffield Department of Orthopaedics, Rheumatology & Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, UK
| | - Vincent Ch Chung
- Australian Research Centre in Complementary and Integrative Medicine (ARCCIM), Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia.,Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
| | - Romy Lauche
- Australian Research Centre in Complementary and Integrative Medicine (ARCCIM), Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia.,Department of Internal and Integrative Medicine, Sozialstiftung Bamberg, Bamberg, Germany
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Reid KF, Bannuru RR, Wang C, Mori DL, Niles BL. The Effects of Tai Chi Mind-Body Approach on the Mechanisms of Gulf War Illness: an Umbrella Review. Integr Med Res 2019; 8:167-172. [PMID: 31304089 PMCID: PMC6600798 DOI: 10.1016/j.imr.2019.05.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 05/10/2019] [Accepted: 05/13/2019] [Indexed: 11/09/2022] Open
Abstract
Gulf War illness (GWI) is a chronic and multisymptom disorder affecting military veterans deployed to the 1991 Persian Gulf War. It is characterized by a range of acute and chronic symptoms, including but not limited to, fatigue, sleep disturbances, psychological problems, cognitive deficits, widespread pain, and respiratory and gastrointestinal difficulties. The prevalence of many of these chronic symptoms affecting Gulf War veterans occur at markedly elevated rates compared to nondeployed contemporary veterans. To date, no effective treatments for GWI have been identified. The overarching goal of this umbrella review was to critically evaluate the evidence for the potential of Tai Chi mind-body exercise to benefit and alleviate GWI symptomology. Based on the most prevalent GWI chronic symptoms and case definitions established by the Centers for Disease Control and Prevention and the Kansas Gulf War Veterans Health Initiative Program, we reviewed and summarized the evidence from 7 published systematic reviews and meta-analyses. Our findings suggest that Tai Chi may have the potential for distinct therapeutic benefits on the major prevalent symptoms of GWI. Future clinical trials are warranted to examine the feasibility, efficacy, durability and potential mechanisms of Tai Chi for improving health outcomes and relieving symptomology in GWI.
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Affiliation(s)
- Kieran F Reid
- Nutrition, Exercise Physiology and Sarcopenia Laboratory, Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, Boston, MA, USA
| | - Raveendhara R Bannuru
- Center for Complementary and Integrative Medicine and Division of Rheumatology, Tufts Medical Center, Tufts University School of Medicine, Boston, MA. USA
| | - Chenchen Wang
- Center for Complementary and Integrative Medicine and Division of Rheumatology, Tufts Medical Center, Tufts University School of Medicine, Boston, MA. USA
| | - DeAnna L Mori
- VA Boston Healthcare System and Boston University School of Medicine, Boston, MA, USA
| | - Barbara L Niles
- National Center for PTSD, VA Boston Healthcare System and Boston University School of Medicine, Boston, MA, USA
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Chung YM, Lou SL, Tsai PZ, Wang MC. The Efficacy of Respiratory Regulation on Parasympathetic Nervous System Appraised by Heart Rate Variability. J Med Biol Eng 2019. [DOI: 10.1007/s40846-019-00472-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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39
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Xu SK, Chen Y, Liu CY, Spekowius G, van Ee R, de Jong M, Shen M, Li Y, Wang JG. A randomized cross-over study on the blood pressure lowering effect of the combined passive head-up and -down movement with Device-Guided slow breathing. Blood Press 2019; 28:291-299. [PMID: 31068018 DOI: 10.1080/08037051.2019.1613884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Purpose: Baroreflex emerges as a therapeutic target of hypertension. We investigated blood pressure (BP) lowering effect of the combined passive head-up and -down movement with device-guided slow breathing in untreated mild hypertension or high-normal BP. Methods: In a randomized, cross-over trial, untreated subjects with an ambulatory systolic/diastolic BP of 125-140/80-90 mmHg and a clinic BP of 130-150/80-90 mmHg were randomized to intervention treatment with head movement and slow breathing or sham control, and then crossed over. Both treatments consisted of 1-week preparation, 2-week treatment, and 1-week recovery. During the 2-week treatment, subjects were treated for a session of 20 min/day. BP, pulse rate and respiration were measured before and after each treatment session. Ambulatory BP monitoring was performed at baseline and the end of the 2-week treatments' period, and home BP monitoring in the morning and evening for the whole 8-week follow-up period. Results: 14 subjects completed the study. The intervention treatment, compared to control, reduced respiration rate by -2.1 breaths/min (95% CI -2.9 to -1.2, p = .0001), but not clinic BP and pulse rate (p ≥ .67). The intervention treatment, compared to control, significantly reduced nighttime systolic/diastolic blood pressure by -5.63/-3.82 mm Hg (p ≤ .01) but not 24-h or daytime ambulatory blood pressure (p ≥ .69). Home BP decreased with the intervention treatment, but the between-treatment difference was not statistically significant (p ≥ .27). Conclusions: The combined head movement with slow breathing did not influence 24-h BP, but reduced nighttime BP in untreated mild hypertension or high-normal BP.
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Affiliation(s)
- Shao-Kun Xu
- Centre for Epidemiological Studies and Clinical Trials, Shanghai Key Laboratory of Hypertension, The Shanghai Institute of Hypertension, Department of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine , Shanghai , China
| | - Yi Chen
- Centre for Epidemiological Studies and Clinical Trials, Shanghai Key Laboratory of Hypertension, The Shanghai Institute of Hypertension, Department of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine , Shanghai , China
| | - Chang-Yuan Liu
- Centre for Epidemiological Studies and Clinical Trials, Shanghai Key Laboratory of Hypertension, The Shanghai Institute of Hypertension, Department of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine , Shanghai , China
| | | | | | | | - Meng Shen
- Health Systems, Philips Research China , Shanghai , China
| | - Yan Li
- Centre for Epidemiological Studies and Clinical Trials, Shanghai Key Laboratory of Hypertension, The Shanghai Institute of Hypertension, Department of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine , Shanghai , China
| | - Ji-Guang Wang
- Centre for Epidemiological Studies and Clinical Trials, Shanghai Key Laboratory of Hypertension, The Shanghai Institute of Hypertension, Department of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine , Shanghai , China
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Lin CH, Yen CC, Hsu YT, Chen HH, Cheng PW, Tseng CJ, Lo YK, Chan JYH. Baroreceptor Sensitivity Predicts Functional Outcome and Complications after Acute Ischemic Stroke. J Clin Med 2019; 8:jcm8030300. [PMID: 30832391 PMCID: PMC6462921 DOI: 10.3390/jcm8030300] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 02/26/2019] [Accepted: 02/27/2019] [Indexed: 11/16/2022] Open
Abstract
Autonomic dysfunctions including impaired baroreflex sensitivity (BRS) can develop after acute ischemic stroke (AIS) and may predispose patients to subsequent cardiovascular adverse events and serve as potential indicators of long-term mortality. This study aimed to determine the potential short-term prognostic significance of BRS after AIS. All patients admitted to Kaohsiung Veterans General Hospital within 72 h after onset of first-ever AIS between April 2008 and December 2012 were enrolled. Autonomic evaluation with continuous 10-minute monitoring of beat-to-beat hemodynamic and intracranial parameters was performed within 1 week after stroke by using the Task Force Monitor and transcranial Doppler. The 176 enrolled AIS patients were divided into high-BRS and low-BRS groups. All but two enrolled patients (who died within 3 months after stroke) attended scheduled follow-ups. The high-BRS group had significantly lower National Institutes of Health Stroke Scale (NIHSS) scores at 1 and 2 weeks after stroke and at discharge; lower modified Rankin scale (mRS) scores 1, 3, 6, and 12 months after stroke; and lower rates of complications and stroke recurrence compared to the low-BRS group. This study provides novel evidence of the utility of BRS to independently predict outcomes after AIS. Furthermore, modifying BRS may hold potential in future applications as a novel therapeutic strategy for acute stroke.
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Affiliation(s)
- Ching-Huang Lin
- Department of Biological Sciences, National Sun Yet-Sen University, Kaohsiung 80424, Taiwan.
- Section of Neurology, Kaohsiung Veterans General Hospital, Kaohsiung 81362, Taiwan.
- Department of Physical Therapy, Shu-Zen Junior College of Medicine and Management, Kaohsiung 82144, Taiwan.
| | - Cheng-Chung Yen
- Section of Neurology, Kaohsiung Veterans General Hospital, Kaohsiung 81362, Taiwan.
| | - Yi-Ting Hsu
- Department of Biological Sciences, National Sun Yet-Sen University, Kaohsiung 80424, Taiwan.
- Section of Neurology, Kaohsiung Veterans General Hospital, Kaohsiung 81362, Taiwan.
| | - Hsin-Hung Chen
- Department of Medical Education and Research, Kaohsiung Veterans General Hospital, Kaohsiung 81362, Taiwan.
| | - Pei-Wen Cheng
- Department of Medical Education and Research, Kaohsiung Veterans General Hospital, Kaohsiung 81362, Taiwan.
| | - Ching-Jiunn Tseng
- Department of Medical Education and Research, Kaohsiung Veterans General Hospital, Kaohsiung 81362, Taiwan.
| | - Yuk-Keung Lo
- Section of Neurology, Kaohsiung Veterans General Hospital, Kaohsiung 81362, Taiwan.
| | - Julie Y H Chan
- Department of Biological Sciences, National Sun Yet-Sen University, Kaohsiung 80424, Taiwan.
- Institute for Translational Research in Biomedicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 83301, Taiwan.
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Chan KS, Lai KPL, Chan PF, Luk MHM, Chao VKD. Evaluation of the applicability of deep breathing test in the diagnosis of hypertension with white-coat effect in Chinese patients in primary care. Clin Hypertens 2019; 25:2. [PMID: 30774977 PMCID: PMC6357457 DOI: 10.1186/s40885-018-0106-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Accepted: 12/19/2018] [Indexed: 01/01/2023] Open
Abstract
Purpose The current gold standard for the diagnosis of white-coat effect is by the 24-h ambulatory blood pressure monitoring (ABPM) which may not be readily available in every primary care setting. Previous studies had shown that deep breathing, through modulating the baroreceptor reflex sensitivity to vagal stimulation over 30 to 60 s, was useful in detection of the white-coat effect. The aim of our study was to evaluate the diagnostic accuracy of the deep breathing test (DBT) as compared with the gold standard of ABPM in the diagnosis of hypertension with white-coat effect in Chinese patients in primary care. Methods This cross sectional study recruited 178 consecutive, eligible, consented, hypertensive patients receiving treatment at a local public primary care Hypertension Clinic. The diagnostic accuracy of the DBT in all recruited patients, patients not taking beta-adrenergic blockers and patients with different clinic SBP cut-off before the DBT by means of area under the receiver operating characteristic (ROC) curve, sensitivity, specificity, positive and negative predictive values was evaluated. Results The results for the ROC curves for systolic and diastolic BP changes after the DBT were statistically insignificant. The ROC curve was statistically significant for SBP change in patients not taking beta-adrenergic blockers and with pre-DBT clinic SBP ≥ 165 mmHg (ROC curve area of 0.719, 95% CI 0.53 to 0.91, p = 0.04). The corresponding sensitivity and specificity of the DBT were 40.9 and 90.9% respectively if SBP drop was > 30 mmHg. Conclusion The DBT, even though could not be clinically applied to all patients, was proven to be a potential screening and diagnostic test for white-coat effect in Chinese hypertensive patients with a pre-test SBP of ≥165 mmHg and who were not taking beta-adrenergic blockers. Trial registration This study was approved by Kowloon East Cluster/ Kowloon Central Cluster Research Ethics Committee/Institutional Review Board of Hospital Authority of Hong Kong under the registration KC/KE-16-0084/ER-3.
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Affiliation(s)
- Kam Sum Chan
- Department of Family Medicine and Primary Health Care, United Christian Hospital and Tseung Kwan O Hospital, Kowloon East Cluster, Hospital Authority, Tseung Kwan O, Hong Kong, China
| | - Kit Ping Loretta Lai
- Department of Family Medicine and Primary Health Care, United Christian Hospital and Tseung Kwan O Hospital, Kowloon East Cluster, Hospital Authority, Tseung Kwan O, Hong Kong, China
| | - Pang Fai Chan
- Department of Family Medicine and Primary Health Care, United Christian Hospital and Tseung Kwan O Hospital, Kowloon East Cluster, Hospital Authority, Tseung Kwan O, Hong Kong, China
| | - Man Hei Matthew Luk
- Department of Family Medicine and Primary Health Care, United Christian Hospital and Tseung Kwan O Hospital, Kowloon East Cluster, Hospital Authority, Tseung Kwan O, Hong Kong, China
| | - Vai Kiong David Chao
- Department of Family Medicine and Primary Health Care, United Christian Hospital and Tseung Kwan O Hospital, Kowloon East Cluster, Hospital Authority, Tseung Kwan O, Hong Kong, China
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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: 1.4] [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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Bussotti M, Sommaruga M. Anxiety and depression in patients with pulmonary hypertension: impact and management challenges. Vasc Health Risk Manag 2018; 14:349-360. [PMID: 30510427 PMCID: PMC6231438 DOI: 10.2147/vhrm.s147173] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Background Anxiety and depression are frequent disorders in patients with pulmonary arterial hypertension (PAH), but despite this only less than one-fourth of them is treated. Our aim was to review the studies regarding the prevalence and the impact of anxiety and depression and to propose management challenges. Methods A literature review regarding 1) anxiety and depression studies in PAH patients and caregivers, 2) psychological interventions, 3) slow breathing approach, and 4) pharmacological approach was performed, based on evidence of effectiveness through a search of the most well-known databases (Cochrane Library, Medline, PsychINFO [2004–2018]). Results The prevalence of mental disorders in PAH patients lies between 7.5% and 53% for depression and 19% and 51% for anxiety and panic disorders. The latest guidelines of the European Society of Cardiology recommend a psychological support with a class of recommendation I and a level of evidence c. The analysis of psychological intervention shows that at present there is no evidence of specific psychological interventions in these patients. However, treatment approaches based on other chronic illnesses are suggested, especially based on relaxation training, slow breathing, and cognitive behavioral therapy. Finally, data concerning the use of antidepressant drugs are conflicting. Conclusion Firstly, our data demonstrate a common underestimation of mental disorders by health professionals and secondly, the need of implementing appropriate methods of screening for mental disorders in PAH patients. However, the paucity of large observational studies in this area requires the attention of researchers. The evidence about optimal approaches for managing anxiety and depression in PAH also remains unclear and largely speculative. The challenge is the introduction of routine psychological intervention, as suggested by the European Society of Cardiology and already applied in other chronic disease.
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Affiliation(s)
- Maurizio Bussotti
- Cardiorespiratory Rehabilitation Unit, Istituti Clinici Scientifici Maugeri, IRCCS, Scientific Institute of Milan, Milan, Italy,
| | - Marinella Sommaruga
- Psychology Unit, Istituti Clinici Scientifici Maugeri, IRCCS, Scientific Institute of Milan, Milan, Italy
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Hasuo H, Kanbara K, Sakuma H, Yoshida K, Uchitani K, Fukunaga M. Self-Care System for Family Caregivers of Cancer Patients Using Resonant Breathing with a Portable Home Device: A Randomized Open-Label Study. J Palliat Med 2018; 22:18-24. [PMID: 30183463 DOI: 10.1089/jpm.2018.0230] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Self-care systems for early-stage specialist palliative care for cancer patients and their family caregivers have received much attention recently. Resonant breathing is an established method for maximizing heart rate variability (HRV), but it has not been implemented for home self-care. OBJECTIVE We aimed to examine the usefulness and ease of implementation for family caregivers to administer resonant breathing using a portable device at home. DESIGN We divided caregivers into two groups-a home self-care group and a control group-and we conducted a randomized open-label study, with rate of change in HRV being the primary outcome. SETTING/SUBJECTS We administered HRV biofeedback (HRV-BF) using resonant breathing to 54 family caregivers who felt burdened by their nursing care responsibilities. RESULTS Among the self-care group, 92.6% of participants completed the study in their homes; 28 days after intervention initiation, the resonant breathing implementation rate at home was 86.1%. There was an interaction between time course and grouping in our HRV comparisons: the change rate in the home self-care group was higher during HRV-BF than before HRV-BF. CONCLUSIONS Because family caregivers in our study learned to quickly administer resonant breathing using a portable device at home, resonant breathing improved rapidly, along with autonomic nerve function and quality of life.
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Affiliation(s)
- Hideaki Hasuo
- Department of Psychosomatic Medicine, Kansai Medical University , Osaka, Japan
| | - Kenji Kanbara
- Department of Psychosomatic Medicine, Kansai Medical University , Osaka, Japan
| | - Hiroko Sakuma
- Department of Psychosomatic Medicine, Kansai Medical University , Osaka, Japan
| | - Kohei Yoshida
- Department of Psychosomatic Medicine, Kansai Medical University , Osaka, Japan
| | - Kazuki Uchitani
- Department of Psychosomatic Medicine, Kansai Medical University , Osaka, Japan
| | - Mikihiko Fukunaga
- Department of Psychosomatic Medicine, Kansai Medical University , Osaka, Japan
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Wongwilairat K, Buranruk O, Eungpinichpong W, Puntumetakul R, Kantharadussadee-Triamchaisri S. Muscle stretching with deep and slow breathing patterns: a pilot study for therapeutic development. JOURNAL OF COMPLEMENTARY & INTEGRATIVE MEDICINE 2018; 16:/j/jcim.ahead-of-print/jcim-2017-0167/jcim-2017-0167.xml. [PMID: 30133419 DOI: 10.1515/jcim-2017-0167] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Accepted: 07/09/2018] [Indexed: 12/20/2022]
Abstract
Background Chronic neck pain is frequently found in office workers affecting quality of life; also, stress is one participating factor. Though stretching incorporating deep-slow breathing (DSB) has benefits on health, an effective and suitable technique for office workers to perform in the workplace is a gap in need of fulfilment. Methods We explored the effective pattern of stretching with DSB to reduce neck tension and promote relaxation within the shortest time. Thirty-two female participants with neck tension were allocated into two steps totaling five patterns (n=8 for each pattern). Firstly, they performed two patterns; two other patterns were developed and compared with DSB alone. Muscle tension, pain score, and heart rate variability (HRV) were immediately measured. Results All patterns performed with the eyes closed decreased muscle tension more than those performed with the eyes open; the pain amid all stretching groups subsequently decreased. Only a bout of slow stretching, performed synchronously with the eyes closed along with a period of deep inhalation increased the parasympathetic activity of HRV; an increase in pain was reported after stretching. Conclusions A slowed and synchronized pattern between stretching with DSB and eyes closed period, performed at least four times repeatedly rendered benefits in reducing neck pain and tension, in addition to promoting relaxation within a short period; however, the DSB pattern and the feeling of the stretched muscle to promote relaxation were individual differences. Thus, future studies should come up with apposite training methods adjusted to fit individuals; self-awareness toward these aspects ought to be encouraged.
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Affiliation(s)
- Kulwarang Wongwilairat
- School of Physical Therapy, Faculty of Associated Medical Sciences, Khon Kaen University, Khon Kaen, Thailand.,Research Center in Back, Neck, Other Joint Pain and Human Performance (BNOJPH), Khon Kaen University, Khon Kaen, Thailand
| | - Orawan Buranruk
- School of Physical Therapy, Faculty of Associated Medical Sciences, Khon Kaen University, Khon Kaen, Thailand.,Research Center in Back, Neck, Other Joint Pain and Human Performance (BNOJPH), Khon Kaen University, Khon Kaen, Thailand
| | - Wichai Eungpinichpong
- School of Physical Therapy, Faculty of Associated Medical Sciences, Khon Kaen University, Khon Kaen, Thailand.,Research Center in Back, Neck, Other Joint Pain and Human Performance (BNOJPH), Khon Kaen University, Khon Kaen, Thailand
| | - Rungthip Puntumetakul
- School of Physical Therapy, Faculty of Associated Medical Sciences, Khon Kaen University, Khon Kaen, Thailand.,Research Center in Back, Neck, Other Joint Pain and Human Performance (BNOJPH), Khon Kaen University, Khon Kaen, Thailand
| | - Somporn Kantharadussadee-Triamchaisri
- Department of Occupational Health, Faculty of Public Health, Chalermkanchana University, Si Sa Ket, Thailand.,Research Center in Back, Neck, Other Joint Pain and Human Performance (BNOJPH), Khon Kaen University, Khon Kaen, Thailand
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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: 2.2] [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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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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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: 11] [Impact Index Per Article: 1.8] [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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Bhagat OL, Kharya C, Jaryal A, Deepak KK. Acute effects on cardiovascular oscillations during controlled slow yogic breathing. Indian J Med Res 2018; 145:503-512. [PMID: 28862183 PMCID: PMC5663165 DOI: 10.4103/ijmr.ijmr_830_15] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background & objectives: Breathing exercises are believed to modulate the cardiovascular oscillations in the body. To assess the validity of the assumption and understand the underlying mechanism, the key autonomic regulatory parameters such as heart rate variability (HRV), blood pressure variability (BPV) and baroreflex sensitivity (BRS) were recorded during controlled slow yogic breathing. Alternate nostril breathing (ANB) was selected as the yogic manoeuvre. Methods: Twelve healthy volunteers (age 30±3.8 yr) participated in the study. ANB was performed at a breathing frequency of 5 breaths per minute (bpm). In each participant, the electrocardiogram, respiratory movements, beat-to-beat BP and end-tidal carbon dioxide were recorded for five minutes each: before, during and after ANB. The records were analyzed for HRV, BPV and BRS. Results: During ANB, HRV analysis showed significant increase in the standard deviation of all NN intervals, low-frequency (LF) component, LF/HF (low frequency/high frequency) ratio and significant decrease in the HF component. BPV analysis showed a significant increase in total power in systolic BPV (SBPV), diastolic BPV (DBPV) and mean BPV. BRS analysis showed a significant increase in the total number of sequences in SBPV and DBPV and significant augmentation of α-LF and reduction in α-HF. The power spectrum showed a dominant peak in HRV at 0.08 Hz (LF component) similar to the respiratory frequency. The acute short-term change in circulatory control system declined immediately after the cessation of slow yogic breathing (ANB) and remained elevated in post-ANB stage as compared to the pre-ANB. Interpretation & conclusions: Significant increase in cardiovascular oscillations and baroreflex recruitments during-ANB suggested a dynamic interaction between respiratory and cardiovascular system. Enhanced phasic relationship with some delay indicated the complexity of the system. It indicated that respiratory and cardiovascular oscillations were coupled through multiple regulatory mechanisms, such as mechanical coupling, baroreflex and central cardiovascular control.
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Affiliation(s)
- Om Lata Bhagat
- Department of Physiology, All Institute of Medical Sciences, New Delhi, India
| | - Chhaya Kharya
- Department of Physiology, All Institute of Medical Sciences, New Delhi, India
| | - Ashok Jaryal
- Department of Physiology, All Institute of Medical Sciences, New Delhi, India
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Fonkoue IT, Marvar PJ, Norrholm SD, Kankam ML, Li Y, DaCosta D, Rothbaum BO, Park J. Acute effects of device-guided slow breathing on sympathetic nerve activity and baroreflex sensitivity in posttraumatic stress disorder. Am J Physiol Heart Circ Physiol 2018; 315:H141-H149. [PMID: 29652544 DOI: 10.1152/ajpheart.00098.2018] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Patients with posttraumatic stress disorder (PTSD) have elevated sympathetic nervous system reactivity and impaired sympathetic and cardiovagal baroreflex sensitivity (BRS). Device-guided slow breathing (DGB) has been shown to lower blood pressure (BP) and sympathetic activity in other patient populations. We hypothesized that DGB acutely lowers BP, heart rate (HR), and improves BRS in PTSD. In 23 prehypertensive veterans with PTSD, we measured continuous BP, ECG, and muscle sympathetic nerve activity (MSNA) at rest and during 15 min of DGB at 5 breaths/min ( n = 13) or identical sham device breathing at normal rates of 14 breaths/min (sham; n = 10). Sympathetic and cardiovagal BRS was quantified using pharmacological manipulation of BP via the modified Oxford technique at baseline and during the last 5 min of DGB or sham. There was a significant reduction in systolic BP (by -9 ± 2 mmHg, P < 0.001), diastolic BP (by -3 ± 1 mmHg, P = 0.019), mean arterial pressure (by -4 ± 1 mmHg, P = 0.002), and MSNA burst frequency (by -7.8 ± 2.1 bursts/min, P = 0.004) with DGB but no significant change in HR ( P > 0.05). Within the sham group, there was no significant change in diastolic BP, mean arterial pressure, HR, or MSNA burst frequency, but there was a small but significant decrease in systolic BP ( P = 0.034) and MSNA burst incidence ( P = 0.033). Sympathetic BRS increased significantly in the DGB group (-1.08 ± 0.25 to -2.29 ± 0.24 bursts·100 heart beats-1·mmHg-1, P = 0.014) but decreased in the sham group (-1.58 ± 0.34 to -0.82 ± 0.28 bursts·100 heart beats-1·mmHg-1, P = 0.025) (time × device, P = 0.001). There was no significant difference in the change in cardiovagal BRS between the groups (time × device, P = 0.496). DGB acutely lowers BP and MSNA and improves sympathetic but not cardiovagal BRS in prehypertensive veterans with PTSD. NEW & NOTEWORTHY Posttraumatic stress disorder is characterized by augmented sympathetic reactivity, impaired baroreflex sensitivity, and an increased risk for developing hypertension and cardiovascular disease. This is the first study to examine the potential beneficial effects of device-guided slow breathing on hemodynamics, sympathetic activity, and arterial baroreflex sensitivity in prehypertensive veterans with posttraumatic stress disorder.
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Affiliation(s)
- Ida T Fonkoue
- Division of Renal Medicine, Department of Medicine, Emory University School of Medicine , Atlanta, Georgia.,Research Service Line, Atlanta Veterans Affairs Medical Center, Decatur, Georgia
| | - Paul J Marvar
- Department of Pharmacology and Physiology, Institute for Neuroscience, George Washington University , Washington, District of Columbia
| | - Seth D Norrholm
- Mental Health Service Line, Atlanta Veterans Affairs Medical Center, Decatur, Georgia.,Psychiatry and Behavioral Sciences, Emory University , Atlanta, Georgia
| | - Melanie L Kankam
- Division of Renal Medicine, Department of Medicine, Emory University School of Medicine , Atlanta, Georgia.,Research Service Line, Atlanta Veterans Affairs Medical Center, Decatur, Georgia
| | - Yunxiao Li
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University , Atlanta, Georgia
| | - Dana DaCosta
- Division of Renal Medicine, Department of Medicine, Emory University School of Medicine , Atlanta, Georgia.,Research Service Line, Atlanta Veterans Affairs Medical Center, Decatur, Georgia
| | | | - Jeanie Park
- Division of Renal Medicine, Department of Medicine, Emory University School of Medicine , Atlanta, Georgia.,Research Service Line, Atlanta Veterans Affairs Medical Center, Decatur, Georgia
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