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Meta-Analysis
. 2012 Oct 17;10(10):CD008250.
doi: 10.1002/14651858.CD008250.pub2.

Breathing exercises for chronic obstructive pulmonary disease

Anne E Holland  1 , Catherine J Hill, Alice Y Jones, Christine F McDonald
Affiliations
Meta-Analysis

Breathing exercises for chronic obstructive pulmonary disease

Anne E Holland et al. Cochrane Database Syst Rev. .

Abstract

Background: Breathing exercises for people with chronic obstructive pulmonary disease (COPD) aim to alter respiratory muscle recruitment, improve respiratory muscle performance and reduce dyspnoea. Although some studies have reported positive short-term physiological effects of breathing exercises in people with COPD, their effects on dyspnoea, exercise capacity and well being are unclear.

Objectives: To determine whether breathing exercises in people with COPD have beneficial effects on dyspnoea, exercise capacity and health-related quality of life compared to no breathing exercises in people with COPD; and to determine whether there are any adverse effects of breathing exercises in people with COPD.

Search methods: The Cochrane Airways Group Specialised Register of trials and the PEDro database were searched from inception to October 2011.

Selection criteria: We included randomised parallel trials that compared breathing exercises to no breathing exercises or another intervention in people with COPD.

Data collection and analysis: Two review authors independently extracted data and assessed the risk of bias. Primary outcomes were dyspnoea, exercise capacity and health-related quality of life; secondary outcomes were gas exchange, breathing pattern and adverse events. To determine whether effects varied according to the treatment used, we assessed each breathing technique separately.

Main results: Sixteen studies involving 1233 participants with mean forced expiratory volume in one second (FEV(1)) 30% to 51% predicted were included. There was a significant improvement in six-minute walk distance after three months of yoga involving pranayama timed breathing techniques (mean difference to control 45 metres, 95% confidence interval 29 to 61 metres; two studies; 74 participants), with similar improvements in single studies of pursed lip breathing (mean 50 metres; 60 participants) and diaphragmatic breathing (mean 35 metres; 30 participants). Effects on dyspnoea and health-related quality of life were inconsistent across trials. Addition of computerised ventilation feedback to exercise training did not provide additional improvement in dyspnoea-related quality of life (standardised mean difference -0.03; 95% CI -0.43 to 0.49; two studies; 73 participants) and ventilation feedback alone was less effective than exercise training alone for improving exercise endurance (mean difference -15.4 minutes; 95% CI -28.1 to -2.7 minutes; one study; 32 participants). No significant adverse effects were reported. Few studies reported details of allocation concealment, assessor blinding or intention-to-treat analysis.

Authors' conclusions: Breathing exercises over four to 15 weeks improve functional exercise capacity in people with COPD compared to no intervention; however, there are no consistent effects on dyspnoea or health-related quality of life. Outcomes were similar across all the breathing exercises examined. Treatment effects for patient-reported outcomes may have been overestimated owing to lack of blinding. Breathing exercises may be useful to improve exercise tolerance in selected individuals with COPD who are unable to undertake exercise training; however, these data do not suggest a widespread role for breathing exercises in the comprehensive management of people with COPD.

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Conflict of interest statement

None known.

Figures

1
1
Study flow diagram.
2
2
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
3
3
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
4
4
Forest plot of comparison: 3 Yoga versus no breathing exercises, outcome: 3.6 Exercise capacity ‐ change in 6MWT at 3 months.
5
5
Forest plot of comparison: 6 Respiratory biofeedback training plus exercise versus exercise alone, outcome: 6.5 Quality of Life ‐ Dyspnoea domain of Chronic Respiratory Disease Questionnaire.
1.1
1.1. Analysis
Comparison 1 Pursed lip breathing versus no breathing retraining, Outcome 1 Dyspnoea ‐ Modified Borg dyspnoea score after 6MWT.
1.2
1.2. Analysis
Comparison 1 Pursed lip breathing versus no breathing retraining, Outcome 2 Dyspnoea ‐ University of California San Diego Shortness of Breath Questionnaire.
1.3
1.3. Analysis
Comparison 1 Pursed lip breathing versus no breathing retraining, Outcome 3 Dyspnoea ‐ Medical Research Council Score at week 8.
1.4
1.4. Analysis
Comparison 1 Pursed lip breathing versus no breathing retraining, Outcome 4 Exercise capacity ‐ 6MWT at 8 weeks.
1.5
1.5. Analysis
Comparison 1 Pursed lip breathing versus no breathing retraining, Outcome 5 Quality of life measured by Hiratsuka scale.
1.6
1.6. Analysis
Comparison 1 Pursed lip breathing versus no breathing retraining, Outcome 6 Quality of life ‐ Total score of Cai scale.
2.1
2.1. Analysis
Comparison 2 Diaphragmatic breathing versus no breathing retraining, Outcome 1 Dyspnoea ‐ change in Medical Research Council Score at week 4.
2.2
2.2. Analysis
Comparison 2 Diaphragmatic breathing versus no breathing retraining, Outcome 2 Exercise capacity ‐ change in 6MWT at 4 weeks.
2.3
2.3. Analysis
Comparison 2 Diaphragmatic breathing versus no breathing retraining, Outcome 3 Quality of life ‐ change in SGRQ at 4 weeks.
2.4
2.4. Analysis
Comparison 2 Diaphragmatic breathing versus no breathing retraining, Outcome 4 Diaphragmatic mobility.
2.5
2.5. Analysis
Comparison 2 Diaphragmatic breathing versus no breathing retraining, Outcome 5 Ratio of rib cage to abdominal motion during normal breathing.
2.6
2.6. Analysis
Comparison 2 Diaphragmatic breathing versus no breathing retraining, Outcome 6 Ratio of rib cage to abdominal motion during deep breathing.
3.1
3.1. Analysis
Comparison 3 Yoga versus no breathing retraining, Outcome 1 Dyspnoea intensity at end of 6MWT.
3.2
3.2. Analysis
Comparison 3 Yoga versus no breathing retraining, Outcome 2 Dyspnoea intensity at end of incremental cycle ergometer test.
3.3
3.3. Analysis
Comparison 3 Yoga versus no breathing retraining, Outcome 3 Dyspnoea distress at the end of 6MWT.
3.4
3.4. Analysis
Comparison 3 Yoga versus no breathing retraining, Outcome 4 Dyspnoea distress at end of incremental cycle ergometer test.
3.5
3.5. Analysis
Comparison 3 Yoga versus no breathing retraining, Outcome 5 Dyspnoea‐related quality of life at 12 weeks.
3.6
3.6. Analysis
Comparison 3 Yoga versus no breathing retraining, Outcome 6 Exercise capacity ‐ change in 6MWT at 3 months.
3.7
3.7. Analysis
Comparison 3 Yoga versus no breathing retraining, Outcome 7 Exercise capacity ‐ peak work on incremental cycle ergometry.
3.8
3.8. Analysis
Comparison 3 Yoga versus no breathing retraining, Outcome 8 Quality of life ‐ change in total score for St Georges Respiratory Questionnaire.
4.1
4.1. Analysis
Comparison 4 Other breathing retraining versus no breathing retraining, Outcome 1 Dyspnoea measured on MRC scale.
4.2
4.2. Analysis
Comparison 4 Other breathing retraining versus no breathing retraining, Outcome 2 Dyspnoea‐related quality of life at 8 weeks.
4.3
4.3. Analysis
Comparison 4 Other breathing retraining versus no breathing retraining, Outcome 3 Exercise capacity ‐ 6MWT at 8 weeks.
4.4
4.4. Analysis
Comparison 4 Other breathing retraining versus no breathing retraining, Outcome 4 Gas exchange ‐ PaO2 at 6 months.
4.5
4.5. Analysis
Comparison 4 Other breathing retraining versus no breathing retraining, Outcome 5 Gas exchange ‐ PCO2 at 6 months.
4.6
4.6. Analysis
Comparison 4 Other breathing retraining versus no breathing retraining, Outcome 6 FEV1 after 6 months.
4.7
4.7. Analysis
Comparison 4 Other breathing retraining versus no breathing retraining, Outcome 7 FER after 6 months.
4.8
4.8. Analysis
Comparison 4 Other breathing retraining versus no breathing retraining, Outcome 8 Exercise capacity ‐ 6MWT at 8 weeks.
5.1
5.1. Analysis
Comparison 5 Pursed lip breathing versus expiratory muscle training, Outcome 1 Dyspnoea ‐ Modified Borg dyspnoea score after 6MWT.
5.2
5.2. Analysis
Comparison 5 Pursed lip breathing versus expiratory muscle training, Outcome 2 Dyspnoea ‐ University of California San Diego Shortness of Breath Questionnaire.
6.1
6.1. Analysis
Comparison 6 Ventilation feedback training plus exercise versus exercise alone, Outcome 1 Exercise capacity ‐ duration of constant work rate exercise at 15 weeks.
6.2
6.2. Analysis
Comparison 6 Ventilation feedback training plus exercise versus exercise alone, Outcome 2 Exercise capacity ‐ change in 6MWT at 4 weeks.
6.3
6.3. Analysis
Comparison 6 Ventilation feedback training plus exercise versus exercise alone, Outcome 3 Dyspnoea at isotime on constant work rate treadmill test.
6.4
6.4. Analysis
Comparison 6 Ventilation feedback training plus exercise versus exercise alone, Outcome 4 Dyspnoea ‐ change in Borg score at end of 6MWT.
6.5
6.5. Analysis
Comparison 6 Ventilation feedback training plus exercise versus exercise alone, Outcome 5 Quality of Life ‐ Dyspnoea domain of Chronic Respiratory Disease Questionnaire.
6.6
6.6. Analysis
Comparison 6 Ventilation feedback training plus exercise versus exercise alone, Outcome 6 Gas exchange ‐ SpO2 at isotime during constant work rate cycle test.
6.7
6.7. Analysis
Comparison 6 Ventilation feedback training plus exercise versus exercise alone, Outcome 7 Ventilation ‐ minute ventilation at isotime during constant work rate treadmill test.
6.8
6.8. Analysis
Comparison 6 Ventilation feedback training plus exercise versus exercise alone, Outcome 8 Energy cost ‐ oxygen consumption isotime during constant work rate test.
6.9
6.9. Analysis
Comparison 6 Ventilation feedback training plus exercise versus exercise alone, Outcome 9 Breathing pattern ‐ respiratory rate at isotime on constant work rate treadmill test.
6.10
6.10. Analysis
Comparison 6 Ventilation feedback training plus exercise versus exercise alone, Outcome 10 Breathing pattern ‐ inspiratory time at isotime on constant work rate treadmill test.
6.11
6.11. Analysis
Comparison 6 Ventilation feedback training plus exercise versus exercise alone, Outcome 11 Breathing pattern ‐ expiratory time at isotime on constant work rate treadmill test.
7.1
7.1. Analysis
Comparison 7 Ventilation feedback training versus exercise training, Outcome 1 Exercise capacity ‐ duration of constant work rate exercise at 15 weeks.
7.2
7.2. Analysis
Comparison 7 Ventilation feedback training versus exercise training, Outcome 2 Gas exchange ‐ SpO2 at isotime during constant work rate cycle test.
7.3
7.3. Analysis
Comparison 7 Ventilation feedback training versus exercise training, Outcome 3 Ventilation ‐ minute ventilation at isotime during constant work rate treadmill test.
7.4
7.4. Analysis
Comparison 7 Ventilation feedback training versus exercise training, Outcome 4 Breathing pattern ‐ respiratory rate at isotime on constant work rate treadmill test.
7.5
7.5. Analysis
Comparison 7 Ventilation feedback training versus exercise training, Outcome 5 Breathing pattern ‐ inspiratory time at isotime on constant work rate treadmill test.
7.6
7.6. Analysis
Comparison 7 Ventilation feedback training versus exercise training, Outcome 6 Breathing pattern ‐ expiratory time at isotime on constant work rate treadmill test.
7.7
7.7. Analysis
Comparison 7 Ventilation feedback training versus exercise training, Outcome 7 Dyspnoea at isotime on constant work rate treadmill test.
8.1
8.1. Analysis
Comparison 8 Diaphragmatic breathing versus inspiratory muscle training, Outcome 1 Other outcomes ‐ inspiratory muscle endurance at 1 month.
8.2
8.2. Analysis
Comparison 8 Diaphragmatic breathing versus inspiratory muscle training, Outcome 2 Other outcomes ‐ inspiratory muscle endurance at 2 months.
9.1
9.1. Analysis
Comparison 9 Pursed lip breathing, diaphragmatic breathing and nutritional supplementation versus usual care, Outcome 1 Quality of life ‐ total score on Cai questionnaire.
9.2
9.2. Analysis
Comparison 9 Pursed lip breathing, diaphragmatic breathing and nutritional supplementation versus usual care, Outcome 2 Other outcomes ‐ FEV1 after 3 months.
9.3
9.3. Analysis
Comparison 9 Pursed lip breathing, diaphragmatic breathing and nutritional supplementation versus usual care, Outcome 3 Other outcomes ‐ FVC after 3 months.
10.1
10.1. Analysis
Comparison 10 Pursed lip breathing, diaphragmatic breathing and respiratory muscle gymnastics versus no breathing retraining, Outcome 1 Other outcomes ‐ change in inspiratory muscle strength.
10.2
10.2. Analysis
Comparison 10 Pursed lip breathing, diaphragmatic breathing and respiratory muscle gymnastics versus no breathing retraining, Outcome 2 Other outcomes ‐ change in expiratory muscle strength.
10.3
10.3. Analysis
Comparison 10 Pursed lip breathing, diaphragmatic breathing and respiratory muscle gymnastics versus no breathing retraining, Outcome 3 Other outcomes ‐ change in Pdi.
10.4
10.4. Analysis
Comparison 10 Pursed lip breathing, diaphragmatic breathing and respiratory muscle gymnastics versus no breathing retraining, Outcome 4 Other outcomes ‐ change in maximal Pdi.
11.1
11.1. Analysis
Comparison 11 Pursed lip breathing, diaphragmatic breathing and walking versus usual care, Outcome 1 Quality of Life ‐ Change in St Georges Respiratory Questionnaire.
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Comment in

References

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