Diaphragmatic breathing, or what is commonly referred to as ‘belly breathing’, is described as the most efficient breathing technique that encourages full oxygen exchange[1]. Your diaphragm plays an important role in breathing. At rest your diaphragm creates a dome shape that is then contracted, causing it to flatten when you inhale. This creates a larger amount of space in the chest cavity, allowing the lungs to expand and air to rush into the lungs efficiently. When you exhale, your diaphragm relaxes creating a dome like shape moving up the chest cavity helping to aid exhalation. However, as people get older, an individuals ability to diaphragmatically breath can be overshadowed by the habit of chest breathing. Chest breathing occurs when on inhalation, instead of the belly moving out, the belly may move in with the chest moving up and out. This means that the individual is activating other respiratory muscles, particularly ones that aid breathing during exercise, thus inducing dyspnoea.
Dyspnoea is common in patients with COPD. Many individuals who suffer from COPD have a reduction in diaphragmatic breathing and thus use other respiratory muscles as a compensatory mechanism. The current study assessed the effects of a short-term diaphragmatic breathing training programme on thoracoabdominal motion, diaphragmatic mobility, and functional capacity in people with COPD[2]. Thirty participants were randomised into either a training group (TG) or control group (CG). The TG completed three 45 minute sessions per week for 4 weeks. Patients were asked to complete breathing exercises in the supine, right and left lateral decubitus, sitting and standing positions (3 sets of 10 repetitions for each position). Each set was followed by 1 minute of normal breathing. Participants were asked to ‘perform a slow maximal inspiration allowing the air to go to your belly’ and ‘perform a normal expiration without forcing abdominal retraction’. Feedback was then provided with both visual and auditory guidance.
Thoracoabdominal motion was assessed by means of a reduction in the amplitude of the rib cage to abdominal motion ratio, recorded using a computer-assisted respiratory inductive plethysmography system. Diaphragmatic mobility was assessed using an ultrasonography examination of the craniocaudal displacement of the left branch of the portal vein. Functional capacity was assessed using spirometry and whole-body plethysmography. Dyspnoea symptoms were assessed at rest using the modified Medical Research Council dyspnoea scale. COPD-specific health-related quality of life was evaluated using the St. George’s Respiratory Questionnaire. Finally, the 6-minute walk test was implemented to assess exercise tolerance.
Results found that those in the TG demonstrated improvements in abdominal motion and diaphragmatic mobility during both normal breathing and voluntary diaphragmatic breathing. It was also observed that the training programme led to benefits in dyspnoea symptoms, health-related quality of life and exercise tolerance.
Thus, the hypothesis was supported, in which a diaphragmatic training programme can induce modifications in habitual breathing patterns and increase diaphragmatic excursion, relieving symptoms of dyspnoea and improving functional capacity in patients with COPD. Therefore, this study can be used as evidence for the support of diaphragmatic training in individuals with COPD in order to improve symptoms of dyspnoea and induce modifications to their breathing habits. However, these results are only in support of shorter-term outcomes and thus the longer-term outcomes need to be considered.
References:
[1] HARVARD MEDICAL SCHOOL, 2016. Learning Diaphragmatic Breathing [12/04/21]. Available from: Learning diaphragmatic breathing - Harvard Health
[2] WELLINGTON, Y et al., 2012. Diaphragmatic Breathing Training Program Improves Abdominal Motion During Natural Breathing in Patients with Chronic Obstructive Pulmonary Disease: Randomised Controlled Trial. Archives of Physical Medicine Rehabilitation, 93(4), 571-577
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