EFFECTS OF COORDINATING INVERSE BREATHING PATTERN WITH ARM MOVEMENTS ON CHEST WALL VOLUMES IN PATIENTS WITH CHRONIC OBSTRUCTIVE PULMONARY DISEASE

A. Tantisuwat¹, W. Mathiyakom², C. Kruapanich³, P. Thaveeratitham¹, N. Ubolnuar⁴

¹Faculty of Allied Health Sciences, Chulalongkorn University, Physical Therapy, Bangkok, Thailand, ²California State University, Physical Therapy, Northridge, United States, ³Faculty of Physical Therapy, Saint Louis College, Bangkok, Thailand, ⁴Faculty of Allied Health Sciences, Burapha University, Physical Therapy, Chonburi, Thailand

Background:​Breathing and arm exercises are essential interventions for patients with chronic obstructive pulmonary disease (COPD) to desensitize dyspnea and improve coordination of the chest and abdominal walls and overall function. When combining these two exercises, patients with COPD typically inhale during arm elevation and exhale during arm lowering. Thoracoabdominal asynchrony (TAA), an indicative of uncoordinated motion between the chest wall compartments commonly observed in patients with COPD, was significantly less when the patients exhaled during arm elevation and inhaled during arm lowering than during the common breath-arm coordination. Additionally, lifting endurance improved significantly in the patients with hyperinflated COPD who were trained to exhale during lifting than those who inhaled during lifting. This inverse breath-arm (IBA) coordination was thought to benefit the respiratory mechanics of patients with COPD. However, the effects of IBA with arms moving in different elevation planes on total and compartmental chest wall volumes and TAA are not currently limited.

Purpose:​This study identified the differences in total and compartment chest wall volumes, TAA, dyspnea, and arm fatigue between different coordination strategies of breathing exercises and arm movements in patients with COPD.

Methods: Twenty-one mild to moderate and stable patients with COPD performed a series of experimental tasks which combined three breathing exercises (quiet breathing; QB, pursed-lip breathing; PLB, and IBA) with three arm movements (flexion, scaption, and abduction). During these tasks, the kinematics of the chest and abdominal walls measured by optoelectronic plethysmography was used to derive total and compartment chest wall volumes and TAA. The sensation of dyspnea and arm fatigue during these tasks were assessed by the modified Borg scale. Between-task differences in chest wall volumes, TAA, dyspnea, and arm fatigue were assessed using repeated measures ANOVA with Bonferroni adjustment. The significance level was 0.05.

Results: The effects of different coordinating breathing patterns with arm movements on chest wall volumes, TAA, dyspnea, and arm fatigue were similar when compared within each plane of arm movement. TAA was significantly less during the IBA than the QB and PLB (P<0.0001). Pulmonary ribcage volume was significantly greater during the IB than during the QB (P<0.05) and PLB (P<0.0001). In contrast, abdominal ribcage and abdominal volumes were significantly smaller during the IBA than during the QB (P<0.05) and PLB (P<0.0001). As a result, total chest wall volume, dyspnea, and arm fatigue were not significantly different between breathing patterns.

Conclusions: Coordinating IBA with arm movements improved TAA by decreasing the lower chest wall and abdominal volumes and increasing the upper chest wall volume compared to the typical breath-arm coordination.The effects of coordinating different breathing exercises with arm movements on TAA and total and compartmental chest wall volumes were similar between the planes of arm movement.

Implications: These results provide insight into how coordinating IBA with arm movements influences the compartmental chest wall volumes and TAA in patients with COPD. This information serves as a foundation for selecting different combinations of breathing exercise and arm movement to improve chest wall mechanics and volumes in patients with COPD.

Funding acknowledgements: The present work was supported by Research Grant for New Researcher (MRG-5980084), the Thai Research Fund, Thailand.

Keywords:
Inverse breathing exercises
Arm movements
COPD

Topics:
Cardiorespiratory

Did this work require ethics approval? Yes

Institution: Chulalongkorn University

Committee: The Research Ethics Review Committee for Research Involving Human Research Participants

Ethics number: no.210/2016