Comparison of Costal Breathing Exercise with Sustained Maximum Inspiration, Flow-oriented and Volume-oriented Incentive Spirometry on Cardiac Autonomic Function in Healthy Adults
Article Sidebar
Main Article Content
Abstract
Background: Breathing exercises are important in physical therapy for preventing respiratory system complications. However, there is limited data regarding the effect of incentive spirometer training on cardiac autonomic nervous system (cANS).
Objective: This study aims to compare the effects of three methods of breathing exercise (costal breathing exercise with sustained maximum inspiration (CSMI), flow-oriented incentive spirometry (FIS), and volume-oriented incentive spirometry (VIS)) against spontaneous breathing (SB) on changes in cANS activity.
Methods: Twenty-four healthy participants were randomly assigned to perform three types of breathing exercises (CSMI, FIS, and VIS). Heart rate variability (HRV) parameters were analysed, including the Standard deviation of NN intervals (SDNN), Square root of the mean of the squares of successive NN interval differences (RMSSD), Low frequency (LF), High frequency (LF) power และ Low frequency/High frequency ratio (LF/HF).
Results: Compared to SB, SDNN significantly increased with all breathing exercise methods (p<0.001). RMSSD significantly increased in the FIS (p=0.031) and VIS (p=0.031). LF and LF/HF significantly increased with all breathing exercise methods (LF (ms2): CSMI (p=0.005), FIS (p=0.001), and VIS (p<0.001); Ln-LF: CSMI (p=0.005), FIS (p=0.001), and VIS (p<0.001); LF/HF: CSMI (p<0.001), FIS (p=0.003), and VIS (p<0.001)).
Conclusion: CSMI, FIS, and VIS affect the cardiac autonomic nervous system, specifically by promoting parasympathetic nervous system activity.
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
References
Végh AMD, Duim SN, Smits AM, Poelmann RE, Ten Harkel ADJ, DeRuiter MC, et al. Part and parcel of the cardiac autonomic nerve system: unravelling its cellular building blocks during development. J Cardiovasc Dev Dis. 2016;3(3): 28.
Wink J, van Delft R, Notenboom RGE, Wouters PF, DeRuiter MC, Plevier JWM, et al. Human adult cardiac autonomic innervation: controversies in anatomical knowledge and relevance for cardiac neuromodulation. Auton Neurosci. 2020;227:102674.
Giannino G, Braia V, Griffith Brookles C, Giacobbe F, D’Ascenzo F, Angelini F, et al. The intrinsic cardiac nervous system: from pathophysiology to therapeutic implications. Biology. 2024;13(2):105.
Manimmanakorn N MA, Vichiansiri R, Saengsuwan J and Leelayuwat N. Heart rate variability assessment and clinical uses. J Thai Rehabil Med. 2018;28(1):32-6.
Boden I, Reeve J, Jernås A, Denehy L, Fagevik Olsén M. Preoperative physiotherapy prevents postoperative pulmonary complications after major abdominal surgery: a meta-analysis of individual patient data. J Physiother. 2024; 70(3):216-23.
Chen J, Peng LH, Min S. Implementation of perioperative breathing exercises and its effect on postoperative pulmonary complications and long-term prognosis in elderly patients undergoing laparoscopic colorectal surgery: A randomized controlled trial. Clin Rehabil. 2022; 36(9):1229-43.
Pu CY, Batarseh H, Zafron ML, Mador MJ, Yendamuri S, Ray AD. Effects of preoperative breathing exercise on postoperative outcomes for patients with lung cancer undergoing curative intent lung resection: A meta-analysis. Arch Phys Med Rehabil. 2021;102(12):2416-27.e4.
Sullivan KA, Churchill IF, Hylton DA, Hanna WC. Use of incentive spirometry in adults following cardiac, thoracic, and upper abdominal surgery to prevent post-operative pulmonary complications: A systematic review and meta-analysis. Respiration. 2021;100(11):1114-27.
Hussein EE, Taha NM. Effect of breathing exercises on quality of recovery among postoperative patients. Int J Nurs Stud. 2018; 3(3):151.
Karagoz O, Sayilan AA. The effection pain and anxiety of a breathing exercise applied following laparoscopic cholecystectomy: A randomized controlled study. Brain Behav Immun Integr. 2023;2:100008.
Kotta PA, Ali JM. Incentive spirometry for prevention of postoperative pulmonary complications after thoracic surgery. Respir Care. 2021;66(2):327-33.
Mendes LPS, Teixeira LS, da Cruz LJ, Vieira DSR, Parreira VF. Sustained maximal inspiration has similar effects compared to incentive spirometers. Respir Physiol Neurobiol. 2019; 261:67-74.
Restrepo RD, Wettstein R, Wittnebel L, Tracy M. Incentive spirometry: 2011. Respir Care. 2011; 56(10):1600-4.
Ladriñán-Maestro A, Sánchez-Infante J, Martín-Vera D, Sánchez-Sierra A. Influence of an inspiratory muscle fatigue protocol on healthy youths on respiratory muscle strength and heart rate variability. A randomized controlled trial. Front Physiol. 2024;15:1457019.
Songsorn P, Chummee K, Yaanan C, Banlueharn A, Yuenyongchaiwat K, Pinupong C, et al. Comparison of respiratory muscle activities and cardiovascular function during different breathing types in healthy adults: Costal breathing, flow incentive spirometry, and volume incentive spirometry. PLOS ONE. 2025; 20(7):e0328739.
Shao R, Man ISC, Lee TMC. The effect of slow-paced breathing on cardiovascular and emotion functions: A meta-analysis and systematic review. Mindfulness. 2024;15(1):1-18.
Sharma G, Goodwin J. Effect of aging on respiratory system physiology and immunology. Clin Interv Aging. 2006;1(3):253-60.
World Health Organization. The Asia-Pacific perspective: redefining obesity and its treatment: Health Communications Australia Pty Limited, 2000.
Miller MR, Hankinson J, Brusasco V, Burgos F, Casaburi R, Coates A, et al. Standardisation of spirometry. Eur Respir J. 2005;26(2):319-38.
Flack JM, Adekola B. Blood pressure and the new ACC/AHA hypertension guidelines. Trends Cardiovasc Med. 2020;30(3):160-4.
Mort JR, Kruse HR. Timing of blood pressure measurement related to caffeine consumption. Ann Pharmacother. 2008;42(1):105-10.
Zerang F, Amouzeshi A, Barkhordari-Sharifabad M. Comparison of the effect of incentive spirometry and deep breathing exercises on hemodynamic parameters of patients undergoing coronary artery bypass graft surgery: A Clinical Trial. J Vasc Nurs. 2022;40(3):134-9.
Chang AT, Palmer KR, McNaught J, Thomas PJ. Inspiratory flow rate, not type of incentive spirometry device, influences chest wall motion in healthy individuals. Physiother Theory Pract. 2010;26(6):385-92.
Giles D, Draper N, Neil W. Validity of the Polar V800 heart rate monitor to measure RR intervals at rest. Eur J Appl Physiol. 2016;116(3):563-71.
Wu L, Shi P, Yu H, Liu Y. An optimization study of the ultra-short period for HRV analysis at rest and post-exercise. J Electrocardiol. 2020;63: 57-63.
Shaffer F, Meehan ZM, Zerr CL. A critical review of ultra-short-term heart rate variability norms research. Front Neurosci. 2020;14:594880.
Laborde S, Allen MS, Borges U, Dosseville F, Hosang TJ, Iskra M, et al. Effects of voluntary slow breathing on heart rate and heart rate variability: A systematic review and a meta-analysis. Neurosci Biobehav Rev. 2022;138: 104711.
Gerritsen RJ, Band GP. Breath of life: The respiratory vagal stimulation model of contemplative activity. Front Hum Neurosci. 2018;12:397.
Chaitanya S, Datta A, Bhandari B, Sharma VK. Effect of resonance breathing on heart rate variability and cognitive functions in young adults: a randomised controlled study. Cureus. 2022;14(2):e22187.
Yeh TT, Ho YC. Immediate effects of structured and natural deep breathing on heart rate variability and blood pressure in community-dwelling older adults. Exp Gerontol. 2024;198: 112644.