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PubMed1985

Trial of relaxation in reducing coronary risk: four year follow up.

On screening 192 men and women aged 35-64 were identified as having two or more of the following risk factors: blood pressure greater than or equal to 140/90 mm Hg, plasma cholesterol concentration greater than or equal to 6.3 mmol/l (243.6 mg/100 ml), and current smoking habit greater than or equal to 10 cigarettes a day. They were randomly allocated to a group for modification of behaviour or to serve as controls. Both groups were given health education leaflets containing advice to stop smoking, to reduce animal fats in the diet, and on the importance of reducing blood pressure. In addition, the treatment group had group sessions of one hour a week for eight weeks in which they were taught breathing exercises, relaxation, and meditation and about managing stress. It had previously been found that after eight weeks and eight months there was a significantly greater reduction in both systolic and diastolic blood pressures in the group taught to relax compared with the control group. After four years of follow up these differences in blood pressure were maintained. Plasma cholesterol concentration and the number of cigarettes smoked were lower in the treatment group at eight weeks and eight months but not at the four year follow up. At four years more subjects in the control group reported having had angina and treatment for hypertension and its complications. Incidence of ischaemic heart disease, fatal myocardial infarction, or electrocardiographic evidence of ischaemia was significantly greater in the control group. If the results of this study could be obtained in a larger study the financial and health care implications would be enormous.

Adult↗
PubMed1988

Increased muscle enzyme activity after yoga breathing during an exacerbation of asthma.

The case is reported of a yoga practitioner who, during an exacerbation of asthma, developed a substantial increase in serum muscle enzymes. This was related to his yoga breathing exercises, which he used to enhance the delivery of aerosolised bronchodilators. As his condition improved and the use of these yoga manoeuvres diminished, the muscle enzyme levels fell to normal.

Asthma↗
PubMed2006

Perspectives that influence action plans for chronic obstructive pulmonary disease.

BACKGROUND: Prompt treatment of acute exacerbations (AEs) in chronic obstructive pulmonary disease (COPD) improves quality of life and reduces the use of health care resources. Although patient self-management through an individualized action plan (AP) can help with early initiation of therapy, its use is critically dependent on the patient recognizing the features of an exacerbation. OBJECTIVE: To describe COPD patients' experiences with AEs, as well as health care professionals' (HCPs') attitudes toward the provision of an AP as part of self-management education. METHODS: Thirty-two patients with moderate to severe COPD who recently experienced at least one AE, and 22 HCPs with experience in the management of COPD, were interviewed. RESULTS: The most common symptoms and signs associated with an AE were difficulty breathing (84%), fatigue (81%), cold symptoms (59%), changes in sputum colour (53%) or amount (47%), and cough (44%). The main precipitants identified were environmental triggers (47%), infective agents (31%), excessive activities (25%), emotional factors (16%) and changes in medications (9%). Strategies for dyspnea relief included increasing medications (72%), resting (56%), avoiding exposure to environmental triggers (41%) and performing breathing exercises (31%). Patients supported the use of an AP and recommended that it be individualized for symptoms and triggers, and that it should also include strategies for addressing anxiety and depression. HCPs also supported the use of an individualized AP and recommended that it be regularly revisited, depending on the patient's disease severity. CONCLUSIONS: Patients' experiences with AEs do not always conform to a standard medical definition. Therefore, an understanding of their experience is of value in the design of an individualized AP. HCPs support the use of an AP that emphasizes self-management of exacerbations as well as general COPD management.

Aged↗
PubMed2001

Physiologic evaluation of 4 weeks of nocturnal nasal positive pressure ventilation in stable hypercapnic patients with chronic obstructive pulmonary disease.

BACKGROUND: The long-term daily use of noninvasive mechanical ventilation (NIMV) to treat chronic respiratory failure in chronic obstructive pulmonary disease (COPD) patients is not widely recommended, partly because of a lack of clear clinical results and partly because the physiological mechanisms by which the daily application of NIMV would be helpful in these patients have not yet been clarified. OBJECTIVES: We designed a physiological study in order to assess the effects of supervised long-term NIMV on gas exchange, respiratory muscle function, pulmonary mechanics and to ascertain the possible effect of the treatment in responders and nonresponders. METHODS: Fourteen consecutive inpatients with stable hypercapnic COPD (pH = 7.37 +/- 0.01; PaCO(2) = 56.73 +/- 6.48 mm Hg) underwent 4 weeks of nocturnal NIMV delivered with a bilevel ventilator 'physiologically' set to reduce tidal transdiaphragmatic pressure (Pdi) by at least 50% and the amount of dynamic intrinsic positive end-expiratory pressure by 70%. Various measurements were compared with those obtained in a control group of consecutive patients with comparable baseline characteristics who refused NIMV and underwent breathing exercises for the same period of time. RESULTS: By the end of the 4 weeks NIMV had induced a slight but significant (p < 0.01) reduction in resting PaCO(2) (53.78 +/- 5.64 mm Hg) associated with a decrease in the pressure time product of the diaphragm per minute (from 172 +/- 60 to 136 +/- 61 cm H(2)O/l/s; p < 0.05). This latter value was primarily due to a significant shortening of the inspiratory duty cycle, while Pdi and lung mechanics were not modified. Eight of the 13 NIMV-treated patients (1 dropped out for nonmedical reasons) had a clear reduction in PaCO(2) (>3 mm Hg or >5% from enrollment) and were classified as responders. The acute reduction in PaCO(2) during the first trial with NIMV resulted to be a strong index of the final response. The subgroup of responders had a significantly increased maximal Pdi (from 41 +/- 19 to 49 +/- 23 cm H(2)O, p < 0.05) and an enhanced ability of the ventilatory pump to clear CO(2) (9.7 +/- 3.4 vs. 7.2 +/- 2.9 cm H(2)O x s/min; p < 0.01). No significant changes were observed in the control group. CONCLUSIONS: These results suggest that in a remarkable and identifyable proportion of patients with stable hypercapnic COPD, nocturnal NIMV may decrease resting PaCO(2), reraising the role of chronically supporting the respiratory pump.

Aged↗
PubMedDate not supplied

Immediate effects of 'voice massage' treatment on the speaking voice of healthy subjects.

'Voice massage' (VM) treatment includes manipulation of muscles related to speech production and voice and breathing exercises. This study investigated the effects of VM in 10 healthy subjects (5 females, 5 males). They recorded repetitions of the word 'paappa' at normal loudness and as softly as possible and read a text sample before and after 1-hour (1) VM treatment, (2) fast walking, (3) sitting in a library and (4) lying on a bed. Subglottic pressure was estimated from oral pressure during [p]. Transglottal flow and glottal resistance were measured. Voice production was studied with electroglottography. Fundamental frequency, sound pressure level (SPL) and alpha ratio [(SPL of the range 1-5 kHz) - (SPL of the range 50 Hz-1 kHz)] were calculated from text samples, which were also evaluated by 7 voice experts. A questionnaire was used to record subjects' sensations. Changes after lying and sitting suggest lowered effort in phonatory muscles, while after fast walking effort seemed to increase. After VM no significant changes were observed in voice parameters or perceptual quality, but ease of phonation and reduced tension in the neck, shoulders and back were reported. The effects of VM may be partly psychological, partly related to a search of phonatory balance.

Adult↗
PubMed2006

The effect of long term combined yoga practice on the basal metabolic rate of healthy adults.

BACKGROUND: Different procedures practiced in yoga have stimulatory or inhibitory effects on the basal metabolic rate when studied acutely. In daily life however, these procedures are usually practiced in combination. The purpose of the present study was to investigate the net change in the basal metabolic rate (BMR) of individuals actively engaging in a combination of yoga practices (asana or yogic postures, meditation and pranayama or breathing exercises) for a minimum period of six months, at a residential yoga education and research center at Bangalore. METHODS: The measured BMR of individuals practicing yoga through a combination of practices was compared with that of control subjects who did not practice yoga but led similar lifestyles. RESULTS: The BMR of the yoga practitioners was significantly lower than that of the non-yoga group, and was lower by about 13 % when adjusted for body weight (P < 0.001). This difference persisted when the groups were stratified by gender; however, the difference in BMR adjusted for body weight was greater in women than men (about 8 and 18% respectively). In addition, the mean BMR of the yoga group was significantly lower than their predicted values, while the mean BMR of non-yoga group was comparable with their predicted values derived from 1985 WHO/FAO/UNU predictive equations. CONCLUSION: This study shows that there is a significantly reduced BMR, probably linked to reduced arousal, with the long term practice of yoga using a combination of stimulatory and inhibitory yogic practices.

Adult↗
PubMed2003

Lymphoedema: Pathophysiology and management in resource-poor settings - relevance for lymphatic filariasis control programmes.

Low cost reduction of morbidity in lymphoedema is an essential goal in the management of lymphatic filariasis. This review emphasises the role of movement and elevation, and refers to the literature on the effects of these on the venous and lymphatic system. The patient with lymphoedema becomes increasingly immobile and the affected limb is often in a permanently dependent position causing venous hypertension and resultant overloading of the failing lymphatics. The evidence that breathing exercises are important for reducing venous hypertension and inducing lymphatic flow is discussed.The contribution of a damaged epidermis to lymphatic failure is emphasised. Loss of barrier function encourages penetration of bacteria and stimulates repair mechanisms that generate cytokines, which, in turn lead to inflammation. Management programmes that improve the health of the epidermis play a part in reducing lymphatic load.In taking morbidity management of lymphoedema into the general health services there are benefits in promoting skin hygiene and self-help regimes that can ameliorate many diseases along with lymphoedema.

Journal Article↗
PubMed2000

Patterns of cardiovascular and ventilatory response to elevated metabolic states in the lizard Varanus exanthematicus.

The principal function of the cardiopulmonary system is the precise matching of O(2) and CO(2) transport to the metabolic requirements of different tissues. In some ecothermic vertebrates (amphibians and reptiles), vdot (O2) increases dramatically following feeding. Factorial increments in vdot (O2) range from 1.7 to 44 times above resting rates, and in some cases vdot (O2) approaches or even exceeds values measured during physical activity. There is virtually no information on the cardiopulmonary response during the postprandial period in these animals or how the pattern of cardiopulmonary support compares with that during activity. In our experiments, pulmonary ventilation ( vdot e), heart rate (fh), systemic blood flow ( qdot (sys)), rate of oxygen consumption ( vdot (O2)) and rate of carbon dioxide production ( vdot (CO2)) were measured at 35 degrees C in the lizard Varanus exanthematicus for 24 h prior to the ingestion of meals of various sizes and measured continuously for up to 72 h during the postprandial period. The results of this study were compared with previously published values for treadmill exercise in the same experimental animals. The change in fh and stroke volume (V(S)) for a given increment in vdot (O2) did not differ during exercise and digestion. In contrast, the ventilatory response was very dependent on the nature of the elevated metabolic state. During digestion, an increase in vdot (O2) resulted in a relative hypoventilation in comparison with resting values, whereas hyperventilation characterized the response during activity. During exercise, breathing frequency (f) increased 10- to 40-fold above resting values accompanied by large reductions in tidal volume (V(T)). In contrast, postprandial increases in vdot (O2) resulted in relatively minor changes in f and V(T) almost doubled. These results indicate that, in these lizards, the cardiac response to elevated vdot (O2) is stereotyped, the response being predictable irrespective of the source of the metabolic increment. In contrast, the ventilatory response is flexible and state-dependent, not only in pattern but also in its frequency and volume components.

Animals↗
PubMed2003

Resistance training on physical performance in disabled older female cardiac patients.

PURPOSE: We evaluated the value of resistance training on measures of physical performance in disabled older women with coronary heart disease (CHD). METHODS: The study intervention consisted of a 6-month program of resistance training in a randomized controlled trial format. Training intensity was at 80% of the single-repetition maximal lift. Control patients performed light yoga and breathing exercises. Study participants included 42 women with CHD, all >or= 65 yr of age and community dwelling. Subjects were screened by questionnaire to have low self-reported physical function. The primary study measurements related to the performance of 16 household activities of the Continuous Scale Physical Functional Performance test (CSPFP). These ranged from dressing, to kitchen and cleaning activities, to carrying groceries and walking onto a bus with luggage, and a 6-min walk. Activities were measured in time to complete a task, weight carried during a task, or distance walked. Other measures included body composition, measures of aerobic fitness and strength, and questionnaire-based measures of physical function and depression score. RESULTS: Study groups were similar at baseline by age, aerobic capacity, strength, body composition, and in performing the CSPFP. After conditioning, 13 of 16 measured activities were performed more rapidly, or with increased weight carried, compared with the control group (all P < 0.05). Maximal power for activities that involved weight-bearing over a distance, increased by 40% (P < 0.05). CONCLUSIONS: Disabled older women with CHD who participate in an intense resistance-training program improve physical capacity over a wide range of household physical activities. Benefits extend beyond strength-related activities, as endurance, balance, coordination, and flexibility all improved. Strength training should be considered an important component in the rehabilitation of older women with CHD.

Activities of Daily Living↗
PubMed2003

Ebstein's anomaly in a beagle dog.

An intact male beagle dog aged 1 year was referred because of shortness of breath, exercise intolerance and cardiac murmur. Based on the results from electrocardiography, thoracic radiography and echocardiography, the dog was diagnosed as Ebstein's anomaly. Although the orally administered digoxin, vasodilators and diuretics partially improved congestive signs, the dog became to be refractory and died 20 months after the diagnosis. Necropsy confirmed malformation and apical displacement of the basal attachment of tricuspid valve leaflets.

Angiotensin-Converting Enzyme Inhibitors↗
PubMed2005

Coping with cancer: what do patients do.

Although psychosocial coping techniques and supportive care services have been shown to improve cancer patients' quality of life, there is evidence that many of these strategies have not been widely integrated into the routine care of cancer patients. This study examined: (1) the extent to which cancer patients use certain coping strategies; (2) reasons for non-use; (3) perceived effectiveness of the coping strategies; (4) participants' interest in trying the strategies; and (5) if the strategies were recommended to participants. At the Northwestern Ontario Regional Cancer Centre in Thunder Bay, Ontario, Canada, 292 outpatients (98% response rate) completed an in-person interview with a research assistant concerning seven individual coping strategies (music, breathing exercises, meditation, prayer, muscle relaxation, visualization/imagery, hypnosis/self-hypnosis) and four coping strategies offered through supportive care services (individual counselling, family counselling, support groups, religious support). Of all the coping strategies presented, prayer was used by the highest number (n = 186) of participants (64%). Music was the next most commonly used strategy, used by 43% (n = 124) of participants, and all other strategies were used by less than 30%of participants. The individualized approaches that are used for disseminating disease and treatment information to cancer patients should also be used to provide them with information on effective coping strategies.

Adaptation, Psychological↗
PubMed1988

Exercise and training in patients with chronic obstructive lung disease.

Exercise protocols and training are used more and more in diagnostic procedures and as a tool in improving physical, social and psychological functioning in chronic obstructive lung disease patients. Before starting a training programme in chronic obstructive lung disease patients, one should exclude ventilatory-limited patients from the group. A maximal ergometer test with arterial blood samples or pulse oximetry must be performed. In mild forms of chronic obstructive lung disease with no ventilatory insufficiency demonstrable with exercise testing, the patient can be trained with no restrictions. Endurance training is permitted. It should be noted that it is possible to train the muscular and cardiovascular system up to a new, possible ventilatory maximum. In severe chronic obstructive lung disease endurance training is accompanied by hypoxia, with an associated risk of rhythm disturbances and right heart failure. Training with supplemental oxygen can reduce this risk, but should be done only under close medical supervision. In very severe chronic obstructive lung disease, when endurance training is only marginally possible even with supplemental oxygen, suppleness, coordination and relaxation exercises should be emphasised in rehabilitation programmes. Postural exercises and breathing control exercises can also give great subjective improvements in this often very disabled group of patients. Furthermore they can reduce fear and panic when dyspnoea occurs. Training of the respiratory muscles in patients with chronic obstructive lung disease must be regarded as an experimental therapy. The clinical importance remains uncertain. Exercise-induced bronchoconstriction should not limit exercises or training, provided it is treated correctly.

Exercise Test↗
PubMed1994

Forced single-nostril breathing and cognition.

This experiment investigated whether forced single-nostril breathing differentially affects cognitive abilities presumed to be mediated by the left and right cerebral hemispheres. Phase I was an attempted replication of a reported sex difference in the effects of unilateral breathing on verbal versus spatial performance and Phase II was a study of breathing effects on different verbal and spatial tests. No differences associated with breathing condition were found in the replication study. In Phase II, men breathing through the right nostril scored significantly lower than men in the control condition on a letter-matching test although they did not differ significantly from men in the left-nostril condition on that test. There were no significant breathing-related differences on two spatial tests, and no differences associated with breathing condition for the women. Assessment of nostril dominance before and after cognitive testing showed that the forced-breathing exercise did not significantly alter subjects' nostril dominance. A significant left-nostril bias was found in this sample.

Adult↗
PubMed1996

An asthma self-management program for children, including instruction in peak flow monitoring by school nurses.

A randomized trial of an instructional method was conducted in which school nurses taught children asthma self-management principles and skills, including peak flow monitoring, in 20-min, individual sessions over an 8-week period. Thirty-six children participated. An intervention group of 18 children received the teaching sessions. A control group of 18 children received regular care by the nurses, but no teaching sessions. The sample included 64% boys, 69% African-Americans, and 69% Medicaid recipients. The average age of subjects was 10.2 years. The two groups were demographically similar, but despite random assignment, the control group had a significantly earlier age of onset of asthma and tended to have had more asthma attacks in the preceding year. These factors were statistically controlled in outcome analyses. Results of group comparisons showed no significant differences in the number of postintervention emergency room visits and days absent from school. However, nurses reported that children who practiced breathing exercises had less anxiety during exacerbations, and the nurses' knowledge of the children's baseline peak expiratory flow rates facilitated care of the children. Nurses expressed the opinion that the individual sessions with students might be useful in motivating them to participate effectively in later group sessions. The intervention was well accepted by students, parents, and nurses. We believe that this intervention is promising as a practical, low-cost approach to enhancing children's asthma self-management skills and warrants further testing in a larger sample, with the intervention conducted over a longer period.

Absenteeism↗
PubMed1991

Efficacy of epidural analgesia for pain management of critically ill patients and the implications for nursing care.

Management of pain for critically ill patients has been shown to be inadequately controlled and can have serious deleterious effects on a patient's recovery. Continuous epidural analgesia can be used to control pain in critical care patients. This mode of analgesia administration provides pain relief without the delays inherent in the as-needed administration of analgesics. Fifteen critical care unit patients were part of a multidisciplinary, prospective, randomized, double-blind study of various epidural analgesic agents in 43 thoracic and 66 abdominal surgery patients. The purpose of the study was to identify the benefits and problems associated with continuous epidural analgesia administration and the implications for the nursing care of critically ill patients. Evaluation of the effectiveness of the analgesia was based on the following measures: 1) pain measured at regular intervals in the 72-hour period with a visual analog; 2) pain as measured after 72 hours with the word descriptor section of the McGill pain questionnaire; 3) amount of supplemental systemic narcotic analgesic needed; 4) recovery of ambulatory and respiratory function, including ability to perform coughing and deep-breathing exercises; 5) occurrence of adverse effects, and 6) the type and distribution of nursing care problems associated with continuous epidural infusions. The results of this study showed that the level of pain relief and recovery of postoperative function was superior to that provided by the more widely used as-needed systemic administration of narcotics. Although some nursing care problems were identified, continuous epidural analgesia can be used for pain relief in critical care patients, if the analgesia is administered by accurate reliable infusion systems and carefully monitored by nursing staff who are knowledgeable about the pharmacologic considerations of epidural analgesic agents and the management of patient care.

Analgesia, Epidural↗
PubMed2003

[Development of a scale to measure self-care for korean patients with chronic obstructive pulmonary disease].

PURPOSE: The objective of this study was the development and validation of a scale to measure the self-care of patients with chronic obstructive pulmonary disease(COPD) in Korea. METHOD: Self-care scale was developed based on the self-care activities patients had to carry out in order to manage their COPD. The original scale contained 34 items rated along a five-point Likert scale and was reviewed by 18 professional nurses and 10 Korean patients with COPD for content validity. Subsequently, patients with COPD were asked to complete this 23-item scale and further tests were done with the 125 useable responses. RESULT: Factor analysis identified eight factors- "maintaining a clean air way", "taking medication", "support from family", "preventing infection", "managing symptoms", "breathing exercising", and "taking in nutrition". The internal consistency of the total scale was Cronbach's alpha=0.7226. These eight factors explained 60.8% of total variance. There was correlation among Korean Self-Care Scale score, administration level, and knowledge level but there was no correlation to patients' satisfaction with medical services. CONCLUSION: The 23 item questionnaire positively identified 8 areas defined important for COPD patients. Further studies are required to see how these can be integrated into patient education.

English Abstract↗
PubMed2002

News on lung volume reduction surgery.

Lung volume reduction surgery (LVRS) is an established therapeutic option for patients with advanced pulmonary emphysema after all conservative measures, including comprehensive pulmonary rehabilitation, have been exhausted. LVRS improves pulmonary function, shortness of breath, exercise capacity and hence quality of life in some 80% of cases for up to four years. Even patients with homogeneous types of pulmonary emphysema improve if those with extremely low FEV1 and/or very low diffusion capacity are excluded. At experienced centres perioperative mortality is less than 2% in appropriately selected patients, and current results suggest that the five-year survival in COPD patients may even be improved by this palliative surgical intervention. In patients under 60 LVRS may serve as a bridging procedure to lung transplantation. Bronchoscopic creation of extraanatomic bronchopulmonary passages--endoscopic LVRS--is a novel approach now under investigation.

Follow-Up Studies↗
PubMed2006

Strategies to reduce postoperative pulmonary complications after noncardiothoracic surgery: systematic review for the American College of Physicians.

BACKGROUND: Postoperative pulmonary complications are as frequent and clinically important as cardiac complications in terms of morbidity, mortality, and length of stay. However, there has been much less research and no previous systematic reviews of the evidence of interventions to prevent pulmonary complications. PURPOSE: To systematically review the literature on interventions to prevent postoperative pulmonary complications after noncardiothoracic surgery. DATA SOURCES: MEDLINE English-language literature search, 1 January 1980 through 30 June 2005, plus bibliographies of retrieved publications. STUDY SELECTION: Randomized, controlled trials (RCTs); systematic reviews; or meta-analyses that met predefined inclusion criteria. DATA EXTRACTION: Using standardized forms, the authors abstracted data on study methods, quality, intervention and control groups, patient characteristics, surgery, postoperative pulmonary complications, and adverse events. DATA SYNTHESIS: The authors qualitatively synthesized, without meta-analysis, evidence from eligible studies. Good evidence (2 systematic reviews, 5 additional RCTs) indicates that lung expansion interventions (for example, incentive spirometry, deep breathing exercises, and continuous positive airway pressure) reduce pulmonary risk. Fair evidence suggests that selective, rather than routine, use of nasogastric tubes after abdominal surgery (2 meta-analyses) and short-acting rather than long-acting intraoperative neuromuscular blocking agents (1 RCT) reduce risk. The evidence is conflicting or insufficient for preoperative smoking cessation (1 RCT), epidural anesthesia (2 meta-analyses), epidural analgesia (6 RCTs, 1 meta-analysis), and laparoscopic (vs. open) operations (1 systematic review, 1 meta-analysis, 2 additional RCTs), although laparoscopic operations reduce pain and pulmonary compromise as measured by spirometry. While malnutrition is associated with increased pulmonary risk, routine total enteral or parenteral nutrition does not reduce risk (1 meta-analysis, 3 additional RCTs). Enteral formulations designed to improve immune status (immunonutrition) may prevent postoperative pneumonia (1 meta-analysis, 1 additional RCT). LIMITATIONS: The overall quality of the literature was fair: Ten of 20 RCTs and 6 of 11 systematic reviews were good quality. CONCLUSIONS: Few interventions have been shown to clearly or possibly reduce postoperative pulmonary complications.

Analgesia↗