Effect of pranayama training on vital capacity, respiratory pressures, and respiratory endurance of young healthy volunteers

Background: There is a paucity of literature on the effects of isolated pranayam practice in particular savitri pranayam. Furthermore, no study depicts the pattern of change and variations in the effects produced. It needed to be found out whether long-term practice of Pranayama improves respiratory endurance and to what extent. Aim and Objectives: The aim of the study was to determine forced vital capacity (FVC), forced expiratory volume in 1stsecond, maximum inspiratory pressure, maximum expiratory pressure, and 40 mm Hg endurance of young healthy volunteers and to study the effect of pranayam on the same. Materials and Methods: Sixty volunteers of age group 20–30 were recruited and were divided into pranayam group and control group. After familiarizing the subjects with lab environment, the pre training values of both the groups were recorded. The parameters recorded were FVC, Forced expiratory volume in 1st s, maximum inspiratory pressure, maximum expiratory pressure, and 40 mm Hg endurance. A spirometer and a mercury manometer were used to measure these parameters. The pranayam group was given training in savitri pranayam for 12 weeks. The parameters were recorded at 4, 8, and 12 weeks of study. Data were collected and analyzed with student-t-test. Tests of significance were calculated by Statistical package for the Social Sciences software version 21.0. Results: There was a highly significant improvement (P < 0.001) in all the parameters among pranayam group. The control group did not showed significant improvement in any of the parameters. Conclusion: The improvement in respiratory efficiency in this study, though highly significant is less in magnitude. Combined practice of asan and pranayam may produce a better improvement than practicing savitri pranayam alone. The pattern of improvement in respiratory variables is not uniform. Individuals respond differently to yoga. Some showed a rapid improvement followed by a plateau, whereas for others the improvement graph appeared slow and steady. Yoga training has to be individualized and yoga therapy should be customized according to individual patient’s receptivity and nature. Savitri pranayam would be an effective tool in promotion of respiratory efficiency.

Physiotherapeutic approaches and the effects on inspiratory muscle force in patients with chronic obstructive pulmonary disease in the pre-operative preparation for abdominal surgical procedures / Abordagens fisioterapêuticas e os efeitos na força muscular inspiratória em pacientes com doença pulmonar obstrutiva crônica no preparo para procedimentos cirúrgicos abdominais

ABSTRACT Background: Abdominal disorders can alter respiratory function and increase the morbidity and mortality of patients with chronic obstructive pulmonary disease. Aim: To improve the physiotherapeutic and muscular capacity in chronic obstructive pulmonary muscular inspiration in the preoperative preparation in abdominal surgeries. Method: Retrospective and documentary study using SINPE © , clinical database software of patients with chronic obstructive pulmonary disease and candidates to abdominal operation. The sample consisted of 100 men aged 55-70 years, all with chronic obstructive pulmonary disease who underwent preoperative physiotherapeutic treatment. They were divided into two groups of 50 individuals (group A and group B). In group A the patients were treated with modern mobility techniques for bronchial clearance and the strengthening of the respiratory muscles was performed with IMT ® Threshold. In group B the treatment performed for bronchial obstruction was with classic maneuvers and for the strengthening of the respiratory muscles for flow incentive was used Respiron ® . Results: Both groups obtained improvement in the values ​​of the PiMáx after the different treatments. Group A obtained greater change in the intervals and a more significant increase of the values of the PiMax in relation to the average pre and post-treatment. However, when analyzing the variance and the standard deviation of the samples, group B presented the best results showing more homogeneity. Conclusions: The modern and traditional bronchial clearance techniques associated with inspiratory muscle training were equally effective in gaining inspiratory muscle strength with increased Pmax. In this way, the two can be used in the preoperative preparation of patients with chronic obstructive pulmonary disease and referred to abdominal operations.

RESUMO Racional: As operações abdominais podem alterar a função respiratória e aumentar a morbimortalidade dos operados com doença pulmonar obstrutiva crônica. Objetivo: Avaliar que técnica fisioterapêutica apresenta melhor efeito na força muscular inspiratória dos pacientes com doença pulmonar obstrutiva crônica no preparo pré-operatório em operações abdominais. Método: Estudo retrospectivo e documental usando o SINPE©, software de banco de dados clínicos de pacientes portadores de doença pulmonar obstrutiva crônica e candidatos a operações abdominais. A amostra foi composta de 100 homens com idade entre 55-70 anos, todos com DPOC com indicação para operação abdominal e que realizaram tratamento fisioterapêutico pré-operatório. Foram divididos em dois grupos de 50 indivíduos (grupo A e grupo B). No grupo A o tratamento realizado para a desobstrução brônquica foi com técnicas modernas e para fortalecimento dos músculos respiratórios foi realizado o Threshold IMT®. No grupo B o tratamento realizado para desobstrução brônquica foi com técnicas tradicionais e para fortalecimento dos músculos respiratórios foi realizado incentivador a fluxo Respiron®. Resultados: Ambos os grupos obtiveram melhora dos valores da PiMáx (Pressão inspiratória Máxima) após o tratamento com abordagens diferentes com melhora também nos intervalos da PiMáx. O grupo A obteve maior mudança nos intervalos e aumento mais significativo dos valores da PiMáx em relação à média pré e pós tratamento. Porém, ao analisar a variância e o desvio-padrão das amostras, o grupo B apresentou melhor distribuição que o grupo A mostrando que seus resultados na amostra foram mais homogêneos. Conclusões: As técnicas modernas e tradicionais de desobstrução brônquica associadas ao treinamento muscular inspiratório mostraram-se igualmente eficazes no ganho de força dos músculos inspiratórios com aumento da PiMáx. Dessa forma as duas podem ser utilizadas no preparo pré-operatório de pacientes com DPOC e encaminhados para operações abdominais.

Comparación de dos piezas bucales en la medición de PImáx y PEmáx en sujetos adultos / Comparison of two mouthpieces in the measurement of MIP and MEP in adults

Objetivos: Comparar y establecer el grado de acuerdo entre los valores de Presión Inspiratoria máxima (PImáx) y Presión Espiratoria máxima (PEmáx) medidos con pipeta bucal y boquilla de buceo, en adultos. El objetivo secundario fue evaluar el grado de acuerdo entre los valores calculados con las ecuaciones de Evans y Whitelaw y los valores máximos obtenidos con cada interfaz. Materiales y método: Se llevó a cabo un estudio observacional, descriptivo, prospectivo y transversal. Se realizó un muestreo consecutivo no probabilístico de sujetos argentinos entre 18 y 69 años de edad. Se midieron PImáx y PEmáx utilizando un sistema de válvulas unidireccionales y un manovacuómetro aneroide, con boquilla de buceo y pipeta bucal. Resultados: Se incluyeron 240 sujetos que completaron la totalidad de las mediciones con ambas interfaces. Los valores de PEmáx con pipeta bucal fueron mayores que los obtenidos con boquilla de buceo (p < 0.01), con un Coeficiente de Correlación Intraclase (ICC sigla en inglés) entre ambas de 0.80 (IC 95% 0.74-0.84). Para PImáx no hubo diferencias entre ambas interfaces, con un ICC de 0.88 (IC 95% 0.85-0.91). Los ICC para las ecuaciones de Evans y Whitelaw y los máximos valores alcanzados por los sujetos fueron de -0.15 a 0.09 mostraron un grado de acuerdo pobre. Conclusión: Los valores de PEmáx con pipeta bucal fueron mayores que los obtenidos con la boquilla de buceo. No se detectaron diferencias entre ambas interfaces para PImáx. En la población estudiada las fórmulas de Evans y Whitelaw no fueron exitosas en la predicción de presiones máximas.

Objectives: To compare and establish the degree of agreement between the values of Maximal Inspiratory Pressure (MIP) and Maximal Expiratory Pressure (MEP) measured with a plastic mouthpiece and a scuba type mouthpiece in adults. The secondary objective was to evaluate the degree of agreement between the values calculated with Evans and Whitelaw equation and the maximal values attained with each mouthpiece. Methods: We conducted an analytical observational transversal study. Sampling was non-probabilistic, of Argentinian subjects aged between 18 and 69 years old. We measured MIP and MEP with an unidirectional valves system and an aneroid manovacuometer, with a plastic mouthpiece and a scuba type mouthpiece. Results: 240 subjects were included and completed all the measurements with both mouthpieces. MEP values were higher when measured with a plastic mouthpiece than with the scuba type (p < 0.01), with an Intraclass Correlation Coefficient (ICC) between both of 0.80 (CI 95% 0.74-0.84). There were no differences in MIP between both mouthpieces, with an ICC of 0.88 (CI 95% 0.85-0.91). The ICC between Evans and Whitelaw predictive values and the maximal values attained by the subjects varied from -0.15 to 0.09, showing a poor degree of agreement. Conclusion: MEP values attained with a plastic mouthpiece are greater than those attained with a scuba type mouthpiece. There are no differences between both mouthpieces for MIP. Evans and Whitelaw equations are not successful in predicting maximal pressures in the population here studied.

Acute effects of different inspiratory resistive loading on heart rate variability in healthy elderly patients

BACKGROUND: The cardiovascular system is noticeably affected by respiration. However, whether different inspiratory resistive loading intensities can influence autonomic heart rate (HR) modulation remains unclear. OBJECTIVE: The objective was to investigate HR modulation at three different inspiratory resistive loading intensities in healthy elderly men. METHOD: This was a prospective, randomized, double-blind study that evaluated 25 healthy elderly men. Cardiac autonomic modulation was assessed using heart rate variability (HRV) indices. All of the volunteers underwent maximal inspiratory pressure (MIP) measurements according to standardized pulmonary function measurements. Three randomly-applied inspiratory resistive loading (30, 60 and 80% of MIP) intensities were then applied using an inspiratory resistance device (POWERbreathe, Southam, UK), during which the volunteers were asked to inhale for 2 seconds and exhale for 3 seconds and complete 12 breaths per minute. Each effort level was performed for 4 minutes, and HR and the distance between 2 subsequent R waves of electrocardiogram (R-R intervals) were collected at rest and at each intensity for further HRV analysis. RESULTS : The parasympathetic HRV (rMSSD, SD1 and HF) indices demonstrated lower values at 80% (rMSSD: 19±2 ms, SD1: 13±2 ms and HF: 228±61 ms2) than at 30% MIP (rMSSD: 25±3 ms, SD1: 18±2 ms and HF: 447±95 ms2; p<0.05). CONCLUSIONS: Lower inspiratory resistive loading intensities promoted a marked and positive improvement of parasympathetic sinus node modulation. .

Comparação entre o manovacuômetro nacional e o importado para medida da pressão inspiratória nasal / Comparison between a national and a foreign manovacuometer for nasal inspiratory pressure measurement

CONTEXTUALIZAÇÃO: A medida da pressão inspiratória nasal, conhecida como sniff teste, desenvolvida como um novo teste de força muscular inspiratória, utilizada principalmente em doenças neuromusculares, é de fácil realização e não invasiva. Apesar da importância clínica da avaliação da pressão inspiratória nasal, não existe um instrumento nacional disponível para realizá-la. OBJETIVOS: Comparar os manovacuômetros eletrônicos nacional e importado para a avaliação da pressão inspiratória nasal em pessoas saudáveis. MÉTODOS: Foram avaliados 18 voluntários saudáveis (idade 21,4±2,8 anos, IMC 23,4±2,5 Kg/m² , CVF 102,1±10,3 por centopred, VEF1 98,4±1 por centopred) por meio de duas medidas de pressão inspiratória nasal em dois equipamentos diferentes: um nacional e outro importado. Todos os sujeitos realizaram a manobra no mesmo horário do dia, em dias ocasionais, sendo a ordem determinada aleatoriamente. Para análise estatística, foi utilizado o teste t pareado, a correlação de Pearson e o Bland-Altman com nível de significância de 5 por cento. RESULTADOS: As médias encontradas durante as duas medidas das pressões nasais foram de 125±42,4 cmH2O para o aparelho importado e de 131,7±28,7 cmH2O para o nacional. A análise de Pearson demonstrou uma correlação significativa entre as médias, com um coeficiente r=0,63. Os valores médios não apresentaram diferenças significativas pelo teste t pareado (p>0,05). Na análise de Bland-Altman, encontrou-se um BIAS igual a 7 cm H2O, desvio-padrão de 32,9 cmH2O para o DP e um intervalo de confiança de -57,5 cmH2O até 71,5 cmH2O. CONCLUSÃO: Os resultados encontrados sugerem que o manovacuômetro eletrônico nacional é viável e seguro para realização do sniff teste em sujeitos saudáveis.

BACKGROUND: The measurement of nasal inspiratory pressure, known as the sniff test, was developed as a new test of inspiratory muscle strength, mainly used in neuromuscular conditions. The test is easy to be performed and noninvasive. Despite the clinical importance of assessment of nasal inspiratory pressure a national equipment is not available to assess it. OBJECTIVES: To compare a national with a foreign manovacuometer in assessing the nasal inspiratory pressure (sniff test) in healthy subjects. METHODS: 18 subjects were evaluated (age 21.44±2.8 years, BMI 23.4±2.5 kg/m² , FVC 102.1±10.3 percent pred, FEV1 98.4±1 percent pred). We performed two measures of nasal inspiratory pressure using two different manovacuometer: a national and a foreign. All subjects performed the tests at the same time of day, in different days being the order of the testes established randomly. It was used the paired t test, Pearson correlation and the Bland-Altman plots for statistical analysis considering a 5 percent significance level. RESULTS: The averages observed for the two measures of nasal pressures were 125±42.4 cmH2O for the foreign equipment, and 131.7±28.7 cmH2O for the national equipment. The Pearson correlation showed significant correlation between the means with a coefficient of r=0.63. The t test showed no significant differences between both measurements (p>0,05). The BIAS±SD found in Bland-Altman plot analysis was 7 cmH2O with limits of agreement between -57.5 cmH2O and 71.5 cmH2O. CONCLUSION: The results suggest that the national electronic device is feasible and safe to the sniff test measurement in healthy subjects.

Clinical Assessment of Rhinitis with Respiratory Pressure Meter / 소아알레르기및호흡기학회지

PURPOSE: Nasal stuffness is one of most common symptom in children who suffer from rhinitis although there is still debates at to the best measurable device. The aim of the study was to evaluate the sniff nasal inspiratory pressure (SNIP) with respiratory pressure meter and compare this with the clinical status of patients. METHODS: We enrolled 57 rhinitis patients who visited our hospital during June 2005 to July 2006. They were treated with intranasal steroid spray (mometasone furoate) for first 2 weeks. To evaluate the outcome of treatment, we used symptom score (SS) and measured the SNIP with respiratory pressure meter (Micro RPM, Micro Medical, Rochester, UK) and also measured peak nasal inspiratory flow (PNIF) with peak nasal inspiratory flow meter (Youlten peak flow meter, Clement Clarke Int., London, UK) before and after the therapy. Skin prick test was performed to all patient to classify the atopic (AR) and non-atopic rhinitis (NAR). RESULTS: Among 57 identified patients (median age, 7 years 9 months), 40 AR and 17 NAR were studied. Most patient showed clinically improvement with 2 weeks intranasal steroid therapy (0 wk SS=4.9, 2 wk SS=1.7 in AR; 0 wk SS=4.5, 2 wk SS=1.5 in NAR, P77.6 L/min, P>0.05). And there was no correlation between SNIP and PNIF measurement. CONCLUSION: The respiratory pressure meter is a useful device to evaluate the therapeutic effectiveness and clinical improvement in pediatric rhinitis patients.

The Relationships of Coughing to the Respiratory Muscle Strength and Pulmonary Compliance in Tetraplegic Patients

OBJECTIVE: To analyze the factors influencing the capacity of cough, the relationships between maximal respiratory pressure, lung compliance, capacity of cough, and assisted cough techniques were evaluated in tetraplegics. METHOD: The vital capacity (VC) in seated and supine position, maximum insufflation capacity (MIC), maximum inspiratory (MIP) and expiratory (MEP) pressure in seated position were measured. Unassisted and assisted peak cough flow (PCF) at two different conditions (a volume assisted method by the mechanical insufflation [PCFmic] and the manual assistance by abdominal compression [MPCF]) were evaluated in 44 tetraplegic patients. RESULTS: The mean value of VC in supine was greater than that of seated position (p<0.01). The MICs of the subjects were significantly higher than VCs in a same position (<0.01). Both volume and manual assisted method showed significantly higher PCF than unassisted PCF (p<0.01). MIP (r=0.53) correlated with UPCF as well as MEP (r=0.68), although MEP was better correlated with UPCF. CONCLUSION: Generally the therapists apply manual pressure only to increase capacity of cough, which assist the expulsive phase. The results of this study showed that both inspiratory and expulsive phases should be assisted to enhance the effectiveness of cough.