Body Positions Alter Hemodynamics and Respiration in Healthy Adults: A Systematic Review and Meta-Analysis.

Objective Different body positions can exert both positive and negative physiological effects on hemodynamics and respiration. This study aims to conduct a literature review and examine hemodynamic and respiratory alterations to different body positions.Methods The study protocol was registered with the International Prospective Registry of Systematic Reviews (register no. CRD42021291464). Two independent reviewers evaluated the methodological quality of all included studies using the Down and Black checklist, while the quality of evidence was evaluated using the Grading of Recommendations, Assessment, Development, and Evaluations approach. The overall effects of different body positions were reported from random effects meta-analysis.Results Three studies with low risk of bias and ten with high risk of bias met the eligibility criteria. The supine resulted in the highest cardiac output compared to the 70 deg head-up tilt, sitting, and standing positions (very low- to moderate-quality evidences) and the lowest systemic vascular resistance compared to the 70 deg head-up tilt and standing positions (moderate-quality evidence). Additionally, the supine was associated with the highest total respiratory resistance compared to the 70 deg head-up tilt, left lateral, and standing positions (very low-to moderate-quality evidence) and higher alveolar ventilation than the prone (low-quality evidence).Conclusions The supine position has the most positive association with hemodynamic variables, resulting in the highest cardiac output and the lowest systemic vascular resistance. The upright positions (70 deg head-up tilt and standing positions) has the most positive association with the respiratory variables, resulting in the lowest total respiratory resistance.

The effect of three-part breathing exercise on smoking cessation: A 6-month cluster-randomized clinical trial.

INTRODUCTION: Negative affect was identified as an important barrier to smoking cessation. Three-part breathing exercise showed a significant effect on decreasing negative affect immediately after being practiced. Thus, this study evaluated the effect of three-part breathing exercise on smoking cessation. METHODS: A 6-month cluster-randomized clinical trial was conducted. Forty-three participants recruited from 8 companies in Bangkok Metropolitan areas were randomly assigned at the cluster level into either the intervention or control groups. Control group (n = 23) received counseling for smoking cessation once a week for 12 weeks. Intervention group (n = 20) received counseling for smoking cessation plus a three-part breathing exercise program once a week for 12 weeks. The primary outcomes were 7-day point prevalence and continuous abstinence rate as validated by saliva cotinine. The secondary outcomes were cigarette cravings, nicotine withdrawal symptoms, affect and quality of life. RESULTS: The results revealed no significant difference in smoking abstinence rate between the three-part breathing exercise and control group. Participants demonstrated significant pre-post improvement in cigarette cravings, nicotine withdrawal symptoms, affect, and quality of life within each group. CONCLUSION: There were no statistically significant differences between the two groups. However, the improvement in abstinence rate from the three-part breathing exercise was deemed clinically relevant. Thus, it may be recommended to smokers interested in smoking cessation and more research is needed on this topic.

Effect of pursed-lip breathing and forward trunk lean positions on regional chest wall volume and ventilatory pattern in older adults: An observational study.

ABSTRACT: Pursed-lip breathing (PLB) and forward trunk lean posture (FTLP) are commonly used to relieve dyspnea and improve ventilation in a rehabilitation program. However, their effect on chest wall volumes and movements in older adults without chronic obstructive pulmonary disease has never been investigated. This observational study aimed to identify the effect of combined PLB and FTLP on total and regional chest wall volumes, ventilatory pattern, and thoracoabdominal movement using in older adults. It was hypothesized that the combined PLB with FTLP would result in the highest chest wall volumes among the experimental tasks. Twenty older adults performed 2 breathing patterns of quiet breathing (QB) and PLB during a seated upright (UP) position and FTLP. An optoelectronic plethysmography system was used to capture the chest wall movements during the 4 experimental tasks. Tidal volume (VT) was separated into pulmonary ribcage, abdominal ribcage, and abdomen volume. The changes in anterior-posterior (AP) and medial-lateral (ML) chest wall diameters at 3 levels were measured and used to identify chest wall mechanics to improve chest wall volumes. The PLB significantly improved ventilation and chest wall volumes than the QB (P < .05). VT of pulmonary ribcage, VT of abdominal ribcage, and VT were significantly higher during the PLB + UP (P < .05) and during the PLB + FTLP (P < .01) as compared to those of QB performed in similar body positions. However, there was no significant in total and regional lung volumes between the PLB + UP and the PLB + FTLP. The AP diameter changes at the angle of Louis and xiphoid levels were greater during the PLB + UP than the QB + UP and the QB + FTLP (P < .01). The AP diameter changes at the umbilical level and the ML diameter changes at the xiphoid level were significantly larger during the PLB + FTLP than the QB + FTLP and the QB + UP (P < .05). The ML diameter changes at the umbilical level were significantly greater during the PLB + FTLP than the QB + UP (P < .05). However, no significant difference in the relative regional chest wall volumes and phase angle among the experimental tasks (P > .05). In conclusion, a combined PLB performed in an FTLP or UP sitting could be used as a strategy to improve chest wall volumes and ventilation in older adults.

The effect of unsupported arm elevations on regional chest wall volumes and thoracoabdominal asynchrony in patients with chronic obstructive pulmonary disease.

OBJECTIVE: To compare the effect of unsupported arm elevation (UAE) in different planes on chest wall volumes, thoracoabdominal asynchrony (TAA), ventilatory demands, dyspnea, and arm fatigue in patients with chronic obstructive pulmonary disease (COPD) and healthy subjects. METHODS: Twenty-one patients with COPD and healthy-matched subjects performed UAE in shoulder flexion, scaption, abduction, and resting. Pulmonary total and regional chest wall volumes (VRCp), abdominal rib cage volume, abdominal volume, TAA, and ventilatory demands during arm positions were measured using optoelectronic plethysmography. RESULTS: In both groups, VRCp and TAA were significantly affected during UAEs compared with the resting position. The healthy subjects had significantly decreased VRCp (L) (p < 0.05) during scaption (0.14 ± 0.07) and abduction (0.15 ± 0.06) than during flexion (0.18 ± 0.07) and no significantly different TAA between UAEs. The COPD group had no significantly different VRCp between UAEs, had significantly increased TAA (p < 0.05) during scaption (31.1°±9.5°) and abduction (32.3°±9.9°) than during flexion (29.7°±9.1°); and had significantly worse VRCp (p = 0.007), TAA (p = 0.0001), ventilatory demands (p < 0.05), dyspnea ((p = 0.03), and arm fatigue (p = 0.002). CONCLUSIONS: In patients with COPD, UAE in different planes similarly restricted the upper chest wall volume. Shoulder scaption and abduction significantly impaired TAA, ventilation, dyspnea, and arm fatigue compared with flexion. These results may help to select the appropriate UAE during physical activities.

Effects of pursed-lip breathing and forward trunk lean postures on total and compartmental lung volumes and ventilation in patients with mild to moderate chronic obstructive pulmonary disease: An observational study.

ABSTRACT: This study identified the effects of pursed-lip breathing (PLB), forward trunk lean posture (FTLP), and combined PLB and FTLP on total and compartmental lung volumes, and ventilation in patients with chronic obstructive pulmonary disease (COPD). Sixteen patients with mild to moderate COPD performed 2 breathing patterns of quiet breathing (QB) and PLB during FTLP and upright posture (UP). The total and compartmental lung volumes and ventilation of these 4 tasks (QB-UP, PLB-UP, QB-FTLP, PLB-FTLP) were evaluated using optoelectronic plethysmography. Two-way repeated measures ANOVA was used to identify the effect of PLB, FTLP, and combined strategies on total and compartmental lung volumes and ventilation. End-expiratory lung volume of ribcage compartment was significantly lower in PLB-UP than QB-UP and those with FTLP (P < .05). End-inspiratory lung volume (EILV) and end-inspiratory lung volume of ribcage compartment were significantly greater during PLB-FTLP and PLB-UP than those of QB (P < .05). PLB significantly and positively changed end-expiratory lung volume of abdominal compartment (EELVAB ) end-expiratory lung volume, EILVAB, tidal volume of pulmonary ribcage, tidal volume of abdomen, and ventilation than QB (P < .05). UP significantly increased tidal volume of pulmonary ribcage, tidal volume of abdomen, and ventilation and decreased EELVAB, end-expiratory lung volume, and EILVAB than FTLP (P < .05). In conclusion, combined PLB with UP or FTLP demonstrates a positive change in total and compartmental lung volumes in patients with mild to moderate COPD.

The Effect of Breathing Exercise on Nicotine Withdrawal Symptoms, Cigarette Cravings, and Affect.

The aim of this study was to evaluate the effects of a single bout of controlled deep breathing and a "three-part breathing" exercise on nicotine withdrawal symptoms, cigarette cravings, and affect. A secondary aim was to determine whether autonomic nervous system activity mediates these effects. Twenty-four participants attended one practical session followed by three intervention sessions on 3 separate days: control condition, controlled deep breathing, and three-part breathing. Participants were asked to abstain from smoking for 15 hours before intervention. Nicotine withdrawal symptoms, cigarette cravings, affect, and heart rate variability were assessed preintervention and again on four occasions postintervention: immediately postintervention and every 10 minutes on three more occasions. Results revealed that the three-part breathing exercise resulted in lower negative affect scores relative to control condition and controlled deep breathing immediately after postintervention (p < .05). In addition, high-frequency heart rate variability score was significantly reduced throughout the 30-minute session.

Effects of Different Modes of Upper Limb Training in Individuals With Chronic Obstructive Pulmonary Disease: A Systematic Review and Meta-Analysis.

OBJECTIVE: To determine effects of different modes of upper limb training on dyspnea and quality of life of individuals with chronic obstructive pulmonary disease (COPD) having different disease severity. METHODS: Randomized clinical trials were retrieved from five electronic databases. Risk of bias and quality of evidence were assessed using the Cochrane Collaboration's tool and the GRADE approach, respectively. Effects of upper limb training compared to control were identified using standardized mean difference and 95% confidence interval. RESULTS: Fifteen studies with 514 subjects were included. When compared to control, upper limb endurance and strength training with moderate quality of evidence resulted in significant improvement in dyspnea. However, quality of life was not significantly different between upper limb training of all modes of and the control. The upper limb training was more effective in reducing dyspnea in patients with severe COPD than in those with mild to moderate levels of COPD. Although quality of life was slightly improved by upper limb training for those with moderate or severe level of COPD, such improvement did not reach a significant level when compared to the control. CONCLUSION: Upper limb endurance and strength training could significantly improve dyspnea in individuals with chronic obstructive pulmonary disease. Thus, incorporating the upper limb training into pulmonary rehabilitation is recommended to reduce dyspnea, especially for those with severe patients. Further studies with larger sample size and standardized training protocol are needed to confirm these finding (Registration No. CRD42018102805).

Effects of Breathing Exercises in Patients With Chronic Obstructive Pulmonary Disease: Systematic Review and Meta-Analysis.

OBJECTIVE: To update evidence on the effects of breathing exercises (BEs) on ventilation, exercise capacity, dyspnea, and quality of life (QoL) in chronic obstructive pulmonary disease (COPD) patients. METHODS: Randomized controlled trials investigating the effects of BEs in COPD patients published through May 2018, were retrieved from five electronic databases (MEDLINE, CINAHL, Cochrane, Scopus, and ScienceDirect). Risk of bias and quality of evidence were assessed, using Cochrane Collaboration's tool, and the Grading of Recommendation Assessment, Development, and Evaluation (GRADE) approach, respectively. RESULTS: Nineteen studies (n=745), were included. Quality of evidence, was low to moderate. When compared to the control groups, respiratory rate significantly (p≤0.001) improved in the pursed-lip breathing (PLB), ventilatory feedback (VF) plus exercise, diaphragmatic breathing exercise (DBE), and combined BEs. Additionally, PLB significantly improved tidal volume (p<0.001), inspiratory time (p=0.007), and total respiratory time (p<0.001). VF plus exercise significantly improved inspiratory capacity (p<0.001), and singing significantly improved the physical component of QoL, than did the control groups (p<0.001). All BEs did not significantly improve dyspnea, compared to the controls (p>0.05). CONCLUSION: PLB, VF plus exercise, DBE, combined BEs, and singing could be used to improve ventilation and QoL. Based on low to moderate quality of evidence, use of these BEs to improve ventilation and QoL in COPD patients is conditional (Registration No. CRD42018102995).

Total and Compartmental Chest Wall Volumes, Lung Function, and Respiratory Muscle Strength in Individuals with Abdominal Obesity: Effects of Body Positions.

Background: Abdominal obesity is a chronic condition that can contribute to impairments in lung function, leading to increased risks for respiratory-related diseases. Body position is an important technique that effectively restores and increases lung function and chest wall volumes. The objective of the current study was to examine the effects of the body positions on total and compartmental chest wall volumes, lung function, and respiratory muscle strength in individuals with and without abdominal obesity. Methods: Twenty obesity and twenty healthy males performed in four body position including sitting without and with back support, Fowler's, and supine positions. Each position was performed for five minutes. Chest wall volumes, lung function, and respiratory muscle strength were assessed in each position. Results: Sitting without and with back support resulted in higher total and rib cage compartmental chest wall volumes, lung function, and inspiratory muscle strength than Fowler's and supine positions in both groups (p < 0.001). Abdominal obesity subjects had significantly less total and compartmental chest wall volumes and lung function across four body positions than healthy subjects (p < 0.001). Respiratory muscle strength in the obesity group was less than that in the healthy control group (p > 0.05). Conclusions: This study provides new information regarding the effect of obesity and body position on chest wall volumes, lung function, and respiratory muscle strength. Among obesity individuals who are bedridden, sitting increases lung function, total and rib cage compartmental chest wall volumes, and inspiratory muscle strength-and would therefore likely to decrease the risk of respiratory-related disease-relative to Fowler's and supine positions.

Which Body Position Is the Best for Chest Wall Motion in Healthy Adults? A Meta-Analysis.

BACKGROUND: Chest wall motion is a vital component of the respiratory system. Body position changes disturb joint orientation around the chest wall and results in performance modifications of respiratory muscles and movement surrounding the rib cage and the abdomen. Body position is a priority treatment for preserving and promoting chest wall motion. The objective of the study was to conduct a meta-analysis to provide insight into which body position most effectively improves chest wall motion. METHODS: Medical literature databases were systemically searched up to January 31, 2018. Methodological quality was evaluated by using a checklist for measuring quality. A meta-analysis was performed to evaluate the effects of body positions on chest wall motion. The quality of evidence was judged by using the GRADE (Grades of Recommendation, Assessment, Development and Evaluation) approach. RESULTS: Six studies (5 high- and 1 low-quality) were identified. Our results showed that the sitting position provided greater improvement in chest-wall diameter changes and volume related to rib-cage function versus other body positions (very low to moderate evidence). The supine position demonstrated greater enhancement of chest-wall-diameter changes and volume in the part of the abdomen than the other body positions with very low to moderate evidence. CONCLUSIONS: The results of this review indicated that the sitting position improved the rib-cage compartment of the chest wall, whereas the supine position resulted in the superior enhancement in the part of the abdomen relative to other body positions. These changes in the body position could have some effect on the movements of the rib cage and abdomen and the variations in lung volumes, which need to be interpreted with caution when considering implementation in the clinical setting.

Effect of exercise type on smoking cessation: a meta-analysis of randomized controlled trials.

BACKGROUND: Exercise is one choice of additional treatment for smoking cessation by relieving nicotine withdrawal symptoms and smoking craving. The possible mechanism of the effect of exercise on relieving nicotine withdrawal symptoms and smoking craving is including affect, biological, and cognitive hypotheses. Evidence suggests that different types of exercise have different effects on these mechanisms. Therefore, type of exercise might have effect on smoking cessation. The purpose of this study is to systematically review randomized controlled trials to gain insight into which types of exercise are effective for smoking cessation. METHODS: Publications were systemically searched up to November 2016 in several databases (PubMed, ScienceDirect, PEDro, Web of Science, Scopus and Cochrane Library), using the following keywords: "physical activity", "exercise", "smoking", "tobacco" and "cigarette". The methodological quality was assessed independently by two authors. Meta-analysis was conducted to examine the effectiveness of the type of exercise on smoking cessation. The quality of the evidence was assessed and rated according to the GRADE approach. RESULTS: 20 articles on 19 studies were judged to meet the selection criteria (seven low-risk of bias RCTs and 12 high-risk of bias RCTs). The findings revealed low quality evidence for the effectiveness of yoga for smoking cessation at the end of the treatment. The evidence found for no effect of aerobic exercise, resisted exercise, and a combined aerobic and resisted exercise program on smoking cessation was of low to moderate quality. Furthermore, very low to low quality evidence was found for no effect of physical activity on smoking cessation. CONCLUSIONS: There was no effect of aerobic exercise, resisted exercise, physical activity and combined aerobic and resisted exercise on smoking cessation. There was a positive effect on smoking cessation at the end of treatment in the program where yoga plus cognitive-behavioral therapy (CBT) was used. However, which of the two work is still to be studied.

The effect of an acupressure backrest on pain and disability in office workers with chronic low back pain: A randomized, controlled study and patients' preferences.

OBJECTIVE: This study investigated the effects of an acupoint-stimulating lumbar backrest on pain and disability in office workers who suffering from low back pain (LBP) as well as the preference influence on pain and disability. METHODS: Sixty-four participants were randomly assigned to two groups: one with no intervention (n=32) and another with 1 month of backrest use (n=32). An additional group (n=37) who wished to try 1 month of acupressure backrest were recruited to indicate the preference effect. Pain and disability were two key outcomes. RESULTS: Significant differences between control and randomized acupressure backrest groups were found at 2 week period for disability and at 4 weeks for pain after the backrest use. Also, significant differences were found in both groups for 3 month period with an increase of the treatment effect on pain and disability. Both control and randomized acupressure backrest groups showed greater improvement in pain and disability scores which were more than the minimal clinically important change (30% improvement for both outcomes). No significant difference was found for pain and disability between the randomized and preferred backrest groups. CONCLUSION: These findings suggested 1-month of acupressure backrest use could improve LBP conditions. Preference was not a powerful moderator to the significant treatment effect.

Effects of smoking on chest expansion, lung function, and respiratory muscle strength of youths.

[Purpose] Smoking has a direct effect on the respiratory system. The rate of cigarette smoking among young people has continued to increase steadily. The present study quantified and compared the respiratory function of smoking and non-smoking youths. [Subjects] Smoking and non-smoking male participants aged between 15 to 18 years were recruited (n=34 per group). [Methods] Participants were asked to complete a questionnaire relating to smoking habits and the Fagerström test for nicotine dependence questionnaire, and their respiratory function was tested (measurement of chest expansion, lung function test with a spirometer, and assessment of respiratory muscle strength). [Results] All respiratory function tests demonstrated significant differences between the smoking and non-smoking groups. Smokers initiated cigarette smoking between the ages of 15 to 18 years. The most common duration of cigarette smoking was 1-3 years and the degree of nicotine dependence among the youths was at a low level. [Conclusion] This study's findings show that the early effects of cigarette smoking found in youths can lead to problems with the respiratory system. Such information can be used to illustrate the harm of smoking and should be used to encourage young people to quit or avoid cigarette smoking.

Effect of flexibility exercise on lumbar angle: a study among non-specific low back pain patients.

The study investigated the influence of lumbar flexibility exercise on the lumbar angle among patients with non-specific low back pain (LBP). Pre-experimental one-group pretest-posttest design trial was conducted at Health Service Center, Chulalongkorn University, Thailand. Thirty-five non-specific LBP patients with limitation in lower back range of motion and without neurological deficits were recruited (based on the LBP guidelines by RCGP 1999). Lumbar flexibility exercise program developed based on McKenzie therapy was performed individually each day for 2 weeks. Patients attended an exercise program daily in the first week under the supervision of a physiotherapist. The exercise program consisted of 7 sets a day (3-2-2 in the morning-afternoon-evening) in series of 10 repetitions for each set for 2 weeks. Lumbar angle was measured at the beginning and at the end of 2 weeks in order to determine the range of motion improved. The results indicated that the low back pain symptom improved as well as the angle.

Effects of human apolipoprotein A-I on endotoxin-induced leukocyte adhesion on endothelial cells in vivo and on the growth of Escherichia coli in vitro.

BACKGROUND: High-density lipoprotein (HDL) has been shown to inhibit leukocyte adhesion to endothelial cells induced by endotoxin in vivo and suppress the growth of bacteria in vitro; however, the components responsible for these effects, either lipids or proteins, are not yet defined. In this study, we examined the effects of apolipoprotein (apo) A-I, the major protein of HDL, on ameliorating the effect of endotoxin and inhibiting the growth of bacteria. MATERIALS AND METHODS: Apo A-I, purified from normal human HDL, was incubated with endotoxin. Leukocyte adhesion to endothelial cells of rat mesenteric venules was assessed using intravital fluorescence microscopy. Ability of apo A-I to inhibit the growth of Escherichia coli was assessed using a spread plate method. RESULTS: Purified, lipid-free apo A-I could inhibit endotoxin-induced leukocyte adhesion to endothelial cells in vivo in a dose-dependent manner. In addition, apoA-I was able to suppress the growth of Escherichia coli in vitro. CONCLUSIONS: These data suggest that apo A-I of HDL can directly interact with endotoxin, ameliorating its effect and that apo A-I may have a direct toxic effect on whole bacteria. Therefore, therapeutic use of apo A-I in septicemia and bacterial infection should be further explored.

High-density lipoproteins (HDL) inhibit endotoxin-induced leukocyte adhesion on endothelial cells in rats: effect of the acute-phase HDL.

High-density lipoprotein (HDL) plays an important role not only in protecting against atherosclerosis but also in innate immunity. Several lines of evidence showed that HDL could ameliorate the toxic effects of endotoxin or lipopolysaccharide (LPS). In this study, we examined whether HDL could inhibit LPS-induced leukocyte adhesion on endothelial cells in rats. Normal HDL and acute-phase HDL (AP-HDL) were purified from plasma of hamsters that received normal saline and LPS injection, respectively. Wistar rats were given LPS injection and the number of leukocytes adhering to endothelial cells of the mesenteric venules was determined using intravital fluorescence videomicroscopy. Intravenous injection of LPS enhanced leukocyte adhesion to the mesenteric venules. However, when LPS was preincubated with normal HDL, leukocyte adhesion on endothelial cells in response to LPS was significantly attenuated in a dose-dependent manner. AP-HDL was also able to significantly decrease LPS-induced leukocyte adhesion on endothelial cells. It appeared to be more effective than normal HDL since lower concentrations were required. This inhibitory effect of HDL was not due to HDL itself but it requires preincubation of HDL with LPS. When HDL was separated into protein and lipid fractions, it was found that lipid-free apoHDL was able to significantly inhibit LPS-induced leukocyte adhesion, whereas lipid component of HDL had no effect. In conclusion, HDL, both normal and acute-phase, could inhibit an inflammatory effect of LPS on endothelial cells in vivo. AP-HDL was more potent than normal HDL in inhibiting LPS-induced leukocyte adhesion, and this effect was attributed to the protein component of HDL.