and Optimal Breathing
There is so much confusion about healthy
breathing and its related oxygenation. The confusion stems largely due to:
A. Business can not patent
breathing. If it could we would be getting junk mail, TV ads and
see road signs about it.
B. Scientific research is based on using mice, monkeys, rats, cats and
dogs etc. None of which breathe like healthy humans.
C. Education overlooked it - MDs study less about healthy breathing in school
then they do about nutrition.
D. Reduction of autopsy rates from 40% in 1940 to 15% in
1999 effectively eliminate longitudinal studying of long term health
implications. Cost and so called lack of need was sited. How well developed or
deteriorated was the person's diaphragm at time of death? No autopsy
makes it far too easy for MDs get to bury their mistakes and miss out on the
lessons of post mortem investigation.
"Advances in diagnostic technology have not diminished the value of
autopsy. The discordance between the clinical cause of death and postmortem
diagnosis was 19.8%. In 44.4% of the discordant cases, knowledge of the
correct diagnosis would have altered therapy. Postmortem study can serve as
a valuable monitor of quality control in diagnostic accuracy of MICU
patients." CHEST 119(2):530-536, 2001. © 2001 ACCP]
Clinical studies including thousands
of participants spanning a 30-year period offer persuasive evidence that
the most significant factor in health and longevity is how well you
1. The Framingham study focused on the long-term predictive power of vital
capacity and forced exhalation volume as the primary markers for life
"This pulmonary function measurement appears to be an indicator of
general health and vigor and literally a measure of living capacity".
Wm B. Kannel and Helen Hubert.
These researchers were able to foretell how long a person was going to
live by measuring forced exhalation breathing (flow rate) aka FEV1 and
hypertension. We know that much of hypertension is controlled by the
way we breathe.
"Long before a person becomes terminally ill, vital capacity can
predict life span." William B. Kannel of Boston School of Medicine
(1981) stated, "The Framingham examinations' predictive powers were
as accurate over the 30-year period as were more recent exams." The
study concluded that vital capacity falls 9 percent to 27 percent each decade depending on age, sex and the time the
test is given. The study's shortcoming was in suggesting that vital
capacity cannot be maintained and or increased, even in severe cases of
chronic obstructive pulmonary disease.
Any opera (not necessarily voice) teacher will support the idea that
breathing volume can be increased. Yet activities such as singing or
sports are no guarantee of optimal breathing. In fact, they can even
invite breathing blocks from gasping, forcing the exhale and breath
heaving. You don't have to learn how to sing to have a huge pair of lungs.
But you DO need to know how to breathe. I maintain that if you train
someone to breathe correctly, they will naturally know how to sing. I have
never seen it fail.
Most of scientific research is and was done with rats and primates
who do not breathe the same as humans. Researchers did not seem to believe
at that time that one could improve one's breathing. Many still do not
believe one can improve one's breathing. This is simply not true.
2. 29 years after the
study, the same conclusions prevail.
Lung Function May Predict Long Life Or Early Death
How well your lungs function may predict how long you live. This finding
is the result of a nearly 30-year follow-up of the association between
impaired pulmonary function and all causes of mortality, conducted by
researchers at the University at Buffalo. Results of the study appear in
the September issue of Chest.
The purpose of the current study was to investigate the association
between pulmonary function and mortality for periods that extended past 25
years, the limit of previous studies. Dr. SchÃ¼nemann and colleagues
also wanted to determine for how long pulmonary function is a significant
predictor of mortality.
Results showed that lung function was a significant predictor of longevity
in the whole group for the full 29 years of follow-up. "It is
important to note that the risk of death was increased for participants
with moderately impaired lung function, not merely those in the lowest
quintile," Dr. Schanemann said. "This suggests that the
increased risk isn't confined to a small fraction of the population with
severely impaired lung function."
The reasons lung function may predict mortality are not clear, Dr.
Schunemann said, noting that increased risk is found in persons who never
smoked, as well as among smokers.
"The lung is a primary defense organism against environmental toxins.
It could be that impaired pulmonary function could lead to decreased
tolerance against these toxins. Researchers also have speculated that
decreased pulmonary function could underlie an increase in oxidative
stress from free radicals, and we know that oxidative stress plays a role
in the development of many diseases."
Dr. Schanemann said the fact that a relationship does exists between lung
function and risk of death should motivate physicians to screen patients
for pulmonary function, even if more research is needed to determine why.
"It is surprising that this simple measurement has not gained more
importance as a general health assessment tool," he noted.
HJ, Dorn J, Grant BJB, Winkelstein W, Jr., Trevisan M. Pulmonary Function
Is a Long-term Predictor of Mortality in the General Population 29-Year
Follow-up of the Buffalo Health Study. Chest 2000;118(3)656-664.
From Mike: "Surprising" puts it mildly!
3. Decline in FEV1
by age and smoking status: facts, figures and fallacies. Thorax 1997
This study shows the importance of longitudinal studies as opposed to
cross sectional ones."
This published article focused on a compilation of 83 published reports
and clinical studies showing clearly that the primary measurement for lung
function -FEV1 - is based on cross sectional data instead of longitudinal
data. This means essentially that they include sick people with widely
diverse circumstances in their statistics and compile everyone's data for
This 1997 research paper points out that; (italics mine) "from one
low measurement of FEV1 (forced exhalation volume) in an adult, it is
impossible to determine whether the reduced lung function is due to not
having achieved a high maximum during early adulthood, or to having an
accelerated rate of decline or to any combination of these."
"Western medical studies, via cross sectioning, continue to look for role modeling epidemiological
"norms" that include the ranks of the ill. Cross sectioning is
60% effective and proven by many to be ineffective over the last 40
The health professional's opinion can have immense personal, social,
legal, and economic consequences. When it is based on information colored
by sick or otherwise non-optimum healthy or inappropriately chosen
individuals, the statistic(s) become weighted in favor of, or excessively
influenced by, illness or what is perceived as illness, and may well be in
reality, simple mechanical dysfunction. Cross sectional studies can bring
the averages down and cause many who do not need the intensity, duration
or style of treatment recommended by many health practitioners to be over
or under medicated, or inappropriately fed, exercised, massaged or
We need to focus on how to improve breathing, not on how it became
impaired. Dwelling too much on problems and pathology gets in the way of
creativity and flexibility.
4. The von Ardenne studies focused on
oxygen's relationship to most major categories of illness. When
your blood oxygen goes way down, you get sick,
die or at least shorten your life span. This book is a masterful
compilation of clinical insights and variations on breathing assessments,
cofactors and some techniques of breathing development called Oxygen
Multistep Therapy Dr. Manfred von Ardenne was a student of Dr. Otto
Warburg. Warburg received the 1931 Nobel Prize for proving that cancer is anaerobic; it cannot
survive in a high oxygen environment. Germs, fungi and bacteria are
anaerobic as well. von Ardenne was also inspired by Karl Lohmann who
discovered adenosine triphosphate, ATP, which many believe to be the human
bodyâ€™s main energy currency. von Ardenne was an electron physicist
who in addition to his interest in astronomy, developed quite a good
reputation for cancer research . He went on to develop a process he called
Oxygen Multistep Therapy. In his book of the same name Dr. von
Ardenne addressed some 150 respiratory and blood gas aspects including
elements of what we might call respiratory psychophysiology.
Some studies addressed in the book are:
Dependence of O2 uptake at rest.
The O2 deficiency pulse reaction as a warning sign of a life-threatening
crisis, and the lasting remedying of the crisis.
Procedures that influence and measure increases and decreases in arterial
and venous O2 blood levels.
The necessary physical exercise to attain a training effect (which is less
than you might expect).
Increases in brain circulation during physical strain.
Rate of blood flow
in the circulation of the organs.
Various examples in changes of O2
uptake. Heart minute volume and blood flow of the organs decisive for O2
Relation of ATP concentrations in rat brains as a function of
the oxygen partial pressure of the inspired air.
He graphed much of his
research. Other cofactors that influence lung volume are airways
hyper-responsiveness, atopy, childhood respiratory infections, air pollution, posture,
subluxation of the spine, exercise, deep and superficial fascia,
nutrition, occupational hazards, abuse and trauma, attitude, and age,
height, weight and sex.
The Manfred von Ardenne studies are best obtained by getting his book
called Oxygen Multistep Therapy. His material is good but remains
primarily within the illness model instead of the wellness model.
Effects of Obesity on Respiratory Resistance (increased force required to
breathe and shortness of breath). Chest 1993 May,103(5):1470-1476. These
findings suggest that in addition to the elastic load, obese subjects have
to overcome increased respiratory resistance from the reduction in lung
related to being overweight.
6. Numerous measurements have shown that the low pO2art resulting
from stressful events of following degeneration of the lung heart
system (LHS) in old age can be re-elevated up to high values.
Manfred von Ardenne - Stress
1981 Vol 2 Autumn.
of death from all causes. Kauffmann F, Annesi I, Chwalow J
-Epidemiological Research Unit INSERM U 169, Villejuif, France.
European Respiratory Journal 1997 Nov; 10(11):2508-2514 In
other words there are ways of your telling yourself how good your
breathing is and what you observe is related to how long you may live due
to good or bad breathing.
8. Breathe Well Be Well. Robert
Fried, Ph D. A strong collection of 18 years working with correlating
hyperventilation and its relationship to many illnesses never before
linked to poor breathing.
"There are varying
reports of its [dysfunctional breathing] frequency in the population at
large, ranging between 10 percent and 25 percent. It has been estimated
to account for roughly 60 percent of emergency ambulance calls in major
US city hospitals." Fried, R. Breathe well, be well. New York: John
Wiley Sons, 1999, p. 45.
Alternative healthcare; Anger management; Athletic coaching;
Biofeedback; Chiropractic; Corporate training; Counseling; Dentistry;
Drug rehabilitation; Education (all levels); Fitness training; Flight
training (aviation); Occupational therapy; Orthodontics; Pain
management; Peak performance training; Performance at large; Performing
arts; Personal coaching; Personal enhancement; Psychology; Public
speaking; Medicine; Meditation; Midwifery (pregnancy); Neurofeedback;
Nursing; Physical therapy; Respiratory therapy; Self-regulation
learning; Skill acquisition; Social work; Speech therapy; Stress
management; Trauma and PTSD; Yoga
9. Dr. Otto Warburg received the 1931 Nobel
price for proving that cancer is anaerobic. It does not survive
in high concentrations of oxygen.
MORE HEALTHY BREATHING COFACTORS
HOW IS THE FOLLOWING RELATED TO WARBURG?
A crucially important factor in breathing is the exhale, which is
longer than the inhale. But contemporary lung volume measurements are
inconsistent and guided by cross sectional criteria instead of
longitudinal data and therefore do not adequately predict decline within
This lack of insight about optimal functioning can cause people to be
trained to do forced inhalations that may actually be harmful in long
Dr. Warburg and cancer. Cancer all other diseases, has countless
secondary causes. But, even for cancer, there is only one prime cause.
Summarized in a few words, the prime cause of cancer is the replacement
of the respiration of oxygen in normal body cells by a fermentation of
sugar. All normal body cells meet their energy needs by respiration of
oxygen, whereas cancer cells meet their energy needs in great part by
fermentation. All normal body cells are thus obligate aerobes, whereas
all cancer cells are partial anaerobes. From the standpoint of the
physics and chemistry of life this difference between normal and cancer
cells is so great that one can scarcely picture a greater difference.
Oxygen gas, the donor of energy in plants and animals is dethroned in
the cancer cells and replaced by an energy yielding reaction of the
lowest living forms, namely, a fermentation of glucose. Cancer cells can
survive in low oxygen environments. More about cancer
Birmingham assessment of breathing study
BACKGROUND: Current international
resuscitation guidelines for lay people rely on the assessment of
"normal breathing" as a key sign of breathing and circulation. However,
it is not known how accurately laypersons can discriminate between
"normal" and "abnormal" breathing. The aim of this study was to test the
ability of medical students to discriminate between simulated normal and
abnormal breathing patterns and select the correct treatment. METHODS:
Six video clips of simulated breathing were recorded showing: normal;
abnormal -shallow, rapid, agonal (obstructed and unobstructed airways);
or absent breathing. The clips were validated by three experienced
emergency practitioners and then shown in a random order to 48
second-year medical students. For each clip observers were asked to
indicate: "Is this patient breathing?" (yes-normal, yes-abnormal, no)
and "What action would you take?" (rescue breathing or recovery
position). RESULTS: All experts correctly identified the breathing type
and agreed on an appropriate emergency action. Students identified
normal breathing as: normal 61%, abnormal 33% and absent 6%; abnormal
breathing as: normal 29%, abnormal 61%, absent 10%; and absent breathing
as: normal 8%, abnormal 6%, absent 85%. Correct actions were selected in
86% during normal breathing, 51% during abnormal breathing and 86%
during absent breathing. The sensitivity for observers correctly
identifying normal from abnormal breathing was 60% and specificity 75%
and for selecting the correct action was 42% and 80%, respectively.
CONCLUSIONS: Medical students were unable to identify normal
breathing from abnormal breathing reliably resulting in a high number of
inappropriate, potentially harmful actions. Further evaluation of the
optimal method for assessing for signs of breathing and circulation is
required. Publication Types: Evaluation Studies
Keywords: abnormal breathing, normal breathing, absent breathing,
medical students, from abnormal, discriminate between, breathing,
normal, abnormal, absent, students, action, medical, correct
Authored by Perkins GD, Stephenson B, Hulme J, Monsieurs KG. Division of
Medical Sciences, University of Birmingham, Birmingham B152TT, UK.
One of the Reasons we like slower breathing rates.
Slow breathing reduces chemoreflex response
to hypoxia and hypercapnia, and increases baroreflex sensitivity.
investigate whether breathing more slowly modifies the sensitivity of
the chemoreflex and baroreflex. DESIGN SETTING: University of Pavia,
IRCCS Policlinico S. Matteo. PARTICIPANTS: Fifteen healthy individuals.
INTERVENTIONS: Progressive isocapnic hypoxia and progressive hyperoxic
hypercapnia were measured during spontaneous breathing and during a
breathing rate fixed at 6 and 15 breaths per minute (b.p.m.). Main
outcome measures: Variations in chemo- and baroreflex sensitivity (by
monitoring ventilation, oxygen saturation, end-tidal carbon dioxide, R-R
interval and blood pressure) induced by different breathing rates.
RESULTS: Breathing at 6 b.p.m. depressed (P < 0.01) both hypoxic and
hypercapnic chemoreflex responses, compared with spontaneous or 15 b.p.m.
controlled breathing. Hypoxic and hypercapnic responses during
spontaneous breathing correlated with baseline spontaneous breathing
rate (r = -0.52 and r = +0.51, respectively; P = 0.05). Baroreflex
sensitivity was greater (P < 0.05) during slow breathing at baseline and
remained greater at end rebreathing. CONCLUSIONS: Slow breathing
reduces the chemoreflex response to both hypoxia and hypercapnia.
Enhanced baroreflex sensitivity might be one factor inhibiting the
chemoreflex during slow breathing. A slowing breathing rate may be of
benefit in conditions such as chronic heart failure that are associated
with inappropriate chemoreflex activation.
Keywords: slow breathing, baroreflex sensitivity, breathing rate,
spontaneous breathing, during slow, during spontaneous, breathing,
chemoreflex, spontaneous, baroreflex, sensitivity
Authored by Bernardi L, Gabutti A, Porta C, Spicuzza L. Department of
Internal Medicine, University of Pavia and IRCCS Ospedale S. Matteo,
Pavia, Italy. email@example.com
Our recommendation. Fundamentals ALL plus Diaphgram Strengthener.
“Systems” disorder. More evidence for a holistic
Mathematical models of periodic breathing and their usefulness in
understanding cardiovascular and respiratory disorders.
Periodic breathing is an
unusual form of breathing with oscillations in minute ventilations and
with repetitive apnoeas or near apnoeas. Reported initially in patients
with heart failure or stroke, it was later recognized to occur
especially during sleep. The recurrent hypoxia and surges of sympathetic
activity that often occur during the apnoeas have serious health
consequences. Mathematical models have helped greatly in the
understanding of the causes of recurrent apnoeas. It is unlikely that
every instance of periodic breathing has the same cause, but many result
from instability in the feedback control involved in the chemical
regulation of breathing caused by increased controller and plant gains
and delays in information transfer. Even when it is not the main cause
of the periodic breathing, unstable control modifies the ventilatory
pattern and sometimes intensifies the recurrent apnoeas. The
characteristics of disturbances to breathing and their interaction with
the control system can be critical in determining ventilation responses
and the occurrence of periodic breathing. Large abrupt changes in
ventilation produced, for example, in the transition from waking to
sleep and vice versa, or in the transition from breathing to apnoea, are
potent factors causing periodic breathing. Mathematical models show that
periodic breathing is a 'systems disorder' produced by the
interplay of multiple factors. Multiple factors contribute to the
occurrence of periodic breathing in congestive heart failure and
cerebrovascular disease, increasing treatment options.
Keywords: periodic breathing, multiple factors, transition from,
mathematical models, heart failure, recurrent apnoeas, breathing,
periodic, apnoeas, factors, control, recurrent
Authored by Cherniack NS, Longobardo GS. New Jersey Medical School UMDNJ,
185 South Orange Avenue, PO Box 1709, Newark NJ 07101-1709, USA.
of respiratory deterioration was significantly predictive of death
from all causes. Kauffmann F, Annesi I, Chwalow J -Epidemiological
Research Unit INSERM U 169, Villejuif, France. European Respiratory
Journal 1997 Nov; 10(11):2508-2514 . In other words there are ways of
your telling yourself how good your breathing is and what you observe is
related to how long you may live due to good or bad breathing. The
Breathing Tests, OB Breathing Skills, UDB check sheet and Breathing
Awareness check sheet in the 4 Week program are our choices for this.
14. The role of inspiratory muscle function (we use our
Diaphragm Strengthener and singing exercises in the OBV ) and training
in the genesis of dyspnoea in asthma and COPD.
IMT offers a relatively
accessible non-pharmacological treatment for dyspnoea that also improves
exercise tolerance and quality of life.
Authored by McConnell AK. Sport
Sciences Department, Brunel University, Uxbridge, Middlesex UB8 3PH, UK.
15. Possible Non
invasive method of measuring diaphragm development.
Diaphragm Paralysis Definitively Diagnosed by
Ultrasonography and Postural Dependence of Dynamic Lung Volumes after
Seven Decades of Dysfunction.
paralysis is an important and often unrecognized cause of dyspnea. In
patients with appropriate risk factors, such as prior head and neck
surgery and presentation of positional dyspnea or dyspnea on submersion,
unilateral diaphragmatic paralysis should be considered. We present our
approach to the diagnosis of diaphragm paralysis and demonstrate the
utility of upright/supine spirometry and M-mode ultrasonography in these
Keywords: diaphragm paralysis, dyspnea, paralysis
Authored by Patel AS, O'donnell C, Parker MJ, Roberts DH. Beth Israel
Deaconess Medical Center and Harvard Medical School, Boston,
16. Breathing Resistance training such
as with the Diaphgram Strengthener not only develops the diaphragm but
other muscles as well.
The influence of inspiratory muscle work
history and specific inspiratory muscle training upon human limb muscle
The purpose of this
study was to assess the influence of the work history of the inspiratory
muscles upon the fatigue characteristics of the plantar flexors (PF). We
hypothesized that under conditions where the inspiratory muscle
metaboreflex has been elicited, PF fatigue would be hastened due to
peripheral vasoconstriction. Eight volunteers undertook seven test
conditions, two of which followed 4 week of inspiratory muscle training
(IMT). The inspiratory metaboreflex was induced by inspiring against a
calibrated flow resistor. We measured torque and EMG during isometric PF
exercise at 85% of maximal voluntary contraction (MVC) torque.
Supramaximal twitches were superimposed upon MVC efforts at 1 min
intervals (MVC(TI)); twitch interpolation assessed the level of central
activation. PF was terminated (T(lim)) when MVC(TI) was <50% of baseline
MVC. PF T(lim) was significantly shorter than control (9.93 +/- 1.95
min) in the presence of a leg cuff inflated to 140 mmHg (4.89 +/- 1.78
min; P = 0.006), as well as when PF was preceded immediately by
fatiguing inspiratory muscle work (6.28 +/- 2.24 min; P = 0.009).
Resting the inspiratory muscles for 30 min restored the PF T(lim) to
control. After 4 weeks, IMT, inspiratory muscle work at the same
absolute intensity did not influence PF T(lim), but T(lim) was
significantly shorter at the same relative intensity. The data are the
first to provide evidence that the inspiratory muscle metaboreflex
accelerates the rate of calf fatigue during PF, and that IMT attenuates
Keywords: inspiratory muscle, muscle work, significantly shorter, muscle
metaboreflex, inspiratory muscles, inspiratory, muscle, metaboreflex,
Authored by McConnell AK,
Lomax M. Centre for Sports Medicine and Human Performance, Brunel
University, Uxbridge UB8 3PH, UK.
17. Detecting Hidden
Breathing Related Disorders
The prevalence of dysfunctional breathing
in adults in the community with and without asthma.
Functional breathing problems, including symptomatic hyperventilation,
may impair quality of life. Symptoms associated with functional
breathing disorders have been reported as being common in secondary care
settings, and can affect 29% of adults with current asthma in the
community. The prevalence of dysfunctional breathing in the general
adult population is unknown. The Nijmegen Questionnaire has been
reported to have useful sensitivity and specificity for diagnosing
dysfunctional breathing. A cross-sectional postal survey of adults
without current asthma was undertaken in a single UK general practice.
The results were analyzed in conjunction with a previously described
survey of adults with current asthma from the same population. The
questionnaire was posted to a random sample of 300 people aged 16-65
without current asthma, and 69% were returned. 8% (95% confidence
intervals 4-12%) had positive screening scores. Positive screening
scores were more common in women (14%, 7-20%) than men (2%, 0-5%,
p=0.003). Comparison with the previous survey showed that the prevalence
of positive screening scores was higher in those with current asthma
than those without (29% vs. 8%, p<0.001). Dysfunctional breathing may
affect up to one in 10 people, and is more common in women and in people
Keywords: current asthma, screening scores, positive screening,
dysfunctional breathing, with current, adults with, more common, without
current, been reported, functional breathing, asthma, breathing,
current, positive, scores, screening, people, dysfunctional, common,
Authored by Thomas M, McKinley RK, Freeman E, Foy C, Price D. GPIAG
Clinical Research Fellow, Department of General Practice and Primary
Care, University of Aberdeen, UK
From Mike: they say it is
10%. We believe it is a lot closer to 80% but at least they are alluding
to the possibility of problems yet to be diagnosed.
18. Inspiratory muscle training:
This article provides a critical review of
inspiratory muscle training (IMT) in chronic obstructive pulmonary
disease (COPD). Although extensive research on
IMT has accumulated, its benefits have been debated, primarily because
of methodological limitations of studies. Using relevant key words,
multiple databases were searched from 1966. Selected studies used PImax
(maximal inspiratory pressure) as an outcome variable. Overall, research
demonstrated that a standard protocol of 30% or higher for a duration of
20 to 30 minutes per day for 10 to 12 weeks improves dyspnea and
inspiratory strength and endurance with either inspiratory resistive or
inspiratory threshold training. Regardless of method, IMT protocols for
people with COPD and inspiratory muscle weakness and dyspnea are
generally safe, feasible, and effective. Patient selectivity and study
of subgroups are recommended.Our
Keywords: inspiratory muscle, inspiratory
Authored by Padula CA, Yeaw E. University of Rhode Island, College of
Nursing, Kingston, RI 02881, USA.
19. This refers to the wisdom of
moderation in exercise and another reason I do not like the cardiac
stress test it being so severe.
muscle work causes reflex reduction in resting leg blood flow in humans.|
1. We recently showed that fatigue of the inspiratory muscles via
voluntary efforts caused a time-dependent increase in limb muscle
sympathetic nerve activity (MSNA) (St Croix et al. 2000). We now asked
whether limb muscle vasoconstriction and reduction in limb blood flow
also accompany inspiratory muscle fatigue. 2. In six healthy human
subjects at rest, we measured leg blood flow (.Q(L)) in the femoral
artery with Doppler ultrasound techniques and calculated limb vascular
resistance (LVR) while subjects performed two types of fatiguing
inspiratory work to the point of task failure (3-10 min). Subjects
inspired primarily with their diaphragm through a resistor, generating (i)
60 % maximal inspiratory mouth pressure (P(M)) and a prolonged duty
cycle (T(I)/T(TOT) = 0.7); and (ii) 60 % maximal P(M) and a T(I)/T(TOT)
of 0.4. The first type of exercise caused prolonged ischaemia of the
diaphragm during each inspiration. The second type fatigued the
diaphragm with briefer periods of ischaemia using a shorter duty cycle
and a higher frequency of contraction. End-tidal P(CO2) was maintained
by increasing the inspired CO(2) fraction (F(I,CO2)) as needed. Both
trials caused a 25-40 % reduction in diaphragm force production in
response to bilateral phrenic nerve stimulation. 3. .Q(L) and LVR were
unchanged during the first minute of the fatigue trials in most
subjects; however, .Q(L) subsequently decreased (-30 %) and LVR
increased (50-60 %) relative to control in a time-dependent manner. This
effect was present by 2 min in all subjects. During recovery, the
observed changes dissipated quickly (< 30 s). Mean arterial pressure
(MAP; +4-13 mmHg) and heart rate (+16-20 beats min(-1)) increased during
fatiguing diaphragm contractions. 4. When central inspiratory motor
output was increased for 2 min without diaphragm fatigue by increasing
either inspiratory force output (95 % of maximal inspiratory pressure
(MIP)) or inspiratory flow rate (5 x eupnoea), .Q(L), MAP and LVR were
unchanged; although continuing the high force output trials for 3 min
did cause a relatively small but significant increase in LVR and a
reduction in .Q(L). 5. When the breathing pattern of the fatiguing
trials was mimicked with no added resistance, LVR was reduced and .Q(L)
increased significantly; these changes were attributed to the negative
feedback effects on MSNA from augmented tidal volume. 6. Voluntary
increases in inspiratory effort, in the absence of diaphragm fatigue,
had no effect on .Q(L) and LVR, whereas the two types of
diaphragm-fatiguing trials elicited decreases in .Q(L) and increases in
LVR. We attribute these changes to a metaboreflex originating in the
diaphragm. Diaphragm and forearm muscle fatigue showed very similar
time-dependent effects on LVR and .Q(L). Publication Types: Research
Support, U.S. Gov't, P.H.S
Keywords: time dependent, diaphragm fatigue, force output, fatiguing
trials, these changes, were unchanged, duty cycle, limb muscle, blood
flow, muscle fatigue, maximal inspiratory, diaphragm, inspiratory,
fatigue, subjects, trials, increased, fatiguing, muscle, caused,
changes, force, output, pressure, reduction, maximal, types, dependent
Authored by Sheel AW, Derchak PA, Morgan BJ, Pegelow DF, Jacques AJ,
Dempsey JA. Department of Population Health Sciences, John Rankin
Laboratory of Pulmonary Medicine, University of Wisconsin-Madison,
Madison, WI, USA. firstname.lastname@example.orgA
20. Points to the wisdom
of practicing some kind of warm up. We recommend our OB Fundamentals
exercises) prior to strenuous exercise.
Effect of specific inspiratory muscle
warm-up on intense intermittent run to exhaustion.
The effects of inspiratory muscle (IM) warm-up on the maximum dynamic IM
function and the maximum repetitions of 20-m shuttle run (Ex) in the
Yo-Yo intermittent recovery test were examined. Ten men were recruited
to perform identical IM function test and exercise test in three
different trials randomly. The control trial was without IM warm-up
while the placebo and experimental trials were with IM warm-up by
performing two sets of 30 breaths with inspiratory pressure-threshold
load equivalent to 15% (IMW(P)) and 40% (IMW) maximum inspiratory mouth
pressure, respectively. In IMW, maximum dynamic IM functions including
the maximal inspiratory pressure at zero flow (P0) and maximal rate of
P0 development (MRPD) were increased compared with control values (P <
0.05). The Ex was also augmented [mean (SD)] [19.5% (12.6)] while the
slope of the linear relationship of the increase in rating of perceived
breathlessness for every 4th exercise interval (RPB/4i) was reduced (P <
0.05). In IMW(P), although increase in Ex and reduction in RPB/4i were
occurred concomitantly in some subjects, the differences in Ex, RPB/4i
and dynamic IM functions between control and IMW(P) trials were not
statistically significant. For the changes (Delta) in parameters in IMW
and IMW(P) (n = 20), negative correlations were found between Delta RPB/4i
and Delta Ex (r = -0.92), DeltaP0 and Delta RPB/4i (r = -0.48), and
Delta MRPD and Delta RPB/4i (r = -0.54). Such findings suggested that
the specific IM warm-up in IMW may entail reduction in breathlessness
sensation, partly attributable to the enhancement of dynamic IM
functions, in subsequent exhaustive intermittent run and, in turn,
improve the exercise tolerance. Publication Types: Randomized Controlled
Keywords: inspiratory pressure, trials were, maximum dynamic, delta,
inspiratory, dynamic, maximum, functions, pressure, trials, exercise,
Authored by Tong TK, Fu FH. Dr. Stephen Hui Research Centre for Physical
Recreation and Wellness, NAB210, L2, David C. Lam Building Shaw Campus,
Hong Kong Baptist University, Kowloon Tong, Hong Kong, China.
21. Points to the wisdom of use
several factors to assess optimal breathing. Our recommendation is the
Optimal Breathing Skills.
The Value of Multiple
Tests of Respiratory Muscle Strength.
BACKGROUND: Respiratory muscle weakness is an important clinical
problem. Tests of varying complexity and invasiveness are available to
assess respiratory muscle strength. The relative precision of different
tests in the detection of weakness is less clear, as is the value of
multiple tests. Methods & PATIENTS: We analyzed the respiratory muscle
function tests of clinical referrals who had multiple tests assessed in
our laboratories over a 6 year period. Thresholds for weakness for each
test were determined from published and in-house laboratory data. The
patients were divided into three groups; those who had all relevant
measurements of global inspiratory muscle strength (group A, n=182),
those with full assessment of diaphragm strength (group B, n=264), and
those for whom expiratory muscle strength was fully evaluated (group C,
n=60). We studied the diagnostic outcome of each inspiratory, diaphragm
and expiratory muscle test, both singly and in combination, and
calculated the impact of using more than one test to detect weakness.
RESULTS: The clinical referrals were primarily for the evaluation of
neuromuscular diseases and dyspnoea of unknown cause. A low maximal
inspiratory mouth pressure (PImax) was recorded in 40.1% of referrals in
group A, while a low sniff nasal pressure (Sniff Pnasal) was recorded in
41.8% and a low sniff oesophageal pressure (Sniff Poes) in 37.9%. When
assessing inspiratory strength with the combination of all three tests
29.6% of patients had weakness. Using the two non-invasive tests, PImax
and Sniff Pnasal, in combination we obtained a similar result (low in
32.4%). Combining Sniff Pdi (low in 68.2%) and Twitch Pdi (low in 67.4%)
reduced the diagnoses of patients with diaphragm weakness to 55.3% in
group B. 38.3% of the patients in group C had expiratory muscle weakness
as measured by PEmax, compared to 36.7% when weakness was diagnosed by
cough Pgas, and 28.3% when assessed by Twitch T10. Combining all three
expiratory muscle tests reduced the number of patients diagnosed as
having expiratory muscle weakness to 16.7%. CONCLUSION: The use
of single tests, such as PImax, PEmax and other available individual
tests of inspiratory, diaphragm and expiratory muscle strength, tend to
overdiagnose weakness. Combinations of tests increase diagnostic
precision, and in the population studied they reduced the diagnosis of inspiratory, specific diaphragm, and expiratory muscle weakness by 19 -
56%. Measuring both PImax and Sniff Pnasal resulted in a relative
reduction of 19.2% of patients falsely diagnosed with inspiratory muscle
weakness. The addition of Twitch Pdi to Sniff Pdi increased diagnostic
precision by a smaller amount, 18.9%. Having multiple tests of
respiratory muscle function available both increases diagnostic
precision, and makes assessment possible in a range of clinical
Keywords: expiratory muscle, muscle weakness, respiratory muscle, muscle
strength, sniff pnasal, diagnostic precision, multiple tests, pressure
sniff, inspiratory diaphragm, inspiratory muscle, muscle function,
clinical referrals, strength group, muscle, tests, weakness, sniff,
expiratory, patients, inspiratory, group, strength, diaphragm,
precision, diagnostic, clinical, respiratory, pimax, diagnosed, pnasal,
reduced, twitch, available, multiple, referrals, three, combination,
Authored by Steier J, Kaul S, Seymour J, Jolley C, Rafferty GF, Man WD,
Luo Y, Roughton M, Polkey MI, Moxham J. King's College Hospital, United
Oxygenation improved by
inspiratory muscle training.
Effects of inspiratory
muscle training on exercise responses in normoxia and hypoxia.
The purpose of this study was to determine the effects of inspiratory
muscle training (IMT) on exercise in hypoxia (H) and normoxia (N). A
4-week IMT program was implemented with 12 healthy subjects using an
inspiratory muscle trainer set at either 15% (C; n=5) or 50% (IMT; n=7)
maximal inspiratory mouth pressure (PI(max)). Two treadmill tests (85% V
O(2max)) to exhaustion and measures of diaphragm thickness (T(di)) and
function were completed before and after training in H and N.
Significant increases of 8-12% and 24.5+/-3.1% in T(di) and PI(max),
respectively, were seen in the IMT group. Time to exhaustion remained
unchanged in all conditions. Inspiratory muscle fatigue ( downward
arrowPI(max)) following exercise was reduced approximately 10% (P<0.05)
in IMT after both N and H. During H, IMT reduced (P<0.05) V O(2) by
8-12%, cardiac output by 14+/-2%, ventilation by 25+/-3%; and increased
arterial oxygen saturation by 4+/-1% and lung diffusing capacity by
22+/-3%. Ratings of perceived exertion and dyspnea were also
significantly reduced. These data suggest that IMT significantly
improves structural and functional physiologic measures in hypoxic
Keywords: inspiratory muscle, inspiratory, reduced, muscle, exercise
Authored by Downey AE, Chenoweth LM, Townsend DK, Ranum JD, Ferguson CS,
Harms CA. Department of Kinesiology, Kansas State University, Manhattan,
1A Natatorium, KS 66506, United States
23. Another reason we like 5 breaths a
minute instead of 10-14.
Effect of deep breathing at six breaths per
minute on the frequency of premature ventricular complexes.
Although the effect of
reflex increase in vagal tone on the frequency of premature ventricular
complexes (PVC) is known, the effect of timed deep breathing on the
frequency of PVC has not been reported. We serendipitously discovered
that deep breathing at six breaths per minute abolished PVC in an
18-year-old female with frequent PVC, anxiety, and palpitations. In five
of a series of 10 consecutive patients with frequent (> or = 10/min)
unifocal PVC, deep breathing at 6 breaths/min reduced the frequency of
PVC by at least 50%. This is possibly due to increased vagal modulation
of sinoatrial and atrioventricular node. However, factors predicting the
response to deep breathing, and the mechanisms involved need to be
studied in a larger number of patients. Publication Types: Letter,
Research Support, Non-U.S. Gov't
Our recommendation. Fundamentals ALL plus Diaphragm Strengthener.
Keywords: deep breathing, with frequent, breathing, frequency
Authored by Prakash ES, Ravindra PN, Madanmohan, Anilkumar R,
24. Breathing Pattern Retraining and Exercise in Persons
with Chronic Obstructive Pulmonary Disease
"Smaller breaths conserve energy in the short
term but contribute to respiratory muscle fatigue and hyperinflation as the
work of exercise increases or is prolonged."
"A properly designed breathing retraining program in
which patients with COPD learn to control their pattern of breathing under
the stress of performing different modes of exercise at increasing
intensity and duration may markedly decrease dyspnea and improve gas
AACN Clinical Issues -Volume 12, number 2, pp
202-209 (c) 2001 AACN
Do you often catch yourself not breathing?
Do you experience shallow,
labored breathing; shortness of breath; a high chest; stuck, erratic, or
Are you unable to catch your breath?
Do you have
blue-tinted lips or fingernails; trouble sleeping; more than 6 -8 resting
breaths per minute with 3-6 second pauses; heart beat irregularities; poor
posture, mild to severe depression; tightness across your chest; excessive
stress; asthma or COPD symptoms; constant fatigue; chronic pain; chest
pains; anger; anxiety; hyperventilation?
Do you think you can't sing or want to sing better?
For more breathing-relevant studies in a free newsletter or to take the
free breathing self tests and see how you compare to others, access
- Telles S. & Desiraju T (1991), Oxygen consumption during
pranayamic type of very slow-rate breathing. Indian Journal of Medical
Research 94 [B]
- Telles S. & Desiraju T (1992). Heart rate alternations in
different types of pranyamas. Indian Journal of Physiology and
Pharmacology, 36 (4):287-288.
- Telles S., Joseph C., Venkatesh S, & Desiraju T. (1992).
Alternation of auditory middle latency evoked potentials during yogic
consciously regulated breathing and attentive state of mind.
International Journal of Psychophysiology, 14:189-198.
- Telles S., Nagarathna R & Nagendra H R (1994). Breathing through
a particular nostril can alter metabolism and autonomic activities.
Indian Journal of Physiology and Pharmacology 32 (4):352
- Telles S., Nagarathna R & Nagendra H R (1995). Improvement in
visual perception following yoga training, Journal of Indian
Psychology 13 (1):30-32
- Telles S., Nagarathna R & Nagendra H R (1996). Physiological
measures of right nostril breathing. Journal of Alternative
Complementary Medicine, 2 (4):479-484
- Raghuraj P, Telles S (1998). Changes in AEP-MLRs during right
nostril yoga breathing, International Journal of Neuroscience.
About the Optimal Breathing
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